Need Another Prostate Biopsy? A PCA3 test can help you decide.

written by Dr Chua Chong Beng on 27 March 2012

Need Another Prostate Biopsy?

A PCA3 test can help you decide.
If you had a prostate biopsy before, you will know the discomfort associated with the procedure. Some men also experience blood in the urine, urinary retention and infection. Of more concern is the increasing trend of serious infections by bacteria that are resistant to common antibiotics. Occasionally these serious infections can become life threatening.
Many men have a persistently high or further rise in PSA after their initial biopsy. This poses a dilemma to both patients and doctors. We know between 20-35% of these men will have prostate cancer that was not detected on the first biopsy. It is therefore important that they undergo a repeat biopsy. However up to 80% of these men will have a negative repeat biopsy at the expense of the discomfort and risk of serious complications.
Making a decision regarding a second or subsequent biopsy is often difficult and many men sit on the fence by waiting and hoping that their PSA will come down. At the same time there is this constant worry that there may be cancer in the prostate that is untreated while they are waiting. What if there is another test, better than PSA, which can help with this decision?
There is indeed a test designed just for this purpose. It is called PCA3 and it helps us predict the likely outcome of a repeat biopsy. Unlike a repeat biopsy, a PCA3 test is painless and is not associated with any significant risk of infection. The test is simple to perform. A urine collection is done after the doctor massages the prostate and the sample is sent to the lab for processing. The test detects the PCA3 gene which is specific to prostate cancer. The result comes back in the form of a numerical PCA3 score. Your doctor will use this score to determine the likelihood of detecting cancer if you undergo a repeat biopsy.
Remember that a PCA3 test does not confirm or rule out prostate cancer. A prostate biopsy is always necessary to diagnose cancer. However a PCA3 can help and is intended to be used as a guide in making a decision whether to proceed with a repeat prostate biopsy or otherwise. It is significantly superior to PSA in this respect and seems to be unaffected by the common factors that cause a falsely elevated PSA such as enlargement of the prostate (BPH), urinary tract infections and drugs.
PCA3 is the first commercially available urine test for detection of prostate cancer and has recently received US FDA approval (PROGENSA®) in February 2012. It is now available to patients in Malaysia.
Dr Chua Chong Beng
Consultant Urologist