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Does PCA3 result justify biopsy in 70 year old w/ normal PSA?

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Posted 1/3/2014 2:18 PM (GMT 0)
I have a 1.2 PSA. Its been that for 3 years. My doc has a new test call a PCA3. Has anyone had or heard of that? He wants to do a biopsy based on the results of that test even though I have a normal PSA. I'm 70.

Gave your post a title

--PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 1/3/2014 9:02:33 AM (GMT-7)

Posted 1/3/2014 2:35 PM (GMT 0)
Buck, welcome to our little corner of the world.

Based on the information you've given us, I don't see a reason for a biopsy...is there something more going on that is causing your doctor to start talking about a biopsy?

You should get quite a few responses about the PCa3 test. From what I know, it's a urine test that can detect the presence of a gene that could trigger prostate cancer. It's not that new and is gaining more acceptance in the medical community as a useful tool in predicting and/or diagnosing prostate cancer.

Why is your doctor ordering this test? A family history? I see by your screen name, that it looks like you've had (or have) melanoma - could this be a reason why your doctor is choosing to investigate further?

Another aspect of a PSA test is the % free PSA...a low number can be a predictor of prostate cancer. Do you happen to know if this was done as part of your PSA screening?

Sorry to pepper you with questions but I'm trying to understand your situation - a steady PSA of 1.2 over 3 years in and of itself does not warrant further investigation so there must be something else at play here.
Posted 1/3/2014 3:29 PM (GMT 0)
With your psa at your age, you sound like a poster boy for someone who does not need a biopsy. Get a second opinion. To actually go out and look for something that is not indicated is odd.
Posted 1/3/2014 4:00 PM (GMT 0)
Welcome to the forum. Glad you found us.

There is no medical advice given here. None of us are doctors. But, the suggestion of a second opinion is always a good idea when we can't understand what a new member's doctor is doing. Nothing you told us seems to indicate the need for a biopsy but there may be things you left out that do. For example, did your doctor feel a lump during a rectal exam? That'd make a difference.
Posted 1/3/2014 4:42 PM (GMT 0)
Welcome to HW, sorry you need to be talking to us.

Did your doctor do a DRE? That would make a difference.

PCA3 is a good test. Might give some useful info.

My doctor wanted to see a pattern of rising PSA before he did a biopsy. In your place I'd be thinking that way too. Before I'd let them to a biopsy I'd ask the question, "why?" and what are the odds that you have PC? and if you did have PC, would it need to be treated?

I'd need more information and a better explanation before agreeing to a biopsy. But that's just me.
The biopsy procedure isn't fun but you can get through it. Still you don't want needles shoved up there unless there is a real need.

A second opinion would like be best after the PCA3 test if a biopsy is recommended.
Hang in there and keep us updated on your progress.
Andrew
Posted 1/3/2014 4:58 PM (GMT 0)
Buck,

PCA3 is only FDA approved for use after an initial negative biopsy when there is reason to suspect the random biopsy missed the cancer. It has only been validated for use in men with elevated PSA or positive DRE who have had a negative biopsy -- it doesn't sound like it is valid in your case.

The other issue with the test is that it has low specificity. This means that that it has a high number of false positives. And it is not at all clear that there is an optimum cut-off value for the test - do you know what your score was and what cut-off was used? What this means is that a high score very seldom predicts prostate cancer. It was never meant to be used alone, but only together with a high PSA.

You may want to raise these issues with your urologist. Perhaps he has other reasons to suspect PC.

- Allen
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