Prostate cancer tests

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PSA

• Prostate specific antigen. Increased PSA correlates with risk of prostate cancer and risk of aggressive prostate cancer, but does not mean that somebody has prostate cancer.
• May be transiently elevated due to:
  • Enlarged prostate, benign prostatic hypertrophy (BPH)
  • Infection (prostatitis)
  • Ejaculation/sexual activity
  • Digital rectal exam (DRE), prostate exam
  • Biopsies or other instrumentation
• Different upper limits of normal values depending on age:

Normal limits of PSA by age (95% percentile)

Age (years)	PSA (ng/mL)
40-49	0-2.5
50-59	0-3.5
60-69	0-4.5
70-79	0-6.5

Free PSA

• Free PSA helps to futher stratify likelihood of detecting prostate cancer for patients with a PSA of 4-10:

PSA	DRE abnormal?	Likelihood of prostate cancer	Free PSA %	Likelihood of prostate cancer (incorportating Free PSA data)
<2	Yes	5%
	No	1%
2-4	Yes	20%
	No	15%
4-10	Yes	45%
	No	25%	0-10	56%
			10-15	28%
			15-20	20%
			20-25	16%
			>25	8%
>10	Yes	>75%
	No	>50%

PCA3 (PROGENSA)

Basics

• PCA3 (prostate cancer gene 3) is a noncoding RNA whose expression is restricted to the prostate, overexpressed in >95% of prostate cancers
• PCA3 is overexpressed 60-100 times higher in prostate cancer cells as opposed to normal prostate gland cells
• PCA3 is independent of prostate volume, age, BPH, and prostatitis

Collection

• Requires "attentive DRE" involving firm pressure applied to the prostate--enough to depress the surface 0.5 to 1 cm from the base to apex and from lateral to median--3 strokes per lobe
• Obtain 20-30 mL first catch urine sample after attentive DRE
• 2.5 ml of urine is aliquoted to the testing containing and sent within 5 days to the PCA3 laboratory.

Analysis

• PCA3 and PSA mRNA are quantified, with PCA3/PSA x 1000 reported.
• PCA3.org

Oncotype DX Prostate

• Oncotype DX Prostate Genomic Health's Genomic Prostate Score (GPS) & prognostic prostate cancer assay

Prolaris

• Prolaris, Myriad's biomarker prognostic prostate cancer assay

Decipher

• Decipher, GenomeDx's genomic prognostic prostate cancer assay
  • "the Decipher Test uses the expression of these biomarkers to calculate the probability of clinical metastasis within 5 years of radical prostatectomy surgery, and within 3 years of successive PSA rise (biochemical recurrence)."