Prostate cancer tests

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  • 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: [1]
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: [2]
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 (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


  • 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 [3]
  • 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.


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


PHI (Prostate Health Index)





Genetic/mutational screening


Oncotype DX Prostate

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


  • Prolaris, Myriad's biomarker prognostic prostate cancer assay


  • 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)."


  1. Oesterling JE, Jacobsen SJ, Chute CG, Guess HA, Girman CJ, Panser LA, Lieber MM. Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA. 1993 Aug 18;270(7):860-4. link to original article PubMed
  2. Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, Richie JP, deKernion JB, Walsh PC, Scardino PT, Lange PH, Subong EN, Parson RE, Gasior GH, Loveland KG, Southwick PC. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998 May 20;279(19):1542-7. link to original article PubMed