Does PCA3 Really Help Urologists?

This review summarizes what is known about the diagnostic and prognostic roles of PCA3, and highlights limitations and perspectives of its clinical usefulness.

We reviewed the literature using the MEDLINE®, Scopus and Web of Science™ databases. We mainly focused on 3 clinical patient populations, including 1) initial biopsy to determine the risk of positive biopsies, 2) rebiopsy in men with 1 or more negative biopsies to determine the risk of positive biopsies and 3) men with prostate cancer to determine the significance and aggressiveness of prostate cancer.

The current literature shows the superiority of the PCA3 score over prostate specific antigen in specificity and predictive values, although it has slightly inferior sensitivity, independent of a biopsy history. PCA3 determination can add specificity to a diagnostic algorithm before biopsy decision making. Optimal cutoffs to consider to aid biopsy decision making might be 25 and 35 before initial and repeat biopsies, respectively. The correlation between PCA3 and cancer significance offers an interesting field in which to explore its role in insignificant cancer detection and active surveillance selection.

Although there is insufficient proof of improved health outcomes, expert opinions and Food and Drug Administration approval suggest a potential benefit of PCA3 use before considering repeat biopsy because the risk of undetected, clinically significant prostate cancer is low in cases of a low PCA3 score. Given that PCA3 may lead to a significant decrease in unnecessary biopsies, the cost-benefit balance of introducing PCA3 needs further assessment based on strict methodology incorporating health care outcomes.