PSA (prostate specific antigen) testing has been used by general practitioners and urologists for many years now and is routinely conducted on men over the age of 50 in the United States and Europe. It assesses the level of PSA in the blood which can be a indicator of risk of developing or having prostate cancer. Whilst this is an excellent method of indicating risk, a more recent test developed in the US is now available here in the UK. This is the PCA3 molecular urine assay test which identifies the presence of the prostate cancer gene. As the gene indicates, it is only presence if the patient has prostate cancer.

In the UK, the first line of testing is through a PSA blood test. If this results in a raised PSA for age group, then there is the option of having a PCA3 test prior to having biopsies. The PCA3 test is conducted by a urologist and the urine sample is provided after the patient has a rectal examination. This releases prostate cells into the urine which in turn are analysed. Through Duncan Harriss’ Nottingham Urology, groups of men have already used the PCA3 test to determine the presence of prostate cancer and this has cost them £450. The test is currently not available on the NHS.

Based on the results of the Prostate Cancer Prevention Trial, a risk calculator has been updated to predict the probability of a positive biopsy in men with suspicion of prostate cancer including the PCA3 score. This algorithm uses data about the patient’s race, age, family history of prostate cancer, PSA results, digital rectal examination, results of any prostate biopsies and PCA3 score.

As a PCA3 score has already been identifed as being predicitive of the outcome of repeat prostate biopsies, it was important to include this information in the Prostate Cancer Risk Calculator. It will help to estimate the probability of a positive prostate biopsy and be an indicator as to whether an urgent prostate biopsy is required. Nottingham Urology use this method to ensure up to date prostate cancer diagnosis.