My prostate is only moderately enlarged (33) as measured by recent renal ultra sound. Most of the times my symptoms are close to normal. I would sometimes need to rush to bathroom, but not always. I may wake up 2 to 3 times a night to go to bathroom, and on some days not get up even once. For about 15 years I have been seeing a urologist every six months, taking 5mg of Hytrin once a day to relieve mild BPH symptoms, and going for PSA test at least once a year. My PSA has been stable around 3.2; my DRE has never showed any lump or bump. Once I was hospitalized for urinary retention and was treated with Levaquin. I always wondered if my urinary difficulties were due to enlarged prostate or frequent bladder infection. Never got a clear answer. Last week I felt pain near the base of my penis; the pain would come randomly and after (and not during) passing urine. I had no difficulty passing urine. Barium based Catscan found a 2mm stone in the bladder, but that is not my concern in writing to you. My concern is: without explaining to me, my urologist took a urine sample and sent it for PCA3 test which came out positive, and now my urologist recommends that I go for biopsy, because, according to him I have one in 2 chances of presently having prostate cancer. How can that be? With stable PSa around 3.2 and no lumps or bumps, and no major problem, how can I be a candidate for biopsy. I stubbornly believe the test results are false positive. Could the problem be that the sample was collected pursuant to a invalid rectal exam? Any thoughts?
I believe I answered your question previously. On a cellular level, the specificity of PCA3 to predict prostate cancer is perfect because of the over-expression of the gene by prostate cancer cells. Elevated PCA3 levels, coupled with varying levels of elevated PSA associated with prostatitis could help clarify your diagnosis.
Ash Tewari, MD
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Dr, I am confused. Please help clarify your response. If the PCA 3 Gene test is perfect in detecting cancer at the cellular level, why would it matter if the PSA levels are rising or not? I am not sure I understand what detecting at Cellular level means. Does this mean that the cancer cells are present, but they have not yet invaded the prostate tissue? If that is true, then that would suggest it is only a matter of time before the cancer cells already present start invading the surrounding tissue. Or, does this mean that the cancer cells already present may lay low for a long time before attacking the organ, and depending upon the age of the patient (65 in my case), the patient may be lable to live his normal life, and dies with the cancerI rather than from it. Would the PCA3 test score indicate the severity or the agressiveness of the cancer cells?
Allow me to clarify. A low level of PCA3 is expressed by normal prostate cells. The PCA3 score tells the expression of PCA3 corrected for the presence of normal or BPH epithelial cells. PCA3 urine tests results are actually a ratio of PCA3 to PSA mRNA. The PCA3 test score should be used to predict the chance of a positive biopsy and presence of cancer.
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