Present Problem: My urologist sprang a surprise on me that a PCA3 urine test came out positive (score 61.3) and I should consider getting a biopsy. This happened because I recently experienced pain at the base of penis. A barium catscan showed the presence of a 2mm stone lodged in my bladder. All other abdomen parts were normal. Could the test results be false positive; the recent pain in penis was a result of bladder stone; and with only a moderate history of BPH, I cannot be a candidate for biopsy. I do not handle pain very well, and really do not want to go for a biopy if I don’t have to. And that brings to my issue for the moment: can PCA3 test results be false positive if the urine sample was not collected as dictated by the attentive 3 stroke procedure. With normal DRE, PSA under 4, moderate urinary difficulties, and the symptoms manageable with just one 5mg of Hytrin a day, do I really need to go for biopsy?
Hstory: I am 65 years old with diabetes and mild BPH symptoms for the past 18 years. Ever since then I have been under care for diabetes; but since my BPH symptoms did not go away I was put one hytrin (now, 5mg) a day with which my symptoms have remained close to normal or at least manageable. With Normal DRE, PSA under 4, mild BPH symptoms, should I get a biopsy because PCA3 test came out positive. Could the test be false positive? What should I do?
Thank you for your question. I am not sure what you are referring to with respect to the "attentive 3 stroke procedure." A rectal exam or prostate massage is performed to order to increase the amount of prostate cells secreted into the urine. Upon urination the cells are collected and analyzed for the presence of PCA3. Prostate cancer cells tend to make much more PCA3 than normal cells. A PCA3 level above 100 has been shown to result in a positive biopsy over 60% of the time.
An elevated PSA along with a positive PCA3 test may point towards prostate biopsy.
Thank you for your question.
Ash Tewari, MD
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Thank you for a prompt response. Three stroke attentive DRE are not my words; I think I read this on the USRF website.From your response and whatever else I could read up upon, it appears PCA3 test is more used to confirm High PSA and/ or previous negative biopsies. Also, is it true that the presence urinary infection could make the PCA3 score higher; for this reason, some doctors do this test after prescribing antibiotics to clear up any infection prior to the test?
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