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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13821
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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PSA of 3.7..

Resolved Question:

My psa has been rangin slightly below 4 for the past 4 years. I had a biopsy in 2009 which was negative. My urologist has seen me each six months. DRE is norma? Slight prostatis.

Next week my urologist at my 6 month exam wants to perform the pca3 test to determine if another biopsy is warranted.

I am 51 one years old and my father had prostate cancer in his mid 60s.

I don't want to have another biopsy and am not too excited about this new somewhat experimental test.

Honestly, I really don't want to deal with this every six months for the rest of my life.

To me this approach is exhausting every six months to go thru the anxiety etc.

Can you give me some advice and thought process if CPA 3 test makes sense or not. I am sure that if the readings somewhat marginal he will want me to take another biopsy which I prefer not want to do.

Erik
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Thank you for using JustAnswer. I will be glad to assist you today.

There is much hope that the PCA3 test will prove beneficial, but the current level of evidence is weak that it improves clinical outcomes. There was a review of the evidence on PCA3 that was published earlier this year, and the conclusion was there was some low strength of evidence that the PCA3 improves diagnostic accuracy for performing biopsies, but there was insufficient evidence that this resulted in improved health outcomes in the intermediate or long-term.

There are some experts that are optimistic that the use of PCA3 along with the PSA and DRE will result in better screening and identification of early prostate cancer, particularly those that are more aggressive, but it will take several years for studies to be done to determine whether this will actually be true.

Therefore, there is a problem of what to do until the studies can be completed. Your Urologist apparently believes that the PCA3 is worth doing. The current recommendations of the Preventive Health Task Force does not support performing the test, because of the absence of evidence of improved outcomes for the intermediate or long term.

What I advise patients is that the testing that should be done depends upon the desire of the patient, and this applies both to PSA and PCA3 testing. If someone is more concerned about the possibility of the development of prostate cancer, then it would be appropriate to perform PSA and PCA3 testing, since there is some weak evidence that it will improve diagnostic accuracy in deciding whether to perform a biopsy. But many men may also decide that they do not want to perform such testing until there is evidence of improved intermediate and long term outcomes. I am of an age to consider prostate cancer screening (although it does not run in my family), but I choose to not perform prostate cancer screening until there is evidence of improved long term survival. There is no right or wrong answer, as the preferences of the patient should guide decision making.

After noting your comments about not wanting to perform a biopsy or testing every 6 months, if you are still of this opinion after knowing that there is weak evidence of improved accuracy and insufficient evidence of improved intermediate or long-term outcomes, then it would be appropriate to not have such testing done. On the other hand, if the knowledge of the weak evidence of improved diagnostic accuracy changes your mind, then it would be appropriate to perform the testing.

If you have any further questions, please let me know.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13821
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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