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Contemporary role of prostate cancer gene 3 in the management of prostate cancer

Purpose of review With increasing evidence that prostate-specific antigen (PSA)-based screening can reduce disease-specific mortality but coincides with unacceptable levels of unnecessary testing and the diagnosis of potentially nonlife-threatening disease, the need for new, more specific biomarkers is urgent. Within this context the role of the prostate cancer gene 3 (PCA3) test is evaluated. Recent findings Studies investigating the value of PCA3 as a diagnostic test virtually all show a beneficial effect as compared to PSA with respect to specificity. Beside the fact that most of these studies are subject to potential bias, the observed increased specificity was accompanied by relatively low sensitivities. Two studies, attempting to avoid selection bias as much as possible, show a marginal beneficial effect of the PCA3 test. Data on PCA3 as a staging tool for prostate cancer remain inconclusive. Summary The PCA3 test is not capable of replacing the PSA test in clinical practice and an appropriate cut-off level with acceptable performance characteristics is hard to define. Its value as a first-line diagnostic test is limited. The addition of PCA3 to risk assessment tools leads to an increase in predictive capability. Data relating to the accuracy of PCA3 on prostate cancer staging are contradictory and PCA3 as prognostic test should be subject of future studies.