PCA3 Materials & News

Interview with Prof. J. Schalken, Radboud University Nijmegen, The Netherlands

• This interview with Prof. Jack Schalken was published on 26-09-2008 on Urosource.com, a medical-urological website published by the European Association of Urology (EAU).
• In this interview Prof. Schalken discusses the advantages of the PCA3 test:
• Serum prostate specific antigen (PSA) screening causes over-diagnosis (i.e. diagnosis of many patients with indolent cancer) and triggers over-treatment. The Prostate Cancer gene 3 (PCA3) test is in this respect advantageous as it has a much higher specificity than PSA.
• The PCA3 test also detects aggressive cancers in the majority of cases, while PSA is not at all selective for aggressive cancers,
• Prof. Schalken refers to a recently published European study by Haese et al.¹ that showed that the PCA3 test may aid in deciding which patients need a repeat biopsy. A higher PCA3 Score corresponded with an increasing probability of a positive repeat biopsy. The PCA3 Score had a greater diagnostic accuracy than %free PSA for predicting repeat biopsy outcome.
• The interview also discusses the current place of the PCA3 test in clinical practice. According to Prof. Schalken, the PCA3 test changes clinical practice in that it offers a more rational biopsy schedule: perform a repeat biopsy when a patient has had a prior negative biopsy and a positive PCA3 test and do not perform a repeat biopsy when a patient has had a prior negative biopsy but a negative PCA3 test. A prior negative biopsy and a high PCA3 Score may indicate a potentially aggressive cancer and further diagnostic tests are in this case required. The use of the PCA3 test in active surveillance and screening is currently being evaluated.
• Regarding the future of the PCA3 test, Prof. Schalken indicates that PCA3 can be the basis for a panel of markers that give information about the presence of significant cancer. In addition, he indicates that great progress is being made in molecular testing and that in 5 years time PCA3 testing may well be available at or near the site of patient care. This will greatly improve the efficiency and logistics of clinics.
• Commercial companies are often involved in de development of diagnostic tests. In this respect, Prof. Schalken comments that at the Radboud University research tests are developed. However, to turn these tests into clinically viable products unique skills, expertises and resources are required. Universities do not have the money, expertise or skills needed for this, while commercial companies do. Therefore, he considers it essential for commercial companies to assist in the development of diagnostic tests.
• Prof. Schalken advocates for reimbursing the PCA3 test through the healthcare system. It should be emphasized to politicians, both in Brussels and in local countries, that diagnostic tests are very important as they can also have a vast impact on treatment strategies.  

1) Haese A, et al. Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol 2008;54:1081-8.

More information: Interview at urosource.com