Urinary prostate cancer antigen 3 as a tumour marker: Biochemical and clinical aspects

Abstract

Due to low specifi city of Prostate-Specifi c Antigen (PSA) we face a certain risk of overdiagnosis and overtreatment of Prostate Cancer (PCa). The benefi ts and harms of PSA-screening are controversially discussed. To overcome this weakness of PSA novel PCa biomarkers and detection tools are required. The urine-based biomarker Prostate Cancer Antigen 3 (PCA3) has been shown to be highly PCa-specifi c. Application of PCA3 was tested in the diagnostic setting and staging. Several studies pointed out the additional value of PCA3 for further stratifi cation of men selected for biopsy (BX) based on an elevated PSA and/or an abnormal digital rectal examination (DRE). Its combined use with established clinical risk factors for positive prostate BX, particularly within nomograms or risk calculators, may represent a valid and helpful aid for clinicians in patient counselling and BX indication confi rmation. When it comes to prediction of favourable or unfavourable histopathological features, respectively, such as tumour volume or PCa signifi cance, PCA3’s value remains controversial. Based on relatively small patient numbers, PCA3 has been identifi ed to independently predict small-volume and insignifi cant PCa. However, in other studies PCA3 was not associated with advanced disease and its ability of predicting PCa aggressiveness in men undergoing radical prostatectomy is limited. PCA3’s value may be best given for BX outcome prediction. Finally, the implementation of the PCA3 promoter in developing new highly PCaspecifi c gene therapies represents a promising perspective in the near future.