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Not understood. I don't know what the Bostwick urine test is about. Is this an update on your status that is also found in the charts? Sorry if its only me in the dark here.
This is a test for the PSA3 molecule that is emmited
by the prostate cancer cell in the human body. No
PSA3 no cancer.
Bostwick Labs claims a 95.7% accuracy rate of this test.
The American Society of Clinical Oncology confirms
this at 95.3% accuracy. Abstract = 20405
Date unknown.
I am a bit behind with my updates, so have not been able to get the latest detail on Ron Hard’s story. It is a remarkable one and is well worth reading, bearing in mind on of the comments on the The Prostate Blog where Dr Jonathan Oppenheimer says For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.
Ron’s reference to the PCA3Plus® needs a little explanation, and this may help:
In looking for a substitute for the PSA test, which as we know is not prostate cancer specific and an inaccurate predictor of prostate cancer, a Canadian company developed what was termed the uPM3 Assay which it was claimed had a positive predictive value of 75% compared to 38% for a serum PSA cutoff of 4.0 ng/ml. In other words, where PCa is diagnosed in about 38% of cases where the PSA is higher than 4.0 ng/ml, the study claimed that uPM3 would identify 75%.
Bostwick Laboratories in the USA bought the distribution rights for the US and announced this in various press releases some three years ago. At the time there was a good deal of discussion on the Internet about the test because it was said that this test required the "vigorous massage" of the prostate gland to be effective.
Apart from some ribald conjecture about what this might be like, that phrase led to some discussion as to what this imprecise (in scientific language ) term might mean and how it might be interpreted. And even if there was some agreement between urologists about how vigorous the massage had to be to be effective, would it be physically possible for all glands to be manipulated in this way? What of the doctor with small hands whose fingers couldn't reach the gland adequately? Would it make any difference if the gland was bigger, or smaller than usual? Would the physical situation of the gland within the man's body make any difference? Would the situation of any tumour within the gland affect the amount of the gene secreted? All significant issues I thought that might make it difficult to replicate the studies referred to in the wider community.
Bostwick Laboratories now say that the test has been improved and you can read what they have to say on their Prostate Service page. As you will see if you page down you can download a brochure describing the test.
The Prostate Service page says in part PCA3Plus® tests for prostate cancer cells that are shed into the urine. The urine sample is sent to Bostwick Laboratories® to be tested for genetic expression of the PCA3 gene. If the sample is positive for PCA3, then the patient has a very high likelihood of having prostatic cancer........[and it].... predicts prostate cancer with a sensitivity of 95.7%.
The brochure on the other hands says
The PCA3Plus® test is the ratio between PCA3 mRNA to PSA mRNA multiplied by 1,000…..in a recent study it was shown to have a specificity of 75%, sensitivity of 57% in distinguishing between high-grade prostatic intraepithelial neoplasia …..and atypical acinar proliferation suspicious for malignancy versus prostate cancer. A PCA3Plus® value of 35 or greater suggests a high likelihood of prostate cancer……it has not been approved by the FDA
So, is the sensitivity 95.7% or, as Ron says "The American Society of Clinical Oncology confirms this at 95.3% accuracy. Abstract = 20405" (I couldn't find that Abstract)or 57% That's a pretty big difference by my reckoning and what, in scientific terms is a "suggestion of a high likelihood of prostate cancer" - how would you measure that?
I also found the detail that the value of the tests relates to the PSA as an aspect that I would like to understand more - if PSA can't be measured accurately (and we know it cannot) and the amount of PCA3 expressed might be varied by manipulation of the gland - see above - then surely with two variables expressed as a ratio, the range might be very large indeed?
Perhaps there is a place for this test in the array of information gathering items. Perhaps a PSA test (for free PSA and total PSA), a standard DRE, followed by a vigorous massage and the expression of urine based PCA3 might in their totality point to the wisdom of further investigation even if each test alone was considered deficient in this regard? But even Bostwick Laboratories say Only a prostate biopsy can diagnose prostate cancer.
Hope this enlightens rather than confuses the issues.
I was a false negative with no rise in my PSA(1.9) over several years. On prostatectomy, I was Gleason 7(4 3)/extracapsular extension with "free" margins. I am now 2months out and PSA <.1. If my PSA did not rise before , why would I think it will now to signify recurrence. Any suggestions? Thanks!
