Figure 3.

(A) Serum prostate-specific antigen (PSA) levels in a man whose level was 1.2 ng/mL when first seen at age 61 years (1998), rising gradually to approximately 2.0 ng/mL over the next several years, with an additional increase to approximately 3.0 ng/mL at age 69 years (2006).

Urinary PCA3 score was 71.7 ng/mL, which confirmed suspicion of increased PSA velocity, leading to discovery of adenocarcinoma with a Gleason score of 7 on biopsy. Radical prostatectomy was performed; cancer was extensive within the prostate but was organ confined. Relatively low levels of PSA are found in some 15% of men with localized prostate cancer.¹²

(B) Serum PSA level was 1.0 ng/mL in this 63-year-old physician who was a member of a family with known mutation in the BRCA2 gene. Prostate examination was unrevealing. His prostate cancer antigen 3 (PCA3) score was 123. Biopsy (bx) revealed adenocarcinoma with a Gleason score of 7, and radical prostatectomy was performed (case courtesy of Jack Schalken, University of Nijmegen, The Netherlands). In neither of these patients did the PSA level exceed 4.0 ng/mL, but both had other indications of concern; PCA3 score was helpful in suggesting cancer and mandating biopsy.