pca3 is a urine test to detect prostate cancer.  It is supposed to not be affected by large prostate or inflammation/infection.  I haven’t routinely ordered this test but it is being used by urologists more and more.  Recent articles praise its use in patients with prior negative biopsy to determine if a repeat biopsy should be done.  There are many patients who have persistently elevated PSA despite negative biopsy.  Will this test be a tie breaker in determining a 70 year old male’s need for a second prostate biopsy for a psa of 5 or 6? Only time will tell.  This test like free psa before it can help us give more potentially confusing information to our patients.  I have done several prostate biopsies on patients with high urine pca3 counts that came back negative.  One should be cautious about changing how we practice medicine based on a single test.  Rectal exam and PSA together are still the best screening tools.  Only a urologist is fully trained to detect prostate cancer.