Uro-oncology – an Update

Kieran JeffersonConsultant Urological Surgeon

UHCW

BMI Meriden Hospital

Warwickshire one-stop haematuria clinic

• BMI Meriden Facilities

• Proximity to UHCW allows rapid turnaround of blood samples

• 64-slice on-site CT scanner• Size of facility allows one-stop cystoscopy

Warwickshire one-stop haematuria clinic

1. Clinical assessment by Consultant Urological Surgeon

2. Blood and urine sampling

3. Renal tract USS + CT Urogram (frank haematuria)

4. Flexible cystoscopy and discussion of results

Warwickshire one-stop haematuria clinic

• www.wonestop.com or www.warwickshireurology.com

• We commit to see referrals on a one-stop basis within 48 hours of referral

PCA-3

• Prostate cancer 3 over-expressed in prostate cancer

• Non-coding RNA; 9q21-22

• DRE releases prostate cells into urine

• Urine sample sent for central analysis using RTqPCR

PCA-3

PCA-3 assay

1. Bead capture of mRNA

2. Amplification of captured gene

3. Hybridisation protection assay using labelled DNA probes

PCA-3

• PCA-3:PSA mRNA ratio in urine is ‘PCA-3 score’

• PCa-3 score offers specificity to complement sensitive but non-specific serum PSA assay

PCA-3 score

PCA-3 usage

Pros/Cons

• Expensive and relatively labour-intensive (but less so than TRUSS-guided biopsy)

• Sensitivity/specificity paradox

• Patients denied biopsy will still need PSA monitoring

Who needs a PCA-3 test?• Not licensed in UK; has FDA approval

• Manufacturers recommend usage to determine need for second biopsy in patients with raised PSA and first negative biopsy

• No substitute for expert management