Synonyms
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Allscripts (AEHR) Order Name
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4K Prostate Score
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Sunrise Clinical Manager (SCM) Order Name
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4K Prostate Score, Serum
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EPIC Order Name
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4K Prostate Score (Serum)
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Clinical Info
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High Grade (Gleason 7+) Prostate Cancer Risk Evaluation
Limitation an Exclusions for the 4Kscore
Do not use this test for a patient:
1) With a previous diagnosis of prostate cancer
2) That has received a DRE in a previous 96 hours (4Days) before phlebotomy. A DRE performed after phlebotomy is acceptable.
3) That has received within the previous six (6) months 5-alpha reductase inbitor such as (5-ARI) therapy such as Avedaart(R) (dutasteride) or Proscar (R) (finasteride).
4) That has undergone within the previous six (6) months any procedure or therapy to treat symptomatic BPH or any invasive, urologic procedure that many be associated with a secondary PSA elevation prior to phlebotomy.
5) That is younger than 40 or older that 80 years of age.
The 4Kscore Test will not be performed with a positive biopsy result
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Specimen Type
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Container
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Gold top tube
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Collection Instructions
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Container/Tube: Gold top tube
Specimen: 3 mL serum
1. 1. Please indicate if the patient has a previous biopsy [] No prior biopsy [] Negative biopsy [] Positive biopsy
2. DRE Results [ ] Nodule [ ] Normal [ ] Not Performed
3. Clinical Indication for ordering 4KScore Test:
Selecting a value below confirms that the patient has two or more elevated PSA results within the past two years.
[ ] 45- 54 years old and total PSA >=2 ng/mL
[ ] 55 -75 years old and total PSA >=3 ng/mL
[ ] >= 76 years old and total PSA >=4 ng/mL
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Transport Instructions
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Refrigerated- If longer then 24 hours please freeze sample.
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Specimen Stability
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Methodology
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Days Performed
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TAT: 4-5 Days
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Performing Laboratory
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BioReference Laboratories-GenPath
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CPT
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81539
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PDM
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1759833
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Result Interpretation
See Report
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Forms
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