Synonyms
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Allscripts (AEHR) Order Name
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Not
Orderable
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Sunrise Clinical Manager (SCM) Order Name
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Not Orderable
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Clinical Info
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High Grade (Gleason 7+) Prostate Cancer Risk Evaluation
The 4K score should only be ordered when medically reasonable for consideration of biopsy after excluding benign cause of PSA elevation.
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 inhibitor such as (5-ARI) therapy such an 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) Test is limited to patients age 45 and over.
The 4Kscore Test will not be performed with a positive biopsy result
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Specimen Type
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Blood
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Container
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Serum Seperator Tube
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Collection Instructions
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Container/Tube: Gold top tube
Specimen: 3 mL serum
Transport Temperature: Refrigerated- If longer then 24 hours please freeze sample.
Specimen is also acceptable if aliquoted & frozen
Note:
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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24 hours Refrigerated
7 days Frozen
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Methodology
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Electrochemiluminescene Immunoassay
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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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84153
84154
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PDM
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1859233
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Result Interpretation
See Report
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Forms
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