Diagnosis of Prostate Cancer—The Clinical Use of Prostate Specific Antigen

Objective: To give recommendations for the clinical use of prostate specific antigen (PSA) and its molecular forms for diagnosis of prostate cancer. Analysis is based on a structured review of clinical guidelines which adhere to the principles of evidence-based medicine. Methods: Original publications on concepts for improving the specificity of PSA were identified and analysed with regard to their clinical utility. They include PSA density, PSA density of the transition zone, age specific reference ranges, ratio of free to total PSA, complexed PSA, isoenzymes of free PSA, PSA velocity and PSA doubling time. National and international guidelines were reviewed in order to define a common denominator for PSA use in routine clinic. Results: PSA in conjunction with digital rectal examination is almost uniformly recommended for early diagnosis of prostate cancer, although the value of (population-based) screening with PSA is still controversial. Static concepts play only a minor role, whereas dynamic concepts are currently being evaluated in large prospective trials. Conclusions: PSA is a useful test for early detection of prostatic carcinoma provided that the patient is well informed and has a life expectancy of at least 10 years.

[1]  A. Zlotta,et al.  Complexed prostate-specific antigen, complexed prostate-specific antigen density of total and transition zone, complexed/total prostate-specific antigen ratio, free-to-total prostate-specific antigen ratio, density of total and transition zone prostate-specific antigen: results of the prospective mu , 2002, Urology.

[2]  M. Benson,et al.  The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. , 1992, The Journal of urology.

[3]  R. Babaian,et al.  Prostate‐specific antigen and prostate gland volume: Correlation and clinical application , 1990, Journal of clinical laboratory analysis.

[4]  A. Lu,et al.  Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml. , 2002, The Journal of urology.

[5]  O. Nilsson,et al.  Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. , 1991, Clinical chemistry.

[6]  D. Chan,et al.  Can complexed PSA be used as a single test for detecting prostate cancer? , 1999, Urology.

[7]  T. Stamey,et al.  Complexed prostate-specific antigen for early detection of prostate cancer in men with serum prostate-specific antigen levels of 2 to 4 nanograms per milliliter. , 2002, Urology.

[8]  C P Price,et al.  Pre- and post-analytical factors that may influence use of serum prostate specific antigen and its isoforms in a screening programme for prostate cancer , 2001, Annals of clinical biochemistry.

[9]  H. Schmid,et al.  Serum free prostate specific antigen: Isoenzymes in benign hyperplasia and cancer of the prostate , 1995, The Prostate.

[10]  P. Pavlica,et al.  Correlation between prostate-specific antigen and prostate volume, evaluated by transrectal ultrasonography: usefulness in diagnosis of prostate cancer. , 1990, European urology.

[11]  U. Stenman,et al.  A complex between prostate-specific antigen and alpha 1-antichymotrypsin is the major form of prostate-specific antigen in serum of patients with prostatic cancer: assay of the complex improves clinical sensitivity for cancer. , 1991, Cancer research.

[12]  S. Loening,et al.  Comparison of the Clinical Validity of Free Prostate–Specific Antigen, Alpha–1 Antichymotrypsin–Bound Prostate–Specific Antigen and Complexed Prostate–Specific Antigen in Prostate Cancer Diagnosis , 2000, European Urology.

[13]  Peter H Gann,et al.  Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. , 2002, Journal of the National Cancer Institute.

[14]  T. Stamey,et al.  Observations on the doubling time of prostate cancer. The use of serial prostate‐specific antigen in patients with untreated disease as a measure of increasing cancer volume , 1993, Cancer.

[15]  W. J. Allard,et al.  Novel immunoassay for the measurement of complexed prostate-specific antigen in serum. , 1998, Clinical chemistry.

[16]  Jerome P. Richie,et al.  Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. , 1998, JAMA.

[17]  L. Klotz,et al.  PSAdynia and other PSA-related syndromes: a new epidemic--a case history and taxonomy. , 1997, Urology.

[18]  A. Semjonow,et al.  The rise and fall of PSA: clinical implications of prostate specific antigen kinetics , 2002, Urological Research.

[19]  E. Metter,et al.  Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. , 1992, JAMA.

[20]  R. Lamerz,et al.  Tumour markers in prostate cancer: EGTM recommendations , 1999 .

[21]  A. Zlotta,et al.  Prostate specific antigen density of the transition zone: a new effective parameter for prostate cancer prediction. , 1997, The Journal of urology.

[22]  S. Loening,et al.  The influence of prostate volume on the ratio of free to total prostate specific antigen in serum of patients with prostate carcinoma and benign prostate hyperplasia , 1997, Cancer.

[23]  M Bolla,et al.  EAU guidelines on prostate cancer. , 2001, European urology.

[24]  E. Diamandis,et al.  Tumor Markers: Physiology, Pathobiology, Technology, and Clinical Applications , 2002 .

[25]  W. Cooner,et al.  Serum PSA adjusted for volume of transition zone (PSAT) is more accurate than PSA adjusted for total gland volume (PSAD) in detecting adenocarcinoma of the prostate. , 1994, Urology.

[26]  M. Barry.  Prostate-Specific–Antigen Testing for Early Diagnosis of Prostate Cancer , 2001 .

[27]  C G Chute,et al.  Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. , 1993, JAMA.

[28]  R. Molina,et al.  Measurement of complexed PSA in the differential diagnosis between prostate cancer and benign prostate hyperplasia , 2000, The Prostate.

[29]  A. Semjonow,et al.  The clinical impact of different assays for prostate specific antigen , 2000, BJU international.

[30]  A S Whittemore,et al.  Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer , 1993, Cancer.

[31]  Taylor Murray,et al.  Cancer Statistics, 2001 , 2001, CA: a cancer journal for clinicians.

[32]  B. Levin,et al.  American Cancer Society Guidelines for the Early Detection of Cancer , 2002, CA: a cancer journal for clinicians.

[33]  T. Stamey,et al.  Prostate-Specific Antigen as a Serum Marker for Adenocarcinoma of the Prostate , 1987 .

[34]  M. Brawer,et al.  Measurement of complexed PSA improves specificity for early detection of prostate cancer. , 1998, Urology.

[35]  C. Sturgeon.  Practice guidelines for tumor marker use in the clinic. , 2002, Clinical chemistry.

[36]  D. Sackett,et al.  Evidence based medicine: what it is and what it isn't , 1996, BMJ.