Prostate-specific antigen in clinical practice.

Currently, in the United States (US), most prostate cancers are diagnosed through screening with digital rectal examination (DRE) and measurement of serum prostate-specific antigen (PSA). The serum PSA level correlates directly with prostate cancer risk and aggressiveness, as well as the outcomes after treatment. PSA testing is also useful in monitoring patients for tumor recurrence after treatment. PSA testing has limited specificity for prostate cancer detection, and its appropriate clinical application has been the topic of debate. Accordingly, several variations on the PSA measurement have emerged as useful adjuncts for prostate cancer screening. These take into consideration additional factors, such as the proportion of different PSA isoforms (free PSA, complexed PSA, pro-PSA and B PSA), the prostate volume (PSA density), and the rate of change in PSA levels over time (PSA velocity or PSA doubling time). Widespread PSA screening is associated with a 75% reduction in the proportion of men who present with metastatic disease since 1985-89 in the US and a 32.5% reduction in the age-adjusted prostate cancer mortality rate through 2003. The history and evidence underlying each of these parameters are reviewed in the following article.

[1]  G. Murphy,et al.  A prostate antigen in sera of prostatic cancer patients. , 1980, Cancer research.

[2]  D. Chan,et al.  Complexed prostate specific antigen provides significant enhancement of specificity compared with total prostate specific antigen for detecting prostate cancer. , 2000, The Journal of urology.

[3]  Robert A Smith,et al.  American Cancer Society guidelines for the early detection of cancer , 2000, CA: a cancer journal for clinicians.

[4]  H. Klocker,et al.  Reduction of prostate cancer mortality in Tyrol, Austria, after introduction of prostate-specific antigen testing. , 2006, American journal of epidemiology.

[5]  D. Ornstein,et al.  Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurements. , 1997, JAMA.

[6]  C. Amling,et al.  Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer† , 2003, Prostate Cancer and Prostatic Diseases.

[7]  H. Klocker,et al.  Proenzyme psa for the early detection of prostate cancer in the 2.5-4.0 ng/ml total psa range: preliminary analysis. , 2003, Urology.

[8]  S. Shariat,et al.  Variation in prostate specific antigen results from 2 different assay platforms: clinical impact on 2304 patients undergoing prostate cancer screening. , 2004, The Journal of urology.

[9]  W. Catalona,et al.  Prostate specific antigen velocity threshold for predicting prostate cancer in young men. , 2007, The Journal of urology.

[10]  A. Renshaw,et al.  Predictors of mortality after prostate-specific antigen failure. , 2006, International journal of radiation oncology, biology, physics.

[11]  Georg Bartsch,et al.  Serum pro-prostate specific antigen preferentially detects aggressive prostate cancers in men with 2 to 4 ng/ml prostate specific antigen. , 2004, The Journal of urology.

[12]  George M Yousef,et al.  Human tissue kallikreins: a family of new cancer biomarkers. , 2002, Clinical chemistry.

[13]  T. Wilt,et al.  Screening for prostate cancer. , 2013, The Cochrane database of systematic reviews.

[14]  G. Murphy,et al.  Purification of a human prostate specific antigen. , 1979, Investigative urology.

[15]  W. Catalona,et al.  Preoperative PSA and progression-free survival after radical prostatectomy for Stage T1c disease. , 2005, Urology.

[16]  A W Partin,et al.  Natural history of progression after PSA elevation following radical prostatectomy. , 1999, JAMA.

[17]  M. Hara,et al.  [Some physico-chemical characteristics of " -seminoprotein", an antigenic component specific for human seminal plasma. Forensic immunological study of body fluids and secretion. VII]. , 1971, Nihon hoigaku zasshi = The Japanese journal of legal medicine.

[18]  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.

[19]  J. Crowley,et al.  Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. , 2004, The New England journal of medicine.

[20]  I. Thompson,et al.  Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. , 2006, Journal of the National Cancer Institute.

[21]  W. Catalona,et al.  Longitudinal screening for prostate cancer with prostate-specific antigen. , 1996, JAMA.

[22]  T. Stamey,et al.  The pathological features and prognosis of prostate cancer detectable with current diagnostic tests. , 1994, The Journal of urology.

[23]  H. Klocker,et al.  Serum pro prostate specific antigen improves cancer detection compared to free and complexed prostate specific antigen in men with prostate specific antigen 2 to 4 ng/ml. , 2003, The Journal of urology.

[24]  Dietmar Schnorr,et al.  Interchangeability of measurements of total and free prostate-specific antigen in serum with 5 frequently used assay combinations: an update. , 2006, Clinical chemistry.

[25]  William J Catalona,et al.  Accuracy of prostate weight estimation by digital rectal examination versus transrectal ultrasonography. , 2005, The Journal of urology.

[26]  Ming-Hui Chen,et al.  Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. , 2004, The New England journal of medicine.

[27]  W. Catalona,et al.  Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. , 1991, The New England journal of medicine.

[28]  Ming-Hui Chen,et al.  Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. , 2005 .

[29]  R. Wolfert,et al.  "BPSA," a specific molecular form of free prostate-specific antigen, is found predominantly in the transition zone of patients with nodular benign prostatic hyperplasia. , 2000, Urology.

[30]  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.

[31]  D. Bostwick,et al.  PSA-detected (clinical stage T1c or B0) prostate cancer. Pathologically significant tumors. , 1993, The Urologic clinics of North America.

[32]  C. Roehrborn,et al.  Variability of repeated serum prostate-specific antigen (PSA) measurements within less than 90 days in a well-defined patient population. , 1996, Urology.

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

[34]  W. Catalona,et al.  Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection. , 1994, The Journal of urology.

[35]  R L Vessella,et al.  Prostatic specific antigen and prostatic acid phosphatase in the monitoring and staging of patients with prostatic cancer. , 1987, The Journal of urology.

[36]  W. Catalona,et al.  The association between total prostate specific antigen concentration and prostate specific antigen velocity. , 2007, The Journal of urology.

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

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

[39]  C Coley,et al.  Prostate-specific antigen best practice policy--part I: early detection and diagnosis of prostate cancer. , 2001, Urology.

[40]  Robert A. Smith,et al.  American Cancer Society Guidelines for the Early Detection of Cancer, 2003 , 2003, CA: a cancer journal for clinicians.

[41]  A. Jemal,et al.  Geographic Patterns of Prostate Cancer Mortality and Variations in Access to Medical Care in the United States , 2005, Cancer Epidemiology Biomarkers & Prevention.

[42]  Paul Schellhammer,et al.  Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. , 2006, International journal of radiation oncology, biology, physics.

[43]  J. Richie,et al.  Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. , 2000, Urology.

[44]  A. Pantuck,et al.  Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. , 1992, The Journal of urology.

[45]  W. Catalona,et al.  Pathological characteristics of prostate cancer detected through prostate specific antigen based screening. , 2006, The Journal of urology.

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

[47]  W. Catalona,et al.  The combination of human glandular kallikrein and free prostate-specific antigen (PSA) enhances discrimination between prostate cancer and benign prostatic hyperplasia in patients with moderately increased total PSA. , 1999, Clinical chemistry.

[48]  J. Brooks,et al.  Preoperative PSA velocity is an independent prognostic factor for relapse after radical prostatectomy. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[49]  Georg Bartsch,et al.  Detection rates and biologic significance of prostate cancer with PSA less than 4.0 ng/mL: observation and clinical implications from Tyrol screening project. , 2005, Urology.

[50]  Lisa M. Schwartz,et al.  Prostate-specific antigen levels in the United States: implications of various definitions for abnormal. , 2005, Journal of the National Cancer Institute.

[51]  W. Catalona,et al.  Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. , 1993, JAMA.

[52]  M. Blute,et al.  Preoperative prostate specific antigen doubling time and velocity are strong and independent predictors of outcomes following radical prostatectomy. , 2005, The Journal of urology.

[53]  W. Catalona,et al.  Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. , 2006, Urology.

[54]  M. Stampfer,et al.  A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. , 1995, JAMA.