A Review on the Clinical Utility of PSA in Cancer Prostate

Abstract

Prostate cancer has come to share the oncological centrestage among male cancers. The availability of Serum Prostate Specific Antigen, PSA, as a marker has encouraged it's use to diagnose both cancer and cancer recurrence. Some clarity is required about its precise role in clinical practice. The available literature on Prostate Specific Antigen was reviewed; Articles were reviewed for content, applicability to the problem at hand, availability of data about sensitivity and specificity of values, refinements in measurements and finally for impact of screening programmes using these values on survival and quality of life. The data in the literature was critically re-evaluated and analysed to draw reasonable conclusions. Serum PSA measurements show variable reliability when it comes to diagnosis of Prostate cancer, given the dynamics of PSA physiology. Surrogate measures like PSA density, PSA velocity, free-to-complexed PSA ratio, percentage Pro-PSA, etc., have been used to improve the predictive utility of this assay for Prostate cancer. The ability of PSA to detect those cancers that will cost life, and thereby permit early curative treatment, is as yet unclear. It's most definitive role appears to be in diagnosing recurrences after adequate surgical treatment, and in evaluating response to treatment.

Quantification of a Proteotypic Peptide from Protein C Inhibitor by Liquid Chromatography–Free SISCAPA-MALDI Mass Spectrometry: Application to Identification of Recurrence of Prostate Cancer

“…We chose to examine the potential predictive value of a selected PCI tryptic peptide in prostate cancer patients who received either external beam radiation or brachytherapy (with or without hormone therapy), because prostate-specific antigen (PSA), the gold standard biomarker for monitoring prostate cancer, is ineffective in predicting recurrence at an early stage in these patients (12 ).…”

Detection of Prostate Cancer Metastasis by Whole Body Magnetic Resonance Imaging Combined with Bone Scintigraphy and PSA Levels

“…Nonetheless, when cancerization occurred to prostate gland, the blood-epithelial barriers were damaged, inducing increased PSA secreted by PCa and incremental flow of PSA into the blood [42]. The high serum PSA level in PCa patients has also been revealed to signal bone metastasis and PCa recurrence among patients who have received localized disease treatments, yet our study was confined for not exploring this [43][44][45]. Besides, scholars have provided a notion that detecting elements relative to dynamic PSA changes, including baseline PSA, PSA nadir, extent of PSA declining, TTPN and PSA doubling time, was able to improve the diagnostic accuracy of PCa [46].…”

Performance of free prostate-specific antigen ratio in differentiating between prostatic cancer and benign prostatic lesions at a referral hospital in South Africa

“…2,6 In the prostate gland, PSA is produced as a proenzyme PSA (proPSA) by the epithelial cells of the acini and ducts of the prostate gland. 5,7 It is then secreted to the lumen where the propeptide is removed and active PSA is formed. Its major function is to regulate seminal fluid viscosity and it plays a major role in dissolving the cervical mucus cap, allowing sperm to enter the uterus.…”

“…TPSA is used in monitoring treatment response in patients with prostate cancer, early detection of recurrence, assessment of tumour mass and is also useful in screening and diagnosing PCA. 2,7,9 Despite its useful clinical applications, TPSA lacks specificity because it can increase in patients with non-cancerous prostatic conditions, including benign prostatic hyperplasia, prostatitis, acute urinary retention , and on digital rectal examination, ejaculation and prostate biopsy. 7,10 Measures have been taken to improve the screening of PCA as the current TPSA screening shows poor sensitivity and specificity, especially in the TPSA grey-zone range (4-10 ng/ml).…”