Clinical use of Prostate Specific Antigen in Patients with Prostate Cancer

Abstract

The clinical use of prostate specific antigen as a screening test for prostate cancer, as a preoperative determinant for staging of prostate cancer and to monitor response to therapy in prostatic cancer patients was evaluated in 168 men with benign prostatic hyperplasia and 231 men with prostate cancer. Only 3% of the men with benign prostatic hyperplasia had prostate specific antigen levels greater than 10 ng. per ml. compared to 44% of the men with proved prostate cancer. Preoperative prostate specific antigen levels increased with higher clinical stages of prostate cancer but there was substantial overlap among stages. Among patients with stage A1 prostate cancer who were followed expectantly none had an elevated prostate specific antigen value or metastatic disease during a followup of 15 to 120 months. After radical prostatectomy serum prostate specific antigen values decreased to undetectable levels (less than 0.6 ng. per ml.) in 89% of the patients with organ-confined disease, in 87% of those with microscopically positive margins only but in only 34% with seminal vesicles or lymph node involvement. Failure of the prostate specific antigen levels to decrease to the undetectable range after radical prostatectomy was associated with a greater likelihood of subsequent tumor recurrence. Only 3 of 18 patients (17%) treated with definitive radiation therapy had post-irradiation prostate specific antigen values of less than 0.6 ng. per ml., while in 39% the prostate specific antigens values remained greater than 4 ng. per ml. and in 4 of 18 (22%) the values were greater than 10 ng. per ml. Of patients with previously untreated stage D2 prostate cancer the mean pre-treatment prostate specific antigen value was 63.7 ng. per ml. compared to a post-hormonal therapy mean value of 31.1 ng. per ml. Of 32 patients treated with hormonal therapy 14 had stable disease, including 13 with prostate specific antigen levels of less than 10 ng. per ml. In contrast, 18 patients had progressive disease, of whom 16 had prostate specific antigen levels of more than 10 ng. per ml. We conclude that the serum prostate specific antigen assay is most useful clinically to monitor the response to therapy of prostate cancer patients.

The changing scenario in diagnosing prostate cancer

“…This was the reason for us to categorize these patients further into Group (a) patients with t-PSA concentration <10 ng/mL; Gr_oup (b) patients with tPSA concentration >10 ng/mL. The results of this study are in accordance with the report which compares BPH and CaP patients with tPSA concentration < 10 ng/mL (13)(14)(15).…”

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

“…10,11 The widespread use of PSA in the clinical setting did not begin until the mid-1980s. The earliest observations had important clinical applications and included: 1) a decrease in the PSA level after hormonal therapy appeared to be correlated with response to treatment [11][12][13] ; 2) an increase in the PSA level after treatment appeared to precede and herald disease recurrence 11,14,15 ; and 3) after radical prostatectomy, PSA should be undetectable; if not, disease recurrence is the rule. 11,14,15 Several of these early investigators rejected the possibility of using PSA for screening because of a substantial overlap in PSA values between patients with and those without carcinoma and the resulting poor test specificity.…”

Influence of dioxin exposure upon levels of prostate-specific antigen and steroid hormones in Vietnamese men

“…In recent years, several clinical studies of hormone treatment for prostate cancer have been done (Cai C et al 2011;Chang KH et al 2011;Mostaghel EA et al 2011;Richards J et al 2012;Mostaghel EA 2013). Prostate-specific antigen (PSA) is a glycoprotein produced almost exclusively by the epithelial cells of the prostate gland, and is used as a marker for the diagnosis and monitoring of prostate cancer (Hudson MA et al 1989;Oesterling JE 1991;Armbruster DA 1993).…”