Monoclonal prostate-specific antigen in untreated prostate cancer. Relationship to clinical stage and grade

Abstract

The authors evaluated 440 men with clinically staged and untreated prostate cancer with a monoclonal prostate-specific antigen (PSA) assay. The serum PSA value correlated significantly with both the stage and grade of disease (P < 0.00005). The relationships between PSA and consecutive Stages A, B, C, and D, (a = 0.15) and between progressive Gleason's scores 2 to 4, 5 to 7, and 8 to 10 (a = 0.15) were statistically significant. Also statistically significant was the correlation between serum PSA level and intracapsular versus extracapsular disease (P < 0.00005), although no one value can be used to differentiate reliably between patients in these two categories. The probability of clinically detectable metastasis (Stage DZ) is 85% if the serum PSA level is greater than 30; however, 12% of patients without clinical evidence of metastases (Stages A, B, and C) have such a serum PSA value. Despite the statistically significant association between PSA and tumor differentiation and volume as reflected by tumor grade and clinical stage, this marker cannot be used to determine either for an individual patient. Cancer 67:2200-2206,1991. ROSTATE-SPECIFIC ANTIGEN (PSA) Was identified inP 1979 by Wang and associates,' who localized its production to the prostatic epithelial cells. Since then, its biologic characterization and amino acid sequence have been determined.2,3 It was first used immunohistochemically to confirm the prostatic origin of metastatic malignant turn or^.^-^ Only recently has the potential clinical value of serum PSA been appreciated. As a tumor marker, it is useful to monitor the status of patients who have undergone radical p r o s t a t e c t~m y ,~~~ irradiation, or hormonal therapy. 'O," Comparative studies have shown that PSA is more sensitive than prostatic acid phosphatase (PAP) as a prostate cancer tumor marker.'2,13From the

Prostate‐specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of cancer

“…2 only 7% of the patients had cancer. Babaian and Camps [6] reported similar results, finding a 23.1 % and 19.6% cancer incidence in men with an abnormal DRE (regardless of TRUS) and an abnormal TRUS (regardless of DRE), respectively, if the PSA was 9 4 compared to 77.8% and 71.2%, respectively, if the PSA was >4.…”

Efficiency of prostate‐specific antigen and digital rectal examination in screening, using 4.0 ng/ml and age‐specific reference range as a cutoff for abnormal values

“…This may be especially true for older men who have coexistent benign prostatic hyperplasia (BPH), which may elevate the PSA level even though prostate cancer may not be present. Even though older men have a higher incidence of prostate cancer, previous studies have reported that BPH is accompanied by PSA levels >4 ng/ ml in 25-53% of cases [11,12]. Thus, using a 4.0-ng/ml cutoff PSA value would give a higher false-positive rate and a lower PPV.…”

The effect of Gleason score on the predictive value of prostate‐specific antigen doubling time

“…These investigators noted that both the presence and intensity of PSA staining inversely correlated with the Gleason grade of the tumour [9]. Other studies have shown a similar correlation of PSA level with grade [28], and have noted poor expression of PSA in high‐grade cancers [7,10,29], although smaller, or exclusively serum‐based, studies have found no consistent correlation of PSA expression with grade [30].…”