Prostate‐specific antigen, clinical use and staging: an overview

Stenman, Ulf‐Hǎkan

doi:10.1111/j.1464-410x.1997.tb00802.x

Cited by 42 publications

(27 citation statements)

References 47 publications

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“…This can be expected given the relatively slow mean growth rate of prostate cancer (Schmid et al, 1993;Stenman, 1997) compared with breast cancer (Peer et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is unclear whether similar criteria of clinical significance can be applied to screening-detected cancers. Longitudinal population studies of serum PSA suggest that most prostate cancers grow at a slow, but steady rate (Schmid et al, 1993;Stenman, 1997). A tumour with a doubling time of 2 years will grow from 1 g to about 32 g in 10 years and to 1 kg, which is likely to be lethal, in 20 years.…”

Section: Discussionmentioning

confidence: 99%

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European randomized study of prostate cancer screening: first-year results of the Finnish trial

et al. 1999

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Prostate cancer is currently the most common cancer among men after skin cancer in most industrialized countries (Parkin et al, 1997). Because of its poorly understood aetiology, primary prevention is not currently feasible and therefore there is considerable interest in screening as a potential approach to prostate cancer control (Schršder and Boyle, 1993). The only means to establish the effect of screening is to conduct large randomized controlled trials with both mortality and quality of life as end points (Denis et al, 1995). Such studies are ongoing both in Europe and North America (Auvinen et al, 1996). In the absence of empirical results, a debate of the issue continues, which is demonstrated by the fact that so far the number of published reviews on the subject exceeds the number of original reports of randomized trials (as identified from Medline).We report here the first-year results of the Finnish trial, which is part of the European Randomized Study of Screening for Prostate Cancer (ERSPC), a multi-centre randomized trial with participating centres from The Netherlands, Finland, Sweden, Belgium, Italy, Portugal and Spain. The common core protocol includes enrolment at ages 55Ð69 and use of Hybritech Tandem-E PSA assay as the screening test with a cut-off level of 4.0 ng ml Ð1 . The primary end point is prostate cancer mortality, with quality of life and cost-effectiveness as the secondary end points. MATERIALS AND METHODSIn the Finnish trial, the subjects are identified from the central population registry of Finland. Enrolment over 4 years with a total study population of 80 000 men is planned. The screening interval is 4 years and up to three screening rounds are planned. The primary end point is mortality from prostate cancer, which will be reported based on 10 years of follow-up from randomization.The study population of the trial consists of men born in 1929Ð1944 and resident in the metropolitan areas of Helsinki and Tampere. In the first year of the study (1996), 20 398 men born in 1929, 1933, 1937 or 1941 were randomized. The subjects were identified from the Population Registry of Finland. The only exclusion criterion was a previous diagnosis of prostate cancer. Information on prostate cancer was obtained through record linkage with the Finnish Cancer Registry. A total of 90 men were excluded before randomization because of previously diagnosed prostate cancer. Approximately 1% of the population (200 men of the eligible study population) has forbidden the use of their address information for any purposes and they were also excluded from randomization. Each year, 8000 men, i.e. approximately one third of the eligible population, are randomized to the screening arm and the rest to the control arm. Of the 8000 men, men who had died or moved out of the study area between the date of randomization (in early January) and date of invitation, were not invited to participate (n = 388 in 1996). Due to an error, additional 275 men were not invited in 1996. Men in the control group were not contacted, ...

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“…This can be expected given the relatively slow mean growth rate of prostate cancer (Schmid et al, 1993;Stenman, 1997) compared with breast cancer (Peer et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

European randomized study of prostate cancer screening: first-year results of the Finnish trial

et al. 1999

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“…In patients with PCa, PSA is thought to be released into the circulation in a more active form than the forms that leak from benign prostatic tissue, which could explain the high proportion of PSA complexed with inhibitors in cancer patients (4,22 ). The IPMA detected 1-10% of free PSA in serum from PCa patients with clearly increased PSA.…”

Section: Discussionmentioning

confidence: 99%

Immunopeptidometric Assay for Enzymatically Active Prostate-Specific Antigen

Zhu

Stenman

et al. 2004

Clinical Chemistry

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Background: Determinations of certain forms of prostate-specific antigen (PSA) have been shown to increase the specificity for prostate cancer (PCa). One such variant, proteolytically active PSA, is a potentially useful tumor marker, but it is not specifically recognized by antibodies. Using phage display libraries, we previously identified a "family" of peptides that bind specifically to active PSA. We used these to develop an immunopeptidometric assay (IPMA) that specifically detects this form of PSA. Methods: Microtitration plates coated with a PSA antibody were used to capture PSA, and a PSA-binding glutathione S-transferase (GST) fusion peptide was used as a tracer. Bound tracer was detected with an antibody to GST labeled with a europium chelate. PSA isoenzymes with high and low enzymatic activity were used to study binding specificity. Results: The IPMA detected enzymatically active PSA but not internally cleaved PSA and pro-PSA, which are enzymatically inactive. The assay detected 1-10% of free PSA in serum from PCa patients. Conclusions: Peptides identified by phage display can be used to develop assays with unique specificities for enzymatically active PSA. IPMA represents a new assay principle with wide potential utility.

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“…34 The proportion of PSA-ACT or cPSA is higher and those of fPSA are lower in PCa patients than in BPH patients. Our results show that these differences are already indicative at low tPSA concentrations.…”

Section: Discussionmentioning

confidence: 94%

Molecular forms of prostate-specific antigen in serum with concentrations of total prostate-specific antigen <4 ?g/L: Are they useful tools for early detection and screening of prostate cancer?

et al. 2001

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Molecular forms of prostate-specific antigen (PSA) improve the differentiation between benign prostatic hyperplasia (BPH) and prostate cancer (PCa) in men with total PSA concentrations between 4 and 10 g/l. To evaluate the diagnostic utility of free PSA (fPSA) and complexed PSA forms for identification of men with PCa in the low PSA range of <4 g/l, total PSA (tPSA), ␣ 1 -antichymotrypsin complexed PSA (PSA-ACT) and fPSA (Roche Elecsys [ES] system) as well as tPSA and complexed PSA (cPSA) (Bayer Immuno 1 system) were measured in archival serum samples from 31 untreated patients with PCa, 66 patients with BPH, and 90 men without prostatic disease. The median ratios of fPSA/tPSA, PSA-ACT/tPSA and cPSA/tPSA were significantly different between patients with BPH and PCa (27.2 vs. 19.4%, 64 vs. 88%, 77.2 vs. 88.2%, p < 0.05). No associations between PSA forms and tumor stage and grade were found. Analysis of the receiver operating characteristic curves showed that these ratios could discriminate better between BPH and PCa patients than determination of the analytes tPSA, fPSA, cPSA and PSA-ACT alone. The use of one of the ratios would have eliminated roughly half of the unnecessary biopsies in this study. The ratios should be considered as potential tools to increase the selectivity of PCa detection at low PSA concentration. The ratios fPSA/tPSA and cPSA/tPSA can be determined using commercially available assays so that one of these ratios could be preferred instead of PSA-ACT determination. The ratios could be useful in assessing the risk of PCa in the individual and therefore in deciding on prostate biopsy for final diagnosis.

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Prostate‐specific antigen, clinical use and staging: an overview

Cited by 42 publications

References 47 publications

European randomized study of prostate cancer screening: first-year results of the Finnish trial

European randomized study of prostate cancer screening: first-year results of the Finnish trial

Immunopeptidometric Assay for Enzymatically Active Prostate-Specific Antigen

Molecular forms of prostate-specific antigen in serum with concentrations of total prostate-specific antigen <4 ?g/L: Are they useful tools for early detection and screening of prostate cancer?

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