Age-Specific Reference Ranges for PSA in the Detection of Prostate Cancer

Size: px
Start display at page:

Download "Age-Specific Reference Ranges for PSA in the Detection of Prostate Cancer"

Transcription

1 Age-Specific Reference Ranges for PSA in the Detection of Prostate Cancer Review Article [1] April 01, 1997 By Edward P. Deantoni, PhD [2] PSA is the best tumor marker yet discovered. Age-specific reference ranges could improve the sensitivity of PSA by detecting curable, organ-confined tumors. ABSTRACT: An association between age and prostate-specific antigen (PSA) has been documented: As men age, their serum PSA value increases. Currently, a single demarcation between normal and elevated PSA values, 4.0 ng/ml, is used as an indication for biopsy among men of all ages. The use of age-specific reference ranges might address several shortcomings of the PSA test. First, age-specific reference ranges could improve the sensitivity of PSA by detecting curable, organ-confined tumors in younger men when the threshold of 4.0 ng/ml is lowered. Second, age-specific reference ranges could improve the specificity of the PSA test by raising the PSA threshold for normal among older men. This would modulate PSA interpretation by taking into account the increasing prevalence of both benign prostatic growth and incidental, non-life-threatening cancers among successively older cohorts of men. Furthermore, many unnecessary (false-positive) biopsies would be avoided. However, the association between PSA values and age is not entirely clear, and whether age-specific reference ranges represent the best interpretive index for PSA remains problematic. [ONCOLOGY 11(4): , 1997] Introduction Prostate-specific antigen (PSA) is the best "tumor marker" yet discovered.[1,2] This enzyme is produced by the columnar epithelial cells of the prostate and periurethral glands. As a serine protease in the kallikrein gene family, PSA presumably has some biologic function in the prostate or in its secretions. Semenogelin, a major protein in seminal fluid, is cleaved by PSA, and this cleavage is apparently an important part of the liquefaction of semen.[3] Prostate-specific antigen also cleaves one of the six binding proteins of the insulin-like growth factor, IGF BP-3. In vitro studies have shown that although IGF BP-3 inhibits the activity of IGF-II, its cleavage by PSA reverses this inhibition and frees IGF to stimulate proliferation.[4,5] Unfortunately, far less is known about other biologic substrates of PSA. The basement membrane of the acini, basal cells lining the acini, and stromal cells act as barriers to prevent the escape of PSA into the bloodstream. Therefore, serum levels of PSA are normally maintained below 4 ng/ml, which corresponds to about 10-6 of the levels of PSA in seminal fluid.[6] Normal prostate epithelial cells and benign hyperplastic tissue actually produce more PSA protein than does malignant tissue, and PSA messenger RNA (mrna) is also expressed at higher levels in benign tissue than in malignant prostate tissue.[7,8] Therefore, PSA is not a true tumor marker. Abnormalities in the architecture of the prostate gland resulting from either trauma or disease cause increased "leakage" of the enzyme into the bloodstream via capillaries and lymphatics.[1] Prostate-specific antigen is specific to the prostate but not to prostate cancer. Prostate cancer can cause a breakdown of the barriers that prevent escape of PSA into the extracellular fluids, resulting in elevated PSA levels in the blood. Prostate-specific antigen levels increase approximately in proportion to the volume of prostate cancer.[9] However, elevated serum levels of PSA do not always result from prostate cancer. Benign conditions, such as bacterial prostatitis, urinary retention, and benign prostatic hyperplasia (BPH), may also cause elevations in serum PSA levels. Although PSA concentrations increase with the volume of BPH tissue, the average increase is small (0.3 ng/ml/g of tissue) when compared with the increase associated with cancer (nearly 3.5 ng/ml/g of malignant tissue).[10] Early Detection of Prostate Cancer Page 1 of 11

2 Prior to the era of PSA testing, the digital rectal examination was the gold standard for the detection of prostate cancer. However, interoperator variance with the digital rectal examination has been documented[11]; its sensitivity is low; and it is more likely to detect locally advanced cancer than organ-confined disease. The PSA test also is not a flawless method of cancer detection. The major shortcoming of the PSA test is its less-than-perfect sensitivity and specificity rates, despite the fact that these rates are among the highest of cancer screening tests currently in use. A relatively high number of false-positive results is common: PSA levels above normal but resultant negative biopsies.[12] In most screening studies, the positive predictive value of a PSA level 4.0 ng/ml or more is approximately 33%.[13-16] Combined use of PSA testing and digital rectal examination is universally recommended because of the significant increase in positive predictive value. Approximately 25% to 33% of patients with prostate cancer have serum PSA concentrations in the normal range at the time of diagnosis, made on the basis of a digital rectal examina-tion or a PSA threshold less than 4.0 ng/ml.[15-17] Only 1 patient in 10 with a suspicious digital rectal examination will prove to have prostate cancer on biopsy if the PSA value is less than 4.0 ng/ml.[17,18] When the PSA value is 10.0 ng/ml or higher, at least 50% of patients will have prostate cancer. Between these two groups is the diagnostic "gray zone" of the PSA value, 4.0 to 10.0 ng/ml, for which a positive biopsy of cancer is problematic. In this range, nearly 25% of men will have prostate cancer, and 75% will have benign prostatic enlargement. In fact, approximately 25% of all men with a histopathologic diagnosis of BPH have serum PSA levels higher than commonly used cut-off value of 4.0 ng/ml.[1] PSA and its Indexes Various analytic methods have been proposed to improve the sensitivity and specificity of PSA testing. Higher standards are necessary but not sufficient proof that PSA testing will reduce mortality from prostate cancer.[19] These indexes include calculations of PSA density,[20] PSA density adjusted for volume of the transition zone,[21] analysis of PSA velocity,[22] molecular forms of PSA,[23,24] and the application of age-specific PSA reference ranges.[25] PSA Density The calculation of PSA density--psa values in relation to the volume of the prostate gland--was initially proposed by Benson and colleagues[20] as a method to differentiate BPH and cancer. Calculation of PSA density necessarily involves a transrectal ultra- sonographic examination to derive an estimation of volume, and the operator dependency of this examination can influence subsequent calculations of prostatic volume. Studies of PSA density have reported mixed findings: Some investigators[26,27] have found that PSA density calculation improves the sensitivity and specificity of PSA testing, whereas others[28] have reported no diagnostic improvement with this calculation. Refinements in the interpretation of PSA density calculation have been attempted, such as consideration of the volume of the transition zone[21]; volume-referenced PSA values[29]; and an unpublished study of age-specific PSA density. However, no consistent diagnostic improvement can be claimed for PSA density and its derivatives. A significant correlation between age and volume of the prostate gland has been documented, and this phenomenon supports the consideration of age-specific reference ranges.[25,30] PSA Velocity A landmark analysis,[31] based on the Baltimore Longitudinal Study of Aging, demonstrated a significant difference in the age-adjusted rate of change in PSA levels among groups of men who had prostate cancer, BPH, and no prostate disease. Carter and associates[31] suggested that a 0.75-ng/mL/yr increase in PSA is predictive of a diagnosis of cancer. However, intraindividual variation of PSA test results, the lack of standardization of PSA assays, and the recommendation that a minimum of three annual tests over a 2-year period be used to calculate PSA velocity, have hampered the establishment of a "normal" PSA change (slope, or velocity) over time. An association between age-specific reference ranges and PSA velocity seems to be intuitively apparent, but long-term prospective studies of such an association have not yet been reported. Different Molecular Forms of PSA Considerable enthusiasm has been generated by the possibility of differentiating benign and malignant disease through the assay of the proportion of different molecular forms of PSA: (1) PSA Page 2 of 11

3 bound to alpha-1-antichymotrypsin, (2) PSA bound to alpha-2-macro-globulin, and (3) unbound (free) PSA. However, establishing a "correct" ratio of these different PSA types that will distinguish prostate cancer from benign growth will likely be debated, much as PSA and its indexes are debated currently. Although the amounts of these different molecular forms and of total PSA apparently vary according to age, the ratios do not, and may ultimately obviate any age-related consideration in diagnostic evaluations.[32] Age-Specific PSA Reference Ranges Studies Establishing Age-Specific Ranges Early studies of PSA testing for the detection of prostate cancer found consistent, strong associations between PSA values and glandular volume, PSA values and age, and age and glandular volume.[14,30,33] Brawer and colleagues[14] found that the mean PSA value increased with age (P = less than.0001), but the correlation coefficient (r)--the degree of correlation between age and PSA values--was only.15. (It is important to note that when the correlation coefficient is squared [r2], resulting in a coefficient of determination, that percent explains the linear relationship between the two variables. In the case of the findings of Brawer's group,[14] this would mean that 2.3% of the variation in PSA levels can be explained by its linear relationship to age). Babaian and colleagues[33] also found a significant association between PSA levels and age and a significant relationship between prostatic volume (determined by transrectal ultrasonography) and increasing PSA levels and age (for all, P less than.00005). The increasing prevalence of both benign prostate disease and prostate cancer as men age had long been reported, and PSA seemed to be related to this phenomenon. This study recommended biopsy when the PSA value is between 4.0 to 10.0 ng/ml and the prostatic volume is 25 ccor less. Collins and associates[30] reported on a clinic population referred for assessment of BPH. The study's objective was to investigate the relationships between prostatic volume and PSA levels and between age and prostatic volume. Correlations were established, but the study also found an independent association between PSA levels and age. Linear regression analysis showed an independent association between PSA levels and age when adjustments were made for prostate volume. Age and prostate volume influence PSA levels independently. A modest correlation of PSA levels and age was reported (r =.37; P less than.0001).table 1 Age-Specific Reference Ranges for PSA Values The seminal study of age-specific reference range by Oesterling and associates[25] reported on a community-based population (N = 471) that had no evidence of prostate cancer. Prostate-specific antigen levels correlated with age (r =.43 [r² = 18.5]; P less than.0001); a higher correlation of PSA with PSA density was found (r =.55; P less than.0001); and PSA density was weakly correlated with age (r =.25; P = less than.001). With the median PSA value plus two standard deviations, age-specific reference ranges were established for 10-year age groups. These age-specific reference ranges have become the standard in the literature (Table 1). Based on regression analysis of the cross-sectional data, this study estimated that the serum PSA concentration increases approximately 3.2% per year. For a healthy, 60-year-old man, that would mean an increase of.04 ng/ml over the next year. Oesterling has been at the forefront of advocating the use of age-specific reference ranges to make PSA a more discriminating tumor marker for detecting clinically significant cancers in older men (increasing specificity by raising the threshold for normal PSA levels) and potentially curable cancers in younger men (increasing sensitivity by lowering the threshold for normal PSA levels).[34,35] Other studies[36,37] have investigated this association between PSA levels and age, and similar age-specific reference ranges have been proposed (Table 1). The age-specific reference ranges of Oesterling's group[25] are relatively conservative, given the generally lower ranges in each age group. This may reflect less PSA variability among the relatively homogeneous male population of Olmstead County, Minnesota. Their age-specific reference ranges may reflect a standard against which "abnormally" high PSA levels can be evaluated. The incidence Page 3 of 11

4 of prostate cancer may also be lower in Olmstead County because of the number of research studies conducted among its population. As increasing percentages of men undergo PSA testing, and as more cancers are detected, regression to the mean PSA values of Olmstead County may occur throughout the country. Application to Clinical Study Results The age-specific reference ranges established by Oesterling's group[25] have been applied retrospectively to a number of studies and have substantiated the contention that this PSA index increases sensitivity among younger men and specificity among older men. In one study[38] of 2,998 men more than 60 years of age from a single urologic practice, age-specific reference ranges decreased sensitivity by 9% but increased specificity by 11% and positive predictive value by 5%. If these reference ranges had been used, 92 biopsies (5.5%) would have been avoided, and only 19 (.6%) cancers would not have been detected. However, of these 19 cancers, 13 were detected in men ³ 70 years of age and 18 were unlikely to be of clinical consequence, based on organ confinement, tumor volume, and Gleason grade. Partin and colleagues[39] reviewed the records of 4,597 men with clinically localized prostate cancer from the extensive Johns Hopkins surgical series. Using the standard reference PSA value of 4.0 ng/ml alone, they found that 82% of tumors would have been detected; age-specific reference ranges would have detected 78%. Age-specific reference ranges would have found 18% more cancers in men less than 60 years of age and 22% fewer cancers in men 60 years of age or more. In men less than 60 years of age, 74 cancers would have been detected by age-specific reference ranges but not by the standard reference. Moreover, of these 74 cancers, 60 (81%) had a favorable pathologic status: either organ confinement or capsular penetration with a Gleason grade of less than 7. In men 60 years of age or more, 252 tumors would not have been detected, but of these tumors, 76% (191) had a favorable pathologic status. This study concluded that age-specific reference ranges are most useful in men 60 years of age or more with T1c prostate cancer (ie, they increase specificity) because 95% of the "missed" tumors among older men had a favorable pathologic status. Another study, apparently based on results from early detection programs, concurred that age-specific reference ranges increased sensitivity in detecting prostate cancer in younger men, who would be more likely to benefit from treatment, while decreasing the biopsy rate in older patients.[40] These investigators concluded that age-specific reference ranges would be most valuable for patients more than 70 years of age, among whom 22% would have been spared transrectal ultrasonography with biopsy. Similarly, Lankford and colleagues[41] found a significant association between PSA levels and age (r =.33) and a significant improvement in specificity when age-specific reference ranges were applied to men 70 years of age or more, as compared with the standard PSA reference (58.6% and 34.2%, respectively). Two European studies[42,43] reported results based on the application of age-specific reference ranges to findings from screening populations. Reissigl and associates[42] reported that an 8% increase in biopsies among younger men (in their 40s and 50s) would have occurred with age-specific reference ranges, but this would have effected an 8% increase in the detection of organ-confined cancer. In older men (more than 60 years), 21% fewer biopsies would have been performed and 4% of organ-confined tumors would have been missed. Using age-specific reference ranges and digital rectal examination as indicators for biopsy, Bangma and colleagues[43] reported that a 37% reduction in biopsies would have occurred, with a 12% loss of detected cancers, all of which were nonpalpable and organ-confined. Although these studies generally support the use of age-specific reference ranges to improve the characteristics of PSA testing, they do not provide sufficient evidence for their universal application. The variability of findings likely reflects the diagnostic capabilities of the clinical investigators, the detection technologies employed, and the different patient populations. One autopsy study confirmed an increased specificity with age-specific reference ranges among men more than 60 years of age,[44] but such studies simply show that cancers are missed and an elevated PSA value (more than 4.0 ng/ml) alone does not indicate cancer. Criticisms of Age-Specific Ranges Widespread acceptance of age-specific PSA reference ranges as a valuable index for the effective and efficient detection of prostate cancer has been compromised by negative clinical findings, philosophy, and the continued adequate performance of the standard reference PSA value of 4.0 ng/ml. Age-specific reference ranges have theoretical appeal, but study results are not consistent Page 4 of 11

5 with regard to the percentage and type of prostate cancers not detected among older men when age-specific reference ranges have been applied retrospectively. Data from the American Cancer Society's National Prostate Cancer Detection Project showed that age-specific reference ranges increased specificity but at a nonsignificant loss of sensitivity.[45] A PSA value of 4.0 ng/ml alone had a sensitivity of 71.9% and a specificity of 90%; age-specific reference ranges had a sensitivity of 67.3% and a specificity of 90.9%. A German study concluded that the application of age-specific reference ranges (or any PSA value less than 3.1 ng/ml) does not improve the test's sensitivity among men younger than age 50. Moreover, using a higher PSA value (7.5 ng/ml) for men more than 70 years of age does improve specificity but lowers sensitivity.[46] Although Oesterling and colleagues[38] and Partin's group[39] each noted that only 5% of cancers undetected with age-specific reference ranges had unfavorable histology, a recent study[47] reported that 60% (9 of 15) of cancers that would have remained undetected by age-specific reference ranges had histologic characteristics qualifying them as large, life-threatening, and clinically significant. All of these cancers were in men younger than age 75. In another extensive critique of age-specific reference ranges, Catalona and associates[48] concluded that if an age-specific reference of 3.5 ng/ml had been used for men between the ages of 50 and 59, there would have been a 45% increase in biopsies, with only a projected 15% increase in cancer detection. If an age-specific reference of 4.5 ng/ml had been used for men between the ages of 60 and 69, 15% fewer biopsies would have occurred, but 8% of organ-confined tumors would have been missed. Increasing the normal PSA cut-off value to 6.5 ng/ml for men more than 70 years would have resulted in 44% fewer biopsies (70 of 159) and would have missed 47% of detected organ-confined cancers (7 of 15). This study concluded that a PSA value of 4.0 ng/ml need not be altered for older men because the number of biopsies performed for each cancer detected remained constant across age groupings, apparently unaffected by the simultaneously increasing prevalence of BPH and cancer with age. In light of the fact that both sensitivity and specificity cannot be improved simultaneously, the philosophical issue surrounding age-specific reference ranges is whether sensitivity or specificity should take priority. Advocates of screening and early detection of prostate cancer favor sensitivity over specificity because more clinically important, organ-confined disease will be detected.[49] In fact, it has been proposed that the threshold for normal be lowered from 4.0 to 2.5 ng/ml for everyone.[50] A more provocative proposal has been to ignore PSA values and age-specific reference ranges completely and simply to perform a biopsy on all men at 50 years of age[51]; specificity would be sacrificed at the altar of universal detection. These and similar proposals may not be implemented because of the relatively satisfactory performance of a single demarcation between normal and elevated PSA levels.[52] The reference for the maximum normal PSA value (4.0 ng/ml) was established with a population mix younger than would be normally tested for prostate cancer: 472 individuals, of whom only 55 were between the ages of 50 and 59 and 19 were 60 years of ageor more.[53] This basis may not reflect the increasing risk of prostate cancer with increasing age, but the objective was to identify a demarcation between normal and elevated PSA levels. Unless another standard becomes more acceptable, the imperfect nature of the PSA test may simply require such a norm; ie, below 4.0 ng/ml to detect more organ-confined cancers regardless of the higher number of false-positive results or above 4.0 ng/ml to detect fewer clinically insignificant cancers while missing more clinically significant cancers. Variations on the Age-Specific Reference Range Theme Attempts to complement the value of age-specific reference ranges in the detection of prostate cancer have included consideration of prostatic volume after age-specific reference ranges and proposed volume-referenced PSA values. Meshref and colleagues[54] studied PSA density with age-specific reference ranges. In a clinically referred population (N = 2,429), transrectal ultrasonography was performed on everyone. This experience alone indicated proficiency in establishing comparable estimations of volume and led to the finding that volume is more strongly correlated to PSA value (r =.46) than are PSA values to age (r =.25). Prostate-specific antigen density (which directly relates serum PSA values to prostatic volume), however, showed a weak correlation with age (r =.1). In multiple regression analysis, prostate volume accounted for 18% of the variation in serum PSA values, whereas age accounted for only an additional 2%. In the patient group with PSA values between the age-specific upper limit of normal and 10.0 ng/ml, the positive rate of biopsy in patients with a PSA density less than.15 was only 1.9% (2/108/315), but in patients with a PSA Page 5 of 11

6 density more than.15, the positive rate of biopsy was 27.2% (59/217/240). This study concluded: (1) that age-specific reference ranges do not totally account for the effect of prostate volume on serum PSA values and (2) that PSA density can still safely be used to reduce the number of biopsies performed in patients with a normal digital rectal examination and transrectal ultrasonography, as well as a serum PSA level 10.0 ng/ml or less but above the age-specific reference range limit of normal. Babaian and associates[29] also attempted to address the mixed results of studies of PSA density and age-specific reference ranges. Because the association of glandular volume with PSA values is stronger than that with age, these investigators developed the concept of volume-referenced PSA testing and compared its sensitivity and specificity with other indices. Volume-referenced PSA testing was more sensitive but less specific than age-specific reference ranges and PSA density; it was only equivalent to PSA testing clinically. Age-specific reference ranges would have prevented more biopsies than volume-referenced testing (39% vs 31%) but would have resulted in the diagnosis of 48% fewer cancers. Receiver-operator characteristic curve analysis demonstrated a better performance for volume-referenced PSA testing and PSA density than for PSA testing or age-specific reference ranges. In the PSA value range of 4 to 10 ng/ml, volume-referenced testing was superior to PSA testing (P = less than.01) and age-specific reference ranges (P less than.001) and equivalent to PSA density. In this range, age-specific reference ranges missed the fewest cancers (6%) but resulted in the fewest biopsies (12%). However, a key point of this study was that enhanced detection of prostate cancer was inversely associated with increasing volume of the prostate gland and directly related to increasing patient age.[29] The relationship between age-specific reference ranges and PSA change--psa velocity--offers another potential PSA index that could improve the test's characteristics. Pearson and colleagues[55] studied annual PSA velocity rates in 727 men (age range, 35 to 92 years) with no history of prostate cancer and a PSA level < 10 ng/ml. The mean PSA velocity and the upper limits of PSA velocity increased significantly with age (P less than.001). Age-specific values for PSA velocity were suggested: less than 50 years of age, ng/ml/yr; 50 to 59 years old, 0.15 ng/ml/yr; 60 to 69 years old, 0.3 ng/ml/yr; and 70 years older more, 0.4 ng/ml/yr.[55] The shortcoming of this study, however, is the particular PSA range of values selected (ie, 4.0 to 10.0 ng/ml) to establish age-specific PSA velocity: Whatever range of PSA values is used to establish "normal" PSA velocity will directly influence the resultant PSA velocity determinations. If, for example, a PSA value of 0.0 to 4.0 ng/ml is used to establish PSA velocity levels, the age-specific rates will be much lower. Again, it becomes a question of whether to emphasize sensitivity or specificity in the detection of prostate cancer by using age-specific PSA velocity values. How Best to Use the PSA-Age Relationship TABLE 2 Mean PSA Values by Age As discussed elsewhere,[37] age-specific reference ranges are a result of the increasing mean PSA values and the increasing PSA variance (standard deviation) in successively older cohorts of men. Mean PSA values are related to the population studied and may also be related to the time during which a particular study was conducted (Table 2). The variability in PSA values as men age suggests that caution should be exercised when considering the clinical implications of age-specific reference ranges.[56] The upper limits are established by two methods: (1) extending mean PSA levels upward two standard deviations to establish a 95% confidence limit, or (2) extending the median PSA value to the 95th percentile. However, the distribution of PSA values in any age group is not a normal distribution: absolute 0.0 ng/ml is always the lowest value.table 3 Median PSA Values and Interquartile Ranks Page 6 of 11

7 The degree of variation in PSA values increases with each older age cohort. That is, men in their 70s exhibit greater variability in PSA values than men in their 60s, who, in turn, exhibit greater variability than men in their 50s, with men in their 40s demonstrating the least variability. In fact, Bangma and associates[43] have shown that the coefficient of correlation weakens as older ages are considered: r =.32 for all men but only.16 for men 50 years or more. Table 3 presents the interquartile ranges for 10-year age cohorts, and the increasing variance on either side of the median--especially between the 50th and 75th percentile--is apparent.figure 1 Variability in PSA With Age If the variance in PSA values is related to the "normal" pattern of prostatic function, it would stand to reason that men in their 40s, when benign prostatic enlargement and prostate cancer are uncommon, would show the least variance in PSA values. With increasing age and greater variability in circulating androgen levels, various endogenous prostatic insults, and other physiologic factors that may be environmentally influenced, some prostates will be stimulated to grow--whether that growth is benign or malignant--whereas others will not.[57] Thus, greater variability is found among PSA levels of successively older men (Figure 1). Age-specific reference ranges will necessarily be less sensitive than the standard of 4.0 ng/ml among older men for two major reasons: (1) poorly differentiated cancers in small-volume prostates will not produce ("leak") sufficient PSA to cross even the current threshold of 4.0 ng/ml let alone a higher threshold; and (2) the variance in PSA values is greater among older men. The men with large-volume prostates bias the age-specific reference ranges for men with normal-volume prostates in every age group.table 4 Age-Specific Reference Ranges for PSA Values: 1-Year, 5-Year, and 10-Year Calculations Ten-year age groupings for age-specific reference ranges may simply be too inclusive (and less sensitive than 4.0 ng/ml) for clinical applicability at this time. Five-year age-specific reference ranges, or even an annual reference point (at the 95th percentile), may provide a sound criterion for clinical interpretation. Based on more than 77,000 individual PSA test results, previously analyzed in 10-year age groups,[37] Table 4 presents the increasingly more specific reference points by 10-, 5-, and 1-year age groupings. For each year of age after the age of 45, more than 1,000 PSA test results provided the basis for computation. Albeit subject to the same shortcomings of 10-year age-specific reference ranges, an annual reference point may help interpret PSA test result. Conclusions Oesterling[25,34,35] has eloquently stated the potential advantages of using age-adjusted PSA standards: (1) to increase the test's sensitivity among younger men, detecting more curable, organ-confined tumors earlier; and (2) to increase the test's specificity among older men, avoiding many unnecessary biopsies. Surely, determining the most effective way of using PSA testing to decide whether or not to perform a biopsy is a complex problem. Attempts to find an easy solution to this problem should be tempered by the dictum of H. L. Mencken: "For every complex problem there is a simple solution, and it is wrong." Page 7 of 11

8 The issue of age-specific reference ranges has emerged because of the lack of sufficient evidence that screening and early detection of prostate cancer with PSA testing improves survival. If the objective is to find curable organ-confined prostate cancers, notwithstanding the debate over labels of "significant" or "insignificant" tumors, sensitivity must be the prime criterion; ie, one needs to perform more biopsies so as not to miss any clinically significant, curable, organ-confined tumors. Studies have shown that the majority of PSA-detected cancers are significant. If, on the other hand, the objectives are to increase specificity, to attempt to limit cost-effectively the number of biopsies performed in older men[35] and to minimize the psychological consequences of false-positive results, age-specific reference ranges make sense. Some curable cancers would be missed in older men with this approach, however. The assumption here is that with the increasing incidence of cancer as men age, one standard cut-off value for PSA (4.0 ng/ml) would tip the scales toward detecting more insignificant tumors. The trade-off between sensitivity and specificity should be the clue that the test is imperfect as it stands. Although there is no easy answer, studies of the molecular forms of PSA and the ratio of free-to- total PSA may render this debate moot by permitting a pre-biopsy determination of benign or malignant disease. However, the single best ratio of free-total PSA will likely be as controversial as any current PSA index. References: 1. Oesterling JE: Prostate specific antigen: A critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol 145: , Partin AW, Oesterling JE: The clinical usefulness of prostate specific antigen: Update J Urol 152: , Lilja H: A kallikrein-like serine protease in prostatic fluid cleaves the predominant seminal vesicle protein. J Clin Invest 76: , Cohen P, Peehl DM, Lamson G, et al: Insulin-like growth factors (IGFs), IGF receptors, and IGF binding proteins in primary cultures of prostate epithelial cells. J Clin Endocrinol Metab 73: , Cohen P, Graves HCB, Peehl DM, et al: Prostate-specific antigen (PSA) is an insulin-like growth factor binding protein-3 protease found in seminal plasma. J Clin Endocrinol Metab 75: , Christensson A, Laurell C-B, Lilja H: Enzymatic activity of prostate-specific antigen and its reactions with extracellular serine proteinase inhibitors. Eur J Biochem 194: , Wang MC, Valenzuela LA, Murphy GP, et al: Purification of human prostate-specific antigen. Invest Urol 17: , Qui S-D, Young CY, Bilhartz DL, et al: In situ hybridization of prostate-specific antigen mrna in human prostate. J Urol 144: , Schmid H-P, McNeal JE, Stamey TA: Observations on the doubling time of prostate cancer. Cancer 71: , Stamey TA, Yang N, Hay AR, et al: Prostate specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317: , Smith DS, Catalona WJ: Interexaminer variability of digital rectal examination in detecting prostate cancer. Urology 45:70-75, Littrup PJ, Kane RA, Mettlin CJ, et al: Cost-effective prostate cancer detection: Reduction of low-yield biopsies: The investigators of the American Cancer Society National Prostate Cancer Page 8 of 11

9 Detection Project. Cancer 74: , Catalona WJ, Smith DS, Ratliff TL, et al: Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324: , Brawer MK, Chetner MP, Beatie J, et al: Screening for prostatic carcinoma with prostate specific antigen. J Urol 147: , Labrie F, Dupont A, Suburu R, et al: Serum prostate specific antigen: A prescreening test for prostate cancer. J Urol 147: , Catalona WJ, Richie JP, Ahmann FR, et al: Comparison of digital rectal examination and serum prostate specific antigen in early detection of prostate cancer: Results of a multicenter clinical trial of 6630 men. J Urol 151: , Hudson MA, Bahnson RR, Catalona WJ: Clinical use of prostate specific antigen in patients with prostate cancer. J Urol 142: , Richie JP, Catalona WJ, Ahmann FR, et al: Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination. Urology 42: , Begg CB: Methodological issues in studies of the treatment, diagnosis, and etiology of prostate cancer. Semin Oncol 21: , Benson MC, Whang IS, Olsson CA, et al: The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol 147: , Kalish J, Cooner WH, Graham Jr SD: Serum PSA adjusted for volume of transition zone (PSAT) is more accurate than PSA adjusted for total gland volume (PSAD) in detecting adenocarcinoma of the prostate. Urology 43: , Carter HB, Pearson JD: PSA velocity for the diagnosis of early prostate cancer: A new concept. Urol Clin North Am 20: , Lilja H: Significance of different molecular forms of serum PSA: The free, noncomplexed form of PSA versus that complexed to a1-antichymotrypsin. Urol Clin North Am 20: , Catalona WJ, Smith DS, Wolfert RL, et al: Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening. JAMA 274: , Oesterling JE, Jacobsen SJ, Chute CG, et al: Serum prostate-specific antigen in a community-based population of healthy men: Establishment of age-specific reference ranges. JAMA 270: , Seaman E, Whang M, Olsson CA, et al: PSA density (PSAD): Role in patient evaluation and management. Urol Clin North Am 20: , Jewett MAS, Jain U, Toi A, et al: Prostate specific antigen density (PSAD): Can it distinguish between benign hyperplasia and malignancy (abstract)? J Urol 149:415A, Brawer MK, Aramburu FAG, Chen GL, et al: The inability of prostate specific antigen index to enhance the predictive value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol 150: , Babaian RJ, Kojima M, Ramierez EI, et al: Comparative analysis of prostate specific antigen and its indexes in the detection of prostate cancer. J Urol 156: , Page 9 of 11

10 30. Collins GN, Lee RJ, McKelvie GB, et al: Relationship between prostate specific antigen, prostate volume, and age in the benign prostate. Br J Urol 71: , Carter HB, Pearson JD, Metter EJ, et al: Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 267: , Oesterling JE, Jacobsen SJ, Klee GG, et al: Free, complexed, and total serum prostate specific antigen: The establishment of appropriate reference ranges for the concentrations and ratios. J Urol 154: , Babaian RJ, Miyashita H, Evans RB, et al: The distribution of prostate specific antigen in men without clinical or pathological evidence of prostate cancer: Relationship to gland volume and age. J Urol 147: , Oesterling JE: The importance of patient age and race in establishing appropriate reference ranges for serum PSA. Proceedings from the 4th International Symposium on Recent Advances in Urological Cancer Diagnosis and Treatment. Paris, France, June 22-24, Oesterling JE: Using prostate-specific antigen to eliminate unnecessary diagnostic tests: Significant worldwide economic implications. Urology 46(suppl 3A):26-33, Dalkin BL, Ahmann FR, Kopp JB: Prostate specific antigen levels in men older than 50 years without clinical evidence of prostatic carcinoma. J Urol 150: , DeAntoni EP, Crawford ED, Oesterling JE, et al: Age- and race-specific reference ranges for prostate-specific antigen from a large community-based study. Urology 48: , Oesterling JE, Jacobsen SJ, Cooner WH: The use of age-specific reference ranges for serum prostate specific antigen in men 60 years old or older. J Urol 153: , Partin AW, Criley SR, Subong ENP, et al: Standard versus age-specific prostate specific antigen reference ranges among men with clinically localized prostate cancer: A pathological analysis. J Urol 155: , El-Galley RES, Petros JA, Saunders WH, et al: Normal range prostate-specific antigen versus age-specific prostate-specific antigen in screening prostate adenocarcinoma. Urology 46: , Lankford SP, Peters KL, Elser RC: Potential effects of age-specific reference ranges for serum prostate-specific antigen. Eur Urol 27: , Reissigl A, Pointer J, Horninger W, et al: Comparison of different prostate-specific antigen cutpoints for early detection of prostate cancer: Results of a large screening study. Urology 46: , Bangma CH, Kranze R, Blijenberg BG, et al: The value of screening tests in the detection of prostate cancer. Part II: Retrospective analysis of free/total prostate-specific analysis ratio, age-specific reference ranges, and PSA density. Urology 46: , Speights Jr VO, Brawn PN, Foster DM, et al: Evaluation of age-specific normal ranges for prostate-specific antigen. Urology 45: , Mettlin C, Littrup PJ, Kane RA, et al: Relative sensitivity and specificity of serum prostate specific antigen (PSA) level compared with age-referenced PSA, PSA density, and PSA change. Cancer 74: , Weichert-Jacobsen K, Tilmann L: Clinical significance of prostate specific antigen age-specific reference ranges. J Urol 153:465A, Abstract. Page 10 of 11

11 47. Borer JG, Sherman J, Solomon MC, et al: Age-specific reference ranges for prostate specific antigen and digital rectal examination may not safely eliminate further diagnostic procedures. J Urol 155:322A, Abstract. 48. Catalona WJ, Hudson MA, Scardino PT, et al: Selection of optimal prostate specific antigen cutoffs for early detection of prostate cancer: Receiver operating characteristic curves. J Urol 152: , Catalona WJ, Smith DS: Comparison of different serum prostate specific antigen measures for early prostate cancer detection (editorial). Cancer 74: , Catalona WJ: What to do when the PSA is 'abnormal.' Proceedings from the American Urological Association Meeting, Orlando, Florida, May 6, Fleming C, Barry MJ, Oesterling JE: Prostate-specific antigen (PSA) age-specific reference ranges versus a single threshold: Is the best answer to bypass PSA and biopsy everyone (abstract)? J Urol 155:452A, Petteway J, Brawer MK: Age specific vs 4.0 ng/ml as a PSA cutoff in the screening population: Impact on cancer detection (abstract). J Urol 153:465A, Myrtle JF, Klimley PG, Ivor LP, et al: Clinical utility of prostate specific antigen (PSA) in the management of prostate cancer, in Advances in Cancer Diagnostics. San Diego, Hybritech, Inc., Meshref AW, Bazinet M, Trudel C, et al: Role of prostate-specific antigen density after applying age-specific prostate-specific antigen reference ranges. Urology 45: , Pearson JD, Carter HB, Metter EJ, et al: Sensitivity and specificity of age-specific reference ranges for PSA velocity (abstract). J Urol 153:465A, Anderson JR, Strickland D, Corbin D, et al: Age-specific reference ranges for serum prostate-specific antigen. Urology 46:54-57, Nadler RB, Humphrey PA, Smith DS, et al: Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 154: , Source URL: Links: [1] [2] Page 11 of 11

Although the test that measures total prostate-specific antigen (PSA) has been

Although the test that measures total prostate-specific antigen (PSA) has been ORIGINAL ARTICLE STEPHEN LIEBERMAN, MD Chief of Urology Kaiser Permanente Northwest Region Clackamas, OR Effective Clinical Practice. 1999;2:266 271 Can Percent Free Prostate-Specific Antigen Reduce the

More information

Elevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017

Elevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Elevated PSA Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Issues we will cover today.. The measurement of PSA,

More information

Prostate Cancer Screening Guidelines in 2017

Prostate Cancer Screening Guidelines in 2017 Prostate Cancer Screening Guidelines in 2017 Pocharapong Jenjitranant, M.D. Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital Prostate Specific Antigen (PSA) Prostate

More information

Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate volume matter?

Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate volume matter? ORIGINAL ARTICLE Gulhane Med J 2018;60: 14-18 Gülhane Faculty of Medicine 2018 doi: 10.26657/gulhane.00010 Contribution of prostate-specific antigen density in the prediction of prostate cancer: Does prostate

More information

Age-specific reference ranges for prostate-specific antigen (PSA) in Jordanian patients

Age-specific reference ranges for prostate-specific antigen (PSA) in Jordanian patients (2003) 6, 256 260 & 2003 Nature Publishing Group All rights reserved 1365-7852/03 $25.00 www.nature.com/pcan Age-specific reference ranges for prostate-specific antigen (PSA) in Jordanian patients 1, *

More information

Enzyme Immunoassay for the Quantitative Determination of Free Prostate Specific Antigen (f-psa) in Human Serum

Enzyme Immunoassay for the Quantitative Determination of Free Prostate Specific Antigen (f-psa) in Human Serum Enzyme Immunoassay for the Quantitative Determination of Free Prostate Specific Antigen (f-psa) in Human Serum FOR RESEARCH USE ONLY Store at 2 to 8 C. PROPRIETARY AND COMMON NAMES f-psa Enzyme Immunoassay

More information

AGE-SPECIFIC REFERENCE RANGES FOR SERUM PROSTATE-SPECIFIC ANTIGEN IN BLACK MEN. The New England Journal of Medicine

AGE-SPECIFIC REFERENCE RANGES FOR SERUM PROSTATE-SPECIFIC ANTIGEN IN BLACK MEN. The New England Journal of Medicine AGE-SPECIFIC REFERENCE RANGES FOR SERUM PROSTATE-SPECIFIC ANTIGEN IN BLACK MEN TED O. MORGAN, M.D., STEVEN J. JACOBSEN, M.D., PH.D., WILLIAM F. MCCARTHY, PH.D., DEBRA J. JACOBSON, M.S., DAVID G. MCLEOD,

More information

SERUM PROSTATE SPECIFIC ANTIGEN LEVELS IN MEN WITH BENIGN PROSTATIC HYPERPLASIA AND CANCER OF PROSTATE. A. AMAYO and W.

SERUM PROSTATE SPECIFIC ANTIGEN LEVELS IN MEN WITH BENIGN PROSTATIC HYPERPLASIA AND CANCER OF PROSTATE. A. AMAYO and W. 22 EAST AFRICAN MEDICAL JOURNAL January 2004 The East African Medical Journal Vol. 81 No. 1 January 2004 SERUM PROSTATE SPECIFIC ANTIGEN LEVELS IN MEN WITH BENIGN PROSTATIC HYPERPLASIA AND CANCER OF PROSTATE.

More information

Introduction. Objective To investigate the clinical significance of the 1.13 ng/ml, P<0.001) and a lower free-to-total PSA

Introduction. Objective To investigate the clinical significance of the 1.13 ng/ml, P<0.001) and a lower free-to-total PSA British Journal of Urology (1998), 81, 532 538 Free-to-total prostate-specific antigen (PSA) ratio improves the specificity for detecting prostate cancer in patients with prostatism and intermediate PSA

More information

NIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1.

NIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1. NIH Public Access Author Manuscript Published in final edited form as: World J Urol. 2011 February ; 29(1): 11 14. doi:10.1007/s00345-010-0625-4. Significance of preoperative PSA velocity in men with low

More information

Evaluation of Prostate Specific Antigen as a Tumor Marker in Cancer Prostate

Evaluation of Prostate Specific Antigen as a Tumor Marker in Cancer Prostate Evaluation of Prostate Specific Antigen as a Tumor Marker in Cancer Prostate Pages with reference to book, From 360 To 363 Farkhanda Ghafoor,Shahzad Khan,Bilquis Suleman,Aman Ullah Khan ( Departments of

More information

Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer {

Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer { Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer { (2003) 6, 39 44 ß 2003 Nature Publishing Group All rights reserved 1365 7852/03 $25.00 www.nature.com/pcan

More information

KEY WORDS : Total Prostate Specific Antigen, Prostatic Acid Phosphatase, Benign Prostatic Hyperplasia, Prostate Cancer, and Sudanese.

KEY WORDS : Total Prostate Specific Antigen, Prostatic Acid Phosphatase, Benign Prostatic Hyperplasia, Prostate Cancer, and Sudanese. International Journal of Pharmaceutical Science Invention ISSN (Online): 2319 6718, ISSN (Print): 2319 670X Volume 3 Issue 1 January 2014 PP.36-40 Serum Total Prostatic Specific Antigen and Prostatic Acid

More information

Subject Review. Prostate-Specific Antigen: Critical Issues for the Practicing Physician

Subject Review. Prostate-Specific Antigen: Critical Issues for the Practicing Physician Subject Review Prostate-Specific Antigen: Critical Issues for the Practicing Physician HERBERT C. RUCKLE, M.D.,* GEORGE G. KLEE, M.D., PH.D., AND JOSEPH E. OESTERLING, M.D. Background: Serum prostate-specific

More information

Use of the Percentage of Free Prostate-Specific Antigen to Enhance Differentiation of Prostate Cancer From Benign Prostatic Disease

Use of the Percentage of Free Prostate-Specific Antigen to Enhance Differentiation of Prostate Cancer From Benign Prostatic Disease Use of the Percentage of Free Prostate-Specific Antigen to Enhance Differentiation of Prostate From Benign Prostatic Disease A Prospective Multicenter Clinical Trial William J. Catalona, MD; Alan W. Partin,

More information

Subject Review. Percent Free Prostate-Specific Antigen: Entering a New Era in the Detection of Prostate Cancer

Subject Review. Percent Free Prostate-Specific Antigen: Entering a New Era in the Detection of Prostate Cancer Subject Review Percent Free Prostate-Specific Antigen: Entering a New Era in the Detection of Prostate Cancer ApOORVA R. VASHI, M.D., AND JOSEPH E. OESTERLING, M.D. The introduction of prostate-specific

More information

Utility of free/total prostate specific antigen (f/t PSA) ratio in diagnosis of prostate carcinoma

Utility of free/total prostate specific antigen (f/t PSA) ratio in diagnosis of prostate carcinoma Disease Markers 19 (2003,2004) 287 292 287 IOS Press Utility of free/total prostate specific antigen (f/t PSA) ratio in diagnosis of prostate carcinoma V. Thakur a,, P.P. Singh b, M. Talwar c and U. Mukherjee

More information

THE SIGNIFICANCE OF HYPOECHOIC LESION DIRECTED AND TRANSITION ZONE BIOPSIES IN IMPROVING THE DIAGNOSTIC ABILITY IN PROSTATE CANCER

THE SIGNIFICANCE OF HYPOECHOIC LESION DIRECTED AND TRANSITION ZONE BIOPSIES IN IMPROVING THE DIAGNOSTIC ABILITY IN PROSTATE CANCER Clinical Urology Brazilian Journal of Urology Official Journal of the Brazilian Society of Urology Vol. 27 (3): 222-226, May - June, 2001 THE SIGNIFICANCE OF HYPOECHOIC LESION DIRECTED AND TRANSITION ZONE

More information

Clinical Use of Tumor Markers Based on Outcome Analysis

Clinical Use of Tumor Markers Based on Outcome Analysis CE UPDATE TUMOR MARKERS I Douglas C. Aziz, MD, PhD Does the test result change the way the clinician ABSTRACT Tumor markers are substances found in the thinks about the patient? serum or urine that can

More information

BPH & Male LUTS INJ 2010;14:

BPH & Male LUTS INJ 2010;14: BPH & Male LUTS INJ 2010;14:100-104 Changes in Serum Prostate-Specific Antigen after Treatment with Antibiotics in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia with Prostatitis

More information

Table 1. Descriptive characteristics, total prostate-specific antigen, and percentage of free/total prostate-specific antigen distribution Age Groups

Table 1. Descriptive characteristics, total prostate-specific antigen, and percentage of free/total prostate-specific antigen distribution Age Groups Oncology Population-based Analysis of Normal Total PSA and Percentage of Free/Total PSA Values: Results From Screening Cohort Umberto Capitanio, Paul Perrotte, Laurent Zini, Nazareno Suardi, Elie Antebi,

More information

Controversies in Prostate Cancer Screening

Controversies in Prostate Cancer Screening Controversies in Prostate Cancer Screening William J Catalona, MD Northwestern University Chicago Disclosure: Beckman Coulter, a manufacturer of PSA assays, provides research support PSA Screening Recommendations

More information

Since the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors

Since the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors 2001 Characteristics of Insignificant Clinical T1c Prostate Tumors A Contemporary Analysis Patrick J. Bastian, M.D. 1 Leslie A. Mangold, B.A., M.S. 1 Jonathan I. Epstein, M.D. 2 Alan W. Partin, M.D., Ph.D.

More information

BPH AND BEYOND. BPSA: A Novel Serum Marker for Benign Prostatic Hyperplasia Kevin M. Slawin, MD, Shahrokh Shariat, MD, Eduardo Canto, MD

BPH AND BEYOND. BPSA: A Novel Serum Marker for Benign Prostatic Hyperplasia Kevin M. Slawin, MD, Shahrokh Shariat, MD, Eduardo Canto, MD BPH AND BEYOND B: A Novel Serum Marker for Benign Prostatic Hyperplasia Kevin M. Slawin, MD, Shahrokh Shariat, MD, Eduardo Canto, MD Baylor Prostate Center, The Scott Department of Urology, Baylor College

More information

Histopathological Study of Transrectal Ultrasound Guided Biopsies of Prostate

Histopathological Study of Transrectal Ultrasound Guided Biopsies of Prostate ORIGINAL ARTICLE Histopathological Study of Transrectal Ultrasound Guided Biopsies of Prostate in Patients With Raised Serum Prostate Specific Antigen Prabha Rathour 1, Hetal Jani 2, Urvi Parikh 3, Hansa

More information

Focus on... Prostate Health Index (PHI) Proven To Outperform Traditional PSA Screening In Predicting Clinically Significant Prostate Cancer

Focus on... Prostate Health Index (PHI) Proven To Outperform Traditional PSA Screening In Predicting Clinically Significant Prostate Cancer Focus on... Prostate Health Index (PHI) Proven To Outperform Traditional PSA Screening In Predicting Clinically Significant Prostate Cancer Prostate Cancer in Ireland & Worldwide In Ireland, prostate cancer

More information

The Utility of Patient Age in Evaluating Prostate Cancer

The Utility of Patient Age in Evaluating Prostate Cancer CLINICAL CHEMISTRY Original Article The Utility of Patient Age in Evaluating Prostate Cancer HARRY T. POTEAT, MD, ScD, 1 GEORGE T. HO, MD, 2 MEI-LING TING LEE, PhD, 3 WILLIAM R. WELCH, MD, 1 KEVIN R. LOUGHLIN,

More information

Review of Clinical Manifestations of Biochemicallyadvanced Prostate Cancer Cases

Review of Clinical Manifestations of Biochemicallyadvanced Prostate Cancer Cases Original Article Review of Clinical Manifestations of Biochemicallyadvanced Prostate Cancer Cases Edmund Chiong, 1,2 Alvin Fung Wean Wong, 2 Yiong Huak Chan 3 and Chong Min Chin, 1,2 1 Department of Surgery,

More information

ISSN X (Print) Pradesh. *Corresponding author Dr. Ashish

ISSN X (Print)   Pradesh. *Corresponding author Dr. Ashish Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(8B):2886-2890 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)

More information

Determination of An Optimum Cut-off Point for % fpsa/tpsa to Improve Detection of Prostate Cancer

Determination of An Optimum Cut-off Point for % fpsa/tpsa to Improve Detection of Prostate Cancer Original Article DOI: 10.21276/APALM.1254 Determination of An Optimum Cut-off Point for % fpsa/tpsa to Improve Detection of Prostate Cancer Vineeth* G Nair and M. H. Shariff Department of Pathology, Yenepoya

More information

The In uence of Prostate Volume on Prostate Cancer Detection

The In uence of Prostate Volume on Prostate Cancer Detection European Urology Supplements European Urology Supplements 1 (2002) 35±39 The In uence of Prostate Volume on Prostate Cancer Detection Michael K. Brawer * Northwest Prostate Institute, Seattle, USA Abstract

More information

Distribution of prostate specific antigen (PSA) and percentage free PSA in a contemporary screening cohort with no evidence of prostate cancer

Distribution of prostate specific antigen (PSA) and percentage free PSA in a contemporary screening cohort with no evidence of prostate cancer Urological Oncology CHUN et al. Distribution of prostate specific antigen (PSA) and percentage free PSA in a contemporary screening cohort with no evidence of prostate cancer Felix K.-H. Chun, Georg C.

More information

Original Article - Urological Oncology. Ho Gyun Park 1, Oh Seok Ko 1, Young Gon Kim 1, Jong Kwan Park 1-4

Original Article - Urological Oncology. Ho Gyun Park 1, Oh Seok Ko 1, Young Gon Kim 1, Jong Kwan Park 1-4 www.kjurology.org http://dx.doi.org/10.4111/kju.2014.55.4.249 Original Article - Urological Oncology http://crossmark.crossref.org/dialog/?doi=10.4111/kju.2014.55.4.249&domain=pdf&date_stamp=2014-04-17

More information

The Prostate Cancer Detection Rate on the Second Prostate Biopsy according to Prostate-Specific Antigen Trend

The Prostate Cancer Detection Rate on the Second Prostate Biopsy according to Prostate-Specific Antigen Trend www.kjurology.org http://dx.doi.org/1.4111/kju.212.53.1.686 Urological Oncology The Prostate Cancer Detection Rate on the Second Prostate Biopsy according to Prostate-Specific Antigen Trend Hyung-Sang

More information

Complexed Prostate-specific Antigen for the Detection of Prostate Cancer

Complexed Prostate-specific Antigen for the Detection of Prostate Cancer Complexed Prostate-specific Antigen for the Detection of Prostate Cancer XAVIER FILELLA 1, DAVID TRUAN 2, JOAN ALCOVER 2, RAFAEL GUTIERREZ 2, RAFAEL MOLINA 1, FRANCISCA COCA 1 and ANTONIO M. BALLESTA 1

More information

Prostate Specific Antigen in a Community-Based Sample of Men Without Prostate Cancer: Correlations With Prostate Volume, Age, Body

Prostate Specific Antigen in a Community-Based Sample of Men Without Prostate Cancer: Correlations With Prostate Volume, Age, Body The Prostate 27:24 1-249 (I 995) Prostate Specific Antigen in a Community-Based Sample of Men Without Prostate Cancer: Correlations With Prostate Volume, Age, Body Mass Index, and Symptoms of Prostatism

More information

or more transrectal ultrasonography (TRUS)-guided ng/ml and 39% if it was 20.0 ng/ml. of >10 ng/ml have prostate cancer [3], many other

or more transrectal ultrasonography (TRUS)-guided ng/ml and 39% if it was 20.0 ng/ml. of >10 ng/ml have prostate cancer [3], many other BJU International (1999), 83, 34 38 Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy? G.C. DURKAN

More information

Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?

Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA? Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA? Connolly, D., Black, A., Murray, L., Nambirajan, T., Keane, P. F., & Gavin, A. (2009). Repeating an abnormal

More information

What to Do with an Abnormal PSA Test. Feinberg School of Medicine, Chicago, Illinois, USA

What to Do with an Abnormal PSA Test. Feinberg School of Medicine, Chicago, Illinois, USA The Oncologist Genitourinary Cancer What to Do with an Abnormal PSA Test STACY LOEB, a WILLIAM J. CATALONA b a Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; b The Northwestern

More information

Role of Prostate-Specific Antigen Change Ratio at Initial Biopsy as a Novel Decision-Making Marker for Repeat Prostate Biopsy

Role of Prostate-Specific Antigen Change Ratio at Initial Biopsy as a Novel Decision-Making Marker for Repeat Prostate Biopsy www.kjurology.org http://dx.doi.org/10.4111/kju.2012.53..46 Urological Oncology Role of Prostate-Specific Antigen Change Ratio at Initial Biopsy as a Novel Decision-Making Marker for Repeat Prostate Biopsy

More information

Supplemental Information

Supplemental Information Supplemental Information Prediction of Prostate Cancer Recurrence using Quantitative Phase Imaging Shamira Sridharan 1, Virgilia Macias 2, Krishnarao Tangella 3, André Kajdacsy-Balla 2 and Gabriel Popescu

More information

PSA screening. To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine

PSA screening. To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine PSA screening To screen or not to screen, that s the question Walid Shahrour FRCSC, MDCM, BSc Assistant professor Northern Ontario School of Medicine Conflict of Interest Declaration: Nothing to Disclose

More information

The Prostate Specific-Antigen (PSA):

The Prostate Specific-Antigen (PSA): The Prostate Specific-Antigen (PSA): Why it could not detect prostate cancer reliably in the past and How it became a sensitive and specific tumor marker Hans H. Glaettli, dipl. Phys. ETH 0. Summary PSA

More information

Clinical audit. symptoms in general practice. An audit of prostate-specific antigen and clinical

Clinical audit. symptoms in general practice. An audit of prostate-specific antigen and clinical Postgrad MedJ 1998;74:28-32 c The Fellowship of Postgraduate Medicine, 1998 Clinical audit An audit of prostate-specific antigen and clinical symptoms in general practice S Ramachandran, MC Foster, DR

More information

Preoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy

Preoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy JBUON 2013; 18(4): 954-960 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Gleason score, percent of positive prostate and PSA in predicting biochemical

More information

Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer

Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Original Article Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Sunai Leewansangtong, Suchai Soontrapa, Chaiyong Nualyong, Sittiporn Srinualnad, Tawatchai Taweemonkongsap and Teerapon

More information

Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30,

Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 158-163 Original Research Article Correlation of serum free prostate-specific antigen level with histological findings in patients

More information

MODULE 8: PROSTATE CANCER: SCREENING & MANAGEMENT

MODULE 8: PROSTATE CANCER: SCREENING & MANAGEMENT MODULE 8: PROSTATE CANCER: SCREENING & MANAGEMENT KEYWORDS: Prostate cancer, PSA, Screening, Radical Prostatectomy LEARNING OBJECTIVES At the end of this clerkship, the medical student will be able to:

More information

Clinical Significance of Measuring Prostate- Specific Antigen

Clinical Significance of Measuring Prostate- Specific Antigen Clinical Significance of Measuring Prostate- Specific Antigen Borros M. Arneth, MS, MD (Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Mainz, Mainz, Germany) DOI:

More information

Ambulatory and Office Urology Optimal Measure of PSA Kinetics to Identify Prostate Cancer

Ambulatory and Office Urology Optimal Measure of PSA Kinetics to Identify Prostate Cancer Ambulatory and Office Urology Optimal Measure of PSA Kinetics to Identify Prostate Cancer Luigi Benecchi, Anna Maria Pieri, Carmelo Destro Pastizzaro, and Michele Potenzoni OBJECTIVES METHODS RESULTS CONCLUSIONS

More information

Prostate-Specific Antigen Testing of Older Men

Prostate-Specific Antigen Testing of Older Men Prostate-Specific Antigen Testing of Older Men H. Ballentine Carter, Patricia K. Landis, E. Jeffrey Metter, Lee A. Fleisher, Jay D. Pearson Background: Elevated serum prostate-specific antigen (PSA) levels

More information

Developing a new score system for patients with PSA ranging from 4 to 20 ng/ ml to improve the accuracy of PCa detection

Developing a new score system for patients with PSA ranging from 4 to 20 ng/ ml to improve the accuracy of PCa detection DOI 10.1186/s40064-016-3176-3 RESEARCH Open Access Developing a new score system for patients with PSA ranging from 4 to 20 ng/ ml to improve the accuracy of PCa detection Yuxiao Zheng, Yuan Huang, Gong

More information

Increasing Awareness, Diagnosis, and Treatment of BPH, LUTS, and EP

Increasing Awareness, Diagnosis, and Treatment of BPH, LUTS, and EP Introduction to Enlarged Prostate E. David Crawford, MD Professor of Surgery (Urology) and Radiation Oncology Head, Urologic Oncology E. David Crawford Endowed Chair in Urologic Oncology University of

More information

Screening for Prostate Cancer Using Prostate-specific Antigen Alone asafirst-linecheckupparameter:resultsofthehealthcheckup System

Screening for Prostate Cancer Using Prostate-specific Antigen Alone asafirst-linecheckupparameter:resultsofthehealthcheckup System Jpn J Clin Oncol 2000;30(2)95 100 Screening for Prostate Cancer Using Prostate-specific Antigen Alone asafirst-linecheckupparameter:resultsofthehealthcheckup System Katsunori Uchida 1, Hitoshi Takeshima

More information

Some prostatic diseases

Some prostatic diseases Some prostatic diseases Benign Prostatic Hyperplasia (Nodular Hyperplasia) Extremely common Present in a significant number of men by the age of 40 & its frequency rises progressively with age, reaching

More information

(2015) : 85 (5) ISSN

(2015) : 85 (5) ISSN Boniol, Mathieu and Autier, Philippe and Perrin, Paul and Boyle, Peter (2015) Variation of prostate-specific antigen value in men and risk of high-grade prostate vancer : analysis of the prostate, lung,

More information

10/2/2018 OBJECTIVES PROSTATE HEALTH BACKGROUND THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION

10/2/2018 OBJECTIVES PROSTATE HEALTH BACKGROUND THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION Lenette Walters, MS, MT(ASCP) Medical Affairs Manager Beckman Coulter, Inc. *phi is a calculation using the values from PSA, fpsa and p2psa

More information

PSA Levels and the Probability ofprostate Cancer on Biopsy

PSA Levels and the Probability ofprostate Cancer on Biopsy European Urology Supplements European Urology Supplements 1 (2002) 21±27 PSA Levels and the Probability ofprostate Cancer on Biopsy Matthew B. Gretzer *, Alan W. Partin Department of Urology, The James

More information

SERUM TOTAL prostate-specific antigen (PSA) concentrations

SERUM TOTAL prostate-specific antigen (PSA) concentrations 0021-972X/00/$03.00/0 Vol. 85, No. 3 The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A. Copyright 2000 by The Endocrine Society Heritability of Prostate-Specific Antigen and Relationship

More information

Age-specific reference levels of serum prostate-specific antigen and prostate volume in healthy Arab men

Age-specific reference levels of serum prostate-specific antigen and prostate volume in healthy Arab men Original Article KEHINDE et al. Age-specific reference levels of serum prostate-specific antigen and prostate volume in healthy Arab men ELIJAH O. KEHINDE, OLUSEGUN A. MOJIMINIYI*, MEHRAJ SHEIKH, KALEEL

More information

APPENDIX. Studies of Prostate-Specific Antigen for Prostate Cancer Screening and Early Detection

APPENDIX. Studies of Prostate-Specific Antigen for Prostate Cancer Screening and Early Detection APPENDIX D Studies of Prostate-Specific Antigen for Prostate Cancer Screening and Early Detection APPENDIX D: STUDIES OF PROSTATE SPECIFIC ANTIGEN FOR PROSTATE CANCER SCREENING AND EARLY DETECTION: RESEARCH

More information

of Nebraska - Lincoln

of Nebraska - Lincoln University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln U.S. Department of Veterans Affairs Staff Publications U.S. Department of Veterans Affairs 8-2000 Detection, Characterization,

More information

Safety and Efficacy of Combined Transrectal Ultrasound-Guided Prostate Needle Biopsy and Transurethral Resection of the Prostate

Safety and Efficacy of Combined Transrectal Ultrasound-Guided Prostate Needle Biopsy and Transurethral Resection of the Prostate www.kjurology.org DOI:10.4111/kju.2010.51.2.101 Urological Oncology Safety and Efficacy of Combined Transrectal Ultrasound-Guided Prostate Needle Biopsy and Transurethral Resection of the Prostate Jeong

More information

Asian J Androl 2005; 7 (2): DOI: /j x

Asian J Androl 2005; 7 (2): DOI: /j x Asian J Androl 5; 7 (2): 159 163 DOI: 1.1111/j.1745-7262.5.29.x. Original Article. Mass screening of prostate cancer in a Chinese population: the relationship between pathological features of prostate

More information

ORIGINAL ARTICLE. Ja Hyeon Ku 1, Kyung Chul Moon 2, Sung Yong Cho 1, Cheol Kwak 1 and Hyeon Hoe Kim 1

ORIGINAL ARTICLE. Ja Hyeon Ku 1, Kyung Chul Moon 2, Sung Yong Cho 1, Cheol Kwak 1 and Hyeon Hoe Kim 1 (2011) 13, 248 253 ß 2011 AJA, SIMM & SJTU. All rights reserved 1008-682X/11 $32.00 www.nature.com/aja ORIGINAL ARTICLE Serum prostate-specific antigen value adjusted for non-cancerous prostate tissue

More information

ORIGINAL ARTICLES P ATIE TS A D METHODS. In patients with a PSA > 50 ng/ml, where no pathology RESULTS

ORIGINAL ARTICLES P ATIE TS A D METHODS. In patients with a PSA > 50 ng/ml, where no pathology RESULTS -----.- SERUM PROSTATE-SPECIFIC ANTIGEN AS SURROGATE FOR THE HISTOLOGICAL DIAGNOSIS OF PROSTATE CANCER C F Heyns, A M audt'!, G Ahmed, H B Stopforth, G A Stellmacher, A J Visser Introduction. To determine

More information

Prostate-Specific Antigen (PSA) Test

Prostate-Specific Antigen (PSA) Test Prostate-Specific Antigen (PSA) Test What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the

More information

Questions and Answers About the Prostate-Specific Antigen (PSA) Test

Questions and Answers About the Prostate-Specific Antigen (PSA) Test CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Questions and Answers

More information

Prostate Cancer Screening: Risks and Benefits across the Ages

Prostate Cancer Screening: Risks and Benefits across the Ages Prostate Cancer Screening: Risks and Benefits across the Ages 7 th Annual Symposium on Men s Health Continuing Progress: New Gains, New Challenges June 10, 2009 Michael J. Barry, MD General Medicine Unit

More information

Screening for prostatic carcinoma: case finding is not the problem

Screening for prostatic carcinoma: case finding is not the problem Personal View Ann Clin Biochem 1997; 34: 333-338 Screening for prostatic carcinoma: case finding is not the problem M W France and C J Seneviratne From the Department ofclinical Biochemistry, Manchester

More information

Prostate specific antigen and acinar density: a new dimension, the Prostatocrit

Prostate specific antigen and acinar density: a new dimension, the Prostatocrit ORIGINAL ARTICLE Vol. 43 (2): 230-238, March - April, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0145 Prostate specific antigen and acinar density: a new dimension, the Prostatocrit Simon Robinson 1, Marc

More information

Effect of Verification Bias on Screening for Prostate Cancer by Measurement of Prostate-Specific Antigen

Effect of Verification Bias on Screening for Prostate Cancer by Measurement of Prostate-Specific Antigen The new england journal of medicine original article Effect of Verification Bias on Screening for Prostate Cancer by Measurement of Prostate-Specific Antigen Rinaa S. Punglia, M.D., M.P.H., Anthony V.

More information

Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 1

Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 1 Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 1 Review Article [1] August 01, 2002 By Alan W. Partin, MD, PhD [2], Gerald E. Hanks, MD [3], Eric A. Klein, MD [4], Judd

More information

DAFTAR KEPUSTAKAAN. Universitas Sumatera Utara

DAFTAR KEPUSTAKAAN. Universitas Sumatera Utara DAFTAR KEPUSTAKAAN Aaron Caplan: Prostate-Specific Antigen and the Early Diagnosis of Prostate Cancer: Pathology Patterns Reviews. Am J Clin Pathol 2002. Amer. Cancer Soc., Cancer Facts and Figures 2005

More information

MRI in the Enhanced Detection of Prostate Cancer: What Urologists Need to Know

MRI in the Enhanced Detection of Prostate Cancer: What Urologists Need to Know MRI in the Enhanced Detection of Prostate Cancer: What Urologists Need to Know Michael S. Cookson, MD, FACS Professor and Chair Department of Urology Director of Prostate and Urologic Oncology University

More information

Urological Society of Australia and New Zealand PSA Testing Policy 2009

Urological Society of Australia and New Zealand PSA Testing Policy 2009 Executive summary Urological Society of Australia and New Zealand PSA Testing Policy 2009 1. Prostate cancer is a major health problem and is the second leading cause of male cancer deaths in Australia

More information

Does normalizing PSA after successful treatment of chronic prostatitis with high PSA value exclude prostatic biopsy?

Does normalizing PSA after successful treatment of chronic prostatitis with high PSA value exclude prostatic biopsy? Original Article Does normalizing PSA after successful treatment of chronic prostatitis with high PSA value exclude prostatic biopsy? Sherif Azab 1, Ayman Osama 2, Mona Rafaat 3 1 Urology Department, Faculty

More information

CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM

CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM RAPID COMMUNICATION CME ARTICLE CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM ALAN W. PARTIN, LESLIE A. MANGOLD, DANA M. LAMM, PATRICK C. WALSH, JONATHAN

More information

Prostate-Specific Antigen in 2006: Effective Use in Benign Prostatic Hyperplasia and Prostate Cancer

Prostate-Specific Antigen in 2006: Effective Use in Benign Prostatic Hyperplasia and Prostate Cancer Volume 1, Number 3 ISSN: 1932-9245 Weill Medical College of Cornell University Reports on Men s Urologic Health 1 Editor: Steven A. Kaplan, MD, Professor of Urology, and Chief, Institute for Bladder and

More information

Title: The Use of Prostate-Specific Antigen in Prostate Cancer Diagnostics

Title: The Use of Prostate-Specific Antigen in Prostate Cancer Diagnostics Title: The Use of Prostate-Specific Antigen in Prostate Cancer Diagnostics Introduction: Prostate-specific antigen (PSA) is a serine protease produced in the prostate and secreted into ejaculate and blood.

More information

INTEROBSERVER VARIATION OF PROSTATIC VOLUME ESTIMATION WITH DIGITAL RECTAL EXAMINATION BY UROLOGICAL STAFFS WITH DIFFERENT EXPERIENCES

INTEROBSERVER VARIATION OF PROSTATIC VOLUME ESTIMATION WITH DIGITAL RECTAL EXAMINATION BY UROLOGICAL STAFFS WITH DIFFERENT EXPERIENCES Clinical Urology International Braz J Urol Official Journal of the Brazilian Society of Urology DIGITAL RECTAL EXAMINATION BY UROLOGICAL STAFFS Vol. 30 (6): 466-471, November - December, 2004 INTEROBSERVER

More information

PSA Screening and Prostate Cancer. Rishi Modh, MD

PSA Screening and Prostate Cancer. Rishi Modh, MD PSA Screening and Prostate Cancer Rishi Modh, MD ABOUT ME From Tampa Bay Went to Berkeley Prep University of Miami for Undergraduate - 4 years University of Miami for Medical School - 4 Years University

More information

Implications of Prostate Specific Antigen and its Molecular Derivatives in the Management of Carcinoma Prostate

Implications of Prostate Specific Antigen and its Molecular Derivatives in the Management of Carcinoma Prostate Review Article DOI: 10.17354/ijss/2015/327 Implications of Prostate Specific Antigen and its Molecular Derivatives in the Management of Carcinoma Prostate Sujan Narayan Agrawal 1, Chanjiv Singh 2, Sanwal

More information

european urology 55 (2009)

european urology 55 (2009) european urology 55 (2009) 385 393 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Is Prostate-Specific Antigen Velocity Selective for Clinically Significant

More information

Original Article. Introduction. Xin LIU 1, *Jie TANG 2, Xiang FEI 2, Qiu-Yang LI 2

Original Article. Introduction. Xin LIU 1, *Jie TANG 2, Xiang FEI 2, Qiu-Yang LI 2 Original Article Prostate-specific Antigen (PSA) Density and Free to Total PSA Ratio in Diagnosing Prostate Cancer with Prostate-Specific Antigen Levels of 4.0 ng/ml or Less Xin LIU 1, *Jie TANG 2, Xiang

More information

Age Specific Reference Levels of Serum. Volume and Prostate Specific Antigen. Density in Healthy Iranian Men

Age Specific Reference Levels of Serum. Volume and Prostate Specific Antigen. Density in Healthy Iranian Men ISSN 1735-1383 Iran. J. Immunol. March 2009, 6 (1), 40-48 Abdol Aziz Khezri, Mehdi Shirazi, Seyyed Mohammad Taghi Ayatollahi, Mehrzad Lotfi, Mehrdad Askarian, Ali Ariafar, Mohammad Amin Afrasiabi Age Specific

More information

Physical activity releases prostate-specific antigen (PSA) from the prostate gland into blood and increases serum PSA concentrations

Physical activity releases prostate-specific antigen (PSA) from the prostate gland into blood and increases serum PSA concentrations linicalhemistiy 42:5 691-695 (1996) Physical activity releases prostate-specific antigen (PSA) from the prostate gland into blood and increases serum PSA concentrations GERHARD M. OREMEK and ULRIH B. SEIFFERT*

More information

Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series

Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series E. Z. Neulander 1, Z. Wajsman 2 1 Department of Urology, Soroka UMC, Ben Gurion University,

More information

Is Prostate Biopsy Essential to Diagnose Prostate Cancer in the Older Patient with Extremely High Prostate-Specific Antigen?

Is Prostate Biopsy Essential to Diagnose Prostate Cancer in the Older Patient with Extremely High Prostate-Specific Antigen? www.kjurology.org http://dx.doi.org/1.4111/kju.1.3..8 Urological Oncology Is Prostate Biopsy Essential to Diagnose Prostate Cancer in the Older Patient with Extremely High Prostate-Specific Antigen? Jee

More information

THE UROLOGY GROUP

THE UROLOGY GROUP THE UROLOGY GROUP www.urologygroupvirginia.com 1860 Town Center Drive Suite 150/160 Reston, VA 20190 703-480-0220 19415 Deerfield Avenue Suite 112 Leesburg, VA 20176 703-724-1195 224-D Cornwall Street,

More information

The role of prostate specific antigen measurement in the detection and management of prostate cancer

The role of prostate specific antigen measurement in the detection and management of prostate cancer The role of prostate specific antigen measurement in the detection and management of prostate cancer A F Nash and I Melezinek Medical Research Department, AstraZeneca, Alderley Park, Macclesfield, Cheshire

More information

Fellow GU Lecture Series, Prostate Cancer. Asit Paul, MD, PhD 02/20/2018

Fellow GU Lecture Series, Prostate Cancer. Asit Paul, MD, PhD 02/20/2018 Fellow GU Lecture Series, 2018 Prostate Cancer Asit Paul, MD, PhD 02/20/2018 Disease Burden Screening Risk assessment Treatment Global Burden of Prostate Cancer Prostate cancer ranked 13 th among cancer

More information

Cancer. Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Original Policy Date: September 9, 2011 Subject:

Cancer. Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Original Policy Date: September 9, 2011 Subject: Subject: Saturation Biopsy for Diagnosis, Last Review Status/Date: September 2016 Page: 1 of 9 Saturation Biopsy for Diagnosis, Description Saturation biopsy of the prostate, in which more cores are obtained

More information

Section Editors Robert H Fletcher, MD, MSc Michael P O'Leary, MD, MPH

Section Editors Robert H Fletcher, MD, MSc Michael P O'Leary, MD, MPH 1 de 32 04-05-2013 19:24 Official reprint from UpToDate www.uptodate.com 2013 UpToDate Author Richard M Hoffman, MD, MPH Disclosures Section Editors Robert H Fletcher, MD, MSc Michael P O'Leary, MD, MPH

More information

Prostate cancer screening: a wobble Balance. Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph

Prostate cancer screening: a wobble Balance. Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph Prostate cancer screening: a wobble Balance Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph Epidemiology Most common non skin malignancy in men in developed countries Third leading

More information

How to detect and investigate Prostate Cancer before TRT

How to detect and investigate Prostate Cancer before TRT How to detect and investigate Prostate Cancer before TRT Frans M.J. Debruyne Professor of Urology Andros Men s Health Institutes, The Netherlands Bruges, 25-26 September 2014 PRISM Recommendations for

More information

Oncology: Prostate/Testis/Penis/Urethra

Oncology: Prostate/Testis/Penis/Urethra 0022-5347/04/1724-1297/0 Vol. 172, 1297 1301, October 2004 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2004 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000139993.51181.5d Oncology: Prostate/Testis/Penis/Urethra

More information

PROSTATE BIOPSY: IS AGE IMPORTANT FOR DETERMINING THE PATHOLOGICAL FEATURES IN PROSTATE CANCER?

PROSTATE BIOPSY: IS AGE IMPORTANT FOR DETERMINING THE PATHOLOGICAL FEATURES IN PROSTATE CANCER? Clinical Urology International Braz J Urol Official Journal of the Brazilian Society of Urology AGE AND PATHOLOGY OF PROSTATE CA Vol. 31 (4): 331-337, July - August, 2005 PROSTATE BIOPSY: IS AGE IMPORTANT

More information

Department of Biochemistry, Nizam s Institute of Medical Sciences, Punjagutta, Hyderabad.

Department of Biochemistry, Nizam s Institute of Medical Sciences, Punjagutta, Hyderabad. RACIAL AND ETHNIC VARIATION OF PSA IN GLOBAL POPULATION: AGE SPECIFIC REFERENCE INTERVALS FOR SERUM PROSTATE SPECIFIC ANTIGEN IN HEALTHY SOUTH INDIAN MALES T.Malati and G.Rajani Kumari Department of Biochemistry,

More information