What to Do with an Abnormal PSA Test. Feinberg School of Medicine, Chicago, Illinois, USA
|
|
- Jack Lynch
- 5 years ago
- Views:
Transcription
1 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 Feinberg School of Medicine, Chicago, Illinois, USA Key Words. Prostate cancer Prostate-specific antigen PSA Screening Detection Prognosis Disclosure: W.C. has received PSA kits at cost and participated in scientific studies with Beckman Coulter (Fullerton, CA). No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article. LEARNING OBJECTIVES After completing this course, the reader will be able to: 1. Take advantage of the use of total PSA thresholds for predicting prostate cancer risk and determining the need for prostate biopsy. 2. Distinguish prostate cancer from benign conditions based on the relative proportions of complexed and free forms. 3. Use PSA density as a means to correct for the effect of prostate volume on the PSA level. 4. Explain the evolving role of PSA kinetics in the prediction of aggressive prostate cancer. 5. Perform the calculations for PSA velocity and PSA doubling time. CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit at CME.TheOncologist.com ABSTRACT For more than a decade, prostate-specific antigen (PSA) has been used for prostate cancer screening. Over the years, this screening has been continually refined, including investigation into the use of lower total PSA thresholds, PSA isoforms, and PSA kinetics. This review describes the evolution of prostate cancer screening and provides clinical insights into the informed use of PSA and its adjunctive measurements. The Oncologist 2008;13: INTRODUCTION It was estimated that there would be 218,890 new cases of and 27,050 deaths from prostate cancer in 2007 [1]. Because of its high prevalence in the adult male population, the optimal protocol for prostate cancer screening continues to be the subject of considerable research and debate. HISTORY OF PROSTATE-SPECIFIC ANTIGEN Prostate-specific antigen (PSA) is a serine protease found in the seminal coagulum that was first used by forensic scientists as a marker for human semen. In the late 1970s, the initial laboratory studies were conducted to evaluate the relationship between PSA and prostatic disease. Wang et al. [2] showed that PSA could be measured in human serum, and Stamey et al. [3] Correspondence: William J. Catalona, M.D., 675 N. Saint Clair Street, Suite , Chicago, Illinois 60611, USA. Telephone: ; Fax: ; wcatalona@nmff.org Received August 8, 2007; accepted for publication November 11, AlphaMed Press /2008/$30.00/0 doi: /theoncologist The Oncologist 2008;13:
2 300 Abnormal PSA Test subsequently reported that PSA diffused into the bloodstream from prostate cancer tissue at a 10-fold higher amount per gram of tissue than from benign prostatic tissue. However, the initial use of PSA in clinical medicine was not for prostate cancer screening but rather as a marker for recurrence after definitive treatment. In 1986, the U.S. Food and Drug Administration (FDA) approved the PSA test for this indication. It was not until the late 1980s that the first clinical studies were initiated to examine the role of PSA in prostate cancer screening. Previously, most prostate cancer cases were diagnosed either through a suspicious digital rectal examination (DRE) or as an incidental finding in the prostate chips from transurethral resection for presumed benign prostatic hyperplasia (BPH). TOTAL PSA MEASUREMENT The largest study on PSA for prostate cancer screening, led by the senior author, enrolled 36,000 men from In the first phase of the study, , a PSA level 4 ng/ml prompted further evaluation with DRE and transrectal ultrasound (TRUS), and biopsy was then recommended if either was abnormal [4]. That portion of the study clearly demonstrated that the use of PSA in conjunction with DRE performed better than DRE alone. As a result, in 1991 the study protocol was revised such that all men received both a PSA test and DRE, with abnormalities in either test leading to a recommendation for biopsy. This study ultimately showed that PSA-based screening led to cancer detection at an earlier and more curable stage [5]. Following the publication of a large multi-institutional trial [6], PSA was approved by the FDA in 1994 as an aid to the early detection of prostate cancer, using a threshold of 4 ng/ml as the upper limit of normal. Nevertheless, subsequent studies have demonstrated that a considerable proportion of men with total PSA levels 4 ng/ml have histological evidence of prostate cancer. For example, the Prostate Cancer Prevention Trial randomized 18,882 men to either finasteride or placebo for a 7-year period to evaluate the differences in prostate cancer detection between the groups [7]. According to their protocol, men who had a PSA 4 ng/ml and negative DRE on the annual screenings during the study were offered an empiric endof-study biopsy. Among men with serum PSA levels 0.5, , , , and ng/ml, prostate cancer was detected in 6.6%, 10.1%, 17.0%, 23.9%, and 26.9%, respectively. Not only is there a strong relationship between the total PSA level and the presence of prostate cancer, but the PSA level also correlates directly with prostate cancer aggressiveness. In a large radical prostatectomy series, Antenor et al. [8] reported 10-year progression-free survival rates of 88%, 80%, 76%, and 61% in men with a preoperative PSA level of , , , and 10 ng/ml, respectively. The corresponding rates of organ-confined disease were 81%, 74%, 72%, and 60%, respectively (p.0001). Thus, the PSA level at diagnosis has obvious implications for treatment with curative intent. Based upon the growing evidence that prostate cancers detected at lower total PSA levels have more favorable characteristics, the senior author lowered the PSA threshold for recommending biopsy to 2.5 ng/ml in Similarly, many other groups in the U.S. and internationally are currently using thresholds in the range of ng/ml to recommend prostate biopsy. Finally, PSA is also useful to predict future prostate cancer risk. Using long-term follow-up data from the Physician s Health Study, Gann et al. [9] showed that, compared with the reference group (baseline PSA level 1 ng/ml), men with baseline PSA levels of , , , , , and 10 ng/ml had a 2.2-, 3.4-, 5.5-, 8.6-, 22.2-, and fold higher risk for a prostate cancer diagnosis in the next 10 years [9]. In 796 men from the Baltimore Longitudinal Study on Aging, Fang et al. [10] showed that men in their 40s with a PSA level 0.6 ng/ml (the age-specific median) were significantly more likely to subsequently develop prostate cancer. Specifically, the 25- year prostate cancer free probability was 89.6% for men with a baseline PSA level 0.6 in their 40s, compared with 71.6% in men with a higher baseline PSA. Similarly, men in their 50s with a median PSA level below the age-specific median had an 83.6% 25-year prostate cancer free probability, compared with 58.9% for men who had a higher baseline PSA. In a later study, our research group showed that men in their 40s and 50s from our prostate cancer screening study with a baseline PSA level above the agespecific median had a and 7.6-fold higher risk for subsequent prostate cancer detection, respectively [11]. In light of these collective findings, some professional organizations are now recommending that all men undergo a baseline PSA measurement at age 40, which can provide useful information about their risk profile and help to individualize the subsequent screening protocol [12]. Despite these multiple applications of PSA testing, there are several problems that complicate its use in daily practice. First, PSA can also be elevated in benign prostatic conditions, limiting its specificity for prostate cancer. Even certain medications (e.g., finasteride), ejaculation, and prostate manipulation (e.g., catheterization, cystoscopy, prostatic massage) can alter PSA levels. Also, because PSA correlates closely with prostate cancer risk along the full spectrum of PSA levels, there is really
3 Loeb, Catalona 301 no threshold below which the risk for prostate cancer is zero. Thus, the determination of PSA cutpoints to be used in clinical practice has remained controversial. To further complicate matters, the initial studies on PSA used assays that were standardized to the Hybritech standard. These studies were used to establish many of the thresholds and PSA parameters that continue to be used in practice today. Nevertheless, in 1999, the Expert Committee on Biological Standardization of the World Health Organization (WHO) introduced alternate reference material for PSA (the so-called 96/670 standard material). Today, about half of the commercially available PSA tests are standardized to Hybritech and the other half to the WHO standard. Yet the PSA results are approximately 23% different between the two [13, 14]. Patients and physicians are largely unaware of which PSA standard has been used when interpreting individual measurements, and the effect that this may have had on clinical outcomes is unknown. Certainly greater awareness of this issue and the use of the same assay on a serial basis could help prevent such problems. As a result of these difficulties, numerous variations on the PSA measurement have evolved to further enhance its utility for the prediction of prostate cancer risk and prognostication. These adjunctive measures are described in the sections to follow. FREE PSA PSA circulates in the bloodstream in several different forms, and the relative proportion of these forms is highly variable. In general, PSA can bind to natural substrates like -1-antichymotrypsin (complexed PSA) or circulate in unbound (free) forms [15]. For more than a decade, the proportion of PSA circulating in the free form (percent free PSA) has been used to help distinguish BPH from prostate cancer. For example, a large multi-institutional study showed that 56% of men with 10% free PSA had prostate cancer, compared with only 8% of men with 25% free PSA [16]. Free PSA was approved by the FDA in 1998 as an aid to prostate cancer detection in men with total PSA levels of 4 10 ng/ml and is usually reported together with the total PSA level to help guide clinicians as to what is causing the PSA elevation. More recently, the use of free PSA has been further refined by the discovery that it is actually comprised of three different isoforms. Two forms B (BPH- PSA) and i (inactive-psa) appear to be relatively greater with BPH [17], while proenzyme (pro-psa) isoforms are found in a greater proportion in men with prostate cancer. For example, Sokoll et al. [18] reported that, in men with total PSA levels of ng/ml, the percentage of pro-psa was 50.1% in men with prostate cancer versus 35.5% in men with a negative prostate biopsy. A higher percentage of pro- PSA also has been associated with a higher risk for prostate cancer in men with total PSA levels of ng/ml [19]. Finally, there is preliminary evidence that a higher proportion of pro-psa may be associated with higher Gleason grade and a greater likelihood of extracapsular tumor extension [20]. Additional studies are needed to further elucidate the role of these PSA isoforms in prostate cancer screening and management. PSA DENSITY Because PSA is produced by prostatic epithelial cells, it makes sense that larger prostate glands produce more PSA. Thus, an evaluation of the PSA level in relation to the size of the prostate is another useful way to differentiate prostate cancer from benign enlargement. To calculate PSA density (PSAD), the PSA level is simply divided by the prostate volume, typically measured by TRUS. Benson et al. [21, 22] reported that the mean PSAD was significantly higher in men with prostate cancer than in those with BPH (0.581 versus 0.044, respectively; p.002). One difficulty with the use of PSAD is that prostate volume assessment by DRE is particularly unreliable [23], necessitating the use of ultrasonography. Because ultrasonography is more invasive than a simple serologic test, it is typically performed only at the time of prostate biopsy, and therefore may be less useful in determining the need for prostate biopsy. This notwithstanding, among men with a positive prostate biopsy, PSAD is useful for prognostication. In a multi-institutional trial of 773 men treated with radical prostatectomy, 74% of men with a preoperative PSAD 0.15 had favorable pathology compared with only 36% of men with a higher PSAD [16]. Thus, PSAD is now among the parameters being used as a surrogate marker for prostate cancer aggressiveness to help determine whether active surveillance is a reasonable strategy for men with otherwise low-risk, low-volume prostate cancer [24]. PSA KINETICS An increasingly popular way to use the total PSA measurement is by evaluating changes over time. Indeed, a rapidly rising PSA is significantly more likely to occur with prostate cancer than with BPH. One way to express longitudinal PSA trends is called PSA velocity (PSAV). A simplified equation for PSAV is: (PSA2 PSA1) (time elapsed between measurements). However, some experts believe that it is most reliable when at least three component PSA measurements are used in the calculation, to help reduce background variability resulting from short-term physiologic PSA fluctuations. In 1992, Carter et al. [25] showed that, in men with PSA
4 302 Abnormal PSA Test levels of 4 10 ng/ml, a PSAV 0.75 ng/ml per year was a significant predictor of prostate cancer. However, the majority of men have total PSA levels 4 ng/ml, and the annual PSA changes in men with BPH are actually very small ( 0.1 ng/ml per year). Furthermore, Carter and colleagues recently reported that men with a PSAV 0.35 ng/ml per year many years prior to diagnosis were significantly more likely to die from prostate cancer over a decade later [26]. Several other research groups have also suggested that a PSAV threshold of approximately 0.4 ng/ml per year is useful for early prostate cancer detection in conjunction with the total PSA level, particularly in young men [27, 28]. As a result of these studies, in its 2007 guidelines the National Comprehensive Cancer Network may recommend that men with a PSA level 2.5 ng/ml should undergo prostate biopsy if their PSAV exceeds 0.35 ng/ml per year to aid in the detection of curable disease [12]. On the other end of the spectrum, men with a PSAV 2 ng/ml per year in the year prior to diagnosis have a significantly higher prostate cancer specific mortality rate after both radiation therapy and radical prostatectomy [29, 30]. Thus, PSAV appears to be a surrogate marker for prostate cancer aggressiveness. An alternate way to describe PSA kinetics is the PSA doubling time (PSADT). This can be calculated by the formula: [log (2) dt] [log PSA2 log PSA1]. For many years, PSADT has been used in the setting of biochemical recurrence after prostate cancer treatment. Pound et al. [31] showed that a postoperative PSADT 10 months was significantly associated with metastatic disease. More recently, Freedland et al. [32] reported on 379 patients with biochemical progression after radical prostatectomy. They showed that a shorter postoperative PSADT was significantly associated with both cancer-specific and overall mortality. Moreover, men with a postoperative PSADT 15 months represented a particularly high-risk population in which prostate cancer accounted for 90% of all deaths at 15 years [32]. Some groups have attempted to instead apply PSADT in the pretreatment setting. For instance, in a large Canadian active monitoring cohort, a PSADT 3 years is considered a sign of more aggressive disease and is used to trigger intervention [33]. Nevertheless, the PSADT calculation is much simpler in recurrence after radical prostatectomy, wherein the PSA starts at zero and subsequently rises. In the pretreatment setting, men start out with very different PSA levels, and the PSADT calculation is strongly influenced by the baseline PSA level (i.e., patients who start with a higher PSA level have to have a greater increase in PSA for it to double). Overall, most clinicians are more facile with the application of PSAV among men with newly diagnosed prostate cancer. DISCUSSION Patients and physicians alike have been receiving mixed messages about the advisability of PSA-based prostate cancer screening from various professional organizations. Those that favor offering PSA screening are the American Cancer Society, the American Urological Association, and the National Comprehensive Cancer Center Network, whereas the American College of Physicians and the U.S. Preventive Services Task Force are less enthusiastic about PSA screening or feel there is insufficient evidence to recommend it. The National Cancer Institute and the Center for Communicable Diseases are fairly neutral while awaiting additional evidence. Despite these disparate recommendations, prostate cancer screening with PSA is very widespread in the U.S. Between 2001 and 2004, 50% of men 50 years old and 87% of male physicians had a PSA test [34]. PSA screening was introduced in the early 1990s, and there followed a striking increase in the incidence rates of prostate cancer, as the inventory of previously undiagnosed cases were discovered. Since then, the incidence rates have returned to lower levels but have continued to rise gradually at a level higher than before the introduction of PSA screening. The first sign of success of PSA screening was a 70% reduction in the proportion of men who presented with metastatic disease at the time of diagnosis. The prostate cancer mortality rates that had been rising steadily for decades leveled off in 1995, and from then through 2003 (the latest figures available), there has been a 32.5% reduction in the ageadjusted prostate cancer specific mortality rate [35]. Perhaps the most convincing evidence of the success of PSA screening is the report by Jemal et al. [36] examining the relationship between PSA screening and the stage of prostate cancer at diagnosis and the prostate cancer death rates in population-based regions of the U.S., representing nearly two thirds of the U.S. population. They found that, in regions where PSA testing was most prevalent, there was a correspondingly lower proportion of men that presented with metastatic disease and a lower prostate cancer mortality rate. In recent years, the question has been raised about whether PSA has fallen victim to its own success, resulting in the detection and treatment of harmless prostate cancers that would not have been detected without PSA screening nor caused suffering or death for the patient. The concerns about overdiagnosis of prostate cancer have become increasingly more resonant.
5 Loeb, Catalona 303 Figure 1. What to do with an abnormal PSA test: Clinical algorithm. Abbreviations: ASAP, atypical small acinar proliferation; DRE, digital rectal examination; PIN, prostatic intraepithelial neoplasia; PSA, prostate-specific antigen; PSAD, PSA density; PSADT, PSA doubling time; PSAV, PSA velocity. There are different ways of defining and estimating the rate of so-called overdiagnosis: (a) epidemiologic, in which the number of new cancer cases detected is compared with the expected number; and (b) clinical and pathologic, in which the features of the cancers detected are scrutinized for the parameters of clinically insignificant disease (i.e., low-volume, organ-confined, and low Gleason grade) [37]. Using epidemiologic criteria, it has been estimated that 25% 50% or more prostate cancers are overdetected [38, 39]. In contrast, using clinical and pathologic criteria, approximately 5% 30% of cancers would fit the published criteria for being harmless [37, 40 42]. The corollary of this analysis is that prostate cancer is still underdiagnosed more frequently than overdiagnosed [41, 42]. By the time of diagnosis, the cancer has spread beyond the prostate in at least 20% of patients, and 30% of patients treated for localized disease require secondary treatment for cancer recurrence. The concept of insignificant cancer is controversial, and in a young man with a long life expectancy, it is impossible to state with certainty that any cancer would remain indolent, because cancers can acquire genetic mutations and more aggressive behavior over time. Nevertheless, concerns about overdiagnosis have given rise to the concept of active monitoring rather than immediate treatment of men with possibly insignificant cancer, even in young patients [43]. Active monitoring is becoming more widespread in the U.S., although the senior author questions its wisdom in young patients. That notwithstanding, PSA testing (total PSA, percent free PSA, PSAD, and PSA kinetics) continues to play an important role in managing patients with this new approach. The challenge to physicians is to avoid both overdiagnosis and underdiagnosis, if possible. In the senior author s opinion, the informed use of PSA includes beginning PSAbased screening of men in their 40s. Baseline measurements not only screen them for prostate cancer at the moment, but also assess their future risk through comparisons of their PSA level with that of the median for their age group. PSA measurements in the 40s also provide useful longitudinal data to measure PSAV. To obtain the most benefit from serial PSA testing, both patients and their physicians should maintain a flow sheet that records the date, the PSA value, and the assay used (to evaluate for possible confounding from differences in PSA assays and standardization). Figure 1 shows an algorithm
6 304 Abnormal PSA Test for management of an abnormal PSA test. PSAD and percent free PSA may be used to estimate possible confounding from BPH. Moreover, in patients with a sudden PSA elevation, subclinical prostatitis can be ruled out with an empirical course of antibiotics and repeat PSA measurements. Finally, PSAV will help distinguish the more aggressive tumors that need to be diagnosed and treated from indolent tumors [26]. We recommend a PSAV threshold of 0.4 ng/ml per year, because this degree of PSA rise does not appear to result from biologic variability of PSA measurements, ejaculation, or prostate manipulation [28, 44]. Once prostate cancer is diagnosed, total PSA, PSAD, percent free PSA, and PSA kinetics are useful in addition to other clinicopathological information (i.e., how much cancer is present in the biopsy specimens, the Gleason score, findings on DRE, and any imaging studies, such as ultrasonography, computed tomography, magnetic resonance imaging, and spectroscopy, if available) to estimate how aggressive the cancer is likely to be. There are numerous algorithms using different combinations of these features that can help to predict the extent of disease and the likelihood of finding insignificant cancer on the radical prostatectomy specimen. For men who elect to undergo definitive treatment, the PSA level correlates with the volume of cancer present in REFERENCES 1 American Cancer Society. Cancer Facts & Figures Available at Accessed May 5, Wang MC, Valenzuela LA, Murphy GP et al. Purification of a human prostate specific antigen. Invest Urol 1979;17: Stamey TA, Yang N, Hay AR et al. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 1987;317: 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 1991; 324: Catalona WJ, Smith DS, Ratliff TL et al. Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA 1993;270: Catalona WJ, Richie JP, Ahmann FR et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men. J Urol 1994; 151: Thompson IM, Pauler DK, Goodman PJ et al. Prevalence of prostate cancer among men with a prostate-specific antigen level or 4.0 ng per milliliter. N Engl J Med 2004;350: Antenor JA, Roehl KA, Eggener SE et al. Preoperative PSA and progression-free survival after radical prostatectomy for Stage T1c disease. Urology 2005;66: Gann PH, Hennekens CH, Stampfer MJ. A prospective evaluation of approximately 90% of cases (excluding men with a very large prostate) [45]. If a patient is deemed to have potentially insignificant cancer and elects to be managed with active monitoring, PSA and its derivatives again may play an important role in determining whether the cancer is progressing (25% 50% have objective evidence of progression within 5 10 years) [33]. CONCLUSIONS PSA and its derivatives are useful predictors of prostate cancer risk and aggressiveness. With regard to screening, men with a PSA 2.5 ng/ml, a suspicious DRE, or a PSAV greater than approximately 0.4 ng/ml per year have a significantly higher risk for prostate cancer, and prostate biopsy should be considered. In terms of prognosis, a PSAD 0.15 ng/ml per gram and a PSAV 2 ng/ml per year are suggestive of more aggressive disease. These patients may not be appropriate candidates for active monitoring and have a greater risk for adverse outcomes after definitive therapy. AUTHOR CONTRIBUTIONS Conception/design: William J. Catalona, Stacy Loeb Provision of study materials or patients: William J. Catalona Collection/assembly of data: William J. Catalona, Stacy Loeb Data analysis and interpretation: William J. Catalona, Stacy Loeb Manuscript writing: Stacy Loeb Final approval of manuscript: William J. Catalona plasma prostate-specific antigen for detection of prostatic cancer. JAMA 1995;273: Fang J, Metter EJ, Landis P et al. Low levels of prostate-specific antigen predict long-term risk of prostate cancer: Results from the Baltimore Longitudinal Study of Aging. Urology 2001;58: Loeb S, Roehl KA, Antenor JA et al. Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. Urology 2006;67: National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection. Available at Accessed July 21, Link RE, Shariat SF, Nguyen CV et al. Variation in prostate specific antigen results from 2 different assay platforms: Clinical impact on 2304 patients undergoing prostate cancer screening. J Urol 2004;171: Stephan C, Klaas M, Muller C et al. Interchangeability of measurements of total and free prostate-specific antigen in serum with 5 frequently used assay combinations: An update. Clin Chem 2006;52: Lilja H, Christensson A, Dahlen U et al. Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem 1991;37: Catalona WJ, Southwick PC, Slawin KM et al. Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology 2000;56: Mikolajczyk SD, Millar LS, Wang TJ et al. BPSA, a specific molecular
7 Loeb, Catalona 305 form of free prostate-specific antigen, is found predominantly in the transition zone of patients with nodular benign prostatic hyperplasia. Urology 2000;55: Sokoll LJ, Chan DW, Mikolajczyk SD et al. Proenzyme PSA for the early detection of prostate cancer in the ng/ml total PSA range: Preliminary analysis. Urology 2003;61: Khan MA, Partin AW, Rittenhouse HG et al. Evaluation of proprostate specific antigen for early detection of prostate cancer in men with a total prostate specific antigen range of 4.0 to 10.0 ng/ml. J Urol 2003;170: Catalona WJ, Bartsch G, Rittenhouse HG et al. Serum pro-prostate specific antigen preferentially detects aggressive prostate cancers in men with 2 to 4 ng/ml prostate specific antigen. J Urol 2004;171: 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 1992;147: Benson MC, Whang IS, Pantuck A et al. Prostate specific antigen density: A means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 1992;147: Loeb S, Han M, Roehl KA et al. Accuracy of prostate weight estimation by digital rectal examination versus transrectal ultrasonography. J Urol 2005; 173: Carter HB, Walsh PC, Landis P et al. Expectant management of nonpalpable prostate cancer with curative intent: Preliminary results. J Urol 2002; 167: Carter HB, Pearson JD, Metter EJ et al. Longitudinal evaluation of prostatespecific antigen levels in men with and without prostate disease. JAMA 1992;267: Carter HB, Ferrucci L, Kettermann A et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst 2006;98: Moul JW, Sun L, Hotaling JM et al. Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening. J Urol 2007;177: ; discussion Loeb S, Roehl KA, Catalona WJ et al. Prostate specific antigen velocity threshold for predicting prostate cancer in young men. J Urol 2007;177: D Amico AV, Chen MH, Roehl KA et al. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004;351: D Amico AV, Renshaw AA, Sussman B et al. Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. JAMA 2005;294: Pound CR, Partin AW, Eisenberger MA et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: Freedland SJ, Humphreys EB, Mangold LA et al. Death in patients with recurrent prostate cancer after radical prostatectomy: Prostate-specific antigen doubling time subgroups and their associated contributions to allcause mortality. J Clin Oncol 2007;25: Zhang L, Loblaw A, Klotz L. Modeling prostate specific antigen kinetics in patients on active surveillance. J Urol 2006;176: ; discussion Chan EC, Barry MJ, Vernon SW et al. Brief report: Physicians and their personal prostate cancer-screening practices with prostate-specific antigen. A national survey. J Gen Intern Med 2006;21: National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 17 Regs Public-Use, Nov 2005 Sub ( varying), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2006, based on the November 2005 submission. Accessed August 28, Jemal A, Ward E, Wu X et al. Geographic patterns of prostate cancer mortality and variations in access to medical care in the United States. Cancer Epidemiol Biomarkers Prev 2005;14: Epstein JI, Walsh PC, Carmichael M et al. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994;271: Draisma G, Boer R, Otto SJ et al. Lead times and overdetection due to prostate-specific antigen screening: Estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003;95: Etzioni R, Penson DF, Legler JM et al. Overdiagnosis due to prostatespecific antigen screening: Lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 2002;94: Loeb S, Gonzalez CM, Roehl KA et al. Pathological characteristics of prostate cancer detected through prostate specific antigen based screening. J Urol 2006;175: Graif T, Loeb S, Roehl KA et al. Under diagnosis and over diagnosis of prostate cancer. J Urol 2007;178: Pelzer AE, Bektic J, Akkad T et al. Under diagnosis and over diagnosis of prostate cancer in a screening population with serum PSA 2 to 10 ng/ml. J Urol 2007;178:93 97; discussion Choo R, Klotz L, Danjoux C et al. Feasibility study: Watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. J Urol 2002;167: Bent S, Kane C, Shinohara K et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006;354: Catalona WJ, Loeb S. The PSA era is not over for prostate cancer. Eur Urol 2005;48:
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 informationControversies 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 informationSince 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 informationPSA Doubling Time Versus PSA Velocity to Predict High-Risk Prostate Cancer: Data from the Baltimore Longitudinal Study of Aging
european urology 54 (2008) 1073 1080 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer PSA Doubling Time Versus PSA Velocity to Predict High-Risk Prostate Cancer:
More informationAlthough 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 informationFocus 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 informationElevated 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 informationUse 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 informationProstate Cancer. Axiom. Overdetection Is A Small Issue. Reducing Morbidity and Mortality
Overdetection Is A Small Issue (in the context of decreasing prostate cancer mortality rates and with appropriate, effective, and high-quality treatment) Prostate Cancer Arises silently Dwells in a curable
More informationAssociation of [ 2]proPSA with Biopsy Reclassification During Active Surveillance for Prostate Cancer
Association of [ 2]proPSA with Biopsy Reclassification During Active Surveillance for Prostate Cancer Jeffrey J. Tosoian,*, Stacy Loeb,*, Zhaoyong Feng, Sumit Isharwal, Patricia Landis, Debra J. Elliot,
More informationProstate 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 informationProstate-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 informationBPH 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 informationContribution 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 informationProstate-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 information10/2/2018 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 informationPreoperative 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 informationPREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS
ADULT UROLOGY PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS ABRAHAM MORGENTALER AND ERNANI LUIS RHODEN ABSTRACT Objectives. To determine
More informationEarly outcomes of active surveillance for localized prostate cancer
Original Article ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER HARDIE et al. Early outcomes of active surveillance for localized prostate cancer CLAIRE HARDIE, CHRIS PARKER, ANDREW NORMAN*, ROS EELES,
More informationeuropean 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 informationUrological 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 informationRepeating 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 informationestimating risk of BCR and risk of aggressive recurrence after RP was assessed using the concordance index, c.
. JOURNAL COMPILATION 2008 BJU INTERNATIONAL Urological Oncology PREDICTION OF AGGRESSIVE RECURRENCE AFTER RP SCHROECK et al. BJUI BJU INTERNATIONAL Do nomograms predict aggressive recurrence after radical
More informationOutcomes 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 informationPROSTATE 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 informationPSA 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 informationEnzyme 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 informationCONTEMPORARY 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 informationWhen PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy
When PSA fails Urology Grand Rounds Alexandra Perks Rising PSA after Radical Prostatectomy Issues Natural History Local vs Metastatic Treatment options 1 10 000 men / year in Canada 4000 RRP 15-year PSA
More informationPCa Commentary. Executive Summary: The "PCa risk increased directly with increasing phi values."
1101 Madison Street Suite 1101 Seattle, WA 98104 P 206-215-2490 www.seattleprostate.com PCa Commentary Volume 77 September October 2012 CONTENT Page The Prostate 1 Health Index Active Surveillance 2 A
More informationDetection & Risk Stratification for Early Stage Prostate Cancer
Detection & Risk Stratification for Early Stage Prostate Cancer Andrew J. Stephenson, MD, FRCSC, FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Risk Stratification:
More informationRelationship between initial PSA density with future PSA kinetics and repeat biopsies in men with prostate cancer on active surveillance
ORIGINAL ARTICLE (2011) 14, 53 57 & 2011 Macmillan Publishers Limited All rights reserved 1365-7852/11 www.nature.com/pcan Relationship between initial PSA density with future PSA kinetics and repeat biopsies
More informationUse 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 informationPost 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 informationAUA Update Series. Lesson 33 Volume Active Surveillance for Prostate Cancer: Patient Selection and Management
AUA Update Series Lesson 33 Volume 27 2008 Active Surveillance for Prostate Cancer: Patient Selection and Management Learning Objective: At the conclusion of this continuing medical education activity,
More informationjournal of medicine The new england Preoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical Prostatectomy abstract
The new england journal of medicine established in 1812 july 8, 4 vol. 31 no. 2 Preoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical Prostatectomy Anthony V. D Amico, M.D.,
More informationPublished Ahead of Print on April 4, 2011 as /JCO J Clin Oncol by American Society of Clinical Oncology INTRODUCTION
Published Ahead of Print on April 4, 2011 as 10.1200/JCO.2010.32.8112 The latest version is at http://jco.ascopubs.org/cgi/doi/10.1200/jco.2010.32.8112 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E
More informationHistopathological findings in extended prostate biopsy with PSA 4 ng/ml
Universidade de São Paulo Biblioteca Digital da Produção Intelectual - BDPI Departamento de Cirurgia - FM/MCG Artigos e Materiais de Revistas Científicas - FM/MCG 2008 Histopathological findings in extended
More informationProstate Cancer: 2010 Guidelines Update
Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer
More informationElsevier Editorial System(tm) for European Urology Manuscript Draft
Elsevier Editorial System(tm) for European Urology Manuscript Draft Manuscript Number: EURUROL-D-13-00306 Title: Post-Prostatectomy Incontinence and Pelvic Floor Muscle Training: A Defining Problem Article
More informationOriginal 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 informationDistribution 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 informationPSA and the Future. Axel Heidenreich, Department of Urology
PSA and the Future Axel Heidenreich, Department of Urology PSA and Prostate Cancer EAU Guideline 2011 PSA is a continuous variable PSA value (ng/ml) risk of PCa, % 0 0.5 6.6 0.6 1 10.1 1.1 2 17.0 2.1 3
More informationFellow 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 informationThe Continuing Role of PSA in the Detection and Management of Prostate Cancer
european urology supplements 6 (2007) 327 333 available at www.sciencedirect.com journal homepage: www.europeanurology.com The Continuing Role of PSA in the Detection and Management of Prostate Cancer
More informationPROSTATE CANCER SURVEILLANCE
PROSTATE CANCER SURVEILLANCE ESMO Preceptorship on Prostate Cancer Singapore, 15-16 November 2017 Rosa Nadal National Cancer Institute, NIH Bethesda, USA DISCLOSURE No conflicts of interest to declare
More informationNewer Aspects of Prostate Cancer Underwriting
Newer Aspects of Prostate Cancer Underwriting Presented By: Jack Swanson, M.D. Keith Hoffman, NFP Moments Made Possible Objectives To review and discuss Conflicting messages about PSA testing Cautions
More informationSERUM 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 informationPSA 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 informationActive Surveillance with High Resolution Color-Doppler Transrectal Ultrasound Monitoring: Is it fool-proof?
Active Surveillance with High Resolution Color-Doppler Transrectal Ultrasound Monitoring: Is it fool-proof? Duke Bahn MD Prostate Institute of America, Ventura, California INTRODUCTION In the November
More informationInformation Content of Five Nomograms for Outcomes in Prostate Cancer
Anatomic Pathology / NOMOGRAMS IN PROSTATE CANCER Information Content of Five Nomograms for Outcomes in Prostate Cancer Tarek A. Bismar, MD, 1 Peter Humphrey, MD, 2 and Robin T. Vollmer, MD 3 Key Words:
More informationScreening for Prostate Cancer US Preventive Services Task Force Recommendation Statement
Clinical Review & Education JAMA US Preventive Services Task Force RECOMMENDATION STATEMENT Screening for Prostate Cancer US Preventive Services Task Force Recommendation Statement US Preventive Services
More informationProstate-Specific Antigen Best Practice Statement: 2009 Update
Prostate-Specific Antigen Best Practice Statement: 2009 Update Prostate-Specific Antigen Best Practice Statement Update Panel Members: Peter Carroll, MD, Chair Peter C. Albertsen, MD, Vice Chair Kirsten
More informationOncology: Prostate/Testis/Penis/Urethra. Prostate Specific Antigen Testing Among the Elderly When To Stop?
Oncology: Prostate/Testis/Penis/Urethra Prostate Specific Antigen Testing Among the Elderly When To Stop? Edward M. Schaeffer,*, H. Ballentine Carter, Anna Kettermann, Stacy Loeb, Luigi Ferrucci, Patricia
More informationAge-Specific Reference Ranges for PSA in the Detection of Prostate Cancer
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
More informationProstate Cancer Screening. Eric Shreve, MD Bend Urology Associates
Prostate Cancer Screening Eric Shreve, MD Bend Urology Associates University of Cincinnati Medical Center University of Iowa Hospitals and Clinics PSA Human kallikrein 3 Semenogelin is substrate Concentration
More informationAmbulatory 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 informationMR-US Fusion Guided Biopsy: Is it fulfilling expectations?
MR-US Fusion Guided Biopsy: Is it fulfilling expectations? Kenneth L. Gage MD, PhD Assistant Member Department of Diagnostic Imaging and Interventional Radiology 4 th Annual New Frontiers in Urologic Oncology
More informationUnderstanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD
Understanding the risk of recurrence after primary treatment for prostate cancer Aditya Bagrodia, MD Aditya.bagrodia@utsouthwestern.edu 423-967-5848 Outline and objectives Prostate cancer demographics
More informationIntroduction. Key Words: high-grade prostatic intraepithelial neoplasia, HGPIN, radical prostatectomy, prostate biopsy, insignificant prostate cancer
Prostate cancer after initial high-grade prostatic intraepithelial neoplasia and benign prostate biopsy Premal Patel, MD, 1 Jasmir G. Nayak, MD, 1,2 Zlatica Biljetina, MD, 4 Bryan Donnelly, MD 3, Kiril
More informationReview 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 informationDAFTAR 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 informationPROSTATE CANCER SCREENING: AN UPDATE
PROSTATE CANCER SCREENING: AN UPDATE William G. Nelson, M.D., Ph.D. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins American Association for Cancer Research William G. Nelson, M.D., Ph.D. Disclosures
More informationTHE 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 informationBPH with persistently elevated PSA 아주대학교김선일
BPH with persistently elevated PSA 아주대학교김선일 PSA in BPH: present status AUA & EAU BPH guideline: PSA: recommended test AUA practice guideline committee. J Urol 2003;170:530 Madersbacher. Eur Urol 2004;46:547
More informationProstate Cancer Incidence
Prostate Cancer: Prevention, Screening and Treatment Philip Kantoff MD Dana-Farber Cancer Institute Professor of fmedicine i Harvard Medical School Prostate Cancer Incidence # of patients 350,000 New Cases
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationDivision of Urologic Surgery and Duke Prostate Center (DPC), Duke University School of Medicine, Durham, NC
LHRH AGONISTS: CONTEMPORARY ISSUES The Evolving Definition of Advanced Prostate Cancer Judd W. Moul, MD, FACS Division of Urologic Surgery and Duke Prostate Center (DPC), Duke University School of Medicine,
More informationAlthough current American Cancer Society guidelines
ORIGINAL ARTICLE Diffuse Adenosis of the Peripheral Zone in Prostate Needle Biopsy and Prostatectomy Specimens Tamara L. Lotan, MD* and Jonathan I. Epstein, MD*w z Abstract: We have observed a group of
More informationAge-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 informationConceptual basis for active surveillance
Conceptual basis for active surveillance 1. Screening results in overdiagnosis 2. Clinically insignificant disease can be identified 3. All treatments have significant side effects and cost. 4. Delayed
More informationDoes 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 informationNIH Public Access Author Manuscript Can J Urol. Author manuscript; available in PMC 2009 September 14.
NIH Public Access Author Manuscript Published in final edited form as: Can J Urol. 2008 December ; 15(6): 4363 4374. Screening for Prostate Cancer: An Update Shahrokh F. Shariat 1, Peter T. Scardino 1,
More informationOriginal Article The implications of prostate-specific antigen density to predict clinically significant prostate cancer in men 50 years
Am J Clin Exp Urol 2014;2(4):332-336 www.ajceu.us /ISSN:2330-1910/AJCEU0002941 Original Article The implications of prostate-specific antigen density to predict clinically significant prostate cancer in
More informationClinical 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 informationHow 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 informationLong-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer
Published Ahead of Print on December 15, 1 as 1.1/JCO.1.55.119 The latest version is at http://jco.ascopubs.org/cgi/doi/1.1/jco.1.55.119 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Long-Term
More informationExpanded criteria for active surveillance in prostate cancer: a review of the current data
Review Article Expanded criteria for active surveillance in prostate cancer: a review of the current data Cameron Jones 1, Mina M. Fam 2, Benjamin J. Davies 2 1 University of Pittsburgh School of Medicine,
More informationORIGINAL 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 informationTable 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 informationCancer. 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 informationQuestions 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 informationJ Clin Oncol 25: by American Society of Clinical Oncology INTRODUCTION
VOLUME 25 NUMBER 21 JULY 20 2007 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Prediction of Prostate Cancer for Patients Receiving Finasteride: Results From the Prostate Cancer Prevention Trial
More informationQ&A. Overview. Collecting Cancer Data: Prostate. Collecting Cancer Data: Prostate 5/5/2011. NAACCR Webinar Series 1
Collecting Cancer Data: Prostate NAACCR 2010-2011 Webinar Series May 5, 2011 Q&A Please submit all questions concerning webinar content through the Q&A panel Overview NAACCR 2010-2011 Webinar Series 1
More informationThe Evolving Role of PSA for Prostate Cancer. The Evolving Role of PSA for Prostate Cancer: 10/30/2017
The Evolving Role of PSA for Prostate Cancer Adele Marie Caruso, DNP, CRNP Adult Nurse Practitioner Perelman School of Medicine at the University of Pennsylvania November 4, 2017 The Evolving Role of PSA
More informationIntermethod Differences in Results for Total PSA, Free PSA, and Percentage of Free PSA
Clinical Chemistry / PSA and Free PSA Method Differences Intermethod Differences in Results for Total PSA, Free PSA, and Percentage of Free PSA Patricia R. Slev, PhD, Sonia L. La ulu, and William L. Roberts,
More informationSection 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 informationProstate Cancer: Is There Standard Treatment? Who has prostate cancer? In this article:
Focus on CME at l Université de Montréal Prostate Cancer: Is There Standard Treatment? Pierre I. Karakiewicz, MD, FRCSC; Paul Perrotte, MD, FRCSC; Fred Saad, MD, FRCSC In this article: 1. Risk factors
More informationCigna Medical Coverage Policy
Cigna Medical Coverage Policy Subject Prostate-Specific Antigen (PSA) Screening for Prostate Cancer Table of Contents Coverage Policy... 1 General Background... 1 Coding/Billing Information... 12 References...
More informationQuestions and Answers about Prostate Cancer Screening with the Prostate-Specific Antigen Test
Questions and Answers about Prostate Cancer Screening with the Prostate-Specific Antigen Test About Cancer Care Ontario s recommendations for prostate-specific antigen (PSA) screening 1. What does Cancer
More informationScreening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality
Screening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality Sanoj Punnen, MD, MAS Assistant Professor of Urologic Oncology University of Miami, Miller School of Medicine and Sylvester
More informationOptimal Baseline Prostate-Specific Antigen Level to Distinguish Risk of Prostate Cancer in Healthy Men Between 40 and 69 Years of Age
ORIGINAL ARTICLE Oncology & Hematology http://dx.doi.org/.46/jkms..7..4 J Korean Med Sci ; 7: 4-45 Optimal Baseline Prostate-Specific Antigen Level to Distinguish Risk of Prostate Cancer in Healthy Men
More informationor 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 informationACTIVE SURVEILLANCE FOR PROSTATE CANCER
ACTIVE SURVEILLANCE FOR PROSTATE CANCER Dr. Michael J Metcalfe PGY-2 Department of Urological Sciences April 25, 2012 CASE RM 65 year old active Caucasian male, married. PSA= 7.0 T2a Gleason 3+3=6 2/6
More informationChapter 2. Understanding My Diagnosis
Chapter 2. Understanding My Diagnosis With contributions from Nancy L. Brown, Ph.D.,Palo Alto Medical Foundation Research Institute; and Patrick Swift, M.D., Alta Bates Comprehensive Cancer Program o Facts
More informationImplications 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 informationSome 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 informationConsensus and Controversies in Cancer of Prostate BASIS FOR FURHTER STUDIES. Luis A. Linares MD FACRO Medical Director
BASIS FOR FURHTER STUDIES Main controversies In prostate Cancer: 1-Screening 2-Management Observation Surgery Standard Laparoscopic Robotic Radiation: (no discussion on Cryosurgery-RF etc.) Standard SBRT
More informationPathology Consultation on Prostate-Specific Antigen Testing
Pathology Consultation on Prostate-Specific Antigen Testing Jaime H. Noguez, PhD, and Corinne R. Fantz, PhD From the Department of Pathology and Laboratory Medicine, Emory University School of Medicine,
More information