The relation of prostate biopsy results and ratio of free to total PSA in patients with a total PSA between 4–20 ng/mL

Objective: In this study our aim was to investigate the efficacy of free tototal PSA ratio in discrimination of benign prostate hyperplasia andprostate cancer.Materials and methods: A total of 194 patients, 52 to 82 years old (mean66.06 ± 0.47 years) with PSA levels between 4 to 20 ng/mL wereincluded into this study. Each patient underwent sextant prostate biopsyunder transrectal ultrasound guidance. The patients were divided into twogroups as PSA 4–10 and 10–20 ng/mL. Patients with benign and malignresults were compared with respect to age, total PSA level, free PSA leveland free/total (f/t) PSA ratio.Results: Biopsies revealed prostate cancer in 16 of 130 patients (12.3%)with serum PSA 4–10 ng/mL and in 10 of 64 patients (15.6%) with serumPSA 10–20 ng/ml. In both PSA groups free PSA and f/t PSA levels werestatistically significant, where total PSA levels were not. In patients with4–20 ng/mL total PSA levels and a cut off level of < 0.18 for f/t PSA, thesensitivity, specificity and positive predictive value for prostate cancerwere 88.5%, 53.6% and 20.4% respectively.Conclusion: Higher levels of PSA suggest prostate cancer, but stilladditional parameters are needed for patients with PSA 4–20 ng/mL, suchas free PSA and f/t PSA. Although a cut off level of < 0.18 for f/t PSA seemsto be the most accurate one to discriminate benign and malign diseasesfurther studies on larger groups of patients are needed.     

A retrospective analysis of the relationship between changes in serum PSA, palliative response and survival following systemic treatment in a Canadian randomized trial for symptomatic hormone-refractory prostate cancer

Background:To investigate the relationship between changesin serum PSA, palliative response and survival following systemictreatment for symptomatic hormone-refractory prostate cancer (HRPC). Patients and methods:A retrospective review of 161patients, treated with mitoxantrone and prednisone (M + P)(n = 80), or prednisone alone (P) (n = 81)from a Canadian randomized phase III clinical trial. PSA response wasdefined by 50% decline compared to baseline. Palliativeresponse was defined by the primary and secondary endpoints of thetrial. All responses were required to be maintained on two visits atleast three weeks apart. The Cox proportional hazards model and alandmark analysis (at nine weeks) were used to evaluate survivaldifferences between PSA responders and non-responders. Results:Using an intent-to-treat analysis in which patientswith missing PSA data are considered non-responders, 34% of M + Pand 11% of P patients achieved a PSA response(P = 0.0001). Nineteen of thirty-six (53%)patients with PSA response and twenty-six of ninety (29%)patients without PSA response achieved a palliative response (P= 0.001 Chi-square test, phi coefficient = 0.28). From the landmarkanalysis, PSA responders had longer survival than non-responders (P= 0.009). In multivariate analysis, better performance status,higher hemoglobin and PSA response (P < 0.001)predicted for survival, but palliative response did not (P=0.11). Conclusions:There is significant but imperfectstatistical association between PSA response and palliative response.PSA response was associated with longer survival. Patients treated withM + P were more likely to achieve a PSA response and a palliativeresponse than those treated with P.     

Mass screening program for prostatic cancer in Japan

Because the idea of "mass screening" in Japan is based upon the concept of "groupism", a fundamental feature of Japanese society, it is very different from the idea of "screening" in Western countries, which arises from an "individualistic" concept. The prevalence of prostatic cancer in Japan remains lower than that in Western countries but it has recently shown a great increase. In this stuation, a mass screening program for prostatic cancer, using prostate-specific antigen (PSA) for the primary study, is thought to be promising in Japan. To exclude false-positive cases in the "gray zone" of PSA values, transrectal power Doppler sonography is remarkably effective. Received: January 31, 2001     

前列腺癌体积的临床预测及其意义

目的　研究以术前前列腺活检资料来推断前列腺癌体积及病理的价值。方法　以 3 3例因前列腺癌而行根治术的患者作为研究对象 ,将术前PSA、PSAD及前列腺 8点活检的结果与前列腺癌体积及病理进行相关分析研究。结果　 (1)前列腺癌体积与术前PSA、PSAD及前列腺活检的结果呈显著正相关 ,而与年龄、术前前列腺体积以及摘除标本的体积无明显相关关系 ;(2 )前列腺活检中阳性点数联合PSA与前列腺癌体积的回归模型预测前列腺癌体积最好 ;(3 )前列腺活检中阳性点数≤ 3点组的癌体积及精囊浸润率低于阳性点数≥ 4点组 ,两者有显著性差异。结论　前列腺 8点活检中阳性点数是预测前列腺癌体积及病理的一个重要参考指标 ,尤其是联合检测PSA ,更增加其预测前列腺癌体积的准确性     

PSA检测在前列腺疾病诊断中的价值

前列腺癌是欧美男性泌尿系统虽常见的恶性肿瘤,在美国现有1000万前列腺癌的患者,每年新发病例约10万,占男性癌症死亡率的第二位。在我国,前列腺癌的发病率比欧美低数十倍,北京为241/10万。     

Reduction of Serum Prostate-Specific Antigen Levels following Varicella-Zoster Infection and Valaciclovir Treatment in Prostate Cancer

We present two prostate cancer patients, including one with a castration-resistant cancer whose rising serum prostate-specific antigen (PSA) levels showed a remarkable drop after a reactivated varicella-zoster virus infection treated with valaciclovir. In one patient, we found a temporary decrease in serum PSA lasting for at least 4 mo. In the patient with castration-resistant prostate cancer, serum PSA decreased to <0.01 μg/l and has remained undetectable since.     

Establishment of the optimal follow-up schedule after radical prostatectomy

Purpose

Monitoring the serum level of prostate specific antigen (PSA) is indispensable for surveillance after radical therapy, and the aim of this study was to establish the optimal follow-up schedule.

Standardization of tumor markers – priorities identified through external quality assessment

Abstract

Tumor markers are often heterogeneous substances that may be present in elevated concentrations in the serum of cancer patients. Typically measured by immunoassay, they contribute to clinical management, particularly in screening, case-finding, prognostic assessment, and post-treatment monitoring. Data both from external quality assessment (EQA) schemes and clinical studies demonstrate significant variation in tumor marker results obtained for the same specimen using different methods. Between-method between-laboratory coefficients of variation (CV) reported by EQA schemes generally reflect the complexity of the measurand, ranging from <5% for the structurally relatively simple α-fetoprotein (AFP) to >25% for the complex mucinous cancer antigen 19-9 (CA19-9). Improving the standardization of tumor marker measurements is particularly important for three reasons. The primary use of tumor markers is in monitoring cancer patients over long periods of time. Clinical interpretation of trends may consequently be affected if results are obtained in different laboratories using different methods or if a laboratory has to change method. Differences in results may have major implications for adoption of area-wide decision cut-offs and make implementation of these difficult. Method-related differences also make it difficult to compare clinical studies. Improving comparability of tumor marker results requires broad international agreement about which molecular forms of the measurand have clinical utility, identifying and adopting pure molecular forms as calibrants, and defining antibody specificities for their optimal detection. These aims have been achieved to varying extents for the most frequently measured serum tumor markers as described in this paper.