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A Review on the Clinical Utility of PSA in Cancer Prostate

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Abstract

Prostate cancer has come to share the oncological centrestage among male cancers. The availability of Serum Prostate Specific Antigen, PSA, as a marker has encouraged it’s use to diagnose both cancer and cancer recurrence. Some clarity is required about its precise role in clinical practice. The available literature on Prostate Specific Antigen was reviewed; Articles were reviewed for content, applicability to the problem at hand, availability of data about sensitivity and specificity of values, refinements in measurements and finally for impact of screening programmes using these values on survival and quality of life. The data in the literature was critically re-evaluated and analysed to draw reasonable conclusions. Serum PSA measurements show variable reliability when it comes to diagnosis of Prostate cancer, given the dynamics of PSA physiology. Surrogate measures like PSA density, PSA velocity, free-to-complexed PSA ratio, percentage Pro-PSA, etc., have been used to improve the predictive utility of this assay for Prostate cancer. The ability of PSA to detect those cancers that will cost life, and thereby permit early curative treatment, is as yet unclear. It’s most definitive role appears to be in diagnosing recurrences after adequate surgical treatment, and in evaluating response to treatment.

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References

  1. Ries LAG, Melbert D, Krapcho M et al (2007) SEER cancer statistics review, 1975 2004. National Cancer Institute, Bethesda

    Google Scholar 

  2. Cancer Incidence and Patterns in Urban Maharashtra (2001) Indian Cancer Society (http://www.indiancancersociety.org)

  3. Lilja H, Christensson A, Dahlén U et al (1991) Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem 37:1618

    PubMed  CAS  Google Scholar 

  4. Mikolajczyk SD, Marks LS, Partin AW, Rittenhouse HG (2002) Free prostate-specific antigen in serum is becoming more complex. Urology 59:797

    Article  PubMed  Google Scholar 

  5. Björk T, Piironen T, Pettersson K et al (1996) Comparison of analysis of the different prostate-specific antigen forms in serum for detection of clinically localized prostate cancer. Urology 48:882

    Article  PubMed  Google Scholar 

  6. Christensson A, Björk T, Nilsson O et al (1993) Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol 150:100

    PubMed  CAS  Google Scholar 

  7. Partin AW, Hanks GE, Klein EA et al (2002) Prostate-specific antigen as a marker of disease activity in prostate cancer. Oncology (Williston Park) 16:1024

    Google Scholar 

  8. Balk SP, Ko YJ, Bubley GJ (2003) Biology of prostate-specific antigen. J Clin Oncol 21:383

    Article  PubMed  CAS  Google Scholar 

  9. Crawford ED (1997) Prostate cancer awareness week: September 22 to 28, 1997. CA Cancer J Clin 47:288

    Article  PubMed  CAS  Google Scholar 

  10. Oesterling JE, Jacobsen SJ, Chute CG et al (1993) Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA 270:860

    Article  PubMed  CAS  Google Scholar 

  11. Ganpule AP, Desai MR, Manohar T et al (2007) Age specific prostate specific antigen and prostate specific antigen density values in a community based Indian population. Indian J Urol 23(2):122

    Article  PubMed  Google Scholar 

  12. Baillargeon J, Pollock BH, Kristal AR et al (2005) The association of body mass index and prostate-specific antigen in a population-based study. Cancer 103:1092

    Article  PubMed  Google Scholar 

  13. Werny DM, Thompson T, Saraiya M et al (2007) Obesity is negatively associated with prostate-specific antigen in U.S. men, 2001–2004. Canc Epidemiol Biomarkers Prev 16:70

    Article  CAS  Google Scholar 

  14. Rundle A, Neugut AI (2008) Obesity and screening PSA levels among men undergoing an annual physical exam. Prostate 68:373

    Article  PubMed  Google Scholar 

  15. Beebe-Dimmer JL, Faerber GJ, Morgenstern H et al (2008) Body composition and serum prostate-specific antigen: review and findings from Flint Men’s Health Study. Urology 71:554

    Article  PubMed  Google Scholar 

  16. Wang LG, Liu XM, Kreis W, Budman DR (1997) Down-regulation of prostate-specific antigen expression by finasteride through inhibition of complex formation between androgen receptor and steroid receptor-binding consensus in the promoter of the PSA gene in LNCaP cells. Cancer Res 57:714

    PubMed  CAS  Google Scholar 

  17. Guess HA, Gormley GJ, Stoner E, Oesterling JE (1996) The effect of finasteride on prostate specific antigen: review of available data. J Urol 155:3

    Article  PubMed  CAS  Google Scholar 

  18. D'Amico AV, Roehrborn CG (2007) Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in men with androgenic alopecia: a randomised controlled trial. Lancet Oncol 8:21

    Article  PubMed  Google Scholar 

  19. Etzioni RD, Howlader N, Shaw PA et al (2005) Long-term effects of finasteride on prostate specific antigen levels: results from the prostate cancer prevention trial. J Urol 174:877

    Article  PubMed  CAS  Google Scholar 

  20. Andriole GL, Bostwick D, Brawley OW et al (2011) The effect of dutasteride on the usefulness of prostate specific antigen for the diagnosis of high grade and clinically relevant prostate cancer in men with a previous negative biopsy: results from the REDUCE study. J Urol 185:126

    Article  PubMed  CAS  Google Scholar 

  21. Chang SL, Harshman LC, Presti JC Jr (2010) Impact of common medications on serum total prostate-specific antigen levels: analysis of the National Health and Nutrition Examination Survey. J Clin Oncol 28:3951

    Article  PubMed  Google Scholar 

  22. Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ (2008) The influence of statin medications on prostate-specific antigen levels. J Natl Canc Inst 100:1511

    Article  CAS  Google Scholar 

  23. Mondul AM, Selvin E, De Marzo AM et al (2010) Statin drugs, serum cholesterol, and prostate-specific antigen in the National Health and Nutrition Examination Survey 2001–2004. Canc Causes Contr 21:671

    Article  Google Scholar 

  24. Bruun L, Becker C, Hugosson J et al (2005) Assessment of intra-individual variation in prostate-specific antigen levels in a biennial randomized prostate cancer screening program in Sweden. Prostate 65:216

    Article  PubMed  CAS  Google Scholar 

  25. Stamey TA, Yang N, Hay AR et al (1987) Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317:909

    Article  PubMed  CAS  Google Scholar 

  26. Tchetgen MB, Oesterling JE (1997) The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration. Urol Clin North Am 24:283

    Article  PubMed  CAS  Google Scholar 

  27. Yuan JJ, Coplen DE, Petros JA et al (1992) Effects of rectal examination, prostatic massage, ultrasonography and needle biopsy on serum prostate specific antigen levels. J Urol 147:810

    PubMed  CAS  Google Scholar 

  28. Nadler RB, Humphrey PA, Smith DS et al (1995) Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 154:407

    Article  PubMed  CAS  Google Scholar 

  29. Chybowski FM, Bergstralh EJ, Oesterling JE (1992) The effect of digital rectal examination on the serum prostate specific antigen concentration: results of a randomized study. J Urol 148:83

    PubMed  CAS  Google Scholar 

  30. (1995) Effect of digital rectal examination on serum prostate-specific antigen in a primary care setting. The Internal Medicine Clinic Research Consortium. Arch Intern Med 155:389

  31. Herschman JD, Smith DS, Catalona WJ (1997) Effect of ejaculation on serum total and free prostate-specific antigen concentrations. Urology 50:239

    Article  PubMed  CAS  Google Scholar 

  32. Tchetgen MB, Song JT, Strawderman M et al (1996) Ejaculation increases the serum prostate-specific antigen concentration. Urology 47:511

    Article  PubMed  CAS  Google Scholar 

  33. Kawakami J, Siemens DR, Nickel JC (2004) Prostatitis and prostate cancer: implications for prostate cancer screening. Urology 64:1075

    Article  PubMed  Google Scholar 

  34. Simardi LH, Tobias-MacHado M, Kappaz GT et al (2004) Influence of asymptomatic histologic prostatitis on serum prostate-specific antigen: a prospective study. Urology 64:1098

    Article  PubMed  Google Scholar 

  35. Benson MC, Whang IS, Olsson CA et al (1992) The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol 147:817

    PubMed  CAS  Google Scholar 

  36. Andriole GL, Telle WB, Coplen DE, Catalona WJ (1992) PSA index (PSAI) as a predictor of prostate cancer in men with persistent serum PSA elevation (abstract). J Urol 147:387A

    Google Scholar 

  37. Benson MC, Whang IS, Pantuck A et al (1992) Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 147:815

    PubMed  CAS  Google Scholar 

  38. Bare R, Hart L, McCullough DL (1994) Correlation of prostate-specific antigen and prostate-specific antigen density with outcome of prostate biopsy. Urology 43:191

    Article  PubMed  CAS  Google Scholar 

  39. Catalona WJ, Richie JP, deKernion JB et al (1994) Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol 152:2031

    PubMed  CAS  Google Scholar 

  40. Smith DS, Catalona WJ (1994) Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection. J Urol 152:1163

    PubMed  CAS  Google Scholar 

  41. Carter HB, Pearson JD, Metter EJ et al (1992) Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 267:2215

    Article  PubMed  CAS  Google Scholar 

  42. Carter HB, Ferrucci L, Kettermann A et al (2006) Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Canc Inst 98:1521

    Article  Google Scholar 

  43. D'Amico AV, Chen MH, Roehl KA, Catalona WJ (2004) Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 351:125

    Article  PubMed  Google Scholar 

  44. D'Amico AV, Renshaw AA, Sussman B, Chen MH (2005) Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. JAMA 294:440

    Article  PubMed  Google Scholar 

  45. Riehmann M, Rhodes PR, Cook TD et al (1993) Analysis of variation in prostate-specific antigen values. Urology 42:390

    Article  PubMed  CAS  Google Scholar 

  46. Catalona WJ, Partin AW, Slawin KM et al (1998) Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 279:1542

    Article  PubMed  CAS  Google Scholar 

  47. Hoffman RM, Clanon DL, Littenberg B et al (2000) Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels. J Gen Intern Med 15:739

    Article  PubMed  CAS  Google Scholar 

  48. Lee R, Localio AR, Armstrong K et al (2006) A meta-analysis of the performance characteristics of the free prostate-specific antigen test. Urology 67:762

    Article  PubMed  Google Scholar 

  49. Carter HB, Partin AW, Luderer AA et al (1997) Percentage of free prostate-specific antigen in sera predicts aggressiveness of prostate cancer a decade before diagnosis. Urology 49:379

    Article  PubMed  CAS  Google Scholar 

  50. Allard WJ, Zhou Z, Yeung KK (1998) Novel immunoassay for the measurement of complexed prostate-specific antigen in serum. Clin Chem 44:1216

    PubMed  CAS  Google Scholar 

  51. Chichibu K, Kuroe K, Hashimoto C, Goto S (1995) Specific quantification of gamma-seminoprotein-alpha 1 antichymotrypsin complex in serum by monoclonal antibody-based enzyme immunoassay. Rinsho Byori 43:1153

    PubMed  CAS  Google Scholar 

  52. Kuriyama M, Ueno K, Uno H et al (1998) Clinical evaluation of serum prostate-specific antigen-alpha1-antichymotrypsin complex values in diagnosis of prostate cancer: a cooperative study. Int J Urol 5:48

    Article  PubMed  CAS  Google Scholar 

  53. Allard WJ, Cheli CD, Morris DL et al (1999) Multicenter evaluation of the performance and clinical utility in longitudinal monitoring of the Bayer Immuno 1 complexed PSA assay. Int J Biol Markers 14:73

    PubMed  CAS  Google Scholar 

  54. Sokoll LJ, Sanda MG, Feng Z et al (2010) A prospective, multicenter, National Cancer Institute Early Detection Research Network study of [-2]proPSA: improving prostate cancer detection and correlating with cancer aggressiveness. Canc Epidemiol Biomarkers Prev 19:1193

    Article  Google Scholar 

  55. Polascik TJ, Oesterling JE, Partin AW (1999) Prostate specific antigen: a decade of discovery–what we have learned and where we are going. J Urol 162:293

    Article  PubMed  CAS  Google Scholar 

  56. Carroll P, Coley C, McLeod D et al (2001) Prostate-specific antigen best practice policy–part I: early detection and diagnosis of prostate cancer. Urology 57:217

    Article  PubMed  CAS  Google Scholar 

  57. Carter HB (2004) Prostate cancers in men with low PSA levels–must we find them? N Engl J Med 350:2292

    Article  PubMed  CAS  Google Scholar 

  58. Tricoli JV, Schoenfeldt M, Conley BA (2004) Detection of prostate cancer and predicting progression: current and future diagnostic markers. Clin Cancer Res 10:3943

    Article  PubMed  Google Scholar 

  59. Schröder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360:1320

    Article  PubMed  Google Scholar 

  60. Wilt TJ, MacDonald R, Rutks I et al (2008) Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med 148:435

    PubMed  Google Scholar 

  61. Wolf AM, Wender RC, Etzioni RB et al (2010) American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 60:70

    Article  PubMed  Google Scholar 

  62. Meigs JB, Barry MJ, Oesterling JE, Jacobsen SJ (1996) Interpreting results of prostate-specific antigen testing for early detection of prostate cancer. J Gen Intern Med 11:505

    Article  PubMed  CAS  Google Scholar 

  63. Brawer MK, Chetner MP, Beatie J et al (1992) Screening for prostatic carcinoma with prostate specific antigen. J Urol 147:841

    PubMed  CAS  Google Scholar 

  64. Catalona WJ, Richie JP, Ahmann FR et al (1994) 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 151:1283

    PubMed  CAS  Google Scholar 

  65. Schröder FH, van der Cruijsen-Koeter I, de Koning HJ et al (2000) Prostate cancer detection at low prostate specific antigen. J Urol 163:806

    Article  PubMed  Google Scholar 

  66. Thompson IM, Pauler DK, Goodman PJ et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med 350:2239

    Article  PubMed  CAS  Google Scholar 

  67. Catalona WJ, Smith DS, Ornstein DK (1997) Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA 277:1452

    Article  PubMed  CAS  Google Scholar 

  68. Babaian RJ, Johnston DA, Naccarato W et al (2001) The incidence of prostate cancer in a screening population with a serum prostate specific antigen between 2.5 and 4.0 ng/ml: relation to biopsy strategy. J Urol 165:757

    Article  PubMed  CAS  Google Scholar 

  69. Gilbert SM, Cavallo CB, Kahane H, Lowe FC (2005) Evidence suggesting PSA cutpoint of 2.5 ng/mL for prompting prostate biopsy: review of 36,316 biopsies. Urology 65:549

    Article  PubMed  Google Scholar 

  70. Porter MP, Stanford JL, Lange PH (2006) The distribution of serum prostate-specific antigen levels among American men: implications for prostate cancer prevalence and screening. Prostate 66:1044

    Article  PubMed  CAS  Google Scholar 

  71. Thompson IM, Ankerst DP, Chi C et al (2005) Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA 294:66

    Article  PubMed  CAS  Google Scholar 

  72. Welch HG, Schwartz LM, Woloshin S (2005) Prostate-specific antigen levels in the United States: implications of various definitions for abnormal. J Natl Canc Inst 97:1132

    Article  Google Scholar 

  73. Stamey TA, Johnstone IM, McNeal JE et al (2002) Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml. J Urol 167:103

    Article  PubMed  CAS  Google Scholar 

  74. Djulbegovic M, Beyth RJ, Neuberger MM et al (2010) Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials. BMJ 341:c4543

    Article  PubMed  Google Scholar 

  75. U.S. Preventive Services Task Force (2002) Screening for prostate cancer: recommendation and rationale. Ann Intern Med 137:915

    Google Scholar 

  76. (1997) Screening for prostate cancer. American College of Physicians. Ann Intern Med 126:480

  77. Greene KL, Albertsen PC, Babaian RJ et al (2009) Prostate specific antigen best practice statement: 2009 update. J Urol 182:2232

    Article  PubMed  CAS  Google Scholar 

  78. Barry MJ (2002) Health decision aids to facilitate shared decision making in office practice. Ann Intern Med 136:127

    PubMed  Google Scholar 

  79. Hanlon AL, Diratzouian H, Hanks GE (2002) Posttreatment prostate-specific antigen nadir highly predictive of distant failure and death from prostate cancer. Int J Radiat Oncol Biol Phys 53:297

    Article  PubMed  Google Scholar 

  80. Perez CA, Michalski JM, Lockett MA (2001) Chemical disease-free survival in localized carcinoma of prostate treated with external beam irradiation: comparison of American Society of Therapeutic Radiology and Oncology Consensus or 1 ng/mL as endpoint. Int J Radiat Oncol Biol Phys 49:1287

    Article  PubMed  CAS  Google Scholar 

  81. Yock TI, Zietman AL, Shipley WU et al (2002) Long-term durability of PSA failure-free survival after radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 54:420

    Article  PubMed  Google Scholar 

  82. Ray ME, Thames HD, Levy LB et al (2006) PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys 64:1140

    Article  PubMed  Google Scholar 

  83. (1997) Consensus statement: guidelines for PSA following radiation therapy. American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys 37:1035

  84. Crook JM, Choan E, Perry GA et al (1998) Serum prostate-specific antigen profile following radiotherapy for prostate cancer: implications for patterns of failure and definition of cure. Urology 51:566

    Article  PubMed  CAS  Google Scholar 

  85. Roach M, Hanks G, Thames H et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65(4):965

    Article  PubMed  Google Scholar 

  86. Shipley WU, Thames HD, Sandler HM et al (1999) Radiation therapy for clinically localized prostate cancer: a multi-institutional pooled analysis. JAMA 281:1598

    Article  PubMed  CAS  Google Scholar 

  87. Satoh T, Ishiyama H, Matsumoto K et al (2009) Prostate-specific antigen ‘bounce’ after permanent 125I-implant brachytherapy in Japanese men: a multi-institutional pooled analysis. BJU Int 103:1064

    Article  PubMed  Google Scholar 

  88. Pound CR, Partin AW, Eisenberger MA et al (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591

    Article  PubMed  CAS  Google Scholar 

  89. Jhaveri FM, Zippe CD, Klein EA, Kupelian PA (1999) Biochemical failure does not predict overall survival after radical prostatectomy for localized prostate cancer: 10-year results. Urology 54:884

    Article  PubMed  CAS  Google Scholar 

  90. Freedland SJ, Humphreys EB, Mangold LA et al (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294:433

    Article  PubMed  CAS  Google Scholar 

  91. D'Amico AV, Moul J, Carroll PR et al (2003) Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 21:2163

    Article  PubMed  Google Scholar 

  92. Kupelian PA, Buchsbaum JC, Patel C et al (2002) Impact of biochemical failure on overall survival after radiation therapy for localized prostate cancer in the PSA era. Int J Radiat Oncol Biol Phys 52:704

    Article  PubMed  CAS  Google Scholar 

  93. Partin AW, Pearson JD, Landis PK et al (1994) Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. Urology 43:649

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Genitourinary Surgery, St. John’s Medical College, Bangalore, India

    Mohan Adhyam & Anish Kumar Gupta

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  1. Mohan Adhyam
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Correspondence to Mohan Adhyam.

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Adhyam, M., Gupta, A.K. A Review on the Clinical Utility of PSA in Cancer Prostate. Indian J Surg Oncol 3, 120–129 (2012). https://doi.org/10.1007/s13193-012-0142-6

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