[Value of determining prostate-specific antigen for early detection or prostatic carcinoma].
The use of prostate-specific-antigen in the early detection of prostatic carcinoma combined with digital-rectal examination results in a 2-3 times increase in prostatic carcinoma detection rate. 2/3 of PSA detected prostatic carcinoma are organ confined vs 40% of those which are detected by digital-rectal examination. 15-35% of all operated localized prostatic carcinoma have a normal PSA. A biopsy is indicated in men with a life expectancy of more than 10 years when the PSA value is above 10 ng/ml and/or digital-rectal examination is suspicious. This concerns only 2% of all men at the age older than 50 years. In 90% of all men older than 50 years the PSA is normal as well as the digital-rectal examination. In 4% of these the result of PSA and digital-rectal examination is false negative that means 4% have prostatic carcinoma. However, repeated digital-rectal examination and PSA determination on a yearly basis detects most of these overlooked prostatic carcinoma which still are organ confined in about 90% of the cases. In men with a minimal elevated PSA-value of 4-10 ng/ml, 25% will have a prostatic carcinoma regardless of the finding on digital-rectal examination. The indication to do a biopsy can be specified by the use of age specific PSA cut-off-levels and most likely in future by determining the free PSA vs the complex-bound PSA. Controversy exists about the usefulness of PSA-density and PSA-velocity.
Hammerer
P
P
Urologische Universitätsklinik, Hamburg-Eppendorf.
Huland
H
H
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000201:enzymology / Q000473:pathology / Q000517:prevention & control*; D012016:Reference Values
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen