title: Early detection of prostate cancer in 2007. Part 1: PSA and PSA kinetics.
abstract: OBJECTIVE
  This is the first of two review papers attempting to clarify the best way to detect prostate cancer (PCa) in 2007. Screening for PCa has not yet been shown to lower PCa mortality. Still, opportunistic screening is wide spread in Europe and in most other parts of the world.
  
  
  METHODS
  Current literature and data from screening studies are reviewed and discussed. Prostate-specific antigen (PSA) has been and remains one of the corner stones of early detection of PCa. Traditionally used cut-off values cannot be applied in an uncritical fashion after it was shown that a significant amount of overdiagnosis and that large proportions of cancers and poorly differentiated cancers are present in the low PSA ranges. The paper addresses the continued relevance of PSA cut-off values. The diagnostic value of PSA velocity is reviewed in conjunction with PSA cut-off values and as a possible replacement of total PSA. A need for more selective screening in the low PSA ranges is pointed out.
  
  
  CONCLUSIONS
  The data show that men presenting initially with PSA values below 1 do not have to be rescreened for a period of 8 yr. In the PSA range 1-2.9 ng/ml, new parameters are needed that improve specificity and are selective for screening for aggressive lesions. PSA velocity so far has not been shown to be useful in the early detection of PCa but may be useful in detecting aggressive PCa selectively. For the time being, it seems sensible to continue using PSA cut-off values such as 3.0 or 4.0 ng/ml provided overtreatment is decreased by using available nomograms.
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Tineke
authors.initials: T
authors.lastname: Wolters
authors.forename: Roderick C N
authors.initials: RC
authors.lastname: van den Bergh
authors.forename: Claartje
authors.initials: C
authors.lastname: Gosselaar
authors.forename: Chris H
authors.initials: CH
authors.lastname: Bangma
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen