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J E Oesterling

Publications and source records attributed to J E Oesterling.

At least 37 records · Page 2Linked to original sources
PubMed1997

Stage T1c prostate cancer: defining the appropriate staging evaluation and the role for pelvic lymphadenectomy.

A good staging system should be able to accurately reflect the natural history of a malignant disease, to express the extent of the disease at the time of diagnosis, and stratify patients in prognostically distinctive groups. The staging system for prostate cancer, as it is today, fails to fulfill these requirements. Approximately one third of the patients who undergo surgery for complete excision of prostate cancer in fact do not have a localize disease. The incidence of tumor at the inked margin may reach 30% for T1 stage and up to 60% for clinical T2b prostate cancer according to comparison with pathologic examination of resected specimen. Several concepts have been recently proposed as a means of improving the accuracy of the available staging system. In this paper, we review current aspects of clinical and pathological staging of prostate cancer, and the importance of these new concepts on the early stages of prostate cancer.

Humans↗
PubMed1997

A nationwide survey of practicing urologists: current management of benign prostatic hyperplasia and clinically localized prostate cancer.

PURPOSE: Our aim was to define the spectrum of urological care for benign prostatic hyperplasia (BPH) and clinically localized prostate cancer. MATERIALS AND METHODS: In 1995 a random sample of 394 American urologists was surveyed with a response rate of 67%. RESULTS: Respondents reported seeing a median of 240 BPH patients during the preceding 12 months, and they had prescribed alpha-blockers for 70 and finasteride for 15. They had performed a median of 25 transurethral prostatectomies but few other operations for BPH. Almost all urologists routinely used digital rectal examinations and prostate specific antigen tests for BPH diagnosis. The next most common studies were American Urological Association symptom scores and uroflowmetry. Pressure-flow studies were rarely done. Respondents reported seeing a median of 35 new patients with prostate cancer during the last year, and performing a median of 90 prostate biopsies and 13 radical prostatectomies. Respondents had referred a median of 10 patients for external beam radiotherapy but few patients received brachytherapy or cryotherapy. Urologist staging practices varied considerably. CONCLUSIONS: These data provide a picture of current practice regarding the management of BPH and prostate cancer.

Data Collection↗
PubMed1997

Determination of the "reflex range" and appropriate cutpoints for percent free prostate-specific antigen in 413 men referred for prostatic evaluation using the AxSYM system.

OBJECTIVES: Prostate-specific antigen (PSA) exists in the serum in two clinically important molecular forms: free PSA and PSA complexed to alpha 1-antichymotrypsin. Total PSA approximates the sum of the free and complexed forms. Preliminary investigations have illustrated the potential benefits of using percent free PSA to enhance the clinical utility of PSA in distinguishing benign prostate disease from prostate cancer. The current study defines the optimal range of total PSA for measuring percent free PSA (reflex range) and generates appropriate cutpoints for percent free PSA within this range. METHODS: A total of 413 patients, 225 (54%) with benign prostate disease (mean age, 67 years) and 188 (46%) with prostate cancer (mean age, 66 years), who had PSA values between 2.0 and 20.0 ng/mL participated in the investigation. All patients underwent a sextant biopsy to establish the diagnosis. The serum specimens were assayed with the AxSYM PSA assay (total PSA) and AxSYM Free PSA assay (Abbott Laboratories; Abbott Park, IL). Percent free PSA was calculated for all patients. Receiver operating characteristic (ROC) curves were generated for various ranges of total PSA to determine the reflex range that maximized the increase in sensitivity and specificity of percent free PSA over total PSA. Within the optimal range, the ROC curves were utilized to generate cutpoints for percent free PSA to be used in clinical practice. RESULTS: The appropriate reflex range for the utility of percent free PSA was 3.0 to 10.0 ng/mL. The appropriate cutpoint for percent free PSA when the total PSA value was 3.0 to 4.0 ng/mL to achieve 90% sensitivity for the detection of prostate cancer was 0.19. This approach resulted in a biopsy rate of 73% and a cancer detection rate of 44% in men with a total PSA value between 3.0 and 4.0 ng/mL. The appropriate cutpoint for percent free PSA when the total PSA value was 4.1 to 10.0 ng/mL to ensure 95% sensitivity for detection of prostate cancer was 0.24. Within the range of 4.1 to 10.0 ng/mL, this approach resulted in 13% fewer negative biopsies and failure to detect 5% of the cancers. CONCLUSIONS: Percent free PSA should be utilized in patients with a total serum PSA value between 3.0 and 10.0 ng/mL. In patients with a total PSA value between 3.0 and 4.0 ng/mL, percent free PSA enhanced the detection of prostate cancer (improving sensitivity). In patients with a total PSA concentration ranging from 4.1 to 10.0 ng/mL, negative biopsies were eliminated (improving specificity).

Adult↗
PubMed1997

Autologous blood donation prior to anatomical radical retropubic prostatectomy: is it necessary?

OBJECTIVES: To determine if autologous blood donation prior to anatomical radical retropubic prostatectomy, given current improvements in surgical technique, is necessary. METHODS: The medical records of 200 consecutive patients undergoing radical retropubic prostatectomy for clinically localized prostate cancer were reviewed with regard to (1) preoperative hematocrit (HCT); (2) estimated blood loss (EBL); (3) postoperative HCT prior to discharge; (4) number of units of autologous blood donated; and (5) number of units of autologous and homologous blood transfused. In addition, the charges associated with autologous blood donation were determined via telephone interview with 14 blood donation centers across the United States. RESULTS: Overall, 189 patients (95%) did not require a homologous blood transfusion. Sixty-four patients (32%) donated autologous units and 136 patients (68%) did not. Of the patients who had donated, only 17 (27%) received their blood back, and none (0%) received any homologous blood. Eleven (8%) of the 136 nondonors received a blood transfusion. The autologous donors, in comparison with nondonors, were found to have a significantly lower preoperative HCT (mean +/- standard deviation: 40 +/- 4.0% versus 42 +/- 2.9%, P < 0.05). However, there was no statistically significant difference in the mean EBL between the two groups, autologous donors versus nondonors (771 +/- 370 versus 737 +/- 425 cc, P = 0.23). The autologous donors had a smaller mean change in HCT versus the nondonors (-9.3 +/- 5.1% versus -11.2 +/- 4.4%, P < 0.05), reflecting an increased willingness to transfuse patients who have autologous units available. With regard to cost, patients, on average, can expect to be charged as much as $745 per unit of autologous blood donated. CONCLUSIONS: These findings suggest that preoperative blood donation prior to radical prostatectomy may not be necessary, because 95% of the patients did not require a homologous blood transfusion. In addition, autologous blood donation can be associated with substantial costs in both time and money. Thus, autologous donation should be left as an option for the patient and should not be considered routine practice.

Adult↗
PubMed1997

Biologic variability of prostate-specific antigen and its usefulness as a marker for prostate cancer: effects of finasteride. The Finasteride PSA Study Group.

OBJECTIVES: The effects of finasteride on prostate-specific antigen (PSA) variability and usefulness in prostate cancer detection were examined. METHODS: Percent change and crossover of PSA levels between the low (1.0 to 3.9 ng/mL) and high (4.0 to 10.0 ng/mL) ranges were evaluated in 72 men with benign prostatic hyperplasia (BPH) and 77 men with both BPH and prostate cancer (PCa) treated with finasteride or placebo for 6 months. Patients with PCa were studied as a model for evaluating the effects on PSA levels in patients with BPH and latent PCa. As recommended on the product label, PSA levels for finasteride-treated patients were doubled for interpretation. RESULTS: In patients with BPH, most placebo- and finasteride-treated patients with low PSA levels at baseline had subsequent PSA levels below 4.0 ng/mL throughout the study. Among patients with high baseline PSA levels, only 1 of 17 finasteride-treated patients compared with 8 of 13 placebo-treated patients crossed into the low range. In the BPH/PCa study, most placebo-treated patients maintained PSA levels in the same range (15 of 19 less than 4.0 ng/mL; 14 of 16 greater than 4.0 ng/mL). Almost one third of finasteride-treated patients with low PSA levels at baseline crossed into the high range (8 of 22), whereas most patients with high PSA levels at baseline were not masked with treatment, with PSA levels remaining high (12 of 15). CONCLUSIONS: PSA levels cross between the low and high PSA ranges in both finasteride- and placebo-treated patients with BPH and those with both BPH and PCa. Doubling the PSA levels in finasteride-treated patients allows appropriate interpretation of PSA values and does not mask the detection of PCa.

Adult↗
PubMed1997

Serial prostate-specific antigen measurements in men with clinically benign prostatic hyperplasia during a 12-month placebo-controlled study with terazosin. HYCAT Investigator Group. Hytrin Community Assessment Trial.

OBJECTIVES: To prospectively analyze whether the treatment of men with clinically benign prostatic hyperplasia (BPH) with alpha blocking agents affects the serum prostate-specific antigen (PSA) levels, and to determine the magnitude of such effect. METHODS: Serial PSA measurements were performed using the Abbott IMx assay over 1 year in 134 men over the age of 55 years participating in the Hytrin Community Assessment Trial (HYCAT). HYCAT is a 1-year, randomized, placebo-controlled, double-blinded study of the alpha1-adrenergic antagonist terazosin. All men had lower urinary tract symptoms and a clinical diagnosis of BPH with an American Urological Association (AUA) symptom index of 13 points or more, an AUA bother score of 8 points or more, and a peak urinary flow rate of less than 15 mL/s. PSA was measured at baseline and at 8, 26, 39, and 52 (end of study) weeks. RESULTS: Baseline serum PSA levels weakly correlated with patients' age at study entry, and modestly with residual urine (positive correlation) and peak flow rate (negative correlation), although none of the levels were statistically significant. Changes of serum PSA during the course of the study did not correlate with either one of the symptom severity or bother assessment tools, residual urine, or peak flow rate. Mean PSA increased from a baseline of 2.5+/-0.22 ng/mL (mean+/-SE) by 0.5+/-0.11 ng/mL in the placebo-, and from 2.7+/-0.23 ng/mL by 0.3+/-0.11 ng/mL in the terazosin-treated patients (P = 0.36 by ANOVA). There were no differences in the changes in serum PSA when patients were stratified by decade of life according to the age-specific PSA reference ranges, or by the final dose of terazosin (2, 5, or 10 mg daily). CONCLUSIONS: The treatment of men with lower urinary tract symptoms and clinical BPH with the alpha1-adrenergic antagonist terazosin does not affect serum PSA concentration, and thus does not confound longitudinal monitoring of serum PSA levels in patients at risk for prostate carcinoma.

Adrenergic alpha-Antagonists↗
PubMed1997

Analysis and presentation. Clinical trials on prostate cancer.

OBJECTIVE: To present guidelines for the analysis and presentation of clinical trials on prostate cancer. METHODS: Textbooks in statistics and oncology were searched for information, as were separate articles on the topic. Previously published advice was fused with own experience. RESULTS: Minimum key points are given for the sections: Introduction, Materials and Methods, Results, Discussion, and Summary. The importance of 1 primary question in any clinical trial is stressed. The value of a detailed presentation of the trial design, the patient population and the inclusion/exclusion criteria, the characterization of the disease, the treatment schedules, and toxicity is underlined. Application of various statistical methods for different endpoints is suggested. Maturity of data, time for publication, and avoidance of publication bias are discussed. Some common pitfalls in the statistical analyses of clinical results are indicated. The impact of prognostic factors, proper staging procedures, and secondary treatments on the interpretation of survival analysis is pointed out. A shift from the (mis-)use of the P value in favor of confidence intervals is strongly encouraged. The use of comparing the survival of responders versus nonresponders is to be abandoned. A few practical hints concerning the presentation are offered. The minimum of data that should be presented in absolute numbers is indicated. Also, the data that should be provided in both graphic and numeric format are exemplified. Examples of essential graphic illustrations are provided. The need for improvements in the design analysis, and presentation of clinical trials is reemphasized. Finally, numerous references are listed. The article is addressed not only to authors and readers of clinical trials, but also to editors of medical journals. CONCLUSION: The suggested guidelines may be useful in the analysis, presentation, and interpretation of clinical trials on prostate cancer. Moreover, compliance with these guidelines may facilitate comparisons with other similar trials and also, the incorporation of single studies into metaanalyses.

Clinical Trials as Topic↗
PubMed1997

The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration.

PSA remains an immensely valuable tool in the diagnosis of prostate adenocarcinoma. Factors such as prostatitis, urinary retention, ejaculation, and inpatient versus outpatient measurement, however, may have a profound effect on the serum PSA concentration. Furthermore, prostate biopsy and TURP result in an increase in the serum PSA value that resolves in 4 to 6 weeks. It is imperative that these factors be taken into account to interpret serum PSA values, to optimize the diagnostic utility of the PSA test.

Aged↗
PubMed1997

Prostate-specific antigen density.

Nearly 20 years have passed since PSA was definitively identified. Throughout this period, its clinical application as a tumor marker has expanded significantly. Today, besides monitoring prostate cancer therapy, PSA is being used extensively in mass screening programs for early detection of adenocarcinoma of the prostate and has become the most important tumor marker in urologic oncology. Although of unquestionable importance, PSA is not the perfect marker because of its lack of efficacy in discriminating BPH from prostate cancer. In order to enhance its sensibility, specificity, and predictive value, a series of variables influencing PSA levels have been studied and new parameters developed to correct discrepancies or confounding factors. Recognition of the relationship between PSA, prostate volume, and their interference with serum PSA levels made possible the development of the PSAD concept. Its wide application in different sets of patients for diagnostic and staging purposes resulted in enough data to demonstrate its usefulness and cost effectiveness as a second-line screening parameter, helping to distinguish BPH from prostate cancer in patients with PSA levels in the intermediate area, and avoiding some unnecessary biopsies. Even though PSAD does not offer a definitive solution for prostate cancer screening or management, its association with all the other diagnostic methods may offer the best way to assess the population at risk and assure their well-being (Fig. 5).

Humans↗
PubMed1997

Age-specific reference ranges for serum prostate-specific antigen.

Since PSA was discovered nearly 20 years ago, significant progress has been made in improving the clinical utility of this glycoprotein as a tumor marker. Factors contributing to the initial limitations in sensitivity and specificity of PSA as a diagnostic tool for early cancer now are understood better. As a result, PSA now is being used [table: see text] widely for the diagnosis of early, curable prostate cancer. PSA, however, because of the inability to differentiate benign processes from malignancy, fails to perform at the ideal tumor-marker level. Nevertheless, in 1997, it remains the best tumor marker in all cancer biology. The research that has been conducted by several independent investigators, showing the correlation between PSA, prostate volume, and patient age, was a vital step in the process of improving the clinical and diagnostic utility of PSA. From this, Oesterling, Dalkin, DeAntoni and others have recommended similar age-specific reference ranges for serum PSA. Subsequent investigations have supported the initial theories that the use of age-specific reference ranges would improve the sensitivity of PSA in younger men, leading to the diagnosis of additional early, organ-confined prostate cancer. The issue of improved specificity in older men has been somewhat less straightforward in that decreasing negative biopsies also result in undetected prostate cancers. The real question involves determining what percent of these undetected prostate cancers are clinically significant to the older patient. Of additional significance is the determination of differing age-specific reference ranges in whites, Asians, and African-Americans (Table 1). In 1997, it is important to know not only the age of the patient but also the race of the patient to interpret the serum PSA concentration. The clinical meaning of a given serum PSA value differs from one race to the next. The recent discovery of the different molecular forms of PSA and their potential ability to improve the diagnostic specificity of PSA is another significant step. Accordingly, the information about the relationship of age to the specific molecular forms and their ratios is a necessity. As urologists continue the quest for the ideal tumor marker for prostate cancer, utilizing age-specific reference ranges will continue to improve the clinical utility of the PSA test.

Adult↗
PubMed1997

Molecular forms of serum prostate-specific antigen. The clinical value of percent free prostate-specific antigen.

The concept of measuring the proportions of various forms of PSA in serum, particularly the proportion of free to total PSA, represents a new and exciting method of detecting early curable prostate cancers and avoiding unnecessary prostate biopsies in men who have BPH only. Compared with other methods of improving diagnostic specificity, it does not require transrectal ultrasound for determination of prostate volume, as does the use of PSA density, and it does not require multiple blood sampling over a sufficiently long period, as does PSA velocity. Recent findings suggest determination of the proportion of free to total PSA, rather than that of complexed to total PSA, to be the optimal discriminator between patients with prostate cancer and those with BPH in the PSA reflex range of 2.5 or 3 ng/mL to 10 ng/mL, and to improve the clinical accuracy of the PSA test substantially. If the total PSA value is normal, percent free PSA improves the sensitivity (increases cancer detection) of the PSA test; if the total PSA value is slightly elevated, percent free PSA enhances the specificity (eliminates unnecessary negative prostate biopsies) of the PSA test. Both of these outcomes are clinically desirable in attempting to diagnose early, curable prostate cancers in a cost-effective manner among men who also have varying degrees of BPH. Figure 5 contains a diagnostic algorithm for the detection of clinically significant prostate cancers at a curable stage, employing the concept of percent free PSA. As more is learned about percent free PSA, however, it may be necessary to make modifications in how this concept is used clinically.

Humans↗
PubMed1997

Use of prostate-specific antigen, Gleason score, and digital rectal examination in staging patients with newly diagnosed prostate cancer.

CT Scan, MR Imaging Scan, and Pedal Lymphangiography. Patients with a PSA greater than 25 ng/mL, a Gleason score greater than 6, and a positive DRE should undergo CT scan with FNA of lymph nodes at least 6 mm in size. Otherwise, CT scan, MR imaging scan, and pelvic lymphangiogram are not indicated. This should eliminate use of these staging studies in over 90% of patients with newly diagnosed adenocarcinoma of the prostate. Pelvic Lymph-Node Dissection. Pelvic lymph-node dissection can be safely eliminated in patients who meet the following predictive criteria: 1. PSA not more than 5 ng/mL or 2. Gleason score not more than 5 or 3. A combination of the following: PSA not more than 25 ng/mL, Gleason score not more than 7, and negative DRE. Following these criteria should eliminate the need for pelvic lymphadenectomy in 60% of patients with newly diagnosed prostate cancer.

Humans↗
PubMed1997

Using prostate-specific antigen to eliminate the staging radionuclide bone scan.

Traditionally the radionuclide bone scan has been the cornerstone of prostate cancer staging. Previous widespread use of bone-scan imaging was certainly reasonable, even in the asymptomatic patient, as clinicians had no methodology to predict who would or who would not have osseous metastases. Now, in the era of PSA testing, clinicians do have a timely, cost-effective method to determine those patients who are highly unlikely to have osseous metastases. As evidenced by several clinical studies noted previously, a radionuclide bone scan should not be obtained in staging the asymptomatic, newly diagnosed prostate cancer patient with a serum PSA level less than or equal to 10 ng/mL. Incorporation of clinical stage and tumor grade does not significantly improve the predictive value of PSA. Those patients with bone discomfort, however, should undergo bone imaging, regardless of the serum PSA level. Similarly, the serum PSA level may be used to avoid unnecessary bone-scan imaging in the patient with recurrent prostate cancer following definitive treatment. At this time, we do not have enough clinical information to determine the optimal PSA level that will predict precisely which patients will have osseous metastases. From the above reports, however, and the present authors' clinical experience, it would seem reasonable to avoid bone-scan imaging if the post-radical prostatectomy serum PSA level is not more than 2 ng/mL. No absolute data are available about recurrence after radiation therapy or for men being managed with watchful waiting. In an attempt to clarify this issue, there is currently a clinical study underway at the University of Michigan. This study assesses the minimum serum PSA elevation that necessitates bone imaging in restaging the asymptomatic patient with recurrent prostate cancer after radical surgery or definitive radiation therapy. The radionuclide bone scan continues to be the gold standard for the detection of osseous metastases in prostate cancer. Nevertheless, it is unnecessary in the specific situations outlined above. Serum PSA testing allows the physician to refine the use and application of this imaging study, thus providing an opportunity to eliminate expensive and time-consuming studies that ultimately do not contribute additional information. The national economic impact of doing so is tremendous.

Bone Neoplasms↗
PubMed1997

Diagnosis and treatment of benign prostatic hyperplasia. Practice patterns of primary care physicians.

OBJECTIVE: To define primary care physicians' (PCPs) practices in managing patients with benign prostatic hyperplasia [BPH], and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists' practices. DESIGN: Mail survey. PARTICIPANTS: Nationwide random sample of PCPs and urologists, selected from the American Medical Association Registry. METHODS: Initial mailing, postcard reminder, second mailing, telephone reminder, final mailing. MAIN RESULTS: Primary care physicians (n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists (n = 394, response = 68%). Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level. Although considered "optional" by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding "not recommended" studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. Eighty-six percent of PCPs reported prescribing medications for BPH over the preceding year; alpha blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios. CONCLUSIONS: Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists' practices. Referral thresholds appear to vary considerably.

Adult↗
PubMed1997

The relationship between prostatic intraepithelial neoplasia and prostate cancer: critical issues.

PURPOSE: Prostatic intraepithelial neoplasia (PIN) is often considered to be a premalignant lesion and the main precursor of invasive carcinoma of the prostate. We evaluated the evidence for and against PIN as a premalignant lesion and determined guidelines for the clinical management of PIN. MATERIALS AND METHODS: Literature analysis of histopathological, morphometric, phenotypic and molecular genetic evidence of progression and of clinical findings regarding PIN was done. Literature searches were performed on MEDLINE with relevant key words. RESULTS: PIN, like prostate cancer, occurs most frequently in the peripheral zone of the prostate and is usually located in close proximity to prostate cancer. The relative PIN and prostate cancer volumes vary inversely. Prostate specific antigen in cases of PIN appears to be intermediate between prostate cancer and normal levels, although this elevation may be explained by concomitant prostate cancer or benign prostatic hyperplasia. Deoxyribonucleic acid ploidy in PIN follows the aneuploid proportion as in the concomitant prostate cancer. Prostate cancer and PIN show evidence of loss of putative tumor suppressor genes on chromosome 8p. The clinical relevance of PIN biopsy findings is based on the association of neoplasia and prostate cancer. High grade PIN in core biopsies without concomitant prostate cancer has a substantial risk for prostate cancer in subsequent biopsies (24 to 73%, up to 100% when the digital rectal examination is suspicious) and should cause further biopsy sampling. CONCLUSIONS: There is convincing evidence that PIN is a precursor lesion to prostate cancer, with a close association of PIN and prostate cancer in biopsy and prostatectomy specimens. A biopsy finding of high grade PIN necessitates further investigation in patients who are candidates for radical treatment for localized prostate cancer.

Algorithms↗
PubMed1997

Update on the appropriate staging evaluation for newly diagnosed prostate cancer.

PURPOSE: Prostate cancer clinical staging methods and decision support tools were reviewed to assess their accuracy to predict pathological staging results and determine what comprises an appropriate clinical staging evaluation. MATERIALS AND METHODS: The MEDLINE data base was searched and 238 abstracts were obtained. Data were extracted from 142 articles that evaluated the preoperative accuracy of digital rectal examination, prostate specific antigen, prostatic acid phosphatase, systematic biopsy parameters (including Gleason scoring), seminal vesicle biopsy, various imaging studies and pelvic lymphadenectomy versus pathological staging results. The sensitivity, specificity and accuracy rates were calculated and tabulated from the reported data on each method or decision support tools for organ confined, nonorgan confined and lymph node metastatic tumor. RESULTS: Decision support tools based on logistic regression analysis, which combine several statistically independent staging parameters, had greater accuracy than any single clinical staging method alone. The most accurate decision support tools for clinical staging combined digital rectal examination (T stage), systematic biopsy parameters (including Gleason scoring) and prostate specific antigen. CONCLUSIONS: The components that comprise the most accurate decision support tools for clinical staging represent an appropriate staging evaluation for the newly diagnosed prostate cancer patient in 1997. Limited use of radiographic imaging and seminal vesicle biopsy may be indicated in select patients to detect bone metastases, and plan pelvic lymphadenectomy and surgical therapy.

Biopsy↗
PubMed1997

Percent free prostate-specific antigen: entering a new era in the detection of prostate cancer.

The introduction of prostate-specific antigen (PSA) testing into clinical medicine in 1986 revolutionized the management of patients with prostate cancer. The major limitation of this tumor marker stems from its inability to provide a clear distinction between benign prostate disease and prostate cancer, especially in patients with upper limit of normal or slightly increased PSA values. Recent research has established that PSA exists in the serum in several molecular forms. Patients with benign prostatic hyperplasia have more of the free form, whereas those with prostate cancer have more of a complexed form (PSA covalently bound to alpha 1-antichymotrypsin). Several investigations have now confirmed that determining percent free PSA (proportion of free PSA to total PSA) enhances the ability of PSA testing to distinguish between prostate cancer and benign prostatic hyperplasia. In addition, percent free PSA seems to have the greatest clinical significance in patients whose total PSA values range from 2.5 or 3.0 ng/mL (lower limit) to 10.0 ng/mL (upper limit). When the total PSA value is in the normal range (2.5 or 3.0 to 4.0 ng/mL), percent free PSA makes PSA a more sensitive test (increases cancer detection). When the total PSA level is minimally increased (4.1 to 10.0 ng/mL), percent free PSA makes PSA a more specific test (eliminates performance of unnecessary prostate biopsies). Although further work remains, it seems that percent free PSA can substantially improve the clinical utility of the PSA test for detecting early, curable prostate cancer.

Age Factors↗