Update on PSA Testing

The use of prostate-specific antigen (PSA) testing for prostate cancer screening has increased dramatically over the past decade. Determining the most efficient way to use PSA testing and how to interpret total PSA levels and changes in PSA values over time remain challenging. Guidelines for early detection of prostate cancer have a direct impact on the number of unnecessary tests performed and are critical for developing a successful screening approach for prostate cancer. The age at which PSA screening should begin, PSA testing intervals, and the importance of understanding fluctuations in PSA values over time are discussed in the framework of recent discoveries in the field. Results from ongoing randomized trials will confirm whether prostate cancer screening is an effective method for reducing deaths from prostate cancer and what approaches will provide the most cost-effective screening strategies.

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Correspondence: Mark L. Gonzalgo, MD, PhD, Department of Urology, Phipps 560-A, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287. E-mail: gonzalgo@jhmi.edu
  • 1.

    CatalonaWJSmithDSRatliffTL. Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA1993;270:948954.

    • Search Google Scholar
    • Export Citation
  • 2.

    CatalonaWJRichieJPAhmannFR. 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 Urol1994;151:12831290.

    • Search Google Scholar
    • Export Citation
  • 3.

    ZhuHRoehlKAAntenorJA. Biopsy of men with PSA level of 2.6 to 4.0 ng/mL associated with favorable pathologic features and PSA progression rate: a preliminary analysis. Urology2005;66:547551.

    • Search Google Scholar
    • Export Citation
  • 4.

    CarterHB. Prostate cancers in men with low PSA levels—must we find them?N Engl J Med2004;350:22922294.

  • 5.

    WelchHGSchwartzLMWoloshinS. Prostate-specific antigen levels in the United States: implications of various definitions for abnormal. J Natl Cancer Inst2005;97:11321137.

    • Search Google Scholar
    • Export Citation
  • 6.

    ChristenssonABjorkTNilssonO. Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol1993;150:100105.

    • Search Google Scholar
    • Export Citation
  • 7.

    LiljaH. Structure, function, and regulation of the enzyme activity of prostate-specific antigen. World J Urol1993;11:188191.

  • 8.

    CatalonaWJPartinAWSlawinKM. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA1998;279:15421547.

    • Search Google Scholar
    • Export Citation
  • 9.

    RoehlKAAntenorJACatalonaWJ. Robustness of free prostate specific antigen measurements to reduce unnecessary biopsies in the 2.6 to 4.0 ng./ml range. J Urol2002;168:922925.

    • Search Google Scholar
    • Export Citation
  • 10.

    RaaijmakersRBlijenbergBGFinlayJA. Prostate cancer detection in the prostate specific antigen range of 2.0 to 3.9 ng/ml: value of percent free prostate specific antigen on tumor detection and tumor aggressiveness. J Urol2004;171:22452249.

    • Search Google Scholar
    • Export Citation
  • 11.

    MohlerJBabaianRJBahnsonRR. The NCCN prostate cancer clinical practice guidelines in oncology version 22007. Available at: http://www.nccn.org/professionals/physician_gls/. Accessed June 24 2007.

    • Search Google Scholar
    • Export Citation
  • 12.

    BensonMCWhangISPantuckA. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol1992;147:815816.

    • Search Google Scholar
    • Export Citation
  • 13.

    SemjonowAHammMRathertP. Prostate-specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ-confined prostatic cancer. Br J Urol1994;73:538543.

    • Search Google Scholar
    • Export Citation
  • 14.

    BensonMCMcMahonDJCoonerWH. An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate-specific antigen density. World J Urol1993;11:206213.

    • Search Google Scholar
    • Export Citation
  • 15.

    WolffJMBoeckmannWEffertPJ. Evaluation of patients with diseases of the prostate using prostate-specific antigen density. Br J Urol1995;76:4146.

    • Search Google Scholar
    • Export Citation
  • 16.

    EpsteinJIChanDWSokollLJ. Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol1998;160:24072411.

    • Search Google Scholar
    • Export Citation
  • 17.

    CatalonaWJRichieJPdeKernionJB. Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol1994;152:20312036.

    • Search Google Scholar
    • Export Citation
  • 18.

    LujanMPaezALlanesL. Prostate specific antigen density. Is there a role for this parameter when screening for prostate cancer?Prostate Cancer Prostatic Dis2001;4:146149.

    • Search Google Scholar
    • Export Citation
  • 19.

    TanejaSSTranKLeporH. Volume-specific cutoffs are necessary for reproducible application of prostate-specific antigen density of the transition zone in prostate cancer detection. Urology2001;58:222227.

    • Search Google Scholar
    • Export Citation
  • 20.

    SmithRACokkinidesVEyreHJ. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin2007;57:90104.

    • Search Google Scholar
    • Export Citation
  • 21.

    ThompsonIM. Counseling patients with newly diagnosed prostate cancer. Oncology2000;14:119126.

  • 22.

    EtzioniRChaRCowenME. Serial prostate specific antigen screening for prostate cancer: a computer model evaluates competing strategies. J Urol1999;162:741748.

    • Search Google Scholar
    • Export Citation
  • 23.

    RossKSCarterHBPearsonJD. Comparative efficiency of prostate-specific antigen screening strategies for prostate cancer detection. JAMA2000;284:13991405.

    • Search Google Scholar
    • Export Citation
  • 24.

    Prostate-specific antigen (PSA) best practice policy. American Urological Association (AUA). Oncology2000;14:267272.

  • 25.

    CarterHBEpsteinJIChanDW. Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer. JAMA1997;277:14561460.

    • Search Google Scholar
    • Export Citation
  • 26.

    HugossonJAusGLiljaH. Prostate specific antigen based biennial screening is sufficient to detect almost all prostate cancers while still curable. J Urol2003;169:17201723.

    • Search Google Scholar
    • Export Citation
  • 27.

    HugossonJAusGLiljaH. Results of a randomized, population-based study of biennial screening using serum prostate-specific antigen measurement to detect prostate carcinoma. Cancer2004;100:13971405.

    • Search Google Scholar
    • Export Citation
  • 28.

    PostmaRRoobolMSchroderFH. Potentially advanced malignancies detected by screening for prostate carcinoma after an interval of 4 years. Cancer2004;100:968975.

    • Search Google Scholar
    • Export Citation
  • 29.

    JohanssonJEAndrenOAnderssonSO. Natural history of early, localized prostate cancer. JAMA2004;291:27132719.

  • 30.

    CarterHBLandisPKMetterEJ. Prostate-specific antigen testing of older men. J Natl Cancer Inst1999;91:17331737.

  • 31.

    WalterLCBertenthalDLindquistK. PSA screening among elderly men with limited life expectancies. JAMA2006;296:23362342.

  • 32.

    RoehrbornCGBoylePGouldAL. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology1999;53:581589.

    • Search Google Scholar
    • Export Citation
  • 33.

    RoehrbornCGMcConnellJBonillaJ. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol2000;163:1320.

    • Search Google Scholar
    • Export Citation
  • 34.

    OesterlingJEJacobsenSJChuteCG. Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA1993;270:860864.

    • Search Google Scholar
    • Export Citation
  • 35.

    MorganTOJacobsenSJMcCarthyWF. Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med1996;335:304310.

    • Search Google Scholar
    • Export Citation
  • 36.

    EasthamJARiedelEScardinoPT. Variation of serum prostate-specific antigen levels: an evaluation of year-to-year fluctuations. JAMA2003;289:26952700.

    • Search Google Scholar
    • Export Citation
  • 37.

    CarterHBPearsonJDMetterEJ. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA1992;267:22152220.

    • Search Google Scholar
    • Export Citation
  • 38.

    SmithDSCatalonaWJ. Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection. J Urol1994;152:11631167.

    • Search Google Scholar
    • Export Citation
  • 39.

    CarterHBPearsonJDWaclawiwZ. Prostate-specific antigen variability in men without prostate cancer: effect of sampling interval on prostate-specific antigen velocity. Urology1995;45:591596.

    • Search Google Scholar
    • Export Citation
  • 40.

    KadmonDWeinbergADWilliamsRH. Pitfalls in interpreting prostate specific antigen velocity. J Urol1996;155:16551657.

  • 41.

    CarterHBFerrucciLKettermannA. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst2006;98:15211527.

    • Search Google Scholar
    • Export Citation
  • 42.

    LoebSRoehlKACatalonaWJ. Prostate specific antigen velocity threshold for predicting prostate cancer in young men. J Urol2007;177:899902.

    • Search Google Scholar
    • Export Citation
  • 43.

    CarterHBKettermannAFerrucciLLandisP. Risk count assessment: a new concept for detection of life threatening prostate cancer during a window of curability. Urology2007;in press.

    • Search Google Scholar
    • Export Citation
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