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Query: UMLS:C1519176 (PSA)
 5,490 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In Spain most prostate cancers are detected once they have already disseminated. The tumor, however, is localized to the prostate gland for a period of time before spreading to other structures. It is therefore important to underscore the value of early diagnosis. And if we take into account that the complications of radical prostatectomy have diminished and life expectancy of the general population has increased, undoubtedly an increased number of patients can benefit from surgery. Radical prostatectomy combined with pre and postoperative hormone therapy may enhance the quality of life of some patients with tumors extending beyond the capsule (clinical stage B2-C), including those with microscopic dissemination to the regional lymph nodes. Surgery should aim at complete removal of the pelvic tumor. Although a statistical relationship exists between blood PSA levels and tumor grade and size, elevation of PSA levels is not sufficient to predict malignancy or tumor spread and is of little value in predicting response to hormone therapy.
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PMID:[Controversy regarding the therapeutic management of stage B2, C and D1 adenocarcinoma]. 128 71

A silver colloid technique for the staining of nucleolar organizer regions (NORs) was applied to paraffin sections of 52 clinical prostate cancers, 5 incidental carcinomas of the prostate, 12 benign prostatic hypertrophy (BPH) specimens and 7 normal prostates. The mean numbers of silver-stained NORs (AgNORs) in these lesions were 3.12 +/- 0.52 in clinical cancer, 2.65 +/- 0.64 in incidental cancer, 1.66 +/- 0.16 in BPH, and 1.76 +/- 0.22 in normal prostate. There was a statistically significant difference in agNORs numbers between cancer and benign prostatic tissues (p < 0.001). However, no significant difference was observed in AgNORs numbers between incidental and clinical carcinoma of the prostate. In clinical cancer, only poorly differentiated adenocarcinoma showed a statistically larger number of AgNORs than the well or moderately differentiated group (p < 0.02). Correlation between AgNORs numbers and clinical stage was not obvious. There was no relationship between the number of AgNORs and serum values of tumor markers such as PAP, PSA and gamma-Sm. Moreover, the AgNORs numbers did not show a relation to decreasing rates of serum marker levels during successful anti-androgen therapy. If the patients with prostate cancer were divided into two groups by 2.9 of AgNORs number, the group with the smaller number of AgNORs (n = 14) was found to have a tendency towards a longer disease-stabilizing period than the larger group (n = 17).
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PMID:Nucleolar organizer regions in prostate cancer. 128 98

Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance of a pelvic nodule positive on biopsy and/or the presence of bone metastases confirmed by bone scan, was studied in a series of patients with prostatic cancer with a follow-up of between 6 months and 5 years. The progression-free survival rate was 86% at 1 year and 60% at 5 years. A progression-free survival rate and the relative risk of progression were established on the basis of the morphological characteristics (anatomical stage, tumour volume, seminal vesicle invasion, condition of the prostatic capsule and lymph nodes, positive resection margins at the apex) and histological features (Gleason's score) of the cancer, allowing determination of the influence of prognostic criteria on the outcome. The positive resection margins at the apex were due to preservation of the nervi erigentes. The preservation of the neurovascular pedicles may not be justified in the case of a tumour confined to the prostatic apex.
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PMID:[Progression after radical prostatectomy of cancer of the prostate: prognostic criteria and the role of PSA in monitoring]. 128 86

The proposal of an early diagnosis of prostate cancer through mass screening with digital rectal examination (DRE), transrectal ultrasound (TRUS) and serum tumor markers remains controversial: there is no high risk population. No study has proven that mass screening reduces the mortality from prostate cancer. However, when clinical and biological data give arguments for the presence of a cancer, every patient requires a prostate biopsy. We have studied the Positive Predictive Value (PPV) of each test in a selected population: 200 men over 50 years of age in which rectal examination or PSA assay was suspicious were investigated. Without any reference to the prostate volume, we considered that the PSA level was "suspicious" when it reached 3 times the upper reference value, or 12 ng/ml. DRE was suspicious in 73%, comprising 50% with prostate carcinoma. PSA assay was suspicious in 65%, comprising 61% with prostate carcinoma. 88% of cancers had a suspicious DRE or PSA assay. TRUS was suspicious in 89%, comprising 45% with prostate carcinoma. Ultrasound guided core biopsies were performed in each case, and allowed a positive diagnosis in 42% of cases, whereas bilateral fine-needle cyto-aspirates were positive in 87% of histologically proven carcinomas. Cytology alone was positive in 3 patients with negative biopsies. Both results show that the PPV of a suspicious DRE associated with an elevated PSA level is 84%. An increased PSA level is correlated with a cancer in 61%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Early diagnosis of prostatic cancer with digital rectal examination, PSA determination, and endorectal echography. Correlations with the morphologic diagnosis in 200 consecutive cases]. 128 56

The incidence of prostate cancer in the UK is increasing, and the disease is being detected more often in younger patients (e.g. from routine PSA measurement during health-care screening). Left untreated, a significant proportion of patients will undergo progression of their disease locally and/or develop metastases. Modern imaging techniques have greatly aided the assessment of early prostatic cancer, enabling both accurate assessment of the primary tumour and giving valuable information regarding lymph node metastases. PSA measurements are also extremely helpful, and this has replaced acid phosphatase as a marker for prostatic malignancy. Controversy still remains, however, over the best form of management. Radical prostatectomy undoubtedly produces the best results in the literature, but the patients are highly selected (e.g. those with nodal metastases are excluded) and some patients with well differentiated tumours may have been over-treated, as they may have been expected to do well with surveillance alone. Full clinical trials are required in identically staged patients to assess the relative merits of surveillance, radiotherapy and surgery, and this should now be possible with recent advances in imaging techniques.
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PMID:Current trends in the management of localised prostate cancer. 130 88

We retrospectively evaluated 51 prostate cancer patients found to have pelvic lymph node metastases at the time of pelvic lymphadenectomy and 125I implantation. All of them were followed until death or for a minimum of 70 months. Rabbit polyclonal anti-PSA, anti-PAP, anti-PSP-94, and mouse TURP-27 monoclonal antibodies were used in immunohistochemical evaluation of the metastatic lesions. In addition, Gleason grade and ploidy were assessed and correlated. No tumor with a Gleason grade of less than 7 could be found in the metastatic lymph nodes. Time to progression (P = .003), disease-specific survival (P = .009), and overall survival (P = .003) were significantly shorter in patients whose tumors had a primary Gleason pattern of 5 (grade 9 or 10). In the PSA study, patients whose tumors were reactive in more than 75% of cancer cells experienced significantly longer survival than those with less than 75% of cancer cells expressing PSA (P = .0006 log rank test). The means of overall survival +/- SEM were 71.5 +/- 5.0 and 34.9 +/- 5.4 months, respectively. Similar correlations were found with disease-specific survival and time to progression. Patterns of PAP expression and TURP-27 reactivity were not prognostically useful, whereas PSP-94 expression may add some additional information. These data suggest that evaluation of tissue PSA heterogeneity in lymph node metastases may offer additional prognostic information on prostate cancer patients. Better prediction of individual prognosis may be possible with the combined use of Gleason grade, flow cytometry, and PSA expression.
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PMID:Prognostic significance of antigenic heterogeneity, Gleason grade, and ploidy of lymph node metastases in patients with prostate cancer. 137 12

Screening for prostate cancer represents a clinical dilemma with no clear evidence to suggest decreased mortality from any diagnostic test. We now possess new knowledge regarding optimal combinations of DRE, TRUS, and PSA. While DRE and TRUS may be too subjective and PSA too nonspecific, their combined predictive values identify not only men at high risk but also those for whom continued frequent screening may not be cost effective. A monoclonal PSA decision level of no more than 4.0 ng/ml should be used, since 40 percent of cancers detected from 4.0 to 10.0 ng/ml already have extracapsular extension. Assuming that DRE is performed by experienced examiners, the combination of PSA and DRE should produce cost-effective early detection and minimize missed cancers below 4.0 ng/ml. TRUS should be reserved for those patients with either PSA elevations and/or DRE abnormalities. The use of TRUS gland volume data to further modify PSA decision levels, such as the "predicted" PSA concept, may also improve TRUS biopsy criteria and predictive values. Prostate cancer detection can then be objectively limited to a small percentage of the population and better selected for earlier, more localized disease. The ultimate decrease in mortality from screening remains to be demonstrated in randomized trials or observed only after decades of increased public awareness about prompt early detection combined with effective, definitive therapy.
CA Cancer J Clin
PMID:Prostate cancer screening: current trends and future implications. 137 79

Twenty-seven of 152 patients (18%) with progressing hormone resistant prostate cancer had normal serum levels of prostate specific antigen (PSA less than or equal to 10 micrograms l-1), when referred for secondary treatment. PSA was significantly correlated with the extent of skeletal metastases (R: 0.35) and the levels of hemoglobin (R: -0.19) and serum alkaline phosphatase (R: 0.30). In a multivariate Cox regression analysis the survival of the 152 patients was not correlated with the PSA level but with the patients performance status, the level of hemoglobin, and the time between primary hormone treatment and relapse. The lack of serum PSA to predict survival may be explained by a heterogenous composition of hormone resistant prostate cancer as regards differentiated and/or PSA producing vs undifferentiated and/or PSA non-producing cells.
Br J Cancer 1992 Jul
PMID:The prognostic significance of prostate specific antigen in metastatic hormone-resistant prostate cancer. 137 59

During the last four years approximately 400 men were evaluated in the early detection program for prostate cancer at The Ohio State University. Of these 400 men, 25 were found to have cancer. Eleven of the 25 had normal PSAs at the time cancer was diagnosed. The rise with a Hybritech assay, PSA of 1.2 ng/ml per year, one to two and subsequent years of greater than 1.2 ng/ml in this study indicates a higher likelihood of having a diagnosis of prostate cancer. Of the 25 patients who have been evaluated, only 4 patients had a subsequent drop of PSA from year one to two when the value dropped less than 0.6 ng/ml. Prostate intraepithelial neoplasia grade III has also been associated in these patients.
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PMID:Changes in PSA and early diagnosis of cancer of the prostate. 138 69

Although PSA is considered to be the true serum marker of prostatic tissue and a valuable indicator for cancer in the gland, knowledge of its significance and limitations is essential to its use for screening, staging, and monitoring CAP. PSA may be used in conjunction with DRE for early detection of CAP. Men with abnormal DRE should have a TRUS with or without biopsy. In men older than 50 years and with negative DRE and PSA < 4 ng/mL, annual evaluations are prudent. In patients with a PSA range of 4.0 to 9.9 ng/mL, high-risk groups such as black males and those with a positive family history should have TRUS. Males with negative DRE in the PSA range of 4.0 to 9.9 ng/mL should have TRUS to evaluate prostate volume and PSAD. Biopsy should be considered in those with PSAD > 0.15. Men with PSA > 10 ng/mL, even in the presence of an enlarged benign prostate, should have multiple directed biopsies under TRUS guidance.
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PMID:The current role of prostatic acid phosphatase and prostate-specific antigen in the management of prostate cancer. 138 63


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