Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C1519176 (PSA)
 5,490 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
 ...
PMID:The current role of prostatic acid phosphatase and prostate-specific antigen in the management of prostate cancer. 138 63

1. With an average follow-up of 53 months (range 12-120 months), 19.4% (185/955) of men have had a cancer recurrence after radical prostatectomy for clinically localized prostate cancer. A detectable serum PSA was the only evidence of recurrence in 11.2%, whereas 2.2% have had a recurrence locally and 6% with distant metastases. 2. The actuarial status at 10 years was 70% for undetectable serum PSA; 23% for isolated serum PSA elevation only; 7% for distant metastases; and 4% for local recurrence. 3. In our study, no patient demonstrated disease progression (local or distant) without detectable serum PSA. 4. The actuarial likelihood of an elevated serum PSA increased with increasing clinical stage, Gleason score, preoperative serum PSA concentration, and pathologic stage. 5. The actuarial recurrence rate for tumors with a Gleason score of 7 was not statistically different from the recurrence rate for lesions of Gleason score 8-10. 6. There exist marked differences in actuarial recurrence-free probabilities for men with tumors of low Gleason score (< 7) compared with those with tumors of high Gleason score (> or = 7) when there is pathologically established capsular penetration. 7. Patients with preoperative serum PSA concentrations greater than 10.0 ng/mL are at a statistically increased risk of recurrence. 8. Men who have detectable serum PSA within the first year after surgery are at a significantly higher risk of disease progression than those men who have measurable serum PSA in postoperative years two and three. 9. Men with an isolated elevation of serum PSA after radical prostatectomy have a 25% likelihood of harboring an occult local recurrence. However, radiation therapy produces a sustained suppression of PSA to undetectable levels for 2 years or more in only 10% of men. This suggests that radiation therapy is not effective in sterilizing occult local residual tumor in many men. 10. Valuable information concerning disease recurrence and progression can be obtained through early postoperative measurement of serum PSA. This article demonstrates the long-term value of serum PSA as a measure of progression after anatomic radical prostatectomy.
 ...
PMID:Serum PSA after anatomic radical prostatectomy. The Johns Hopkins experience after 10 years. 750 80

The patterns of expression of polysialylated ("embryonic") form of Neural Cell Adhesion Molecule (PSA/E-N-CAM) and of all N-CAM isoforms were investigated by indirect immunofluorescence and immunoblotting during the development of the Central Nervous System (CNS) and during the regeneration of the caudal Spinal Cord (SC) of the amphibian urodeles Pleurodeles waltl (Pw) and Notophthalmus viridescens (Nv). In this study, a monoclonal antibody to group B Meningococcus (anti-Men-B) which recognizes alpha-2,8-linked sialic units of PSA-N-CAM, and polyclonal anti-total N-CAM antibodies were used. Total-N-CAM immunoreactivities were consistently detected throughout the CNS of developing and adult newts. PSA-N-CAM expression predominated in "embryonic" developing CNS and was reduced to certain CNS areas in the adult urodeles. In the case of SC, the expression level of this isoform of N-CAM dramatically decreased to become low and nearly restricted to some ependymoglial cell surfaces. Interestingly, during newt tail regeneration, PSA-N-CAM was intensely reexpressed in regenerating SC, at the surface of ependymoglial cell processes and in axonal compartments. Expression was maximal at 4 to 6 weeks following amputation, and then gradually returned to a normal adult low level in well differentiated SC. These findings strongly supported the view that the expression of PSA-N-CAM was associated with the properties of plasticity shown by the SC ependymoglial tissue in newts, during tail regeneration. On the other hand, the high level of PSA-N-CAM expression in axonal compartments of regenerating as well as developing SC suggested that these isoforms of N-CAM could be implicated in axonal outgrowth within the "tunnels" defined by the radial ependymoglial processes. This transient PSA-N-CAM expression could therefore be considered both as a negative modulator of cell-cell and cell-substrate interactions and as a permissive factor for neuron differentiation.
 ...
PMID:Expression of polysialylated neural cell adhesion molecule (PSA-N-CAM) in developing, adult and regenerating caudal spinal cord of the urodele amphibians. 839 80

Five randomized pilot studies of screening for prostate cancer (PC) have been conducted in the area of Rotterdam from 1991 to 1994. The purpose of these studies was to establish the feasibility of a randomized screening protocol with PC mortality as the major end point in The Netherlands and at a European level. All procedures related to recruitment of participants, to application of the screening tests and to data collection were evaluated. Men (7,200) aged 55-74 years were invited through the Rotterdam Population Registry. The recruitment rate over the 5 pilot studies averaged 38.2% (2,747 men). Recruitment procedures proved to be relevant for establishing higher participation rates (invitation and consent by mail). The screening tests were well accepted and tolerated. The general population-based character of the sample was confirmed by studying symptoms of prostatic disease in participants and in men who refused participation. Data based on one PSA serum determination, rectal examination and transrectal ultrasonography are presented; 204/1,403 men (14.5%) had a positive screening result by either test combination and underwent biopsy. Forty-nine cancers were found in 1,403 men (3.5%); 65% of prostate cancers (17/26) identified in men who eventually underwent radical prostatectomy proved to be locally confined. From the pilot studies, we conclude that a large contribution to a European Randomized Study of Screening for Prostate Cancer (ERSPC) can be made by recruiting about 40,000 men in the area of Rotterdam. The preliminary data suggest that after confirmation of the present data during the first years in the European study, DRE and TRUS can be withheld depending on the PSA result in a large proportion of the screening population.
 ...
PMID:European randomized study of screening for prostate cancer--the Rotterdam pilot studies. 856 9

Serum PSA-based early detection for prostate cancer has been studied fairly extensively for the past several years. It appears that we can state fairly categorically what the relative performances of total serum PSA, DRE, and TRUS are in detecting early-stage prostate cancer; that initial screening is effective in detecting histologically significant and pathologically organ-confined prostate cancer; that annual, serial, repetitive screening, at least over a 4- to 5-year horizon, does not overdetect prostate cancer, and that the results of early detection will improve as our ability to use certain PSA transformations such as PSA density, PSA slope, age-specific PSA adjustment, and knowledge of free versus total serum PSA is better characterized. These advances in our ability to diagnose early-stage prostate cancer likely will be coupled with an increased ability to predict the behavior, curability, and significance of individual tumors. It is hoped that information soon will be available to allow physicians to categorize an individual tumor as insignificant, significant and surgically curable, or significant and incurable by standard approaches. This ability, coupled with the demonstrated ability to detect prostate cancer, will make an even more compelling argument for widespread PSA-based screening. At present, annual DRE and total serum PSA measurements are recommended for men older than 50 and among younger men at high risk for prostate cancer. All suspicious DRE findings should be evaluated with prostatic biopsy. Among younger men, PSA levels over 2.5 ng/mL should be considered worrisome and further evaluated. For men older than 65, serum PSA levels above 4 ng/mL should be considered abnormal and warrant biopsy. Men with persistent serum PSA elevation and a negative biopsy should undergo repeat biopsy at least once, and perhaps more often if PSA slope exceeds 0.75 per year, if density is greater than 0.10, or if f-PSA is less than 20%.
 ...
PMID:Prostate-specific antigen as a screening test for prostate cancer. The United States experience. 912 27

In a series of 1623 men with a follow-up of 5 +/- 3 years (range 1-13) after anatomic RRP for clinically localized prostate cancer, 17% (276/1623) have shown recurrence. A detectable PSA was the only evidence of recurrence in 7.9%, whereas 2.5% have recurred locally and 5.4% have developed distant metastases. The overall actuarial progression-free rate for these men at 10 years was 68%. Actuarial rates at 10 years were 18% for development of an isolated PSA recurrence, 8% for local recurrence, and 9% for distant recurrence. The actuarial likelihood of a postoperative recurrence increased with increasing clinical stage, Gleason score, preoperative PSA level, and pathologic stage. Although not shown in our previous report, the actuarial rate of recurrence of tumors with a Gleason score of 7 was statistically different from that of tumors of higher Gleason score (8-10). As well, men with preoperative PSA levels of 10.1 to 20 ng/mL experienced recurrence at a significantly lower rate than did men with preoperative PSA levels greater than 20 ng/mL. By using a combination of Gleason score, pathologic stage, and surgical margin status, we demonstrated that the presence of a positive surgical margin did not dramatically affect recurrence in tumors of Gleason scores 2 to 6 with capsular penetration. Surgical margin status was important in high-grade tumors with capsular penetration. In fact, tumors with capsular penetration, Gleason score of at least 7, and a positive surgical margin behaved similarly to tumors with invasion of the seminal vesicles. Preservation of potency did not adversely influence cancer control. The Gleason score, presence or absence of seminal vesicle or lymph node involvement, and the timing of PSA recurrence are all important variables in predicting eventual local versus distant failure associated with an isolated rise in serum PSA. Overall actuarial cause-specific survival at 5 and 10 years was 99% and 93%. Although there was no difference in survival among men grouped by TNM stage or preoperative PSA, advancing histologic grade and pathologic stage did have an effect on actuarial cause-specific survival. Men undergoing RRP for clinically localized prostate cancer showed a 16% actuarial rate of development of metastatic disease at 10 years. This is considerably better than conservative therapy and justifies RRP as the treatment of choice for men with clinically localized disease who are otherwise healthy and have a greater than 10-year life expectancy.
 ...
PMID:Prostate-specific antigen after anatomic radical retropubic prostatectomy. Patterns of recurrence and cancer control. 912 37

In determining whether or not to undergo early detection tests (PSA and DRE), men must weight the possibility of early diagnosis and treatment of potentially aggressive prostate cancer against the limitation of these tests and decisions they will be faced with regarding treatment choices, effectiveness and side effects. The Prostate Cancer Alliance recommends that men 50 years of age or older talk to their physicians and inform themselves about the benefits and risks of early detection testing using PSA and DRE in order to make an informed decision about whether to have the tests. Men in higher risk categories (those with a family history of the disease or with an African Canadian ancestry) should consider this recommendation starting at age 40. Extensive information is available on these matters. Men should request such information from their family physician or their urologist and consult any or all of the groups sponsoring this message.
 ...
PMID:The early detection of prostate cancer. Prostate Cancer Alliance of Canada. 986 77

The recurrence of prostate cancer after potentially curative local therapy is becoming a significant urologic problem. There are few prospective randomized trials, and the optimal diagnostic and treatment strategies for men who fail potentially curative therapy are not known. The experience to date seems to suggest the following as a reasonable approach. A detectable serum PSA level (> or = 0.4 ng/mL) after radical prostatectomy is evidence of residual or recurrent prostate cancer. Men with low- or moderate-grade cancers (Gleason score < 7), with capsular penetration, or with positive surgical margins in whom disease recurs more than 2 years after radical prostatectomy with a PSA doubling time greater than 12 months seem likely to harbor a local recurrence and are the only good candidates for salvage therapy. Unless there is a palpable recurrence, transrectal ultrasound and biopsy are generally not recommended, and CT scanning and bone scintigraphy usually do not provide helpful information. The role of monoclonal antibody scanning is currently investigational. Men with high-grade tumors (Gleason score > or = 7) or with seminal vesicle or lymph node involvement in whom disease recurs within 2 years of radical prostatectomy are most appropriately observed or treated with early hormonal therapy. Men who do not achieve a PSA nadir of 0.5 ng/mL or less within 2 years of radiotherapy are very likely to harbor residual disease. For young healthy men who are willing to accept a substantial risk of impotency, urinary incontinence, and bladder neck contractures, salvage radical prostatectomy is a reasonable option if the preradiation tumor characteristics are acceptable (PSA < 10 ng/mL, Gleason score < or = 6) and if the current PSA is less than 10 ng/mL. Salvage cryotherapy may result in substantial morbidity and should only be offered on an investigational basis. Other men failing radiation may be observed or treated with hormonal therapy. There is seldom a role for repeat biopsy. Because the optimal time to begin hormone therapy is still not known, early or delayed treatment are both reasonable options. Testicular androgen ablation by orchiectomy or LHRH agonists is considered standard therapy. Combined therapy with an antiandrogen does not seem to be beneficial for all patients and should not be routinely used. Sexually active men in whom preservation of potency is important can be offered an investigational regimen such as a 5-alpha-reductase inhibitor combined with an oral antiandrogen or intermittent LHRH agonist therapy. It is hoped that the results of ongoing randomized trials and future research will establish efficient and effective practice guidelines to evaluate and treat men who have failed potentially curative therapy for localized prostate cancer. This remains a very important and controversial topic that will challenge many practicing urologists.
 ...
PMID:Evaluation and management of the man who has failed primary curative therapy for prostate cancer. 1002 68

It has been claimed, though not scientifically proven, that early diagnosis and treatment of prostate cancer reduce cancer-related mortality. The aim of the present study is to assess the frequency of PSA-based screening in Norwegian primary health care. In 1998 Norwegian general practitioners and occupational physicians reported their use of diagnostic PSA (prostatic specific antigen) testing in men without urinary symptoms (opportunistic PSA screening). There were considerable variations between counties and an increasing tendency to screen 60% of physicians performed opportunistic PSA screening; however, 55% only "sometimes". Men over 75 were frequently tested. The results reflect the scientific uncertainty regarding opportunistic PSA screening. PSA screening as an element of health care policy can only be recommended if cancer-related mortality is reduced by early diagnosis and treatment of prostate cancer.
 ...
PMID:[Timely screening routines for prostatic cancer by Norwegian physicians]. 1056 74

Prevention of prostate cancer up to now is not possible, advanced stages of prostate cancer are not curable. About 13 000 men a year die of prostate cancer in Germany. PSA-based screening has been shown to be effective in detecting prostate cancer at an early, potentially curable stage; however, this tumor marker is limited by appreciable false-positive and false-negative results. Several PSA-related indexes may improve the power of PSA in early detection: As PSA density, age-adjusted PSA, and percent free PSA. These indexes can improve positive predictive value of PSA-testing, but are not able to differentiate carcinoma from benign hyperplasia on an individual basis. Men presenting for early detection have to be informed about possible overtreatment before undergoing biopsy to further investigate increased PSA above 4.0 ng/ml or suspect findings in digital rectal examination.
 ...
PMID:[PSA-based early detection of prostate cancer]. 1066 92


1 2 3 4 5 6 7 8 Next >>