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Prostate-specific Antigen: Advances and Challenges

Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287
^a Address correspondence to this author at: Department of Pathology, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Meyer B-121, Baltimore, MD 21287. Fax 410-955-0767; e-mail dchan@pathlan.path.jhu.edu.

In the quarter-century since its discovery (1), prostate-specific antigen (PSA) has been recognized as the most effective tumor marker for prostate cancer and has unquestionably played an important role in the diagnosis and clinical management of this disease. Prostate cancer remains the leading cancer site in men, with 179 300 new cancer cases estimated by the American Cancer Society for 1999, a slight decrease from the 1998 estimate of 184 500 cases(2). In addition to decreasing cancer cases, deaths from prostate cancer and cancer in general are declining, and prostate cancer survival rates are increasing (2). The incidence of prostate cancer has changed dramatically in the PSA era following the introduction of the first generation of PSA assays in the mid-1980s. Prostate cancer incidence increased 84% between 1987 and 1992 and then declined 46% between 1992 and 1994. This pattern has been attributed, in part, to increased cancer detection as a result of PSA testing with subsequent earlier diagnoses (3). Early detection of cancer affords a greater chance of detecting cancers at an early stage, when cancer is confined to the prostate and curative treatment is possible.

Although PSA is considered an effective tumor marker and is for all intents and purposes organ specific, it is not cancer specific. There is considerable overlap in PSA concentrations in men with prostate cancer and men with benign prostate diseases, particularly in the range of 4–10 µg/L. This range has thus been termed the diagnostic gray zone. Several approaches have been proposed and investigated to improve the diagnostic accuracy of PSA, including age-specific reference ranges, PSA density, PSA velocity, neural network-derived indexes, and the molecular forms of PSA (4). Use of the molecular forms, primarily focusing on free PSA and PSA bound to ₁. . . [Full Text of this Article]

References

The following articles in journals at HighWire Press have cited this article:

				B. R. Grzeda, T. Le Bui, C. N. Warner, T. L. Pirucki, L. M. Dewey, M. Babich, and J. A. Maggiore Measurement of Prostate-specific Antigen by Use of a Novel Blood Collection and Analytical System Clin. Chem., August 1, 2002; 48(8): 1272 - 1278. [Abstract] [Full Text] [PDF]

				K. R. Swanson, L. D. True, D. W. Lin, K. R. Buhler, R. Vessella, and J. D. Murray A Quantitative Model for the Dynamics of Serum Prostate-Specific Antigen as a Marker for Cancerous Growth : An Explanation for a Medical Anomaly Am. J. Pathol., June 1, 2001; 158(6): 2195 - 2199. [Abstract] [Full Text] [PDF]

				D. W. Chan and L. J. Sokoll WHO First International Standards for Prostate-specific Antigen: The Beginning of the End for Assay Discrepancies? Clin. Chem., September 1, 2000; 46(9): 1291 - 1292. [Full Text] [PDF]