PROSTATE-SPECIFIC ANTIGEN IN SCREENING OF PROSTATE-CANCER

Prostate-specific antigen (PSA) is a well-characterized human prostate -specific glycoprotein. PSA has been shown to be the most effective im munohistologic marker for prostate cancer, as well as the most useful serologic test in staging and monitoring prostate cancer and in early detection of recurrent disease. The greatest clinical value of PSA is as an aid for early detection of prostate cancer. Recent studies have indicated that PSA-based screening of the older population for organ-c onfined early-stage prostate cancer is an acceptable, practical, and r eliable modality. The accuracy of PSA screening is within the same ran ge as the mammogram. The cost-effectiveness of PSA is comparable to ot her cancer screening tests. Although the increase in the patient's sur vival due to PSA-based detection of early prostate cancer remains to b e documented, it is generally agreed that the PSA test along with digi tal rectal examination (DRE) should be included in the annual physical examination for men 50 years of age or older. High-risk men are urged to commence at age 40. Asymptomatic men who have both a negative DRE and normal PSA blood test need only to continue an annual DRE and PSA check-up. Men who have a negative DRE and elevated PSA, and all those who have a suspicious DRE regardless of PSA results, should undergo fu rther diagnostic workup, such as transrectal ultrasonography with biop sy of visible lesions. The cure rate is high with timely treatment, wh en prostate cancer is detected while still confined to the prostate. ( C) 1994 Wiley-Liss, Inc.