Prostate Specific Antigen in the Preoperative and Postoperative Evaluation of Localized Prostatic Cancer Treated with Radical Prostatectomy

Abstract

The usefulness of prostate specific antigen to predict final pathological stage was studied in 178 consecutive patients. Prostate specific antigen was determined preoperatively in all patients by a monoclonal immunoradiometric assay. All pathological specimens were examined for capsular penetration, seminal vesicle involvement and lymph node involvement. Prostate specific antigen correlated directly with capsular penetration (p less than 0.002), seminal vesicle involvement (p less than 0.02) and lymph node involvement (p less than 0.05). However the diagnostic accuracy of an elevated serum antigen level on an individual basis was only 55 per cent for capsular penetration and 50 per cent for seminal vesicle involvement and lymph node involvement. With a log-linear regression model, the half-life of prostate specific antigen was calculated to be 3.15 +/- 0.09 days. From the equation PSA (t) equals PSA (2) e[-0.2197(t-2)], prostate specific antigen can be used to detect residual cancer on day t in the immediate postoperative period. With respect to long-term followup, 127 patients have been monitored for longer than 2 months postoperatively with prostate specific antigen (mean followup 2 years, range 2 months to 8.6 years). Of the 101 patients who had favorable pathological findings at operation (organ-confined cancer or capsular penetration only) 92 (91 per cent) had a followup antigen concentration in the female range (0.0 to 0.2 ng. per ml.), whereas only 5 of 26 men (19 per cent) with either seminal vesicle involvement or lymph node involvement had an antigen value that was less than 0.2 ng. per ml. All patients with a documented clinical recurrence (8 of 127, 6 per cent) had an elevated followup serum prostate specific antigen concentration. These findings suggest that preoperative levels of prostate specific antigen are not sufficiently reliable to predict final pathological stage on an individual basis in patients with early prostatic cancer, and that the antigen is a sensitive tumor marker for the detection of residual disease after radical prostatectomy and subsequent recurrence of tumor on long-term followup.

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

“…The earliest observations had important clinical applications and included: 1) a decrease in the PSA level after hormonal therapy appeared to be correlated with response to treatment [11][12][13] ; 2) an increase in the PSA level after treatment appeared to precede and herald disease recurrence 11,14,15 ; and 3) after radical prostatectomy, PSA should be undetectable; if not, disease recurrence is the rule. 11,14,15 Several of these early investigators rejected the possibility of using PSA for screening because of a substantial overlap in PSA values between patients with and those without carcinoma and the resulting poor test specificity. 11,16,17 Recognizing the critical nature of specificity in a screening tool for prostate carcinoma, Guinan et al established an ULN for PSA of 24 ng/mL in a case-control study.…”

Longitudinal Evaluation of Prostate-Specific Antigen Levels in Men With and Without Prostate Disease

“…3,4 However, men with BPH have PSA elevations in 21% to 86% of cases, 2,5,6 and men with prostate cancer have normal PSA levels in 21% to 35% of cases. [4][5][6] Therefore, PSA elevations are not specific for prostate cancer, and a normal PSA level does not exclude the presence of cancer. This is reflected in the 78.7% sensitivity and 59.2% specificity using a PSA of 4.0 μg/L or greater as a detection criterion in a recent prostate cancer screening study.…”

“…1 Cross-sectional analysis of serum PSA levels in men with and without prostate discent studies suggest that PSA may be useful in the early detection of prostate cancer, 3,4 it is known that PSA elevations occur in men with BPH 2,5,6 and that men with prostate cancer can have normal PSA levels. [4][5][6] are not specific for prostate cancer, and a normal PSA level does not exclude the presence of cancer.The longitudinal changes in PSA that occur with age in men with and without prostate disease have not been reported previously. In addition, although it is well known that PSA is under the influence of androgen, 7,8 the influence of age-related decreases in androgen levels on PSA has not been studied.…”

Importance of Prostatic Specific Antigen (Psa) in Clinical Practice : Our Experience

“…Ereole et al 1980 [13], had 18% and 3% ofBPH cases with serum PSA levels of 4-10 nglml and> 10nglmi respectively. In another study [14] it was 43% and 10% of BPH cases in the same range, where as Annitage et al [15] had 35% and 12% cases in the same range of PSA. In our series the figures comparatively match with those found in other international studies.…”