Skip to main content

Advertisement

SpringerLink
Log in

Prostate-specific antigen and related isoforms in the diagnosis and management of prostate cancer

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Despite its unparalleled merits for prostate cancer detection and staging, prostate-specific antigen (PSA) is not a marker for prostate cancer only, but also is expressed in benign conditions. For early detection, limitations of PSA are obvious. Its widespread use has led to an extensive amount of expensive and often unnecessary diagnostic procedures associated with significant morbidity. Total PSA derivatives may enhance the accuracy of prostate cancer diagnosis. The ratio of free-to-total PSA improves specificity while maintaining a high sensitivity for prostate cancer detection for men with a total PSA of 2.5 to 10 ng/mL. Human glandular kallikrein also has the potential to be a valuable tool in combination with total and free PSA for early diagnosis of prostate cancer. Complex PSA seems to be a reliable tool to improve specificity at high sensitivity levels in men with suspected prostate cancer (mainly in PSA levels below 4 ng/mL). Newly discovered isoforms of free PSA also may impact early detection of prostate cancer with encouraging preliminary results that warrant further clinical investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Polascik TJ, Oesterling JE, Partin AW: Prostate-specific antigen: a decade of discovery. What we have learned and where we are going. J Urol 1999, 162:293–306. An important summary on the clinical application of prostatespecific antigen.

    Article  PubMed  CAS  Google Scholar 

  2. Wingo PA, Landis S, Ries LA: An adjustment to the 1997 estimate for new prostate cancer cases. Cancer 1997, 80:1810–1813.

    Article  PubMed  CAS  Google Scholar 

  3. Mettlin CJ, Murphy GP, Ho R, Menck HR: The National Cancer Data Base report on longitudinal observations on prostate cancer. Cancer 1996, 77:2162–2166.

    Article  PubMed  CAS  Google Scholar 

  4. Ito K, Kubota Y, Suzuki K, et al.: Correlation of prostate-specific antigen before prostate cancer detection and clinicopathologic features: evaluation of mass screening populations. Urology 2000, 55:705–709.

    Article  PubMed  CAS  Google Scholar 

  5. Plawker MW, Fleisher JM, Vapnek EM, Macchia RJ: Current trends in prostate cancer diagnosis and staging among United States urologists. J Urol 1997, 158:1853–1858.

    Article  PubMed  CAS  Google Scholar 

  6. Partin AW, Kattan MW, Subong EN, et al.: Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional update. JAMA 1997, 277:1445–1451. This paper validated one of today’s most important nomogram to predict prostate cancer stage, the Partin tables.

    Article  PubMed  CAS  Google Scholar 

  7. Partin AW, Mangold LA, Walsh LD, et al.: Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology 2001, 58:843–848.

    Article  PubMed  CAS  Google Scholar 

  8. Gann PH, Hennekens CH, Stampfer MJ: A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA 1995, 273:289–294.

    Article  PubMed  CAS  Google Scholar 

  9. Epstein JI, Chan DW, Sokoll LJ, et al.: Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate-specific antigen levels and needle biopsy findings. J Urol 1998, 160:2407–2411.

    Article  PubMed  CAS  Google Scholar 

  10. Belville WD: Are T1c tumors different from incidental tumors found at autopsy? The risk and reality of overdetection. Semin Urol Oncol 1995, 13:181–186.

    PubMed  CAS  Google Scholar 

  11. Mettlin C, Murphy GP, Lee F, et al.: Characteristics of prostate cancer detected in the American Cancer Society-National Prostate Cancer Detection Project. J Urol 1994, 152:1737–1740.

    PubMed  CAS  Google Scholar 

  12. Catalona WJ, Smith DS, Ratliff TL, Basler JW: Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA 1993, 270:948–954. A landmark paper describing the use of PSA for early detection of prostate cancer

    Article  PubMed  CAS  Google Scholar 

  13. Partin AW, Carter HB, Chan DW, et al.: Prostate-specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol 1990, 143:747–752.

    PubMed  CAS  Google Scholar 

  14. Oesterling JE, Chan DW, Epstein JI, et al.: Prostate-specific antigen in the preoperative and postoperative evaluation of localized prostatic cancer treated with radical prostatectomy. J Urol 1988, 139:766–772.

    PubMed  CAS  Google Scholar 

  15. Stamey TA, Kabalin JN, McNeal JE, et al.: Prostate-specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II: radical prostatectomy treated patients. J Urol 1989, 141:1076–1083.

    PubMed  CAS  Google Scholar 

  16. Hoekx L, Jeuris W, Van Marck E, Wyndaele JJ: Elevated serum prostate-specific antigen (PSA) related to asymptomatic prostatic inflammation. Acta Urol Belg 1998, 66:1–2.

    PubMed  CAS  Google Scholar 

  17. Ornstein DK, Smith DS, Humphrey PA, Catalona WJ: The effect of prostate volume, age, total prostate-specific antigen level, and acute inflammation on the percentage of free serum prostate-specific antigen levels in men without clinically detectable prostate cancer. J Urol 1998, 159:1234–1237.

    Article  PubMed  CAS  Google Scholar 

  18. Ramos CG, Carvahal GF, Mager DE, et al.: The effect of high grade prostatic intraepithelial neoplasia on serum total and percentage of free prostate-specific antigen levels. J Urol 1999, 162:1587–1590.

    Article  PubMed  CAS  Google Scholar 

  19. Herschman JD, Smith DS, Catalona WJ: Effect of ejaculation on serum total and free prostate-specific antigen concentrations. Urology 1997, 50:239–243.

    Article  PubMed  CAS  Google Scholar 

  20. Oesterling JE, Rice DC, Glenski WJ, Bergstralh EJ: Effect of cystoscopy, prostate biopsy, and transurethral resection of prostate on serum prostate-specific antigen concentration. Urology 1993, 42:276–282.

    Article  PubMed  CAS  Google Scholar 

  21. Pannek J, Marks LS, Pearson JD, et al.: Influence of finasteride on free and total serum prostate-specific antigen levels in men with benign prostatic hyperplasia. J Urol 1998, 159:449–453.

    Article  PubMed  CAS  Google Scholar 

  22. Catalona WJ, Smith DS, Ratliff TL, et al.: Measurement of prostatespecific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991, 324:1156–1161.

    Article  PubMed  CAS  Google Scholar 

  23. Catalona WJ, Smith DS, Ornstein DK: Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination: enhancement of specificity with free PSA measurements. JAMA 1997, 277:1452–1455.

    Article  PubMed  CAS  Google Scholar 

  24. Schroder FH, van der Cruijsen-Koeter I, de Koning HJ: Prostate cancer detection at low prostate-specific antigen. J Urol 2000, 163:806–812.

    Article  PubMed  CAS  Google Scholar 

  25. Lodding P, Aus G, Bergdahl S, et al.: Characteristics of screening detected prostate cancer in men 50 to 66 years old with 3 to 4 ng./mL: prostate-specific antigen. J Urol 1998, 159:899–903.

    Article  PubMed  CAS  Google Scholar 

  26. Catalona WJ, Richie JP, Ahmann FR, et al.: Comparison of digital rectal examination and serum prostate-specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6630 men. J Urol 1994, 151:1283–1290.

    PubMed  CAS  Google Scholar 

  27. Cooner WH, Mosley BR, Rutherford CL Jr, et al.: Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate-specific antigen. J Urol 1990, 143:1146–1152.

    PubMed  CAS  Google Scholar 

  28. Hammerer P, Huland H: Systematic sextant biopsies in 651 patients referred for prostate evaluation. J Urol 1994, 151:99–102.

    PubMed  CAS  Google Scholar 

  29. Ellis WJ, Chetner MP, Preston SD, Brawer MK: Diagnosis of prostatic carcinoma: the yield of serum prostate-specific antigen, digital rectal examination, and transrectal ultrasonography. J Urol 1994, 152:1520–1525.

    PubMed  CAS  Google Scholar 

  30. Lilja H, Christensson A, Dahlen U, et al.: Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem 1991, 37:1618–1625. First description of the free and complexed PSA isoforms.

    PubMed  CAS  Google Scholar 

  31. Stenman UH, Leinonen J, Alfthan H, et al.: A complex between prostate-specific antigen and alpha 1-antichymotrypsin is the major form of prostate-specific antigen in serum of patients with prostatic cancer: assay of the complex improves clinical sensitivity for cancer. Cancer Res 1991, 51:222–226.

    PubMed  CAS  Google Scholar 

  32. Luderer AA, Chen YT, Soriano TF, et al.: Measurement of the proportion of free to total prostate-specific antigen improves diagnostic performance of prostate-specific antigen in the diagnostic gray zone of total prostate-specific antigen. Urology 1995, 46:187–194.

    Article  PubMed  CAS  Google Scholar 

  33. Christensson A, Bjork T, Nilsson O, et al.: Serum prostatespecific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol 1993, 150:100–105.

    PubMed  CAS  Google Scholar 

  34. Catalona WJ, Partin AW, Slawin KM, et al.: Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective, multicenter clinical trial. JAMA 1998, 279:1542–1547. This manuscript led to the FDA-approval of %fPSA for early detection of prostate cancer.

    Article  PubMed  CAS  Google Scholar 

  35. Carter HB, Partin AW, Luderer AA, et al.: Percentage of free prostate-specific antigen in sera predicts aggressiveness of prostate cancer a decade before diagnosis. Urology 1997, 49:379–384.

    Article  PubMed  CAS  Google Scholar 

  36. Lilja H, Haese A, Bjork T, et al.: Significance and metabolism of complexed and noncomplexed prostate-specific antigen forms, and human glandular kallikrein 2 in clinically localized prostate cancer before and after radical prostatectomy. J Urol 1999, 162:2029–2034; discussion 2034–2035.

    Article  PubMed  CAS  Google Scholar 

  37. Haese A, Graefen M, Noldus J, et al.: Prostatic volume and ratio of free-to-total prostate-specific antigen in patients with prostatic cancer or benign prostatic hyperplasia. J Urol 1997, 158:2188–2192.

    Article  PubMed  CAS  Google Scholar 

  38. Partin AW, Catalona WJ, Southwick PC, et al.: Analysis of percent free prostate-specific antigen (PSA) for prostate cancer detection: influence of total PSA, prostate volume, and age. Urology 1996, 48:55–61.

    Article  PubMed  CAS  Google Scholar 

  39. Christensson A, Lilja H: Complex formation between protein C inhibitor and prostate-specific antigen in vitro and in human semen. Eur J Biochem 1994, 220:45–53.

    Article  PubMed  CAS  Google Scholar 

  40. Okihara K, Fritsche H, Ayala A, et al.: Can complexed prostatespecific antigen enhance prostate cancer detection in men with total prostate-specific antigen between 2.4 and 4 ng/mL. J Urol 2001, 165:1930–1936.

    Article  PubMed  CAS  Google Scholar 

  41. Mitchell ID, Croal BL, Dickie A, et al.: A prospective study to evaluate the role of complexed prostate-specific antigen and free/total prostate-specific antigen ratio for the diagnosis of prostate cancer. J Urol 2001, 165:1549–1553.

    Article  PubMed  CAS  Google Scholar 

  42. Brawer MK, Cheli CD, Neaman IE, et al.: Complexed prostatespecific antigen provides significant enhancement of specificity compared with total prostate-specific antigen for detecting prostate cancer. J Urol 2000, 163:1476–1480.

    Article  PubMed  CAS  Google Scholar 

  43. Okegawa T, Noda H, Nutahara K, Higashihara E: Comparison of two investigative assays for the complexed prostatespecific antigen in total prostate-specific antigen between 4.1 and 10ng/mL. Urology 2000, 55:700–704.

    Article  PubMed  CAS  Google Scholar 

  44. Stamey TA, Yemoto CE: Examination of the 3 molecular forms of serum prostate-specific antigen for distinguishing negative from positive biopsy: relationship to transition zone volume. J Urol 2000, 163:119–126.

    Article  PubMed  CAS  Google Scholar 

  45. Miller MC, O’Dowd GJ, Partin AW, Veltri RW: Contemporary use of complexed PSA and calculated percent free PSA for early detection of prostate cancer: impact of changing disease demographics. Urology 2001, 57:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  46. Djavan B, Remzi M, Zlotta AR, et al.: Complexed prostatespecific antigen, complexed prostate-specific antigen density of total and transition zone, complexed/total prostatespecific antigen ratio, free-to-total prostate-specific antigen ratio, density of total, and transition zone prostate-specific antigen: results of the prospective multicenter European trial. Urology 2002, 60:4–9.

    Article  PubMed  Google Scholar 

  47. Veltri RW, Miller MC, O’Dowd GJ, Partin AW: Impact of age on total and complexed prostate-specific antigen cutoffs in a contemporary referral series of men with prostate cancer. Urology 2002, 60:47–52.

    Article  PubMed  Google Scholar 

  48. Mikolajczyk SD, Millar LS, Wang TJ, et al.: “BPSA”, a specific molecular form of free prostate-specific antigen, is found predominantly in the transition zone of patients with nodular benign prostatic hyperplasia. Urology 2000, 55:41–45.

    Article  PubMed  CAS  Google Scholar 

  49. Linton HJ, Marks LS, Millar LS, et al.: Benign prostate-specific antigen (BPSA) in serum is increased in benign prostate disease. Clin Chem 2003, 49:253–259.

    Article  PubMed  CAS  Google Scholar 

  50. Wang TJ, Slawin KM, Rittenhouse HG, et al.: Benign prostatic hyperplasia-associated prostate-specific antigen (BPSA) shows unique immunoreactivity with anti-PSA monoclonal antibodies. Eur J Biochem 2000, 267:4040–4045.

    Article  PubMed  CAS  Google Scholar 

  51. Lovgren J, Rajakoski K, Karp M, et al.: Activation of the zymogen form of prostate-specific antigen by human glandular kallikrein 2. Biochem Biophys Res Commun 1997, 238:549–555.

    Article  PubMed  CAS  Google Scholar 

  52. Kumar A, Mikolajczyk SD, Goel AS, et al.: Expression of pro form of prostate-specific antigen by mammalian cells and its conversion to mature, active form by human kallikrein 2. Cancer Res 1997, 57:3111–3114.

    PubMed  CAS  Google Scholar 

  53. Takayama TK, Fujikawa K, Davie EW: Characterization of the precursor of prostate-specific antigen: activation by trypsin and by human glandular kallikrein. J Biol Chem 1997, 272:21582–21588.

    Article  PubMed  CAS  Google Scholar 

  54. Takayama TK, Carter CA, Deng T: Activation of prostate-specific antigen precursor (pro-PSA) by prostin, a novel human prostatic serine protease identified by degenerate PCR. Biochemistry 2001, 40:1679–1687.

    Article  PubMed  CAS  Google Scholar 

  55. Mikolajczyk SD, Millar LS, Wang TJ, et al.: A precursor form of prostate-specific antigen is more highly elevated in prostate cancer compared with benign transition zone prostate tissue. Cancer Res 2000, 60:756–759.

    PubMed  CAS  Google Scholar 

  56. Sokoll LJ, Chan DW, Mikolajczyk SD, et al.: Proenzyme PSA for the early detection of prostate cancer in the 2.5–4.0 ng/mL total PSA range: preliminary analysis. Urology 2003, 61:274–276.

    Article  PubMed  Google Scholar 

  57. Peter J, Unverzagt C, Krogh TN, et al.: Identification of precursor forms of free prostate-specific antigen in serum of prostate cancer patients by immunosorption and mass spectrometry. Cancer Res 2001, 61:957–962.

    PubMed  CAS  Google Scholar 

  58. Nurmikko P, Vaisanen V, Piironen T, et al.: Production and characterization of novel anti-prostate-specific antigen (PSA) monoclonal antibodies that do not detect internally cleaved Lys145-Lys146 inactive PSA. Clin Chem 2000, 46:1610–1618.

    PubMed  CAS  Google Scholar 

  59. Nurmikko P, Pettersson K, Piironen T, et al.: Discrimination of prostate cancer from benign disease by plasma measurement of intact, free prostate-specific antigen lacking an internal cleavage site at Lys145-Lys146. Clin Chem 2001, 47:1415–1423.

    PubMed  CAS  Google Scholar 

  60. Steuber T, Nurmikko P, Haese A, et al.: Discrimination of benign from malignant prostatic disease by selective measurements of single chain, intact free prostate-specific antigen. J Urol 2002, 168:1917–1922.

    Article  PubMed  CAS  Google Scholar 

  61. Schedlich LJ, Bennetts BH, Morris BJ: Primary structure of a human glandular kallikrein gene. DNA 1987, 6:429–437.

    Article  PubMed  CAS  Google Scholar 

  62. Young CY, Andrews PE, Montgomery BT, Tindall DJ: Tissuespecific and hormonal regulation of human prostate-specific glandular kallikrein. Biochemistry 1992, 31:818–824.

    Article  PubMed  CAS  Google Scholar 

  63. Darson MF, Pacelli A, Roche P, et al.: Human glandular kallikrein 2 (hK2) expression in prostatic intraepithelial neoplasia and adenocarcinoma: a novel prostate cancer marker. Urology 1997, 49:857–862.

    Article  PubMed  CAS  Google Scholar 

  64. Darson MF, Pacelli A, Roche P, et al.: Human glandular kallikrein 2 expression in prostate adenocarcinoma and lymph node metastases. Urology 1999, 53:939–944.

    Article  PubMed  CAS  Google Scholar 

  65. Siivola P, Pettersson K, Piironen T, et al.: Time-resolved fluorescence imaging for specific and quantitative immunodetection of human kallikrein 2 and prostate-specific antigen in prostatic tissue sections. Urology 2000, 56:682–688.

    Article  PubMed  CAS  Google Scholar 

  66. Piironen T, Lovgren J, Karp M, et al.: Immunofluorometric assay for sensitive and specific measurement of human prostatic glandular kallikrein (hK2) in serum. Clin Chem 1996, 42:1034–1041.

    PubMed  CAS  Google Scholar 

  67. Klee GG, Goodmanson MK, Jacobsen SJ, et al.: Highly sensitive automated chemiluminometric assay for measuring free human glandular kallikrein-2. Clin Chem 1999, 45:800–806.

    PubMed  CAS  Google Scholar 

  68. Becker C, Piironen T, Pettersson K, et al.: Discrimination of men with prostate cancer from those with benign disease by measurements of human glandular kallikrein 2 (HK2) in serum. J Urol 2000, 163:311–316.

    Article  PubMed  CAS  Google Scholar 

  69. Becker C, Piironen T, Kiviniemi J, et al.: Sensitive and specific immunodetection of human glandular kallikrein 2 in serum. Clin Chem 2000, 46:198–206.

    PubMed  CAS  Google Scholar 

  70. Partin AW, Catalona WJ, Finlay JA, et al.: Use of human glandular kallikrein 2 for the detection of prostate cancer: preliminary analysis. Urology 1999, 54:839–845.

    Article  PubMed  CAS  Google Scholar 

  71. Grauer LS, Finlay JA, Mikolajczyk SD, et al.: Detection of human glandular kallikrein, hK2, as its precursor form and in complex with protease inhibitors in prostate carcinoma serum. J Androl 1998, 19:407–411.

    PubMed  CAS  Google Scholar 

  72. Saedi MS, Hill TM, Kuus-Reichel K, et al.: The precursor form of the human kallikrein 2, a kallikrein homologous to prostate-specific antigen, is present in human sera and is increased in prostate cancer and benign prostatic hyperplasia. Clin Chem 1998, 44:2115–2119.

    PubMed  CAS  Google Scholar 

  73. Nam RK, Diamandis EP, Toi A, et al.: Serum human glandular kallikrein-2 protease levels predict the presence of prostate cancer among men with elevated prostate-specific antigen. J Clin Oncol 2000, 18:1036–1042.

    PubMed  CAS  Google Scholar 

  74. Klee GG, Young CY, Tindall DJ: Human glandular kallikrein protein. In Prostate-specific Antigen, vol 1. Edited by Brawer MK. New York: Dekker; 2001:283–296.

    Google Scholar 

  75. Kwiatkowski MK, Recker F, Piironen T, et al.: In prostatism patients the ratio of human glandular kallikrein to free PSA improves the discrimination between prostate cancer and benign hyperplasia within the diagnostic “gray zone” of total PSA 4 to 10 ng/mL. Urology 1998, 52:360–365.

    Article  PubMed  CAS  Google Scholar 

  76. Magklara A, Scorilas A, Catalona WJ, Diamandis EP: The combination of human glandular kallikrein and free prostate-specific antigen (PSA) enhances discrimination between prostate cancer and benign prostatic hyperplasia in patients with moderately increased total PSA. Clin Chem 1999, 45:1960–1966.

    PubMed  CAS  Google Scholar 

  77. Becker C, Piironen T, Pettersson K, et al.: Clinical value of human glandular kallikrein 2 and free and total prostatespecific antigen in serum from a population of men with prostate-specific antigen levels 3.0 ng/mL or greater. Urology 2000, 55:694–699.

    Article  PubMed  CAS  Google Scholar 

  78. Epstein JI, Pizov G, Walsh PC: Correlation of pathologic findings with progression after radical retropubic prostatectomy. Cancer 1993, 71:3582–3593.

    Article  PubMed  CAS  Google Scholar 

  79. Pound CR, Partin AW, Epstein JI, Walsh PC: Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urol Clin North Am 1997, 24:395–406.

    Article  PubMed  CAS  Google Scholar 

  80. McNeal JE, Villers AA, Redwine EA, et al.: Capsular penetration in prostate cancer: significance for natural history and treatment. Am J Surg Pathol 1990, 14:240–247.

    Article  PubMed  CAS  Google Scholar 

  81. Narayan P, Gajendran V, Taylor SP, et al.: The role of transrectal ultrasound-guided biopsy-based staging, preoperative serum prostate-specific antigen, and biopsy Gleason score in prediction of final pathologic diagnosis in prostate cancer. Urology 1995, 46:205–212.

    Article  PubMed  CAS  Google Scholar 

  82. Partin AW, Yoo J, Carter HB, et al.: The use of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol 1993, 150:110–114.

    PubMed  CAS  Google Scholar 

  83. Chybowski FM, Keller JJ, Bergstralh EJ, Oesterling JE: Predicting radionuclide bone scan findings in patients with newly diagnosed, untreated prostate cancer: prostate-specific antigen is superior to all other clinical parameters. J Urol 1991, 145:313–318.

    PubMed  CAS  Google Scholar 

  84. Lerner SE, Jacobsen SJ, Lilja H, et al.: Free, complexed, and total serum prostate-specific antigen concentrations and their proportions in predicting stage, grade, and deoxyribonucleic acid ploidy in patients with adenocarcinoma of the prostate. Urology 1996, 48:240–248.

    Article  PubMed  CAS  Google Scholar 

  85. Noldus J, Graefen M, Huland E, et al.: The value of the ratio of free-to-total prostate-specific antigen for staging purposes in previously untreated prostate cancer. J Urol 1998, 159:2004–2007; discussion 2007–2008.

    Article  PubMed  CAS  Google Scholar 

  86. Graefen M, Karakiewicz PI, Cagiannos I, et al.: Percent free prostate-specific antigen is not an independent predictor of organ confinement or prostate-specific antigen recurrence in unscreened patients with localized prostate cancer treated with radical prostatectomy. J Urol 2002, 167:1306–1309.

    Article  PubMed  Google Scholar 

  87. Hara I, Miyake H, Hara S, et al.: Value of the serum prostatespecific antigen-alpha 1-antichymotrypsin complex and its density as a predictor for the extent of prostate cancer. BJU Int 2001, 88:53–57.

    Article  PubMed  CAS  Google Scholar 

  88. Kuriyama M, Ueno K, Uno H, et al.: Clinical evaluation of serum prostate-specific antigen-alpha1-antichymotrypsin complex values in diagnosis of prostate cancer: a cooperative study. Int J Urol 1998, 5:48–54.

    PubMed  CAS  Google Scholar 

  89. Taneja SS, Hsu EI, Cheli CD, et al.: Complexed prostate-specific antigen as a staging tool: results based on a multicenter prospective evaluation of complexed prostate-specific antigen in cancer diagnosis. Urology 2002, 60:10–17.

    Article  PubMed  Google Scholar 

  90. Graefen M, Haese A, Pichlmeier U, et al.: A validated strategy for side specific prediction of organ confined prostate cancer: a tool to select for nerve sparing radical prostatectomy. J Urol 2001, 165:857–863.

    Article  PubMed  CAS  Google Scholar 

  91. Haese A, Becker C, Noldus J, et al.: Human glandular kallikrein 2: a potential serum marker for predicting the organ confined versus non-organ confined growth of prostate cancer. J Urol 2000, 163:1491–1497.

    Article  PubMed  CAS  Google Scholar 

  92. Haese A, Graefen M, Steuber T, et al.: Human glandular kallikrein 2 levels in serum for discrimination of pathologically organconfined from locally-advanced prostate cancer in total PSAlevels below 10 ng/mL. Prostate 2001, 49:101–109.

    Article  PubMed  CAS  Google Scholar 

  93. Recker F, Kwiatkowski MK, Piironen T, et al.: Human glandular kallikrein as a tool to improve discrimination of poorly differentiated and non-organ-confined prostate cancer compared with prostate-specific antigen. Urology 2000, 55:481–485.

    Article  PubMed  CAS  Google Scholar 

  94. Pound CR, Partin AW, Eisenberger MA, et al.: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999, 281:1591–1597.

    Article  PubMed  CAS  Google Scholar 

  95. Stamey TA, Yang N, Hay AR, et al.: Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 1987, 317:909–916.

    Article  PubMed  CAS  Google Scholar 

  96. Bjork T, Ljungberg B, Piironen T, et al.: Rapid exponential elimination of free prostate-specific antigen contrasts the slow, capacity-limited elimination of PSA complexed to alpha 1-antichymotrypsin from serum. Urology 1998, 51:57–62.

    Article  PubMed  CAS  Google Scholar 

  97. Oh J, Colberg JW, Ornstein DK, et al.: Current follow-up strategies after radical prostatectomy: a survey of American Urological Association urologists. J Urol 1999, 161:520–523.

    Article  PubMed  CAS  Google Scholar 

  98. Lange PH, Ercole CJ, Lightner DJ, et al.: The value of serum prostate-specific antigen determinations before and after radical prostatectomy. J Urol 1989, 141:873–879.

    PubMed  CAS  Google Scholar 

  99. Haese A, Huland E, Graefen M, et al.: Ultrasensitive detection of prostate-specific antigen in the follow-up of 422 patients after radical prostatectomy. J Urol 1999, 161:1206–1211.

    Article  PubMed  CAS  Google Scholar 

  100. Stamey TA, Graves HC, Wehner N, et al.: Early detection of residual prostate cancer after radical prostatectomy by an ultrasensitive assay for prostate-specific antigen. J Urol 1993, 149:787–792.

    PubMed  CAS  Google Scholar 

  101. Bostwick DG, Egbert BM, Fajardo LF: Radiation injury of the normal and neoplastic prostate. Am J Surg Pathol 1982, 6:541–551.

    Article  PubMed  CAS  Google Scholar 

  102. Critz FA, Williams WH, Holladay CT, et al.: Post-treatment PSA < or = 0.2 ng/mL defines disease freedom after radiotherapy for prostate cancer using modern techniques. Urology 1999, 54:968–971.

    Article  PubMed  CAS  Google Scholar 

  103. Zagars GK, Pollack A, Kavadi VS, von Eschenbach AC: Prostatespecific antigen and radiation therapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 1995, 32:293–306.

    Article  PubMed  CAS  Google Scholar 

  104. Hanks GE, Perez CA, Kozar M, et al.: PSA confirmation of cure at 10 years of T1B, T2, N0, M0 prostate cancer patients treated in RTOG protocol 7706 with external beam irradiation. Int J Radiat Oncol Biol Phys 1994, 30:289–292.

    PubMed  CAS  Google Scholar 

  105. American Society for Therapeutic Radiology and Oncology Consensus Panel: Consensus statement: guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 1997, 37:1035–1041.

    Article  Google Scholar 

  106. Bruchowsky N: Androgens and antiandrogens. In Cancer Medicine. Edited by Holland JF, Frei E, Bast RC, et al. Philadelphia: Lea & Fibiger; 1993:884–896.

    Google Scholar 

  107. Isaacs JT, Coffey DS: Adaptation versus selection as the mechanism responsible for the relapse of prostatic cancer to androgen ablation therapy as studied in the Dunning R-3327-H adenocarcinoma. Cancer Res 1981, 41:5070–5075.

    PubMed  CAS  Google Scholar 

  108. Gleave ME, Goldenberg SL, Jones EC, et al.: Biochemical and pathological effects of 8 months of neoadjuvant androgen withdrawal therapy before radical prostatectomy in patients with clinically confined prostate cancer. J Urol 1996, 155:213–219.

    Article  PubMed  CAS  Google Scholar 

  109. Miller JI, Ahmann FR, Drach GW, et al.: The clinical usefulness of serum prostate-specific antigen after hormonal therapy of metastatic prostate cancer. J Urol 1992, 147:956–961.

    PubMed  CAS  Google Scholar 

  110. Bruchovsky N, Goldenberg SL, Akakura K, Rennie PS: Luteinizing hormone-releasing hormone agonists in prostate cancer: elimination of flare reaction by pretreatment with cyproterone acetate and low-dose diethylstilbestrol. Cancer 1993, 72:1685–1691.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University Clinic Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Alexander Haese MD

Authors
  1. Alexander Haese MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Markus Graefen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hartwig Huland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans Lilja MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haese, A., Graefen, M., Huland, H. et al. Prostate-specific antigen and related isoforms in the diagnosis and management of prostate cancer. Curr Urol Rep 5, 231–240 (2004). https://doi.org/10.1007/s11934-004-0042-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-004-0042-6

Keywords

Search

Navigation