Partin Alan W, Hanks Gerald E, Klein Eric A, Moul Judd W, Nelson William G, Scher Howard I
Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287, USA.
Oncology (Williston Park). 2002 Aug;16(8):1024-38, 1042; discussion 1042, 1047-8, 1051.
Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a recent roundtable discussion, examines whether PSA measurements can be used rationally in several clinical settings. Following radical prostatectomy and radiation therapy, prediction of survival by PSA level is most reliable in high-risk patients. PSA doubling time after radiation therapy is the strongest predictor of biochemical failure. PSA measurements have been associated with inconsistent results following hormonal treatment; reduced PSA levels may result from antiandrogen treatment, which decreases expression of the PSA gene, and therefore, the level of PSA production. In the setting of primary and secondary cancer prevention, PSA is important in risk stratification when selecting patients for studies. Part 1 of this two-part article, which concludes in the September issue, focuses on the physiology of PSA, its measurement and use in clinical practice, and its predictive value following radical prostatectomy and radiation therapy.
尽管前列腺特异性抗原（PSA）检测对前列腺癌的检测和管理产生了影响，但关于其作为疾病活动标志物的有用性仍存在争议。本综述基于最近的一次圆桌讨论，探讨了PSA测量在几种临床情况下是否能合理使用。在根治性前列腺切除术和放射治疗后，PSA水平对高危患者生存的预测最为可靠。放射治疗后PSA倍增时间是生化失败的最强预测指标。激素治疗后PSA测量结果不一致；抗雄激素治疗可能导致PSA水平降低，因为抗雄激素治疗会降低PSA基因的表达，从而降低PSA的产生水平。在原发性和继发性癌症预防方面，在选择研究患者时，PSA在风险分层中很重要。这篇分两部分的文章的第一部分将于9月刊出，重点介绍PSA的生理学、其在临床实践中的测量和应用，以及根治性前列腺切除术和放射治疗后的预测价值。
