Fitzpatrick John M, Banu Eugeniu, Oudard Stephane
Mater Misericordiae Hospital and University College Dublin, Dublin, Ireland.
BJU Int. 2009 Mar;103(5):578-87. doi: 10.1111/j.1464-410X.2009.08345.x. Epub 2009 Feb 6.
The successful management of prostate cancer requires early detection, appropriate risk assessment and optimum treatment. To this end, much research has been conducted over many years with the goal of identifying a reliable and easily measurable tumour marker that could be used on a large scale for the diagnosis, staging and monitoring of the disease. Prostate-specific antigen (PSA) was independently discovered by two groups in the 1960s and 1970s, in semen and prostate tissue, and given different names. It later became evident that these proteins were encoded by the same gene and were the same protein. PSA was then identified as a useful marker for assessing patients with prostate cancer during their follow-up. In 1986, PSA was approved by the United States Food and Drug Administration to monitor prostate cancer, and in 1994 approved as a tool for detecting the disease in men aged > or =50 years. PSA is now the most widely used serum marker for detecting and monitoring prostate cancer, but its use as a diagnostic marker is controversial because it has several limitations, including its low specificity (PSA levels are also increased in benign prostatic hyperplasia, and in general inflammatory responses) and low sensitivity. Furthermore, PSA levels are highly variable over time, and PSA poorly distinguishes indolent from aggressive cancers. As such, the use of PSA level as a diagnostic tool can lead to over-detection of cancers that pose little threat to health and/or life. Moreover, the impact of PSA screening on prostate cancer mortality rates remains controversial, and will do so until the results of currently ongoing randomized controlled studies in Europe and the USA become available. To overcome the limitations of using PSA, research on PSA kinetics has developed considerably in the last decade. We review publications on the added value of PSA kinetics compared with single PSA measurements in the early detection of prostate cancer, and in predicting the outcome of patients with localized and advanced disease.
前列腺癌的成功管理需要早期检测、适当的风险评估和最佳治疗。为此，多年来已经进行了大量研究，目标是确定一种可靠且易于测量的肿瘤标志物，可大规模用于该疾病的诊断、分期和监测。前列腺特异性抗原（PSA）在20世纪60年代和70年代由两组分别在精液和前列腺组织中独立发现，并被赋予了不同的名称。后来发现这些蛋白质由同一基因编码，是同一种蛋白质。随后，PSA被确定为在前列腺癌患者随访期间评估病情的有用标志物。1986年，PSA被美国食品药品监督管理局批准用于监测前列腺癌，1994年被批准作为检测50岁及以上男性该疾病的工具。PSA现在是检测和监测前列腺癌最广泛使用的血清标志物，但其作为诊断标志物存在争议，因为它有几个局限性，包括特异性低（良性前列腺增生以及一般炎症反应中PSA水平也会升高）和敏感性低。此外，PSA水平随时间变化很大，PSA难以区分惰性癌和侵袭性癌。因此，将PSA水平用作诊断工具可能导致对健康和/或生命威胁不大的癌症过度检测。此外，PSA筛查对前列腺癌死亡率的影响仍存在争议，在欧洲和美国目前正在进行的随机对照研究结果出来之前，这种争议将一直存在。为了克服使用PSA的局限性，在过去十年中，关于PSA动力学的研究有了很大发展。我们综述了与单次PSA测量相比，PSA动力学在前列腺癌早期检测以及预测局限性和晚期疾病患者预后方面的附加值的相关出版物。
