Salman J W, Schoots I G, Carlsson S V, Jenster G, Roobol M J
Department of Urology, Erasmus Medical Centre, Na-1710, 2040, 3000 CA, Rotterdam, Netherlands.
Adv Exp Med Biol. 2015;867:93-114. doi: 10.1007/978-94-017-7215-0_7.
In this chapter the use of prostate specific antigen (PSA) as a tumor marker for prostate cancer is discussed. The chapter provides an overview of biological and clinical aspects of PSA. The main drawback of total PSA (tPSA) is its lack of specificity for prostate cancer which leads to unnecessary biopsies. Moreover, PSA-testing poses a risk of overdiagnosis and subsequent overtreatment. Many PSA-based markers have been developed to improve the performance characteristics of tPSA. As well as different molecular subforms of tPSA, such as proPSA (pPSA) and free PSA (fPSA), and PSA derived kinetics as PSA-velocity (PSAV) and PSA-doubling time (PSADT). The prostate health index (phi), PSA-density (PSAD) and the contribution of non PSA-based markers such as the urinary transcripts of PCA3 and TMPRSS-ERG fusion are also discussed. To enable further risk stratification tumor markers are often combined with clinical data (e.g. outcome of DRE) in so-called nomograms. Currently the role of magnetic resonance imaging (MRI) in the detection and staging of prostate cancer is being explored.
本章讨论了前列腺特异性抗原（PSA）作为前列腺癌肿瘤标志物的应用。本章概述了PSA的生物学和临床方面。总PSA（tPSA）的主要缺点是其对前列腺癌缺乏特异性，这会导致不必要的活检。此外，PSA检测存在过度诊断和后续过度治疗的风险。为了改善tPSA的性能特征，已经开发了许多基于PSA的标志物。除了tPSA的不同分子亚型，如前PSA（pPSA）和游离PSA（fPSA），以及PSA衍生动力学指标如PSA速度（PSAV）和PSA倍增时间（PSADT）。还讨论了前列腺健康指数（phi）、PSA密度（PSAD）以及非基于PSA的标志物的作用，如PCA3的尿转录本和TMPRSS-ERG融合。为了实现进一步的风险分层，肿瘤标志物通常与临床数据（如直肠指检结果）结合在所谓的列线图中。目前正在探索磁共振成像（MRI）在前列腺癌检测和分期中的作用。
