Department of Urology, Yale School of Medicine, New Haven, CT.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland.
Urol Oncol. 2025 Jan;43(1):41-48. doi: 10.1016/j.urolonc.2024.06.003. Epub 2024 Jul 17.
Prostate specific antigen (PSA) has transformed the diagnosis and treatment of prostate cancer by enabling early detection at global scale. Due to expression in both benign and malignant cells, PSA-based prostate cancer screening using single cut-points yields imperfect diagnostic performance and has led to the detection and over-treatment of low-grade prostate cancer. Additional challenges in the interpretation of PSA include substantial inter and intrapersonal variation, differences with age and prostate volume, and selection of standardized PSA value cutoffs for clinical application. In response, refinements to PSA including risk and age-based thresholds, age and genetic adjustments, PSA density, percentage free PSA, and PSA velocity have been proposed and extensively studied. In this review, we focus on the clinical role of PSA as a screening biomarker with a particular emphasis on its test characteristics, clinically actionable thresholds, and strategies to refine its clinical interpretation.
前列腺特异性抗原（PSA）通过在全球范围内实现早期检测，改变了前列腺癌的诊断和治疗方式。由于 PSA 在良性和恶性细胞中均有表达，因此基于 PSA 的前列腺癌筛查使用单一切点会导致诊断性能不理想，并导致低级别前列腺癌的过度诊断和治疗。PSA 解读的其他挑战包括个体内和个体间的显著差异、年龄和前列腺体积的差异，以及为临床应用选择标准化 PSA 值截断值。为了解决这些问题，提出了包括风险和年龄为基础的阈值、年龄和遗传调整、PSA 密度、游离 PSA 百分比和 PSA 速度等 PSA 指标的改进方法，并进行了广泛的研究。在这篇综述中，我们重点关注 PSA 作为筛查生物标志物的临床作用，特别强调其检测特征、临床可操作的阈值以及改善其临床解释的策略。
