Defining an Optimum PSA-Based Screening Strategy for Young Men

  • Judd W. Moul
Part of the Current Clinical Urology book series (CCU)


Prostate cancer is the most common malignancy in American men, accounting for >29% of all diagnosed cancers and approx 13% of all cancer deaths (1). Nearly one of every six men will be diagnosed with the disease at some time in their lives (1). In 2003 alone, an estimated 221,000 US men were diagnosed with prostate cancer, and more than 28,000 died of the disease (1). Even though population-based screening for prostate cancer has yet to be definitively proved or disproved to affect the disease-specific mortality, this summary explores changes in the PSA era (defined as the time in the United States when the PSA screening test came into widespread clinical use) and the prospects for testing younger men in their fifth decade of life, namely, high-risk and average-risk men between the ages of 40 and 49 yr old.


Prostate Cancer Cancer Detection Rate Prostate Disease Research 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin 2003; 53: 5–26.PubMedCrossRefGoogle Scholar
  2. 2.
    Walsh PC. Using prostate-specific antigen to diagnose prostate cancer: sailing in uncharted waters. Ann Intern Med 1993; 119: 948–949.PubMedGoogle Scholar
  3. 3.
    Woolf SH. Screening prostate cancer with prostate-specific antigen. An examination of the evidence. N Engl J Med 1995; 333: 1401–1405.PubMedCrossRefGoogle Scholar
  4. 4.
    Mettlin C, Jones G, Avetett H, et al. Defining and updating the American Cancer society guidelines for the cancer-related check-up: prostate and endometrial cancers. Cancer J Clin 1993; 43: 42–46.CrossRefGoogle Scholar
  5. 5.
    American Urological Association. Early detection of prostate and cancer use of transrectal ultrasound, in American Urological Association 1992 Policy Statement Book. American Urological Association, Baltimore, MD, 1992, pp. 4–20.Google Scholar
  6. 6.
    US Preventive Service Task Force. Screening for prostate cancer, in Guide to Clinical Preventive Services. 2nd ed. Williams and Wilkins, Baltimore, MD, 1996, p. 119.Google Scholar
  7. 7.
    American College of Physicians. Screening for prostate cancer. Ann Intern Med 1997; 126: 480–484.Google Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Catalona WJ. Screening for prostate cancer (Letter). N Engl J Med 1996; 334: 666–667.CrossRefGoogle Scholar
  10. 10.
    Morrison AS. The effects of early treatment, lead time, and length time bias the mortality experienced by cases detected by screening. Int J Epidemiol 1982; 11: 261–267.PubMedCrossRefGoogle Scholar
  11. 11.
    Jacobsen SJ, Katusic SK, Bergstralh EJ, et al. Incidence of prostate cancer diagnosis in the eras before and after serum prostate specific-antigen. JAMA 1995; 274: 1445–1455.PubMedCrossRefGoogle Scholar
  12. 12.
    Stephenson RA. Population-based prostate cancer trends in the PSA era: data from the Surveillance, Epidemiology, and End Results (SEER) Program. Monogr Urol 1998; 19: 3–19.Google Scholar
  13. 13.
    Farkas A, Schneider D, Perotti M, Cummings KB, Ward WS. National trends in the epidemiology of prostate cancer, 1973 to 1994: evidence for the effectiveness of prostate-specific antigen screening. Urology 1998; 52: 444–448.PubMedCrossRefGoogle Scholar
  14. 14.
    Schwartz KL, Serverson RK, Gurney JG, Montie JE. Trends in the stage specific incidence of prostate carcinoma in the Detroit metropolitan area. Cancer 1996; 78: 1260–1266.PubMedCrossRefGoogle Scholar
  15. 15.
    Threlfall TJ, English DR, Rouse IL. Prostate cancer in Western Australia: trends in incidence and mortality from 1985 to 1996. Med J Aust 1998; 169: 21–24.PubMedGoogle Scholar
  16. 16.
    Roberts RO, Bergstralh EJ, Katusic SK, Lieber MM, Jacobson SJ. Decline in prostate cancer mortality from 1980 to 1997, and an update on incidence trends in Olmsted County, Minnesota. J Urol 1999; 161: 529–533.PubMedCrossRefGoogle Scholar
  17. 17.
    Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 1985; 312: 1604–1608.PubMedCrossRefGoogle Scholar
  18. 18.
    Stephenson RA, Stanford JL. Population based prostate cancer trends in the United States: patterns of change in the era of prostate specific-antigen. World J Urol 1997; 15: 331–335.PubMedCrossRefGoogle Scholar
  19. 19.
    Lefevre ML. Prostate cancer screening: more harm than good? Am Fam Physician 1998; 58: 432–438.PubMedGoogle Scholar
  20. 20.
    Sun L, Gancarczyk K, Paquette EL, et al. Introduction to Department of Defense Center for Prostate Disease Research Multicenter National Prostate Cancer Database and analysis in the PSA era. Urol Onc ol 2001; 6: 203–209.CrossRefGoogle Scholar
  21. 21.
    Oesterling JE, Jacobsen SJ, Chute CG, et al. Serum prostate-specific antigen in a community-based population of healthy men: established age-specific reference ranges. JAMA 1993; 270: 860–864.PubMedCrossRefGoogle Scholar
  22. 22.
    Morgan TO, Jacobsen SJ, McCarthy WF, et al. Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med 1996; 335: 304–310.PubMedCrossRefGoogle Scholar
  23. 23.
    Chodak GW, Thisted RA, Gerber GS, et al. Results of conservative management of clinically localized prostate cancer. N Engl J Med 1994; 330: 242–248.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith CV, Bauer JJ, Connelly RR, et al. Prostate cancer in men age 50 years or younger: a review of the Department of Defense Center for Prostate Disease Research multicenter prostate cancer database. J Urol 2000; 164: 1964–1967.PubMedCrossRefGoogle Scholar
  25. 25.
    Herold DM, Hanlon AL, Movsas B, Hanks GE. Age-related prostate cancer metastases. Urology 1998; 51: 985–990.PubMedCrossRefGoogle Scholar
  26. 26.
    Carter HB, Epstein JI, Partin AW. Influence of age and prostate-specific antigen on the change of curable prostate disease. Urology 1999; 53: 126–130.PubMedCrossRefGoogle Scholar
  27. 27.
    Litwiller SE, Djavan B, Klopukh BV, Richier JC, Roehrborn CG. Radical retropubic prostatectomy for localized carcinoma of the prostate in a large metropolitan hospital: changing trends over a 10 year period (1984–1994). Urology 1995; 45: 813–822.PubMedCrossRefGoogle Scholar
  28. 28.
    Newcomer LM, Stanford JL, Blumenstein BA, Brawer MK. Temporal trends in rates of prostate cancer: declining incidence of advanced stage disease, 1974 to 1994. J Urol 1997; 158: 1427–1430.PubMedCrossRefGoogle Scholar
  29. 29.
    Perez CA, Hanks GE, Leibel SA, Zietman AL, Fuks Z, Lee WR. Localized carcinoma of the prostate (stages T1b, T1c, T2, and T3). Review of Management with external beam radiation therapy. Cancer 1993; 72: 3156–3173.PubMedCrossRefGoogle Scholar
  30. 30.
    Catalona WJ, Smith DS. 5-year tumor recurrence rates after anantomical radical reptropubic prostectectomy for prostate cancer. J Urol 1994; 153: 1837–1842.Google Scholar
  31. 31.
    Smith DS, Catalona WJ. The nature of prostate cancer detected through prostate specific antigen based screening. J Urol 1994; 152: 1732–1736.PubMedGoogle Scholar
  32. 32.
    Vijayakumar S, Vaida F, Weichselbaum R, Hellman S. Race and the Will Rogers phenomenon in prostate cancer. Cancer J Sci Am 1998; 4: 27–34.PubMedGoogle Scholar
  33. 33.
    Partin AW, Kattan MW, Subong EN, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathologic stage of localized prostate cancer: a multi-institutional update. JAMA 1997; 277: 1445–1451.PubMedCrossRefGoogle Scholar
  34. 34.
    Moul JW, Connelly RR, Lubeck DP, et al. Predicting risk of prostate specific antigen recurrence after radical prostatectomy with the Center for Prostate Disease Research and Cancer of the Prostate Strategic Urologic Research Endeavor databases. J Urol 2001; 166: 1322–1327.PubMedCrossRefGoogle Scholar
  35. 35.
    Preston DM, Bauer JJ, Connelly RR, et al. Prostate-specific antigen to predict outcome of external beam radiation for prostate cancer: Walter Reed Army Medical Center experience, 1988–1995. Urology 1999; 53: 131–138.PubMedCrossRefGoogle Scholar
  36. 36.
    Schwartz KL, Grignon DJ, Sakr WA, Wood DP. Prostate cancer histologic trends in the Metropolitan Detroit area, 1982 to 1996. Urology 1999; 53: 769–774.Google Scholar
  37. 37.
    Hankey BF, Feuer EJ, Clegg LX, et al. Cancer surveillance series: interpreting trends in prostate cancer—Part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst 1999; 91: 1017–1024.PubMedCrossRefGoogle Scholar
  38. 38.
    McNeal JE, Redwine EA, Freiha FS, et al. Zonal distribution of prostatic adenoncarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 1988; 12: 897–900.PubMedCrossRefGoogle Scholar
  39. 39.
    Lee F, Siders DB, Torp-Pedersen ST, et al. Prostate cancer: transrectal ultrasound and pathology comparison. A preliminary study of outer gland (peripheral and central zones) and inner gland (transition zone) cancer. Cancer 1991; 67: 1132–1142.PubMedCrossRefGoogle Scholar
  40. 40.
    Chodak GW. The role of watchful waiting in the management of localized prostate cancer. J Urol 1994; 152: 1766–1768.PubMedGoogle Scholar
  41. 41.
    Johansson JE. Expectant management of early stage prostatic cancer: Swedish experience. J Urol 1994; 152: 1753–1756.PubMedGoogle Scholar
  42. 42.
    Albertson PC, Hanley JA, Gleason DF, et al. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 1998; 280: 975.CrossRefGoogle Scholar
  43. 43.
    Gilliland FD, Hunt WC, Key CR. Improving survival for patients with prostate cancer diagnosed in the prostate-specific antigen era. Urology 1996; 48: 67–71.PubMedCrossRefGoogle Scholar
  44. 44.
    Etzioni R, Legler JM, Feuer EJ, Merrill RM, Cronin KA, Hankey BF. Cancer surveillance series: interpreting trends in prostate cancer—Part III: Quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality. J Natl Cancer Inst 1999; 91: 1033–1039.PubMedCrossRefGoogle Scholar
  45. 45.
    Paquette EL, Connelly RR, Sesterhenn IA, et al. Improvements in pathologic staging for African American men undergoing radical retropubic prostatectomy during the prostate specific antigen era: implications for screening a high-risk group for prostate carcinoma. Cancer 2001; 15: 92: 2673–2679.CrossRefGoogle Scholar
  46. 46.
    Labrie F, Candas B, Dupont A, et al. Screening decreases prostate cancer death: first analysis of the 1988 Quebec Prospective Randomized Controlled Trial. Prostate 1999; 38: 83–91.PubMedCrossRefGoogle Scholar
  47. 47.
    Bartsch G, Horninger W, Klocker H, et al. Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria. Urology 2001; 58: 417–424.PubMedCrossRefGoogle Scholar
  48. 48.
    Barry MJ, Roberts RG. Indications for PSA testing. JAMA 1997; 277: 955–956.PubMedCrossRefGoogle Scholar
  49. 49.
    Smith RA, Von Eschenbach AC, Wender R, et al. American Cancer Society Guidelines for Early Detection of Cancer: Update of Early Detection Guidelines for Prostate, Colorectal and Endometrial Cancers. CA Cancer J Clin 2001; 51: 38–75.PubMedCrossRefGoogle Scholar
  50. 50.
    American Urologic Association’s prostate-specific antigen (PSA) Best practice policy. Oncology 2000; 14: 267–286.Google Scholar
  51. 51.
    Moul JW. Screening for prostate cancer in African Americans. Curr Urol Rep 2000; 1: 57–64.PubMedCrossRefGoogle Scholar
  52. 52.
    Young CD, Lewis P, Weinberg V, et al. The impact of race on freedom from prostate-specific antigen failure in prostate cancer patients treated with definitive radiation therapy. Semin Urol Oncol 2000; 18: 121–126.PubMedGoogle Scholar
  53. 53.
    Fowler JE Jr, Bigler SA. Racial differences in prostate carcinogenesis. Histologic and clinical observations. Urol Clin North Am 2002; 29: 183–191.PubMedCrossRefGoogle Scholar
  54. 54.
    Fowler JE Jr, Bigler SA, Farabaugh PB, Wilson SS. Prostate cancer detection in Black and White men with abnormal digital rectal examination and prostate specific antigen less than 4 ng/ml. J Urol 2000; 164: 1961–1963.CrossRefGoogle Scholar
  55. 55.
    Bunker CH, Patrick AL, Konety BR, et al. High prevalence of screening-detected prostate cancer among Afro-Caribbeans: The Tobago Prostate Cancer Survey. Cancer Epidemiol Biomarkers Prev 2002; 11: 726–729.PubMedGoogle Scholar
  56. 56.
    Steinberg GD, Carter BS, Beaty TH, Childs B, Walsh PC. Family history and the risk of prostate cancer. Prostate 1990; 17: 337–347.PubMedCrossRefGoogle Scholar
  57. 57.
    Spitz MR, Currier RD, Fueger JJ, Babaian RJ, Newell GR. Familial patterns of prostate cancer: a case-control analysis. J Urol 1991; 146: 1305–1307.PubMedGoogle Scholar
  58. 58.
    Gronberg H, Damber L, Damber JE. Studies of genetic factors in prostate cancer in a twin population. J Urol 1994; 152: 1484–1487.PubMedGoogle Scholar
  59. 59.
    Gronberg H, Damber L, Damber JE. Familial prostate cancer in Sweden. Cancer 1996; 77: 138–143.PubMedCrossRefGoogle Scholar
  60. 60.
    Bauer JJ, Srivastava S, Connelly RR, et al. Significance of familial history of prostate cancer to traditional prognostic variables, genetic biomarkers, and recurrence after radical prostatectomy. Urology 1998; 51: 970–976.PubMedCrossRefGoogle Scholar
  61. 61.
    Valeri A, Cormier L, Moineau MP, et al. Targeted screening for prostate cancer in high risk families: early onset is a significant risk factor for disease in first degree relatives. J Urol 2002; 168: 483–487.PubMedCrossRefGoogle Scholar
  62. 62.
    Gann PH, Hennekens CH, Stamfer JJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostate cancer. JAMA 1995; 273: 289–294.PubMedCrossRefGoogle Scholar
  63. 63.
    Fang J, Metter EJ, Landis P, Chan DW, Morrell CH, Carter HB. Low levels of prostae-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging. Urology 2001; 58: 411–416.PubMedCrossRefGoogle Scholar
  64. 64.
    DeAntoni EP, Crawford ED, Oesterling JE, et al. Age-and race-specific reference ranges for prostate-specific antigen from a large community based study. Urology 1996; 48: 234–238.PubMedCrossRefGoogle Scholar
  65. 65.
    Hartzell JD, Kao T, Holland JC, et al. Age-specific reference ranges for prostate specific antigen in young men: retrospective study from the National Defense University. Prostate J 2002; 3: 36–41.CrossRefGoogle Scholar
  66. 66.
    Chautard D, Daver A, Mermod B, Tichet A, Bocquillon V, Soret JY. Values for the free to total prostate-specific antigen ratio as a function of age: necessity of reference range validation. Eur Urol 1999; 36: 181–186.PubMedCrossRefGoogle Scholar
  67. 67.
    Weinrich MC, Jacobsen SJ, Weinrich SP, et al. Reference ranges for serum prostate-specific antigen in black and white men without cancer. Urology 1998; 52: 967–973.PubMedCrossRefGoogle Scholar
  68. 68.
    Oesterling JE, Jacobsen SJ, Klee GG, et al. Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios. J Urol 1995; 154: 1090–1095.PubMedCrossRefGoogle Scholar
  69. 69.
    Anderson JR, Strickland D, Corbin D, Byrnes JA, Zweiback E. Age-specific reference ranges for serum prostate-specific antigen. Urology 1995; 46: 54–57.PubMedCrossRefGoogle Scholar
  70. 70.
    Cooney KA, Strawderman MS, Wojno KJ, et al. Age-specific distribution of serum prostate-specific antigen in a community-based study of African-American men. Urology 2001; 57: 91–96.PubMedCrossRefGoogle Scholar
  71. 71.
    Imai K, Ichinose Y, Kubota Y, Yamanaka H, Sato J. Diagnostic significance of prostate specific antigen and the development of a mass screening system for prostate cancer. J Urol 1995; 154: 1090–1095.CrossRefGoogle Scholar
  72. 72.
    Preston DM, Levin LI, Jacobson DJ, et al. Prostate-specific antigen levels in young white and black men 20 to 45 years old. Urology 2000; 56: 812–816.PubMedCrossRefGoogle Scholar
  73. 73.
    Moul JW, Connely RR, Barko WF, Vaitkus M. Should healthy men between the age of 40–49 be screened for prostate cancer: a Department of Defense (DOD), Center for Prostate Disease Research (CPDR), and Army Physical Fitness Research Institute (APFRI) prospective study at the U.S. Army War College (USAWC). J Urol 1999;163:4, suppl.Google Scholar
  74. 74.
    Moul JW, Sesterhenn IA, Connelly RR, et al. Prostate-specific antigen values at the time of prostate cancer diagnosis in African-American men. JAMA 1995; 274: 1277–1281.PubMedCrossRefGoogle Scholar
  75. 75.
    Moul JW, Connelly RR, Mooneyhan RM, et al. Racial differences in tumor volume and prostate specific antigen among radical prostatectomy patients. J Urol 1999; 162: 394–397.PubMedCrossRefGoogle Scholar
  76. 76.
    Smith DS, Carvalhal GF, Mager DE, Bullock AD, Cantolona WJ. Use of lower prostate specific antigen cutoffs for prostate cancer screening in black and white men. J Urol 1998; 160: 1734–1738.PubMedCrossRefGoogle Scholar
  77. 77.
    Recker F, Kwiatkowski MK, Huber A, Stamm B, Lehmann K, Tscholl R. Prospective detection of clinically relevant prostate cancer in the prostate specific antigen rang 1 to 3 ng/ml combined with free-to-total ratio 20% or less: the Aarau experience. J Urol 2001; 166: 851–855.PubMedCrossRefGoogle Scholar
  78. 78.
    Nixon RG, Lilly JD, Liedtke RJ, Batjer JD. Variation of free and total prostate-specific antigen levels: the effect on the percent free/total prostate-specific antigen. Arch Pathol Lab Med 1997; 121: 385–391.PubMedGoogle Scholar
  79. 79.
    Prestigiacomo AF, Stamey TA. Physiological variation of serum prostate specific antigen in the 4.0 to 10.0 ng./ml. range in male volunteers. J Urol 1996; 155: 1977–1980.PubMedCrossRefGoogle Scholar
  80. 80.
    Morote J, Encabo G, Lopez M, De Torres IM. Individual variations of total and percent free serum prostatic specific antigen: could they change the indication of prostatic biopsy? Oncol Rep 1999; 6: 887–890.PubMedGoogle Scholar
  81. 81.
    Ornstein DK, Smith DS, Rao GS, Basler JW, Ratliff TL, Catalona WJ. Biological variation of total, free and percent free serum prostate specific antigen levels in screening volunteers. J Urol 1997; 157: 2179–2182.PubMedCrossRefGoogle Scholar
  82. 82.
    Eastham JA, Riedel E, Scardino PT, et al. Variation of serum prostate-specific antigen levels: an evaluation of year-to-year fluctuations. JAMA 2003; 289: 2695–2700.PubMedCrossRefGoogle Scholar
  83. 83.
    Tchetgen MB, Song JT, Strawderman M, Jacobsen SJ, Oesterling JE. Ejaculation increases the serum prostate-specific antigen concentration. Urology 1996; 47: 511–516.PubMedCrossRefGoogle Scholar
  84. 84.
    Netto NR Jr, Apuzzo F, de Andrade E, Srulzon GB, Cortado PL, Lima ML. The effects of ejaculation on serum prostate specific antigen. J Urol 1996; 155: 1329–1331.PubMedCrossRefGoogle Scholar
  85. 85.
    Heidenreich A, Vorreuther R, Neubauer S, Westphal J, Engelmann UH, Moul JW. The influence of ejaculation on serum levels of prostate specific antigen. J Urol 1997; 157: 209–211.PubMedCrossRefGoogle Scholar
  86. 86.
    Herschman JD, Smith DS, Catalona WJ. Effect of ejaculation on serum total and free prostate-specific antigen concentrations. Urology 1997; 50: 239–243.PubMedCrossRefGoogle Scholar
  87. 87.
    Yavascaoglu I, Savci V, Oktay B, Simsek U, Ozyurt M. The effects of ejaculation on serum prostate-specific antigen (PSA). Int Urol Nephrol 1998; 30: 53–58.PubMedCrossRefGoogle Scholar
  88. 88.
    Stenner J, Holthaus K, Mackenzie SH, Crawford ED. The effect of ejaculation on prostate-specific antigen in a prostate cancer-screening population. Urology 1998; 51: 455–459.PubMedCrossRefGoogle Scholar
  89. 89.
    Zisman A, Soffer Y, Siegel YI, Paz A, Lindner A. Postejaculation serum prostate-specific antigen level. Eur Urol 1997; 32: 54–57.PubMedGoogle Scholar
  90. 90.
    Kao GD, Devine P. Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy. Cancer 2000; 88: 615–619.PubMedCrossRefGoogle Scholar
  91. 91.
    Jones HA, Metz JM, Devine P, Hahn SM, Whittington R. Rates of unconventional medical therapy use in patients with prostate cancer: standard history versus directed questions. Urology 2002; 59: 272–276.PubMedCrossRefGoogle Scholar
  92. 92.
    Ostrow MJ, Cornelisse PG, Heath KV, et al. Determinants of complementary therapy use in HIV-infected individuals receiving antiretroviral or anti-opportunistic agents. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 15: 115–120.PubMedCrossRefGoogle Scholar
  93. 93.
    Allen T, Thomson WM, Emmerton LM, Poulton R. Nutritional supplement use among 26-year-olds. N Z Med J 2000; 14; 113: 274–277.Google Scholar
  94. 94.
    Heuschkel R, Afzal N, Wuerth A, et al. Complementary medicine use in children and young adults with inflammatory bowel disease. Am J Gastroenterol 2002; 92: 382–388.CrossRefGoogle Scholar
  95. 95.
    Gerber GS, Zagaja GP, Bales GT, Chodak GW, Contreras BA. Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology 1998; 51: 1003–1007.PubMedCrossRefGoogle Scholar
  96. 96.
    Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 1996; 29: 231–240.PubMedCrossRefGoogle Scholar
  97. 97.
    Guess HA, Gormley GJ, Stoner E, Oesterling JE. The effect of finasteride on prostate specific antigen: review of available data. J Urol 1996; 155: 3–9.PubMedCrossRefGoogle Scholar
  98. 98.
    Cooper CS, Perry PJ, Sparks AE, Maclndoe JH, Yates WR, Williams RD. Effect of exogenous testosterone on prostate volume, serum and semen prostate specific antigen levels in healthy young men. J Urol 1998; 159: 441–443.PubMedCrossRefGoogle Scholar
  99. 99.
    Douglas TH, Connelly RR, McLeod DG, Erickson SJ, Barren R 3rd, Murphy GP. Effect of exogenous testosterone replacement on prostate-specific antigen and prostate-specific membrane antigen levels in hypogonadal men. J Surg Oncol 1995; 59: 246–250.PubMedCrossRefGoogle Scholar
  100. 100.
    Oremek GM, Seiffert UB. Physical activity releases prostate specific antigen (PSA) from the prostate gland into blood and increases serum PSA concentrations. Clin Chem 1996; 42: 691–695.PubMedGoogle Scholar
  101. 101.
    Crawford ED 3rd, Mackenzie SH, Safford HR, Capriola M. The effect of bicycle riding on serum prostate specific antigen levels. J Urol 1996; 156: 103–105.PubMedCrossRefGoogle Scholar
  102. 102.
    Swain RA, Montalto N, Ross D. The effect of long-distance cycling on the prostate-specific antigen level. Arch Fam Med 1997; 6: 500–502.PubMedCrossRefGoogle Scholar
  103. 103.
    Leventhal EK, Rozanski TA, Morey AF, Rholl V. The effects of exercise and activity on serum prostate specific antigen levels. J Urol 1993; 150: 893–894.PubMedGoogle Scholar
  104. 104.
    Tymchuk CN, Tessler SB, Aronson WJ, Barnard RJ. Effects of diet and exercise on insulin, sex hormone-binding globulin, and prostate-specific antigen. Nutr Cancer 1998; 31: 127–131.PubMedCrossRefGoogle Scholar
  105. 105.
    Roehl KA, Antenor JA, Catalona WJ. Robustness of free prostate specific antigen measurements to reduce unnecessary biopsies in the 2.6 to 4.0 ng/ml range. J Urol 2002; 168: 922–925.PubMedCrossRefGoogle Scholar
  106. 106.
    Haese A, Dworschack RT, Partin AW. Percent free prostate specific antigen in the total prostate specific antigen 2 to 4 ng/ml range does not substantially increase the number of biopsies needed to detect clinically significant prostate cancer compared to the 4 to 10 ng/ml range. J Urol 2002; 168: 504–508.PubMedCrossRefGoogle Scholar
  107. 107.
    Fang J, Metter EJ, Landis P, Carter HB. PSA velocity for assessing prostate cancer risk in men with PSA levels between 2.0 and 4.0 ng/ml. Urology 2002; 59: 889–893.PubMedCrossRefGoogle Scholar
  108. 108.
    Ellis WJ, Etzioni R, Vessella RL, Hu C, Goodman GE. Serial prostate specific antigen, free-to-total prostate specific antigen ratio and complexed prostate specific antigen for the diagnosis of prostate cancer. J Urol 2001; 166: 93–98.PubMedCrossRefGoogle Scholar
  109. 109.
    Crawford ED, Chia D, Andriole GL, et al. PSA testing interval reduction in screening intervals: data from the prostate lung, colorectal and ovarian cancer ( PLCO) screening trial. Proc ASCO 2002; 21.Google Scholar
  110. 110.
    Nijs HG, Essink-Bot ML, DeKoning HJ, Kirkels WJ, Schroder FH. Why do men refuse or attend population-based screening for prostate cancer? J Public Health Med 2000; 22: 312–316.PubMedCrossRefGoogle Scholar
  111. 111.
    Crawford ED, Leewansangtong S, Goktas S, Holthaus K, Baier M. Efficiency of prostate-specific antigen and digital rectal examination in screening, using 4.0 ng/ml and age-specific reference range as a cutoff for abnormal values. Prostate 1999; 38: 296–302.PubMedCrossRefGoogle Scholar
  112. 112.
    Lujan Galan M, Paez Borda A, Romero Cajigal I, et al. Role of PSA velocity in the detection of prostate cancer. A study of 986 males. Actas Urol Esp 2001; 25: 139–139.Google Scholar
  113. 113.
    Stirling BN, Shockley KF, Carothers GG, Maatman TJ. Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology 2002; 60: 89–92.PubMedCrossRefGoogle Scholar
  114. 114.
    Brawer MK, Meyer GE, Letran JL, et al. Measurement of complexed PSA improves specificity for early detection of prostate cancer. Urology 1998; 52: 372–378.PubMedCrossRefGoogle Scholar
  115. 115.
    Brawer MK, Cheli CD, Neaman IE, et al. Complexed prostate specific antigen provides significant enhancement of specificity compared with total prostate specific antigen for detecting prostate cancer. J Urol 2000; 163: 1476–1480.PubMedCrossRefGoogle Scholar
  116. 116.
    Maeda H, Arai Y, Aoki Y, Okubo K, Okada T, Maekawa S. Complexed prostate-specific antigen and its volume indexes in the detection of prostate cancer. Urology 1999; 54: 225–228.PubMedCrossRefGoogle Scholar
  117. 117.
    Okihara K, Cheli CD, Partin AW, et al. Comparative analysis of complexed prostate specific antigen, free prostate specific antigen and their ratio in detecting prostate cancer. J Urol 2002; 167: 2017–2023.PubMedCrossRefGoogle Scholar
  118. 118.
    Tanguay S, Begin LR, Elhilali MM, et al. Comparative evaluation of total PSA, free/total PSA, and complexed PSA in prostate cancer detection. Urology 2002; 59: 261–265.PubMedCrossRefGoogle Scholar
  119. 119.
    Okihara K, Fritsche HA, Ayala A, Johnston DA, Allard WJ, Babaian RJ. Can complexed prostate specific antigen and prostatic volume enhance prostate cancer detection in men with total prostate specific antigen between 2.5 and 4.0 ng./ml? J Urol 2001; 165: 1930–1936.PubMedCrossRefGoogle Scholar
  120. 120.
    Horninger W, Cheli CD, Babaian RJ, et al. Complexed prostate-specific antigen for early detection of prostate cancer in men with serum prostate-specific antigen levels of 2 to 4 nanograms per milliliter. Urology 2002; 60 (4 suppl 1): 31–35.PubMedCrossRefGoogle Scholar
  121. 121.
    Petricoin EF III, Ardekani AM, Liotta LA, et al. Use of proteomic patterns in serum to identify ovarian cancer. Lancet 2002; 359: 572–577.PubMedCrossRefGoogle Scholar
  122. 122.
    Adam BL, Qu Y, Wright GL Jr, et al. Serum protein fingerprinting coupled with a pattern-matching algorithm distinguishes prostate cancer from benign prostate hyperplasia and healthy men. Cancer Res 2002; 62: 3609–3614.PubMedGoogle Scholar
  123. 123.
    Cazares LH, Adam BL, Wright GL Jr, et al. Normal, benign, preneoplastic and malignant cells have distinct protein expression profiles resolved by surface enhanced laser desorption/ionization mass spectrometry. Clin Cancer Res 2002; 8: 2541–2552.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Judd W. Moul

There are no affiliations available

Personalised recommendations