Topic
Prostate-specific antigen
About: Prostate-specific antigen is a research topic. Over the lifetime, 14642 publications have been published within this topic receiving 597231 citations. The topic is also known as: KLK3 & prostate-specific antigen.
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TL;DR: Low-risk patients had estimates of 5-year PSA outcome after treatment with RP, RT, or implant with or without neoadjuvant androgen deprivation that were not statistically different, whereas intermediate- and high- risk patients treated with RP or RT did better then those treated by implant.
Abstract: Context.—Interstitial radiation (implant) therapy is used to treat clinically
localized adenocarcinoma of the prostate, but how it compares with other treatments
is not known.Objective.—To estimate control of prostate-specific antigen (PSA) after radical
prostatectomy (RP), external beam radiation (RT), or implant with or without
neoadjuvant androgen deprivation therapy in patients with clinically localized
prostate cancer.Design.—Retrospective cohort study of outcome data compared using Cox regression
multivariable analyses.Setting and Patients.—A total of 1872 men treated between January 1989 and October 1997 with
an RP (n=888) or implant with or without neoadjuvant androgen deprivation
therapy (n=218) at the Hospital of the University of Pennsylvania, Philadelphia,
or RT (n=766) at the Joint Center for Radiation Therapy, Boston, Mass, were
enrolled.Main Outcome Measure.—Actuarial freedom from PSA failure (defined as PSA outcome).Results.—The relative risk (RR) of PSA failure in low-risk patients (stage T1c,
T2a and PSA level ≤10 ng/mL and Gleason score ≤6) treated using RT,
implant plus androgen deprivation therapy, or implant therapy was 1.1 (95%
confidence interval [CI], 0.5-2.7), 0.5 (95% CI, 0.1-1.9), and 1.1 (95% CI,
0.3-3.6), respectively, compared with those patients treated with RP. The
RRs of PSA failure in the intermediate-risk patients (stage T2b or Gleason
score of 7 or PSA level >10 and ≤20 ng/mL) and high-risk patients (stage
T2c or PSA level >20 ng/mL or Gleason score ≥8) treated with implant compared
with RP were 3.1 (95% CI, 1.5-6.1) and 3.0 (95% CI, 1.8-5.0), respectively.
The addition of androgen deprivation to implant therapy did not improve PSA
outcome in high-risk patients but resulted in a PSA outcome that was not statistically
different compared with the results obtained using RP or RT in intermediate-risk
patients. These results were unchanged when patients were stratified using
the traditional rankings of biopsy Gleason scores of 2 through 4 vs 5 through
6 vs 7 vs 8 through 10.Conclusions.—Low-risk patients had estimates of 5-year PSA outcome after treatment
with RP, RT, or implant with or without neoadjuvant androgen deprivation that
were not statistically different, whereas intermediate- and high-risk patients
treated with RP or RT did better then those treated by implant. Prospective
randomized trials are needed to verify these findings.
3,408 citations
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TL;DR: The guidelines have been updated and level of evidence/grade of recommendation added to the text enables readers to better understand the quality of the data forming the basis of the recommendations.
3,209 citations
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TL;DR: Several clinical parameters help predict the outcomes of men with PSA elevation after radical prostatectomy, and these data may be useful in the design of clinical trials, the identification of men for enrollment into experimental protocols, and counseling men regarding the timing of administration of adjuvant therapies.
Abstract: Context
In men who develop an elevated serum prostate-specific
antigen level (PSA) after having undergone a radical prostatectomy, the
natural history of progression to distant metastases and death due to
prostate cancer is unknown.
Objective
To characterize the time course of disease progression
in men with biochemical recurrence after radical prostatectomy.
Design
A retrospective review of a large surgical series with
median (SD) follow-up of 5.3 (3.7) years (range, 0.5-15 years) between
April 1982 and April 1997.
SettingAn urban academic tertiary referral institution.Patients
A total of 1997 men undergoing radical
prostatectomy, by a single surgeon, for clinically localized prostate
cancer. None received neoadjuvant therapy, and none had received
adjuvant hormonal therapy prior to documented distant metastases.
Main Outcome Measures
After surgery, men were followed up with PSA
assays and digital rectal examinations every 3 months for the first
year, semiannually for the second year, and annually thereafter. A
detectable serum PSA level of at least 0.2 ng/mL was evidence of
biochemical recurrence. Distant metastases were diagnosed by
radionuclide bone scan, chest radiograph, or other body imaging, which
was performed at the time of biochemical recurrence and annually
thereafter.
Results
The actuarial metastasis-free survival for all 1997 men
was 82% (95% confidence interval, 76%-88%) at 15 years after
surgery. Of the 1997 men, 315 (15%) developed biochemical PSA level
elevation. Eleven of these underwent early hormone therapy after the
recurrence and are not included in the study. Of the remaining 304 men,
103 (34%) developed metastatic disease within the study period. The
median actuarial time to metastases was 8 years from the time of PSA
level elevation. In survival analysis, time to biochemical progression
(P<.001), Gleason score (P<.001), and PSA
doubling time (P<.001) were predictive of the probability
and time to the development of metastatic disease. An algorithm
combining these parameters was constructed to stratify men into risk
groups. Once men developed metastatic disease, the median actuarial
time to death was 5 years. The time interval from surgery to the
appearance of metastatic disease was predictive of time until death
(P<.02).
Conclusions
Several clinical parameters help predict the outcomes
of men with PSA elevation after radical prostatectomy. These data may
be useful in the design of clinical trials, the identification of men
for enrollment into experimental protocols, and counseling men
regarding the timing of administration of adjuvant
therapies.
2,854 citations
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TL;DR: After 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.
Abstract: Background The effect of screening with prostate-specific–antigen (PSA) testing and digital rectal examination on the rate of death from prostate cancer is unknown. This is the first report from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial on prostate-cancer mortality. Methods From 1993 through 2001, we randomly assigned 76,693 men at 10 U.S. study centers to receive either annual screening (38,343 subjects) or usual care as the control (38,350 subjects). Men in the screening group were offered annual PSA testing for 6 years and digital rectal examination for 4 years. The subjects and health care providers received the results and decided on the type of follow-up evaluation. Usual care sometimes included screening, as some organizations have recommended. The numbers of all cancers and deaths and causes of death were ascertained. Results In the screening group, rates of compliance were 85% for PSA testing and 86% for digital rectal examination. Rates of screening in the control...
2,758 citations
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TL;DR: Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less--levels generally thought to be in the normal range.
Abstract: Background The optimal upper limit of the normal range for prostate-specific antigen (PSA) is unknown. We investigated the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng per milliliter or less. Methods Of 18,882 men enrolled in the prevention trial, 9459 were randomly assigned to receive placebo and had an annual measurement of PSA and a digital rectal examination. Among these 9459 men, 2950 men never had a PSA level of more than 4.0 ng per milliliter or an abnormal digital rectal examination, had a final PSA determination, and underwent a prostate biopsy after being in the study for seven years. Results Among the 2950 men (age range, 62 to 91 years), prostate cancer was diagnosed in 449 (15.2 percent); 67 of these 449 cancers (14.9 percent) had a Gleason score of 7 or higher. The prevalence of prostate cancer was 6.6 percent among men with a PSA level of up to 0.5 ng per milliliter, 10.1 percent among those with values of 0.6 to 1.0 ng per mi...
2,425 citations