文章：

前列腺特异性抗原与前列腺癌：预测、检测和监测

Prostate-specific antigen and prostate cancer: prediction, detection and monitoring

原文发布日期：2008-04-01

DOI: 10.1038/nrc2351

类型: Review Article

开放获取: 否

要点：

1. Prostate-specific antigen (PSA) is one of the few molecular markers routinely used for detection, risk stratification and monitoring of a common cancer.
2. PSA is specific to the prostate but not to prostate cancer: benign prostate diseases often cause increases in serum PSA and most men with increased PSA do not have prostate cancer.
3. PSA strongly discriminates different cancer stages: it is higher in men with localized disease than in cancer-free controls, is associated with stage and grade in localized disease and is higher in patients with metastatic compared with localized disease.
4. Men with a higher PSA at the time of initial therapy have increased risk of recurrence.
5. PSA is a sensitive indicator of recurrence after radical prostatectomy, but far less sensitive as an indicator of recurrence after radiation therapy.
6. PSA before age 50 is a strong predictor of prostate cancer occurring up to 25 years later.
7. The introduction of PSA as a screening test has led to a sharp increase in the incidence of prostate cancer because there has been a shift to diagnosis at earlier stages and there is probably substantial 'overdiagnosis' — men diagnosed with prostate cancer whose cancer would never have affected their lives if they had not had a PSA test.
8. The effects of PSA screening on prostate cancer mortality are not yet clear.

要点翻译：

1. 前列腺特异性抗原（PSA）是少数常规用于常见癌症检测、风险分层和监测的分子标志物之一。
2. PSA对前列腺具有特异性，但对前列腺癌不具备特异性：良性前列腺疾病常引起血清PSA升高，且多数PSA升高的男性并未罹患前列腺癌。
3. PSA能显著区分不同癌症分期：局部病变患者的PSA水平高于无癌对照组，与局部病变的分期和分级相关，且转移性患者的PSA水平高于局部病变患者。
4. 初始治疗时PSA水平较高的患者复发风险更高。
5. PSA是根治性前列腺切除术后复发的敏感指标，但对放疗后复发的敏感性显著较低。
6. 50岁前的PSA水平可强效预测未来25年内前列腺癌的发生风险。
7. PSA作为筛查手段的推广导致前列腺癌发病率急剧上升，这既因诊断阶段前移，也可能存在显著“过度诊断”——即若未进行PSA检测，本不会影响患者生命的癌症被确诊。
8. PSA筛查对前列腺癌死亡率的影响尚未明确。

英文摘要：

Testing for prostate-specific antigen (PSA) has profoundly affected the diagnosis and treatment of prostate cancer. PSA testing has enabled physicians to detect prostate tumours while they are still small, low-grade and localized. This very ability has, however, created controversy over whether we are now diagnosing and treating insignificant cancers. PSA testing has also transformed the monitoring of treatment response and detection of disease recurrence. Much current research is directed at establishing the most appropriate uses of PSA testing and at developing methods to improve on the conventional PSA test.

摘要翻译： 

前列腺特异性抗原（PSA）检测深刻影响了前列腺癌的诊断和治疗。PSA检测使医生能够在肿瘤尚小、分化良好且局限时发现前列腺癌。然而，正是这种能力引发了争议：我们是否正在诊断和治疗本无临床意义的癌症。PSA检测也改变了治疗反应的监测和疾病复发的发现。当前大量研究致力于确定PSA检测的最适应用场景，并开发方法以改进传统PSA检测。

原文链接：

Prostate-specific antigen and prostate cancer: prediction, detection and monitoring