[The role of prostate-specific antigen in the diagnosis and treatment of prostatic adenocarcinoma]

Abstract

Serum prostate-specific antigen (PSA) levels were determined in four groups of patients with prostatic carcinoma: 230 untreated patients with adenocarcinoma of the prostate after careful clinical staging; in 102 patients with localized prostatic carcinoma who were treated by radical prostatectomy; in 183 patients after radiation therapy for adenocarcinoma of the prostate; and in 45 antiandrogen-treated patients with documented metastatic disease. Within each treatment modality PSA proved to be a powerful tool in predicting stage and prognosis of each patient. In the untreated group the PSA level was directly proportional to advancing clinical stage and Gleason score. The rate of increase of PSA in clinical stage A and B cancer patients suggested a doubling time of at least 2 years. In the group of patients who underwent radical prostatectomy, PSA correlated extremely well with the tumor volume and had a high predictive value for pelvic lymph node metastasis. No patient with pelvic lymph node metastasis achieved an undetectable PSA level following radical prostatectomy without adjunctive therapy. Both anti-androgen and radiation treatment were followed initially by dramatic falls in serum PSA concentrations, but the majority of patients soon experienced a reversal of this initial response, signifying early failure and again providing new information unavailable from any other source.