Diagnosis by Biopsy the Gold Standard

Biopsy represents the gold standard of prostate cancer diagnosis. There is no better proof of the presence of a cancer than the histologic evidence. It is clear that the incidence of PCa is influenced by the method of prostate sampling. The real incidence of prostate cancer is unknown, as is the natural history concerning size and location within the prostate. In a small series of radical cystoprostatectomy specimens, removed for urothelial carcinoma, small volume prostate cancers were found in...

The Classic Three Prostate Specific Antigen Digital Rectal Examination Transrectal Ultrasonography

Various diagnostic modalities are discussed below, starting with the classic three PSA, DRE, and TRUS. Most early detection efforts focused on these modalities, and each of them was at some time thought to be useful as an independent screening tool. In these studies, younger age was excluded from analysis, based on the clinical presentation of prostate cancer. Age, however turned out to be a valuable tool, especially in relation to PSA, and will be discussed in the section on prostate volume...

Free to Total PSA Ratio

One of the more recent PSA derivatives is the comparison of unbound free PSA to the total amount of PSA in the serum. The PSA can exist as free PSA and as PSA bound to Od-antichymotrypsin ACT or a2-macroglobulin A2M .43'44 The PSA bound to A2M PSA-A2M is anti-genically shielded and not measurable by any PSA assay. The PSA-ACT complex, however, is immunoreactively unique and can be measured in the serum as a separate moiety. As a result, it is possible to compare the amount of free PSA to the...

PSA Density

PSA density PSAD is one such variation and is defined mathematically as total PSA ng mL divided by the volume of the prostate gland cc . The concept of PSAD is based on the assumption that the PSAD calculation would standardize the amount of PSA produced per cubic centimeter of prostate tissue. A volume occupied by cancer will result in a higher serum PSA than a volume occupied by benign tissue. It was postulated that PSAD would be able to identify which patients had an elevated PSA secondary...

Racial Ethnic Epidemiologic Statistics

The clinical incidence of prostate cancer reported by the American Cancer Society in 1997 was 66 higher among African American men than among Caucasian men.9 In the past, the clinical incidence of prostate cancer has ranged from 30 to 50 higher among African Americans than among Caucasians. Also, there have been variations among the two groups in the lifetime risk of being diag nosed with prostate cancer. In 1993, 1 of 11 African Americans was diagnosed with prostate cancer compared to 1 of 9...

Androgen Receptor GGC Repeats

In addition to containing a polymorphic CAG repeat in the transactivation domain, exon one of the androgen receptor also contains a polymorphic GGC repeat. The GGC repeat encodes for a variable number of glycines and is located approximately 1.1 kilobases 3' of the CAG repeat. The variable GGC repeat 4 to 24 triplets follows an invariant GGT 3GGG GGT 2 repeat that also encodes for six consecutive glycines. The median and mean GGC repeat length are both approximately 16.9,10 Unpublished...

Info

Prostate cancer incidence rates by age group at diagnosis and race. Rates are age-adjusted to the 1990 United States standard population. From Merrill RM, Potosky AL, Feuer EJ. Changing trends in U.S. prostate cancer incidence rates. J Natl Cancer Inst 1996 88 1683-5. on SEER public-use data available only through 1993. Because of the rapid rise in the number of incidence cases reported during the early 1990s, the ACS projections initially underestimated and then over-estimated the...

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