Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death among men in 2020. For a disease as common as prostate cancer, relatively little is known about its etiology. Established risk factors are limited to advancing age, family history of this malignancy, and certain genetic mutations (eg, BRCA1 and BRCA2) and conditions (Lynch syndrome). [1] prostate-specific antigen (PSA) is the most widely used tumor maker in prostate cancer. Multi-center study found that the percentage of fPSA and PSA help to detect early prostate cancer.
PSA is the most important marker of prostate cancer and is widely used in early detection, aiding diagnosis and recurrence monitoring. Men with a PSA >1 ng/ml at age 40 yr and >2 ng/ml at age 60 yr are at increased risk of PCa metastasis or death several decades later. It is recommended that PSA testing can be taken into account in every 2 years for men at increased risk[2,3].
When PSA is between 4-10ng/ml, the fPSA level is negatively correlated with the incidence of prostate cancer. If fPSA/tPSA,0.25, the probability of prostate cancer is only 8%.
[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338.
[2] Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, Fossati N, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, Matveev VB, Moldovan PC, van den Bergh RCN, Van den Broeck T, van der Poel HG, van der Kwast TH, Rouvière O, Schoots IG, Wiegel T, Cornford P. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017 Apr;71(4):618-629. doi: 10.1016/j.eururo.2016.08.003. Epub 2016 Aug 25. PMID: 27568654.
[3] Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, van der Poel HG, van der Kwast TH, Rouvière O, Wiegel T, Mottet N. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol. 2017 Apr;71(4):630-642. doi: 10.1016/j.eururo.2016.08.002. Epub 2016 Aug 31. PMID: 27591931.
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