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| J Korean Med Assoc > Volume 53(2); 2010 > Article |
Abstract
The purpose of this article is to summarize up-to-date changes and policies in the diagnosis of prostate cancer. The triads of DRE (digital rectal examination), serum PSA (prostate specific antigen), and TRUS (transrectal ultrasound) that directed prostatic biopsy have been considered a gold standard in the early detection of prostate cancer. Even though PSA is a very useful test, its low specificity has made some controversy until now. Moreover, it is not verified whether PSA screening would contribute to the decline in prostate cancer mortality. TRUS directed prostate biopsy also has some criticisms. For example, appropriate number of biopsy core, determination of whether a patient should undergo a repeat biopsy and its timing remain controversial. This article presents guidelines on prostate cancer diagnosis with partial results of randomized controlled trials to verify aforementioned criticisms Since recently published trials show different results regarding the impact of prostate cancer screening on mortality, further analyses are needed to determine the specific parameters for optimal screening (i.e. the age at which screening should begin, re-screening intervals, the age at which screening should be discontinued, and novel screening biomarkers). Unless a new and effective screening biomarker is discovered, PSA will maintain a superlative position for screening of prostate cancer. Hence, we have to find an optimal cut-off value of PSA derivatives for Korean people. With respect to prostate biopsy, current literatures support the use of more extensive biopsy techniques to increase the likelihood of prostate cancer detection.
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Figure 1
The cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; p=0.04). (Schroder, et al.(9) reproduced with permission of the publisher, NEJM).
Figure 2
Number of prostate cancer deaths. Through 10 years, there was little difference between the two groups in terms of the proportion of deaths according to tumor stage. (Andriole, et al.(11) reproduced with permission of the publisher, NEJM).
Table 1
Up- to-date guidelines on prostate cancer screening
*AUA 2009 refer to the AUA Best Practice Statement 2009
PSA: prostate-specific antigen, PSAV: PSA velocity, DRE: digital rectal examination, AUA: American Urologic Association, EAU: European Urology, NCCN: National Comprehensive Cancer Network, ACS : American Cancer Society, USPSTF: United States Preventive Services Task Force
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