[Prostate specific antigen in individual cancer checkups and in therapeutic treatment]

Prostate specific antigen (PSA) has become the most important tumor marker in Oncology. Its importance ranges from early detection of prostate cancer until therapy decision making in hormone refractory cancer To prevent initial PSA "terrorism" in early detection the patient must be well informed about risk of prostate cancer and therapeutic options inclusively possible side effects. Does the man at risk agree further evaluation by biopsy has to be performed directly above a PSA cutoff 4.0 ng/ml. A high percentage of free PSA is not allowed to prolong diagnostic procedure. A diagnostic "grey zone" does not exist anymore. In the PSA range 2.0-3.9 ng/ml, yearly measurement is to propose. PSA levels below 2.0 ng/ml allow control every second year About 2-9% of newly detected cancers are clinically insignificant. Models based on PSA, Gleason Score and tumor load of biopsies are helpful in identifying these men for "watchful waiting" in curative intent.

"Not every early detected cancer must be cured, but cancer where cure is necessary, must be early detected!" After primary therapy (operation/radiotherapy) one third of men will document a PSA only relapse. 30% of them will develop clinical symptoms and possible die from disease. PSA and especially PSA doubling time is a promising marker to identify these men at risk for whom salvage radiotherapy, salvage prostatectomy or hormonal therapy can be an option. However the benefit in survival must be weight against a possible loss in quality of life.