Prostate-specific antigen: what's new in 1997

When used alone, prostate-specific antigen (PSA) is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity, PSA density, and age-related PSA values were developed. Although PSA velocity provides excellent results, its determination requires three PSA values over a 2-year period. The value of PSA density rests on the accurate determination of prostatic volume by transurethral ultrasound (TRUS), which is examiner-dependent. Age-specific reference ranges appear to be more sensitive in men under age 60 than in those over 60. The molecular forms of PSA, especially the percentage of free PSA, seem to be useful tools for the detection of prostate cancer in men with slightly elevated total PSA. New molecular techniques, such as the reverse transcriptase-polymerase chain reaction (RT-PCR), enable the detection of minimal amounts of PSA messenger RNA (mRNA). Human kallikrein 2 (hK2), a serine protease closely related to PSA that also is expressed predominantly in the prostate, may be a new marker for prostate cancer.