In 1996, an estimated 317,000 new cases of prostate cancer will be diagnosed in the United States, and an estimated 41,000 men will die of this disorder.<sup>26Parker S.L., Tong T., Bolden S., e al. Cancer Statistics, 1996 CA Cancer J Clin 1996 ;  46 : 5 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Clearly, cancer of the prostate is an important disease process that deserves the attention of clinicians and researchers alike. Managing prostate cancer in a clinically efficient manner ultimately will allow improved economic conditions that will serve our community. For this reason, efforts have been made to improve many facets of the management of prostate cancer, including staging. Scientists continue to seek molecular, clinical, and radiographic aids to develop a refined, low-cost, and precise staging system.

Traditionally, the standard initial staging evaluation for the newly diagnosed prostate cancer patient included the digital rectal examination (DRE), serum prostatic acid phosphatase (PAP) measurement, a chest radiograph, and a radionuclide bone scan. In more recent years, important clinical data<sup>15Lowe F., Trauzzi S. Prostatic acid phosphatase in 1993: Its limited clinical utility Urol Clin North Am 1993 ;  20 : 589-595

Cliccare qui per andare alla sezione Riferimenti, 20Myrtle J., Klimley P., Ivor L., e al.   Clinical utility of prostate-specific antigen (PSA) in the management of prostate cancer : Adv Cancer Diag, Hybritech, Inc (1986). 

Cliccare qui per andare alla sezione Riferimenti, 23Oesterling J.E., Chan D., Epstein J., e al. Prostate specific antigen in the preoperative and postoperative evaluation of localized prostatic cancer treated with radical prostatectomy J Urol 1988 ;  139 : 766-772

Cliccare qui per andare alla sezione Riferimenti, 24Oesterling J., Martin S., Bergstralh E., e al. The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer JAMA 1993 ;  269 : 57-60

Cliccare qui per andare alla sezione Riferimenti, 29Stamey T., Kabalin J., Ferrari M. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate: III. Radiation treated patients J Urol 1989 ;  141 : 1084-1087

Cliccare qui per andare alla sezione Riferimenti, 30Stamey T., Kabalin J., Ferrari M., e al. Prostate specific antigen in the diagnoses and treatment of adenocarcinoma of the prostate. IV: Anti-androgen treated patients J Urol 1989 ;  141 : 1088-1090

Cliccare qui per andare alla sezione Riferimenti</sup> have permitted prostate-specific antigen (PSA) essentially to replace PAP as a staging tumor marker. Under specific clinical situations, PSA also may replace other staging modalities, such as the radionuclide bone scan.

This article discusses the rationale and methods for using the serum PSA level to eliminate the radionuclide bone scan as a staging tool in many patients with newly diagnosed prostate cancer. Specific clinical scenarios in which this elimination is applicable are outlined and reviewed in the discussion that follows.