The availability of post-treatment serum prostate-specific antigen (PSA) levels provides a more precise identification of persistent disease after treatment for localized prostate cancer. Post-treatment serum PSA level has become the primary risk factor for predicting success or likelihood of clinical treatment failure. In addition, the pretreatment serum PSA level now is recognized as a critical prognostic parameter, equally or more so than stage and grade, in estimating the likelihood of a subsequently rising PSA level after a definitive therapy.<sup>8 Fijuth J., Chauvet B., Vincent P. , e al. Serum prostatic-specific antigen in monitoring the response of carcinoma of the prostate to radiation therapy Radiother Oncol 1992 ;  23 : 236-240

Cliccare qui per andare alla sezione Riferimenti, 16 Kuban D., El-Mahdi A., Schellhammer P. Prostate-specific antigen for pretreatment prediction and posttreatment evaluation of outcome after definitive irradiation for prostate cancer Int J Radiat Oncol Biol Phys 1995 ;  32 : 307  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 18 Lee W.R., Hanks G.E., Schultheiss T.E. , e al. Localized prostate cancer treated by external beam radiotherapy alone: Serum prostate-specific antigen: Driven outcome and analysis J Clin Oncol 1995 ;  13 : 464

Cliccare qui per andare alla sezione Riferimenti, 23 Partin A.W., Pound C.R., Clemens J.Q. , e al. Serum PSA after anatomic radical prostatectomy Urol Clin North Am 1993 ;  20 : 713

Cliccare qui per andare alla sezione Riferimenti, 24 Perez C.A. Carcinoma of the prostate: A model for management under impending health care system reform Radiology 1995 ;  196 : 309-322

Cliccare qui per andare alla sezione Riferimenti, 25 Pisansky T.M., Cha S.S., Earle J.D. , e al. Prostate-specific antigen as a pre-therapy prognostic factor in patients treated with radiation therapy for clinically localized prostate cancer J Clin Oncol 1993 ;  11 : 2158-2166

Cliccare qui per andare alla sezione Riferimenti, 39 Zagars G. Serum PSA as a tumor marker for patients undergoing definitive radiation therapy Urol Clin North Am 1993 ;  20 : 737

Cliccare qui per andare alla sezione Riferimenti, 41 Zietman A.L., Coen J.J., Shipley W.U. , e al. Radical radiation therapy in the management of prostatic adenocarcinoma: The initial prostate-specific antigen value as a predictor of treatment outcome J Urol 1994 ;  151 : 640-645

Cliccare qui per andare alla sezione Riferimenti</sup> Several cautions are warranted. The assumption that a rising PSA level serves as a surrogate end point that correlates with survival has not been validated.<sup>31 Schellhammer P, Cockett A, Buccon-Gibod L, et al: Assessment of endpoints for clinical trials for localized prostate cancer. Urology (suppl), in press

Cliccare qui per andare alla sezione Riferimenti</sup> Although the qualitative implication of a rising PSA level after therapy for local disease is persistent and progressive disease, there is insufficient data to quantitate time intervals from PSA failure to first symptoms, disease progression, or death for the individual patient. The detection of a rise in PSA presents the physician with the dilemma of what treatment to recommend, when to initiate the treatment, and how to assess the impact of the treatment on quantity and quality of life. Furthermore, information has arisen to call into question the previously unquestioned organ specificity of PSA. Although PSA expression in cells of the perianal and periurethral glands can be explained by embryologic or anatomic proximity to the prostate, this 30-kd serine protease also has been found in normal and malignant breast tissue, ovary, endometrium, colon, liver, kidney, and, in fact, virtually any tissue expressing hormone receptor activity.<sup>7 Diamandis E.P., Yu H. New biological functions of prostate-specific antigen [editorial]? J Clin Endocrinol Metab 1995 ;  80 : 1515

Cliccare qui per andare alla sezione Riferimenti</sup>

This article specifically discusses the prognostic value of the PSA level before external beam radiation therapy and the role of post-treatment PSA nadir level in predicting progression-free survival.