In the United States in 1995, a new case of prostate cancer was diagnosed on average every 3 minutes. The majority of these newly diagnosed cases were detected through transrectal ultrasound (TRUS)–guided biopsy of the prostate, prompted only by an elevated serum prostatic-specific antigen (PSA) level. Although there is controversy regarding the benefit of early detection of prostate cancer,<sup>36 Litwin M.S., deKernion J.B. Editorial: Perspectives on the problem of prostate cancer J Urol 1994 ;  152 : 1680-1681

Cliccare qui per andare alla sezione Riferimenti</sup> it has been demonstrated that early detection can best be achieved through the use of a combination of digital rectal examination (DRE) and PSA.<sup>12 Catalona W.J., Richie J.P., Ahmann F.R. , e al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men J Urol 1994 ;  151 : 1283-1290

Cliccare qui per andare alla sezione Riferimenti, 35 Littrup P.J., Kane R.A., Mettlin C.J. , e al. Cost-effective prostate cancer detection Cancer 1994 ;  74 : 3146-3158  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 58 Stone N.N., DeAntoni E.P., Crawford E.D. Screening for prostate cancer by digital rectal examination and prostate-specific antigen: Results of prostate cancer awareness week, 1989–1992 Urology 1994 ;  44 : 18-25  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The substantial overlap in serum PSA between men with prostate cancer and men with benign prostatic hyperplasia (BPH)<sup>46 Partin A.W., Carter H.B., Chan D.W. , e al. Prostate specific antigen in the staging of localized prostate cancer: Influence of tumor differentiation, tumor volume and benign hyperplasia J Urol 1990 ;  143 : 747-752

Cliccare qui per andare alla sezione Riferimenti</sup> has prompted a great deal of enthusiasm for the development of better methods of using PSA in the diagnosis and management of men with prostate cancer.<sup>48 Partin A.W., Oesterling J.E. The clinical usefulness of prostate specific antigen: Update 1994 J Urol 1994 ;  152 : 1358-1368

Cliccare qui per andare alla sezione Riferimenti</sup> Four methods have been proposed for improving the clinical usefulness of serum PSA: (1) PSA density,<sup>3 Benson M.C., Whang I.S., Olsson C.A. , e al. Use of prostate specific antigen density to enhance predictive value of intermediate levels of serum prostate specific antigen J Urol 1992 ;  147 : 817-821

Cliccare qui per andare alla sezione Riferimenti, 4 Benson M.C., Whang I.S., Pantuck A. , e al. Prostate specific antigen density: Means of distinguishing benign prostatic hypertrophy and prostate cancer J Urol 1992 ;  147 : 815-816

Cliccare qui per andare alla sezione Riferimenti</sup> (2) PSA velocity,<sup>10 Carter H.B., Pearson J.D., Metter J.E. , e al. Longitudinal evaluation of prostate specific antigen levels in men with and without prostate disease JAMA 1992 ;  267 : 2215-2220

Cliccare qui per andare alla sezione Riferimenti, 52 Smith D.S., Catalona W.J. Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection J Urol 1994 ;  152 : 1163-1167

Cliccare qui per andare alla sezione Riferimenti</sup> (3) use of age-specific PSA reference ranges,<sup>43 Oesterling J.E., Jacobsen S.J., Chute C.G. , e al. Serum prostate-specific antigen in a community-based population of healthy men: Establishment of age-specific reference ranges JAMA 1993 ;  270 : 860-864

Cliccare qui per andare alla sezione Riferimenti</sup> and (4) most recently the molecular forms of PSA.<sup>32 Lilja H. Significance of different molecular forms of serum PSA; the free, non-complexed form of PSA versus that complexed to ⍺₁-antichymotrypsin Urol Clin North Am 1993 ;  20 : 681-686

Cliccare qui per andare alla sezione Riferimenti, 39 McCormack R.T., Rittenhouse H.G., Finlay J.A. , e al. Molecular forms of prostate-specific antigen and the human kallikrein gene family: A new era Urology 1995 ;  45 : 729-744  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 45 Oesterling J.E., Lilja H. Early detection and diagnosis Comprehensive Textbook of Genitourinary Oncology Baltimore: Williams and Wilkens (1995).  668-673

Cliccare qui per andare alla sezione Riferimenti, 51 Prestigiacamo A.F., Stamey T.A. Clinical usefulness of free and complexed PSA Scand J Clin Lab Invest Suppl 1995 ;  221 : 32-34

Cliccare qui per andare alla sezione Riferimenti</sup> The point and counter-point arguments for early detection programs for prostate cancer and the use of PSA as an adjunct for early detection of prostate cancer have been presented elsewhere in this issue. This article outlines the clinical use of PSA for early detection of prostate cancer and focuses primarily on the value of molecular forms of PSA (free PSA, complexed PSA, and total PSA) in the diagnosis of localized prostate cancer.