CA: A Cancer Journal for Clinicians, Vol 39, 361-375, Copyright
© 1989 by American Cancer Society
Prostate-Specific Antigen and Premalignant Change: Implications for Early Detection
Michael K. Brawer MD1 and
Paul H. Lange MD2
1 Chief of Urology in the Department of Surgery at the Veterans Administration Medical Center, and Assistant Professor of Urology at the University of Washington Medical Center, in Seattle, Washington.
2 Professor and Chairman of the Department of Urology at the University of Washington Medical Center in Seattle, Washington.
PSA represents a major advance in our tumor marker armamentarium. PIN fulfills the majority of requirements for a premalignant change. If we could determine a subset of individuals with PIN, an enriched population on which to base screening studies would emerge. In this regard the observation that PIN may be associated with elevation of the serum PSA is particularly intriguing.
Considerable interest exists for early detection of prostate cancer. The high morbidity and mortality associated with this tumor coupled with the late stage at presentation by conventional means underscore the justification for such enthusiasm. However, the wisdom of screening for a cancer for which the mortality is far less than the histologic incidence remains to be proven. In the final analysis, the question is not whether we can detect more carcinoma, but rather whether we can significantly decrease patient morbidity and mortality. Until prospective randomized clinical trials demonstrate the effectiveness of early detection programs for carcinoma of the prostate, it is difficult to recommend such screening to the general public.
