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From prostate cancer to benign hypertrophy: How do the miraculous changes in PSA affect diagnosis?
Prostate-specific antigen (PSA) is a glycoprotein secreted by epithelial cells in the prostate gland. Its main function is to liquefy semen and promote sperm movement. Although usually present in only trace amounts in the serum of healthy men, PSA levels often rise significantly in conditions such as prostate cancer, prostatitis, and benign prostatic hypertrophy. Therefore, PSA is used as a biomarker for prostate disease. With the advancement of science and technology and medical research, changes in PSA have affected the diagnosis and screening of prostate diseases to some extent.
PSA Screening: The Game Between Benefits and Risks
In the United States, the FDA approves the PSA test as an annual screening tool for men over 50 years old. However, this screening measure is controversial. The medical community still has differing views on the risks of overdiagnosis and overtreatment. Research shows:
Although PSA screening helps one patient avoid dying from prostate cancer, within 10 years 4 to 5 men will still die from prostate cancer despite being screened.
This highlights the conflict between the benefits and risks of PSA screening. Many patients often face anxiety and subsequent unnecessary biopsies after detecting abnormal PSA levels. These procedures may bring pain or the risk of infection. Therefore, doctors have a responsibility to educate patients about the possible risks and benefits before performing PSA screening.
Risk stratification and cancer staging
For men with diagnosed prostate cancer, PSA level is one of three main variables for risk stratification, along with the cancer's Gleason score and clinical stage. According to the D'Amico criteria, men can be divided into three categories: low risk, moderate risk, and high risk. This allows clinicians to develop individualized treatment plans for different risk stratifications.
Post-treatment monitoring and the significance of PSA
For men with previously treated prostate cancer, PSA levels are monitored regularly. After a successful radical prostatectomy, the patient's PSA level should drop to undetectable within a few weeks. However, if PSA levels rise again, it may mean there is a risk of the cancer coming back. The medical community generally defines PSA rigidly as:
After radical prostatectomy, a PSA level above 0.2 ng/mL is generally considered an indicator of cancer recurrence.
This is critical for monitoring cancer patients' recovery. On the other hand, interpretation of PSA levels in patients undergoing radiation therapy is more complicated because low levels of PSA may still be detected even after successful treatment.
The relationship between prostatitis and PSA
In addition to prostate cancer, PSA can also rise significantly in cases of infection or inflammation of the prostate (i.e., prostatitis). In some cases, PSA measurements may help doctors diagnose these conditions, however, relying solely on the PSA number is not always accurate because it can be affected by a combination of factors.
Applications in Forensic Medicine
PSA plays a key role in forensic medicine, particularly in detecting the presence of semen. For example, PSA can be used to indicate the possible presence of semen in a sample. This feature makes it extremely valuable when investigating rape cases. However, this also brings the risk of false positive results, so caution must be taken when using PSA for forensic testing.
Future research directions
As PSA and its changes are better understood, many new studies are underway in an attempt to improve prostate cancer screening and diagnosis. For example, replacing or assisting PSA with more targeted biomarkers is becoming a hot spot in medical research. Through multi-parametric imaging technology and other more precise diagnostic tools, doctors are able to more accurately assess a patient's condition.
Changes in PSA undoubtedly influence the diagnosis of prostate disease, however, the advantages and disadvantages of these tests remain controversial. In the future, how to balance the benefits and potential risks of screening will be a difficult problem that continues to trouble the medical community. Do you think current diagnostic methods are reliable enough, or do they need further improvement?
