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Application of PSA

Prostate cancer is one of the most common tumors in men. The disease is common in older men over 60. Genetic factors, family history, nutritional factors (such as vitamin D deficiency or high calcium intake), obesity and a high-fat diet are all risk factors for prostate cancer. Prostate cancer has a long incubation period, high disability rate and mortality. Due to the introduction and renewal of diagnostic techniques such as PSA testing, as well as the early intervention treatment of diseases, the mortality rate of prostate cancer is gradually decreasing. The latest figures show that the rate of early diagnosis of prostate cancer by PSA has increased 1.6 times and the mortality rate has decreased by 21 percent.

PSA is a proteolytic enzyme produced by prostate epithelial cells. It exists in the cytoplasm of prostate epithelial cells and is normally secreted into prostatic fluid or semen. The majority of PSA in serum comes from prostate gland, which is organ specific. The data showed that PSA and prostate stage are positively correlated, and the higher PSA level is, the higher the probability of prostate cancer is. Therefore, PSA is used as the most sensitive marker of prostate cancer, and is widely used in the early diagnosis, treatment response monitoring and prognosis judgment of prostate cancer. At the same time, PSA combined with rectal fingerprinting can also be used for prostate screening in high-risk groups (family history and age > 50 years old). It is worth noting that PSA level is positively correlated with age. The older the PSA is, the higher the PSA level is, and each age group has its own reference value. Only on this basis can the comparison be more accurate. PSA is a prostate-specific antigen, not a specific antigen for prostate cancer. When prostatitis and benign prostatic hyperplasia occur, PSA can also be increased, so other benign diseases should be excluded. To eliminate benign prostate diseases, simultaneous fPSA testing may be considered. PSA is divided into Tpsa, cPSA, fPSA and Tpsa.Only detecingt fPSA in serum makes little sense to the diagnosis of prostate cancer, but, fPSA/tPSA ratio can be used to identify prostate cancer and benign prostatic hyperplasia: when less than 10 ng/ml (tPSA, fPSA/tPSA can increase the diagnosis of prostate cancer specific degrees, the ratio is usually lower than normal and prostate hyperplasia of prostate cancer patients (usually > 0.25), and fPSA/tPSA is less than 0.16 is highly suggestie of prostate cancer, must further clinical diagnosis.

However, since serum PSA test has been used for prostate cancer screening for more than 20 years, it is controversial whether to carry out universal prostate cancer screening. The data showed that PSA test could not distinguish the aggressive or slow progression of prostate cancer due to the limitation of sensitivity and specificity of PSA test. For slow-moving prostate cancer, screening is unnecessary and even harmful because it can lead to unnecessary invasive biopsies and overtreatment. Therefore, it is necessary to apply PSA test extensively to prostate cancer screening only for high-risk groups (family history, age 55 to 69).

It is worth noting that PSA, as an organ-specific antigen, has long been used only as a screening indicator for prostate cancer, and is only used for men, but not for women. However, more and more studies show that serum PSA test can also be applied to the screening and diagnosis of some clinical diseases in women. The female serum PSA mainly has the mammary gland secretion, the normal situation can see the low level secretion. Benign breast disease and breast cancer patients is significantly higher, PSA PSA levels and molecular forms can be used to distinguish between Ⅰ and Ⅱ breast cyst. Therefore, women can also add PSA and fPSA tests when testing for breast diseases.

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