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Numerous efforts have been made to improve the effectiveness
of diagnosis of early prostate cancer. Two articles in the current Prostate
Update address this issue. The use of the free-to-total PSA ratio has become
common in an effort to improve the specificity of this test. Dr. Michael Brawer
in his article, argues for the use of complex PSA as a more specific marker
for prostate cancer detection. The data presented suggests that the single test
for complex PSA (complexed to alpha-1-antichymotrypsin) provides equivalent
sensitivity and specificity as compared with the free-to-total PSA ratio. This
contrast with the authors’ earlier report which had indicated increased
specificity. Readers are referred to the recent article by Stamey et al. on
this topic in the Journal of Urology, 163:119, 2000. The next issue of Prostate
Update will feature a contribution on free PSA.
The article by Shinohara looks at refinement in biopsy technique. The use of
sextant biopsies was a major advance in prostate cancer detection. Numerous
studies, not surprisingly, have shown that increasing the number of biopsies
increases the prostate cancer yield. How many biopsies are enough? Not only
number but the site of the biopsies are important as addressed in this article.
Curtis Nickel provides an update on the activities of the International Prostatitis
Collaborative Network (IPCN). It is reassuring to see the increase in research
activity occurring in regard to this common and frustrating clinical problem.
Dr. E. W. Ramsey
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