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Transkript

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2 GX\DUOÕOÕNLOHVDSWDPDNWDKDVWD\ÕEL\RSVLGHQNXUWDUDELOPHNWHGLUKDVWDODUÕQµ 6RQXo RODUDN.$DQDOL]LSURVWDWNDQVHULQLQ QJ U OPHVLQGHGH HUOLELUDUDoRODUDNJ U QPHNWHGLU $QDKWDU.HOLPHOHU 3URVWDWNDQVHUL3URVWDWHVSHFLILFDQWLJHQ.DUDUD DFÕDQDOL]L *LULú Prostat NDQVHULHUNHNWHHQVÕNUDVWODQÕODQNDQVHUGLU [1]. Neyse ki, serum Prostate Specific Antigen (PSA), \Dú, Dijital Rektal 0XD\HQH'50\DUGÕPÕ\ODW P U QHUNHQG QHPGHWHúKLVHGLOPHVL mümkündür. +DVWDGDSURVWDWNDQVHULQGHQú SKHOHQLOGL LQGHKHNLPELUEL\RSVLDOÕQPDVÕQÕ QHULU. Kimi zaman, J oo EXOJXODUQHGHQL\OHEL\RSVLNDUDUÕYHUPHNNROD\GÕUgWH\DQGDQH HUEXlgular gri alandaysa, hekim ve hasta gereksiz yere biyopsi alõqpdvõ YH\D YDURODQ SURVWDW NDQVHULQLQ DWODQPDVÕ JLEL ULVNOHUOHLoLoHELUNDUDUYHUPHN]RUXQGDNDOÕU [2]. +DVWDQÕQ VHUXPXQGD EXOXQD PSA UXWLQ ELU EL\RNLP\DVDO LúOHPOH NROD\FD Oo OHELOLU. Serum düzeyinin 4 ng/ml ]HULQGHROPDVÕSURVWDWNDQVHULRODVÕOÕ ÕQÕQJ VWHUJHVLRODUDNDOJÕODQÕUYHKDVWD NDQVHUDoÕVÕQGDQNOLQLNGH HUOHQGLUPH\HDOÕQÕU. *HQLúHUNHNVHULOHULQGH\DSÕODQoDOÕúPDODUGDVHUXP 36$ Oo P Q QLOHELUOLNWH'50NRPELQHRODUDNGH HUOHQGLULOGL LQGHNDQVHULVDSWDPDDoÕVÕQGDQ ID\GDOÕ ROGX X J U OP úw U [3, 4]. gwh \DQGDQ GL HU ED]Õ odoõúpdodu 36$ QÕQ GX\DUOÕOÕ Õ YH VHoLFLOL LNRQXVXQGDFLGGLVRUXLúDUHWOHULRUWD\DNR\PXúWXU [5, 6]. *HUHNVL] EL\RSVLOHUGHQ NDoÕQPDN DPDFÕ\OD 1989 den beri PSA nõq WDQÕVDO GR UXOX XQX J oohqgluphn LoLQ odoõúpdodu \DSÕOPDNWDGÕU [7]. Bu amaçla, ancak transrektal ultrasonografi (TRUS) \DUGÕPÕ\OD Oo OHELOHQ PSA \R XQOX X ve transizyonel bölgenin PSA \R XQOX X JLEL kayudpoduruwd\doõnpõúwõu [8, 9]. TRUS ile saptanan SURVWDWKDFPLFLGGLGH LúNHQOLNJ VWHUHELOLU 'DKDVÕ, TRUS KHU\HUGHEXOXQPD\DELOLU]DPDQDOÕFÕGÕUYHJ UHFHRODUDNSDKDOÕGÕU. 36$ QÕQ VHoLFLOL LQL DUWÕUPDN LoLQ UHJUHV\RQ DQDOL]L \DSD\ VLQLU D ODUÕ YH QRPRJUDPODU JLEL NDUPDúÕN \ QWHPOHU GH YDUGÕU [10-14]. Bu yöntemlerle yararoõ VRQXoODU HOGH HGLOPHNOH ELUOLNWH EXQODUKHQ ]J QO NUXWLQHJLUHFHNNDGDUoDOÕúÕOPDPÕúWÕU. Free PSA (fpsa) RUDQÕ (serum fpsa/psax100) \DUGÕPÕ\OD VHoLFLOL LQ DUWÕUÕODELOHFH L GH QH V U OP úw U. fpsasod]pdsurwhlqohulqhed OÕROPD\DQ36$PLNWDUÕGÕU [15]. %DúNDELUoDOÕúPD\D J UH IUHH 36$ RUDQÕ \DOQÕ]FD 36$ \D J UH GDKD ID]OD GX\DUOÕOÕ D VDKLSWLU. Free PSA RUDQÕQÕQ WHQN o NROPDVÕKDOLQGH4-10 ng/ml DUDOÕ ÕQGDGX\DUOÕOÕNELOGLULOPLúWLU[16]. %HOOL ELU FR UDIL DODQGDNL KDVWDODUÕQ LQFHOHQGL L EDúND ELU odoõúpdgd NDQVHUOHULQ LQLQ 36$ QÕQ1 3 ng/ml DUDOÕ ÕQGDROPDVÕKDOLQGHIUHH36$RUDQÕQÕQ QLQDOWÕQGDROGX XROJXODUGD UDVWODQGÕ ÕELOGLULOPLúWLU [17]. %LUEDúNDoDOÕúPD\D J UH[18], tarama popülasyonunda free PSA RUDQÕQÕQ LQDOWÕQGDROGX XROJXODUGD LQ VW QGHROGX XROJXODUDJ UHGDKDVÕNNDQVHU görülmektedir. Türki\H GH \DSÕODQ ELU odoõúpdgd J UH, IUHH 36$ RUDQÕQÕQ UHFeiver operator characteristic (ROC) area under curve (AUC) GH HUL0.553 olarak bildirilmlúwlu. 3URVWDWÕFF QLQ DOWÕQGDRODQROJXODUGDLVHDrea under the ROC curve ti [19]. )UHH 36$ \Õ GD LoHUHQ orn GH LúNHQOL PRGHOOHU JHQHOOLNOH EX GH LúNHQLQ HN ELU GH HUL ROGX X sonucunu verir [20]. <LQHGHIUHH36$GH HULGLNNDWOHHOHDOÕQPDOÕGÕU o QN ED]ÕDQDOL] QFHVLYH NOLQLNIDNW UOHUIUHH36$RUDQÕQÕHWNLOH\HELOLU)ree PSA 4 C YH\DRGDVÕFDNOÕ ÕQGDLQVWDELOGLU WH yandan büyük prostatlarda bir dilüsyon etkisinden söz edilebilir [8]..DUDU D DoODUÕQÕQ ROXúWXUXOPDVÕ LoLQ ELUNDo DOJRULWPD YDUGÕU. Bunlardan birisi Loh and Shih 69

3 WDUDIÕQGDQ JHOLúWLULOHQ QUEST tir (Quick, Unbiased and Efficient Statistical Tree) [21]. Karar D DFÕQÕROXúWXUDQalgoritma, ROJXODUÕELUNDoULVN G ]H\LQHD\ÕUÕU. Bu algoritma, sadece verilerin DUDúWÕUÕOPDVÕ\ NVHNULVNOLDOWJUXSODUÕQEHOLUOHQPHVLHWNLOHúLPOHULQEHOLUOHQPHVLYH\DSURJQRVWLN faktörlerin LQFHOHQPHVLDPDFÕ\ODNXOODQÕODELOLU..DUDU D DFÕ DQDOL]L úlpgl\h NDGDU WÕSWD ohúlwol SUREOHPOHULQ DQDOL]LQGH NXOODQÕOPÕúWÕU EXQODUÕQ içinde prostat kanserinin öngörülphvl SUREOHPL GH YDUGÕU. Garzotto YH DUNDGDúODUÕ [22] prostat NDQVHULú SKHVLRODQKDVWDODUGDclassification and regression tree (CART) anall]llohelundudud DFÕ ROXúWXUPXúWXU. Serum PSA düzeyi QJP/RODQKDVWDLQFHOHQPLúWLU. Analiz, demografik, laboratuvar ve ultrason verilerini içermektedir. &$57 DQDOL]L LOH DWODQDQ ROJXODUÕQ Gleason skoru 6 YH\D GDKD D] RODQ ROJXODUGÕU. ROC curve analizine göre CART ile lojistik regresyon modelleri EHQ]HUGR UXOX DVDKLSWLU (VÕUDVÕ\ODAUC= 0.74 ve 0.72). %XoDOÕúPDGDYHUL setinde free PSA yoktur. PSA W P U WDUDPDVÕQGD NXOODQÕODQ HQ QHPOL EHOLUWHoWLU, IDNDW GX\DUOÕOÕ Õ YH VHoLFLOL L ]D\ÕIWÕU. 36$ QÕQGX\DUOÕOÕ ÕYHVHoLFLOL LQLDUWÕUPDNLoLQJ Q P ]HNDGDUoHúLWOLoDOÕúPDODU\DSÕOPÕúWÕU. Bu odoõúpdqõq DPDFÕQUEST anall]llohhoghhglohqndudud DFÕQÕQGH HULQLLQFHOHPHNWLU. *HUHoYH< QWHP 2OJXODU Akdeniz Üniversitesi Hastanesi ne Ocak 2001 ile Nisan 2007 DUDVÕQGDEDúYXUDQW P QH7586 HúOL LQGH EL\RSVL \DSÕOPÕú ROJXODU LQFHOHQPLúWLU. øqfhohqhn dönemde, 1830 hastaya ilk prostat EL\RSVLVL\DSÕOPÕúWÕU. %XoDOÕúPDGDserum fpsa GH HULEDNÕOPÕúYHVHUXPPSA GH HUL 0-10 ng/ml DUDVÕQGDRODQROJXGDKLOHGLOPLúWLU 2OJXODUÕQSURVWDWÕQGDQHQD]DOWÕSDUoDEL\RSVLDOÕQPÕúWÕUYH tümünün histopatolojik WDQÕODUÕPHYFXWWXU. $QDOL] Veriler, forward stepwise lojistik regresyon analizi (LR) YH.DUDU $ DFÕ DQDOL]L.$ LOH LQFHOHQPLúWLU. +HUELU\DNODúÕPLoLQROC AUC KHVDSODQPÕúWÕU.$GÕúÕQGDNLWHVWOHUSPSS 11.0 (SPSS Inc., Chicago) LOH\DSÕOPÕúWÕU. Tüm LVWDWLVWLNVHODQDOL]OHULNL\ QO G UYHDOIDGH HUL0.05 RODUDN NDEXO HGLOPLúWLU..DUDU D DFÕ DQDOL]L QUEST Classification Tree LOH \DSÕOPÕúWÕU (version 1.9.2, $QDOL]GHED ÕPOÕGH LúNHQWDQÕGÕUYHPDOLJQLOHEHQLJQROPDN ]HUHLNLVÕQÕIWDQROXúPDNWDGÕU. %D ÕPVÕ] GH LúNHQOHU úxqodugõu \Dú (nümerik), PSA (nümerik), free PSA (nümerik), free PSA RUDQÕ(nümerik), Dijital Rektal Muayene I (DRM I, ovõqõinegatif, ú SKHOL, pozitif), DRM II (iki VÕQÕInegatif- ú SKHli veya pozitif). Veri rastjhohúhnloghodoõúpd(%75) ve test (validasyon) (%25) JUXSODUÕQDE O QP úw U. <DQOÕú VÕQÕIODPD EHGHOL HúLW ROPD\DFDN úhnlogh D\DUODQPÕúWÕU NDQVHU ROJXVXQXQ EHQLJQ RODUDN VÕQÕIODQPDVÕQÕQEHGHOLDOWÕNDWGDKD\ NVHNWLU. < QWHP ddoõúpdjuxexqxq(n=562) RUWDODPD\DúÕVWDQGDUWVDSPDVÕ W 2UWDQFD PSA düzeyi 5.65 ng/ml, ortanca fpsa düzeyi 0.95 ng/ml RODUDN VDSWDQGÕ. '50 ROJXODUÕQ %47.5 unda normal, %15.3 QGH ú SKHOL 37.2 sinde pozitifti. Doksan sekiz (%17.4) olguda kanser VDSWDQPÕúWÕYHEXQODUGDQ21 (%3.2) tanesi yüksek grade maligndi (Gleason grade 70

4 QUEST algoritmdvõ GH LúLN G ]H\GH NDQVHU ROPD RODVÕOÕ Õ RODQ EHú JUXS VDSWDGÕ (ùhnlo 1): (1) PSA VÕ 5.98 ng/ml den yüksek; (2) PSA QJP/ve DRM ú SKHOi veya pozitif; (3) PSA 5.98 ng/ml ve DRE negatif ve fpsa 0.81 den yüksek; (4) PSA QJP/ve DRM negatif ve fpsa ve \Dú 36$ QJP/ve DRM negatif ve fpsa ve \Dú 57 den yüksek. %XJUXSODUGDNDQVHURUDQÕVÕUDVÕ\OD %25, %15, %0, %4 ve %16 idi. Üçüncü ve dördüncü G POHULQQHJDWLIRODUDNNDEXOHGLOPHVLKDOLQGH, sistem GX\DUOÕOÕNLOHNDQVHUKDVWDVÕQGDQ 97 tanesini saptamakta, 74 olguyu (%13) biyopsiden kurtarabilmektedir. ùhnlo48(67dqdol]llohhoghhglohqndudud DFÕ Test grubu (n=188) LOH DQDOL] WHNUDUODQPÕú VLVWHP GX\DUOÕOÕN LOH NDQVHU KDVWDVÕQGDQ WDQHVLQL VDSWDPÕúWÕU. ddoõúpd JUXEX LOH WHVW JUXEXQXQ NDUúÕODúWÕUÕOPDVÕ 7DEOR, GH J VWHULOPLúWLU ho QF G PGHoDOÕúPDJUXEXQGDGDWHVWJUXEXQGDGDNDQVHU KDVWDVÕ\RNWXU' UG QF G PGH LNLNDQVHUKDVWDVÕYDUGÕUEXQODUGDQELULoDOÕúPDJUXEXQGDELULGHWHVWJUXEXQGDGÕU%XLNLKDVWD Gleason grade 5 ve 6 GÕU (G ú N grade). 7DEOR.DUDUD DFÕVRQXoODUÕQÕQoDOÕúPDYHWHVWJUXSODUÕQGDNDUúÕODúWÕUPDVÕ ' P ddoõúpdjuxexndqvhuwrsodp NDQVHU\ ]GHVL 1 62/251, 25% 22/98, 22% 2 30/205, 15% 11/58, 19% 3 0/47, 0% 0/14, 0% 4 1/27, 4% 1/7, 14% 5 5/32, 16% 2/11, 18% Toplam 98/562, 17% 36/188, 19% 71 7HVWJUXEXNDQVHUWRSODP NDQVHU\ ]GHVL

5 QUEST ile eldhhglohqvrqxoodud\qõidnw UOHUNXOODQÕODUDN UHWLOPLú lojistik regresyon modeli ile NDUúÕODúWÕUÕOGÕ..DUDU D DFÕQÕQ ROC curve AUC GH HUL 0.62 KHVDSODQGÕ (95% J YHQ DUDOÕ ÕQGD ). /RMLVWLN UHJUHV\RQ PRGHOLQGH \Dú (p=0.036), DRM (p=0.001) ve PSA (p=0.001) LVWDWLVWLNVHO RODUDN DQODPOÕ GH LúNHQOHUGL YH AUC 0.68 di (95% J YHQ DUDOÕ ÕQGD ). <DOQÕ]FDI36$RUDQÕLoLQAUC GH HUL0.56 idi (95% J YHQDUDOÕ ÕQGD ). <XNDUÕGDNL$8& KHVDSODUÕW PYHULVHWL ]HULQGHQ\DSÕOGÕ. Benign olgularda yaúdj UHIPSA G ]H\OHULYHI36$RUDQÕùHNLO GHJ VWHULOPLúWLU. Serum fpsa G ]H\L\DúLOHUOHGLNoH\ NVHOPHNWHYHserum fpsa RUDQÕ55-59 \DúJUXEXQDNDGDUD]DOÕUNHQGDKD VRQUDNL\DúJUXSODUÕQGDDúDPDOÕRODUak yükselmektedir. 6HUXPIUHH36$QJP/ 1,6 1,4 1,2 1 0,8 0,6 0,4 0,2 0 DOWÕ üstü <Dú Free PSA Free PSA/PSA )UHH36$36$ ùhnlo.dqvhuropd\dqrojxodugdruwdqfdi36$yhi36$rudqõgh HUOHUL 7DUWÕúPD %X odoõúpd LOH SURVWDW NDQVHULQLQ QJ U OPHVL SUREOHPLQGH LON NH] QUEST NDUDU D DFÕ DQDOL]L NXOODQÕOPÕúWÕU. 'DKD QFHNLOLWHUDW UGHD\QÕSUREOHP48(67 HEHQ]HUELUDOJRULWma olan CART ile DQDOL] HGLOPLúWLU. %X odoõúpdgd 433 KDVWDQÕQ demografik verileri, DRM ve TRUS VRQXoODUÕ serum PSA G ]H\OHUL NXOODQÕOPÕúWÕU [22]. %X odoõúpdqõq VRQXoODUÕ EL]LPNL LOH ELUH ELU NDUúÕODúWÕUÕODELOLUQLWHOLNWHGH LOGLUo QN EXoDOÕúPDGDEL]LPoDOÕúPDPÕ]GDNXOODQÕODQI36$YHULVL EXOXQPD]NHQ EL]LP odoõúpdpõ]gd GD sözü edilen odoõúpdgd NXOODQÕODQ 7586 YHULOHUL NXOODQÕOPDPDNWDGÕU. %XoDOÕúPDGDHOGHHGLOHQNDUDUD DFÕEL]HoRNG ú NNDQVHURODVÕOÕ ÕRODQLNLG PYHUPLúWLU(a) serum PSA VÕ6 ng/ml DOWÕQGD, DRM si negatif ve serum fpsa düzeyi 0.81 ng/ml üzerinde olan olgular, (b) serum PSA VÕ 6 ng/ml DOWÕQGD, DRM si negatif, serum fpsa düzeyi QJP/ve \Dú olan olgular. %XPRGHOoDOÕúPDJUXEXQGDWHVWJUXEXQGDGX\DUOÕOÕNJ VWHUPLúWLU. 0RGHOHJ UHPLQLPDOELUGX\DUOÕOÕNND\EÕLOHROJXODUÕQ EL\RSVLGHQNXUWXODELOLU. KA AUC GH HUL fpsa RUDQÕQÕQ$8&GH HULQGHQKDILI\ NVHN/5$8&GH HULQGHQKDILIG ú NW UIDNDW 72

6 modeli anlamak da, klinik uygulamada kullanmak da görece olarangdkdnrod\gõu. LRNDUPDúÕN KHVDSODUD JHUHNVLQLPGX\PDNYHXoGH HUOHUGHVDSPDODU J VWHUPHN JLEL LNL QHPOLGH]DYDQWDMD sahiptir. %XPRGHOLQLOJLQoELUVRQXFXGDKDYDUGÕUserum PSA düzeyi 6 ng/ml DOWÕQGD, DRM si negatif ve serum fpsa düzeyi 0.81 LQDOWÕQGDRODQROJXODULNLG PHE O QPHNWHGLU. %XQODUÕQLoLQGH \DúÕQGDQN o NHUNHNOHUNDQVHURODVÕOÕ ÕQDVDKLSNHQGDKD\DúOÕHUNHNOHUGHEXRUDQ GÕU %XQRNWDGDELUKDWÕUODWPDGD \DSÕOPDOÕGÕU \DSÕODQDQDOL]I36$RUDQÕQÕGH LOGHI36$G ]H\LQL seçmiúwlu fpsa RUDQÕ fpsa QÕQELUW UHYLGLUYHG ú NI36$ OÕROJXODUGDI36$RUDQÕQÕQGDG ú N ROPDH LOLPLYDUGÕU. ' ú N fpsa RUDQÕQÕQNDQVHULKWLPDOLQLDUWÕUGÕ ÕJHQHORODUDNELOLQPHNWHGLU DQFDNEXRUDQLOH\DúÕQLOLúNLVLL\LoDOÕúÕOPDPÕúELUNRQXGXU KA anaol]lqhj UHI36$ QÕQG ú N ROGX XJHQoKDVWDODUGDH HUserum PSA 6 ng/ml QLQDOWÕQGDLVHYH'50QHJDWLIVHNDQVHULKWLPDOL \ NVHNGH LOGLU. <DNÕQODUGD\DSÕODQELUoDOÕúPDGDI36$ QÕQ44-50 \DúODUÕQGDNLHUNHNOHUGHNDQVHU LOHLOLúNLVLROPDGÕ ÕELOGLULOPLúWLU [23]..DQVHUROPD\DQROJXODUÕQGDKDLOHULLQFHOHPHVLQGHRUWDQFD fpsa RUDQÕQÕQ \DúÕQD NDGDU LQ DOWÕQGD ROGX X J U OP úw U. $PHULND %LUOHúLN 'HYOHWOHUL QGH\DSÕODQELUoDOÕúPDGD [24], ortanca fpsa \DúODUÕQGDNL0.22 ng/ml iken 80 \DúYH ]HULQGHEXGH HU0.58 ng/ml \HNDGDUoÕNPDNWDGÕU. %L]LPoDOÕúPDPÕ]GDD\QÕ\DúJUXSODUÕ LoLQVÕUDVÕLOH 0.40 ve 1.30 GH HUOHULHOGHHGLOPLúWLU. 6 ] HGLOHQoDOÕúPDGDRUWDQFDfPSA RUDQÕQÕQ ohúlwol\dújuxsoduõqgd28 ile %30 DUDVÕQGDR\QDGÕ ÕJ U OP úw U. Bizim çalõúpdpõ]gdfpsa RUDQÕ ohúlwol \Dú JUXSODUÕQGD DUDVÕQGD GH LúPHNWHGLU. %X VRQXoODUD J UH GH LúLN toplumlarda serum fpsa düzeyinin daha yüksek ve fpsa RUDQÕQÕQ G ú N ROPDVÕ P PN QG U. ddoõúpdpõ]gd fpsa RUDQÕQÕQ GH LúNHQOL LQLQ GH \ NVHN ROGX X J ]OHndi. Bu durum, odoõúpdpõ]õq \DSÕVÕQD GD ED OÕ RODELOLU o QN EDWÕ WRSOXPODUÕQGDNL odoõúpdodu JHQHOOLNOH popülasyon WDUDPDVÕ LOH HOGH HGLOHQ ROJXODUD GD\DQÕUNHQ EL]GH E \OH ELU VLVWHPDWLN \RNWXU. Bu YHULOHUVDGHFHEL\RSVLDOÕQDQROJXODUDDLWWLU. 'L HUELUPXKWHPHOVHEHSHWQLNIDUNOÕOÕNODURODELOLU 'DKD QFH7 UNL\H GH\DSÕODQELUoDOÕúPDGD[19], fpsa RUDQÕQÕQEL\RSVLVRQXFXLOHLOLúNLVLQLQN W ROGX XELOGLULOPLúWLU. 6RQXo %X odoõúpdqõq VRQXoODUÕQD J UH serum PSA VÕ 6 ng/ml DOWÕQGD serum fpsa VÕ 0.81 ng/ml VW QGH YH '50 VL QHJDWLI ELU ROJXGD NDQVHU RODVÕOÕ Õ orn G ú NW U. %XQD HN RODUDN ( HU \DúÕQGDQN o NELUROJXGDVerum PSA düzeyi 6 mg/dl QLQDOWÕGDYH DRM negatifse bu olgudan VHUXPI36$WHWNLNLLVWHPHQLQJHUH LROPD\DELOLUo QN EXoDOÕúPDQÕQVRQXoODUÕna göre bu tip bir KDVWDGDI36$GH HULQLQNDQVHr QJ U V QHELUNDWNÕVÕ\RNWXU %XVRQXoODUIDUNOÕHWQLNJUXSODUGD I36$ YH I36$ RUDQÕQÕQ D\QÕ DQODPD JHOPH\HELOHFH LQL G ú QG UPHNWHGLU. fpsa QÕQ YH fpsa RUDQÕQÕQ\DúODLOLúNLVLQLLQFHOHPHNLoLQGDKDID]ODoDOÕúPD\DSÕOPDOÕGÕU. %XoDOÕúPDGD.$D DFÕ DQDOL]LEHNOHQPHGLNEXOJXODUYHUPLúWLUEXQGDQGROD\ÕNDUPDúÕNWÕEELSUREOHPOHULQLQFHOHQPHVL LoLQ\DUDUOÕELUDUDoROGX XQXG ú Q \RUX]..D\QDNoD [1] Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, CA Cancer J Clin 2007;57: [2] Tricoli JV, Schoenfeldt M, Conley BA. Detection of prostate cancer and predicting progression: current and future diagnostic markers. Clin Cancer Res 2004;10(12 Pt 1): [3] Labrie F, Dupont A, Suburu R, et al. Serum prostate specific antigen as pre-screening test for prostate cancer. J Urol 1992;147(3 Pt 2): [4] Catalona WJ, Smith DS, Ratliff TL, et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324: , Erratum in: N Engl J Med 1991;325: 1324,

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