ONCOLOGY Vol 11 No 4

This phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line

Dr. DeAntoni has carefully reviewed the literature on age-specific reference ranges for prostate-specific antigen (PSA) in the diagnosis of prostate cancer and the controversy surrounding their use. Key to understanding of this debate are two fundamental concepts: (1) the definition of "clinically significant prostate cancer" and (2) the use of sensitivity and specificity, which is frequently obscured by the surrounding rhetoric. The assumption that all readers uniformly interpret the meaning of clinically significant prostate cancer and wish to achieve the same results by manipulating sensitivity and specificity is probably incorrect.

As the number of cases of newly diagnosed prostate cancer has risen dramatically in the United States during the past decade, the management of a rising prostate-specific antigen (PSA) level following definitive therapy has become an increasingly common dilemma. Waxman and associates provide a concise, focused review of many of the key issues and controversies surrounding this dilemma. Several of these issues warrant particular attention.

PSA is the best tumor marker yet discovered. Age-specific reference ranges could improve the sensitivity of PSA by detecting curable, organ-confined tumors.

Controversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.

This article addresses an increasingly common dilemma: the finding of a rising prostate-specific antigen (PSA) level in an asymptomatic patient following radical surgery or radiation therapy for prostate cancer. The incidence of prostate cancer has skyrocketed, and the number of men being treated with radiation or radical prosta-tectomy has similarly increased. The most common basis for the initial diagnosis of prostate cancer is an elevated PSA. For the patient who is already sensitized to PSA as a diagnostic marker, it is extremely distressing to learn that his PSA is rising following radical treatment. This is particularly true for the patient who has experienced a treatment-related adverse effect on quality of life. For the treating physician, this all-too common scenario is disappointing and even guilt-laden.

Dr. DeAntoni provides a timely, critical review of the concept of age-specific prostate-specific antigen (PSA) ranges, as well as other frequently used attempts to improve the accuracy of serum PSA testing in the diagnosis of unsuspected prostate cancer. His review is complete, and his assessments of each of the modalities reflect not only the majority view but also realistic appraisals of the limitations of this less-than-perfect test.