Prostate-Specific Antigen: Critical Issues for the Practicing Physician  HERBERT C. RUCKLE, M.D., GEORGE G. KLEE, M.D., PH.D.,, JOSEPH E. OESTERLING, M.D.  Mayo Clinic Proceedings  Volume 69, Issue 1, Pages 59-68 (January 1994) DOI: 10.1016/S0025-6196(12)61614-0 Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Probability of prostate cancer as function of prostate-specific antigen (PSA) density. For PSA density of 0.15, risk of prostate cancer is approximately 12%. (From Benson and associates.20 By permission of the American Urological Association.) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Serum prostate-specific antigen (PSA) concentration as function of time before diagnosis of prostatic condition. Note substantial increase in serum value years before local or regional cancer or metastatic cancer was diagnosed. BPH=benign prostatic hyperplasia. (From Carter and associates.26 By permission of the American Medical Association.) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Serum prostate-specific antigen (PSA) concentration as function of age. Scattergram of individual serum PSA values for 471 men; nomogram demonstrates 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles for serum PSA on basis of age. (From Oesterling and associates.23 By permission of the American Medical Association.) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Diagnostic algorithm for using age-specific prostate-specific antigen (PSA) reference ranges and digital rectal examination (DRE) to detect clinically significant prostate cancers at early, curable stage. TRUS = transrectal ultrasonography. (From Oesterling and associates.31 By permission of Saunders.) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Effect of digital rectal examination (DRE) on serum prostate-specific antigen (PSA) concentration for men in study group (order of tests: PSA, DRE, PSA) and men in control group (order of tests: PSA, PSA, DRE). (Data from Chybowski and associates.36) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 6 Effect of finasteride therapy on serum prostate-specific antigen (PSA) value. Within 3 months after initiation of therapy, PSA level decreased to 50% of pretreatment value. (Data from Gormley and associates.39) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 7 Cumulative distribution of prostate-specific antigen (PSA) values at baseline (solid line) and at month 12 (dashed line) among men with benign prostatic hyperplasia but without known prostate cancer who received 5-mg daily dose of finasteride in North American phase III clinical trials. Note that PSA values for specific proportion of patients are shifted downward by 50% after 12 months of finasteride treatment. (From Guess and associates.41 By permission of Saunders.) Mayo Clinic Proceedings 1994 69, 59-68DOI: (10.1016/S0025-6196(12)61614-0) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions