Understand how prostate-specific antigen (PSA) is used in the monitoring of prostate cancer, and controversies regarding use of PSA as a cancer screening test.
Learn how β-human chorionic gonadotropin (β-hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LD) levels are used in the management of patients with certain germ cell testicular tumors.
Learn how tests of androgen metabolism and regulation can be used in diagnosis of male gonadal dysfunction.
Learn the major causes of male infertility, and the major tests involved in semen analysis.
The penis, testes, epididymis, vas deferens, seminal vesicles, and the prostate comprise the male genital tract. Circulating markers have been identified for prostate cancer and testicular cancer. For that reason, a discussion of these tumors and their serum markers is presented in this chapter (Table 19–1). Also, laboratory tests are often used in evaluating men with gonadal dysfunction and men who may be subfertile, infertile, or sterile. A summary of these tests and their usage is also provided. The male genital tract is the site of many infectious diseases, a significant proportion of which are sexually transmitted. These are discussed in Chapter 5.
Table 19–1Clinical Utility of Serum Tumor Markers for Prostate Cancer and Testicular Cancer |Favorite Table|Download (.pdf) Table 19–1 Clinical Utility of Serum Tumor Markers for Prostate Cancer and Testicular Cancer
|Cancer Purpose ||Prostate Cancer: Prostate-specific Antigen (PSA) ||Testicular Germ Cell Tumors (LD, AFP, hCG) |
|Screening ||Controversial for men older than 50 years ||Not useful |
|Establishing a diagnosis ||Not useful ||Can suggest histologic type(s) present, especially for small clusters of 1 tumor type that may be missed by histology |
|Indicator of disease extent ||If PSA <20 ng/mL, bone metastasis unlikely ||Of use in identifying clinically undetectable metastatic disease |
|Monitoring response to treatment ||Useful to monitor success of treatment ||Useful; markers should fall to undetectable with successful treatment |
|Monitoring for recurrence ||Useful ||Useful |
Prostate cancer is a common malignancy of men that increases in incidence with age. It is second only to nonmelanoma skin cancer as the most commonly diagnosed cancer in men (over 150 cases/100,000 men), and second only to lung cancer as the most common cause of cancer death in males. However, most cases are slowly progressive and do not cause major morbidity or lead to death. A major unresolved challenge is differentiating the rapidly progressive and fatal form of prostate cancer from the indolent forms that do not cause death. Mortality associated with the disease has been decreasing. This has been attributed by some to early detection, although a systematic review of published studies has shown no consistent difference in prostate cancer mortality between those who have and those who have not been screened for the disease. The use of laboratory assays to measure the serum prostate-specific antigen (PSA) concentration, however, has had ...