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Free PSA Isoforms

Prostate specific antigen (PSA) is widely used as a screening tool for prostate cancer. It circulates in the bloodstream in free and bound forms. Free PSA exists in three forms in the blood: nicked PSA (also known as benign PSA), pro-PSA (which is processed to generate active PSA) and intact free PSA.

Free PSA Isoforms

Why Free PSA Isoforms matters

Current total PSA tests lack sensitivity and specificity for early detection of prostate cancer. Measuring specific free PSA isoforms may help to improve diagnostic accuracy and reduce the number of men sent for unnecessary biopsies. Pro-PSA is an inactive precursor of the PSA protein that shows strong associations with prostate cancer, particularly 2-pro-PSA, a truncated form of pro-PSA that has been shown to accumulate in men with prostate cancer. Conversely, nicked PSA is more likely to be increased in men with benign enlargement of the prostate. Combining these new tests with traditional PSA testing has the potential to significantly improve the ability to differentiate between prostate cancer and benign prostate disease.

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References

Canto, E. I. (2004). Serum BPSA outperforms both total PSA and free PSA as a predictor of prostatic enlargement in men without prostate cancer. Urology, 905-911.Catalona, W. J. (1998). Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA, 1542-1547.Filella, X. (2013). Evaluation of [-2] proPSA and Prostate Health Index (phi) for the detection of prostate cancer: a systematic review and meta-analysis. Clinical Chemistry and Laboratory Medicine, 729-739.Guazzoni, G. N. (2011). Prostate-specific antigen (PSA) isoform p2PSA significantly improves the prediction of prostate cancer at initial extended prostate biopsies in patients with total PSA between 2 and 10ng/ml: results of a prospective study in a clinical setting. European Urology, 214-222.Heidegger, I. K. (2014). [-2]proPSA is an early marker for prostate cancer aggressiveness. Prostate Cancer and Prostatic Diseases, 70-74.Hori, S. B. (2013). From prostate-specific antigen (PSA) to precursor PSA (proPSA) isoforms: a review of the emerging role of proPSAs in the detection and management of early prostate cancer. BJU International, 717-728.Jansen, F. H. (2010). Prostate-specific antigen (PSA) isoform p2PSA in combintation with total and free PSA improves diagnostic accuracy in prostate cancer detection. European Urology, 921-927.Marks, L. S. (2001). BPSA is a Potential Serum Marker for Benign Prostatic Hyperplasia (BPH). Retrieved from Urological Sciences Research Foundation: https://www.usrf.org/AUA2001_BPSA_SerumMarker.htmlMikolajczyk, S. D. (2000). ""BPSA"", a specific molecular form of free prostate-specific antigen, is found predominantly in the transition zone of patients with nodular benign prostatic hyperplasia. Urology, 41-45.Mikolajczyk, S. D. (2000). A precursor form of prostate-specific antigen is more highly elevated in prostate cancer compared with benign transition zone prostate tissue. Cancer Research, 756-759.Shariat SF, C. E. (2004). Beyond prostate-specific antigen: new serologic biomarkers for improved diagnosis and management of prostate cancer. Reviews in Urology, 58-72.Sokoll, L. J. (2010). A prospective, multicenter National Cancer Institute Early Detection Resarch Network study of [-2]proPSA: improving prostate cancer detection and correlating with cancer aggressiveness. Cancer Epidemiology, Biomarkers & Prevention, 1193-1200.