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Conclusion

The importance of PSA as a tumor marker in the follow-up is beyond dispute. Controversial but is still the routine PSA testing in symptom-free.

Despite this relative lack of specificity of PSA, particularly in the range 4-10 ng concerns / ml, the PSA test is no longer the diagnosis of prostate cancer and in particular from the later observation in prostate cancer after initiation of therapy indispensable, As always, it is also a nature.

At a point on which everyone agrees, however: Because of the significant dependence on laboratory blood sample should always be sent to the same laboratory and the blood from the same doctor are made.

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PSA course after treatment of prostate cancer

As for the value of PSA for clinical monitoring after treatment of prostate cancer, were the introduction of the PSA test supplanted all other methods of relapse search.

should be in this case, the PSA controls in the first year, every three months thereafter for a further four years in half yearly basis.

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improve PSA sensitivity and specificity in screening

, the separation between benign enlargement and prostate cancer are increased and therefore unnecessary biopsies can be reduced with the help of age-related PSA threshold values, the respect of the free PSA level (tPSA), PSA density and PSA increase speed.

A. Age-related PSA values \u200b\u200b

This can reduce unnecessary biopsies and discover potentially aggressive tumors in young patients, in addition:

- < 50 Lebensjahr: < 2,5 ng/ml
- 50-59 years: < 3,5 ng/ml
- 60-69 years: < 4,5 ng/ml
- 70-79 years: The use of < 6,5 ng/ml

age-based limits is controversial.

B. Free PSA concentration (fPSA)

The fPSA is used to the sensitivity of PSA for screening in the range of 2-4 ng / ml to increase. Furthermore, with the fPSA specificity of PSA in the range of 4-10 ng / be improved ml.

studies have shown that a high free PSA in the gray area rather than for a benign enlargement of prostate cancer (prostate cancer) is talking about. On the other hand, speaks a lower share of a developing prostate cancer, which should be further clarified or verified.

The following examples illustrate how difficult is the assessment of these values:

- if the t-PSA in the normal range of less than 4 ng / ml and f-PSA-percent value is low at 9 percent, so the values \u200b\u200bare very suspicious for cancer.

- Is the t-PSA level above 10 ng / ml increased and is found while a high f-PSA-percent value greater than 21 percent, is so most probably not cancer.

C. PSA density (PSA D ensity)

The PSA density (prostate volume ratio) to avoid unnecessary prostate biopsies in the course. It is a calculation of the PSA value to the particular means of TRUS prostate volume:



It is used in patients with benign prostate enlargement and PSA levels of 4-10 ng / ml. In a PSA density less than 0.15 a carcinoma is unlikely. In contrast, the probability of prostate cancer rises from a prostate volume ratio of 0.15. This assessment is scientifically controversial, however.

D. increase in PSA velocity (PSA V elocity)

The increase in PSA velocity can with the help of 3 PSA determinations (be PSA1-3) within 2 time periods (t1-2) calculated from a total of at least 2 years:



is particularly suitable increase in PSA velocity in patients with low PSA levels and for patients after negative biopsy. A rapid rise in blood levels - at the same laboratory tests - over a shorter period may be a warning signal. More specifically, an increase in PSA velocity has more than 0.75 ng / ml / year indicate a prostate cancer. This assessment, however, is also controversial.

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What impact on the PSA level can have?

following points highlight which may affect the PSA level:

A. size of the prostate
In almost all men, the prostate gradually increased with age (see above benign prostate enlargement). One gram of healthy prostate tissue increases the PSA to 0.3 ng / ml, a gram of prostate cancer but ng to 10 times or about 3 / ml. In addition, increases in prostate cancer the PSA level in the blood faster than in the benign prostate enlargement. The weight of the prostate can be by means of transrectal ultrasound (TRUS) to determine quite precisely over the measured volume. Prostate weight of 40 grams of age are not uncommon.
as pressure on the prostate
The PSA level may be increased by pressure on the prostate gland, which exerts example, during the cycling, sexual activity or sexual intercourse or rectal examination of the prostate. Thus should be avoided in such cases on a subsequent blood sample, since such an increase - albeit small - can distort the evaluability, especially if the PSA level in the so-called marginal or gray area between 4 and 10 ng / ml, in the no clear statement can be made.
C. Acute urinary retention
(possible large increase in PSA)
D. cystoscopy
(possible large increase in PSA)
E. catheterization
(possible large increase in PSA)
F. trauma
(possible increase in PSA) prostate biopsy
G.
(limited potential for increase in time)
H. Acute or chronic prostatitis
(possible increase in PSA)
I. Finasteridhaltige drugs
(possible severe reduction in PSA)
J. Radiation therapy of prostate
(transient increase in PSA)
K. transurethral prostate resection
(possible increase a time period)
L. Radical prostatectomy
(decrease of PSA level)

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distinction between benign and malignant changes in the biochemistry of PSA prostate

The PSA level in blood is used as tumor markers and cancer markers. In addition to the malignant prostate enlargement (prostate cancer), benign prostate enlargement, however, are (benign prostatic adenoma (benign prostatic hyperplasia, BPH, increase in cell number), prostatitis (inflammation), prostate infarction (blood disorder)) reported. Thus, PSA is not as pure tumor markers, but as a tissue marker, ie, PSA has a high organ specificity for prostate cancer with limited specificity.

general rule today is that blood levels of small als 4 ng/ml unbedenklich sind. Dagegen werden Werte größer als 10 ng/ml als sehr verdächtig für eine Entartung von Prostatazellen (Prostatakarzinom) angesehen. Zwischen 4 und 10 ng/ml liegt die so genannte Grauzone.

Mit der Einführung dieser Normwerte wurden somit die falsch-positiven Befundergebnisse wesentlich eingeschränkt, aber immer noch nicht ausgeschlossen.

Wird allerdings die PSA-Bestimmung mit der digitalen-rektalen Palpation (Tastbefund) durch einen erfahrenen Untersucher kombiniert, steigt die Erkennungsrate.

Diese digitale-rektale Palpation ist aber allein keine Früherkennungsuntersuchung, sie wird durch die Bestimmung des PSA-Wertes ergänzt. Erst bei verdächtigem DRE or a PSA level above the threshold of 4 ng / ml is taken from a tissue sample of the prostate. With the PSA level alone can not diagnose prostate cancer.

The PSA is only indirect evidence for a prostate cancer because it is produced not only by prostate cancer, as is often erroneously assumed by the patient, but a very large prostate gland produces a lot of PSA.

Note
In recent years, the so-called PSA cut-off values \u200b\u200b- values, from which the probability of the existence of prostate cancer (prostate cancer) likely to rise significantly - from former 4 ng / ml to 2, 5-3 ng / ml reduced (Prostate Cancer Prevention Study), so dass damit noch mehr klinisch insignifikante Prostatakrebse operiert werden mit all den damit verbundenen negativen Auswirkungen auf die Sexualität. Bei dieser Studie zeigte sich außerdem, dass auch Männer mit PSA-Werten zwischen 0,5 – 4 ng/ml durchaus ein Prostatakarzinom aufweisen können, wenn man bei ihnen Gewebeproben aus der Prostata (so genannte Prostatastanzbiopsien) entnimmt.

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Im Serum liegt das PSA meist an andere Proteine (Alpha1-Antichymotrypsin, Alpha1-Antitrypsin, Alpha2-Makroglubulin (Antiproteasen) und Protein C) gebunden vor. Dieses so genannte komplexierte PSA (cPSA) macht einen deutlich größeren Anteil (70-90%) am totalen PSA (tPSA) als das freie - Not bound or unbound to a protein - for PSA (fPSA, 10-30%). When speaking in general but only on the PSA value to the whole or the total PSA meant.

Note
All investigations should be conducted in the same laboratory or to compare two levels of PSA in the time interval should always be the same laboratory tests are used because not all methods of investigation - despite the normal range - measure the same, so that obtained in different laboratories results can not be compared easily and thoughtlessly.

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concentrations of PSA

The PSA is found almost exclusively in the prostate and can be detected both in seminal fluid than in blood. In Cytoplasm of the prostate and in seminal fluid concentrations of PSA in the range are mg / dl. In the blood, the concentration of PSA up to 1,000 times smaller, usually less than 4 ng / ml.

Note
is in low concentrations and without clinical significance of PSA detected in breast, breast, endometrium and tumors of the kidneys and adrenal glands.

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Where can one determine the PSA level?

The PSA level is generally determined when a specialist in urology. Pharmacies in prostate rapid tests will be offered the PSA measure the total value. For men who refuse to check-up at the doctor, they are a way to approach the topic. A cancer screening or no diagnosis but not replace them.

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When is the measured PSA level? What

The PSA level is measured in suspected prostate cancer and with existing prostate cancer. It can also be determined in the annual prostate cancer screening regularly. In the presence of prostate cancer

the PSA level is checked regularly to monitor tumor growth and to measure the success of therapy.

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the prostate specific antigen (PSA) is?

The prostate specific antigen (PSA) is a glycoprotein (serine protease) with a molecular mass of 34 kD, which produces the prostate gland in men (prostate) to liquefy the seminal fluid.

Note
In small amounts, the PSA also produced in women in small, situated next to the urethral glands.

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The largest mailing ever

As says the postman, because the Federal Central Office for fiscal numbers has begun at the end of 2007 82 million new tax numbers to send! Everyone in Germany, whether baby or Renter has received a partial and probably still does the shipping, for we only now have they received in August 2008.
The new tax identification number is now to apply for life and for the income tax immediately.
82000000 letters as likely to have enjoyed the post about the large order and with more than 1,000 tons of paper it would be the largest mail item in the history of Benson Republic of Germany (!) - Let's hope that's crept no standard error and to of a recall campaign comes ....

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Blog Contest

A small guest article by Frank who wants to draw attention to a blog competition, is interested in all the bloggers here. The
Blogitzeljagd by the end of February and held back only by blogging, you can win! Simply use the
competition report, visit the Spnsoren according to the task and find the treasure map and press the thumb.
Spnsorlinks:
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mezzanine capital and financing

Mezzanine? Are they any new vitamins or even viruses?
course not, because the word comes Mezzanine originally from the field of architecture and where it refers to a mezzanine.
or mezzanine capital financing Menzzanine are therefore to be understood as an umbrella term for certain types of financing, which are a mix of equity and debt.
summary, this external financing of a company funds are provided, without additional loans taken, and without which you will need to demonstrate further safety.
The aim of such a form of financing is, in fact, means to feed and the exit of the investor later to finance on its own. A more precise definition of
Mezzanine Capital and financing be found among others in the Accountants Society Rhein Main Trust . or also at wikipedia.