{"id":9291,"date":"2020-04-23T04:33:49","date_gmt":"2020-04-23T01:33:49","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/psa-antigen-specific-prostatic\/"},"modified":"2026-02-19T00:27:34","modified_gmt":"2026-02-18T22:27:34","slug":"psa-antigen-specific-prostatic","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/psa-antigen-specific-prostatic\/","title":{"rendered":"\u041f\u0421\u0410 (\u0430\u043b\u043b\u0435\u0440\u0433\u0435\u043d-\u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0430\u043d\u0442\u0438\u0433\u0435\u043d \u043f\u0440\u043e\u0441\u0442\u0430\u0442\u044b)"},"content":{"rendered":"<p><strong><em>Informa\u0163ii generale \u015fi recomand\u0103ri pentru determinarea PSA<\/em><\/strong><\/p>\n<p>Antigenul specific prostatic (PSA) este un component esen\u0163ial al plasmei seminale, av\u00e2nd o greutate molecular\u0103 de 33 kDa. Este sintetizat \u00een celulele acinare \u015fi \u00een epiteliul ductal al prostatei sub controlul hormonilor androgeni (testosteron, dihidrotestosteron), dup\u0103 care este secretat \u00een sistemul ductal unde atinge concentra\u0163ii mari. Se pare c\u0103 PSA, prin func\u021bia de serin-proteaz\u0103, are rol \u00een liza coagulului seminal, fiind implicat astfel \u00een fertilitatea masculin\u0103.<\/p>\n<p>\u00cen mod obi\u015fnuit PSA este prezent \u00een ser \u00een concentra\u0163ii reduse. \u00cen cazurile \u00een care se produce alterarea structurii microscopice a prostatei (cancer, hipertrofie prostatic\u0103 benign\u0103, prostatit\u0103 acut\u0103, biopsie prostatic\u0103), PSA va difuza \u00een strom\u0103, de unde va ajunge \u00een circula\u0163ia general\u0103, pe calea sistemului limfatic \u015fi capilar.<\/p>\n<p>\u00cen ser PSA formeaz\u0103 complexe stabile cu \u03b11-antichimotripsina (ACT) \u015fi cu \u03b12-macroglobulina. 86% din PSA circulant este reprezentat de complexul PSA-ACT, o mic\u0103 por\u0163iune de PSA este legat\u0103 de \u03b12-macroglobulin\u0103, iar restul constituie PSA nelegat (free-PSA)<sup>1<\/sup>.<\/p>\n<p>PSA este aproape \u00een exclusivitate asociat cu afec\u0163iunile prostatei, dar <em>nu este specific <\/em>pentru cancerul de prostat\u0103 (CP), valori crescute fiind \u00eent\u00e2lnite \u015fi \u00een alte condi\u0163ii (adenomul de prostat\u0103, prostatita acut\u0103 sau cronic\u0103, infarctul prostatic). \u00cen plus, aproximativ 25% din cazurile de CP prezint\u0103 la diagnostic valori PSA normale. Cu toate aceste limit\u0103ri, PSA este cel mai utilizat marker \u00een evaluarea CP, at\u00e2t \u00een scop de screening \u0219i de diagnostic, c\u00e2t \u0219i de monitorizare<sup>2<\/sup>.<\/p>\n<p>CP este al 2-lea cancer ca frecven\u021b\u0103, dup\u0103 cancerul pulmonar, la b\u0103rba\u021bii din \u00eentreaga lume, reprezent\u00e2nd aproximativ 15% din totatul cancerelor diagnosticate, cu varia\u021bii geografice \u0219i rasiale foarte mari<sup>3<\/sup>. De\u0219i a fost demonstrat\u0103 existen\u021ba unei predispozi\u021bii genetice, doar \u00een cca 9% din cazuri CP este ereditar (familie cu cel pu\u021bin 3 rude afectate sau 2 rude ce au dezvoltat cancer de prostat\u0103 la v\u00e2rste &lt;55 ani). Inciden\u021ba CP este dependent\u0103 de v\u00e2rst\u0103. De\u0219i o varietate de factori exogeni\/de mediu pot avea un impact asupra progresiei CP nu exist\u0103 m\u0103suri specifice de preven\u021bie legate de diet\u0103 \u0219i stilul de via\u021b\u0103<sup>4<\/sup>.<\/p>\n<p>Screening-ul CP bazat pe testarea PSA constituie unul din subiectele cele mai controversate din urologie \u0219i oncologie. O analiz\u0103 sistematic\u0103 Cochrane (2013) a relevat urm\u0103toarele aspecte:<\/p>\n<ul>\n<li>screening-ul CP a fost asociat cu cre\u0219terea num\u0103rului de cazuri de CP diagnosticate, \u00een special a formelor localizate de boal\u0103;<\/li>\n<li>rezultatele a 5 studii prospective randomizate ce au inclus 341 000 b\u0103rba\u021bi au ar\u0103tat c\u0103 screening-ul CP nu a crescut rata de supravie\u021buire specific\u0103 sau global\u0103 a pacien\u021bilor cu CP;<\/li>\n<li>screening-ul CP prezint\u0103 dezavantaje prin riscul de supradiagnosticare \u0219i de tratament excesiv;<\/li>\n<li>de\u0219i beneficiul asupra men\u021binerii calit\u0103\u021bii vie\u021bii este \u00eenc\u0103 neclar screening-ul nu a fost defavorabil la nivelul popula\u021biei generale<sup>5<\/sup>.<\/li>\n<\/ul>\n<p>Recomand\u0103rile din ghidurile interna\u0163ionale privind depistarea precoce a cancerului de prostat\u0103 au variat \u00een decursul timpului. Astfel, \u00een 2012, U.S. Preventive Services Task Force (USPSTF) a recomandat s\u0103 nu se mai efectueze un screening general al CP bazat pe PSA<sup>6<\/sup>. In mai 2018, USPSTF a adoptat o pozi\u021bie mai pu\u021bin radical\u0103, \u00een sensul c\u0103 screening-ul CP va fi oferit b\u0103rba\u021bilor cu v\u00e2rste de 55-69 ani <em>ce doresc un diagnostic precoce \u0219i \u00ee\u0219i asum\u0103 riscurile unor investiga\u021bii invazive excesive<\/em><sup>7<\/sup>.<\/p>\n<p>\u00cen 2017, Asocia\u021bia European\u0103 de Urologie (European Association of Urologists, EAU) \u00een colaborare cu Societatea European\u0103 de Radioterapie \u0219i Oncologie (European Society for Radiotherapy and Oncology, ESRO) \u0219i Societatea Interna\u021bional\u0103 de Oncologie Geriatric\u0103 (International Society of Geriatric Oncology, SIOG) a elaborat un ghid ce include urm\u0103toarele recomand\u0103ri privind screening-ul CP \u0219i utilizarea testului PSA:<\/p>\n<ul>\n<li>testarea PSA va fi efectuat\u0103 dup\u0103 o consiliere adecvat\u0103 a pacien\u021bilor privind beneficiile\/riscurile asociate;<\/li>\n<li>strategia de detectare precoce CP \u0219i intervalul de timp la care se va efectua monitorizarea va fi adaptat\u0103 \u00een func\u021bie de riscul individual;<\/li>\n<li>testarea PSA precoce va fi oferit\u0103 pe baza unei <u>decizii informate<\/u> b\u0103rba\u021bilor &gt; 50 ani, b\u0103rba\u021bilor &gt; 45 ani cu istoric familial de CP, celor cu valori anterioare PSA &gt; 1 ng\/mL la 40 ani, celor cu valori anterioare PSA &gt; 2 ng\/mL la 60 ani;<\/li>\n<li>v\u00e2rsta la care va fi stopat\u0103 testarea PSA va fi stabilit\u0103 \u00een func\u021bie de speran\u021ba de via\u021b\u0103 \u0219i statusul de performan\u021b\u0103 al pacientului;<\/li>\n<li>valoarea PSA va fi interpretat\u0103 \u00een func\u021bie de v\u00e2rst\u0103; ca variabil\u0103 independent\u0103, valorile PSA au o valoare predictiv\u0103 pentru CP mai mare dec\u00e2t tu\u0219eul rectal sau ecografia transrectal\u0103;<\/li>\n<li>la pacien\u0163ii cu valori ale PSA cuprinse \u00eentre 4 \u015fi 10 ng\/mL (\u201ezona gri\u201d) \u015fi cu tu\u015feu rectal negativ se poate determinarea free-PSA din acela\u015fi ser \u0219i calcula raport freePSA\/PSA total;. s-a dovedit c\u0103 efectuarea suplimentar\u0103 a acestui test reduce num\u0103rul de biopsii nenecesare<sup>8<\/sup>.<\/li>\n<\/ul>\n<p>La pacien\u021bii depista\u021bi cu CP, PSA prezint\u0103 valoare discriminativ\u0103 \u00eentre stadiile bolii. Astfel, \u00een formele localizate, PSA se coreleaz\u0103 cu stadiul \u0219i gradul tumorii, \u00een timp ce \u00een boala metastatic\u0103, PSA atinge valori mult mai mari comparativ cu boala localizat\u0103. Valorile PSA crescute \u00een momentul ini\u021bierii terapiei se asociaz\u0103 cu un risc mare de recuren\u021b\u0103<sup>9<\/sup>.<\/p>\n<p>PSA de\u0163ine un rol important \u015fi \u00een monitorizarea cancerului de prostat\u0103 \u00een diverse etape ale acestuia: supraveghere, stabilirea op\u0163iunii terapeutice, estimarea prognosticului \u015fi evaluarea eficien\u0163ei tratamentului (chirurgical, hormonal). Dup\u0103 tratamentul primar al CP localizat rec\u0103derile survin \u00een 20-30% din cazuri, de aceea PSA va fi monitorizat de rutin\u0103 la 3, 6 \u0219i 12 luni; apoi la fiecare 6 luni; dup\u0103 cel de-al 3-lea an PSA va fi determinat anual. Dup\u0103 prostatectomia radical\u0103 valorile PSA detectabile la nivel sc\u0103zut \u0219i constant indic\u0103 cel mai probabil prezen\u021ba unui \u021besut prostatic restant benign, \u00een timp PSA &gt;\u00a0 0.2 ng\/mL la cel pu\u021bin 2 determin\u0103ri, cu tendin\u021b\u0103 de cre\u0219tere reprezint\u0103 un indicator de recuren\u021b\u0103 biochimic\u0103. Dup\u0103 radioterapie valorile PSA scad lent ating\u00e2nd o valoare minim\u0103 dup\u0103 mai multe luni. Free-PSA nu ofer\u0103 informa\u0163ii clinice relevante \u00een monitorizarea cancerului de prostat\u0103, de aceea nu se recomand\u0103 utilizarea testului \u00een acest scop<sup>8;9<\/sup>.<\/p>\n<p><strong><em>Preg\u0103tire pacient <\/em><\/strong><em>- <\/em>\u00e0 jeun (pe nem\u00e2ncate). Recoltarea probei de s\u00e2nge trebuie efectuat\u0103 diminea\u0163a (deoarece exist\u0103 mici varia\u0163ii diurne), \u00eenaintea oric\u0103rei manevre urologice (inclusiv tu\u015feul rectal) \u015fi la c\u00e2teva s\u0103pt\u0103m\u00e2ni dup\u0103 vindecarea unei afec\u0163iuni inflamatorii a prostatei (prostatit\u0103)<sup>10<\/sup>. \u00cen cazul screening-ului CP, se recomand\u0103 ca medicul specialist urolog s\u0103 efectueze o consiliere pretestare, privind riscuril\/beneficiile asociate<sup>8<\/sup>.<\/p>\n<p><strong><em>Specimen recoltat <\/em><\/strong><em>- <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c<sup>10<\/sup>.<\/p>\n<p><strong><em>Recipient de recoltare <\/em><\/strong><em>- <\/em>vacutainer f\u0103r\u0103 anticoagulant, cu\/f\u0103r\u0103 gel separator<sup>10<\/sup>.<\/p>\n<p><strong><em>Prelucrare necesar\u0103 dup\u0103 recoltare<\/em><\/strong> \u2013 se separ\u0103 serul prin centrifugare; se lucreaz\u0103 serul proasp\u0103t \u00een maxim 2 ore; dac\u0103 acest lucru nu este posibil, serul se p\u0103streaz\u0103 la 2-8\u00b0C, la -20\u00b0C sau la -70\u00b0C<sup>10<\/sup>.<\/p>\n<p><strong><em>Volum prob\u0103<\/em><\/strong> \u2013 minim 0.5 mL ser<sup>10<\/sup>.<\/p>\n<p><strong><em>Cauze de respingere<\/em><\/strong> <strong><em>a probei<\/em><\/strong><\/p>\n<ul>\n<li>specimen hemolizat;<\/li>\n<li>specimen expus la temperatur\u0103 ridicat\u0103;<\/li>\n<li>specimen contaminat bacterian<sup>10<\/sup>.<\/li>\n<\/ul>\n<p><strong><em>Stabilitate prob\u0103 <\/em><\/strong>\u2013 serul separat este stabil <em>5 zile<\/em> la\u00a0 2-8\u00b0C; <em>6 luni<\/em> la -20\u00b0C sau -70\u00b0C<sup>10<\/sup>.<\/p>\n<p><strong><em>Metod\u0103 <\/em><\/strong>- <u>imunochimic\u0103 cu detec\u0163ie prin electrochemilumiscen\u0163\u0103 (ECLIA)<\/u><sup>10<\/sup>.<\/p>\n<p><strong><em>Valori de referin\u0163\u0103 \u0219i interpretarea rezultatelor<\/em><\/strong><sup>10,11<\/sup><\/p>\n<p><strong>PSA total<\/strong> \u2013 sunt dependente de v\u00e2rst\u0103:<\/p>\n<p>&lt;40 ani:\u00a0\u00a0 \u00a0\u2264 1.4 ng\/mL;<\/p>\n<p>40-50 ani: \u2264\u00a0 2.0 ng\/mL;<\/p>\n<p>50-60 ani: \u2264\u00a0 3.1 ng\/mL;<\/p>\n<p>60-70 ani: \u2264 4.1 ng\/mL;<\/p>\n<p>&gt;70 ani: \u00a0\u00a0\u00a0\u2264\u00a0 4.4 ng\/mL.<\/p>\n<p>Probabilitatea de a depista CP la biopsia prostatic\u0103 la persoanele cu tu\u0219eu rectal negativ cre\u0219te odat\u0103 cu cre\u0219terea valorilor PSA total:<\/p>\n<ul>\n<li>PSA total &lt; 4 ng\/mL: probabilitate CP 17.1% (12.4-21.6%)<\/li>\n<li>PSA total 4-10 ng\/mL: probabilitate CP 30.3% (26.8-33.8%)<\/li>\n<li>PSA total &gt; 10 ng\/mL: probabilitate CP 49.1% (42.5-55.7%)<\/li>\n<\/ul>\n<p><strong>Free-PSA<\/strong>: se exprim\u0103 procentual raportul dintre PSA liber detectat de analizor \u015fi PSA total (obligatoriu cele 2 teste se efectueaz\u0103 din acela\u015fi ser!).<\/p>\n<p>Interpretarea rezultatelor free-PSA% (valid\u0103 numai dac\u0103 PSA total 4-10 ng\/mL!):<\/p>\n<p>\u25a0 Valorile free PSA &lt; 10% indic\u0103 o probabilitate de 49-65% (\u00een func\u021bie de v\u00e2rst\u0103) de a depista CP la biopsia prostatic\u0103<\/p>\n<p>\u25a0 Valorile free PSA &gt; 25% indic\u0103 o probabilitate de 9-16% (\u00een func\u021bie de v\u00e2rst\u0103) de a depista CP la biopsia prostatic\u0103<\/p>\n<p>Probabilitatea de a depista CP la biopsia prostatic\u0103 cre\u0219te odat\u0103 cu v\u00e2rsta \u0219i cu sc\u0103derea free PSA %:<\/p>\n<table class=\"wp-block-table w-100\">\n<tbody>\n<tr>\n<td width=\"162\"><strong>\u0421\u0432\u043e\u0431\u043e\u0434\u043d\u044b\u0439 PSA <\/strong><\/p>\n<p><strong>(raportat la PSA total)<\/strong><\/td>\n<td width=\"169\"><strong>50-59 ani<\/strong><\/td>\n<td width=\"169\"><strong>60-69 ani <\/strong><\/td>\n<td width=\"162\"><strong>\u226570 ani<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"162\">\u2264 10%<\/td>\n<td width=\"169\">49.2%<\/td>\n<td width=\"169\">57.5%<\/td>\n<td width=\"162\">64.5%<\/td>\n<\/tr>\n<tr>\n<td width=\"162\">11-18%<\/td>\n<td width=\"169\">26.9%<\/td>\n<td width=\"169\">33.9%<\/td>\n<td width=\"162\">40.8%<\/td>\n<\/tr>\n<tr>\n<td width=\"162\">19-25%<\/td>\n<td width=\"169\">18.3%<\/td>\n<td width=\"169\">23.9%<\/td>\n<td width=\"162\">29.7%<\/td>\n<\/tr>\n<tr>\n<td width=\"162\">&gt;25%<\/td>\n<td width=\"169\">9.1%<\/td>\n<td width=\"169\">12.2%<\/td>\n<td width=\"162\">15.8%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Nu se recomand\u0103 free-PSA la pacien\u021bii afla\u021bi sub medica\u021bie anti-androgenic\u0103.<\/p>\n<p><strong><em>Limita de detec<\/em><\/strong><strong><em>\u0163ie <\/em><\/strong>\u00a0\u2013 PSA total: \u00a0\u00a00.003 ng\/mL.<\/p>\n<p>\u2013 \u00a0Free-PSA : 0.01 ng\/mL<sup>10<\/sup>.<\/p>\n<p><strong><em>Interpretarea rezultatelor, limite \u015fi interferente<\/em><\/strong><\/p>\n<p>Un rezultat \u00een intervalul de referin\u021b\u0103 corespunz\u0103tor v\u00e2rstei un exclude CP<sup>11<\/sup>.<\/p>\n<p>Efectul manevrelor\u00a0 urologice asupra nivelului de PSA:<\/p>\n<ul>\n<li>Tu\u015feu rectal: poate determina cre\u015fteri minore, rareori clinic semnificative.<\/li>\n<li>Masaj prostatic: poate determina cre\u015fteri minore la unii pacien\u0163i.<\/li>\n<li>Rezec\u0163ie transuretral\u0103: determin\u0103 cre\u015fteri semnificative (recoltarea se va face dup\u0103 cel pu\u0163in 6 s\u0103pt\u0103m\u00e2ni).<\/li>\n<li>Biopsie\u00a0 prostatic\u0103: determin\u0103 cre\u015fteri semnificative (recoltarea se va face dup\u0103 cel pu\u0163in 6 s\u0103pt\u0103m\u00e2ni).<\/li>\n<li>Echografie: poate determina cre\u015fteri la un nrum\u0103r mic de pacien\u0163i.<\/li>\n<li>Cistoscopie: aparent folosirea cistoscopului flexibil nu modific\u0103 nivelul PSA, pe c\u00e2nd folosirea cistoscopului rigid poate determina apari\u0163ia unor niveluri crescute<sup>2<\/sup>.<\/li>\n<\/ul>\n<p>Ejacularea poate determina cre\u015fteri tranzitorii ale PSA<sup>1;2<\/sup>.<\/p>\n<p>Dup\u0103 tratamentul hormonal valorile PSA nu reflect\u0103 \u00eentotdeuna comportamentul tumorii. Medica\u0163ia anti-androgenic\u0103 poate genera valori sc\u0103zute de PSA, \u00een prezen\u0163a bolii reziduale.<\/p>\n<ul>\n<li>Medicamente: inhibitorii de 5-alfa reductaz\u0103 (Finasterida, Dutasterida) \u2013 utiliz\u0163i \u00een tratamentul hipertrofiei de prostat\u0103, determin\u0103 reducerea nivelului de PSA cu aproximativ 50% dup\u0103 6 luni. Din acest motiv, pentru a interpreta o valoare izolat\u0103 a PSA la o persoan\u0103 tratat\u0103 cu inhibitori de 5-alfa reductaz\u0103 timp de \u015fase luni sau mai mult, valorile PSA ar trebui s\u0103 fie dublate pentru a le compara cu valorile PSA-ului pacien\u0163ilor la care nu se administreaz\u0103 tratamentul. Aceast\u0103 ajustare p\u0103streaz\u0103 sensibilitatea \u015fi specificitatea testului PSA \u015fi \u00eei men\u0163ine capacitatea de a depista cancerul de prostat\u0103. Concentra\u0163iile plasmatice totale ale PSA revin la valoarea ini\u0163ial\u0103 \u00een \u015fase luni de la \u00eentreruperea tratamentului. Raportul PSA liber\/total r\u0103m\u00e2ne constant, chiar sub influen\u0163a inhibitorilor de 5-alfa reductaz\u0103<sup>12<\/sup>.<\/li>\n<li>Interferen\u0163e analitice<\/li>\n<\/ul>\n<p>Pot produce interferen\u0163e cu unele componente ale kit-ului \u015fi conduce la rezultate neconcludente urm\u0103toarele:<\/p>\n<p>\u2013 tratamentul cu biotin\u0103 \u00een doze mari (&gt;5 mg\/zi); de aceea se recomand\u0103 ca recoltarea de s\u00e2nge s\u0103 se fac\u0103 dup\u0103 minimum 8 ore de la ultima administrare;<\/p>\n<p>\u2013 titrurile foarte crescute de anticorpi anti-streptavidin\u0103 \u015fi anti-ruteniu;<\/p>\n<p>\u2013 anticorpii monoclonali proveni\u0163i de la \u015foarece administra\u0163i la unii pacien\u0163i \u00een scop diagnostic sau terapeutic<sup>2<\/sup>.<\/p>\n<p>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/p>\n<ol>\n<li>Lothar Thomas. Tumor Markers. In <em>Clinical Laboratory Diagnostics<\/em>, 1998, 982-985.<\/li>\n<li>Frances Fischbach. Chemistry Studies. In <em>\u0410<\/em> <em>Manual of Laboratory and Diagnostics<\/em> <em>Tests,<\/em> 8 Ed., 2009, 410-412.<\/li>\n<li>Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality\u00a0 worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359-86.<\/li>\n<li>Leitzmann MF, Rohrmann S. Risk factors for the onset of prostatic cancer: age, location, and behavioral correlates. Clin Epidemiol. 2012;4:1-11.<\/li>\n<li>Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev. 2013.<\/li>\n<li>Moyer VA; U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Jul 17;157(2):120-34.<\/li>\n<li>US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, Garc\u00eda FAR, Gillman MW, Harper DM, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Owens DK, Phillips WR, Phipps MG, Pignone MP, Siu AL. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 May 8;319(18):1901-1913.<\/li>\n<li>Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, Fossati N, Gross T, Henry AM, Joniau S, Lam TB, Mason, MD, Matveev VB, Moldovan PC, van den Bergh RCN, Van den Broeck T, van der Poel HG, van der Kwast TH, Rouvi\u00e8re O, Schoots IG, Wiegel T, Cornford P. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017 Apr;71(4):618-629.<\/li>\n<li>Parker C, Gillessen S, Heidenreich A, Horwich A; ESMO Guidelines Committee. Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep;26 Suppl 5:v69-77.<\/li>\n<li>Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2018. Ref Type: Catalog.<\/li>\n<li>Mayo Clinic. Mayo Medical Laboratories. Test catalog. Prostate-Specific Antigen (PSA), Total and Free, Serum. <a href=\"http:\/\/www.mayomedicallaboratories.com\" rel=\"nofollow noopener\" target=\"_blank\">www.mayomedicallaboratories.com<\/a> 2018.<\/li>\n<li>Nicolae Calomfirescu. Diagnosticul precoce al cancerului de prostat\u0103. Conferin\u0163a AMFB, oct. 2010.<\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"<p>\u041f\u0440\u043e\u0441\u0442\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0430\u043d\u0442\u0438\u0433\u0435\u043d (\u041f\u0421\u0410) \u0441\u0435\u043a\u0440\u0435\u0442\u0438\u0440\u0443\u0435\u0442\u0441\u044f \u044d\u043f\u0438\u0442\u0435\u043b\u0438\u0430\u043b\u044c\u043d\u044b\u043c\u0438 \u043a\u043b\u0435\u0442\u043a\u0430\u043c\u0438 \u043a\u0430\u043d\u0430\u043b\u044c\u0446\u0435\u0432 \u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0436\u0435\u043b\u0435\u0437\u044b. \u0412 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0435 \u043a\u0440\u043e\u0432\u0438 \u043e\u043d \u0441\u043e\u0434\u0435\u0440\u0436\u0438\u0442\u0441\u044f \u0432 \u0434\u0432\u0443\u0445 \u0444\u043e\u0440\u043c\u0430\u0445 \u2013 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