血清PSA持续异常患者前列腺癌诊断方法研究进展

目的：探讨血清PSA持续异常患者前列腺癌诊断的临床对策.方法：总结国内外最新相关文献,对血清PSA持续异常患者的临床处理方法及其应用价值进行阐述.结果：对血清PSA持续异常、肛门指检和前列腺穿刺活检阴性的患者,行重复活检、诊断性TURP,可提高前列腺癌的检出率;DD3和EPCA在PCa早期预测和筛查中具有重要作用,有望成为诊断PCa新的特异性标志物.结论：对血清PSA持续异常患者进行重复活检、诊断性TURP可显著提高前列腺癌的检出率,DD3和EPCA有望成为诊断PCa新的标志物,但是具体应用于临床还需进一步的研究.     

PSA、cPSA检测和骨显像对前列腺癌早期骨转移的诊断价值

目的:分析前列腺特异性抗原(PSA)、复合前列腺特异性抗原(cPSA)联检和核素全身骨显像对前列腺癌早期骨转移的诊断价值.方法:选择152例患者(其中74例为临床确诊的前列腺癌患者,78例为良性前列腺疾病患者),全部进行血清PSA、cPSA检测,并同时对74例临床确诊的前列腺癌患者进行核素全身骨显像.另选择正常健康查体男性90例检测血清PSA、cPSA结果作为对照组.并计算cPSA/PSA比值.结果:前列腺癌患者血清PSA、cPSA检测结果及cPSA/PSA比值显著高于良性前列腺疾病患者及正常健康男性.其中,骨转移阳性显像组血清PSA、cPSA水平及cPSA/PSA比值显著高于非骨转移显像组,检测存在显著性差异(P＜0.05).结论:当PSA＞20μg/L、cPSA＞10μg/L、cPSA/PSA＞0.80时,发生前列腺癌骨转移的可能性较大,应常规做核素全身骨显像,可早期、全面地发现前列腺癌骨转移.     

PSA、SPECT骨显像在前列腺癌诊断和治疗中的临床价值

目的:探讨PSA、SPECT骨显像在前列腺癌诊断及治疗中的临床应用.方法:对72例经临床确诊的前列腺癌患者全部行血清PSA测定及全身骨显像,并对部分患者治疗后进行了随访.结果:前列腺癌组PSA明显高于正常对照组、良性前列腺疾病组;前列腺癌骨转移组PSA明显高于非骨转移组;72例前列腺癌初诊患者骨显像发现24例骨转移瘤,阳性率33.3%.结论:血清PSA与骨显像联检对前列腺癌临床诊断、疗效观察及预后判定具有重要的指导意义.     

AMACR/P504S的发现及其在前列腺癌诊断中应用

前列腺特异性抗原（PSA）是诊断前列腺癌并判断其预后最常用的血浆生物学标记物。然而，PSA并不是癌症的特异性标记物，它在正常和恶变的前列腺上皮细胞中均可表达。血浆PSA水平不但在前列腺癌中升高，而且在许多良性疾病中也会升高，例如良性前列腺增生（BPH）和前列腺炎。因此，血浆PSA升高的患者必须接受组织活检以确定或排除前列腺癌。     

经直肠超声联合血清PSA在经会阴前列腺穿刺活检诊断前列腺癌中的价值

目的:探讨经直肠超声(Tranrectal ultrasound,TRUS)检查联合血清前列腺特异性抗原(Prostate specific antigen,PSA)在经会阴前列腺穿刺活检诊断前列腺癌(Prostate cancer,PCA)中的临床意义。方法:对我院2016年6月至2018年11月收治的203例疑诊前列腺癌患者,回顾分析经直肠超声检查图像特征和经会阴前列腺穿刺活检结果与血清PSA间的关系。结果:203例血清PSA增高的患者中,检出前列腺癌患者110例,检出率为54.19%。超声图像特征越明显,前列腺癌穿刺活检的检出率越高(P0.05)。随着血清PSA值增高以及年龄的增长,前列腺癌穿刺活检的检出率增高(P0.05)。术后出现肉眼血尿19例(9.35%),发热3例(1.48%),迷走神经反射1例(0.05%),尚未出现严重并发症的患者。结论:经直肠超声联合血清PSA水平行直肠超声引导下前列腺穿刺活检,对临床诊断早期前列腺癌具有重要的参考价值。     

游离前列腺特异抗原在前列腺癌诊断中的应用

随着人口结构老化、饮食习惯的改变、加上男性荷尔蒙使用不当,使近年来我国前列腺癌(carcinomaof prostate,CaP)和前列腺增生(benign prostatehyperplasia,BPH)的发病率迅速增长,其中前列腺癌占男性发病率的第二位,死亡率的第三位[1].众所周知,血清前列腺特异抗原(PSA)现已被公认为前列腺癌评估/监测的重要且有用的标记物,但是PSA只是对前列腺组织特异而非对前列腺癌特异[2].因前列腺增生和前列腺癌患者的PSA值重叠部份很多,因此单凭PSA血清值作为前列腺癌筛检或早期侦测的指标,还是不够理想的(但相较于其他肿瘤标记物,PSA是目前最理想的).     

老年人PSA水平与前列腺疾病的关系研究

目的:观察老年男性血清PSA水平与前列腺疾病的相关性.方法:采用放射免疫分析,分别对845例老年人和前列腺良性疾患与前列腺癌病人进行了血清PSA的检测,并与40例正常人比较.结果:老年体检组中各年龄段的血清PSA平均水平明显升高,显著高于正常对照组(P＜0.01);前列腺癌患者血清PSA水平显著高于前列腺良性疾患组和正常对照组(P＜0.01),前列腺良性疾患组又明显高于正常对照组(P＜0.01).结论:检测老年男性血清PSA水平有助于鉴别诊断前列腺癌和前列腺良性疾病及泌尿系统等疾病,但PSA不能成为唯一诊断前列腺癌的血清学指标.     

血清PSA与PAP检测在前列腺癌诊断中的应用价值

目的：探讨血清前列腺特异性抗原（PSA）及酸性磷酸酶（PAP）对前列腺癌患者的辅助诊断价值。方法：采用免疫放射分析法（IRMA）对98例前列腺癌患者,45例前列腺良性疾患及40例正常健康人进行血清PSA,PAP测定。结果：前列腺癌组PSA,PAP水平均显著高于前列腺良性疾患组及正常对照组（P＜0．01）,PSA对前列腺癌的灵敏性为93．9％）,特异性为93．3％,PAP对前列腺癌的灵敏性为71．％,特异性为91．1％。结论：血清PSA与PAP检测对前列腺癌的早期诊断有较高的临床价值,是临床分期, 效监测及判断预后的重要参考指标。     

CLIA法检测血清PSA在前列腺疾病诊断中的临床价值

评价血清前列腺特异性抗原 (PSA)在前列腺癌与前列腺增生症 (BPH)鉴别诊断中的意义。采用化学发光免疫法 (CLIA)检测 10名健康志愿者、2 3例前列腺癌患者、6 1例BPH患者、11例BPH伴急性尿潴留患者血清PSA。对其中 16例前列腺癌患者进行 1- 6个月随访检测。结果 :① 10名正常志愿者血清PSA均小于 4μg/L ;前列腺癌组血清PSA明显升高 ,BPH组及BPH伴急性尿潴留组血清PSA亦高于正常 ,后三组间在统计学上均有显著差异性 (P <0 .0 1)。②CLIA法检测血清PSA的鉴别诊断阈值以 2 0 μg/L为低限。③ 16例前列腺癌患者术后 1个月内血清PSA均下降。其中 14例病情稳定者血清PSA下降至正常 ,2例病情恶化者术后 3个月血清PSA迅速回升。血清PSA对鉴别诊断前列腺良、恶性疾病具有重要价值 ,有助于前列腺癌疗效的预测及预后的判断     

前列腺癌患者术前PSA、PSAD与Gleason分级、临床分期的相关性研究

目的 探讨前列腺癌患者术前前列腺特异性抗原(PSA prostate specific antigen)、前列腺特异性抗原密度(PSAD prostate specific antigen density)与前列腺癌Gleason评分、临床分期的相关性.方法 对2012年3月～2013年6月在我院收治的经病理确诊为前列腺癌62例患者进行回顾性分析.分别通过检测其术前PSA、PSAD并与前列腺癌Gleason评分及临床分期进行方差分析、Spearman相关性分析.结果 血清PSA与前列腺癌Gleason评分成正相关关系(rs=0916,P＜0.01).血清PSA与前列腺癌临床分期成正相关关系(rws=0 585,P＜0.01).PSAD与前列腺癌Gleason评分呈正相关关系(rs=0.748,P＜0.01).PSAD与前列腺癌临床分期呈正相关关系(rs=0.378,P＜0.01).结论 PSAD可作为前列腺癌重要的临床指标,以便指导前列腺癌的治疗及判断前列腺癌预后.     

Beyond PSA: the next generation of prostate cancer biomarkers

Since the introduction of serum prostate-specific antigen (PSA) screening 25 years ago, prostate cancer diagnosis and management have been guided by this biomarker. Yet, PSA has proven controversial as a screening assay owing to several inherent limitations. The next wave of prostate cancer biomarkers has emerged, introducing new assays in serum and urine that may supplement or, in time, replace PSA because of their higher cancer specificity. This expanding universe of biomarkers has been facilitated, in large part, by new genomic technologies that have enabled an unbiased look at cancer biology. Such efforts have produced several notable success stories that involve rapidly moving biomarkers from the bench to the clinic. However, biomarker research has centered on disease diagnostics, rather than prognosis and prediction, which would address disease management. The development of biomarkers to stratify risk of prostate cancer aggressiveness at the time of screening remains the greatest unmet clinical need in prostate cancer. We review the current state of prostate cancer biomarker research, including the PSA revolution, its impact on early cancer detection, the recent advances in biomarker discovery, and the future efforts that promise to improve clinical management of this disease.     

前列腺特异抗原及其密度测定在前列腺癌

为探讨前列腺特异抗原（PSA）及前列腺特异抗原密度（PSAD）的临床应用价值,用放射免疫分析法测定了28例前列腺癌（Pca)及80例良性前列腺增生（BPH）患者的治疗前,后PSA含量,其中18例Pca及50例BPH患者同时测定了PSAD,结果PSA诊断Pca的灵敏度,特异性和准确度分别为85．7％,80．0％和81．4％,在鉴别Pca和BPH上PSAD优于PSA,使假阳性率由PSA的20％降到6％,但在临床应用中要注意结合其它检查进行综合分析。治疗后定期检测血清PSA对早期发现局部复发或转移,判断疗效和估测预后均有重要价值。     

血清PSA和性激素六项联合检测与前列腺良恶性疾病的关系

为探讨血清前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、f/t PSA及性激素六项在前列腺疾病中的应用价值,用放射免疫法(RIA)测定72例前列腺增生(BPH)患者和40例前列腺癌(Pca)患者血清中的PSA、fPSA、f/t PSA及性激素六项[睾酮(T)、孕酮(P)、雌二醇(E2)、垂体泌乳素(PRL)、促黄体生成素(LH)、促卵泡成熟激素(FSH)]水平.结果表明,BPH组的性激素T、E2、PRL、LH、FSH水平均明显低于Pca组,Pca组中P水平明显低于BPH组;BPH组fPSA、f/t PSA比值均明显高于Pca组.提示前列腺良恶性疾病(BPH和Pca)与激素水平失调有关,血清tPSA、fPSA均是诊断Pca和BPH的重要指标,与血清f/t PSA联合测定,可提示哪些患者需要进行前列腺TRUS,并可提高Pca早期检出率.     

Tumor-associated forms of prostate specific antigen improve the discrimination of prostate cancer from benign disease

Prostate-specific antigen (PSA) is a widely used serum marker for prostate cancer, but has limited specificity for distinguishing early prostate cancer(PCa) from benign disease since serum PSA can leak from both tumor and prostate tissues with benign disease. Molecular forms of free PSA have been identified that are associated with either benign or malignant prostate tissues. BPSA is a form of free PSA that is associated with benign prostatic hyperplasia(BPH), the predominant benign disease in men. The inactive precursor of PSA, proPSA, is associated with prostate tumors. We have developed research immunoassays with high sensitivity and specificity for BPSA and proPSA. Each of these PSA forms can range from 0-50% of the free PSA in individual serum samples in the total PSA range of 2-10 ng/ml. Typically, BPSA represents from 20-30% of the free PSA in serum, while proPSA ranges from 30-40% of the free PSA. ProPSA greatly improves the early detection of cancer in men with less than 4 ng/ml total PSA. More importantly, proPSA is more highly associated with aggressive cancers than other PSA forms such as PSA-ACT and free PSA. The BPH-associated BPSA and cancer-associated proPSA forms are complementary and provide improved detection of prostate cancer from benign disease.     

A community-based intervention to promote informed decision making for prostate cancer screening among Hispanic American men changed knowledge and role preferences: a cluster RCT

Objective

We assessed the short-term effects of a community-based intervention for Hispanic men to encourage informed decision making (IDM) about prostate cancer screening with prostate specific antigen (PSA).

Methods

All senior social and housing centers in El Paso, TX were randomized to intervention, a group-based Spanish language educational program facilitated by promotores (12 centers; 161 men) [I's], or to control, promotores-facilitated diabetes video and discussion (13 centers; 160 men) [C's].

Results

Participants had low levels of schooling and baseline knowledge; 44% reported previous PSA testing. At post-test, the I's made large knowledge gains, increased their understanding that experts disagree about testing, shifted toward more active decision making roles, were more likely to believe that it is important to weigh the advantages and disadvantages of screening and to anticipate potential screening outcomes in making a decision, and were less likely to consider the screening decision easy. The I's did not change in their screening intention or the belief that choosing not to be screened could be a responsible choice.

Conclusions

A community-based intervention to support IDM for prostate cancer screening can increase knowledge and may promote more active involvement in decision making about prostate cancer screening. Such an approach can increase knowledge and may promote more active involvement in decision making about prostate cancer screening.

Practice implications

It is feasible to develop and implement a community-based intervention program to promote IDM for prostate cancer screening.     

前列腺健康指数在前列腺癌早期诊断中的价值

PSA是目前PCa诊断应用最广泛的指标,但由于其敏感性和特异性欠佳,还是造成较多患者接受不必要的前列腺穿刺活检。PHI与传统PSA相比,具有更高的AUC;2012年美国食品和药物管理局批准了PHI用于PSA处于4~10 ng/ml,首次前列腺穿刺活检前的评估,明显提高了前列腺癌检出率。本文就PHI在前列腺穿刺患者的选择和其在高危前列腺癌判断中的价值做一综述。     

西乐葆对雄激素剥夺治疗的前列腺癌患者血清PSA的影响

目的：初步评价选择性环氧合酶-2（COX-2）抑制剂西乐葆对雄激素剥夺治疗（AAT）前列腺癌（Pca）患者血清前列腺特异抗原（PSA）的影响.方法：对33例接受AAT后PSA升高的Pca患者口服西乐葆0.4 g/d,治疗3、6个月时随访血清tPSA、fPSA和f/tPSA,通过比较治疗前后PSA倍增时间（PSADT）、fPSA和f/tPSA的变化,评价西乐葆对AAT患者PSA的影响.结果：西乐葆治疗前,高PSADT 18例（54.5%）,无一例出现tPSA下降;治疗后3、6月时, PSADT延长、血清tPSA下降例数分别为13、10;与治疗前相比,治疗后3、6个月时PSADT、fPSA、f/tPSA差异具有统计学意义（P＜0.05）.结论：选择性COX-2抑制剂西乐葆可降低血清PSA增加速率,对AAT前列腺癌患者产生良好的疗效.     

PSA与fPSA联合诊断前列腺疾病的临床研究

评价前列腺特异抗原（PSA）和游离前列腺特异抗原（fPSA)的联合检测在前列腺疾病鉴别诊断中的价值。采用化学发光免疫分析法（CLIA）对前列腺癌患者32例、前列腺增生症患者76例及30名正常人的PSA、fPSA和fPSA/PSA比值进行了检测和分析。结果表明，如果以血清PSA值4ng/mL为阈值，诊断前列腺癌的灵敏度为100％，特异性为50．6％；如果以血清PSA值4ng/mL为阈值，同时结合fPSA/PSA并以16％为阈值，诊断前列腺癌的灵敏度为100％，而特异性则为85．3％。这说明联合检测对提高前列腺癌诊断的特异性有一定的价值。     

The Relationship of Baseline Prostate Specific Antigen and Risk of Future Prostate Cancer and Its Variance by Race

Purpose

Several studies suggest that a baseline prostate specific antigen (PSA) measured in young men predicts future risk of prostate cancer. Considering recent recommendations against PSA screening, high-risk populations (e.g. black men, men with a high baseline PSA) may be particularly vulnerable in the coming years. Thus, we investigated the relationship between baseline PSA and future prostate cancer in a black majority–minority urban population.

多囊卵巢综合征患者血清前列腺特异抗原水平

研究多囊卵巢综合征（PCOS）患者血清前列腺特异抗原（PSA）是否升高。正常对照组50名,PCOS组40例,分别测定血清PSA、睾酮（T）、性激素结合球蛋白（SHBG）、硫酸脱氢表雄酮（DHEA-S）水平,对两组测定值进行统计学分析。正常对照组血清PSA值为3.56±0.44pg/mL,PCOS组为15.64±3.36pg/mL,两组值有显著性差异（P〈0.01）。血清PSA值与T、DHEA-S值之间有弱的正相关关系（分别为r=0.467P〈0.01;r=0.205,P〈0.05）;与SHBG值之间有弱负相关关系（r=-0.260,P〈0.05）。PCOS患者血清PSA水平高于正常人,PSA可作为女性雄激素增高的标志物而在临床应用。