血清游离PSA和游离/总PSA在前列腺癌诊断中的价值

探讨游离前列腺特异性抗原(FPSA)和游离/总前列腺特异性抗原比值(F/T PSA)在前列腺癌(PC)和良性前列腺增生(BPH)鉴别诊断中的价值.采用美国DPC公司的酶放大化学发光仪测定89名正常志愿者、85例PC患者和97例BPH患者血清FPSA和TPSA水平,并计算F/T PSA的比值.结果表明正常男性(41～88岁)组血清FPSA和TPSA水平与青年组相比明显升高,老年组升高特别明显(P＜0.01),直线相关统计分析表明,年龄与血清FPSA和TPSA水平有显著正相关性(FPSA/年龄:r为0.49～0.51,P＜0.01;TPSA/年龄:r为0.44～0.45,P＜0.01);PC组和BPH组血清FPSA、TPSA水平明显高于对照组(P＜0.01),而PC组F/T PSA比值则明显低于BPH组和对照组(P＜0.01).血清TPSA＜4.0、4.0～10.0和＞10.0μg/L的BPH患者分别占65.0%、30.9%和4.1%,PC患者分别为5.9%、20.0%和74.1%,经卡方检验,两组间患者的分布差别有极显著性意义(P＜0.01);F/T PSA比值的分段研究显示,在TPSA灰色区,F/T PSA 0.1,提示PC可能性较大(88.9%),而F/T PSA＞0.25时,表明PC可能性很小(6.1%).提示40岁以上正常男性血清FPSA和TPSA水平随年龄升高而增加,并与年龄呈明显的正相关;约30.9%的BPH与20.0%的PC患者血清TPSA水平存在重叠,F/T PSA比值的应用可以明显提高TPSA在灰色区鉴别诊断PC的特异性.     

412例前列腺癌患者血清前列腺特异抗原游离与总量比值及骨转移的分析

目的分析前列腺癌(Pca)患者血清前列腺特异抗原游离(FPSA)与总(TPSA)比值(F/T)的结果及骨转移的特点。方法对412例Pca患者术前血清TPSA、FPSA含量和F/T比值及99mTC-MDPECT全身骨骼显像分为二组进行分析。结果无骨转移组为25.5%(105/412例);有骨转移组为74.5%(307/412)。307例Pca骨转移组患者,共有2907个转移病灶,97.5%(2834/2907)显示为"热区"病灶,2.5%显示为"冷区"病灶(73/2907)。有Pca骨转移组血清TPSA、FPSA和F/T分别是97.9±59.4μg/L,10.2±8.1μg/L和0.09±0.04;无ca骨转移组29.6%(16/54),分别是24.8±23.0μg/L,4.4±3.4μg/L和0.12±0.05;二组有显著性差异(P0.01)。TPSA与骨转移程度呈负相关(r=-0.487,P0.05)。当PSA10μg/L,骨转移率为2.6%;当PSA 10～20μg/L,为10.5%;PSA 21～50μg/L,为52.6%;PSA 51～100μg/L,为92.7%;PSA100μg/L,为100%。F/T比值与骨转移程度呈负相关(r=-0.641,P0.05)。F/T0.15者,有84%的Pca患者有骨转移;F/T0.10者,100%的患者有骨转移。结论血清F/T比值小于0.15者,必要时行ECT全身骨骼显像。骨转移的好发部位依次是盆骨、椎骨和肋骨。     

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。     

Utility of free/total prostate specific antigen (f/t PSA) ratio in diagnosis of prostate carcinoma

The discovery that PSA exists in serum in both free and complexed forms led to development of immunoassays specific for different PSA forms. This helped in measuring free PSA in the presence of PSA-ACT (PSA-alpha antichymotrypsin), hence it was possible to calculate the percent free PSA or free to total PSA ratio, measurement of which was helpful in reducing the number of unnecessary biopsies significantly, while maintaining a high clinical sensitivity for detection of cancer. The study was performed on 103 consecutive male patients (mean age 68 +/- 10.8 years SD) comprising of 90 patients with benign disease (87%) and 13 prostate carcinoma patients (13%), who had histologically proven prostate cancer. Patients with total PSA between 2-25 ng/ml were included in the study. 30 normal healthy males with age 58 +/- 10 years, served as control. Serum total PSA and free PSA were analyzed using streptavidin biotin EIA method (M/s Roche Diagnostics, Germany). The mean total PSA in normal healthy control subjects was 1.86 +/- 1.07 ng/ml. It was increased significantly in diseased condition. Its mean concentration in carcinoma patients was 12.6 +/- 5.3 ng/ml and in benign patients it was 6.3 +/- 4.6 ng/ml. The free to total PSA ratio in all the three groups was significantly different (p < 0.004) from each other. In carcinoma patients, mean f/t PSA ratio was 0.12 +/- 0.06 as compared to 0.21 +/- 0.11 and 0.28 +/- 0.17 in benign patients and in control respectively. The sensitivity and specificity of the test was calculated at different f/t PSA ratio cutoff. At 0.1 cutoff value, sensitivity of the test was 54% and specificity was 83%. The positive predictive value (ppv) was 32% and negative predictive value (npv) was 92%. From cutoff value of 0.12 to 0.16, sensitivity was increased from 54% to 85% but specificity was reduced from 78% to 67%. The ppv did not show much change and npv was increased from 92% to 97%. Increasing the cut off value thereafter showed no change in sensitivity but specificity was further reduced to 40%, therefore in this patient series, f/t PSA ratio cutoff of 0.16 was found to be the appropriate cutoff value. Combination of this ratio cutoff with other parameters like serum total PSA, DRE and TRUS helped in increasing the sensitivity of the test and this also helped in reducing the number of unnecessary biopsies. In 103 men who were biopsied, 13 (12.6%) prostatic carcinoma were identified. Among these 13 cancer patients, 9 patients had abnormal findings in DRE.7 individuals out of these 9, also had free to total PSA ratio lower than 0.16 and would have been biopsied and diagnosed anyway. If we use only f/t PSA ratio less than 0.16, to decide whom to biopsy, we would have biopsied and diagnosed 11/13 cases i.e. sensitivity of 85% but If we decide to biopsy those patients who had abnormal DRE and those who had low f/t PSA ratio, we could identify 13/13 carcinoma i.e. 100% sensitivity. Combining the f/t PSA ratio with total PSA, DRE and TRUS findings could help in reducing the number of unnecessary biopsies. 37 patients who were negative for malignancy having total PSA in the range of 5-20 ng/ml, normal DRE and TRUS findings, have been biopsied but with combination of total PSA in the range of 5-20 ng/ml, normal findings in digital rectal examination and TRUS and f/t PSA ratio more than 0.16 (cutoff), we could have avoided 16 biopsies which were unnecessary that means there was 43% reduction in unnecessary biopsies.     

TRFIA法检测血清F-PSA在前列腺癌诊断中的应用

探讨血清游离PSA(F-PSA)、总PSA(T-PSA)和游离/总(F/T)PSA比值测定对良恶性前列腺疾病鉴别诊断的价值. 采用全自动时间分辨荧光免疫分析法(TRFIA)进行检测. T-PSA在2-20ng/mL范围内的患者共86例, 根据术后病检结果分为两组: 前列腺增生(BPH)症组68例, 前列腺癌组18例, 分析比较两组患者血清F-PSA、T-PSA和F/T PSA比值.结果是: ①前列腺癌组的F-PSA、T-PSA和前列腺增生组的F-PSA、T-PSA皆无显著性差异(P＞0.05), 但F/T PSA比值, 在前列腺癌组明显低于前列腺增生组(P＜0.01).②以F/T PSA=0.18作为诊断阈值, F/T PSA比值对前列腺癌诊断的灵敏度、特异性和阳性预测值分别为85%、72.5%、43.6%.结论是: F/T PSA比值测定有利于前列腺癌与前列腺增生症的鉴别诊断; 当T-PSA在2-20ng/mL范围时, 选用0.18作为诊断阈值有较大的临床应用价值.     

Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial

Background

Men considering the prostate specific antigen (PSA) test for prostate cancer, an increasingly common male cancer, are encouraged to make informed decisions, as the test is limited in its accuracy and the natural history of the condition is poorly understood. The Web-based PSA decision aid, Prosdex, was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions.

Objectives

The aim of this study was to evaluate the effect of the Web-based PSA decision aid, Prosdex, on informed decision making.

Methods

A Web-based randomized controlled trial was conducted in South Wales, United Kingdom. Men aged 50 to 75 who had not previously had a PSA test were randomly allocated to two intervention and two control groups. Participants in the intervention groups either viewed Prosdex or were given a paper version of the text. The main outcome measures were the three components of informed decision making: (1) knowledge of prostate cancer and PSA, (2) attitude toward PSA testing, (3) behavior using a proxy measure, intention to undergo PSA testing. Decisional conflict and anxiety were also measured as was uptake of the PSA test. Outcomes were measured by means of an online questionnaire for the Prosdex group, the paper version group, and one of two control groups. Six months later, PSA test uptake was ascertained from general practitioners’ records, and the online questionnaire was repeated. Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes (U/mm), line of no effect 0.50.

Results

Participants were 514 men. Compared with the control group that completed the initial online questionnaire, men in the Prosdex group had increased knowledge about the PSA test and prostate cancer (U/mn 0.70; 95% CI 0.62 - 0.76); less favourable attitudes to PSA testing (U/mn 0.39, 95% CI 0.31 - 0.47); were less likely to undergo PSA testing (U/mn 0.40, 95% CI 0.32 - 0.48); and had less decisional conflict (U/mn 0.32, 95% CI 0.25 - 0.40); while anxiety level did not differ (U/mn 0.50, 95% CI 0.42 - 0.58). For these outcomes there were no significant differences between men in the Prosdex group and the paper version group. However, in the Prosdex group, increased knowledge was associated with a less favourable attitude toward testing (Spearman rank correlation [ρ] = -0.49, P < .001) and lower intention to undergo testing (ρ = -0.27, P = .02). After six months, PSA test uptake was lower in the Prosdex group than in the paper version and the questionnaire control group (P = .014). Test uptake was also lower in the control group that did not complete a questionnaire than in the control group that did, suggesting a possible Hawthorne effect of the questionnaire in favour of PSA testing.

Conclusions

Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer. Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing. Prosdex appears to promote informed decision making regarding the PSA test.

Trial Registration

ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK)     

f/t-PSA比值对t-PSA在正常范围内的Pca患者早期诊断的临床意义

目的:研究前列腺特异性抗原游离与总量(f/t-PSA)比值对t-PSA在正常范围内前列腺癌(Pca)早期诊断的价值.方法:采用电化学发光免疫分析技术检测150例正常健康男性,106例t-PSA>4.0μg/L及22例t-PSA<4.0μg/L的Pca患者血清t-PSA和f-PSA并求出f/t-PSA比值,然后进行统计学...     

血清总前列腺特异抗原、f/t值及PSAD在鉴别前列腺良恶性疾病中的价值

目的　比较血清总前列腺特异抗原 (tPSA)、游离PSA(fPSA)与tPSA的比值 (f t)、前列腺特异抗原密度 (PSAD)鉴别前列腺增生 (BPH)和前列腺癌 (Pca)的价值。方法　回顾性总结 2 0 0 0 - 0 1— 2 0 0 2 - 12在山西医科大学第二医院泌尿外科住院的 176例BPH患者及 5 6例Pca患者的血清tPSA、fPSA、经腹部B超前列腺的前后径、左右径、上下径、年龄 ,计算出f t比值、前列腺体积 (PV)及PSAD值。分别比较tPSA、f t及PSAD在诊断灰区、灰区外低值区、灰区外高值区中鉴别 2种疾病的能力。结果　在诊断灰区外高值区tPSA、f t及PSAD在 2组间的差别均有显著意义 (P <0 .0 0 1,P <0 .0 5和P <0 .0 1) ;在诊断灰区 ,2组患者间tPSA差别无显著意义 (P >0 .5 ) ,而f t、PSAD的差别则有显著意义 (P <0 .0 5 ) ;在灰区外低值区tPSA、f t及PSAD在2组间的差别均无显著意义 (P >0 .0 5 )。结论　血清tPSA为前列腺癌的标志物。f t及PSAD作为tPSA的辅助指标 ,在诊断灰区有重要的意义     

Exponential Rise in Prostate-Specific Antigen (PSA) during Anti-Androgen Withdrawal Predicts PSA Flare after Docetaxel Chemotherapy in Patients with Castration-Resistant Prostate Cancer

PurposeTo investigate the relationship between rising patterns of prostate-specific antigen (PSA) before chemotherapy and PSA flare during the early phase of chemotherapy in patients with castration-resistant prostate cancer (CRPC).ResultsThere were two growth patterns of PSA doubling time: 22 patients (40.0%) had a steady pattern with a more prolonged PSADT2 than PSADT1, while 33 (60.0%) had an accelerating pattern with a shorter PSADT2 than PSADT1. During three cycles of chemotherapy, PSA flare occurred in 11 patients (20.0%); of these patients, 3 were among 33 (9.1%) patients with an accelerating PSA growth pattern and 8 were among 22 patients (36.4%) with a steady PSA growth pattern (p=0.019). Multivariate analysis showed that only PSA growth pattern was an independent predictor of PSA flare (p=0.034).ConclusionAn exponential rise in PSA during anti-androgen withdrawal is a significant predictor for PSA flare during chemotherapy in CRPC patients.     

人前列腺特异抗原（hPSA）的纯化及放射免疫分析的建立

本文介绍前列腺特异抗原的纯化，免疫动物得到特异性抗ＰＳＡ抗体，并建成放射免疫分析。方法简便快速，灵敏度较高，准确性及重复性良好。与国外相应试剂盒比较有良好的相关性。本分析各项质量控制指标均符合ＲＩＡ的质量控制要求     

PSA、PSAD在前列腺癌与前列腺增生鉴别诊断中的价值

目的：探讨血清总前列腺特异抗原（PSA）及前列腺特异抗原密度（PSAD）在前列腺癌与良性前列腺增生鉴别诊断中的价值。方法：用化学发光免疫分析检测前列腺癌患者（48例）和前列腺增生患者（86例）血清PSA含量,NNNNB超测定每个病人的前列腺体积,计算出PSAD,将病人分组进行比较。结果：前列腺癌组PSA和PSAD均显著高于前列腺增生组（P〈0．01）。前列腺癌组病人PSAD≥0．15比例明显高于前列腺增生组。结论：PSA和PSAD可提高前列腺癌与良性前列腺增生鉴别诊断的准确性。     

前列腺增生及前列腺癌患者f-PSA/T-PSA的变化

目的:探讨诊断灰区内血清游离态前列腺特异性抗原与总前列腺特异性抗原的比值,在前列腺增生与前列腺癌的鉴别诊断中的应用价值.方法:选择血清总前列腺特异性抗原(4.0～10.0)μg/L的39例前列腺癌患者和36例前列腺增生患者,检测血清中总前列腺特异性抗原(T-PSA)和游离态前列腺特异性抗原(f-PSA),计算f/T比值.结果:T-PSA在(4.0～10.0)μg/L,组间T-PSA浓度无显著性差异(P＞0.05),而(f/T)PSA比值有显著性差异(P＜0.05),前列腺癌患者f/T比值明显低于前列腺增生患者(P＜0.01).结论:应用f/T比值＜0.16为鉴别点,提高了对前列腺癌诊断灵敏性和特异性,尤其T-PSA在(4.0～10.0)μg/L更有意义.     

Nomogram for Prediction of Prostate Cancer with Serum Prostate Specific Antigen Less than 10 ng/mL

Although prostate-specific antigen (PSA) is a very useful screening tool, prostate biopsy is still necessary to confirm prostate cancer (PCA). However, it is reported that PSA is associated with a high false-positive rate and prostate biopsy also has various procedure-related complications. Therefore, the authors have devised a nomogram, which can be used to estimate the risk of PCA, using available clinical data for men with a serum PSA less than 10 ng/mL. Prostate biopsies were obtained from 2,139 patients from January 1998 to March 2011. Of them, 1,171 patients with a serum PSA less than 10 ng/mL were only included in this study. Patient age, PSA, free PSA, prostate volume, PSA density and percent free PSA ratio were analyzed. Among 1,171 patients, 255 patients (21.8%) were diagnosed as PCA. Multivariate analyses showed that patient age, prostate volume, PSA and percent free PSA had statistically significant relationships with PCA (P < 0.05) and were used as nomogram predictor variables. The area under the (ROC) curve for all factors in a model predicting PCA was 0.759 (95% CI, 0.716-0.803).

Graphical Abstract

相似文献   

前列腺癌患者血清fPSA与IGF-1联检的临床价值

目的 :探讨血清游离前列腺特异性抗原 (fPSA)和胰岛素生长因子 - 1(IGF - 1)联检对前列腺癌早期诊断的价值。方法 :分别测定正常对照组、前列腺增生组及前列腺癌组的fPSA和IGF - 1水平 ,并对结果进行组间t检验分析。结果 :前列腺增生及前列腺癌组的fPSA和IGF - 1水平均显著高于正常对照组 (P <0 0 5 ) ,且统计分析发现fPSA、IGF - 1及二者联检对前列腺癌诊断的阳性率分别为 83 3%、79 2 %、95 8%。结论 :联检fPSA和IGF - 1水平能提高对前列腺癌检出的敏感性 ,是前列腺癌筛查的有效手段。     

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。     

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.     

前列腺特异抗原和酸性磷酸酶测定用于鉴别前列腺癌和前列腺肥大

本文报告了１８０名正常人，１１８例前列腺癌和９５３例前列腺肥大病人的ＰＳＡ和ＰＡＰ测定结果。正常人、前列腺肥大和前列腺癌病人血清ＰＳＡ水平的中位数依次为１．３、３．０和１５２μｇ／ｌ、血清ＰＡＰ的中位数为０．６、１．２和１３．５μｇ／ｌ。如分别以４．２μｇ／ｌ和２．８μｇ／ｌ为正常上限，则前列腺肥大的阳性检出率为３８．９％和１８．７％。推荐血清ＰＳＡ以２０μｇ／ｌ、ＰＡＰ以１０μｇ／ｌ为鉴别前列腺癌和前列腺肥大的有效水平，此时ＰＣａ的阳性检出率分别为９７．２％和５９．２％，但ＢＰＨ的交叉率下降到５．４％和３．１％。     

前列腺特异抗原在前列腺癌诊断中的作用

前列腺特异抗原（ＰＳＡ）是目前最佳的前列腺癌标志物。我们对２５４例包括前列腺素、非前列腺癌和部分正常人血清ＰＳＡ值进行了分析，以４ｎｇ／ｍｌ为正常参考值，其相应的灵敏度、特异度、阳性预测值、阴性预测值分别为８２．２％、８２．８％、５７．５％、９４．３％。ＰＳＡ还可为是否行前列腺穿刺活检提供依据。当ＰＡＳ≤４ｎｇ／ｍｌ时，患者可暂无须行穿刺活检，仅有５．７％的风险。而当ＰＳＡ〉１０ｎｇ／ｍｌ时，应即