表面增强激光解析电离飞行时间质谱技术在前列腺癌蛋白质组研究中的应用

Objective To study biomarkers by use of surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS) in the serum from prostate cancer and benign prostatic hyperplasia,and then to explore the relationship between expression of biomarkers and grade of pathology,clinical stage.The mechanic of hormone-refractory prostate cancer (HRPC) was explored.Methods The serums from forty five prostate cancer and forty five benign prostatic hyperplasia(BPH)patients were detected by Immobilized Metal Affinity Capture(IMAC-CU).Samples of 21 androgen-dependent prostate cancer (ADPC) and 21 HRPC were also detected.The data of spectra were analyzed by bioinformatics tools Biomarker Wizard.Results Compared with the spectra of BPH patients,there were 9 potential markers detected in untreated prostate cancer patients,the protein expression levels were high in 7 of which and low in 2 of which.Combined two biomarker(m/z 3771 and m/z 4481) test achieved 86.49% sensitivity an 89.19% specificity in diagnose of prostate cancer.There was statistical difference of expression of different serum biomarkers among different grades of pathology.Compared with the spectra of ADPC,there were 6 potential markers detected in HRPC(P＜0.05). In HRPC two masses were up-regulated and four masses were down regulated.When protein 5185 or 4205 was applied to diagnose HRPC,the sensitivity was 86.7%,80.0% respectively,the specificity was 76.9%,88.5% respectively.Conclusion SELDI-TOF-MS shows great potentiality for prostate cancer in early diagnosis and screening of tumor biomarkers. Combining several biomarkers to detect prostate cancer can improve sensitivity and specificity.There is statistical difference of expression of different Serum biomarkers among different grades of pathology,which have a close relationship with differentiation of tumor.The differential proteins may play important roles in the course of ADPC transferring to HRPC.Detecting differential proteins help to diagnose HRPC,judge prognosis,guide treatment.     

The Significance of PSA Modified Parameters （F/T）/ PSAD for Diagnosing Prostatic Cancer in the Grey Zone of 4-10 ng/ml

OBJECTIVE To investigate the diagnostic value of modified prostate specific antigen(PSA)parameters in the diagnosis of prostate cancer(PCA) when the serum PSAis in a grey zone of 4~10 ng/ml. METHODS The results of serum PSA determinations of the patients receiving a transrectal ultrasound-guided multiphase prostatic biopsy,were retrospectively analyzed.In the 88 patients with a serum PSA value of 4-10 ng/ml,the final diagnosis of PCA was made in 21,and that of benign prostate hyperplasia(BPH)in 67 patients.The percentage of the free-serum PSA([FPSA]/total-serum PSA[TPSA],F/T),PSA density(PSAD)and the sensitivity and specificity of the new PSA modified parameter(F/T)/PSAD in diagnosing PCA,within a set threshold value,was compared. RESULTS In the 88 patients with serum PSA in the grey zone of 4.0-10.0 ng/ml,there was no significant difference in comparing the TPSA between the 21 PCA patients and 67 BPH patients(P>0.05).However, there was a significant difference in the value of modified PSA parameters, such as F/T,PSAD and(F/T)/PSAD,between the PCA and the BPH groups (P<0.001).As the cut off point-value of the F/T,PSAD and(F/T)/PSAD was set at 0.16,0.15 and 0.8,the diagnostic sensitivity for PCA was 66.7%, 76.2%and 85.7%,and the specificity was 41.8%,43.3%and 68.7%,respectively.There was no significant difference in the sensitivity comparing the modified parameters for diagnosing PCA(P>0.05),whereas an overt predominance was present in the specificity of(F/T)/PSAD for PCAdiagnosis (P<0.05). CONCLUSION In the serum PSA grey zone of 4-10 ng/ml,a modified PSA parameter can improve the PCA diagnostic accuracy rate.With a considerably high sensitivity,application of the(F/T)/PSAD may effectively enhance the diagnostic specificity,which is superior to the F/T and PSAD, and can be expected to be one of the new indices derived from the PSA.     

Mucin-Producing Urothelial-Type Adenocarcinoma of the Prostate （a Case Report and Review of the Literature）

OBJECTIVE To report clinical and pathologic findings of one case of mucin-producing urothelial-type adenocarcinoma of the prostate, and to discuss the diagnosis and prognosis of this disease. METHODS The patient was a 60-year-old man who had an 8-month history of urinary frequency and dysuria culminating in an aggravating condition for 10-days. Laboratory results were tPSA 3.0 and fPSA 0.4. An ultrasound and digital rectal exam showed no abnormal findings, so he was diagnosed as having benign prostatic hyperplasia, and underwent a transurethral prostate resection. RESULTS The findings during the operation resembled benign prostatic hyperplasia (BPH), whereas the pathological exam showed that the pro-static construction was deranged in the tumor infiltrating region, with many mucin lakes and signet ring cell in the cancer tissue. Immunohisto-chemical staining revealed that the cancer tissue was negative for prostate-specific antigen (PSA) and postive for carcinoembryonic antigen (CEA). Final diagnosis: mucin-producing urothelial-type adenocarcinoma of the prostate. After 50 Gy radiotherapy, the patient was free of recurrent signs and metastasis up to 8 months after operation. CONCLUSION Mucin-producing urothelial-type adenocarcinoma of the prostate is extremely rare. Its differential diagnosis mainly includes conventional prostatic adenocarcinoma with mucin production and secondary adenocarcinoma. The diagnosis and treatment of this disease should be further investigated.     

A Serum Biomarker Model to Diagnose Pancreatic Cancer Using Proteomic Fingerprint Technology

OBJECTIVE To establish a serum protein pattern model for screening pancreatic cancer. METHODS Twenty-nine serum samples from patients with pancreatic cancer were collected before surgery,and an additional 57 serum samples from age and sex-matched individuals without cancer were used as controls.WCX magnetic beans and a PBS Ⅱ-C protein chip reader (Ciphergen Biosystems Inc) were employed to detect the protein fingerprint expression of all serum samples. The resulting profiles comparing serum from cancer and normal patients were analyzed with the Biomarker Wizard system,to establish a model using the Biomarker Pattern system software. A double-blind test was used to determine the sensitivity and specificity of the model. RESULTS A group of 4 biomarkers(relative molecular weights were 5,705 Da,4,935 Da,5,318 Da,3,243 Da) were selected to set up a decision tree to produce the classification model to effectively screen pancreatic cancer patients.The results yielded a sensitivity of 100%(20/20),specificity of 97.4% (37/38).The ROC curve was 99.7%.A double-blind test used to challenge the model resulted in a sensitivity of 88.9% and a specificity of 89.5%. CONCLUSION New serum biomarkers of pancreatic cancer have been identified.The pa ern of combined markers provides a powerful and reliable diagnostic method for pancreatic cancer with high sensitivity and specificity.     

Value of EZH2 expression in expressed prostatic secretion in diagnosis of prostate cancer

Objective: To reveal the clinical value of enhancer of zeste homolog 2 (EZH2) expression in expressed prostatic secretion (EPS) in the diagnosis of prostate cancer (PCa), and to provide a new idea for non-invasive diagnosis of PCa. Methods: A total of 100 EPS samples from patients with prostatitis, benign prostatic hyperplasia (BPH), and suspected PCa with prostate puncture indication were collected from Suzhou Ninth People's Hospital from December 2017 to December 2019. According to clinical and pathological results, 32 patients were in the prostatitis group, 33 patients in the BPH group, and 35 patients in the PCa group. Twenty healthy examiners were recruited from Suzhou Ninth People's Hospital from June 2019 to December 2019 as the control group. EZH2 expression in EPS of different groups was detected by RT-PCR and ELISA. Spearman correlation was used to analyze the relationship between EZH2 expression in EPS and clinicopathological characteristics. The area under the receiver operating characteristic (ROC) curve was used to analyze the clinical application value of EZH2 in EPS in the diagnosis of PCa. Results: The expression level of EZH2 in EPS of the PCa group was significantly higher than those of the prostatitis group, the BPH group and the control group (all P< 0.05); while there was no significant difference in the expression of EZH2 in EPS between the prostatitis group and the BPH group and the control group (both P> 0.05). The expression level of EZH2 in EPS of PCa patients was statistically significant in different pathological grades of PCa (P< 0.05). The area under the ROC curve of the EPS EZH2 mRNA level for the diagnosis of PCa was significantly higher than that of prostate specific antigen level (0.966 vs. 0.649). When the relative expression of EPS EZH2 mRNA was ≥0.55, the sensitivity of diagnosing PCa was 97.1%, and the specificity was 87.9%. Conclusions: The expression level of EZH2 in EPS was up-regulated in PCa patients. The expression level of EZH2 in EPS has high sensitivity and specificity for the diagnosis of PCa. © 2022, The Second Affiliated Hospital, College of Medicine, Zhejiang University.. All right reserved.     

Application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with magnetic resonance spectroscopy(MRS)in prostate cancer diagnosis

Objective The aim of the study was to investigate the application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with magnetic resonance spectroscopy(MRS)in prostate cancer diagnosis.Methods In the outpatient department of our hospital(Sichuan Cancer Hospital,Chengdu,China),60 patients diagnosed with prostate disease were selected randomly and included in a prostate cancer group,60 patients with benign prostatic hyperplasia were included in a proliferation group,and 60 healthy subjects were included in a control group,from January 2013 to January 2017.Using Siemens Avanto 1.5 T high-field superconducting MRI for DCE-MRI and MRS scans,after the MRS scan was completed,we used the workstation spectroscopy tab spectral analysis,and eventually obtained the crest lines of the prostate metabolites choline(Cho),creatine(Cr),citrate(Cit),and the values of Cho/Cit,and(Cho+Cr)/Cit.Results Participants who had undergone 21-s,1-min,and 2-min dynamic contrast-enhanced MR revealed significant variations among the three groups.The spectral analysis of the three groups revealed a significant variation as well.DCE-MRI and MRS combined had a sensitivity of 89.67%,specificity of 95.78%,and accuracy of 94.34%.Conclusion DCE-MRI combined with MRS is of great value in the diagnosis of prostate cancer.     

Combined detection of serum matrix metalloproteinase 9, acetyl heparinase and Cathepsin L in diagnosis of ovarian cancer

Objective:To investigate the clinic values of combining test of serum matrix metalloproteinase 9(MMP-9),acetyl heparinase(Hpa) and Cathepsin L(CL) in diagnosis of ovarian cancer.Methods:Serum levels of MMP-9,Hpa and CL were detected in a total of 418 cases,including 217 cases with ovarian malignant tumor,100 cases with ovarian benign tumor and 101 healthy controls,by using enzyme-linked immunosorbent assay(ELISA).Their correlation with clinicopathologic feature of ovarian malignant tumor was analyzed and their diagnosis performance was evaluated by receiver operating characteristic(ROC).The combined diagnosis model was established by logistic regression analysis.Results:The serum levels of MMP-9,Hpa and CL were significantly higher in patients with ovarian malignant tumor than in benign tumor and healthy control,the serum levels of CL and Hpa were higher in epithelial cancer than in non-epithelial tumor,and MMP-9,Hpa and CL were elevated in low grade and advanced stage compared to high grade and early stage.The sensitivity for diagnosis of ovarian malignant tumor from high to low was CL,Hpa and MMP-9,and the specificity was MMP-9,CL and Hpa.The united diagnosis model was established and showed the sensitivity and specificity of combined detection were 84.6% and 82.1%,respectively,which were significantly higher than a single tumor marker.Conclusion: Serum MMP‐9, Hpa and CL were correlated with ovarian malignant tumor and the combined detection of which may be valuable for clinical diagnosis of ovarian malignant tumor.     

Expression of 6 microRNAs in prostate cancer and its significance

OBJECTIVE Numerous microRNAs （miRNAs） are deregulated in human cancers. The experimental evidence supports that miRNAs plays a role in the initiation and progression of human malignancies.The present study was undertaken to evaluate the differential expression of 6 miRNAs as biomarker for early detection of prostate cancer, and then to determine whether the expression profiling of these miRNAs could predict the prognosis of prostate cancer. METHODS The expression profilings of these 6 miRNAs were investigated using the method of locked nucleic acid （LNA）- modified oligonucleotide in situ hybridization （ISH）. And the technology of tissue microarray （TMA） was employed using the formalin-fixed, paraffin-embedd （FFPE） specimens taken from 52 patients with prostate carcinoma （PCa） and 38 patients with benign prostatic hyperplasia （BPH）. RESULTS The rates of positive expression for 6 miRNAs （miR- 15b, miR-16, let-7g, miR- 96,miR-182 and miR-183） were 26.92%, 15.38%, 15.38%, 67.31%, 61.54% and 71.15% in the specimens of prostate cancer, and 57.89%, 76.32%, 68.42%, 44.74%, 31.58%, 47.37% in the tissues of benign prostatic hyperplasia, respectively. The expressions of all 6 miRNAs between the prostate cancer and benign prostatic hyperplasia tissues were significantly different （P 〈 0.05）. The positive rate of these 6 miRNAs was significantly related to the Gleason Grading of prostate cancer （P 〈 0.01）. There was no significant correlation between the expression of these miRNAs and age and the concentration of serum PSA of the patient （P 〉 0.05）. We also found that the expression of miR-15b, miR-96 and miR-182 correlated with clinical stages of tumor （P 〈 0.05）. The expression of miR-96 correlated with lobus prostatae of tumor invasion （P 〈 0.01）, but the expressions of the remaining five miRNAs were not correlated with that （P 〉 0.05）. In addition, the expression of miR-15b was negatively related to that of miR-96, miR-182 and miR-183, respectively （P 〈 0.01, r 〈 0.00）.There was a positive correlation among the expressions of miR-96, miR-182 and miR-183 in prostate cancer （P 〈 0.01, r 〉 0.00）. The expression of miR-16 was positively related to that of miR-let-7g （P 〈 0.01, r 〉 0.00）. CONCLUSION The results suggest that miRNA expression profiling could have relevance to the biological and clinical behavior of prostate cancer, and they might be important biomarkers for early detection and prognostic assessment of prostate cancer.     

Is extended biopsy protocol justified in all patients with PSA ≥ 20 ng/mL？

The aim of this study was to investigate whether it was necessary to increase the number of cores at initial prostate biopsy with patients of prostate-specific antigen （PSA） ≥ 20 ng/mL and to explore an appropriate individualized transrectal ultrasonograhpy （TRUS）-guided prostate biopsy for the detection of prostate cancer in men suspicious of prostate cancer. Methods： A total of 115 patients with PSA ≥ 20 ng/mL and suspicious of prostate cancer were prospectively randomized to perform TRUS-guided biopsy. Patients were randomized to a ＂6 ＋ X＂ cores or a ＂10 ＋ X＂ cores protocol. The primary end point was cancer detection rate. Secondary end points were cancer characteristics, rate of complications and the level of pain experienced by patients during TRUS-guided prostate biopsy. Results： Preoperative variables were similar in both groups. The overall prostate cancer detection rate was 73.9%. The ＂10 ＋ X＂ cores strategy increased cancer detection rate only 9.7% in patients with PSA ≥ 20 ng/mL but 〈 50 ng/mL, while there was no difference between the two strategies for cancer detection in patients with PSA ≥ 50.1 ng/mL. The number of extended biopsy cores and pain score of extended biopsy in prostate cancer patients increased significantly （P 〈 0.001）. Conclusion： Our findings suggest that there is no significant advantage in using extended biopsy protocol in all patients with PSA≥20 ng/mL.     

Mammography combined with breast dynamic contrast-enhanced-magnetic resonance imaging for the diagnosis of early breast cancer

Objective The aim of this study was to investigate the application of mammography combined with breast dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) for the diagnosis of early breast cancer. Methods Mammography and DCE-MRI were performed for 120 patients with breast cancer(malignant, 102; benign; 18). Results The sensitivity of mammography for early diagnosis of breast cancer was 66.67%, specificity was 77.78%, and accuracy was 68.33%. The sensitivity of MRI for early diagnosis of breast cancer was 94.12%, specificity was 88.89%, and accuracy was 93.33%. However, the sensitivity of mammography combined with DCE-MRI volume imaging with enhanced water signal(VIEWS) scanning for early diagnosis of breast cancer was 97.06%, specificity was 94.44%, and accuracy was 96.67%. Conclusion Mammography combined with DCE-MRI increased the sensitivity, specificity, and accuracy of diagnosing early breast cancer.     

Molecular forms of prostate‐specific antigen in serum with concentrations of total prostate‐specific antigen <4 μg/L: Are they useful tools for early detection and screening of prostate cancer?

Molecular forms of prostate-specific antigen (PSA) improve the differentiation between benign prostatic hyperplasia (BPH) and prostate cancer (PCa) in men with total PSA concentrations between 4 and 10 microg/l. To evaluate the diagnostic utility of free PSA (fPSA) and complexed PSA forms for identification of men with PCa in the low PSA range of <4 microg/l, total PSA (tPSA), alpha(1)-antichymotrypsin complexed PSA (PSA-ACT) and fPSA (Roche Elecsys [ES] system) as well as tPSA and complexed PSA (cPSA) (Bayer Immuno 1 system) were measured in archival serum samples from 31 untreated patients with PCa, 66 patients with BPH, and 90 men without prostatic disease. The median ratios of fPSA/tPSA, PSA-ACT/tPSA and cPSA/tPSA were significantly different between patients with BPH and PCa (27.2 vs. 19.4%, 64 vs. 88%, 77.2 vs. 88.2%, p < 0.05). No associations between PSA forms and tumor stage and grade were found. Analysis of the receiver operating characteristic curves showed that these ratios could discriminate better between BPH and PCa patients than determination of the analytes tPSA, fPSA, cPSA and PSA-ACT alone. The use of one of the ratios would have eliminated roughly half of the unnecessary biopsies in this study. The ratios should be considered as potential tools to increase the selectivity of PCa detection at low PSA concentration. The ratios fPSA/tPSA and cPSA/tPSA can be determined using commercially available assays so that one of these ratios could be preferred instead of PSA-ACT determination. The ratios could be useful in assessing the risk of PCa in the individual and therefore in deciding on prostate biopsy for final diagnosis.     

前列腺癌实验室诊断指标的ROC曲线分析

目的应用ROC曲线分析血清游离前列腺特异性抗原（fPSA）,总前列腺特异性抗原（tPSA）及其比值（fP-SA/tPSA）在前列腺癌中的诊断价值。方法应用受试者工作特征曲线（ROC）对健康男性组,前列腺增生组及前列腺癌组血清tPSA,fPSA及fPSA/tPSA结果进行分析。结果前列腺癌组血清的tPSA、fPSA及f/t与其余两组比较均有差异。经ROC曲线分析,tPSA、fPSA及f/t的阈值分别为7.14μg/L、1.31μg/L及0.235。三者分别及联合检测的ROC曲线下面积分别为0.905、0.770、0.352与0.968。结论 tPSA、fPSA及f/t三者联合检测可以提高对前列腺癌的诊断。     

Molecular forms of prostate-specific antigen and human kallikrein 2 as promising tools for early diagnosis of prostate cancer.

Prostate-specific antigen (PSA) is the most useful marker in the early detection of prostate cancer and for the monitoring of patients with this diagnosis. Molecular forms of PSA and also human kallikrein 2 have been used to discriminate between benign prostatic hyperplasia and prostate cancer as well as for the detection of prostate cancer within the gray zone of PSA. In this respect, a literature survey on the diagnostic validity of free PSA (fPSA) related to total PSA (tPSA), PSA bound to alpha1-antichymotrypsin (ACT-PSA), and complexed PSA is given together with our results. The ratio of fPSA:tPSA has been shown to improve the specificity of prostate cancer diagnosis on the basis of tPSA measurements. Unnecessary biopsies can be reduced by about 19-64% in the total PSA range of 4-10 microg/liter while only missing 5-10% of cancers. Furthermore, carcinomas in patients with PSA values <4 microg/liter can be detected, indicating an improved sensitivity because of the percent fPSA at low PSA values. ACT-PSA or complexed PSA alone and the calculated derivatives are not superior in their discriminatory power compared with the percent fPSA. The diagnostic significance of the other molecular PSA forms and human kallikrein 2 needs to be evaluated in more extensive clinical trials.     

血清PSA及fPSA/tPSA比值在前列腺癌骨转移诊断中的价值

目的:通过分析前列腺癌患者血清中前列腺癌特异性抗原（PSA）浓度和游离前列腺特异性抗原（fPSA）/总前列腺特异性抗原（tPSA）与骨转移的关系,探讨血清PSA和fPSA/tPSA在诊断前列腺癌骨转移中的价值。方法:采用电化学发光法检测74例前列腺癌患者血清中的fPSA、tPSA浓度并计算fPSA/tPSA,并对所有前列腺癌患者进行全身骨扫描显像。结果:74例前列腺癌患者当中无骨转移的29例,有骨转移的45例,分别占前列腺癌患者的39.2％和60.8％。在发生骨转移的前列腺癌患者当中单一病灶的有5例,占11.1%,其中3例转移灶在骨盆,2例在椎体;转移灶为两处的有3例,占6.7%;三处或三处以上转移的有37例,占82.2%。从骨转移发生的部位来看,椎体转移的最多,有35例;其次为骨盆转移,有31例;发生肋骨转移的有28例;四肢骨转移的有9例;其它部位转移的有2例。前列腺癌骨转移组和无骨转移组的PSA和fPSA/tPSA分别为（57.68±38.67） ng/ml、0.14±0.08和（21.61±17.87） ng/ml、0.25±0.09,差异均有统计学意义（P<0.05）。结论:前列腺癌骨转移以多发病灶为主,且病灶主要发生在脊柱和骨盆。前列腺癌患者随血清PSA浓度的升高,fPSA/tPSA比值降低,发生骨转移的比例增高,当PSA>20.00 ng/ml或fPSA/tPSA≤0.15时,诊断前列腺癌骨转移的灵敏度和特异度较高。     

Comparative value of molecular forms of prostate-specific antigen in diagnosis of prostatic cancer

The aim of the study was to compare diagnostic significance of free PSA (fPSA)/total PSA (tPSA) versus PSA complex with alpha1-antichymotrypsin (cPSA) in tPSA level within 4-10 ng/ml in differential diagnosis of prostatic cancer (PC). A complete urological examination (digital rectal test, transrectal ultrasound investigation, serum assay for fPSA and tPSA, multifocal transperineal prostatic biopsy) was made in 108 patients with tPSA blood level 4-10 ng/ ml. Prostatic adenoma (PA) was histologically verified in 61 of 108 patients, fPSA/tPSA was normal. In the other 39 of 108 patients fPSA/tPSA was under 15% while cPSA was in the range 3.8-9.6 ng/ml. A course of etiotropic therapy of chronic prostatic inflammation produced no significant changes in fPSA/tPSA and cPSA in 28 out of 39 patients. Histologically, these 28 patients had PC. In the rest 11 of 39 patients chronic prostatitis treatment fPSA/tPSA significantly rose to 18.2%, on the average. CPSA decreased to 2.4 ng/ml. These 11 patients were found histologically to have PA and signs of chronic inflammation. In 8 of 108 patients fPSA/tPSA was not indicative of PC being 18,2% on the average while cPSA indicated the presence of PC and was 4.2 ng.ml, on the average. PC was verified histologically in these 8 patients. Thus, cPSA in PC suspects is more informative than fPSA/tPSA in PC diagnosis. CPSA in the serum depends on prostatic inflammation making difficult differential diagnosis of PC in interpretation of tPSA, fPSA/tPSA and cPSA. Therefore, estimation of PSA variants and molecular forms in PC suspects and prostatic inflammation should be made after etiotropic therapy.     

血清铁蛋白联合前列腺特异性抗原检测对前列腺癌的诊断价值

目的探讨血清铁蛋白(Ferr)、总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(f PSA)、fPSA/tPSA联合检测对前列腺癌(PCa)的诊断价值。方法选择90例PCa患者、84例前列腺良性病变患者和50例健康男性体检者分别作为PCa组、良性组和对照组,检测3组研究对象的血清Ferr、tPSA、fPSA水平并计算fPSA/tPSA,分析Ferr、tPSA、fPSA、fPSA/tPSA联合检测对PCa的诊断价值。结果PCa组患者的血清Ferr、tPSA、fPSA水平均高于良性组和对照组,fPSA/tPSA低于良性组和对照组,差异均有统计学意义(P﹤0.05)。良性组患者的血清Ferr、tPSA、fPSA水平均高于对照组,fPSA/tPSA低于对照组,差异均有统计学意义(P﹤0.05)。PCa患者的血清Ferr与tPSA、fPSA均呈正相关,tPSA与f PSA呈正相关,tPSA与fPSA/tPSA呈负相关(P﹤0.05)。血清Ferr、tPSA、fPSA、fPSA/tPSA联合检测诊断PCa的灵敏度、特异度、曲线下面积均高于四个指标的三联、两联、单独检测。结论PCa患者的血清Ferr、t PSA、fPSA水平均高于前列腺良性病变患者,fPSA/tPSA低于前列腺良性病变患者。血清Ferr、tPSA、f PSA、f PSA/tPSA联合检测对PCa具有较高的诊断价值,值得在临床中推广应用。     

Human Kallikrein-2, Prostate Specific Antigen and Free- Prostate Specific Antigen in Combination to Discriminate Prostate Cancer from Benign Diseases in Syrian Patients

Background: The high incidence of prostate cancer as the most common malignancy in males in many countriesraises the question of developing reliable detection tests. The prostate specific antigen (PSA) test is the mostwidely used for screening for prostate cancer; however, its low specificity elevates the number of unnecessarilybiopsies. Serum human kallikrein-2 (hK2) is considered as a promising marker, and especially its ratio to fPSA,for predicting the presence of malignancy to select the best choice referring to biopsy or surveillance. In this study,we investigated the role of hK2 and its combinations with other markers to discriminate prostate cancer frombenign diseases in Syrian patients. Materials and Methods: In this prospective oriented cross-sectional cohortstudy, serum samples were collected from patients referred to many Hospitals in Damascus, Syria, between May2011 and March 2012, and diagnosed with biopsy proven benign prostate hyperplasia (BPH) or prostate cancer(PCa). Serum was analyzed for hK2, PSA and fPSA, and the ratios of fPSA/PSA and hK2/fPSA were calculated.Results: We found that mean hK2/fPSA ratios were significantly higher (P=0.01) in prostate cancer patientsthan in the BPH or control groups. Also the ratio hk2/fPSA gave the largest area under the curve (AUC:0.96)which was significantly larger than for fPSA/PSA (AUC:0.41) indicative of higher specificity. Conclusions: Ourresults demonstrate that the ratio of hK2/fPSA might be superior to the use of fPSA/PSA alone. The hK2 couldbe shown to enhance the early detection of prostate cancer; especially the ratio hK2/fPSA improves specificityand hence may reduce the number of negative biopsies.     

A new Model Consists of Intravesical Prostatic Protrusion,Prostate Volume and Serum Prostatic-Specific Antigen in the Evaluation of Prostate Cancer

The Prostate-specific antigen (PSA) level is largely used to diagnose prostate cancer (PCa) in last decades. However, its specificity is low in patients with a PSA level ranging from 4.0 to 10.0 ng/ml. This study aims to define the correlation between intravesical prostatic protrusion (IPP) and PSA and to establish a new model to predict PCa. A total of 339 patients order than 45 years examined between October 2010 and June 2012 were enrolled. Eligible patients were recommended for transrectal ultrasonography (TRUS)-guided prostate biopsies after measuring total prostate volume (TPV), tranzisional zone volume (TZV) and IPP. The levels of total PSA (tPSA), free PSA (fPSA) were analyzed by using Hybritech calibrated Access tPSA and fPSA assays. A new mathematical model, named IPP removed PCa predicting score (IRPPS), consists of tPSA, TZV and IPP was established. The predictive accuracy of IRPPS, PSA density (PSAD), %PSA and tPSA were compared using receiver-operator characteristic (ROC) analysis. Eighty-six patients had PSA levels of 4.0–10.0 ng/ml. Twenty of them were diagnosed as PCa. Using ROC curves, the areas under the curve for IRPPS, PSAD and %PSA and tPSA were 0.786, 0.768 and 0.664 and 0.585, respectively. We suggested IPP grade had a significant relationship with serum tPSA levels. The predictive accuracy of IRPPS was higher than the other 3 indictors.     

The ratio of prostate-specific antigen (PSA) to prostate volume (PSA density) as a parameter to improve the detection of prostate carcinoma in PSA values in the range of < 4 ng/mL

BACKGROUND: The objective of this study was to evaluate the prostate specific antigen (PSA) density (PSAD) (the quotient of PSA and prostate volume) compared with the percent free PSA (%fPSA) in different total PSA (tPSA) ranges from 2 ng/mL to 20 ng/mL. Possible cut-off levels depending on the tPSA should be established. METHODS: In total, 1809 men with no pretreatment of the prostate were enrolled between 1996 and 2004. Total and free PSA were measured with the IMMULITE PSA and Free PSA kits (Diagnostic Products, Los Angeles, CA). Prostate volume was determined by transrectal ultrasound. The diagnostic validity of tPSA, %fPSA, and PSAD was evaluated by receiver operation characteristic (ROC) curve analysis. RESULTS: The PSAD differed significantly (P < 0.0001) between patients with prostate carcinoma and patients with benign prostatic hyperplasia in all analyzed ranges of tPSA and prostate volume. At the 90% and 95% sensitivity levels and regarding the area under the ROC curve (AUC) within the tPSA range of 2-4 ng/mL, The PSAD was significantly better than tPSA and %fPSA. Within the tPSA range of 4-10 ng/mL, the PSAD did not perform better than %fPSA. CONCLUSIONS: PSAD showed a better performance than %fPSA at tPSA concentrations < 4 ng/mL for detecting prostate carcinoma, with a significantly larger AUC for PSAD (0.739) compared with %fPSA (0.667). PSAD did not perform better than %fPSA when the tPSA range of 4-10 ng/mL was analyzed. Different PSAD cut-off values of 0.05 at tPSA 2-4 ng/mL, 0.1 at tPSA 4-10 ng/mL, and 0.19 at 10-20 ng/mL were necessary to reach 95% sensitivity.