前列腺癌血清PSAD与原位PSA的相关性研究

目的 :探讨前列腺癌患者血清前列腺特异抗原密度 (PSAD)与组织原位PSA表达的关系。方法 :参照Gleason标准对 2 5例前列腺腺癌组织进行分级 ,用免疫组织化学SP法检测前列腺癌组织中PSA ,术前 1周用化学发光分析法测定血清PSA浓度及经腹B超测定前列腺体积 ,二者之比为PSAD。结果 :5例高分化肿瘤全部呈强阳性 ;13例中分化肿瘤中 ,4例呈强阳性 ,9例呈弱阳性 ;7例低分化肿瘤中 ,1例呈强阳性 ,3例呈弱阳性 ,3例阴性。 2 5例腺癌PSAD为 0 .36～ 1.5 3(U =0 .75 )。不同分化的癌组织的PSA表达强度差异有显著性意义(P <0 .0 5 ) ,高、中分化组的血PSAD与低分化组差异有显著性意义 (P <0 .0 5 ) ,不同PSA表达强度的患者血PSAD差异无显著性意义 (P >0 .0 5 )。结论 :癌组织中蛋白酶的破坏造成PSA漏出增多 ,可能与血PSAD升高有关。癌组织PSA的免疫组织化学反应强度不能用于解释血PSAD的变化     

Clinical impact of body mass index on prostate biopsy in patients with intermediate PSA levels

From April 2005 to September 2007, 480 patients underwent transrectal prostate biopsy at our institution. The clinical data including age, serum prostate specific antigen (PSA) level, prostate volume and body mass index (BMI) were obtained, and the cancer detection rates and pathological findings were evaluated in 305 cases with a PSA concentration of 4.0 to 10.0 ng/ml. Prostate volume was calculated from magnetic resonance imaging (MRI) findings. The 305 patients were categorized according to their BMI into three groups (normal, less than 22 kg/m2 ; overweight, 22-25 kg/m2 ; and obese, more than 25 kg/m2). Cancer detection rates and histopathologic findings were compared between the groups. Multivariate logistic regression analysis was also performed. Prostate cancer was detected in 127 patients. No significant differences in BMI were observed between biopsy-positive and biopsy-negative cases (p = 0.965), and the detection rates of prostate cancer observed in the three groups were not significantly different. There was a significant association between BMI and the findings of high Gleason score (more than 4+3) (p = 0.048). BMI was not a contributory factor of prostate cancer detection for cases with intermediate PSA levels; however, patients with high BMI may have high-grade malignancy features.     

The relationship of body mass index and serum testosterone with disease outcomes in men with castration-resistant metastatic prostate cancer

The purpose of this study was to evaluate the relationship of baseline body mass index (BMI) and serum testosterone level with prostate cancer outcomes in men with castration-resistant metastatic prostate cancer (CRPC). BMI and testosterone levels were evaluated for their ability to predict overall survival (OS) and prostate-specific antigen (PSA) declines in the TAX327 clinical trial, an international phase III randomized trial of one of the two schedules of docetaxel and prednisone compared with mitoxantrone and prednisone. In this study of 1006 men with CRPC, the median serum testosterone level was 14.5 ng per 100 ml (range 0-270), the median BMI was 27 kg m(-2) (range 15.7-46.5), and 26% of men were obese or morbidly obese (BMI>or=30). Obesity was associated with younger age, lower PSA and alkaline phosphatase levels, and higher performance status, primary Gleason sum, testosterone and hemoglobin compared to absence of obesity. In multivariate analysis, neither BMI, presence of obesity, nor baseline testosterone was significantly associated with OS or PSA declines. Higher testosterone levels among obese men suggest incomplete gonadal suppression with current therapies, but these differences may not be clinically relevant in men with CRPC. There was evidence of potential hemodilution of PSA and alkaline phosphatase levels in obese men.     

Prostate specific antigen in a community-based sample of men without prostate cancer: Correlations with prostate volume,age, body mass index,and symptoms of prostatism

The correlation between both prostate specific antigen levels (PSA) and prostate specific antigen density (PSAD) and age, prostate volume parameters, body mass index, and the International Prostate Symptom Score (IPSS) were studied in a community-based population. A sample of 502 men aged 55 through 74 years was evaluated, excluding those with a serum PSA above 10 ng/ml, those with biopsy proven prostate cancer, and those who had previously undergone a prostate operation. PSA and PSAD did not correlate with the body mass index. Weak correlations were found between PSA and age (r = 0.25; P < 0.001), PSAD and age (r = 0.17; P < 0.001) and between PSA and the total prostate volume (r = 0.58; P < 0.001). PSA did not correlate independently with age after adjustment for volume (P = 0.22). The finding that PSAD correlates with age (r = 0.17; P < 0.001) is partly explained by the incomplete volume adjustment of PSAD which is proved by the positive correlation between PSAD and prostate volume (r = 0.26; P < 0.001). In the main target age-range for prostate cancer screening there is a poor basis for the use of age-specific reference values or volume adjustment for PSA levels in order to increase the clinical usefulness of this serum marker. Comparison of the results of the present study and studies conducted in others regions shows that there may be significant differences in PSA values per age stratum. Further studies are needed to clarify the reasons for these differences. © 1995 Wiley-Liss, Inc.     

The effect of body mass index on PSA levels and the development, screening and treatment of prostate cancer

The prevalence of both obesity and prostate cancer are increasing in the US. Recently, there has been keen interest in the relationship between obesity and the biology of cancers, including prostate cancer. This article reviews the current literature regarding body mass index (BMI) and its relationship with various clinical aspects of prostate cancer, including its incidence, screening, diagnosis and treatment. Despite several biological mechanisms that potentially link obesity to prostate cancer, the effects of obesity on serum PSA levels and prostate volume, and the subsequent effects on the detection of prostate cancer, are not consistent according to the available literature. Additionally, the epidemiologic data for the incidence of prostate cancer in obese and non-obese populations are conflicting. Treatment of prostate cancer in obese populations is problematic, but data on the ability to overcome these difficulties are unclear. It is difficult to determine whether oncologic and functional outcomes in obese patients differ substantially from those in non-obese patients. Separating the contributions of technical issues from potentially different tumor biologies is not currently possible. Hopefully, the increasing focus on these two highly prevalent health problems might further elucidate their complex relationship.     

血清PSA与前列腺癌病理分级的相关性

目的 探讨血清前列腺特异性抗原（PSA）与前列腺癌（PCa）病理组织学分级的相关性。方法前列腺手术前检测血清PSA，术后经病理检查确诊为前列腺癌患者58例。根据苏木素一伊红切片中肿瘤的组织学形态进行病理分级。采用Spearman等级相关分析PSA与前列腺癌病理分级的关系。结果血清PSA值与前列腺癌的病理分级呈正相关。结论血清PSA与前列腺癌组织学分级问的相关性可能协助判断前列腺癌分级及预后。     

Relationship of body mass index and prostate specific antigen in a population-based study

This study was designed to use a prospectively analyzed, population-based, multiethnic cohort of men to determine if there is a relationship between one measure of obesity/overweight (Body Mass Index) and Prostate Specific Antigen (PSA). A total of 1565 men without a prior diagnosis of prostate cancer were prospectively enrolled in the San Antonio study of Biomarkers Of Risk (SABOR) Clinical and Epidemiologic Center of the Early Detection Research Network of the National Cancer Institute. Body Mass Index (BMI) was compared with serum PSA levels, stratifying by ethnic group. No relationship was found between BMI and PSA in any ethnic group or in the cohort as a whole. This study suggests that there is no increased risk of overdetection of prostate cancer among obese men due to an elevation in PSA.     

Radium-223 in patients with prostate specific antigen (PSA) progression and without clinical metastases following maximal local therapy: A pilot study

BackgroundDespite the curative intent of radical prostatectomy (RP) (+/- radiotherapy (RT)), 30% of the clinically localized prostate cancer (CaP) patients will develop rising PSA (prostate specific antigen). In absence of clinical recurrence, there is a lack of effective treatment strategies in order to control the disease at its earliest (micro)metastatic stage. The aim of this study was to assess safety, tolerability, and biochemical response of off-label Radium-223 (Xofigo) treatment in CaP patients with PSA relapse following maximal local therapy.MethodsWe conducted a prospective, single arm, single center open-label, pilot study with Radium-223 in CaP patients with rising PSA (>0.2 ng/ml) following RP + adjuvant/salvage RT. Negative staging with ⁶⁸Ga-PSMA-11 PET/CT and whole-body MRI was mandatory at time of inclusion. Patients were eligible if they exhibited adverse clinico-pathological features predictive of significant recurrence. Safety, tolerability, biochemical progression (defined as PSA increase >50% from PSA nadir) and clinical recurrence were assessed.ResultsIn total, 23 patients were screened of whom 8 patients were included is the study. Radium-223 treatment was safe with no serious treatment related adverse events. One patient developed grade 3 lymphopenia. All patients rapidly developed PSA progression (median PSA progression-free survival: 5.5 months). Eventually all patients experienced clinical recurrence (median clinical recurrence-free survival 11.0 months) of whom only 2 patients developed skeletal recurrence.ConclusionsRadium-223 in patients with PSA relapse following maximal local treatment without clinical metastases is safe. However, the clinical benefit of Ra-223 in this setting is doubtful as significant oncological benefit is lacking.     

Analysis of the impact of the body mass index in patients with gastric carcinoma

Background

Body mass index (BMI) has been suggested to provide clinicopathological information in tumor development and progression in patients with gastric carcinoma.

Methods

The correlation of BMI with clinicopathological features and operation-related factors was analyzed in 308 patients with gastric carcinoma who had undergone distal or total gastrectomy.

Results

There was no significant correlation of obesity, indicated by a high value of BMI, with tumor-related factors including survival, or with operation-related factors. On the other hand, more advanced tumors and worse preoperative nutritional and immunological conditions were found in patients with a lower value of BMI.

Conclusions

BMI might be a representation of the physical condition brought about by the extent of tumor progression rather than a factor influencing the factors related to gastric carcinoma.     

血清／尿PSA比值对血清PSA处于“灰区”中前列腺癌的诊断价值

目的探讨血清前列腺特异性抗原（sPSA）与尿前列腺特异性抗原（uPSA）比值（s／uPSA）对血清PSA处于诊断“灰区”—sPSA于4．0～10．0ng／ml（放射免疫法范围）前列腺癌的诊断价值。方法选择血清PSA（sPSA）于诊断“灰区”的共191例前列腺疾病患者，采用放射免疫方法检测其尿PSA（uPSA）水平，根据前列腺活检结果分为前列腺癌组（PCa组，n=76）和良性前列腺增生症组（BPH组，n=115），比较两组s／uPSA比值以及两组间sPSA和s／uPSA比值的受试者运算特性曲线（ROC）面积。结果BPH组与PCa组的sPSA分别为（5．20±1．09）ng／ml和（6．41±2．12）ng／ml，uPSA分别（3．57±0．97）ng／ml和（2．17±0．61）ng／ml，sPSA和uPSA在BPH组与PCa组两者间差别均无统计学意义（t=0．91，t=1．24，P〉0．05）;BPH组与PCa组的s／uPSA分别为（2．32±0．61）和（4．13±1．09），PCa组s／uPSA比值明显高于BPH组，差别具有统计学意义（t=4．17，P〈O．01）。s／uPSA比值和sPSA的ROC曲线下面积分别为0．836和0．703。在保持95％敏感性时，s／uPSA比值和sPSA的特异性分别为77．1％和39．6％。结论在血清PSA值4．0～10．0ng／ml范围内，s／uPSA比值较sPSA更好地检出前列腺癌：在保持同一敏感性时，s／uPSA较sPSA具有更高的特异性。     

The effect of ergobromocriptine on serum testosterone and prolactin levels in patients with carcinoma of the prostate

The effect of Ergobromocriptine treatment on serum testosterone and prolactin levels in 15 patients with prostatic carcinoma and 15 patients with benign prostatic hyperplasia was examined. The prolactin levels which were elevated in patients with prostatic carcinoma showed a significant decrease after suppression with Ergobromocriptine. The selective effect of Ergobromocriptine on prolactin levels of patients with prostatic carcinoma may control the progression of the disease.     

Comparison of serum testosterone levels in prostate cancer patients receiving LHRH agonist therapy with or without the removal of the prostate

Introduction:

The prostate secretes enzymes and nutrients to promote sperm motility. Recent reports suggest that the prostate may also secrete testosterone, which is believed to be a fuel for prostate tumour growth. The aim of this study was to determine if a difference in serum testosterone levels exists between men on luteinizing hormone releasing-hormone (LHRH) agonists who have undergone radical prostatectomy, radiation or hormone therapy as primary prostate cancer treatment.

Methods:

Serum testosterone levels were evaluated in 165 consecutive prostate cancer patients using LHRH analogues for >3 months. We excluded patients receiving either radiation or chemotherapy at time of time of testosterone measurement. Patients were classified based on primary treatment: (1) radical prostatectomy; (2) radiation; or (3) primary hormone therapy. We used one-way ANOVA to compare testosterone levels. Pearson correlation was used to correlate testosterone with prostate-specific antigen (PSA) and time on LHRH agonists. Multivariable linear regression was used to predict serum testosterone levels.

Results:

The median (interquartile range) serum testosterone levels were 1.4 (1–1.9), 1.3 (1–1.625) and 1.25 (0.9–1.525) nmol/L for radical prostatectomy, radiation and primary hormone therapy groups, respectively. There was no statistically significant difference in testosterone levels between the groups (p = 0.3). No correlation was found between testosterone and PSA levels or time on LHRH (r = 0.02 and r = 0.01), respectively. Multivariable linear regression showed that none of the clinical variables were predictors of serum testosterone levels.

Conclusion:

Our study suggests that primary treatment does not affect serum testosterone levels among men using LHRH analogues.     

The impact of age, body mass index and testosterone on erectile dysfunction

PURPOSE: Erectile dysfunction (ED) may be associated with low serum total testosterone (T), low serum bioavailable testosterone (BAT) and high body mass index (BMI) in aging men. MATERIALS AND METHODS: A total of 675 workers (age range 45 to 60 years old) were entered into this study. Investigations were performed directly at their place of work. Exclusion criteria were abnormal urogenital status, antihypertensive drugs, medication possibly affecting the endocrine function and a history of previous pelvic trauma. T and sex hormone-binding globulin were measured with commercially available assays, and BAT was calculated from T and sex hormone-binding globulin. BMI was assessed and every individual completed a self-administrated questionnaire for erectile function (International Index of Erectile Function [IIEF-5]). RESULTS: T and BAT showed a significantly negative correlation with age and BMI. Each additional year of increase in age caused a decrease in the IIEF-5 score of 0.195 (p <0.001). Increase in BMI by 1 kg/m reduced IIEF-5 by 0.141, independent of age (p =0.005). Multiple logistic regression analyses confirmed the influence of increased age and higher BMI on the risk of ED. The corresponding odds ratio for ED was 1.082 (p <0.001) and 1.076 (p <0.001), respectively. These data indicate an increase in ED risk by 8.2% per year and by 7.6% per kg/m BMI. Severe cases of ED (IIEF-5 score 7 or less) were significantly associated with a decrease in T and BAT. Individuals with low BAT (1 ng/ml or less) had a 3 times higher risk of severe ED compared with men with BAT greater than 1 ng/ml (odds ratio 3.045, 95% CI 1.088 to 8.522, p =0.034). The result of the multiple logistic regression analysis was adjusted to age and BMI, and did not show a significant influence on the incidence of severe ED. CONCLUSIONS: BMI contributes strongly to ED. Low T or BAT are only relevant if IIEF-5 questionnaire results in severe ED.