游离与总PSA比值——一种前列腺癌检测的可靠指标

用放射免疫方法测定１１７例前列腺疾病患者血清游离ＰＳＡ（ＦＰＳＡ）、总ＰＳＡ（ＴＰＳＡ）值，并计算游离与总ＰＳＡ比值（Ｆ／Ｔ比值）。其中前列腺癌３１例，前列腺增生８６例。结果显示：Ｆ／Ｔ比值前列腺癌组明显低于前列腺增生组（Ｐ＜０．０１）。认为Ｆ／Ｔ比值可用于区别前列腺癌与前列腺增生，尤其当ＰＳＡ水平限定在４～１０μｇ／Ｌ范围内，应用Ｆ／Ｔ比值较ＰＳＡ为优     

前列腺特异性抗原普查在诊断前列腺癌中的作用

目的 了解血清叫前列腺特异抗原（Ｔ－ＰＳＡ）、游离ＰＳＡ（Ｆ－ＰＳＡ）、ＰＳＡ密度（ＰＳＡＤ）在诊断前列腺癌中的作用。方法 门诊检查４０岁以上男性病人共３２４例，活检筛查出前列腺癌９例（２．８％），将病人分组进行比较。结果 前列腺癌组Ｔ－ＰＳＡ、Ｆ－ＰＳＡ和ＰＳＡＤ高于前列腺增生和其他疾病组（Ｐ〈０．０５）。血清Ｔ－ＰＳＡ〈４ｎｇ／ｍｌ、４～１０ｎｇ／ｍｌ、〉１０ｎｇ／ｍｌ者发现前列腺癌的比例分别     

F／TPSA在TPSA4—10μg／L之间的前列腺增和玫前列腺癌鉴别诊断中的 …

目的：探讨总前列腺特异性抗原（ＴＰＳＡ）与游离流列腺特异性抗原（ＦＰＳＡ）的比值在ＴＰＳＡ４－１０μｇ／Ｌ之间的良性前列腺增生（ＢＰＨ）和前列腺癌（ＰＣ）中鉴别诊断的意义，方法：采用放免法对２８１例病人的ＴＰＳＡ和ＦＰＳＡ进行测定，并计算Ｆ／ＴＰＳＡ，其中ＴＰＳＡ在４－１０μｇ／Ｌ的ＰＣ和ＢＰＨ病人分别是１０例和５１例，结果：ＰＣ组和ＢＰＨ组的ＴＰＳＡ分别是６．２２μｇ／Ｌ和６．０４μｇ／Ｌ，两组     

前列腺疾病诊断中血清游离态PSA指标的应用价值

目的探讨血清游离态ＰＳＡ（ＦＰＳＡ）和总ＰＳＡ（ＴＰＳＡ）及游离态／总（Ｆ／Ｔ）ＰＳＡ比值作为前列腺疾病诊断指标的价值。方法测定５６例未经治疗的ＢＰＨ病人和３９例前列腺癌病人血清ＦＰＳＡ和ＴＰＳＡ,并计算Ｆ／Ｔ比值。结果ＴＰＳＡ及Ｆ／Ｔ可有效区分ＢＰＨ和前列腺癌（Ｐ＜０．００５）,尤其在诊断灰区（ＴＰＳＡ为４．０～１０．０μｇ／Ｌ）中效果更明显。以ＴＰＳＡ≤１０．０μｇ／Ｌ,Ｆ／Ｔ≥０．１６为界值时,前列腺癌筛选的临床概率敏感度为９４．７％。结论ＦＰＳＡ和Ｆ／Ｔ比值的引入,使血清ＰＳＡ测定更为精细,保持了实验的高敏感度,尤其是在前列腺癌的诊断灰区     

血清游离PSA和游离/总PSA比值在前列腺癌诊断中的应用

血清游离ＰＳＡ（ＦＰＳＡ）和游离／总ＰＳＡ比值（Ｆ／ＴＰＳＡ）是一种新的前列腺癌筛选诊断方法。较之单纯ＰＳＡ测定，Ｆ／ＴＰＳＡ具有更高的特异性和整体准确性，有助于诊断前列腺癌，减少阴性活检。也有学者认为该方法的特异性和敏感性比起ＰＳＡ未见优越     

F/T-PSA比值对PSA灰区中前列腺癌的诊断意义

我们检测 11例前列腺癌和 32例良性前列腺增生 (ＢＰＨ)患者的ＰＳＡ相关指标 ,分析探讨游离前列腺特异性抗原 (Ｆ ＰＳＡ)与总前列腺特异性抗原 (Ｔ ＰＳＡ)比值 (Ｆ/Ｔ)对诊断灰区 (Ｔ ＰＳＡ值 4～ 10ｎｇ/ｍｌ)中前列腺癌的意义 ,报告如下。资料与方法　对Ｔ ＰＳＡ 4～ 10     

游离PSA百分率的临床研究进展

近年来有关游离ＰＳＡ的百分率（Ｆ／Ｔ百分率）的临床研究已有不少报道，本文综述Ｆ／Ｔ百分率的生化研究进展及其与前列腺操作、病人年龄、前列腺体积、病理分期及Ｇｌｅｓｓｏｎ分级评分的关系，并阐明其在前列腺疾病中的临床应用。     

前列腺特异性抗原（PSA）生物学特性研究进展

前列腺特异性抗原（ＰＳＡ）是由位于第１９对染色体的ＫＬＫ－３基因表达，并受雄激素的调节。ＰＳＡ主要由前列腺细胞合成，为一单链糖蛋白本质是一种蛋白水解酶，在某些细胞癌变，或在激素刺激下的正常乳腺细胞中也可有ＰＳＡ基因表达。ＰＳＡ在血清以游离（Ｆ－ＰＳＡ）和结合（Ｔ－ＰＳＡ）两种形式存在，血清ＰＳＡ浓度，以及血清Ｆ－ＰＳＡ／Ｔ－ＰＳＡ比值，尿ＰＳＡ浓度的变化等均有助于前列腺疾病的诊断和鉴别诊断。     

前列腺特异性抗原(PSA)生物学特性研究进展

前列腺特异性抗原（ＰＳＡ）是由位于第１９对染色体的ＫＬＫ－３基因表达，并受雄激素的调节。ＰＳＡ主要由前列腺细胞合成，为一单链糖蛋白，本质是一种蛋白水解酶。在某些细胞癌变，或在激素刺激下的正常乳腺细胞中也可有ＰＳＡ基因表达。ＰＳＡ在血清以游离（Ｆ－ＰＳＡ）和结合（Ｔ－ＰＳＡ）两种形式存在，血清ＰＳＡ浓度，以及血清Ｆ－ＰＳＡ／Ｔ－ＰＳＡ比值，尿ＰＳＡ浓度的变化等均有助于前列腺疾病的诊断和鉴别诊断。     

前列腺特异抗原临床研究进展

前列腺特异抗原（ＰＳＡ）是检测前列腺癌的最具临床价值的瘤标,为增加前列腺癌诊断的特异性和敏感性,近年来发现ＰＳＡ与前列腺体积、年龄、游离ＰＳＡ有关,从而出现了以下四种参数：ＰＳＡ密度、ＰＳＡ速率、特定年龄范围及游离ＰＳＡ与总ＰＳＡ百分率;采用ＲＴ－ＰＣＲ方法测定血液中产生ＰＳＡ的癌细胞,对前列腺癌的分期、治疗选择及预后估价起重要作用。本文就以上内容进行了综述。     

游离PSA与总PSA比值在前列腺癌鉴别诊断中的意义

目的　探讨游离前列腺特异性抗原 (fPSA)与总前列腺特异性抗原 (tPSA)比值 (f tPSA)在tPSA为 4～ 10ng ml时对前列腺癌和良性前列腺增生 (BPH)鉴别的意义及其局限性。方法　对1998年 10月至 2 0 0 2年 10月接受诊治的 180例血清tPSA为 4～ 10ng ml的前列腺癌和BPH患者进行回顾性分析。经组织学证实 ,36例 (2 0 % )是前列腺癌 ,14 4例 (80 % )是BPH。血清中tPSA和fPSA通过酶免微粒子捕捉法测定。前列腺体积通过经腹壁超声测定。前列腺癌与BPH组间比较用t检验。采用Pearson相关系数分析前列腺体积与f tPSA之间的相关性。结果　前列腺癌患者的tPSA、f tPSA平均值分别是 6 75ng ml与 0 17;BPH患者则是 6 4 8ng ml和 0 2 5。两组患者的tPSA差异无显著意义 (P >0 0 5 ) ,而前列腺癌患者的f tPSA值显著低于BPH患者 (P <0 0 1)。此外 ,两组患者的前列腺体积与f tPSA均呈显著正相关 (前列腺癌组相关系数r=0 5 0 ,P <0 0 1;BPH组r=0 2 4 ,P <0 0 1)。在前列腺体积小于 4 0cm3,两组患者的f tPSA差异有显著意义 (P <0 0 5 ) ,当体积超过 4 0cm3,则差异无显著意义 (P >0 0 5 )。结论　f tPSA对tPSA在 4～ 10ng ml之间的前列腺癌和BPH的鉴别诊断有重要意义 ,但由于受前列腺体积的影响 ,只有在     

Study of free to total prostate specific antigen ratio in the detection of patients with prostate cancer

BACKGROUND: We investigated the clinical usefulness of free to total serum prostate specific antigen (PSA) ratio (F/T ratio) in order to improve the specificity of total PSA measurement for detecting prostate cancer. METHOD: In this study 129 patients with total PSA level 4-20 ng/ml underwent transrectal ultrasound guided sextant biopsy. Serum samples were assessed for total PSA, free PSA and the F/T ratio calculated. All patients were pathologically diagnosed as benign prostatic hyperplasia or prostate cancer. RESULTS: Of 129 patients 21 had prostate carcinoma (PCa) and 108 had benign prostatic hyperplasia (BPH) from the results of prostate biopsies. The mean of total PSA were not significantly different between men with PCa and with BPH. The mean of free PSA for PCa was significantly lower than that for BPH (p = 0.043). Furthermore, the mean of F/T ratio was significantly different between PCa and BPH group (p = 0.0014). The F/T ratio had a higher specificity than total PSA at all levels of sensitivity in detecting prostate cancers. Sensitivity, specificity and accuracy for cancer detection at a cut off 0.12 was 90.4%, 51.8% and 58.1%, respectively. Also, free PSA was as useful as F/T ratio for cancer detection when analyzed in receiver operating characteristic curves analysis. When determined the cut off number of free PSA at 0.78 ng/ml, the sensitivity, specificity and accuracy for cancer detection were 61.9%, 66.7% and 65.9%, respectively. CONCLUSION: This study indicated that the F/T ratio and free PSA could improve the specificity without impairing the sensitivity for detecting PCa in patients with 4-20 ng/ml of total PSA.     

Hormonal predictors of prostate cancer

INTRODUCTION: Androgens are necessary for the development and functioning of the prostate gland. The association of serum testosterone and pituitary hormone levels with prostate cancer development is not completely understood. In this clinical study, we evaluated the role of serum testosterone, free testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in predicting prostate cancer risk in patients who had transrectal ultrasonography-guided prostate biopsy with the suspicion of prostate cancer. MATERIAL AND METHODS: A total of 211 patients who were selected to undergo prostatic biopsy due to abnormal digital rectal examination and/or a serum prostate-specific antigen (PSA) level >2.5 ng/ml were included in the study. The patient characteristics of total PSA, free/total PSA ratio, serum total testosterone, free testosterone, free/total testosterone ratio, FSH and LH levels were compared according to the pathological diagnosis. RESULTS: The mean age was 63.91 years (range 44-83) and the mean PSA level was 9.23 ng/ml (range 0.13-50.41) in the whole group. Of 211 patients, 69 (32.7%) were positive for prostate cancer. The patients who were positive for prostate cancer had statistically lower levels of serum total testosterone compared with the patients who were diagnosed as having benign prostatic hyperplasia (BPH; 405 vs. 450.5 ng/dl, respectively; p = 0.013). The serum FSH level was significantly higher in men with prostatic cancer than in men with BPH (7.56 vs. 6.06 mIU/ml, respectively; p = 0.029). No significant differences between men with prostatic cancer and those with BPH were found for serum LH levels. When normal ranges for serum free and total testosterone levels were defined as 9 pg/ml and 300 ng/dl, respectively, patients who had low free testosterone and total testosterone levels had significantly higher cancer detection rates than patients with high serum androgen levels: 40.8% (40/98) versus 25.6% (29/113) (p = 0.021), and 48.6% (18/37) versus 29.3% (51/174), respectively (p = 0.023). After logistic regression analysis, none of the hormones showed a significant difference in predicting the risk of prostate cancer in patients undergoing prostate biopsy with suspicion of the disease. CONCLUSION: Our data suggest that patients diagnosed with prostate cancer have low levels of serum testosterone and high levels of serum FSH compared with the patients with BPH. No support was found for the theory that high levels of testosterone increase prostate cancer risk. Further studies are needed to clarify the relationship between hormones and prostate cancer etiology.     

High serum prostate-specific antigen levels in the absence of prostate cancer in Middle-Eastern men: the clinician's dilemma

OBJECTIVE: To investigate the common causes of total serum prostate-specific antigen (PSA) values of> 10 ng/mL in an Arab population, as in the USA and Europe the risk of prostate cancer is considered high in men with such PSA levels. PATIENTS AND METHODS: Serum total PSA was measured in men presenting to our hospital as part of the investigation for prostate cancer screening and/or in elderly men with prostatism. Men with a serum PSA level of> 10 ng/mL were further investigated by transrectal ultrasonography (TRUS) of the prostate and biopsy of suspicious lesions for histological diagnosis. In addition, the percentage of free PSA, PSA velocity and PSA density were determined. All the patients included in this study were men of Arab origin residing in Kuwait. RESULTS: In all, 1700 men (mean age 55.6 years, range 35-94) were assessed; of these, 161 had a serum PSA of> 10 ng/mL, attributable to benign prostatic hyperplasia (BPH) in 110 (68%), BPH with histological features of prostatitis in 33 (21%) and prostate cancer in 18 (11%). TRUS of the prostate in 143 of the 161 men with either BPH or BPH with prostatitis showed varying grades of intraprostatic calcifications in 22 (15%). Both PSA density and percentage free PSA did not contribute to determining the causes of total PSA levels of> 10 ng/mL. There was a progressive decline in PSA in all patients with BPH and prostatitis, except one who at re-biopsy had prostate cancer (T1N0M0, G1). CONCLUSION: Total PSA values of> 10 ng/mL in Arab men may be a result of BPH, BPH with prostatitis or prostate cancer, in that order. A gradual decline in total PSA (decreased PSA velocity) with time to < 4 ng/mL often confirms the diagnosis of BPH with prostatitis. The percentage of free PSA and PSA density may not be helpful in diagnosing prostate cancer with certainty in these patients. Compared with Caucasians in the USA and Europe, BPH and BPH with prostatitis appear to be more frequent causes of serum PSA levels of> 10 ng/mL in Arab men.     

f/t PSA比值、PSA密度、PSA移行带密度在tPSA灰区前列腺偶发癌诊断中的意义

【摘要】 目的： 探讨血清f/t PSA比值、PSA密度、PSA移行带密度在tPSA位于灰区时前列腺癌诊断中的意义。方法： tPSA位于4～10ng/ml的前列腺增生患者112例,术前经前列腺穿刺活检均证实为前列腺增生,行TURP术后病理证实21例为前列腺偶发癌患者。回顾性分析该21例前列腺偶发癌患者和其余前列腺增生患者间的血清f/t PSA比值、PSA密度、PSA移行带密度,并进行统计学分析,以了解其在tPSA灰区前列腺偶发癌诊断中的意义。结果：前列腺偶发癌组和BPH组血清f/t PSA比值分别为0.13±0.03、0.21±0.04;PSAD分别为0.20±0.05 ng/ml2 、0.12±0.04 ng/ml2;PSATZ分别为0.38±0.06 ng/ml2 、 0.21±0.05 ng/ml2;两组在以上三个检测指标上差异具有显著性(P<0.05)。以0.15 ng/ml2为截断点则PSAD 灵敏性为76.115%,特异性为69.146%;以0.35 ng/ml2为截断点则PSATZ 灵敏性为60.642%,特异性为93.943%。结论：f/t PSA比值、PSAD、PSATZ对前列腺偶发癌的诊断具有重要价值,其中尤以PSATZ更具预测价值。     

Measurement of serum PSA values by DELFIA PSA and its clinical significance on diagnosis and follow-up of prostate cancer patients]

Serum prostate specific antigen (PSA) values detected by DELFIA PSA were evaluated for usefulness in the diagnosis and follow-up of patients with prostate cancer. The system is time-resolved fluoroimmunoassay using europium as a tracer, which has a detectable range of 0.10-500 ng/ml with a small sample volume (25 microliters) and reliable quality control data. Furthermore, serum PSA values detected by the assay were equivocal to those detected by Tandem-R PSA. From the mean +3 S.D. of serum PSA values obtained on 227 normal males, 1.98 ng/ml was decided as an upper normal level. Serum PSA values in benign prostatic hyperplasia (BPH) (n = 69) and prostate cancer (n = 86) patients were statistically higher than those in normal males. However, when 1.98 ng/ml was used as a cut-off value, the false positive rate in BPH cases elevated up to 80%. Therefore, in the differential diagnosis of prostate cancer and BPH, we recommend 11.7 ng/ml (mean + S.D. in BPH cases) as a cut-off value, in which sensitivity is 72.1%, 88.4% are true negative in BPH, and efficacy is 79.4%. Serially determined serum PSA values in following up the patients with prostate cancer were confirmed to be highly effective for diagnosing recurrence and evaluating treatment responses. These findings suggest that DELFIA PSA is a useful tool for determination of serum PSA values.     

前列腺特异性抗原密度的测定在诊断前列腺癌中的价值

对１０例非转移性前列腺癌和２０例前列腺增生的前列腺特异性抗原密度（ＰＳＡＤ）进行研究。前列腺癌平均ＰＳＡＤ值为０．７１１，而前列腺增生为０．０７５；两者有极显著性差异（Ｐ＜０．００１）。９例ＰＳＡＤ＞０．２者，８例为前列腺癌。１６例ＰＳＡＤ＜０．１者，无１例前列腺癌。８例前列腺癌患者中有３例前列腺特异性抗原（ＰＳＡ）＜１０ｎｇ／ｍｌ，１例＜２．８ｎｇ／ｍｌ。１６例前列腺增生患者中７例ＰＳＡ＞２．８ｎｇ／ｍｌ，３例＞１０ｎｇ／ｍｌ。表明血清ＰＳＡ轻中度增高或正常时，ＰＳＡＤ可作为前列腺癌早期筛选诊断的有效指标之一。     

A comparison of the free fraction of serum prostate specific antigen in men with benign and cancerous prostates: the best case scenario

Purpose

In most previous studies of free-to-total serum prostate specific antigen (PSA) ratios, the specimens from patients with prostate cancer or those with benign prostatic hyperplasia (BPH) have not been highly characterized. We compared preoperative sera from post-radical prostatectomy patients with clinically significant cancers of at least 2 cm.³ to sera from those with BPH and large, biopsy negative prostates.

Materials and Methods

We used 2 different time resolved immunofluorometric assays for free and total PSA, and a combination of a chemoluminescent immunoassay for free PSA detection with an immunoradiometric assay for total PSA to measure free and total PSA. The serum ratios of free-to-total PSA in these assays were compared to those obtained previously from gel filtration studies. Sera from 51 men with prostate cancer volumes of 2 to 18 cm.³ were compared to those from 48 men with BPH and a mean prostate volume of 78 plus/minus 7 cm.³. The respective mean serum PSA levels plus or minus standard deviation were 10.0 plus/minus 6.3 and 8.9 plus/minus 7.2 ng./ml.

Results

Monoclonal assays for free PSA confirmed the previous study with gel filtration. For PSA 4 to 10 ng./ml., 94 to 95 percent of the men with prostate cancer were correctly diagnosed, with a cutoff of less than 15 percent for free-to-total PSA on immunofluorometric assay and less than 14 percent for chemoluminescent immunoassay with immunoradiometric assay. However, 46 percent (immunofluorometric assay) and 36 percent (chemoluminescent immunoassay and immunoradiometric assay) of men with BPH did not have enough free PSA for diagnosis of BPH (that is 36 to 46 percent false-positive rate).

Conclusions

For total PSA 4 to 10 ng./ml., the sensitivity of approximately 15 percent free-to-total PSA for prostate cancer is high (94 to 95 percent) but 36 to 46 percent of men with BPH and a large gland will not be correctly identified. For PSA 2 to 4 ng./ml., no ratio of percent free-to-total PSA discriminated BPH from prostate cancer.     

Comparison of the clinical value of complexed PSA and total PSA in the discrimination between benign prostatic hyperplasia and prostate cancer

BACKGROUND: To compare the clinical value of the measurement of complex and total PSA in the discrimination between benign prostatic hyperplasia (BPH) and prostate cancer. METHODS: In serum samples collected from 166 men with histopathologically proven clinically localized prostate cancer and of 97 men with BPH, total prostate-specific antigen (PSA), complexed PSA and the free to total PSA ratio were determined. The statistical analysis was done by the comparison of the receiver operator characteristic (ROC) curves. RESULTS: The areas under the ROC curves were 0.776 for total PSA, 0.799 for complexed PSA (total PSA vs. cPSA: p < 0.0001) and 0.812 for the free to total PSA ratio. With a cut-off of 3.0 ng/ml for complexed PSA, the sensitivity was 90%, the specificity 58%, the positive and the negative predictive values 79 and 78%, respectively. With a cut-off of 4.0 ng/ml for total PSA, the sensitivity was 87%, the specificity 59%, the positive and the negative predictive values were 78 and 72%, respectively. CONCLUSIONS: There was a statistically significant advantage for complexed PSA compared to total PSA in the discrimination between BPH and prostate cancer. The difference was, however, small and its clinical relevance is questionable.     

Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml.

PURPOSE: Serum prostate specific antigen (PSA) is widely used as a guide to initiate prostatic biopsies and to follow men older than 50 years old with and without prostate cancer. However, benign prostatic hyperplasia (BPH) is a common cause of serum PSA values between 2 and 10 ng./ml. A better understanding of the relationships among serum PSA, prostate cancer and BPH is important. MATERIALS AND METHODS: A total of 875 men underwent radical prostatectomy at our institution between December 1984 and January 1997. Of these men 784 had a serum PSA of 2 to 22 ng./ml., including 579 with the largest cancer located in the peripheral zone of the prostate. Of the 579 men 406 had serum PSA followups for greater than 3 years after radical prostatectomy. We examined Pearson correlations (R2) between preoperative serum PSA, and the volume of Gleason grades 4/5 and 3 to 1 cancer in 784 men, separating peripheral zone from transition zone cancers. We used broken line regression with break points of 7 and 9 ng./ml. preoperative PSA to summarize the relationship of each PSA doubling to 5 different morphological variables in 579 men with peripheral zone cancer. A 9 ng./ml. break point was used for prostate weight. Trend summaries with a local regression line for the relationships between 6 morphological variables and PSA were superimposed on full scatterplots of the 579 men with PSA less than 22 ng./ml. Cox proportional hazard models were used to examine 5-year PSA failure-free probabilities based on 406 men with minimal PSA followups greater than 3 years at break points of 7 to 9 ng./ml. PSA. RESULTS: Pearson correlation between cancer volume and preoperative serum PSA in 875 men was weak (r2 = 0.27) and driven by large cancers with serum PSA greater than 22 ng./ml. For peripheral zone cancer the overall R2 x 100 for 641 men with low and high grade cancer was 10% and only 3% for low grade cancer, that is almost no PSA produced by these peripheral zone cancers enters the serum. All morphological variables changed at rates of doubtful medical significance below a PSA of 7 to 9 ng./ml. but at rates that were significantly worse above 9 ng./ml. R2 for these relationships was never greater than 15%. Large individual morphological variations at all levels of PSA emphasize the serious limitation of PSA as a predictor of prostate cancer morphology. Below 9 ng./ml. prostate weight increased by 21% for each doubling of PSA but above 9 ng./ml. the increase was only 4.8%. CONCLUSIONS: Preoperative serum PSA has a clinically useless relationship with cancer volume and grade in radical prostatectomy specimens, and a limited relationship with PSA cure rates at preoperative serum PSA levels of 2 to 9 ng./ml. Trend summaries for prostate weight on broken line regression showed that below 9 ng./ml. BPH is a strong contender for the cause of PSA elevation, constituting the primary cause of the over diagnosis of prostate cancer.