有症状性和无症状性前列腺炎对血清tPSA及fPSA影响的比较

目的:探讨有症状性和无症状性前列腺炎患者的血清总前列腺特异抗原(tPSA)、游离型PSA(fP SA)以及fPSA/tPSA间是否存在差异。方法:对比分析53例有临床症状、41例无临床症状的前列腺炎患者及22例非前列腺炎患者的血清tPSA、fPSA浓度以及fPSA/tPSA比值间的差异,并对比39例有症状性前列腺炎患者治疗前后tPSA、fPSA以及fPSA/tPSA比值的变化。结果:有症状性及无症状性前列腺炎患者间tPSA、fPSA以及fPSA/tPSA的差异均无统计学意义(P>0.05),但与对照组之间的差异均有统计学意义(P<0.01)。有症状患者治疗后tPSA、fPSA均比治疗前明显下降(P<0.01)。结论:有症状性和无症状性前列腺炎均可导致血清tPSA、fPSA升高,在以其作为前列腺癌诊断和筛选的指标时,应该考虑前列腺炎所造成的干扰;血清tPSA、fPSA可以作为前列腺炎诊断和疗效判断的一项辅助指标。     

有下尿路症状的良性前列腺增生患者前列腺特异性抗原检测的临床意义

目的:探讨前列腺特异性抗原(PSA)测定在有下尿路症状的良性前列腺增生(BPH)患者的临床意义。方法:比较520例有症状和196例无症状的BPH患者的总PSA(tPSA),游离PSA(fPSA)和fPSA/tPSA等指标,并进行统计学分析。结果:有症状组和无症状组的tPSA值分别为(5.13±2.49)、(1.73±1.26)μg/L,差异有极显著性(P<0.01);fPSA分别为(1.57±0.80)、(0.54±0.38)μg/L,差异有极显著性(P<0.01);fPSA/tPSA分别为0.31±0.09和0.30±0.11,差异无显著性(P>0.05)。结论:有下尿路症状BPH患者的tPSA、fPSA明显高于无症状,但fPSA/tPSA比值在BPH患者中稳定。     

慢性前列腺炎对血清PSA水平的影响

目的 :研究慢性前列腺炎 (chronicprostatitis ,CP)中前列腺特异性抗原 (PSA)水平。　方法 :选择诊断为ⅢA型前列腺炎患者 4 5例 ,30例健康男性为正常对照 ,分别检测血清PSA水平 ,并进行分析。　结果 :在 4 5例ⅢA型前列腺炎患者中 ,血清PSA水平为 2 .4 1± 0 .6 4 μg/L ,而正常对照组为0 .93± 0 .5 2 μg/L ,2组PSA水平差异具有显著性(P <0 .0 5 )。其中 ,ⅢA型前列腺炎患者中血清PSA超过 4 .0 μg/L的共有 6例 (1 3.3%) ,而正常对照组中仅有 1例(3.3%)。ⅢA型前列腺炎患者中 ,随着前列腺按摩液内白细胞数增加 ,PSA水平有一定程度的增高 ,但没有显著性差异。　结论 :ⅢA型前列腺炎可以使血清PSA水平有一定程度的增高 ,在诊断过程中应予以考虑。     

Ⅳ型前列腺炎炎症分级和范围与前列腺特异性抗原之间的关系

目的:探讨Ⅳ型前列腺炎炎症组织病理学分级和范围与前列腺特异性抗原(PSA)的关系。方法:对120例临床可疑前列腺癌患者采用B超引导下经会阴前列腺穿刺病理活检,排除前列腺癌及不合并炎症的前列腺增生病例,仅BPH合并前列腺炎病例入选,采用NIH-Ⅳ型前列腺炎组织病理学分类方法对每例患者标本按炎症位置、范围和分级3方面分3级比较,评价炎症与血清PSA的关系。结果:120例患者中BPH合并前列腺炎症46例。①组织病理学炎症范围分级,1级35例,2级7例,3级4例,tPSA分别为(8.46±4.09)μg/L、(15.26±5.26)μg/L和(21.05±7.58)μg/L,fPSA分别为(1.75±0.93)μg/L、(2.54±0.72)μg/L和(3.19±1.13)μg/L,PSAD分别为0.15±0.11、0.26±0.07和0.42±0.19。三级之间比较tPSA(P=0.001)、fPSA(P=0.008)和PSAD(P<0.001)差异均具有显著性。②组织病理学炎症分级,1级32例,2级10例,3级4例。tPSA分别为(8.37±4.07)μg/L、(13.30±5.69)μg/L和(21.05±7.58)μg/L。fPSA分别为(1.76±0.93)μg/L、(3.27±2.21)μg/L和(3.19±1.13)μg/L。PSAD分别为0.14±0.11、0.25±0.06和0.42±0.19。三级之间比较tPSA(P=0.002)、fPSA(P=0.024)和PSAD(P<0.001)差异均有显著性。③组织病理学炎症位置分级,1级19例,2级17例,3级10例,三级之间tPSA、fPSA、%fPSA差异均无显著性(P>0.05)。④组织病理学炎症范围与tPSA(r=0.6,P<0.001)、fPSA(r=0.5,P=0.001)和PSAD(r=0.6,P<0.001)呈显著正相关关系。组织病理学炎症分级与tPSA(r=0.5,P<0.001)、fPSA(r=0.4,P=0.008)和PSAD(r=0.7,P<0.001)呈显著正相关关系,与%fPSA呈显著负相关关系(r=-0.4,P=0.013)。结论:无症状前列腺炎症患者组织病理学炎症的分级和范围与血PSA显著相关,病理医生应对前列腺穿刺标本进行炎症描述,其对高分级前列腺炎症患者可避免反复活检。     

泽桂癃爽及抗生素对ⅢA型前列腺炎患者血清PSA浓度的影响

目的:探讨ⅢA型前列腺炎患者经过泽桂癃爽联合抗生素治疗前后血清前列腺特异抗原(tPSA)及游离PSA百分率(F-PSAR)的变化意义.方法:120例ⅢA型前列腺炎患者,前4周合用泽桂癃爽及司帕沙星,后4周单独应用泽桂癃爽.行治疗前、治疗后第4周和第8周血清tPSA、NIH-CPSI评分及EPS检查并统计学分析.结果:血tPSA治疗后第4周较治疗前显著下降(P<0.05);F-PSAR治疗后4周和治疗后8周与治疗前相比均有显著性差异(P<0.05).与治疗前相比,治疗后4周和8周NIH-CPSI总体评分也有显著性差异(P<0.05).结论:给予泽桂癃爽联合抗生素治疗,能有效减轻ⅢA型前列腺炎患者的不适症状,显著降低患者血清PSA水平.     

单纯前列腺上皮内瘤回顾性分析(附142例病例分析)

目的通过对前列腺上皮内瘤(PIN)临床资料分析,探讨PIN的生物特性及应对策略。方法对31例无前列腺癌PIN(NPCaPIN)改变患者(其中1级23例,2、3级8例)的临床资料(包括患者血清PSA、fPSA/tPSA、PSA密度等区域计数资料以及穿刺标本免疫组织化学染色结果)进行回顾性分析,以同期确诊为前列腺癌(PCa)、良性前列腺增生(BPH)患者资料作为对照,分析低级别PIN(LGPIN)和高级别PIN(HGPIN)改变之间及NPCaPIN临床特征与PCa、BPH患者临床特征的差异。结果LGPIN和HGPIN改变的患者之间血清PSA水平和年龄存在差异(P<0.05);LGPIN和PCa患者之间血清PSA水平、前列腺体积、fPSA存在显著差异(P<0.01),PSA密度、fPSA/tPSA比值存在差异(P<0.05),和BPH患者之间各项均无明显差异;HGPIN改变和PCa患者之间前列腺体积、fPSA水平和年龄存在差异(P<0.05),和BPH患者之间血清PSA水平差异显著(P<0.01),fPSA/tPSA比值和年龄(P<0.05)存在差异;NPCaPIN和PCa患者之间血清前列腺体积、fPSA水平和年龄、血清PSA水平、PSA密度存在显著差异(P<0.01),和BPH患者之间fPSA/tPSA比值(P<0.05)存在差异。P63、AE1、AE3、P504S、PSA免疫组织化学结果NPCaPIN组类似于BPH而完全异于PCa。结论LGPIN的临床和病理特征与BPH相似,而HGPIN的临床和病理方面具有一定的前列腺恶性肿瘤特征,需要积极的临床追踪观察。     

前列腺腺癌患者血清PSA水平对Gleason评分的预测价值

目的探讨前列腺腺癌患者血清前列腺特异性抗原(PSA)水平对Gleason评分的预测价值。方法研究血清PSA三种主要指标和Gleason分级主要指标均值;比较不同组别之间的差异,分析血清PSA与Gleason评分相关性,并观察血清总PSA(tPSA)与Gleason评分之间变化趋势。结果血清tPSA≤4.0、4.1~10.0、10.1~20.0、20.1~100.0、100.0ng/mL组Gleason评分均值分别为6.31±0.47、6.66±0.89、7.04±1.11、7.56±1.03以及7.91±1.01;血清游离PSA(fPSA)≤1.0、1.1~10.0、10.0组Gleason评分均值分别为6.45±0.69、6.98±0.98以及7.75±1.05;血清总PSA(tPSA)t/fPSA≤0.16、0.17~0.50以及0.50组Gleason评分均值分别为6.72±0.88、7.45±1.04以及8.36±1.12。血清tPSA、fPSA以及fPSA/tPSA比值分别与Gleason评分、主要分级以及次要分级显著正相关;Gleason评分、主要分级以及次要分级均随血清tPSA、fPSA以及fPSA/tPSA逐渐增加而增加。结论前列腺腺癌患者血清PSA对Gleason评分的具有预测价值;与fPSA和fPSA/tPSA比值相比,tPSA是最有预测价值的指标。     

ROC曲线分析比较tPSA、fPSA／tPSA和PSAD在PSA灰区前列腺癌诊断中的价值

目的 ROC曲线分析探讨前列腺特异性抗原密度(PSAD)、总PSA(tPSA)和游离PSA/总PSA(fPSA/tPSA)3者在PSA灰区前列腺癌(PCa)中的临床诊断价值.方法 同顾性分析tPSA在4～10ng/ml之间的前列腺增生(BPH)患者75例和前列腺癌患者31例.化学发光法测定血清tPSA和fPSA,经直肠超声(TRUS)测定前列腺体积,计算fPSA/tPSA和PSAD.比较BPH组和PCa组间tPSA、PSAD和fPSA/tPSA各指标的差异,分析各指标在ROC曲线卜的面积、各指标的诊断特异性及敏感性.结果 PCa组与BPH组tPSA差异无统计学意义(P＞0.05),PCa组fPSA/tPSA比值较BPH组降低(P＜0.01),PSAD值较BPH组升高(P＜0.05).ROC曲线下的面积从大到小为fPSA/tPSA＞PSAD＞tPSA.在诊断敏感性相同的情况下,fPSA/tPSA比值诊断特异性高于PSAD的诊断特异性.当fPSA/tPSA临界值取0.16时,诊断前列腺癌的灵敏度和特异性为67.7%和79.7%,PSAD临界值取0.12时,其灵敏度和特异性为61.3%和62.7%.结论 当tPSA在诊断灰区时,PSAD和fPSA/tPSA可以提高前列腺癌的诊断特异性和敏感性,fPSA/tPSA较PSAD有更高的诊断价值.     

慢性Ⅳ型前列腺炎患者血PSA的变化

目的:探讨无症状性前列腺炎(NIH-IV)对血PSA的影响。方法:选择常规体检男性242例,慢性前列腺炎症状评分(CPSI)指数评分<8分。患者前列腺指诊及尿液分析未见异常,检查前先抽血查PSA,取前列腺按摩液(EPS)行白细胞计数,评估Ⅳ型前列腺炎发病情况,比较Ⅳ型前列腺炎及对照组的血PSA水平,并分析Ⅳ型前列腺炎患者EPS中白细胞的数目与PSA升高的相关性。结果:在242例体检男性中,Ⅳ型前列腺炎的发病率为34.3%(83/242)。Ⅳ型前列腺炎组与对照组间的年龄、前列腺体积差异无统计学意义(P>0.05),而PSA在Ⅳ型前列腺炎组为(2.88±2.60)μg/L,显著高于对照组(1.59±1.76)μg/L(P<0.05)。Ⅳ型前列腺炎组中PSA≥4μg/L的比例为13.3%(11/83),而对照组中PSA≥4μg/L的比例为4.4%(7/159),两者差异有统计学意义(P<0.05)。Ⅳ型前列腺炎患者EPS中白细胞数目多少与PSA的高低并无统计学意义(P>0.05)。结论:Ⅳ型前列腺炎亦是血PSA升高的原因之一。     

良性前列腺增生病人血清不同类别PSA的检测与分析

目的 :分析前列腺增生 (BPH)病人血清中不同前列腺特异抗原 (PSA)的稳定性 ,探讨其在前列腺疾病诊断中的应用价值。　方法 :将病理诊断证实的 1 0 5例BPH病人按总PSA(tPSA)水平分为 3组 :A组 (tPSA <4μg/L)67例 ,B组 (tPSA值 4～ 1 0 μg/L) 2 6例 ,C组 (tPSA >1 0 μg/L) 1 2例。按年龄分为 3组 :a组 (≤ 55岁 ) 1 8例 ,b组 (56～ 69岁 ) 33例 ,c组 (≥ 70岁 ) 54例。采用Bayer磁微粒化学发光免疫方法 ,测定各组BPH病人血清中的复合PSA(cPSA)、tPSA、游离PSA(fPSA) ,并计算cPSA/tPSA、fPSA/tPSA、fPSA/cPSA比值 ,比较它们在不同年龄和tPSA水平组间的稳定性。　结果 :无论在不同的tPSA水平组 ,还是在不同的年龄组 ,cPSA/tPSA比值和fPSA/tPSA、fP SA/cPSA比值比其它各种PSA更稳定。　结论 :cPSA/tPSA比值和fPSA/tPSA、fPSA/cPSA比值在前列腺疾病的诊断中可能更具有应用价值     

Tissue type plasminogen activator as a marker for functional zones, within the human prostate gland

The cellular distribution of tissue plasminogen activator in the prostate central zone, prostate peripheral zone, and seminal vesicle was studied by using immunohistochemistry. Samples of these three regions were taken from 20 radical prostatectomy specimens. Sixteen of 18 central zone samples showed positive staining of 20-90% of the epithelial cells. All 15 peripheral zone samples were negative, and only three of 14 seminal vesicles showed positive staining, which was present in less than 5% of cells. The distribution of tissue plasminogen activator within the prostate was the same as that previously reported for pepsinogen II. This suggests that the central zone of the prostate may be the selective site of origin for proteolytic enzymes in seminal fluid.     

Anatomy of the prostate: An historical survey of divergent views

Historically, the study of the prostate anatomy has been characterized by a proliferation of contradictory findings. The major divergent views of prostate anatomy are here reviewed and compared in order to facilitate further study and the ultimate selection of the best anatomical model. The details of Lowsley's original concept of the prostate lobes and the subsequent evolution of this concept into several contradictory hypotheses are traced. Discrepancies between the findings of Lowsley, Franks, and McNeal are explained. Conclusions are drawn which may facilitate the further study of anatomy and disease in both the human animal prostate.     

Impact of the static prostatic urethral angle on men with lower urinary tract symptoms

ObjectiveThe purpose of this study was to investigate the relationship between the prostatic urethral angle (PUA) and the peak urinary flow rate (Q_max), as well as the severity of lower urinary tract symptoms (LUTS) in men with benign prostate hyperplasia.Materials and methodsThe records of first-visit male patients with LUTS in the outpatient department of our institution were obtained. A transrectal ultrasound was performed on these patients after a detailed physical examination and medical history taking were performed. The International Prostate Symptom Score (IPSS) of the patients, the prostate size, the length of intravesical prostatic protrusion (IPP), and the PUA were evaluated. The patients also underwent uroflowmetry and bladder scan for residual urine.ResultsA total of 227 patients were included in this study. The mean PUA was 44.58 ± 12.87°. The mean prostate volume was 39.39 ± 19.79 mL, and the mean IPP was 4.82 ± 6.82 mm. After utilizing multivariate linear regression analysis, PUA was independently associated with IPSS (p < 0.001) and Q_max (p < 0.001). However, prostate volume and IPP were not associated with the above clinical items. None of the prostatic parameters were associated with the amount of postvoiding residual urine.ConclusionPUA has a remarkable correlation with Q_max and IPSS in men with LUTS. As PUA increased, IPSS also increased, and urinary flow rate decreased, exhibiting an inverse relationship.     

Course of localized adenocarcinoma of the prostate treated by radical prostatectomy

Among 562 patients with histologic stage B-1, B-2, or C adenocarcinoma of the prostate treated by radical prostatectomy and pelvic lymphadenectomy, analysis revealed that increasing histologic stage, tumor size, degree of capsular invasion, seminal vesicle involvement, and histologic grade all were highly correlated with both local and systemic progression (log-rank two-sided P less than or equal to 0.0001). No variable correlated with survival--a result that may reflect appropriate adjuvant therapy given at the time of progression. The death rate from prostatic cancer did appear to rise progressively with increase of stage. Overall, the projected 10-year survival was 76%.     

Other biomarkers for detecting prostate cancer

Prostate‐specific antigen (PSA) has been used for detecting prostate cancer since 1994. Although it is the best cancer biomarker available, PSA is not perfect. It lacks both the sensitivity and specificity to accurately detect the presence of prostate cancer. None of the PSA thresholds currently in use consistently identify patients with prostate cancer and exclude patients without cancer. Novel approaches to improve our ability to detect prostate cancer and predict the course of the disease are needed. Additional methods for detecting prostate cancer have been evaluated. Despite the discovery of many new biomarkers, only a few have shown some clinical value. These markers include human kallikrein 2, urokinase‐type plasminogen activator receptor, prostate‐specific membrane antigen, early prostate cancer antigen, PCA3, α‐methylacyl‐CoA racemase and glutathione S‐transferase π hypermethylation. We review the reports on biomarkers for prostate cancer detection, and their possible role in the clinical practice.     

Reference ranges for serum prostate-specific antigen in black and white men without cancer

Objectives. To determine the age- and race-specific prostate-specific antigen (PSA) distributions in healthy men in central South Carolina and to compare these to data from other studies.Methods. Two thousand ninety-two black men aged 40 to 69 years and white men aged 50 to 69 years from the general population in 11 counties of central South Carolina participated in a prostate cancer educational program. Seventy-two percent of the participants were black—about double the proportion in the general population—and 63% of the men (1319 of 2092) subsequently obtained a PSA determination from their own physician. The distribution of serum PSA was compared with distributions from the Olmsted County study and from the Walter Reed Army Medical Center/Center for Prostate Disease Research study.Results. Older men without cancer had higher PSA levels. Regression analyses yielded an associated increase of about 3.3% per year. Reference ranges for normal PSA in men without cancer (based on their sample 95th percentiles) were zero to 1.9, 3.8, and 5.7 ng/mL in black men aged 40 to 49, 50 to 59, and 60 to 69 years, and zero to 2.7 and 4.9 mg/mL in white men aged 50 to 59 and 60 to 69 years, respectively.Conclusions. Reference ranges for normal serum PSA levels should take into account the population from which they are derived and to which they will be applied. Reference ranges that are useful in the general population can differ from those that are appropriate in a hospital setting. For the general population in central South Carolina, reference ranges for serum PSA levels are lower than previously published reference ranges, particularly among black men.     

Expression of prostatic TRH-like peptides differs between species and between malignant and nonmalignant tissues

Thyrotropin-releasing hormone-immunoreactive peptides (iTRH) were analyzed in normal rat and rabbit prostates and in human benign prostatic hyperplasia (BPH) and prostate cancer. Peptides were extracted from tissues, fractionated by anion and cation exchange chromatography, and analyzed by TRH radioimmunoassay. pGlu-Glu-Pro-NH₂ predominated in rabbit, but accounted for only 10–15% of iTRH in rat and human BPH. Uncharged peptides predominated in rat and human prostate. Authentic TRH (pGlu-His-Pro-NH₂) is not present in rabbit prostate, but may account for up to 25% of iTRH in rat and human prostate. iTRH was virtually absent in prostate cancer. These results demonstrate considerable heterogeneity in the expression of TRH-like peptides in the prostates of various animal species, and suggest decreased expression of these peptides in prostate cancer. © 1993 Wiley-Liss Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America

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Which is the best radiological imaging method for predicting actual prostate weight?

In this study, we compared the weight of the prostate specimen removed after robotic radical prostatectomy with the prostate weight measured pre-operatively by four different imaging modalities. Pre-operative prostate weight before robotic radical prostatectomy was measured by Transabdominal Ultrasonography (TAUS), Transrectal Ultrasonography (TRUS), Abdominal Tomography (CT) and MultiparametricProstate Magnetic Resonance imaging (mpMRI). Of the 170 patients enrolled in the study, the mean age was 65.2 ± 7.08 (46–84) years and mean prostate-specific antigen (PSA) 9.6 ± 7.7 (1.8–50). The mean post-operative actual prostate weight was 63.1 ± 30 gr. The mean pre-operative prostate volumes measured by TAUS, TRUS, CT and MPMRI were 64.5 ± 28.5, 49.1 ± 30.6, 54.5 ± 30.5 and 68.7 ± 31.7 ml, respectively (p < .001). Post-operative actual prostate weight correlated with prostate weight measured by TAUS, TRUS, CT and mpMRI (r coefficient 0.776, 0.802, 0.768 and 0.825 respectively). The best of these was mpMRI. Although prostate weight measured by different imaging methods has a high correlation to predict actual prostate weight, actual prostate weight is best predicted by measurements with mpMRI. However, errors and deviations that may occur with these imaging methods should be taken into consideration.