游离与总PSA比值检测在前列腺癌诊断中的作用

为提高前列腺癌的诊断水平 ,我们对游离与总ＰＳＡ比值 (Ｆ Ｔ)在前列腺癌鉴别诊断中的应用进行研究。材料与方法　 1998年 9月至 2 0 0 1年 1月前列腺癌患者 47例。年龄 6 0～85岁 ,平均 71岁。均由穿刺活检或手术病理证实。良性前列腺增生患者 46例。年龄 5 5～ 83岁 ,平均 71岁。前列腺癌行ＴＵＲＰ术或双睾切除术后患者 18例 ,年龄 6 2～ 85岁 ,平均 6 9岁。患者取清晨空腹静脉血 ,分离血清后 ,用瑞典ＣａｎＡｇ公司生产的ＥＬＩＳＡ试剂盒 ,分别测定血清Ｆ ＰＳＡ、Ｔ ＰＳＡ ,计算Ｆ Ｔ值。统计分析采用ｔ检验。结果　前列腺癌组血清…     

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     

复合PSA、游离PSA及其比值在发现前列腺癌中的作用比较

作者评价了血浆总ＰＳＡ、游离ＰＳＡ和复合ＰＳＡ对前列腺癌的诊断作用 ,及其比值增加前列腺癌检出的特异性。采用回顾性和前瞻性研究 ,涉及 354例行前列腺穿刺活检的非连续性病例 ,其中1 2 2例发现癌 ,占 34 %。接受者操作特征曲线用于计算和比较总ＰＳＡ、复合ＰＳＡ百分比和游离ＰＳＡ百分比的作用 ,此外 ,还计算比较了相关的敏感性和特异性。结果 :接受者操作特征曲线下面积以游离ＰＳＡ比例最大 ,其次为复合ＰＳＡ百分比、复合ＰＳＡ和总ＰＳＡ。与总ＰＳＡ 4 .0ｎｇ/ｍｌ相比 ,复合ＰＳＡ以 3 .45ｎｇ/ｍｌ为正常值 ,能发现相同的肿…     

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和游离／总ＰＳＡ比值是一种新的前列腺癌筛选诊断方法。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对前列腺癌检测的新进展

前列腺特异性抗原（ＰＳＡ）作为前列腺癌（Ｐｃａ）的癌标已有十几年，其最大局限性在于不能明确区分良性前列腺疾病与Ｐｃａ。为提高其特异性与敏感性，最近对游离ＰＳＡ的百分率进行了研究。本文就近年来的有关研究资料进行综述。     

游离PSA对前列腺癌检测的新进展

前列腺特异性抗原（ＰＳＡ）作为前列腺癌（Ｐｃａ）的癌标已有十几年，其最大局限性在于不能明确区分良性前列腺疾病与Ｐｃａ。为提高其特异性与敏感性，最近对游离ＰＳＡ的百分率进行了研究。本文就近年来的有关研究资料进行综述。     

游离PSA/总PSA比值诊断前列腺癌的临床意义

目的　探讨血清游离前列腺特异抗原（ｆＰＳＡ）／ 总前列腺特异抗原（ｔＰＳＡ）比值对前列腺癌的诊断价值。方法　用酶联双抗夹心法检测２２ 例前列腺癌,４８ 例前列腺增生（ＢＰＨ） 和２０ 例正常对照组的血清ｆＰＳＡ、ｔＰＳＡ,并计算ｆＰＳＡ／ｔＰＳＡ 比值,评价其对前列腺癌的诊断价值。结果　以ｆＰＳＡ／ｔＰＳＡ０．１５ 为判断上限时,其诊断敏感性为９０ ．９％ ,特异性为８７．５％ ,诊断准确性为８８ ．６ ％ ,明显优于ｔＰＳＡ和ｆＰＳＡ 单独测定结果。结论　ｆＰＳＡ／ｔＰＳＡ可更有效地诊断前列腺癌。     

前列腺体积和游离PSA百分比对总PSA2.6-10.0ng／ml男性前列腺癌检测的影响

在总PSA4.1-10.0ng／ml男性的研究中已经发现游离PSA百分比和PSA密度能独立地增加前列腺癌筛查的特异性。新近研究提示行前列腺穿刺活检的总PSA临界值为2．6ng／ml。作者分析了游离PSA百分比和前列腺体积对总PSA2.6-10.0ng／ml男性前列腺癌检测的影响。     

PSA密度在血清PSA〈10ng／ml时的鉴别诊断意义

对14例血清前列腺特异性抗原（PSA）值＞10ng／ml的良性前列腺增生症（BPH）患者（BPH组）及12例前列腺癌（PC）患者（PC组）进行了术前PSA及前列腺特异性抗原密度（DPSA）测定。结果BPH织PSA值为29.61±15．89ng／ml，DPSA值为0．60±0．36；PC组PSA值为85．89±53．76ng／ml，DPSA值为1．93±1．31，两组间PSA及DPSA。均有统计学差异（P＜0．002）。认为当血清PSA力10ng／ml时．PSA几乎不能区分BPH和PC，而DPSA以0．7为标准值时，其诊断价值则明显优于PSA。同时分析厂造成BPH者PSA值＞10ng／ml的可能原因。     

经直肠超声造影靶向前列腺穿刺活检在PSA水平为4~20 ng/ml患者中的作用

目的：探讨前列腺超声造影在经直肠前列腺靶向穿刺活检中的临床应用价值.方法选择96例血清PSA在4~20 ng/ml行前列腺穿刺活检的患者,其中50例行经直肠超声前列腺13针系统性穿刺活检;46例先行经直肠前列腺超声造影,后对超声造影异常增强区靶向穿刺加6点常规穿刺,超声造影无异常者同系统性穿刺.比较两组穿刺活检的效率.结果系统性穿刺组前列腺癌的阳性率为22.0％,造影穿刺组为41.3％,两组间对单纯移行区肿瘤的检出率有统计学差异(P＜0.05).系统穿刺组人均穿刺13.0针,单针阳性率为11％;造影穿刺组人均穿刺10.9针,单针阳性率为20％;两组单针阳性率、人均穿刺针数差异均有统计学意义(P＜0.05).超声造影异常的患者单针阳性率明显高于普通超声检查的患者(31.5％ v s 11.3％),同时人均穿刺针数低于超声引导下系统性穿刺(9.7 vs 13.0针),差异具有统计学意义(P＜0.05).系统性穿刺组前列腺癌患者总 Gleason评分为74分,人均6.7分,超声造影穿刺组则分别为133、7.0分,两组比较有统计学差异.两组无严重并发症.结论对于PSA＜20 ng/ml 的患者,超声造影对引导经直肠前列腺靶向穿刺活检具有更高的效率,可减轻患者的痛苦.     

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.     

Under diagnosis and over diagnosis of prostate cancer in a screening population with serum PSA 2 to 10 ng/ml

PURPOSE: Since the implementation of widespread serum total prostate specific antigen based screening, the risk of prostate cancer over diagnosis has become a concern. We evaluated the amount of possible over and under diagnosis of prostate cancer in an asymptomatic screening population with a total prostate specific antigen of 2.0 to 3.9 (lower range) and 4.0 to 10.0 ng/ml (higher range). MATERIALS AND METHODS: A total of 680 patients with prostate cancer were included. Possible over diagnosis was defined as Gleason score less than 7, pathological stage pT2a and negative surgical margins. Under diagnosis was defined as pathological stage pT3 or greater, or positive surgical margins. Furthermore, insignificant tumors according to the Epstein criteria were evaluated in a small subset of patients for whom cancer volume information was available. RESULTS: In the lower and higher total prostate specific antigen ranges there was an over diagnosis rate of 19.7% and 16.5%, and an under diagnosis rate of 18.9%* and 36.7%, respectively (p<0.05). In the prostate specific antigen range of 2.0 to 10.0 ng/ml combined the rates of over and under diagnosis were 17.6% and 30.3%, respectively. In addition, 8.7% of tumors with total prostate specific antigen 2.0 to 10.0 ng/ml met the Epstein criteria for insignificance. CONCLUSIONS: These data show that the reported estimates of over diagnosis in the low total prostate specific antigen group are exaggerated in a screening population. Using our criteria prostate cancer under diagnosis occurs more frequently than over diagnosis in the total prostate specific antigen range of 4.0 to 10 ng/ml.     

Pre-operative percent free PSA predicts clinical outcomes in patients treated with radical prostatectomy with total PSA levels below 10 ng/ml

INTRODUCTION: To evaluate the association of total prostate specific antigen (T-PSA) and percent free PSA (%F-PSA) with prostate cancer outcomes in patients treated with radical prostatectomy (RP). METHODS: Pre-operative serum levels of T-PSA and F-PSA were prospectively measured in 402 consecutive patients treated with RP for clinically localized prostate cancer who had T-PSA levels below 10 ng/ml. RESULTS: T-PSA was not associated with any prostate cancer characteristics or outcomes. Lower %F-PSA was significantly associated with higher percent positive biopsy cores, extracapsular extension, seminal vesicle involvement, lympho-vascular invasion, perineural invasion, positive surgical margins, and higher pathologic Gleason sum. When adjusted for the effects of standard pre-operative features, lower %F-PSA significantly predicted non-organ confined disease, seminal vesicle involvement, lympho-vascular invasion, and biochemical progression. %F-PSA did not retain its association with biochemical progression after adjusting for the effects of standard post-operative features. Based on data from 22 patients with biochemical progression, lower %F-PSA was correlated with shorter T-PSA doubling time after biochemical progression (rho = 0.681, p = 0.010). %F-PSA was lower in patients who failed salvage radiation therapy (p = 0.031) and in patients who developed distant cancer metastases compared to patients who did not (p < 0.001). CONCLUSIONS: Pre-operative T-PSA is not associated with prostate cancer outcomes after RP when levels are below 10 ng/ml. In contrast, pre-operative %F-PSA is associated with adverse pathologic features, biochemical progression, and features of aggressive disease progression in patients treated with RP and T-PSA levels below 10 ng/ml. %F-PSA may improve pre-operative predictive models for predicting clinical outcomes of patients diagnosed with prostate cancer nowadays.     

Influence of prostate volume and percent free prostate specific antigen on prostate cancer detection in men with a total prostate specific antigen of 2.6 to 10.0 ng/ml

PURPOSE: Percent free prostate specific antigen and prostate specific antigen density have been independently shown to increase the specificity of prostate cancer screening in men with prostate specific antigen levels between 4.1 and 10.0 ng/ml. Recent data suggest the total prostate specific antigen cutoff for performing a biopsy should be 2.6 ng/ml. We assessed the influence of percent free prostate specific antigen and prostate volume on cancer detection in men with a prostate specific antigen between 2.6 and 10.0 ng/ml. MATERIALS AND METHODS: From 1991 to 2005 all transrectal ultrasound guided prostate biopsies (5,587) for abnormal digital rectal examination and/or increased age specific prostate specific antigen were evaluated. A total of 1,072 patients with a prostate specific antigen between 2.6 and 10.0 ng/ml and any percent free prostate specific antigen were included in study. The cancer detection rate was calculated for each percent free prostate specific antigen/volume stratum. RESULTS: Prostate cancer was detected in 296 patients (27.6%). The mean age and prostate specific antigen of the patients with benign pathology and prostate cancer were similar. Mean percent free prostate specific antigen was 17.5% and 14.1% (p>0.05), and the mean volume was 62.0 and 46.0 cc (p=0.001), respectively. The strongest risk factors for a positive biopsy were percent free prostate specific antigen (odds ratio 0.004, p<0.001), volume (OR 0.977, p<0.001) and digital rectal examination (OR 1.765, p=0.007), but not total prostate specific antigen (p=0.303). When stratified by volume and percent free prostate specific antigen, distinct risk groups were identified. The probability of detecting cancer inversely correlated with prostate volume and percent free prostate specific antigen. CONCLUSIONS: In men with prostate specific antigen levels between 2.6 and 10.0 ng/ml, the probability of detecting cancer was inversely proportional to prostate volume and percent free prostate specific antigen. This table may assist in predicting patient risk for harboring prostate cancer.     

前列腺特异性抗原(PSA)及其相关参数在PSA灰区诊断前列腺癌的临床研究

为临界值,以提高前列腺在灰区的断特异度和敏感度.     

BPH相关性抗原表达的临床意义

目的:探讨BPH相关性抗原(BPSA)在BPH、前列腺癌(PCa)诊断中的作用。方法:采用免疫组织化学ABC法,用BPSA单克隆抗体对62例BPH患者、37例PCa患者及30例其他肿瘤组织标本中的BPSA表达进行检测。结果:BPSA在100% BPH、88% PCa组织中呈不同程度的阳性表达,且在BPH组织中呈明显高表达。非前列腺肿瘤组织染色均呈阴性。组织BPSA表达与肿瘤病理分级无相关性(P>0. 05)。结论:BPSA具有良好的组织器官特异性,有助于早期PCa和BPH的鉴别诊断。     

嗜铬粒蛋白A在前列腺癌诊断中的意义

目的　探讨血清嗜铬粒蛋白A(CgA)在前列腺癌 (PCa)诊断中的作用。 　方法　采用ELISA法测定 30例健康志愿者 ,35例前列腺癌患者及 10例良性前列腺增生 (BPH)患者的血清CgA ,分析比较各组CgA的水平。 　结果　PCa患者血清CgA(16 2± 12 .5 )ng/ml,与正常对照组 (6 0 .2± 19.8)ng/ml及BPH组 (81.3± 4 3.0 )ng/ml比较差异有显著性意义 (P <0 .0 5 )。血清CgA水平随癌分期的升高而升高 ,D2 患者血清CgA水平明显高于正常对照组及其他分期PCa组 (P分别 <0 .0 1和 <0 .0 5 )。CgA和前列腺特异抗原 (PSA)联合检测可提高对前列腺癌的诊断价值 ,平行试验敏感度83% ,系列试验特异度 93%。　结论　血清CgA水平可应用于前列腺癌的诊断、监测和疗效观察 ,尤其对PSA阴性或伴有远隔转移的病例具有重要意义。     

An artificial neural network for prostate cancer staging when serum prostate specific antigen is 10 ng./ml. or less

PURPOSE: An artificial neural network was developed to improve the prediction of pathological stage before radical prostatectomy based on variables available at biopsy and clinical parameters. MATERIALS AND METHODS: We used the prospectively accrued European prostate cancer detection data base to train an artificial neural network to predict pathological stage in 200 men with serum prostate specific antigen (PSA) 10 ng./ml. or less who underwent radical prostatectomy. Variables included in the artificial neural network were patient age, serum PSA, free-to-total PSA ratio, PSA velocity, transrectal ultrasound calculated total and transition zone volumes with their associated PSA parameters (transition zone PSA density and PSA density), digital rectal examination and Gleason score on biopsy. Two multilayer perceptron neural networks were trained on the remaining variables. Data on the 200 patients were divided randomly into a training set, a test set and a validation or prospective set. RESULTS: Overall classification accuracy of the artificial neural network was 92.7% and 84.2% for organ confined and advanced prostate cancer staging, respectively. For preoperatively predicting local versus advanced stage the area under the ROC curve for the artificial neural network was significantly larger (0.91) compared with logistic regression analysis (0.83), Gleason score (0.69), PSA density (0.68), prostate transition zone volume (0.63) and serum PSA (0.62) (all p <0.01). CONCLUSIONS: The artificial neural network outperformed logistic regression analysis and correctly predicted pathological stage in more than 90% of the validation patients with serum PSA 10 ng./ml. or less based on clinical, biochemical and biopsy data. In the future artificial neural networks may represent a significant step for improved staging of prostate cancer when counseling patients referred for radical prostatectomy or other curative treatments.