经尿道前列腺电切术治疗晚期前列腺癌伴膀胱出口梗阻的疗效观察

目的：探讨经尿道前列腺电切术（TURP）联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的疗效及安全性。方法：回顾性分析2007年5月～2012年5月采用TURP联合内分泌治疗拟或单纯内分泌治疗晚期前列腺癌伴膀胱出口梗阻患者32例,其中13例行单纯行内分泌治疗,19例行TURP联合内分泌治疗。观察两组患者治疗前后血清前列腺特异抗原（PsA）、剩余尿量、最大尿流率、国际前列腺症状评分（IPSS）及5年生存率。结果：术后3个月,TURP＋内分泌治疗组血PSA、剩余尿量及IPSS分别由术前的（35．7±12．1）ng／ml、（145．0±65．8）ml、（21．4±5．1）分降至（4．9±1．9）ng／ml、（27．0±15．2）ml、（8．7±2．6）分（P〈0．05）,最大尿流率由（4．3±1．6）ml／S增至（11．7±3．7）ml／s（P〈0．05）;治疗12个月后差异仍有显著性（P〈0．05）。单纯内分泌组术后3个月血PSA由（31．4±10．7）ng／ml降至（5．6±2．2）ng／ml,两组比较,血PSA差异无统计学意义;剩余尿量、最大尿流率及IPSS差异均有统计学意义（P〈0．05）。内分泌组5年生存率为50％,TURP＋内分泌组为51．5％,总体生存率差异两组无统计学意义（P=0．919）。结论：TURP＋内分泌治疗能够显著缓解晚期前列腺癌患者膀胱出口梗阻症状,提高患者生活质量,且不影响生存率,是一种安全有效的治疗方式。     

经尿道双极等离子汽化电切术治疗26例高危复发性前列腺增生

目的探讨经尿道双极等离子汽化电切术（PKRP）治疗高危复发l性前列腺增生症的临床效果与安全性。方法对2008年8月至2013年5月间在我院接受经尿道双极等离子汽化电切术治疗的高危复发性前列腺增生症26例患者进行回顾性研究,分析术前及术后6个月、12个月国际前列腺症状评分（1PSS）、生活质量评分（QOL）、最大尿流率（Qmax）、膀胱残余尿（PVR）以及前列腺特异性抗原（PSA）等指标,评估其疗效。结果26例患者平均手术时间（52．4±23．5）min,术后均未输血及使用止血、血管活性药物。术后3月、6个月IPSS、QOL、Qmax、PVR、PSA各指标较术前明显改善（P〈0．05）。术后12个月较术后6个月无明显的改变（P〉0．05）。结论经尿道双极等离子汽化电切术治疗高危复发性前列腺增生具有安全性高、临床效果显著的特点,具有良好的应用前景。     

KTP激光汽化治疗伴下尿路梗阻的晚期前列腺癌

目的 总结经尿道KTP激光前列腺汽化术(PVP)治疗伴有下尿路梗阻晚期前列腺癌的临床疗效.方法 伴有下尿路梗阻的晚期前列腺癌患者33例.年龄(76±6)岁.其中T3 18例,T4 15例.前列腺体积36～140 ml.患者术前IPSS为28.2±3.6,QOL为5.0±0.7,Q_(max) 4.7～10.1 ml/s,残余尿量(RU)为(126.0±25.2)ml.33例均行KTP激光经尿道汽化前列腺治疗.19例初发前列腺癌患者同时行PVP和睾丸切除,14例为睾丸切除和抗雄激素等治疗后仍有明显的排尿梗阻症状,有尿潴留史15例.分别对术前及PVP术后1、6个月患者IPSS、QOL Qmax、血PSA、RU等指标进行统计分析.采用SPSS 13.0软件处理数据,均数间比较采用配对t检验.结果 33例手术经过顺利.28例术后3～4 d拔除导尿管,排尿情况改善明显;5例初次拔管后仍有排尿困难而再次留置导尿,延时拔管后均能自行排尿.术后并发症包括血尿14例、短暂尿失禁3例.术后1个月时IPSS、QOL、Q_(max)、血PSA、RU分别为14.6±2.8、3.1±0.4、(13.2±5.6)ml/s、(16.3±13.4)ng/ml、(24.6±5.9)ml;术后6个月时分别为14.2±3.3、3.4±0.5、(12.2±3.4)ml/s、(8.0±6.5)ng/ml、(31.1±8.7)ml.术后1、6个月的IPSS评分、QOL、Qmax、血PSA与术前比较差异均有统计学意义(P＜0.01),术后1、6个月间IPSS评分、QOL、Q_(max)比较差异无统计学意义(P＞0.05).结论 PVP可以有效解除前列腺癌患者的下尿路梗阻症状,明显改善患者生活质量.安全、有效.     

经尿道前列腺电汽化术及等离子电切术后5年疗效随访

目的 观察经尿道前列腺电汽化(transurethal electrovaporization of the prostate,TUVP)、经尿道前列腺等离子电切(transurethal plasmakinetic resection of the prostate,PKRP)术后患者的远期主要并发症,探讨常见并发症的原因及防治措施. 方法 回顾性分析92例TUVP、226例PKRP患者的临床资料,随访患者术后1、3、5年的相关情况,包括患者主观症状(如IPSS、QOL)、客观指标(如血清PSA、Qmax、残余尿量)、远期主要并发症等.对术后出现的并发症或其他疾病采取相应的治疗方法. 结果 TUVP、PKRP术后1年患者IPSS[(7.3±2.8),(7.2±2.5)分]、QOL[(2.6±0.7),(2.7±0.5)分]、Qmax[(25.2 ±3.5),(25.5±3.8)ml/s]、残余尿量[(18.7±5.4),(17.8±6.3)ml],组间比较差异无统计学意义(P＞0.05);术后3年患者IPSS[ (7.4±2.6),(7.5±2.9)分]、QOL[(2.7±0.4),(2.7±0.9)分]、Qmax[(24.8±3.3),(25.0±4.2) ml/s]、残余尿量[(19.4±6.0),(18.3±6.7)ml],组间比较差异无统计学意义(P＞0.05);术后5年患者IPSS[(7.5±3.1),(7.6±2.7)分]、QOL[ (2.7±0.8),(2.8±0.6)分]、Qmax[(24.1±4.4),(24.8±4.5)ml/s]、残余尿量[(20.1±5.8),(19.0 ±7.1)ml],组间比较差异无统计学意义(P＞0.05).TUVP组术后1、3、5年膀胱颈挛缩发生率为1.1％、3.3％和2.3％,尿道狭窄为3.3％、2.2％和1.1％,前列腺残留腺体增生为1.1％、2.2％和4.5％;PKRP组膀胱颈挛缩发生率为0.9％、2.7％和1.8％,尿道狭窄发生率为3.1％、2.2％和0.9％,前列腺残留腺体增生为1.3％、2.7％和3.7％. 结论 TUVP、PKRP治疗BPH具有良好的安全性和临床疗效.膀胱颈挛缩、尿道狭窄、前列腺残留腺体增生仍是TUVP、PKRP术后患者的远期主要并发症.对前列腺电切术后患者应进行规范的、长期的随访,针对不同并发症采取相应治疗措施.     

经尿道双极等离子前列腺腔内剜除术治疗前列腺增生220例临床疗效分析

目的观察前列腺增生腔内治疗方法——经尿道双极等离子前列腺腔内剜除法的临床疗效。方法对220例前列腺增生患者行经尿道双极等离子前列腺腔内剜除术,观察手术时间,术中出血量,术后留置导尿管时间,术后并发症,比较手术前后的国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(RU)、最大尿流率(Qmax)的差异。结果手术时间30～90min,平均40±10min;术中出血量70±10ml;术后留置导尿管时间4±0.5d;全部患者随访6～12个月,IPSS由27.8±2.3分下降9.6±2.6、QOL由5.5±0.5减少至1.5±0.5;剩余尿量由110±7ml下降到25±4ml;Qmax由8.0±2.3ml/s上升至18±2.4ml/s。所有病例随访6～12个月。结论经尿道双极等离子前列腺腔内剜除法切除组织彻底,出血少,并发症少,技术可行,疗效确定。     

经尿道双极等离子前列腺剜除联合等离子电切术治疗良性前列腺增生的临床效果

目的评价经尿道双极等离子前列腺剜除联合等离子电切术与传统经尿道前列腺等离子剜除手术(transurethral plasmakinetic enucleation of the prostate,TPKEP)对良性前列腺增生(benign prostate hyperplasia,BPH)患者手术后的不同治疗效果。方法 研究比较贵州医科大学附属肿瘤医院及江苏省宿迁市第一人民医院行经尿道前列腺剜除术治疗的BPH患者86例,其中43例患者采取经尿道双极等离子前列腺剜除联合等离子电切术设为试验组,另外43例患者采用传统经尿道等离子前列腺剜除方式设为对照组,对比术前及术后6个月复查国际前列腺症状评分(International Prostate Symptom Score,IPSS)、最大尿流率(maximum urinary flow rate,Qmax)、残余尿量(residual urine volume,RVU)变化情况;以及术后两组患者拔除尿管后24 h、1周、1个月尿失禁发生情况。结果 试验组和对照组术后6个月术后IPSS评分较术前明显降低,Qmax明显高于术前,RVU较术前明显减...     

等离子电切治疗前列腺增生症

目的探讨经尿道等离子双极电切治疗前列腺增生症(PKRP)的安全性和疗效。方法回顾分析经尿道等离子双极电切治疗前列腺增生112例,比较术前术后尿流率,前列腺症状评分,残余尿量;记录手术失血量,体重变化,切除前列腺组织重量。结果所有手术顺利完成,切除前列腺重量65±15.5g,手术时间40±7.5min,平均出血量150ml,最大尿流率(Qmax)术前7.4±2.6ml/s术后3个月为18.6±4.6ml/s;国际前列腺症状评分(IPSS)术前生活质量评分22.6分,术后3个月为6.5;残余尿量(RUV)术前>60m1,术后<20ml。结论等离子双极电切治疗前列腺增生症具有安全,有效,经济,技术易于掌握等优点,适合基层医院开展。     

钬激光前列腺剜除术治疗良性前列腺增生合并膀胱过度活动症的临床观察

目的 探讨钬激光前列腺剜除术治疗良性前列腺增生(BPH)合并膀胱过度活动症(OAB)的临床效果.方法 2007年5月至2010年5月,应用钬激光前列腺剜除术治疗BPH合并OAB患者37例,年龄52～89岁,平均(76±3)岁.术后3～6个月之内复查尿流率和残余尿量,术后平均随访4.9个月,通过国际前列腺症状评分(IPSS评分)、生活质量(QOL)评分、最大尿流率(Qmax)、残余尿量、影像尿动力学评价疗效.结果 本组患者术前平均IPSS评分29.6±5.2,术后下降到4.6±1.2.术前平均QOL评分4.3±0.9,术后下降到1.2±1.0.术前平均Qmax为(6±3)ml/s,术后升高到(21±5)ml/s.术前残余尿量平均(167±11)ml,术后下降到(41±18)ml.随访期间86.5%的患者OAB症状及生活质量改善,但仍有13.5%的患者术后OAB症状持续存在.结论 合并OAB的BPH患者存在明确膀胱出口梗阻时,可以首先解除膀胱出口梗阻,但术后仍有部分患者残留有OAB症状.     

前列腺动脉介入栓塞治疗前列腺增生症的临床评价

目的探讨前列腺动脉介入栓塞治疗良性前列腺增生症的临床疗效。方法2009年8月至2011年8月,选择确诊为前列腺增生、内科保守治疗无效、难以接受和不愿外科手术治疗的16例患者作为观察组,行放射介入法选择性前列腺动脉栓塞治疗。随机选择在我院行经尿道前列腺等离子电切术确诊前列腺增生的病例35例作为对照组。术后6个月随访。观察两组患者手术前后国际症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）、残余尿（RU）以及前列腺体积的变化。结杲16例接受PAE治疗的患者,IPSS由术前的（23．5±1．8）分降至术后的（13．1±1.7）分（P〈0.05）;QOL由术前的（4．7±0．5）分降至术后的（2．4±0．6）分（P〈0．05）;残余尿量由术前的（92．3±14．2）mL降至术后的（36．2±3．8）mL（P〈O．05）;Qmax由术前的（7．1±2．1）mL／s升至术后的（18．6±2．4）mL／s（P〈0．05）;前列腺体积由术前的（49．5±15．3）mL降至术后的（29．4±8．6）mL（P〈0．05）。结论PAE治疗前列腺增生安全、有效,且具有损伤小、出血少、手术风险低的优点,尤其适用于年老体弱、合并心肺并发症耐受力低下和拒绝接受外科治疗者,是前列腺电切术的有益补充。     

经尿道双极等离子前列腺切除术治疗良性前列腺增生

目的 探讨经尿道双极等离子前列腺切除术（PKRP）的安全性与有效性，提高PKRP质量。方法 回顾性分析273例良性前列腺增生（BPH）患者PKRP资料，比较手术前后最大尿流率（Qmax）、膀胱剩余尿量（RUV）及国际前列腺症状评分（IPSS）。结果273例手术均顺利完成，术中输血6例，无闭孔神经反射、永久性尿失禁、经尿道电切综合征（TURS）及死亡病例，随访2～26个月，平均5．63个月，Qmax平均增至15，9ml／s，RUV平均降至16．0ml，IPSS平均9分。与术前相比，各项指标均有明显改善。结论 PKRP具有良好的组织切割功能及可靠的止血作用，治疗BPH安全有效。     

Prostate specific antigen: a prognostic marker of survival in good prognosis metastatic prostate cancer? (EORTC 30892)

PURPOSE: We study the value of PSA response and PSA progression as prognostic factors for survival in good prognosis metastatic prostate cancer. METHODS: Data from 257 patients treated with Flutamide or Cyproterone acetate within the EORTC GU Group protocol 30892 have been used and analysis by Cox models. RESULTS: A PSA response defined as a decrease to < or = 1 ng/ml and to between 1 and 10 ng/ml was associated with a hazard ratio of 0.30 and 0.61 for overall survival, respectively, as compared to the non-responders (PSA> 10 ng/ml). Five definitions of PSA progression were considered: (1) a confirmed or (2) a repeated doubling of the PSA over nadir and unconfirmed (3) 100%, (4) 50% and (5) 20% increase of the PSA over nadir, each to a value > 4 ng/ml. Definition (5) was the most sensitive with sensitivity 76.20% and specificity 32.08%. With this definition, 70.0% of the patients had a PSA progression, which occurred in median 1.98 years before death. CONCLUSIONS: For good prognosis metastatic prostate cancer patients under anti-androgen treatment, PSA response at 6 months with cut-off levels of < or = 1 ng/ml and < or = 10 ng/ml is prognostic for survival. A 20% increase over nadir to a value > 4 ng/ml is prognostic for a poor survival with a 76.20% sensitivity. In this study, confirmation of the increase by a second observation did not seem necessary. Genuine surrogacy is not established in this study.     

晚期前列腺癌内分泌治疗药物的疗效观察

目的 观察比较晚期前列腺癌内分泌治疗中比卡鲁胺与氟他胺的药物疗效及不良作用情况.方法 回顾分析行内分泌治疗的晚期前列腺癌患者136例,其中黄体生成素释放激素类似物(LHRHa)联用比卡鲁胺间歇性内分泌治疗52例(A组);行LHRHa联用氟他胺间歇性内分泌治疗60例(B组);单纯行睾丸切除24例(C组).分析比较3组患者在临床症状、血清PSA值、疾病进展风险、生存率、药物不良反应等方面的差异.结果 A、B组症状缓解率分别为80.8%(42/52)和81.7%(49/60),高于C组的70.8%(17/24);A、B组PSA平均值分别由治疗前的133.3(17.9～982.8)、142.6(20.2～1001.0)ng/ml下降到15.8(0.02～28.9)、16.1(0.07～53.8)ng/ml,较C组由治疗前的142.3(27.1～988.0)ng/ml下降到27.6(6.0～62.1)ng/ml下降得更多;A、B组生化复发率分别为34.6%(18/52)和36.7%(22/60),低于C组的58.3%(14/24);A、B组平均生化复发时间为22(5～52)和22(6～65)个月,长于C组的11(5～54)个月;A、B组病死率分别为26.9%(14/52)和31.7%(19/60),低于C组的66.7%(16/24).服用比卡鲁胺组持续用药的患者占88.5%(46/52),服用氟他胺组持续用药者占66.7%(40/60).比卡鲁胺组药物不良反应发生率低于氟他胺组.结论 氟他胺和比卡鲁胺均可以有效治疗前列腺癌,降低治疗前列腺癌进展的风险;比卡鲁胺治疗前列腺癌更安全、有效,值得临床推广.     

Bone alkaline phosphatase serum level predicts the response to antiandrogen withdrawal

OBJECTIVE: To analyze if the biochemical response to antiandrogen withdrawal correlates with total and percent free serum prostate specific antigen (PSA) and bone alkaline phosphatase (BAP). MATERIALS AND METHODS: A group of 46 patients in whom maximal androgen blockade (MAB) failed was included in this study. Flutamide was used in 32 patients and bicalutamide in 14. Total and free PSA and BAP were determined in serum the same day in which antiandrogen was withdrawn. Thereafter, serum PSA was determined every 15 days. A biochemical response was established when a decrease in serum PSA greater than 50% was observed. The duration of biochemical response was considered until the first of two consecutive PSA serum elevations. RESULTS: The rate of biochemical responses was 23.9%. The mean duration of responses was 5.2 months. The mean serum PSA in patients who responded to the antiandrogen withdrawal was 86.4 ng/ml, while it was 98.6 ng/ml in those who did not respond, P > 0.05. The mean of percent free PSA was 13.9 and 17.7%, respectively, P > 0.05. However, the mean BAP in responder patients was significantly lower, 18.9 ng/ml versus 100.6 ng/ml, P < 0.03. The rate of responses to flutamide withdrawal was 25% and to bicalutamide withdrawal 21.4%, P > 0.05. Other factors as age, Gleason score, initial clinical stage and the period of antiandrogen exposure were also analyzed. However, none of them had statistical significance. Serum BAP was the only predictor of response in the logistic regression analysis and a cut-off point of 50 ng/ml provided a relative risk of 1.46 (95% CI 1.17-1.83). CONCLUSIONS: Lower serum levels of BAP seems to correlate with a better response to antiandrogen withdrawal. Moreover, a level of BAP higher than 50 ng/ml would predict strongly the absence of response.     

Gleason10分前列腺癌患者的临床特点分析

目的 观察Gleason 10分前列腺癌患者的临床诊疗及疾病变化过程,总结该类前列腺癌患者的临床特点及预后影响因素. 方法 2005年1月至2010年5月,21例初诊为前列腺癌、Gleason 10分、行手术去势加抗雄激素治疗的患者纳入本研究.初诊年龄56～85岁,平均73岁.PSA 8.9～261.0 ng/ml,平均60.8 ng/ml,其中6例PSA≤20 ng/ml.行核素骨扫描发现骨转移16例.予双侧睾丸切除术加氟他胺或比卡鲁胺全雄激素阻断治疗.术后1个月复查PSA,以后每3个月随访PSA.治疗后6个月为单纯内分泌治疗观察终点.6个月内PSA未降至＜4 ng/ml且无远处转移者加用局部外放射治疗,伴骨转移者使用基于多西他赛与泼尼松的全身化疗.患者死亡为研究终点.结果 15例初诊PSA＞ 20 ng/ml患者中,5例治疗后6个月内血清PSA未降至正常水平,其中4例伴骨转移.该4例子全身化疗后PSA均未降至正常水平,3例1年内死亡,1例诊断后19个月死亡,1例疾病局限患者予外放射治疗,PSA下降至正常水平8个月后出现肿瘤进展,诊断后11个月死亡.10例治疗后6个月内血清PSA降至正常水平,其中3例分别于诊断后第19、28、36个月死于肿瘤,7例存活.6例初诊时PSA≤20 ng/ml患者中3例治疗后6个月内PSA未降至正常水平,其中2例伴骨转移予化疗后于1年内死亡;1例PSA下降至正常水平但仍出现肿瘤进展,全身多发骨转移,化疗无效,1年内死亡;1例4年后因前列腺癌死亡;1例随访6个月,PSA降至0.07 ng/ml. 结论 Gleason 10分前列腺癌肿瘤进展迅速,抗雄激素治疗疗效不佳,行伞雄激素阻断后6个月内PSA无法下降至正常水平患者病情进展凶险.初诊PSA≤20 ng/ml且病理证实Gleason 10分者可能预示预后不佳.     

Clinical usefulness of serum prostate specific antigen for the detection of prostate cancer is preserved in men receiving the dual 5alpha-reductase inhibitor dutasteride

PURPOSE: We determined whether the decrease in serum PSA seen with 5alpha-reductase inhibitors affects the clinical usefulness of PSA for prostate cancer screening using data from 2 dutasteride benign prostatic hyperplasia studies. MATERIALS AND METHODS: A total of 2,802 men 50 years or older with a clinical diagnosis of benign prostatic hyperplasia, no history of prostate cancer, PSA 1.5 to 10 ng/ml, prostate volume 30 cc or greater, an American Urological Association symptom score of 12 or greater and peak urinary flow rate 15 ml per second or less were randomized to 0.5 mg dutasteride daily or matching placebo for 24 months. Increases in PSA from baseline and the maximum increase from nadir to month 24 were compared between the groups and analyzed by prostate cancer status, as determined by PSA driven biopsy and an advised cutoff of more than 4 ng/ml after doubling to correct for dutasteride treatment with sensitivity and specificity calculated for each. RESULTS: In placebo treated men without prostate cancer there was an 8.3% median increase in PSA at month 24 compared with -59.5% in those who received dutasteride, using doubled values to correct for dutasteride treatment. In those with prostate cancer these changes were 23.8% and -37.2%, respectively. Using the upper PSA limit of 4 ng/ml sensitivity for prostate cancer in men receiving dutasteride vs placebo was 0.737 vs 0.804, while specificity was 0.671 vs 0.578. Using a PSA increase from nadir of 0.8 ng/ml the sensitivity of dutasteride was 0.548 and its specificity was 0.795. CONCLUSIONS: A doubling factor is effective for maintaining the sensitivity and specificity of PSA for prostate cancer detection in men on dutasteride. Increases in serum PSA in men receiving dutasteride should be considered suspicious and serial PSA measurements should be used to evaluate changes from nadir.     

Advanced prostate cancer with extremely low prostate-specific antigen value at diagnosis: An example of high dose hook effect

A 67-year-old man presented with a lower abdominal mass. Radiographic examination revealed a huge mass filling the entire pelvis. Although prostate-specific antigen (PSA) was 1.4 ng/ml, percutaneous needle biopsy revealed adenocarcinoma compatible with prostate cancer, which stained positive for PSA. Hormone therapy was initiated and 1 month later his PSA was as high as 2713 ng/ml, although the mass had decreased in size. High dose hook effect was suspected and hormone therapy was continued. PSA is presently under control and below 0.1 ng/ml. When prostate cancer with very high PSA is suspected and the PSA value is unexpectedly low hook effect should be considered and PSA should be re-analyzed.     

前列腺癌患者粒子植入治疗后血清PSA变化的观察

目的探讨前列腺癌患者粒子植入治疗后血清PSA变化规律.方法前列腺癌患者13例.临床分期：T1cN0M08例,T2aN0M05例;Gleason评分：5分4例,6分9例;血清PSA 2.8～14.6 ng/ml,平均8.2 ng/ml.采用125I粒子植入治疗,治疗剂量D90为140～155 Gy.术后定期复查血清PSA,观察其变化规律.结果13例患者随访3～23个月.术后1、2、3、6、9、12、15、18及21个月血清PSA中位值为6.7、5.0、2.7、1.6、1.2、0.9、0.8、0.8及0.7 ng/ml.分别为术前血清PSA中位数的72%、51%、29%、20%、13%、11%、9%、9%及8%.术后1个月30%患者血清PSA有波动.结论前列腺癌粒子植入治疗后患者血清PSA下降缓慢,早期有波动.术后1年尤其术后3个月内血清PSA下降相对较快.     

The percentage of free prostatic-specific antigen is also useful in men with normal digital rectal examination and serum prostatic-specific antigen between 10.1 and 20 ng/ml

OBJECTIVE: The percentage of free prostatic-specific antigen (PSA) has been introduced as a tool to avoid unnecessary biopsies in men with normal digital rectal examination (DRE) and serum PSA between 4.1 and 10 ng/ml. In this series we also analyze its utility in men with normal DRE and serum PSA between 10.1 and 20 ng/ml. MATERIALS AND METHODS: A series of 1149 consecutive men with normal DRE and serum PSA between 4.1 and 20 ng/ml submitted for the first ultrasound guided sextant biopsy is analyzed. In 921 (80.2%) the serum PSA was from 4.1 to 10 ng/ml and in 228 (19.8%) from 10.1 to 20 ng/ml. Total and free serum PSA determinations were done by the inmunoradiometric assays Tandem and Tandem free PSA (Hybritech Inc.). RESULTS: The overall detection rate of prostate cancer was 27.9%. In the group of men which serum PSA ranged from 4.1 to 10 ng/ml the rate of detection was 25.4% and 37.7% when it was between 10.1 and 20 ng/ml. Using 25% or less of percent free PSA as a criterion for performing prostatic biopsy it would have detected 95.3% and 95.4% of the prostate cancers, respectively. The rate of unnecessary avoided biopsies would be 17.5% when serum PSA ranged from 4.1 to 10 ng/ml and 17.6% between 10.1 and 20 ng/ml. CONCLUSIONS: This prospective study demonstrates that the percentage of free PSA seems to have similar utility when serum PSA levels are between 4.1 and 10 ng/ml and between 10.1 and 20 ng/ml, at the time of the first prostatic biopsy indication.     

氟他胺撤退综合征(附78例报告)

目的 观察前列腺癌患者完全性雄激素阻断治疗出现血清前列腺特异性抗原（PSA）升高后，停用氟他胺后PSA的变化。方法 78例前列腺癌患者，全雄阻断治疗PSA正常后若再次PSA〉4ng／ml，则停服氟他胺至少连续3月，观察PSA的变化情况。结果 （1）停服氟他胺后有42例PSA下降超过50％以上：（2）42例PSA下降超过50％以上者，19例停药后3月内达到，23例6月内达到；（3）23／42例停药6月内维持PSA〈4ng／ml，14／42例停药12月内维持PSA〈4ng／ml，5／42例维持12月以上：（4）42例患者中停药后PSA再次升高超过4ng／ml者，再次服用氟他胺后，9例PSA出现下降表现。结论前列腺癌患者在手术去势和氟他胺联合治疗后出现PSA上升者，在改用二线治疗前可先停用氟他胺。     

Perception of abnormal serum prostate-specific antigen (PSA) test results amongst family practitioners

INTRODUCTION

With increased use of serum prostate-specific antigen (PSA) testing, prostate cancers are diagnosed at an earlier stage in younger men, when radical curative treatments are appropriate. Modifications of the PSA test such as PSA velocity and age-adjusted values are available to aid in the selection of patients for biopsy. However, it is not clear whether these data are used in general practice.

PATIENTS AND METHODS

A self-administered questionnaire was mailed to all primary care practices within one region in the UK. A series of visual analogue questions designed to identify referral thresholds for age-adjusted PSA levels and PSA velocity were used to identify patterns in referral behaviour.

RESULTS

Individual family practitioners see only small numbers of patients requesting PSA tests or with newly diagnosed prostate cancer each year. The median (range) thresholds considered for referral at ages 45, 55, 65, 75 and 85 years were 4.5 ng/ml (2.5–15.5 ng/ml), 5.5 ng/ml (3.0–15.5 ng/ml), 6.5 ng/ml (3.5–15.5 ng/ml), 6.5 ng/ml (3.5–25.5 ng/ml), and 7.5 ng/ml (3.5–25.5 ng/ml), respectively. Only 5% of practitioners correctly identified the age-specific PSA threshold for referral of a 45-year-old man.

CONCLUSIONS

It is important to remember that younger men (even those in their forties and fifties) may be at risk of prostate cancer even if asymptomatic. It is important in a climate of increasing demand for PSA testing that those who initiate the process understand the implications and limitations of testing, including appropriate triggers for referral to secondary care. The exact approach required for the successful dissemination of this information to primary care is not clear, but our data suggest that a better understanding is required.