PSA、FPSA检测和骨显像对前列腺癌骨转移的诊断价值

目的:探讨联合应用前列腺特异性抗原(PSA)、游离PSA(FPSA)检测和全身骨显像诊断前列腺癌骨转移的意义.方法:回顾性分析70例经临床确诊的前列腺癌患者,全部行血清PSA、FPSA测定,并作全身骨显像.结果:PSA<4ng/ml在14例病人中,发生骨转移者7例,诊断阳性率为50%;PSA 4ng/ml～20ng/ml共7例,发生骨转移者6例,诊断阳性率为87%;PSA＞20ng/ml组49例,发生骨转移45例,阳性率为92%.结论:PSA、FPSA检测结合全身骨显像,可尽早、全面地发现前列腺癌患者全身骨转移.     

血清缓激肽与前列腺癌的相关性研究

目的 探讨血清缓激肽在前列腺癌的诊断及鉴别诊断中的临床应用价值.方法 收集68例前列腺癌患者和32例前列腺增生患者,以同期体检的健康男性32例为对照组,收集其血清,酶联免疫吸附试验(enzymelinked immuno sorbent assay,ELISA)法检测血清中的缓激肽水平,比较各组血清缓激肽水平的差异以及前列腺癌患者在不同年龄、临床分期、病理分期(Gleason评分)、前列腺特异抗原(prostate specific antigen,PSA)水平、肿瘤体积以及骨转移、淋巴结转移、局部侵犯与否状态下血清缓激肽水平的差异.比较血清缓激肽与PSA联合诊断前列腺癌和PSA独立诊断前列腺癌的敏感度差异.结果 前列腺癌组血清缓激肽水平[(16.44 ±0.91) μg/L]低于对照组[(19.72±1.10) μg/L]和前列腺增生组[(20.93±1.80) μg/L],差异均具有统计学意义(均P＜0.05).在肿瘤体积较大的前列腺癌患者血清缓激肽水平较低(P＜0.05),而血清缓激肽水平在年龄、肿瘤临床分期、病理分期(Gleason评分)、PSA水平及骨转移、淋巴结转移、局部侵犯与否方面比较差异均无统计学意义(均P＞0.05).血清缓激肽与PSA联合诊断前列腺癌较单独诊断敏感度提高(P＜0.05).结论 前列腺癌患者血清缓激肽表达水平较低,且与肿瘤体积相关.血清缓激肽与PSA联合诊断前列腺癌敏感度较单独诊断高.     

血清LncRNAs对肺癌骨转移的诊断价值

目的 探讨血清LncRNA HOTAIR、HOTTIP、CRNDE和AFAP1-AS1在肺癌骨转移（LCWBM）患者血清中的表达情况，阐明其对LCWBM的诊断价值。方法 收集发生骨转移与未发生骨转移肺癌（LCWOBM）患者各38例，调查问卷收集其基本资料，采集其外周静脉血，分离血清。荧光定量PCR技术检测血清HOTAIR、HOTTIP、CRNDE和AFAP1-AS1的表达水平，分析其对LCWBM的诊断价值。结果 LCWBM患者血清中HOTAIR的表达水平明显低于LCWOBM患者（P<0.05），血清HOTAIR诊断LCWBM的ROC曲线下面积为0.722，敏感度和特异性分别为70.0%和81.3%；LCWBM患者血清中HOTTIP的表达水平明显高于LCWOBM患者（P<0.05），血清HOTTIP诊断LCWBM的ROC曲线下面积为0.784，敏感度和特异性分别为100%和45.5%。血清HOTAIR、HOTTIP两指标联合诊断LCWBM的ROC曲线下面积为0.818，敏感度和特异性为87.5%和72.7%，阳性预测值和阴性预测值为70.0%和88.9%。结论 血清LncRNA HOTAIR和HOTTIP有作为预测肺癌骨转移生物标志物的潜力。     

放射性核素骨显像联合血清PSA、fPSA、ALP及BAP在评价内分泌疗法治疗前列腺癌疗效中的应用价值

目的探讨放射性核素骨显像联合前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、碱性磷酸酶(ALP)及骨特异性碱性磷酸酶(BAP)在评价内分泌疗法治疗前列腺癌疗效中的应用价值。方法选取2016年1月至2017年12月于随州市中心医院接受内分泌疗法治疗的64例前列腺癌患者作为研究对象。接受内分泌治疗后1年,进行PSA、fPSA、ALP、BAP水平检测以及放射性核素骨显像检查,根据检查结果评估放射性核素骨显像在评价前列腺癌内分泌疗法治疗效果中的应用。结果内分泌治疗后的64例患者经放射性核素骨显像检查结果显示共发生51例骨转移;放射性核素骨显像转移灶数目2个骨转移灶的患者的血清PSA、fPSA水平高于骨转移灶≤2个患者的的血清PSA、fPSA水平(均P0. 05);随着骨显像分型的增高,前列腺癌骨转移患者血清PSA、ALP与BAP水平均增高,呈正相关(均P0. 05)。结论放射性核素骨显像联合PSA、fPSA、ALP、BAP能够实现内分泌疗效的准确评价与骨转移瘤的早期诊断。     

放射性核素骨显像联合血清PSA、fPSA、ALP及BAP在评价内分泌疗法治疗前列腺癌

目的 探讨放射性核素骨显像联合前列腺特异性抗原（PSA）、游离前列腺特异性抗原（fPSA）、碱性磷酸酶（ALP）及骨特异性碱性磷酸酶（BAP）在评价内分泌疗法治疗前列腺癌疗效中的应用价值。 方法 选取2016年1月至2017年12月于随州市中心医院接受内分泌疗法治疗的64例前列腺癌患者作为研究对象。接受内分泌治疗后1年，进行PSA、fPSA、ALP、BAP水平检测以及放射性核素骨显像检查，根据检查结果评估放射性核素骨显像在评价前列腺癌内分泌疗法治疗效果中的应用。 结果 内分泌治疗后的64例患者经放射性核素骨显像检查结果显示共发生51例骨转移；放射性核素骨显像转移灶数目＞2个骨转移灶的患者的血清PSA、fPSA水平高于骨转移灶≤2个患者的的血清PSA、fPSA水平（均P＜005）；随着骨显像分型的增高，前列腺癌骨转移患者血清PSA、ALP与BAP水平均增高，呈正相关（均P＜005）。 结论 放射性核素骨显像联合PSA、fPSA、ALP、BAP能够实现内分泌疗效的准确评价与骨转移瘤的早期诊断。     

血清PSA、PSAD、ALP联合检测对前列腺癌骨转移的临床诊断价值

目的 探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)、碱性磷酸酶(ALP)联合检测对前列腺癌(PCa)骨转移的诊断价值.方法 回顾性分析98例PCa患者的临床资料,根据是否发生骨转移分为骨转移组(n=56)和非骨转移组(n=42).检测患者的血清PSA、PSAD、ALP水平,分析3项指标单独及联合检测对PCa骨转移的诊断价值.结果 98例PCa患者中,56例患者发生骨转移,骨转移率为57.1％.骨转移组患者的PSA和PSAD值均高于非骨转移组,差异均有统计学意义(P<0.05).ALP+PSA+PSAD联合诊断PCa骨转移的灵敏度(98.34％)、阳性预测值(90.53％)、阴性预测值(92.33％)及约登指数(73.84)均高于PSA、PSAD、ALP单独诊断的结果.结论 血清PSA、PSAD、ALP联合检测对于PCa骨转移具有较高的诊断价值,值得临床推广应用.     

PSA、FPSA检测和骨显像对前列腺癌骨转移的诊断价值

目的：探讨联合应用前列腺特异性抗原（PSA）、游离PSA（FPSA）检测和全身骨显像诊断前列腺癌骨转移的意义。方法：回顾性分析70例经临床确诊的前列腺癌患者，全部行血清PSA、FPSA测定，并作全身骨显像。结果：PSA〈4ng／ml在14例病人中，发生骨转移者7例，诊断阳性率为50％；PSA4ng／ml～20ng／ml共7例，发生骨转移者6例、诊断阳性率为87％；PSA〉20ng／ml组49例，发生骨转移45例，阳性率为92％。结论：PSA、FPSA检测结合全身骨显像，可尽早、全面地发现前列腺癌患者全身骨转移。     

血清hK2、AMACR联合PSA检测对前列腺癌诊断及预后判断的临床价值

目的:探讨血清腺激肽释放酶2（hK2）、甲基酰基辅酶A消旋酶（AMACR）联合前列腺特异性抗原（PSA）检测对前列腺癌诊断及预后判断的临床价值。方法:前瞻性选取2016年01月至2018年01月收治的前列腺癌患者50例为前列腺癌组和良性前列腺增生患者50例为良性前列腺增生组。并以同期健康查体者50例为对照组。检测比较三组血清hK2、AMACR和PSA水平,Logistic分析血清hK2、AMACR和PSA水平对前列腺癌发生状况的影响,ROC曲线分析血清hK2、AMACR和PSA水平联合检测对前列腺癌的诊断效能。对前列腺癌组进行为期3年的随访,记录患者复发和生存情况。比较不同复发和生存预后情况患者的基线血清hK2、AMACR和PSA水平,Logistic分析基线血清hK2、AMACR和PSA水平对前列腺癌患者复发和生存预后的影响,ROC曲线分析血清hK2、AMACR和PSA水平联合检测对前列腺癌患者复发和死亡早期评估效能。结果:前列腺癌组血清hK2、AMACR水平高于良性前列腺增生组和对照组（P＜0.05）;而良性前列腺增生组和对照组血清hK2、AMACR水平比较差异无统计学意义（P＞0.05）。前列腺癌组、良性前列腺增生组和对照组的血清PSA水平依次降低（P＜0.05）。Logistic分析结果显示,血清hK2、AMACR和PSA水平对前列腺癌发生状况具有明显影响（P＜0.05）。ROC曲线分析结果显示血清hK2、AMACR和PSA水平联合检测对前列腺癌具有良好的诊断效能。前列腺癌组50例患者的3年复发率和生存率分别为56%（28/50）和52%（26/50）。前列腺癌组复发患者的血清hK2、AMACR和PSA水平均高于未复发患者（P＜0.05）;且前列腺癌组死亡患者的血清hK2、AMACR和PSA水平均高于存活患者（P＜0.05）。Logistic分析结果显示,血清hK2、AMACR和PSA水平均受到前列腺癌患者复发和生存预后的影响（P＜0.05）。ROC曲线分析结果显示血清hK2、AMACR和PSA水平联合检测对前列腺癌患者复发和死亡均具有良好的早期评估效能。结论:血清hK2、AMACR和PSA水平在前列腺癌患者中表达水平较高,具有一定的前列腺癌诊断价值,且可能作为预后早期预测的有效参考指标。     

血清PSA及fPSA/tPSA比值在前列腺癌骨转移诊断中的价值

目的:通过分析前列腺癌患者血清中前列腺癌特异性抗原（PSA）浓度和游离前列腺特异性抗原（fPSA）/总前列腺特异性抗原（tPSA）与骨转移的关系,探讨血清PSA和fPSA/tPSA在诊断前列腺癌骨转移中的价值。方法:采用电化学发光法检测74例前列腺癌患者血清中的fPSA、tPSA浓度并计算fPSA/tPSA,并对所有前列腺癌患者进行全身骨扫描显像。结果:74例前列腺癌患者当中无骨转移的29例,有骨转移的45例,分别占前列腺癌患者的39.2％和60.8％。在发生骨转移的前列腺癌患者当中单一病灶的有5例,占11.1%,其中3例转移灶在骨盆,2例在椎体;转移灶为两处的有3例,占6.7%;三处或三处以上转移的有37例,占82.2%。从骨转移发生的部位来看,椎体转移的最多,有35例;其次为骨盆转移,有31例;发生肋骨转移的有28例;四肢骨转移的有9例;其它部位转移的有2例。前列腺癌骨转移组和无骨转移组的PSA和fPSA/tPSA分别为（57.68±38.67） ng/ml、0.14±0.08和（21.61±17.87） ng/ml、0.25±0.09,差异均有统计学意义（P<0.05）。结论:前列腺癌骨转移以多发病灶为主,且病灶主要发生在脊柱和骨盆。前列腺癌患者随血清PSA浓度的升高,fPSA/tPSA比值降低,发生骨转移的比例增高,当PSA>20.00 ng/ml或fPSA/tPSA≤0.15时,诊断前列腺癌骨转移的灵敏度和特异度较高。     

血清PSA、骨扫描诊断前列腺癌骨转移的临床价值

目的 探讨血清PSA、骨扫描对前列腺癌骨转移的临床价值.方法 回顾性分析89例(骨转移组52例、非骨转移组37例)前列腺癌病人的PSA值、骨扫描资料与骨转移的关系.结果 PSA值在骨转移组与非骨转移组差异有显著性(P＜0.01).PSA与骨转移的程度有一定的相关性,PSA＜10 μg/L,骨转移率为20.0﹪(2/10);PSA10-40 μg/L,骨转移率为19.0﹪(4/22);PSA 40-60 μg/L,骨转移率为66.7﹪(11/15);PSA 60-100 μg/L,骨转移率为77.8﹪(14/18);PSA＞100μg/L,骨转移率为88.0﹪(22/25).骨扫描诊断前列腺癌骨转移的敏感度为98.1﹪,特异度为75.7﹪.结论 骨扫描对前列腺癌骨转移有较高的敏感性,但对单个浓聚灶的诊断应结合CT、MR.对于怀疑有骨转移的前列腺患者,不宜单独用血清PSA浓度来判断骨转移,应常规行全身骨扫描.     

前列腺癌组织BSP和PSA的表达及意义

[目的]探讨骨唾液酸蛋白（BSP）与前列腺特异性抗原（PSA）在前列腺癌组织中的表达及意义。[方法]选取不同病理分级的前列腺癌组织（68例）和前列腺增生组织（22例）,采用免疫组织化学SP法染色,检测BSP及PSA的表达情况。[结果]BSP在前列腺癌中阳性率为76.47%,显著高于前列腺增生组织（13.64%）（χ^2=27.614,P〈0.001）。BSP在不同分化程度前列腺癌组织中表达差异无统计学意义（χ^2=0.057,P=0.972）。前列腺增生组织、前列腺癌组织的PSA表达率分别为90.91%、69.12%,差异有统计学意义（χ^2=4.149,P=0.042）。不同分化程度前列腺癌PSA表达差异有统计学意义（χ^2=11.437,P=0.003）。BSP与PSA表达具有显著相关性（rs=0.654,P〈0.001）。[结论]BSP在前列腺癌中高表达,与PSA表达相关。BSP可能在前列腺癌的发生、发展中起重要作用,可能成为前列腺癌治疗的新靶点。     

Clinical Usefulness of Serum Carboxyterminal Propeptide of Type I Procollagen and Pyridinoline Cross-linked Carboxyterminal Telopeptide of Type I Collagen in Patients with Prostate Cancer

A study was undertaken to evaluate the clinical usefulness ofmeasurements of serum concentrations of the carboxyterminalpropeptide of type I procollagen (PICP) and the pyridinolinecross-linked carboxyterminal telopeptide of type I collagen(ICTP) as parameters of bone metastasis in patients with prostatecancer. Serum PICP, ICTP, prostate-specific antigen (PSA), andalkaline phosphatase (ALP) were evaluated in 82 patients withprostate cancer and 26 patients with benign prostatic hyperplasia(BPH). These markers were measured serially in 16 prostate cancerpatients during treatment. The serum levels of PICP, ICTP, ALP,and PSA were significantly higher in prostate cancer patientswith bone metastasis than in patients with either BPH or prostatecancer without bone metastasis. Although the rate of detectionof bone metastasis with PICP and ICTP was slightly lower thanthat with PSA determined by the receiver operating characteristiccurve, the correlation between both PICP and ICTP and the extentof disease was much higher than that of PSA. PICP and ICTP levelsvaried with ALP and PSA levels, the patient's clinical courseafter the start of endocrine therapy and the progression ofbone metastasis. The levels of PICP and ICTP did not changesubstantially in patients who developed local regrowth or lymphnode metastasis, and decreased as bone metastases respondedto radiotherapy. PICP and ICTP thus reflect the metastatic burdenin bone and are useful for monitoring the response of bone metastasisto therapy.     

Diagnosis of bone metastasis in men with prostate cancer by measurement of serum ICTP in combination with alkali phosphatase and prostate-specific antigen

AimsCarboxy-terminal telopeptide of type I collagen (ICTP) is a parameter of bone absorption, and has recently been introduced to monitor bone metastases. The aim of this retrospective study was to investigate the potential of ICTP as a candidate serum marker of bone metastasis in prostate cancer.Materials and methodsSerum markers in 155 men pathologically diagnosed with prostate cancer were measured. The serum levels of ICTP, prostate-specific antigen (PSA), and alkali phosphatase (ALP) were compared to assess the extent of disease (EOD) scores from bone scans and then analysed statistically.ResultsThe serum ICTP levels were not well correlated with the EOD scores in the total group of men, men newly diagnosed with prostate cancer, or men previously diagnosed with prostate cancer who were followed up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ICTP (cut-off value, 5.0 ng/ml) of the men newly diagnosed with prostate cancer were 78.6%, 88.0%, 78.6%, and 88.0%, respectively. In these men, the specificity and PPV of ALP (cut-off value, 335 IU/l) were 100%, whereas the sensitivity and NPV of PSA (cut-off value, 40 ng/ml) were 100% in this study. The serum levels of ICTP in the men with low ALP (<335 IU/l) and high PSA (≥40 ng/ml) clearly separated the men with or without bone metastasis, as judged by bone scans.ConclusionWe found that the ICTP is not a superior serum marker for bone metastases compared with ALP or PSA. Our study suggests, however, that the ICTP measurement is useful in a certain subset of men with the combination of PSA and ALP in distinguishing men with bone metastasis from those without.     

Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer.

PURPOSE: To describe the natural history of nonmetastatic prostate cancer and rising prostate-specific antigen (PSA) despite androgen deprivation therapy. PATIENTS AND METHODS: The 201 patients in this report were the placebo control group from an aborted randomized controlled trial to evaluate the effects of zoledronic acid on time to first bone metastasis in men with prostate cancer, no bone metastases, and rising PSA despite androgen deprivation therapy. Relationships between baseline covariates and clinical outcomes were assessed by Cox proportional hazard analyses. Covariates in the model were baseline PSA, Gleason sum, history of bilateral orchiectomies, regional lymph node metastases at diagnosis, prior prostatectomy, time from androgen deprivation therapy to random assignment, time from diagnosis to random assignment, and PSA velocity. RESULTS: At 2 years, 33% of patients had developed bone metastases. Median bone metastasis-free survival was 30 months. Median time to first bone metastases and overall survival were not reached. Baseline PSA level greater than 10 ng/mL (relative risk, 3.18; 95% CI, 1.74 to 5.80; P < .001) and PSA velocity (4.34 for each 0.01 increase in PSA velocity; 95% CI, 2.30 to 8.21; P < .001) independently predicted shorter time to first bone metastasis. Baseline PSA and PSA velocity also independently predicted overall survival and metastasis-free survival. Other covariates did not consistently predict clinical outcomes. CONCLUSION: Men with nonmetastatic prostate cancer and rising PSA despite androgen deprivation therapy have a relatively indolent natural history. Baseline PSA and PSA velocity independently predict time to first bone metastasis and survival.     

前列腺癌骨显像诊断骨转移与病理分级及血清PSA的关系探讨

Objective  

The aim of the study was to investigate the correlations between pathological grade, serum prostate-specific antigen (PSA) and bone scintigraphy in the diagnosis of metastasis diseases for prostate cancers, and to explore the characteristics of bone metastases for prostate cancer.     

PSA Doubling Time and Absolute PSA Predict Metastasis-free Survival in Men With Biochemically Recurrent Prostate Cancer After Radical Prostatectomy

IntroductionThe aim of this study was to investigate the association of prostate-specific antigen (PSA) values on metastasis-free survival (MFS) in men with biochemically recurrent prostate cancer (BRPC) and PSA doubling time (PSADT) < 12 months. This dataset also reflects an update with longer follow-up of our prior publications on the natural history of BRPC in the absence of treatment.Materials and MethodsIn this report, we combined databases from the Center for Prostate Disease Research and Johns Hopkins University (CPDR/JHU). In the CPDR/JHU radical prostatectomy database (30,936 total patients), 656 men with BRPC (> 0.2 ng/mL) after prostatectomy and PSADT < 12 months, who received no adjuvant/salvage androgen deprivation and/or radiation therapy, were prospectively followed until radiologic evidence of metastasis and are included in this analysis.ResultsMetastasis occurred in 250 of 656 patients with BRPC (median follow-up, 5 years). PSADT < 7.5 months and Gleason score were independent risk factors for distant metastasis in multivariable analysis. Risk of metastasis increased for PSADT 6.01 to 7.50, 4.51 to 6.0, 3.01 to 4.50, and ≤ 3.0 months, after adjusting for Gleason score. A PSA value ≥ 0.5 ng/mL significantly and independently increased risk of metastasis in patients with PSADT < 12 months (hazard ratio, 2.79; 95% confidence interval, 1.47-5.29; P = .001).ConclusionsIn men with PSADT < 12 months, PSADT ≤ 7.5 months, PSA ≥ 0.5 ng/mL, and Gleason score are independent predictors of MFS on multivariable analysis.     

Zinc-alpha2-glycoprotein expression as a predictor of metastatic prostate cancer following radical prostatectomy

The risk of metastatic progression for prostate cancer patients who undergo radical prostatectomy is best estimated presently based on prostate-specific antigen (PSA) doubling time (PSADT). However, additional markers of risk are needed to identify patients who may benefit from aggressive salvage treatment. A decrease in zinc-alpha2-glycoprotein (AZGP1) mRNA levels in malignant prostate epithelium was previously shown to predict biochemical recurrence, as defined by rising levels of serum PSA after radical prostatectomy. We assessed the reliability with which AZPG1 expression could predict clinical recurrence and metastatic progression. Using immunohistochemical methods, we analyzed AZPG1 expression in malignant prostate epithelium in prostatectomy specimens from 228 prostate cancer patients. Low (i.e., absent or weak) AZGP1 expression was associated with clinical recurrence (defined as confirmed localized recurrence, metastasis, or death from prostate cancer; hazard ratio [HR] = 4.8, 95% confidence interval [CI] = 2.2 to 10.7, P<.001) and with bony metastases or death from prostate cancer (HR = 8.0, 95% CI = 2.6 to 24.3, P<.001). Among the 17 patients in the cohort in whom clinical recurrence was associated with short PSADT, absent or weak AZGP1 expression was observed in 13 patients. If these preliminary findings are validated in independent cohorts, the measurement of AZGP1 levels in radical prostatectomy specimens may permit an accurate and timely assessment of risk of metastatic progression after radical prostatectomy.     

前列腺癌ADC值与血清IL-6、VEGF、PSA的相关性分析

目的:探讨前列腺癌（prostate cancer,PCa）患者表观扩散系数（apparent diffusion coefficient,ADC）与血清血管内皮生长因子（vascular endothelial growth factor,VEGF)、白细胞介素-6（interleukin-6,IL-6）、前列腺特异性抗原（prostate specific antigen,PSA）的相关性。方法:收集2016年1月至2017年12月经临床病理证实且资料齐全的60例PCa患者,将其分成两组,经SPECT/CT全身骨显像诊断为30例骨转移患者及30例未发生全身骨转移患者。采集全部患者的肘静脉血,利用酶联免疫吸附法（ELISA法）及化学发光法测定血清VEGF、IL-6及PSA水平。结果:60例PCa患者ADC值与血清VEGF、IL-6及PSA存在负相关(r=-0.431,P=0.001＜0.005;r=-0.534,P=0.000<0.005;r=-0.593,P=0.000＜0.005),骨转移组血清VEGF、IL-6及PSA水平明显高于无骨转移组（P＜0.05）。结论:血清VEGF、IL-6及PSA与PCa发生、进展及转移关系密切。PCa患者ADC值与血清VEGF、IL-6、PSA的相关性可以作为评估患者病情进展程度的一个指标。