前列腺癌的早期诊断、分期及治疗进展

Ｐｅａ是欧美国家最常见的肿瘤,在美国是男性第二位癌症死因。随着我国社会老年化进程的加快,我国的Ｐｃａ发病率越来越高,但在临床上Ｐｃａ的早期发现并不多。目前诊断Ｐｃａ的常用方法有ＰＳＡ、ＤＲＥ、ＴＲＵＳ,前列腺穿刺活检等。并通过ＰＳＡ。ＲＴ－ＰＣＲ、前列腺穿刺活检及阳性活检百分比,ＧＬＥＡＳＯＮ积分,同位素骨扫描、ＣＴ、ＭＲＩ：、淋巴管造影、盆腔淋巴结活检等了解Ｐｃａ的分期,指导治疗。本文的目的是如何应用上述检查诊断早期Ｐｃａ并进行临床分期,选择治疗方案。１Ｐｃａ的早期诊断１．１前列腺特异抗原系统…     

前列腺体积对前列腺特异抗原的影响

目的：研究前列腺特异怕（ＰＳＡ）与前列腺增生腺体体积的关系及其在前列腺癌（ＰＣａ）诊断中的价值。方法：７５例前列腺增生症（ＢＰＨ）患者根据其ＰＳＡ〉或≤４μｇ／Ｌ分为两组,另有２５例ＰＣａ患者,术后用放射免疫法测定血清ＰＳＡ《所有患者经Ｂ超测出前列腺体积,用ｔ检验和相关分析研究各组间的差异及相关性。结果：ＰＳＡ〉４μｇ／Ｌ的ＢＰＨ较之ＰＳＡ≤４μｇ／Ｌ者,腺体体积显著增大且ＰＳＡ和ＰＳＡ密度（ＰＳ     

骨髓瘤标与前列腺癌骨转移

为探讨骨髓ＰＳＡ和ＰＡＰ与前列腺癌骨转移的关系，对３１例前列腺癌患者，按同位素骨扫描结果，分为阴性组（１２例）和阳性组（１９例），分别检测骨髓及血清中ＰＳＡ和ＰＡＰ值。结果：两组骨髓ＰＳＡ值、ＰＳＰ值（Ｐ＜００５）差异有显著性，骨扫描阳性组各值高于阴性组。若以骨髓／血清ＰＳＡ比值０７０作阳性参考值，则预测前列腺癌骨转移的敏感性为８９５％，特异性为８３３％，提示骨髓ＰＳＡ、ＰＡＰ与前列腺癌骨转移密切相关，骨髓／血清ＰＳＡ比值可作为骨转移的诊断指标之一。     

前列腺癌骨转移与PSA、BCL-2和P53的关系

随着人口老龄化的加剧 ,前列腺癌 (ＰＣａ)的发病人数在我国逐年增加〔1〕。ＰＣａ骨转移是ＰＣａ最常见的转移方式 ,其机制尚不清楚。前列腺特异抗原 (ＰＳＡ)为前列腺上皮细胞生成的一种蛋白质 ,在ＰＣａ患者中可明显增高 ,已用作ＰＣａ的特异性、敏感性强的肿瘤标记物〔2〕。ＢＣＬ 2基因及突变型Ｐ5 3基因的表达与ＰＣａ的病理过程有关〔3〕,而ＰＣａ骨转移与这两种基因及血清ＰＳＡ浓度的关系报道较少。为此 ,我们分析了ＰＣａ骨转移与血清ＰＳＡ浓度及ＰＣａ组织中ＢＣＬ 2、突变型Ｐ5 3表达的关系 ,现将结果报告如下。1　材料与方法1…     

ATP试验诊断缺血性心脏病的价值

我们对３８例（男２１例，女１７例）住院患者（冠心病１９例、可疑冠心病１２例，对照组７例）行ＡＴＰ试验（ＡＴＰＴ），其中部分病例做了运动＋静息＋＾９９锝心肌核索显像（ＳＰＥＣＴ）检查做对比。结果３８例中１６例ＡＴＰＴ阳性，总阳性率４２．２％。其中冠心病１９例中１２例阳性，阳性率为６３．１５％；可疑冠心病组１２例中４例阳性，其阳性率为３３．３％；对照组７例中无１例阳性。ＡＴＰＴ与ＳＰＥＣＴ诊断冠心病的     

双抗体夹心一步法检测前列腺特异抗原及应用的评价

用聚乙二醇、葡聚糖凝胶（ＰＥＧ、Ｓｅｐｈａｄｅｘ）两步法提取精浆前列腺特异抗原（ＰＳＡ），建立了一步检测血清ＰＳＡ的ＥＬＩＳＡ法及正常参考值范围。经５８例临床标本及９５例正常男性血清ＰＳＡ测定，对前列腺癌诊断的敏感性和特异性分别为１００％和９４．２％；６０岁以下和６０岁以上的男性血清ＰＳＡ临界值分别为３．４μｇ／Ｌ和４．６μｇ／Ｌ。表明年龄因素对ＰＳＡ测定有较大影响，在判断测定结果时必须加以考虑。     

前列腺特异抗原密度及移行区体积密度测定在前列腺癌诊断中的价值

我们通过测定前列腺癌 (ＰＣａ)和良性前列腺增生 (ＢＰＨ)患者血清Ｔ ＰＳＡ ,Ｂ超测前列腺体积 ,移行区体积 ,计算特异性抗原密度 (ＰＳＡＤ) ,前列腺移行区体积密度 (ＰＳＡＴ) ,探讨ＰＳＡＤ、ＰＳＡＴ测定在ＰＣａ诊断中的价值。现报告如下。材料与方法　ＰＣａ患者 2 5例 ,平均年龄 68岁。均经穿刺细胞学或病理检查证实。ＢＰＨ患者 75例 ,平均年龄 70岁。均经病理检查证实。检查或治疗前抽取清晨空腹静脉血3ｍｌ,分离血清后用Ｔ ＰＳＡ试剂盒在Ａｂ ｂｏｔｔＡＸＳＹＭ仪器上应用酶联微粒子捕捉法 (ＭＥＩＡ)测定Ｔ ＰＳＡ。采用意大…     

前列腺特异抗原在前列腺癌诊治中的意义

应用酶联免疫检查法测定４７例前列腺癌患者血清ＰＳＡ值。探讨ＰＳＡ在前列腺癌诊断、鉴别诊断、疗效监测等方面的意义。结果表明：血清ＰＳＡ与ＡＣＰ、ＡＫＰ比较，ＰＳＡ对前列腺的诊断敏感性为８９．３６％，ＡＣＰ、ＡＫＰ的敏感性分别为２０．４５％、１３．６０％。血清ＰＳＡ对前列腺癌临床分期、肿瘤分级具有参考价值。随访观察３８例前列腺癌患者治疗４～６周后ＰＳＡ值，结果显示：ＰＳＡ可作为前列腺癌疗效监测有价值的指标。     

前列腺特异性抗原密度对前列腺癌骨转移诊断意义的回顾性…

对２６例病理学，ＣＴ及ＥＣＴ确诊之前列腺癌腺外或骨转移病人术前、术后ＰＳＡ、ＰＳＡＤ作为回顾性研究，同时测定３０例良性前列腺前生症病人作为对照。结果：２６例患者术前ＰＳＡＤ平均值为２．４１，大于２．４１者１９例，占７３．０８％，以０．１作为标准值，则２５例为阳性，占９６．１５％，而对照组大于０．１者３例，假阳性率１０％，大于０．２例，假阳性率６．６７％。结果表明ＰＳＡＤ对前列腺疾病的诊断价值优于Ｐ     

前列腺增生对前列腺特异性抗原血清浓度的影响

检测１１８例ＢＰＨ患者和２０例对照组血清ＰＳＡ和ＰＡＰ。发现３７．２９％（４４／１１８）的ＢＰＨ患者血清ＰＳＡ浓度高于正常，但与前列腺体积和患者年龄无关。前列腺按摩可使血清ＰＳＡ和ＰＡＰ浓度明显升高（Ｐ＜０．００１），１ｈ时达高峰，７ｈ开始下降，３～７天后恢复正常，建议血清ＰＳＡ和ＰＡＰ检测前１周内禁行前列腺指检。     

PSA和SPECT骨显像在前列腺癌诊断治疗中的意义

目的：研究PSA、SPECT骨显像在前列腺癌诊断及治疗中的临床意义。方法：对100例经临床确诊的前列腺癌患者全部行血清PSA测定及全身骨显像。结果：发生骨转移的患者为81％,PSA≥20tμg／I．的患者发生骨转移的为60％。结论：血清PSA与骨显像联检对前列腺癌临床诊断、疗效观察及预后判定具有重要的指导意义。     

Effect of NIH-IV prostatitis on free and free-to-total PSA

OBJECTIVE: To examine the effect of asymptomatic prostatic inflammation (NIH category IV prostatitis) on total PSA (tPSA), free serum PSA (fPSA) and the ratio of free-to-total prostate specific antigen (%fPSA). The role of free and %fPSA as a diagnostic tool for distinguishing between cancer and non-malignant diseases of the prostate was also investigated. MATERIAL AND METHODS: In a retrospective study 1090 prostate biopsies performed between January 2000 and September 2003 were evaluated and the levels of serum total and free PSA as well as the f/tPSA ratio were determined in samples obtained immediately before biopsy. 404 patients with full clinical and histological records were included in the study. All patients underwent 6 or 8 core primary prostate needle biopsies. RESULTS: A total of 404 patients were included in the analysis. 100 prostate cancer (PCa) (24.8%), 137 NIH-IV prostatitis (33.9%) and 143 patients with benign prostatic hyperplasias (BPH) (35.4%) were identified. 24 (5.9%) patients presented with both PCa and prostatitis on histology and were excluded from further analysis. The mean (median) levels of tPSA, fPSA and %fPSA were 11.94 ng/ml (8.0), 1.31 ng/ml (1.07) and 0.15 (0.14) for NIH-IV prostatitis; 11.94 ng/ml (8.35), 1.54 ng/ml and 0.13 (0.11) for prostate cancer; and 8.19 ng/ml (7.0), 1.48 ng/ml (1.03) and 0.18 (0.15) for BPH. No significant difference was found in tPSA levels between PCa and prostatitis (p = 0.32), while the difference in tPSA levels between PCa and BPH was significant (p = 0.007). Free PSA alone had no diagnostic power in distinguishing PCa from prostatitis (p = 0. 37) and BPH (p = 0. 61). By contrast, the f/tPSA ratio showed significant between-group differences (PCa versus prostatitis (p = 0. 011), PCa versus BPH (p = 0.0001). CONCLUSIONS: Chronic asymptomatic prostatitis NIH category IV has similar effects on total PSA and free PSA levels in serum as PCa. fPSA alone cannot distinguish prostate cancer from non-malignant inflammatory disease of the prostate. The ratio of free-to-total PSA is significantly different in PCa and NIH category IV prostatitis.     

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.     

前列腺癌患者中性粒细胞与淋巴细胞比值检测的意义

目的探讨中性粒细胞和淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对前列腺癌(prostate cancer,PCa)分期和分级的价值.方法对180例 PCa 患者进行外周血细胞计数检查,计算 NLR 值,比较不同危险度、不同侵犯范围、不同血清 PSA 水平、不同病理分期和是否存在骨转移患者的 NLR 值,探讨 PCa 患者 NLR 值与危险度、侵犯范围和血清 PSA 水平的相关性.结果随着危险度的增加、肿瘤侵犯范围的扩大和血清 PSA 水平的增加,NLR 值和高 NLR 率均呈增加趋势(P ＜0．05,P ＜0．01);存在骨转移及 TNM 分期Ⅲ~Ⅳ期患者 NLR 值分别高于无骨转移和 TNM 分期Ⅰ~Ⅱ期患者(P ＜0．01).相关性分析显示 PCa 患者 NLR 值与危险度、侵犯范围、血清 PSA 水平均呈正相关(P ＜0．05).结论 NLR 值与血清 PSA 水平、肿瘤侵犯范围及危险度有一定的相关性,可作为 PCa 分期和分级的有效指标.     

中性粒细胞与淋巴细胞比值对前列腺癌诊断的临床价值及与危险分级的关系

目的 分析中性粒细胞与淋巴细胞比值（NLR）单独或联合前列腺特异性抗原（PSA）和年龄预测前列腺癌（PCa）的临床价值及其与危险分级的关系。方法 收集2016年6月至2020年6月在新乡医学院第三附属医院和第一附属医院就诊的1 205例患者,根据诊断结果将患者分为对照组（1 060例）和PCa组（145例）。根据欧洲泌尿外科协会指南再将PCa患者分为低（48例）、中（62例）、高（35例）危组。比较患者的一般资料,采用单因素和多因素logistic回归分析影响PCa的危险因素,采用受试者工作特征（ROC）曲线评估NLR、PSA和年龄单独检测预测PCa的临床价值,并建立联合预测模型方程。比较不同PCa危险分级组间的NLR水平。结果 PCa组的年龄、PSA、空腹血糖（FBG）、NLR和单核细胞与淋巴细胞比值（MLR）高于对照组,淋巴细胞计数低于对照组,差异均有统计学意义（均P<0.05）。单因素logistic回归分析结果显示,年龄、PSA、淋巴细胞计数、血红蛋白、FBG和NLR与PCa均有相关性(均P<0.05)。多因素logistic回归分析结果显示,年龄、PSA和NLR为影响PCa的独立危险因素（均P<0.05）。PSA和NLR预测PCa的临床价值均高于年龄预测PCa的价值（Z=8.604、9.204,均P<0.001）。NLR、PSA和年龄联合检测建立的ROC曲线下面积为0.905,灵敏度和特异度为82.5%和80.7%。低危组、中危组和高危组的NLR水平分别为(2.05±0.26)、(2.36±0.34)和(2.75±0.61),三组差异有统计学意义（F=32.021,P<0.001）,且高危组的NLR水平均高于中危组和低危组（q=11.132、6.494,均P<0.001）,中危组的NLR水平高于低危组（q=5.709,P<0.001）。结论 NLR为PCa的独立危险因素,与患者的危险度分级有关,与PSA和年龄联合检测可有效预测PCa。     

血清PSA值和前列腺结节指导前列腺穿刺活检的临床意义

目的 探讨血清ＰＳＡ浓度变化与前列腺癌及其骨转移的相关性。方法 对９３例直肠指诊异常及血清ＰＳＡ〉４ｎｇ／ｍｌ的患者,行直脾性Ｂ超引志下前列腺穿刺活检;用９９ｍＴｃ－ＭＤＰ行全身骨扫描判断有无骨。结果 ９３例中前列腺活检阳性者６０例,其中２６例扫描阳性;随血清ＰＳＡ浓度升高,前列腺阳性活检率及其远处骨转移阳性率升高。 血清ＰＳＡ升高与前列腺癌及其骨转移的发生率呈正相关。     

Dual monoclonal antibody immunoassay for free prostate-specific antigen

Prostate-specific antigen (PSA) is the most important tumor marker for early detection and monitoring of prostate cancer (PCa) patients. PSA is also elevated in many patients with benign prostatic hyperplasia (BPH). The study of the serum PSA forms, free PSA (f-PSA) and PSA complexed with α₁-antichymotrypsin (PSA-ACT), may improve the discrimination between PCa and BPH. An immunoassay specific for f-PSA is reported with very low cross-reactivity (0.7%) to PSA-ACT. Serum specimens from BPH and PCa patients (determined by biopsy) with PSA levels from <1 to >100 ng/ml were tested. No f-PSA was detected in serum specimens from normal females (N = 50). Low levels (0–0.3 ng/ml) were detected in specimens from healthy males (N = 60). In specimens from PCa and BPH patients, the f-PSA to total PSA ratio (f/t) was found to range from 1% to higher than 60%. While maintaining an 80% sensitivity for cancer, the f/t ratio improved specificity to approximately 80%, as compared to 55% for total PSA alone. The receiver operating characteristics (ROC) curve analysis of the f/t ratio displayed a greater area under the plot (0.84) compared to total PSA alone (0.745). The results demonstrate that the f/t ratio significantly increases specificity for PCa detection compared to total PSA alone, showing the potential clinical value of the f-PSA immunoassay. © 1996 Wiley-Liss, Inc.     

Value of PSA in the staging of prostatic cancer]

The clinical value of Serum Prostate Specific Antigen (PSA) in the staging of prostatic carcinoma was evaluated in 62 patients who underwent radical retropubic prostatectomy. Preoperative levels of PSA were compared with the final pathological stage obtained from all surgical specimens examined for capsular penetration, seminal vesical invasion and lymph node involvement. PSA level was closely correlated with the volume and the stage of the prostatic carcinoma. 93% of the patients with PSA < or = 10 ng/ml had tumor confined to the gland. All patients with PSA > 20 ng/ml had extraprostatic tumor extension (stage C or D). Patients with histologically proved prostatic carcinoma, PSA > 20 ng/ml and negative bone scan can be assumed to have extraprostatic disease and/or lymphatic involvement. Patients with PSA (drawn in the requested conditions) < or = 10 ng/ml can be considered to have organ confined disease, and can be spared a bone scintigraphy. Our study indicate an increasing role of PSA in the clinical staging of patients with prostatic carcinoma.     

Clinical relevance of transurethral resection of the prostate in "asymptomatic" patients with an elevated prostate-specific antigen level

OBJECTIVES: To determine the clinical relevance of transurethral resection of the prostate (TURP) in patients with minor lower urinary tract symptoms (LUTS) but elevated prostate-specific antigen (PSA) levels. METHODS: We retrospectively included 82 patients, aged 50.2-78.2 yr, with minor LUTS, elevated PSA (> or =4 ng/ml), and no signs of prostate cancer (PCa) after (multiple) negative multisite biopsies who underwent TURP after they were diagnosed by urodynamics with bladder outlet obstruction (BOO). We evaluated the clinical benefit of TURP by assessing its effect on International Prostate Symptom Score (IPSS) and PSA and the diagnostic value of histologic examination of the resected tissue for the presence of PCa. RESULTS: After TURP, histologic analysis of the resected specimen revealed that eight patients (9.8%) had PCa; seven of these patients had a tumour that needed further treatment. The remaining 74 patients (90.2%) were diagnosed with BOO due to benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE). In this group, the mean PSA level decreased from 8.8 ng/ml before TURP to 1.1 ng/ml in the first year and 1.3 ng/ml in the second year after TURP; the mean IPSS decreased from 8.8 to 1.5 in the first year after TURP. CONCLUSIONS: The current data suggest that patients with minor LUTS and elevated PSA without evidence of PCa are very likely to have BOO due to BPH/BPE and may benefit from TURP if obstruction is proved. However, a prospective trial is warranted to assess the impact of these results on clinical practice.