PSA、PSAD测定对前列腺癌诊断的价值

目的：探讨血清前列腺特异抗原（PSA）和前列腺特异性抗原密度（PSAD）作为前列腺癌（PC）诊断指标的价值。方法：采用放射免疫分析方法测定50例前列腺增生（BPH）患者36例前列腺癌（PC）患者的血清PSA水平，B超测定前列腺体积，计算单位体积的PSA值（PSAD），结果：PSA界限值定为4μg/L时，其诊断PC敏感度为94％，特异度为36％，准确度为60％，PSA界限值为10μg/L时，敏感度为89％，特异率为62％，准确度为73％，PSAD测定诊断PC敏感度为89％，特异度为90％，准确度为90％，结论：对于前列腺癌的诊断，PSAD值测定较PSA值测定的准确度高。     

PSAD和游离/总PSA比值在前列腺癌诊断中的意义

 目的　比较研究前列腺特异抗原(PSA)、PSA密度(PSAD)和游离/总PSA比值(F/TPSA)在前列腺癌诊断中的价值。方法　41例前列腺增生和22例前列腺癌患者,术前用放免法测定血清PSA和游离PSA。所有患者经直肠腔内B超测出前列腺体积,求得PSAD,用t检验比较分析。结果　前列腺癌组的PSA、PSAD均显著高于前列腺增生组(PSA：46.3±33.8μg/Lvs7.04±6.91μg/L,P=0.000021;PSAD：1.43±1.21μg。L-1。ml-1vs0.14±0.15ng。ml-1。ml-1,P=0.000055)。两组的F/TPSA比值无显著差异(0.18±0.11vs0.22±0.18,P=0.34)。结果　PSA和PSAD是鉴别前列腺癌的良好指标,对于PSA可疑者,PSAD有助于区分前列腺癌和前列腺增生,本组游离/总PSA比值不能帮助鉴别诊断。     

血清PSA联合PSAD检测对前列腺癌的诊断价值

目的:探讨血清前列腺特异抗原（PSA）、前列腺特异抗原密度（PSAD）对前列腺癌的诊断价值。方法:检测经病理确诊的57例前列腺癌、125例前列腺增生患者的血清PSA。经直肠超声测定其前列腺的体积（PV）并计算PSAD。结果:前列腺癌组患者的PSA、PSAD明显高于前列腺增生组(P<0.05)。PSA值在4.1-10.0,10.1-20.0,>20.0ng/ml区间时PCa诊断率分别为8.8%,36.8%,54.4%。前列腺癌组的ROC曲线图中PSAD的AUC值（0.682）高于PSA的AUC值（0.601）,当取PSAD≥0.18ng/（ml·cm3）时,敏感性为84.5%,特异性为78.6%。比较58例重复穿刺患者的PSA、PSAD,只有PSAD差异有统计学意义(P<0.05)。结论:PSA动态监测结合PSAD是重复穿刺的重要参考指标,PSAD是PSA对前列腺癌诊断的有益补充。     

f/T-PSA比值和PSA密度对TPSA灰区前列腺癌的诊断意义

目的探讨游离前列腺特异抗原/总前列腺特异抗原(fPSA/TPSA,f/T)比值和TPSA灰区前列腺特异抗原密度(PSAD)(4.0~10.0ng/m l)对诊断前列腺癌的临床意义。方法回顾性分析TPSA在灰区的38例前列腺癌和56例良性前列腺增生症血清PSA相关检测结果,将两组患者f/T比值和PSAD值进行对比分析。结果两组患者TPSA值无显著性差异(P=0.337);f/T比值(P=0.001)和PSAD值(P=0.012)有显著性差异。f/T比值在前列腺癌患者中较低,而PSAD值较高。当f/T比值和PSAD分别以0.15和0.16作为临界值时,其诊断前列腺癌的灵敏度和特异度分别为81.6%和75.0%、65.8%和57.1%。结论f/T比值和PSAD对TPSA灰区的前列腺癌的诊断有重要的临床意义。     

血清前列腺特异抗原检测对前列腺癌早期诊断价值探讨

目的　探讨血清前列腺特异抗原 (PSA)对前列腺癌的早期诊断价值。方法　采用双抗体夹心酶联免疫法 (ELISA)检测健康对照组 110例 ;前列腺增生症 42例 ;前列腺炎 15例 ;前列腺癌 2 5例血清PSA水平。结果　前列腺癌组的血清PSA平均水平 (40 72 5±19 6 0 2ng/ml) ,明显高于健康对照组 (2 745± 1 12 4ng/ml) (P <0 0 1) ;而前列腺增生症组 (3 35 2± 1 30 2ng/ml)和前列腺炎组 (3 72 5± 1 412ng/ml)与健康对照组比较没有显著性差异 (P >0 0 5 )。结论　检测血清PSA水平对前列腺癌的早期诊断有重要参考价值。     

前列腺特异性抗原的检测对前列腺癌及前列腺增生的诊断意义

目的　探讨血清总前列腺特异性抗原 (t PSA)、游离PSA (f PSA)、PSA密度 (PSAD )及其f PSA/t PSA比值对前列腺癌 (PCa)及前列腺增生 (BPH )的诊断价值。方法　采用酶联免疫分析方法 (ELISA )检测未经治疗的 62例BPH患者和 2 4例PCa患者血清f PSA、t PSA水平 ,并计算f PSA/t PSA值和PSAD ,对检测结果进行统计学处理。结果　BPH组与PCa组的f PSA、t PSA水平均明显高于对照组 (P <0 .0 1) ;前列腺癌组的f PSA /t PSA值明显小于对照组及前列腺癌增生组 (P <0 .0 1) ;PCa组PSAD明显大于对照组和BPH组 (P <0 .0 1)。结论　检测f PSA/t PSA和PSAD比单一检测f PSA、t PSA可显著提高对PCa诊断的特异性及符合率 ,对前列腺体积较大的BPH和PCa患者 ,检测PSAD更有意义     

t—PSA,f—PSA／t—PSA诊断前列腺癌的临床意义

为了探讨游离前列腺特异抗原（ｆＰＳＡ）与总前列腺特异抗原（ｔＰＳＡ）比率对前列腺癌的诊断价值,采用酶联免疫方法分别测定４１例前列腺癌病人,３６例前列腺增生（ＢＰＨ）病人血清ｔＰＳＡ、ｆＰＳＡ,并计算出ｆＰＳＡ／ｔＰＳＡ比率。ｔＰＳＡ界限值为４μｇ／Ｌ时,敏感度,特异度,准确度分别为８２．９％,６０．０％,７２．４％;ｆＰＳＡ／ｔＰＳＡ界限值定为１７．０％时,敏感度,特异度,准确度分别为８７．８％,９３．０％,８４．２％。结果表明：ｆＰＳＡ／ｔＰＳＡ在保持敏感度的同时,可显著地提高特异度,能更有效地诊断前列腺癌     

前列腺癌实验室诊断指标的ROC曲线分析

目的应用ROC曲线分析血清游离前列腺特异性抗原（fPSA）,总前列腺特异性抗原（tPSA）及其比值（fP-SA/tPSA）在前列腺癌中的诊断价值。方法应用受试者工作特征曲线（ROC）对健康男性组,前列腺增生组及前列腺癌组血清tPSA,fPSA及fPSA/tPSA结果进行分析。结果前列腺癌组血清的tPSA、fPSA及f/t与其余两组比较均有差异。经ROC曲线分析,tPSA、fPSA及f/t的阈值分别为7.14μg/L、1.31μg/L及0.235。三者分别及联合检测的ROC曲线下面积分别为0.905、0.770、0.352与0.968。结论 tPSA、fPSA及f/t三者联合检测可以提高对前列腺癌的诊断。     

前列腺癌患者血清类胰岛素生长因子Ⅰ测定的意义

目的观察前列腺癌患者血清类胰岛素生长因子I(IGF-I)与病情及前列腺特异抗原的关系。方法采用免疫放射法(IRMA)和放射免疫法(RIA)测定30例前列腺癌患者血清IGF-I和前列腺特异抗原(PSA),并以30例前列腺增生症(BPH)和30例健康人作对照。结果前列腺癌组血清IGF-I(148±49.6)μg/L明显高于BPH和健康组(均为P<0.001)。30例前列腺癌患者中16例(53.3%)血清IGF-I升高,A期与D期之间差异无显著性(P>0.05)。IGF-I水平升高则前列腺癌的危险性也升高。结论IGF-I可能增加患前列腺癌的危险性。     

游离PSA/总PSA比值检测前列腺癌及其临床意义

探讨血清游离前列腺特异性抗原(F-PSA)/总前列腺特异性抗原(T-PSA)比值对前列腺癌的诊断价值。方法:用ELISA方法测定121例患者血清F-PSA、T-PSA值,并计算F/T比值,评价其对前列腺癌的诊断价值;其中前列腺癌47例,前列腺增生46例,前列腺炎10例,前列腺癌术后患者18例。结果:T-PSA在4～10ng/ml范围内,应用F/T比值可区分前列腺癌与前列腺增生(P<0.005)。以F/T比值0.16为判断上限时,其诊断敏感性为91.3%,特异性为88.5%,诊断准确性为89.8%,明显优于T-PSA和F-PSA单独测定结果。结论:F/T比值可用于区别前列腺癌和前列腺增生。     

前列腺特异性抗原在前列腺癌诊断中的意义

前列腺特异性抗原（PSA)在前列腺癌的诊断中被广泛应用，全文就PSA生物学特性、年龄标准化PSA、PSA速度、PSA密度和游离PSA与总PSA的比值几个指标进行了介绍，并分析了它们在前列腺癌诊断中的作用。     

Prostate Specific Antigen: A review

Despite its identification in the 1970s, prostate specific antigen (PSA) has only recently gained widespread utility. in this review, we will describe significant aspects of the biochemistry of PSA, immunohistochemical applications, the effect of prostatic manipulation on the serum level of this analyte, and other considerations in the determination of the level of PSA. in addition, the effect of benign prostatic hyperplasia (BPH) on serum PSA will be described. Finally, the application of PSA in the detection, staging and monitoring of patients with prostatic carcinoma will be discussed.     

Diagnostic Role of Serum Free-to-Total Prostate Specific Antigen (PSA) Ratio in Prostate Cancer with Serum Total Concentration of PSA below 4 ng/mL

Purpose: To examine the effectiveness of serum free-to-total prostate specific antigen ratio (%fPSA) forthe detection of prostate cancer (PCa) in men with different serum total PSA (tPSA) categories. Materials andMethods: From January 2010 to December 2013, a total of 225 patients with lower urinary tract symptoms(LUTS) underwent tPSA and %fPSA measurements. Histological examination with calculation of Gleasonscore and whole body bone scans were performed in identified cases of PCa. Results: PCa was diagnosed in 44(19.6%) patients and the remaining 181 patients had benign prostate disease. PCa was detected in 5 (23.8%),13 (8.7%) and 26 (47.3%) cases with tPSA level ranges ≤4 ng/ml, 4 to 10 ng/ml and >10 ng/ml, respectively. Theaverage Gleason score was 7.2±0.2. Some 6 (13.6%) out of 44 PCa patients had bone metastases. The sensitivitywas 80% and specificity was 81.3% at the cut-off %fPSA of 15% in PCa patients with a tPSA level below 4 ng/mL. A lower %fPSA was associated with PCa patients with Gleason score ≥7 than those with Gleason score≤6 (11.7±0.98 vs. 16.5±2.25%, P=0.029). No obvious relation of %fPSA to the incidence of bone metastasis wasapparent in this study. Conclusions: The clinical application of %fPSA could help to discriminate PCa frombenign prostate disease in men with a tPSA concentration below 4 ng/mL.     

Effects of Aging and Ethnicity on Serum Free Prostate Specific Antigen

Understanding the relationship between ethnicity and free prostate specific antigen (fPSA) could identify the population that should be targeted for intervention and prevention program regarding prostate disease. In this study, we therefore examine the effects of aging and ethnicity on fPSA, measured in serum by chemiluminescent assay (CLIA) method of 351 men visiting Tribhuvan University Teaching Hospital (TUTH) for fPSA test from December to March. Medicinal records abstracts were used to obtain information regarding the ethnicity and age of the cases. Those cases whose age and surname could not be obtained were excluded in our study. The subjects were stratified in four ethnic groups viz; Indo-Nepalese, Tibeto-Nepalese, Indigenous and Other based on the origin. The relationship between age and fPSA level was analysed using bivariate coorelation. The age and the fPSA level of the cases were expressed in Mean ± SEM. The association among different age-group and ethnicity with fPSA were analysed using one way ANOVA. The mean fPSA and mean age of the subjects were 1.74 ± 0.22 and 66.84 ± 0.64 respectively. fPSA level was fairly correlated with the age (r=0.146, p=<0.01). The mean fPSA level (ng/ml) among the four age category (<45, 45-60, 60-75 and >75) were 0.49 ± 0.13, 0.69 ± 0.10, 1.94 ± 0.04 and 2.33 ±0.43 respectively. The difference in mean fPSA level among four different age-groups was statistically significant (p=0.031). Analysis showed no correlation between the fPSA level and the ethnicity. These data suggest that the fPSA level is associated with the age.     

The Relationship of PSA, PSAD and Clinicopathological Stage in Patients with Prostate Cancer

OBJECTIVE To investigate the relationship between the clinicopatho- logical stage and serum prostate specific antigen(PSA)concentration and PSAdensity(PSAD)in patients with prostate cancer. METHODS The clinicopathological stage was determined on the basis of a pathological examination and clinical data in 65 prostate cancer patients treated by radical prostatectomy.PSA and PSAD were measured before the operation.The Spearman rank correlation was applied to evaluate the relationship between the clinicopathological stage,serum PSAconcentration and PSAD. RESULTS Patients with higher PSA and PSAD were significantly more likely to have higher clinical stages,a higher Gleason score,positive surgical margins,capsular penetration,and seminal vesicle invasion(each P<0.05). But there was no significant association between PSA and lymph node metastasis(P=0.053).The levels of serum PSA concentration and PSAD were significantly correlated with the clinical stage(P<0.05)in the prostate cancer patients. CONCLUSION The level of both PSA and PSAD were significantly correlated with the clinical stage(P<0.05)in the prostate cancer patients.But PSAD may be a more powerful predictor of clinical stage and prognosis than PSA.     

Prostate cancer progression in the presence of undetectable or low serum prostate-specific antigen level

BACKGROUND: The serum prostate-specific antigen (PSA) level after definitive treatment for prostate cancer (PC) is a powerful predictor of outcome. Occasionally, PC progression can occur despite low or undetectable PSA levels. The authors report on the clinical and pathologic characteristics of patients who experienced PC progression with undetectable or low PSA levels. METHODS: From an electronic database of all patients with PC who were treated at The University of Texas M. D. Anderson Cancer Center between 1999 and 2004, a group of 46 patients was identified who had progression to metastatic PC detected with concomitant PSA levels from 0.1 ng/mL to 2 ng/mL. Patient charts were reviewed for tumor stage, Gleason score, pretreatment PSA level, and the presence of atypical histologic variants (ie, ductal, sarcomatoid, or small cell cancers). The nadir PSA level after treatment and the PSA level at the time metastatic PC was detected were determined. The patients were followed semiannually, and imaging studies were obtained at the discretion of treating physicians. The sites of metastasis and histologic confirmation were reported when available. RESULTS: Twenty-three of 46 patients underwent radical prostatectomy, 11 patients received radiation therapy, and 12 received hormone treatment as their initial form of therapy. Progression to metastatic disease with concomitant, undetectable PSA levels occurred in 10 patients, including 3 patients who had not received treatment with hormones. The sites of metastasis included bone (n = 35 patients), liver (n = 7 patients), retroperitoneal lymph nodes (n = 5 patients), lungs (n = 4 patients), and brain (n = 1 patient). Aggressive and locally advanced PC were common features in these patients: Eighty-five percent had Gleason scores >or=7, 63% had clinical T3 or T4 tumors, and 41% had pretreatment PSA levels >10 ng/mL. Atypical histologic variants were observed in 21 patients (46%) and in 8 of 10 patients who progressed with undetectable PSA levels. In 10 patients (22%), metastasis were detected in the presence of an undetectable PSA level. Eight of those patients had small cell carcinoma. In 19 patients (41%), progression to metastasis occurred without any increase in their PSA from the nadir level. Thirty-one patients (67%) were asymptomatic at the time metastasis was detected, and the detection of metastasis in these patients occurred only because of routine imaging studies. CONCLUSIONS: Progression of PC may occur despite undetectable or low PSA levels. Complete physical evaluation and imaging studies may be indicated in the surveillance of patients with high-grade, locally advanced tumors, especially when atypical histologic variants are present.