血清TSGF和PSA联合检测对前列腺肿瘤诊断的意义

目的 探讨特异性肿瘤生长因子(TSGF)和前列腺特异性抗原(PSA)联合检测在前列腺痛诊断中的意义.方法 对26例前列腺癌,76例前列腺良性增生,28例急性细菌性前列腺炎,45例慢性前列腺炎,30例正常对照,进行TSGF和PSA联合测定.结果 TSGF测定值存前列腺癌组与良性增生、慢性炎症、健康对照组比较差异具有统计学意义(P<0.01),与急性炎症组比较差异无统计学意义(P>0.05).前列腺癌组PSA测定值与急、慢性炎症组,正常对照组比较差异具有统计学意义(P<0.01),与良性增生组比较差异无统计学意义(P>0.05);前列腺癌组TSGF单独测定敏感性和特异性分别为84.6%、88.4%,PSA单独测定敏感性和特异性分别为88.4%38.4%,二者测定敏感性和特异性分别为92.3%,92.3%.结论 TSGF和PSA联合检测对早期前列腺癌的诊断有一定的临床价值.     

游离前列腺特异性抗原与总前列腺特异性抗原比值在前列腺癌鉴别诊断中的应用

 目的 探讨游离前列腺特异性抗原（fPSA）与总前列腺特异性抗原（tPSA）比值在前列腺癌（PCa）鉴别诊断中的意义。方法 采用电化学免疫发光技术对86例前列腺良性增生（BPH）45例PCa患者和60例健康男性体检者（正常对照组）血清fPSA和tPSA同时进行测定，并计算出fPSA／tPSA，进行统计分析。结果 BPH、PCa组tPSA水平明显高于正常对照组（P＜0.05）。PCa组和BPH组的血清tPSA差异亦有统计学意义，但当tPSA在4.0 ~ 10.0 μg／L范围时，PCa组血清fPSA／tPSA比值却明显低于BPH组（P＜0.01）。把fPSA／tPSA比值划分成8个区间，当fPSA／tPSA比值15 ％作为诊断灰区PCa诊断的临界值时，诊断的敏感性、特异性、阳性预测值、阴性预测值及正确诊断指数分别为72.8 %、67.5 %、62.5 %、82.2 %、50.2 %。结论 当血清tPSA处于诊断灰区时，联合检测fPSA／tPSA比值可明显提高tPSA对PCa早期诊断的特异性。     

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     

前列腺癌患者治疗前后PSA水平

目的　探讨PSA在前列腺癌临床诊疗中的应用价值。方法　采用ELISA法测定 3 3例健康者、3 6例良性前列腺增生及 3 3例前列腺癌治疗前后T PSA和F PSA并动态观察 2 0例放疗后T PSA水平变化。结果　前列腺癌T PSA和F PSA、F/T均显著高于良性前列腺增生 (P <0 .0 1) ;前列腺癌治疗后T PSA和F PSA显著下降 (P <0 .0 1) ,而F/T无明显改变 (P >0 .0 5 ) ;前列腺癌放疗后病情稳定T PSA下降 ,病情进展则T PSA升高。结论　动态测定前列腺癌患者治疗前后PSA水平变化 ,可判断近期疗效 ,监测病情变化。     

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.     

前列腺特异性膜抗原和前列腺特异性抗原表达强度与前列腺癌Gleason评分之间的相关性研究

目的研究前列腺特异性膜抗原(PSMA)和前列腺特异性抗原(PSA)的表达强度与前列腺癌Gleason评分之间的相关性。方法制备抗PSMA膜外段表位的单克隆抗体,应用免疫组织化学方法检测前列腺癌中PSMA的表达,统计分析其与Gleason评分之间的相关性,并和PSA与Gleason评分之间的相关性进行对比。结果制备出8株分泌抗PSMA膜外段表位的单抗的杂交瘤细胞株。免疫组化结果表明,PSMA的表达强度与前列腺癌的Gleason评分之间存在相关性。在分化差的前列腺癌中,PSMA水平高于分化中等和分化良好的前列腺癌(P<0.01),而PSA在前列腺癌中的表达无明显差异(P>0.05)。结论PSMA表达水平在分化差的前列腺癌中明显升高,与Gleason评分存在相关性,可以作为前列腺癌的Gleason分级的标记物,提示PSMA可以作为对激素疗法效果不敏感的低分化前列腺癌抗体介导的免疫治疗靶点。     

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。     

分析血清PSA系列及Gleason评分在前列腺癌分期中的预测价值

目的：探讨血清前列腺特异性抗原（prostate specific antigen,PSA）系列及穿刺活检Gleason评分对前列腺癌病理分期的预测价值。方法：回顾性分析根治术后病理证实为前列腺腺癌的92例患者资料,具备术前总前列腺特异抗原（total pros-tate specific antigen,tPSA）、游离PSA（free prostate specific antigen,fPSA）、fPSA/tPSA、前列腺特异抗原密度（prostate specific antigen density,PSAD）及穿刺活检Gleason评分。比较器官局限组和包膜外侵犯组之间以上指标的差异,运用工作特征曲线（ROC曲线）比较各指标的预测价值,并通过多因素logistic回归分析筛选器官局限最主要的影响因素。结果：包膜外侵犯组PSAD、tPSA、fPSA/tPSA和穿刺活检Gleason评分值均高于器官局限组（P〈0.05）;ROC曲线对器官局限性前列腺癌的单因素预测比较,仅PSAD、tPSA预测价值较好[工作特征曲线下面积（areaunder ROC,AUC）〉0.7,P〈0.05];多因素分析中仅PSAD、穿刺活检Gleason评分为器官局限最主要的影响因素（P〈0.05）,AUC达0.8（P=0.000）。结论：PSAD比tPSA对病理分期显示了更好的预测价值,病理分期预测模型可考虑以PSAD替代tPSA,结合其他因素,有望提高预测准确度。     

前列腺穿刺患者前列腺癌检出率及其与 PSA、年龄的相关性

目的：探讨前列腺穿刺患者前列腺癌检出率情况,并分析其与前列腺特异性抗原（prostate specific an-tigen,PSA）、年龄的相关性。方法：回顾性收集2009年1月至2015年12月自贡市第一人民医院收治的年龄≥50岁且符合前列腺穿刺活检指征患者232例,对患者行 PSA 检测、直肠指诊（digital rectal examination,DRE）和经腹前列腺超声、MRI 检查,计算前列腺癌的检出率,分析前列腺癌检出率与年龄、PSA 水平的相关关系。结果：本组232例穿刺活检患者中,病理诊断为前列腺癌74例,阳性检出率为31．9％（74／232）。74例患者中,高分化癌16例（21.6％）、中分化癌24例（32．4％）、低分化癌34例（45．9％）。PSA 值＜4μg／L、4．1～10μg／L、10．1～20μg／L、＞20μg／L 4组患者前列腺癌检出率分别为9．1％、13．0％、16．2％、52．3％,随着 PSA 值的增加,前列腺癌检出率增长明显,呈明显的上升趋势（P ＜0．001）。随着年龄增高,PSA 值也越大,差异有统计学意义（Z ＝－3．328,P ＜0.001）;年龄＜60岁、60～69岁、70～79岁、≥80岁4个年龄组前列腺癌的检出率分别为11．1％、23．6％、40．0％、46.7％,随着年龄的增长,前列腺癌的检出率增长明显（P ＝0．011）。前列腺穿刺患者前列腺癌检出率与血清 PSA值呈正相关（r ＝0．376,P ＜0．001）,前列腺癌检出率与年龄亦呈正相关（r ＝0．288,P ＝0．019）。结论：随着年龄的增加、血清 PSA 值增高,前列腺穿刺患者前列腺癌的检出率也相应增高。     

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.     

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.     

Percent free prostate-specific antigen (PSA) is an accurate predictor of prostate cancer risk in men with serum PSA 2.5 ng/mL and lower

BACKGROUND: Up to 17% of men with a prostate-specific antigen (PSA) level below the accepted prostate biopsy cutoff of 2.5 ng/mL may have prostate cancer. Because identification of these patients represents a difficult task, we assessed the ability of percent free PSA to discriminate between benign and malignant prostate biopsy outcomes in men with PSA < or =2.5 ng/mL. METHODS: Between 1999 and 2006, 543 men with a PSA < or =2.5 ng/mL were referred for initial prostate biopsy. Age, total PSA, percent free PSA, and digital rectal examination findings represented predictors of prostate cancer at biopsy in logistic regression models. The area under the receiver operating characteristics curve (AUC) quantified the discriminative ability of the predictors. The pathological characteristics of the detected cancers were assessed in individuals treated with radical prostatectomy. RESULTS: Of all, 23% had prostate cancer on biopsy, 16.5% of patients treated with radical prostatectomy had pT3 stage, and 35.6% had a pathological Gleason score of 3 + 4 or higher. The most accurate predictor of prostate cancer on biopsy was percent free PSA (0.68) versus age (0.50), total PSA (0.57), or rectal examination findings (0.58). Of patients with percent free PSA below 14%, 59% had prostate cancer. In multivariate models, percent free PSA (P < .001) and rectal examination findings (P = .001) were the only independent predictors of prostate cancer. The combined AUC of all predictors (0.69) was not significantly (P = .7) higher than that of percentage of free PSA alone (0.68). CONCLUSIONS: The risk of prostate cancer is clearly non-negligible in patients with PSA < or =2.5 ng/mL. The percent free PSA can accurately predict the prevalence of prostate cancer at prostate biopsy in these individuals.     

血清PSA、FPSA/TPSA与ACP联合检测对前列腺癌诊断的意义

目的：探讨血清PSA、FPSA、FPSA/TPSA与ACP联合检测在前列腺癌诊断中的临床意义。方法：用化学发光法检测前列腺癌（PC）与良性前列腺增生（BPH）患者血清中的PSA和FPSA,计算FPSA/TPSA比值;用速率法检测前列腺疾病患者血清中的酸性磷酸酶（ACP）含量,并与正常人群进行比较。结果：PC组血清PSA、FPSA和ACP水平显著高于BPH组和对照组（P〈0.01）,BPH组又显著高于对照组（P〈0.01）;PC组FPSA/TPSA比值显著低于BPH组和对照组（P〈0.01）。结论：联合检测PSA、FPSA、FPSA/TPSA与ACP可有效地提高诊断PC的特异性和灵敏度;血清ACP检测可用于PC转移患者的诊断和术后监测。     

同期经尿道电切术治疗膀胱癌合并良性前列腺增生的临床分析

目的探讨同期经尿道切除膀胱肿瘤和前列腺治疗表浅性膀胱癌合并良性前列腺增生症的手术安全性和临床疗效。方法 72例表浅性膀胱癌合并良性前列腺增生症患者,先行经尿道膀胱肿瘤电切术(TURBT)切除肿瘤后同期行经尿道前列腺电切术(TURP)切除前列腺。结果患者均顺利完成手术,无膀胱穿孔和电切综合征发生,术后随访14～54个月,平均24个月,35例发生膀胱肿瘤复发,平均复发时间16个月,复发部位均不在膀胱颈口和前列腺尿道,全部再次行TURBT。结论同期经尿道切除膀胱肿瘤和前列腺治疗表浅性膀胱癌合并良性前列腺增生症手术安全、短期疗效确切,可适用于一部分年龄较大伴有严重的下尿路梗阻的且肿瘤分期、分级低的表浅性膀胱肿瘤患者。     

Algorithms based on prostate-specific antigen (PSA), free PSA, digital rectal examination and prostate volume reduce false-positive PSA results in prostate cancer screening

Our objective was to determine whether multivariate algorithms based on serum total PSA, the free proportion of PSA, age, digital rectal examination and prostate volume can reduce the rate of false-positive PSA results in prostate cancer screening more effectively than the proportion of free PSA alone at 95% sensitivity. A total of 1,775 consecutive 55- to 67-year-old men with a serum PSA of 4-10 microg/l in the European Randomized Study of Screening for Prostate Cancer were included. To predict the presence of cancer, multivariate algorithms were constructed using logistic regression (LR) and a multilayer perceptron neural network with Bayesian regularization (BR-MLP). A prospective setting was simulated by dividing the data set chronologically into one set for training and validation (67%, n = 1,183) and one test set (33%, n = 592). The diagnostic models were calibrated using the training set to obtain 95% sensitivity. When applied to the test set, the LR model, the BR-MLP model and the proportion of free PSA reached 92%, 87% and 94% sensitivity and reduced 29%, 36% and 22% of the false-positive PSA results, respectively. At a fixed sensitivity of 95% in the test set, the LR model eliminated more false-positive PSA results (22%) than the proportion of free PSA alone (17%) (p < 0.001), whereas the BR-MLP model did not (19%) (p = 0.178). The area under the ROC curve was larger for the LR model (0.764, p = 0.030) and the BR-MLP model (0.760, p = 0.049) than for the proportion of free PSA (0.718). A multivariate algorithm can be used to reduce unnecessary prostate biopsies in screening more effectively than the proportion of free PSA alone, but the algorithms will require updating when clinical practice develops with time.     

Relation of Free PSA/Total PSA in Serum for Differentiating Between Patients with Prostatic Cancer and Benign Hyperplasia of the Prostate: Which Cutoff Should Be Used?

A review on literature data is given concerning free prostate-specific antigen (f-PSA) and the corresponding cutoffs off-PSA/t-PSA for differentiating patients with cancer of the prostate from those with benign prostatic hyperplasia. The special importance of the diagnostic criterion (sensitivity, specificity, efficiency) for establishing the cutoff is demonstrated. On the basis of our own data, the application of the f-PSA% is recommended as an additional decision criterion for biopsy.     

The Relationship Between Prostate Biopsy Results and PSA and Free PSA Ratio Changes in Elevated Serum PSA Patients with and without Antibiotherapy

Objectives: To evaluate the impact of antibiotic treatment on total prostate specific antigen (PSA) levels and free/total (f/t) PSA ratio and the relevance of these changes to prostate biopsy results. Methods: We retrospectively evaluated 1,062 patients with elevated age-adjusted serum PSA levels who underwent prostate biopsy between 2004 and 2016. A total of 303 cases with followup PSA levels and f/t PSA ratio before and after antibiotherapy were included into this study. There were 214 patients with persistent elevated serum PSA levels after antibiotic treatment followed by prostate biopsy (treatment group) and 89 patients who had prostate biopsy after a mean followup of 1 month without antibiotherapy (control group). The groups were compared with regard to both 5% and 10% cut off changes in serum PSA levels and f/t PSA ratios. Results: Antibiotic treatment had no impact on the relation between serum PSA levels and biopsy results at both cut off values. On the other hand, f/t PSA ratio changes at both cut off values with relevance to antibiotic treatment were found to be related with histopathologic results. While increase in f/t PSA ratio was more related with benign biopsies, decrease in f/t PSA ratio was more related with cancer (for 5% cut off value p= 0.014, p= 0.004; for 10% cut off value p= 0.026, p= 0.014). Conclusion: Changes at f/t PSA ratio rather than total PSA only, particularly in antibiotic treated cases appear to be more useful in decision making for biopsy.     

Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Iran.

PURPOSE: To evaluate the natural background of prostate cancer in Iran a large population-based study of screening using total prostate-specific antigen (tPSA) and per cent free PSA (fPSA) as the initial test was performed. MATERIALS AND METHODS: For 9 years (1996 to 2004) in Tehran, Iran, 3670 Iranian men older than 40 years were mass checked by PSA-based screening. They were invited to have a digital rectal examination (DRE), serum PSA assay and transrectal ultrasonography (TRUS)-guided sextant prostate biopsy to see if the DRE was clinically suspicious of malignancy, the serum PSA was > or =2.1 ng/ml or free-to-total PSA (f/tPSA) ratio < or=15%. RESULTS: In 433 (11.8%) of screened males, tPSA levels exceeded the cut-off value of > or =2.1 ng/ml and 128 prostate cancers were diagnosed [positive predictive value (PPV) 29.6%] corresponding to an overall detection rate of 3.5%. Altogether 138 cancers were detected (detection rate 3.8%); none were stage M(1), three were stage N(+) and 4 stage T(3). A threshold tPSA of > or =2.1 ng/ml would have detected 128 cancers in 447 biopsied men (PPV 29%). There were 109 of 138 (79%) men with cancer who had an f/tPSA of < or =15%, while 152 of 305 (49.8%) with benign biopsies had a f/tPSA of < or =15%, which corresponds to a PPV of 30.8%. CONCLUSION: PSA-based screening with low PSA cut-off values increase the detection rate of clinically significant, organ confined and potentially curable prostate cancer. Further studies are warranted in order to determine the incidence and prevalence of prostate cancer in different ethnic groups.