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     

直肠指诊,血清PSA及经直肠穿刺活检联合诊断前列腺癌的评价（？…

前列腺癌的早期诊断对于选择有效的治疗方法至关重要。对我科１９８８年１１月至１９９８年１１月收治并明确诊断的４９例前列腺癌的直肠指诊（ＤＲＥ）、血清前列腺特异性抗原（ＰＳＡ）及经直肠前列腺穿刺活检方法进行了分析 ,并探讨三种方法单独与联合对前列腺癌的诊断价值。１临床资料本组４９例 ,年龄４６～８３岁 ,平均６４．５岁。主要临床表现有：排尿困难３９例 ,无痛肉眼血尿１４例 ,腰痛７例 ,消瘦及恶液质４例。全部病例均行ＤＲＥ检查 ,发现前列腺异常者４０例（８１．６%）,包括前列腺质地坚硬３５例（７１．４%）；表面不光…     

前列腺特异性抗原检测及临床应用价值

应用放射免疫法测定１５例前列腺癌、６０例前列腺增生、６０例慢性前列腺炎以及４０例非前列腺疾病患者的血清ＰＳＡ值，并随访观察８例前列腺癌患者接受内分泌治疗后ＰＳＡ值变化。结果表明，前列腺癌的ＰＳＡ阳性率明显高于其它疾病组（Ｐ＜０．０１），其敏感性为９３．３％；特异性不高，为７４．４％，作为前列腺癌的筛选指标有一定的局限性。但对前列腺癌的分期、疗效监测有较大价值，其数值升高或下降与临床症状和体征变化呈正相关关系。     

前列腺特异性抗原的测定在前列腺癌诊断中的价值

目的：针对血清酸性磷酸酶（ＰＡＰ）对前列腺癌检出率偏低的现状，采用目前国内外公认的最佳前列腺癌标志物即前列腺特异性抗原（ＰＳＡ）作为前列腺癌的诊断、分期、判断预后以及监测病情变化的指标。方法：本研究采用ＥＬＩＳＡ夹心法对２０例正常男性、２０例正常女性、２１例良性前列腺增生（ＢＰＨ）、３６例前列腺癌（ＰＣ）、２４例其他癌症患者血清ＰＳＡ进行测定。结果：表明前列腺癌症组患者血清ＰＳＡ非常显著地高于正常男性组、ＢＰＨ组及其他癌症组（Ｐ＜０．００１），而后三组之间ＰＳＡ无统计学差异（Ｐ＞０．０５）。结论：ＰＳＡ测定虽不能作为前列腺癌的筛选诊断，但其测定有助于前列腺癌的监测与疗效观察，同时对鉴别前列腺良、恶性疾病患者有一定价值。     

前列腺癌诊断方法与临床价值

回顾分析６６例前列腺癌并复习文献，认为前列腺癌绝大多数发生于老年男性，常伴有前列腺增生症，８７．９％可通过肛指检查及，肛指可用于健康检发现早期病例，经直肠Ｂ超可发现部分肛指未能们及病例，细针穿针活检仍是目前确诊前列腺产最重要的，简便，阳性率高，无严重并发症。血清瘤标以ＰＳＡ最重要，有较高的敏感性及特异性，结合肛批，经直肠Ｄ超等可诊断前列腺癌，对前列腺增大的老年人应列为常规检查项目。ＣＴ对局部浸润及     

161例前列腺癌的临床诊断分析

目的：提高前列腺癌的诊断水平。方法：对１９８０年１月～１９９９年５月收治的１６１例前列腺癌根据临床症状、直肠指检、Ｂ超、ＣＴ、ＭＲＩ、活检、瘤标及同位素骨扫描,分析其诊断价值。结果：临床症状中排尿不畅１５４例（９５．６％）,尿潴留３０例（１８．６％）,血尿５６例（３４．８％）,骨痛、消瘦８例（４．９％）,截瘫２例（１．３％）;直肠指检,前列腺质地坚硬１２７例（７８．９％）,可触及结节１１９例（７３．９％）,腺体表面高低不平４７例（３７．１％）;Ｂ超检查,前列腺体积为２４－１５１ｍｌ,腺体增大凸入膀胱２７例（２１．１％）,内部强回声１４例（１０．９％）,低回声５８例（４５．３％）,前列腺两侧叶不对称,伴高低不平３１例（２４５．２％）,浸润膀胱颈部和三角区１４例（１０．９％）,侵润精囊１１例（８．６％）;有４６例行     

前列腺癌诊断方法与临床价值（附66例临床报告）

回顾分析６６例前列腺癌并复习文献，认为前列腺癌绝大多数发生于老年男性，常伴有前列腺增生症。８７．９％可通过肛指检查扪及，肛指可用于健康体检发现早期病例。经直肠Ｂ超可发现部分肛指未能扪及病例。细针穿刺活检仍是目前确诊前列腺癌最重要的方法，简便、阳性率高、无严重并发症。血清瘤标以ＰＳＡ最重要，有较高的敏感性及特异性，结合肛指、经直肠Ｂ超等可诊断前列腺癌，对前列腺增大的老年人应列为常规检查项目。ＣＴ对局部浸润及淋巴结转移有较大价值，核素扫描能发现较早期骨转移灶。     

前列腺癌的诊断

回顾性分析了１８年间１５９例前列腺癌的诊断结果，其发病率近９年明显增高。发病率与年龄呈正相关。直肠指诊诊断阳性率为７２．９６％，经腹Ｂ超６９．２％，ＣＴ９０．３２％，ＡＣＰ４５．７１％，ＰＳＡ８５．９２％，穿刺活检８９．３２％。作者建议：ＤＲＥ，ＰＳＡ可作为６０岁以上男性排尿困难患者的常规检查，期望早期检出前列腺癌。     

前列腺癌诊断与治疗——附九例报告

１９９４年２月～１９９８年１２月我院及北京友谊医院（进修期间）泌尿科收治明确诊断的前列腺癌９例,对其诊断方法及治疗效果进行探讨。１　临床材料１．１　一般资料　本组９例,年龄５２～７７岁,平均６４５岁。主要临床症状：排尿不畅和（或）尿频８例（８８８％）,尿潴留２例（２２２％）,无痛性肉眼血尿３例（３３３％）,消瘦、下肢及阴囊水肿１例（１１１％）。１．２　检查方法及结果１．２．１　直肠指检（ＤＲＥ）　前列腺质地坚硬和结节８例（８８８％）;前列腺上缘不可触及、表面高低不平、硬结大小不等３例…     

前列腺癌患者血清PSA和PTHrP联合检测及临床价值

目的：观察３１例前列腺癌患者血清ＰＳＡ与ＰＴＨｒＰ的关系。方法：用放射免疫分析法（ＲＩＡ）和免疫放射分析法（ＩＲＭＡ）。结果：１）正常组测得血清ＰＳＡ值为２．０±１．４４μｇ／Ｌ（ｘ±ｓ），血清ＰＴＨｒＰ（１～８６）值为１．６±０．６ｐｍｏｌ／Ｌ（ｘ±ｓ）。２）前列腺癌组测得血清ＰＳＡ值为８０±５２．５５μｇ／Ｌ（ｘ±ｓ），ＰＴＨｒＰ测得值为４．５８±４．４０ｐｍｏｌ／Ｌ（ｘ±ｓ），显著高于健康组（ｔ＝２．７４９，Ｐ＜０．０１和ｔ＝２．７５，Ｐ＜０．０１）。３）２１例伴发ＨＨＭ前列腺癌患者，ＰＴＨｒＰ（１～８６）升高的有１３例，占６１．９％（１３／２１），测得均值为７．４ｐｍｏｌ／Ｌ（２．８８～１９．１ｐｍｏｌ／Ｌ）。４）２１例伴发ＨＨＭ前列腺癌患者ＰＳＡ和ＰＴＨｒＰ浓度呈显著正相关（ｒ＝０．８２３，Ｐ＜０．０１）。结论：血清ＰＳＡ和ＰＴＨｒＰ的联合测定可作为前列腺癌诊断与疗效监测的指标     

The role of prostate-specific antigen as part of the diagnostic triad and as a guide when to perform a biopsy.

The authors reviewed the results and relationship of prebiopsy prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasound (TRUS) in 124 consecutive patients who underwent a prostate biopsy because of abnormal results of either DRE or TRUS. Results of the three tests (PSA, DRE, and TRUS) showed abnormalities in 54%, 75%, and 84.6% of patients, respectively; biopsy results were positive for cancer in 45.2%. Cancer detection rate increased as the PSA value increased from less than or equal to 4 ng/ml (17.5%) to more than 4 ng/ml (68.7%) to more than 20 ng/ml (83.3%), and as the number of positive tests increased (6.9% for one, 32.7% for two, and 82.6% for three). The PSA assay was the most important parameter of the diagnostic triad. These results suggested that regardless of DRE and TRUS findings, PSA less than or equal to 4 ng/ml confers a low prostate cancer risk, PSA more than 4 ng/ml but less than or equal to 10 ng/ml confers an intermediate prostate cancer risk, and PSA more than 10 ng/ml confers a high prostate cancer risk. Regardless of other findings, all patients with a PSA value more than 10 ng/ml require biopsy because of the high likelihood of cancer. All patients with abnormal DRE or TRUS results still require biopsy despite a low index of suspicion of prostate cancer when the PSA value is less than or equal to 4 ng/ml.     

Utility of Digital Rectal Examination,Serum Prostate Specific Antigen,and Transrectal Ultrasound in the Detection of Prostate Cancer: A Developing Country Perspective

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen(tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men withlower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serumtPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue wereobtained from different areas of the peripheral prostate and examined histopathologically for the nature of thepathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changeswith or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) ofpatients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCahad abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA>20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: Theincidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can befurther improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.     

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.     

Prostate-specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of cancer.

Over a 4 1/2 year period, 1,940 asymptomatic men were entered in a prostate cancer detection program consisting of digital rectal examination (DRE), prostate-specific antigen (PSA), and transrectal prostate ultrasound (TRUS). Four hundred and sixteen biopsies were performed resulting in the diagnosis of 79 cancers; 82% had clinically organ confined tumors. A recommendation for biopsy was made in 260 (62%) based on the TRUS alone, 55 (13%) by DRE alone, 92 (22%) when the DRE and TRUS were both abnormal, and in 9 (2.2%) cases when only PSA levels were elevated. The DRE, PSA, and TRUS were abnormal in 1,261 (65%), 989 (51%), and 1,552 (80%) of the patients with cancer, respectively. Prostate cancer detection increased as the serum PSA level increased above 4 ng/ml. The positive predictive value of both DRE and TRUS were significantly influenced by an elevated PSA, (P = .042 and P less than .00005, respectively). The results of this study support the idea that, although the prostate cancer detection rate is influenced by these three modalities and the detection rate of localized disease can be improved by early detection programs, its effect on mortality rates remains undefined at this time.     

The relationship of prostate-specific antigen to digital rectal examination and transrectal ultrasonography. Findings of the American Cancer Society National Prostate Cancer Detection Project.

The participating institutions of the American Cancer Society National Prostate Cancer Detection Project did 520 biopsies on 2425 men over a 3.5-year period. A total of 88 cancers were confirmed pathologically, 93% of which clinically were organ confined. In 324 men (62.3%), a recommendation for biopsy was made based solely on the results of transrectal ultrasonography (TRUS); in 69 patients (13.3%), solely on the digital rectal examination (DRE); in 116 patients (22.3%), on abnormal DRE and TRUS examinations; and in 11 patients (2.1%), in whom DRE and TRUS were normal, on elevated prostate-specific antigen (PSA) levels. The TRUS was abnormal in 80.6% of men found to have cancer, and the PSA level and DRE were abnormal for 67% and 50% of cancers, respectively. The influence of PSA level on cancer detection increased as the serum level increased above 4 ng/ml. The positive predictive values of both the DRE and TRUS were influenced significantly by the presence of an elevated PSA level (P = 0.044 and P less than 0.001, respectively). The results of this ongoing multicenter study support the following statements: (1) the prostate cancer detection rate is influenced by this diagnostic triad and (2) the detection rate of organ-confined disease can be improved substantially by early detection programs.     

前列腺肿物检查方法的临床评价

目的评价血清前列腺特异性膜抗原（PSA）和各项物理检查对指导前列腺活检的意义。方法结合血清PSA、直肠指诊（DRE）、直肠B超（TRUS）及磁共振成像（MRI）检查,对148例可疑前列腺病变患者,经直肠B超引导下行前列腺穿刺活检。结果前列腺活检阳性率为43.9%（65/148）。DRE和PSA对前列腺癌的诊断有意义(P＜0.05),其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE（P<0.01）,但前述三者之间对前列腺癌的诊断差异无显著性（P=0.46,P＝0.16,P＝0.52）。MRI的敏感性高于DRE和TRUS（P=0.05,P=0.01）,TRUS的特异性高于PSA或MRI（P=0.02,P=0.001）。结论前列腺活检是诊断前列腺癌的重要手段,其初步筛选以DRE加PSA为主,同时结合TRUS及MRI,可提高筛选的敏感性和特异性,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。     

Changing role of 3 screening modalities in the European randomized study of screening for prostate cancer (Rotterdam).

A randomized screening trial was started in Europe to show the effect of early detection and treatment of prostate cancer on mortality (European Study on Screening of Prostate Cancer). In one centre (Rotterdam), the screening protocol initially consisted of 3 screening tests for all men: prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasonography (TRUS). A PSA value of >/=4 ng/ml and/or an abnormality on DRE and/or TRUS were taken to indicate that biopsy was required. In this study, we examined the possibilities for a more efficient screening protocol. A logistic-regression model was used to predict the number of cancers for PSA < 4 ng/ml if all men were biopsied (predictive index, PI). Effects of a change in PSA cut-off on the screening results were explored. Weights were applied to procedures and cancers to explore the possibility of expressing differences between protocols in one overall figure. Biopsies in men with PSA < 1 ng/ml and a positive DRE or TRUS were very inefficient. Applying DRE and TRUS only in the PSA ranges 1.5 to 3.9 and 2 to 3.9 ng/ml to determine whether a biopsy was required would result in a decrease of 29 to 36% in biopsies and a decrease of 5 to 8% in cancers. However, the results of DRE and TRUS could not be duplicated entirely. A protocol with only PSA >/= 3 ng/ml as a direct biopsy indicator resulted in a decrease of detected cancers by 7.6% and of biopsies by 12%, also a much simpler screening procedure. Use of the PI would give more efficient protocols, but this should be viewed as a preliminary finding, with the disadvantage of necessitating many additional screening visits. Since the results of DRE and TRUS could not be duplicated, a change in protocol towards PSA >/= 3 ng/ml appears acceptable. If this proves effective, a final judgement about the optimal combination of screening tests may be made. Int. J. Cancer (Pred. Oncol.) 84:437-441, 1999.     

Histological diagnosis of prostate cancer in Korean men aged 70-79 years

BACKGROUND: The objective of this study was to evaluate the value of the prostate-specific antigen (PSA) in the diagnosis of prostate cancer in elderly Korean men, aged 70-79 years. METHODS: Patients with an abnormal digital rectal examination (DRE) and/or a serum PSA level greater than 2.0 ng/ml underwent a biopsy. A total of 344 men (median age 73 years) constituted the study cohort. RESULTS: Of 344 men, 163 (47.4%) were diagnosed with prostate cancer upon initial biopsy. The positive predictive value (PPV) for cancer was 48.4% for a PSA cutoff of 4 ng/ml, 65.3% for a cutoff of 10 ng/ml, and 87.0% for a cutoff of 20 ng/ml. When combined with an abnormal DRE, the predictive values for these PSA cutoffs increased to 79.3, 87.3 and 100%, respectively. When 10 ng/ml was chosen as a PSA cutoff level, about 50% of patients were found to have a Gleason score of 7 or higher. When 4 ng/ml was chosen as a PSA cutoff level, more than 50% of patients with an abnormal DRE were found to have a Gleason score of 7 or higher. CONCLUSIONS: In elderly men, more than 50% of patients are found to have cancers with a Gleason score of 7 or higher when their PSA level is greater than 10 ng/ml. This threshold may be lowered to 4 ng/ml in the presence of an abnormal DRE. Our findings provide a rationale for recommending a prostate biopsy in elderly patients with an abnormal DRE and/or an elevated serum PSA level. However, at present, it is not clear whether elderly men have better outcomes when they undergo cancer screening.     

Transrectal ultrasound guided biopsy for detecting early prostate cancer: An Indian experience

BACKGROUND: With the advent of prostate specific antigen the number of patients undergoing prostate biopsy has dramatically increased. The sextant biopsy technique has been conventionally used for the diagnosis of prostate cancer. Recently, concern has arisen that the original sextant method may not include an adequate sample of the prostate, hence it may result in high false negative rates. We conducted a prospective study to determine whether the 5-region prostate biopsy technique significantly increases the chance of prostate cancer detection as compared to the sextant biopsy technique. AIMS: To evaluate the efficacy of TRUS guided sextant and 5-region biopsy techniques in detecting carcinoma prostate in patients with PSA between 4 and 10 ng/ml and normal digital rectal examination. METHODS AND MATERIAL: Between December 2001 and August 2003 one forty-two men, aged 49-82 years, who presented with LUTS, normal digital rectal examination (DRE) and PSA between 4 and 10 ng/ml underwent TRUS guided sextant prostate biopsy. Serum PSA was reassessed after 3 months in patients whose biopsies were negative for cancer. If PSA was still raised, the patients underwent extensive 5-region biopsy. RESULTS: Mean patient age was 64 years and median PSA was 6.9 ng/ml. TRUS guided sextant biopsy revealed adenocarcinoma prostate in 34 men (24%). Median Gleason score was 7. Seven men (4.9%) had cellular atypia and 3(2.1%) had prostatic intraepithelial neoplasia (high grade). On repeat PSA estimation after 3 months, 48 patients showed stagnant or rising trend for which they underwent TRUS guided 13-core biopsy. Five (10.4%) patients were detected to have adenocarcinoma on repeat biopsy. Biopsy negative patients are on regular follow up with yearly PSA estimation. Complications included transient mild haematuria in14 patients (9.82%) and haematospermia in 4 (2.8%). Urinary retention developed in one patient and required an indwelling catheter for 4 days. CONCLUSION: Transrectal ultrasound guided sextant biopsy has shown a false negative rate of approximately 11%. A repeat 5- region (13-core) biopsy strategy can decrease the false negative rate of conventional sextant biopsy in patients with previously negative biopsies but persistently high PSA levels, high grade PIN or cellular atypia.     

The American Cancer Society National Prostate Cancer Detection Project. Findings on the detection of early prostate cancer in 2425 men.

The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multidisciplinary, multicenter effort to assess the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA) assay. By June 1990, 2425 men not previously suspected of having prostate cancer had been examined in ten participating clinical centers according to the project protocol. Three hundred ninety-six men (16.3%) were recommended for biopsy on the basis of TRUS or DRE. An analysis of the results of 330 completed biopsies showed 52 cancers detected by DRE and/or TRUS. Forty-four (84.6%) of the men with cancer had positive TRUS examination results compared with 33 (63.5%) with positive DRE. Five additional cancers were discovered as a result of elevated PSA levels. The overall detection rate was 2.4% and this rate varied by age. The detection rate in men 55 to 60 years of age was 1.3% and this rose to 3.3% in men older than 65 years of age. The estimated sensitivity was significantly greater for TRUS compared with DRE (77.2% versus 57.9%; P less than 0.05). The estimated specificity of DRE was greater than that of TRUS (96.3% versus 89.4%; P less than 0.01). The positive predictive value (PPV) for the tests varied as a function of patient and disease characteristics. The overall PPV was 28.0% for DRE and 15.2% for TRUS. The occurrence of elevated PSA levels significantly increased the PPV of both TRUS and DRE. The majority of cancers detected were at early stages. These preliminary data suggest the feasibility of using these techniques to promote cancer control, but additional data and follow-up are needed to assess the significance of the results.