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。     

ROC曲线分析波谱定量分析在前列腺癌中的诊断价值

目的：探讨MR波谱（magnetic resonance spectroscopy,MRS）定量分析方法在前列腺癌（prostatic carci-noma,PCa）诊断中的意义。方法：对所有疑诊PCa患者行前列腺磁共振波谱分析,酶联免疫法测定血清前列腺特异抗原（PSA）,经直肠超声测定前列腺体积,计算前列腺特异抗原密度（PSAD）,经超声引导下系统穿刺活检证实的71例良性前列腺增生患者和31例PCa患者,分别测量各个位置（胆碱＋肌酸）/枸橼酸盐[（Cho＋Cre）/Cit]的比值,并取均值。结果：前列腺穿刺阳性组的PSA、PSAD及（Cho＋Cre）/Cit的比值分别为23.73±19.06、0.62±0.42、2.33±0.66;前列腺穿刺阴性组的PSA、PSAD及（Cho＋Cre）/Cit的比值分别为8.61±4.47、0.15±0.13、0.73±0.39。阳性组的检测值均较阴性组高（P〈0.05）。PSA、PSAD及（Cho＋Cre）/Cit在ROC曲线下的面积分别为0.71、0.76、0.84。在保持93.5%的敏感性以上时,PSA、PSAD及（Cho＋Cre）/Cit的特异性是43.7%、63.4%和83.1%,（Cho＋Cre）/Cit较PSA、PSAD能更好地检出PCa。结论：MRS分析方法定量评价PCa的代谢改变,有助于PCa的早期诊断,同时结合PSA、PSAD更有助于前列腺癌诊断的特异性。     

ROC曲线分析波谱定量分析在前列腺癌中的诊断价值

目的:探讨MR波谱(magnetic resonance spectroscopy,MRS)定量分析方法在前列腺癌(prostatic carci-noma,PCa)诊断中的意义。方法:对所有疑诊PCa患者行前列腺磁共振波谱分析,酶联免疫法测定血清前列腺特异抗原(PSA),经直肠超声测定前列腺体积,计算前列腺特异抗原密度(PSAD),经超声引导下系统穿刺活检证实的71例良性前列腺增生患者和31例PCa患者,分别测量各个位置(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]的比值,并取均值。结果:前列腺穿刺阳性组的PSA、PSAD及(Cho+Cre)/Cit的比值分别为23.73±19.06、0.62±0.42、2.33±0.66;前列腺穿刺阴性组的PSA、PSAD及(Cho+Cre)/Cit的比值分别为8.61±4.47、0.15±0.13、0.73±0.39。阳性组的检测值均较阴性组高(P<0.05)。PSA、PSAD及(Cho+Cre)/Cit在ROC曲线下的面积分别为0.71、0.76、0.84。在保持93.5%的敏感性以上时,PSA、PSAD及(Cho+Cre)/Cit的特异性是43.7%、63.4%和83.1%,(Cho+Cre)/Cit较PSA、PSAD能更好地检出PCa。结论:MRS分析方法定量评价PCa的代谢改变,有助于PCa的早期诊断,同时结合PSA、PSAD更有助于前列腺癌诊断的特异性。     

经直肠超声引导前列腺穿刺活检方案的合理选择

目的 分析经直肠超声(TRUS)和前列腺特异性抗原(PSA)及其相关参数在前列腺穿刺活检中的作用,探讨个体化前列腺穿刺方案的可行性。方法 回顾性分析195例患者的首次穿刺活检资料,所有患者均采用系统8点穿刺方案,并对可疑病灶增加1~2点。依据穿刺病理结果,分析前列腺癌(PCa)检出率与TRUS、PSA及其相关参数的关系。结果 195例患者中检出PCa 98例(50.3%),其中PSA 4~10 ng/mL组45例,检出PCa 16例(35.6%),其中TRUS(+)且PSATZ≥0.35 ng/mL² 210例均证实为PCa;PSA＞10 ng/mL组150例,检出PCa 82例(54.7%)。PSA 4~10 ng/mL与PSA＞10 ng/mL两组患者PCa检出率差异有统计学意义(P＜0.05),且两组中TRUS(+)与TRUS(-)患者相较PCa检出率差异均有统计学意义(P＜0.01)。结论 依据TRUS、PSA及其相关参数制定个体化前列腺穿刺方案是可行的。     

不同PSA水平的国人首次前列腺穿刺活检所需穿刺针数的研究

目的 比较不同PSA水平患者采用6点法和12点法的前列腺活检阳性率,探讨针对不同的患者人群设计国人合理的首次前列腺穿刺点数。 方法 通过研究首次接受直肠超声引导经会阴前列腺穿刺的425例患者,在PSA的不同水平段,比较6点法和12点法的阳性率的差异,以及阳性患者穿刺活检Gleason评分与前列腺癌根治术后病理标本Gleason评分之间的差异。 结果 425例患者中6点法穿刺224例,12点法201例。PSA＞20 ng/ml的患者6点法与12点法的阳性率分别为85.3%、77.5%（P＞0.05）;PSA10~20 ng/ml患者6点法和12点法的阳性率分别为33.8%、39.1%（P＞0.05）。两者的12点法比6点法没有更高的阳性率。PSA≤10 ng/ml患者6点法和12点法的阳性率分别为24.1%、45.8%（P＜0.05）,12点法比6点法阳性率显著提高。结论 对于国人首次行前列腺穿刺,若PSA＞20 ng/ml推荐行6点法穿刺;PSA≤10 ng/ml推荐12点法穿刺,而PSA在10~20 ng/ml则两种穿刺方法均可以选用。     

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%;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.     

尿液前列腺癌基因-3在前列腺癌诊断中的临床价值

[目的]探讨尿液中前列腺癌基因-3(prostate cell antigen 3,PCA3)对前列腺癌的诊断价值.[方法]收集119例前列腺癌(prostate cancer,PCa)患者和207例前列腺增生(benign prostatic hyperplasia,BPH)患者前列腺按摩后尿液,采用反转录聚合酶链反应技术,分析PCA3基因在PCa和BPH患者尿液中的表达情况,并与血中前列腺特异性抗原(prostate specific of antigen,PSA)进行应用价值的比较.[结果]尿PCA3 mRNA阳性104例,其中PCa100例、BPH 4例.尿PCA3 mRNA诊断PCa的敏感度、特异性、准确率、阳性预测值(PPV)、阴性预测值(NPV)、阳性似然比(+LR)、阴性似然比(-LR)分别为84.03％、98.07％、92.94％、96.15％、91.44％、43.49、0.16;血PSA诊断PCa的检出率为48.92％(113/231),明显低于尿PCA3 mRNA诊断PCa的检出率96.15％(100/104),差异有统计学意义(P＜0.01).此外,PSA位于灰色区域4～10ng/ml77例,病理结果显示PCa 8例,BPH 69例,PCa检出率10.39％;尿PCA3 mRNA阳性7例,其中PCa 6例、BPH 1例,PCa检出率85.71％;尿PCA3 mRNA诊断PCa的敏感度和特异性分别为75.00％和98.55％.[结论]与血PSA相比,尿PCA3 mRNA诊断PCa敏感度稍低,但具有很好的特异性和阳性预测值,对于首次活检阴性而尿PCA3 mRNA阳性的患者意义重大,提示可能需要重复穿刺活检.在PSA介于灰色区域4～10ng/ml时,穿刺结果阳性率较低(10.39％),尿PCA3 mRNA诊断PCa的特异性达98.55％,可协助判断是否需要穿刺活检.     

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。     

前列腺癌组织p504S和p63与血清PSA表达水平相关性分析

目的:探讨p504S、p63在前列腺癌(PCa)组织中的表达与血清前列腺特异性抗原(PSA)的关系。方法:采用免疫组织化学方法检测p504S、p63在前列腺增生(BPH)、前列腺上皮内瘤变(PIN)和前列腺癌(PCa)组织中的表达,并探讨前列腺癌(PCa)组织中p504S表达与血清PSA水平的相关性。结果:18例PCa组织中,p504S阳性表达16例(88.89%);28例PIN中,p504S阳性表达6例(21.43%);124例BPH中,p504S弱阳性表达8例(6.45%),p504S在PCa组织中的阳性表达率明显高于PIN与BPH组织,P<0.05。18例PCa组织中,p63呈不连续阳性表达2例(11.11%);28例PIN中,p63阳性表达24例(85.71%);124例BPH中,p63阳性表达116例(93.55%),p63在PCa组织中的表达阳性率明显低于BPH与PIN组织,P<0.05。p504S在血清PSA水平<4 ng/mL的8例PCa中7例阳性表达,在>4 ng/mL的10例PCa中9例阳性表达,两者比较差异无统计学意义,P>0.05。结论:对血清PSA>4 ng/mL、临床疑为PCa的病例,可行穿刺活检联合免疫组织化学方法明确诊断。     

血清cPSA对前列腺癌诊断价值的研究

 目的　探讨血清中结合前列腺特异性抗原 (c PSA)在前列腺癌 (PCa)诊断中的临床价值。方法　用磁微粒子免疫化学发光法测定 72例良性前列腺增生 (BPH)患者和 38例PCa患者c PSA、t PSA ,并计算c PSA/t PSA比值。结果　c PSA及c PSA/t PSA比值可有效地区分BPH和PCa(P <0 .0 0 5 ) ,尤其是在诊断灰值区 (t PSA为 4～ 1 0ng/ml)时效果更显著。在以t PSA≤1 0 .0ng/ml和c PSA/t PSA≥0 .72为筛选界值联合对PCa进行筛选时 ,临床概率敏感度为 93.8%。结论　c PSA的引入及c PSA/t PSA比值的应用 ,对PCa的诊断具有重要临床意义 ,尤其是在前列腺特异性抗原的诊断灰值区。     

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.     

血清铁蛋白联合前列腺特异性抗原检测对前列腺癌的诊断价值

目的探讨血清铁蛋白(Ferr)、总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(f PSA)、fPSA/tPSA联合检测对前列腺癌(PCa)的诊断价值。方法选择90例PCa患者、84例前列腺良性病变患者和50例健康男性体检者分别作为PCa组、良性组和对照组,检测3组研究对象的血清Ferr、tPSA、fPSA水平并计算fPSA/tPSA,分析Ferr、tPSA、fPSA、fPSA/tPSA联合检测对PCa的诊断价值。结果PCa组患者的血清Ferr、tPSA、fPSA水平均高于良性组和对照组,fPSA/tPSA低于良性组和对照组,差异均有统计学意义(P﹤0.05)。良性组患者的血清Ferr、tPSA、fPSA水平均高于对照组,fPSA/tPSA低于对照组,差异均有统计学意义(P﹤0.05)。PCa患者的血清Ferr与tPSA、fPSA均呈正相关,tPSA与f PSA呈正相关,tPSA与fPSA/tPSA呈负相关(P﹤0.05)。血清Ferr、tPSA、fPSA、fPSA/tPSA联合检测诊断PCa的灵敏度、特异度、曲线下面积均高于四个指标的三联、两联、单独检测。结论PCa患者的血清Ferr、t PSA、fPSA水平均高于前列腺良性病变患者,fPSA/tPSA低于前列腺良性病变患者。血清Ferr、tPSA、f PSA、f PSA/tPSA联合检测对PCa具有较高的诊断价值,值得在临床中推广应用。     

Screening for prostate cancer in Dutch hereditary prostate cancer families

It is common belief that in families with hereditary prostate cancer (HPC), unaffected men should be screened periodically with PSA, but little is known about the effects of such screening. We studied test and tumor characteristics in unaffected 50-75-year-old screenees from HPC families. In the Netherlands, 153 verified HPC families are registered; 132 unaffected men in these families were not under surveillance for prostate cancer and gave informed consent for PSA testing by their GP and referral to a urologist in the case of a PSA level >or= 3.0 ng/ml. Results were compared to published data from the Rotterdam and G?teborg sections of the European Randomized Study of Screening for Prostate Cancer (ERSPC). A PSA >or= 3.0 ng/ml was found in 20 men: referral rate, 15.1% (ERSPC Rotterdam: 20.1%; ERSPC G?teborg: 12.0%). Only 3 cases of prostate cancer were diagnosed in these men: detection rate in the first screening round 2.3% (ERSPC Rotterdam: 5.3%; ERSPC G?teborg: 2.3%). Frequent opportunistic PSA testing made it impossible to estimate the detection rates in subsequent screening rounds. In the first and subsequent PSA screening rounds, 11 cases of cancer were detected. All but 1 had favorable tumor characteristics (cT1c/pT2; Gleason < 7). These results raise the question as to whether men from all HPC families should be considered at high-risk. We suggest that the same PSA testing guidelines should apply to HPC families and the general population. A more aggressive screening policy in HPC families does not seem to be justified.     

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。     

超声引导下经直肠前列腺穿刺活检560例分析

目的：探讨15针经直肠超声引导下前列腺穿刺活检术诊断前列腺癌的临床价值及其安全性。方法：回顾性分析我院2010-01—10—2012—12—20560例初次行经直肠超声引导下前列腺穿刺活检术的可疑前列腺癌患者的临床资料,对穿刺结果及穿刺后并发症情况做相关分析。结果：560例穿刺患者平均年龄（67．34±9．75）岁,平均前列腺特异性抗原（prostatespecificantigen,PSA）水平为（8．41±33．45）μg／L,平均前列腺体积大小为（64．52±35．47）mL,穿刺结果为前列腺癌214例（38．2％）,前列腺增生65例（11．6％）,前列腺增生伴低级别上皮内瘤变（prostaticintraepithelialneoplasia,PIN）I128例（22．9％）,PINII～Ⅲ35例（6．3％）,良性前列腺增生（benignprostatichyperplasia,BPH）伴慢性炎症96例（17．1％）,腺泡状横纹肉瘤1例。穿刺术后119例出现肉眼血尿（21．3％）,尿频、尿急和尿痛18例（3．2％）,直肠出血3例（0．5％）,急性尿潴留15例（2．7％）,发热10例（1．8％）,无其他严重并发症。结论：经直肠超声引导下前列腺15针系统穿刺法穿刺阳性率高,并发症少,是诊断前列腺癌的安全、有效方法,值得推广。     

前列腺特异膜抗原对前列腺疾病的临床诊断意义

目的评价血清中前列腺特异膜抗原（PSMA）浓度对前列腺疾病的辅助诊断意义。方法采用Western印迹分析检测患者血清中PSMA的浓度,前列腺特异抗原（PSA）检测采用通用的免疫化学发光法检测。分析二者在不同分组中的浓度差异及相关性。结果前列腺癌患者的血清中PSMA浓度显著高于正常人群,良性前列腺增生和前列腺炎的患者则低于正常人群,而PSA浓度无论是前列腺癌还是前列腺良性病变均高于正常人。结论前列腺特异膜抗原浓度可以作为区分前列腺癌和良性前列腺增生的辅助诊断标志物。     

Prostate-specific antigen velocity and prostate cancer gleason grade and stage

BACKGROUND: Increased preoperative prostate-specific antigen (PSA) velocity (PSAV) has been associated with increased prostate cancer mortality and higher Gleason scores. The authors evaluated the relation between PSAV, biopsy Gleason score, and pathologic stage in men who were enrolled in a prostate cancer screening trial. METHODS: Data were analyzed from 1441 men who were enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who received > or =2 PSA screens and were diagnosed with prostate cancer within 1 year of the last screen. PSAV was estimated by using all screening PSA values within 6 years prediagnosis. RESULTS: Both PSA and PSAV were related to biopsy Gleason score. The multivariable odds ratios (OR), controlling for PSA and demographics, for having a Gleason score of 7 to 10 were 1.3 (95% confidence interval [95% CI], 0.9-1.9), 2.2 (95% CI, 1.5-3.3), and 2.3 (95% CI, 1.4-3.9) for men with PSAV values from 0.5 to 1 ng/mL per year, from 1 to 2 ng/mL per year, and >2 ng/mL per year, respectively, compared with men who had PSAV values <0.5 ng/mL per year. The median PSAV was 0.60 ng/mL per year for men with Gleason scores from 2 to 6 versus 0.84 ng/mL per year for men with Gleason scores from 7 to 10 (P < .0001). Among 658 men who underwent prostatectomy, both PSA and PSAV were associated with advanced pathologic stage in univariate analyses; however, when the analysis controlled for clinical stage and biopsy Gleason score, the associations of PSA and PSAV were no longer statistically significant. CONCLUSIONS: PSAV and PSA levels were associated independently with biopsy Gleason score. Among men who underwent prostatectomy, PSAV and PSA were not predictive of advanced pathologic stage when the analysis was controlled for biopsy Gleason score and clinical stage. It cannot be determined yet whether PSAV is predictive of long-term prostate cancer outcome in this cohort.     

晚期前列腺癌的外照射治疗

目的：研究晚期前列腺癌的外照射治疗的疗效。方法：１９９３年３月－１９９９年３月共收治晚期前列腺癌４５例,Ｃ期３２例,Ｄ期１３例,对所有病例均予外照射治疗,局部肿瘤量达５５－７０Ｇｙ／５．５－７周。结果：所有病例放疗后排尿困难、骨转移疼痛改善,血尿消失,放疗后血前列腺特异性抗原（ＰＳＡ）均明显下降,为０．０１－２．８ｎｇ／ｍｌ,平均０．３５ｎｇ／ｍｌ,放疗后９个月复查局部肿瘤消失２９例,明显缩小１６     

Evaluation of prediagnostic prostate‐specific antigen dynamics as predictors of death from prostate cancer in patients treated conservatively

Prostate‐specific antigen (PSA) dynamics have been proposed to predict outcome in men with prostate cancer. We assessed the value of PSA velocity (PSAV) and PSA doubling time (PSADT) for predicting prostate cancer‐specific mortality (PCSM) in men with clinically localized prostate cancer undergoing conservative management or early hormonal therapy. From 1990 to 1996, 2,333 patients were identified, of whom 594 had two or more PSA values before diagnosis. We examined 12 definitions for PSADT and 10 for PSAV. Because each definition required PSA measurements at particular intervals, the number of patients eligible for each definition varied from 40 to 594 and number of events from 10 to 119. Four PSAV definitions, but no PSADT, were significantly associated with PCSM after adjustment for PSA in multivariable Cox proportional hazards regression. All four could be calculated only for a proportion of events, and the enhancements in predictive accuracy associated with PSAV had very wide confidence intervals. There was no clear benefit of PSAV in men with low PSA and Gleason grade 6 or less. Although evidence that certain PSAV definitions help to predict PCSM in the cohort exist, the value of incorporating PSAV in predictive models to assist in determining eligibility for conservative management is, at best, uncertain.     

Biological aggressiveness of prostate cancer in the Finnish screening trial

Prostate cancer aggressiveness was evaluated based on pathologic characterization of cases detected in the Finnish prostate cancer screening trial. The trial population consists of 80,458 men aged 55–67 years. A total of 32,000 men were randomized to the screening arm. The remaining 48,000 men formed the control arm. The interval cases and cancers among nonparticipants and in the control arm were identified from the Finnish Cancer Registry. Random samples were selected from screen‐detected cases (126 of 543 in the first and 133 of 508 in the second round) and control arm cancers (133 out of 863), in addition to all 92 interval cancers and 106 cases among nonparticipants. All the biopsies were regraded according to the Gleason system. The expression of the proliferation antigen Ki‐67 was determined in 479 cases (72%). More than half of the tumors diagnosed in the first round of screening were high‐grade cancers (Gleason 7 or higher). In the second round, the proportion of low‐grade cancers increased from 47% to 70%. Cancers in the screening arm were more commonly focal and fewer bilateral cancers were detected. The cancers among nonparticipants were the most aggressive group. The aggressiveness of the interval cancers was between the cancers detected in the first and the second round. Our results indicate that prostate cancers detected through screening are less biologically aggressive. This was most notable after the first screening round. Nonparticipants had more aggressive cancers. © 2008 Wiley‐Liss, Inc.