血清PSA、PSAD和PSAT在前列腺穿刺活检中的意义

目的探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)和前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义。方法对192例患者行前列腺穿刺活检,其中PSA≥4ng/ml者184例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者8例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果192例患者中经前列腺穿刺诊断为前列腺癌(PCa)100例,活检阳性率52.1%,其中8例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,良性前列腺增生7例;93例PSA>20ng/ml者中80例为PCa,活检阳性率86.0%;91例PSA4~20ng/ml者中19例为PCa,活检阳性率20.9%。血清PSA4~20ng/ml患者,PSAD>0.10或PSAT>0.10时,敏感性均为100%,特异性为11.1%或4.2%,阳性预测值为22.9%或21.6%,可避免8.8%(8/91)或3.3%(3/91)阴性穿刺结果。血清PSA4~20ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为(13.2±4.7)和(11.4±4.6)ng/ml(P>0.05);PSAD分别为0.36±0.18和0.19±0.09(P=0.001);PSAT分别为0.67±0.36和0.32±0.18(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.613、0.810和0.833,PSAD和PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P<0.05)。结论PSA>20ng/ml时应做前列腺穿刺活检;PSA4~20ng/ml时,PSAD和PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

前列腺特异性抗原密度的测定在诊断前列腺癌中的价值

对１０例非转移性前列腺癌和２０例前列腺增生的前列腺特异性抗原密度（ＰＳＡＤ）进行研究。前列腺癌平均ＰＳＡＤ值为０．７１１，而前列腺增生为０．０７５；两者有极显著性差异（Ｐ＜０．００１）。９例ＰＳＡＤ＞０．２者，８例为前列腺癌。１６例ＰＳＡＤ＜０．１者，无１例前列腺癌。８例前列腺癌患者中有３例前列腺特异性抗原（ＰＳＡ）＜１０ｎｇ／ｍｌ，１例＜２．８ｎｇ／ｍｌ。１６例前列腺增生患者中７例ＰＳＡ＞２．８ｎｇ／ｍｌ，３例＞１０ｎｇ／ｍｌ。表明血清ＰＳＡ轻中度增高或正常时，ＰＳＡＤ可作为前列腺癌早期筛选诊断的有效指标之一。     

Utility of prostate specific antigen doubling time in repeat biopsy for prostate cancer

PURPOSE: It is not rare that the repeat biopsy is performed when the initial biopsy was negative. However, there is not a clear indication for the repeat biopsy. We evaluated the utility of prostate specific antigen doubling time (PSA-DT) as indication for the repeat biopsy. MATERIALS AND METHODS: Of men 103 underwent repeat biopsy after initial negative prostate biopsy, 55 men who had three or more serial PSA measurements until repeat biopsy were evaluated. PSA-DT was calculated using a log-linear regression model and compared with other PSA-related parameters. RESULTS: Prostate cancer was diagnosed in 22 patients (40.0%). Mean PSA-DT in 55 patients was 59.3 months. Comparing of repeat positive biopsy group and negative group, PSA density (PSAD) and PSA velocity (PSAV) in the positive biopsy group were significantly greater than in the negative biopsy group. Age, serum PSA concentration at initial and repeat biopsy, PSA adjusted for volume of transition zone (PSATZ), free to total PSA ratio (%F/T) did not recognize significant differences between both biopsy groups. PSA-DT of positive biopsy group (35.1 months) was significantly shorter than that of negative biopsy group (76.5 months). None was diagnosed prostate cancer whose PSA-DT was longer than 96 months. CONCLUSION: When we considered prostate repeat biopsy, it was thought that PSA-DT could be one important material, but it was limitation for indication as to other PSA-related parameters.     

游离前列腺特异抗原百分比/前列腺特异抗原密度在前列腺癌诊断中的应用

目的探讨游离前列腺特异抗原百分比（FPSA／TPSA值）／前列腺特异抗原密度[（F／T）／PSAD值]在前列腺癌诊断中的意义。方法回顾分析204例行经直肠超声引导前列腺穿刺活检患者的诊断资料,其中前列腺癌90例、良性前列腺增生114例,分析总PSA（TPSA）、FPSA／TPSA值、PSAD、（F／T）／PSAD值等指标在判断前列腺癌的敏感性为90％时的截点及相应的特异性。结果不同血清PSA水平（〈4．0,4．0～,10．1～和〉20．0μg／L）的前列腺癌患者的（F／T）／PSAD值与良性前列腺增生患者比较,差异有统计学意义（P〈0．05）;前列腺癌患者的（F／T）／PSAD值低于良性前列腺增生患者;（F／T）／PSAD值比FPSA／TPSA值和PSAD更有助于提高诊断特异性,在敏感性为90％左右的前提下,FPSA／TPSA值的特异性为31．6％,PSAD的特异性为45．6％,（F／T）／PSAD值的特异性为64．0％;PSA水平不同,取的（F／T）／PSAD值截点也不同：PSA〈4．0μg/L时截点为2．5,PSA为4．0～20．0μg／L时截点为0．8;PSA〉20．0μg／L时截点为0．5。结论应用（F／T）／PSAD值能够在保持较高敏感性的前提下,显著提高前列腺癌诊断的特异性。     

血清PSA含量及前列腺PSA密度与经直肠超声引导下前列腺穿刺活检诊断前列腺癌的关系

目的探讨经直肠超声引导下前列腺穿刺活检术前列腺癌检出率与血清前列腺特异性抗原(PSA)及血清前列腺特异性抗原密度(PSAD)的关系。方法对134例患者行经直肠超声引导下前列腺5区13针系统穿刺活检。根据PSA水平分为PSA≤4ng/ml组(7例)、4ng/mlPSA15ng/ml组(48例)及PSA≥15ng/ml组(79例)。测量并计算前列腺体积(PV)及PSAD,分析前列腺癌检出率及不同PSA、PSAD水平下对前列腺癌的诊断效能。比较前列腺癌与非前列腺癌患者PSA、PV及PSAD的差异。结果前列腺癌总检出率为50.75%(68/134),前列腺患者共68例(前列腺癌组),非前列腺癌患者共66例(非前列腺啊组)。PSA≤4ng/ml、4ng/mlPSA≤15ng/ml及PSA15ng/ml组前列腺癌检出率分别为14.29%(1/7)、20.83%(10/48)及72.15%(57/79),差异有统计学意义(P0.05)。PSA≥4ng/ml时前列腺癌检出率随着PSA值的增高而上升。134例患者PSAD值为(1.09±1.72)ng/(ml·cm3),以PSAD≥0.19ng/(ml·cm3)为截点诊断前列腺癌的敏感度为95.59%(65/68),特异度为51.52%(34/66),阳性预测值67.01%(65/97),阴性预测值为32.99%(32/97)。4ng/mlPSA≤15ng/ml组中,以PSAD≥0.19ng/(ml.cm3)为截点诊断前列腺癌的敏感度为80.00%(8/10),特异度为71.05%(27/38),阳性预测值为42.11%(8/19),阴性预测值为57.89%(11/19)。前列腺癌组PSA及PSAD值均高于非前列腺癌组(P均0.05),PV小于非前列腺癌组(P0.05)。4ng/mlPSA≤15ng/ml组中,前列腺癌与非前列腺癌患者PSA及PV差异均无统计学意义(P均0.05),前列腺癌患者PSAD高于非前列腺癌患者(P0.05)。结论血清PSA及PSAD均与前列腺穿刺活检前列腺癌检出率有关,PSA15ng/ml应行穿刺活检,PSAD对4ng/mlPSA≤15ng/ml的患者是否应行穿刺活检具有指导意义。     

Prediction of extraprostatic cancer by prostate specific antigen density,endorectal MRI,and biopsy Gleason score in clinically localized prostate cancer

BACKGROUNDS: The present study was designed to identify the preoperative parameters, including PSA-based parameters, and endorectal MRI, predictive of pathological stage in males who underwent radical prostatectomy. METHODS: We studied 114 patients who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized prostate cancer. Clinical stage was assessed by DRE, pelvic CT scan, endorectal MRI, and bone scan. The correlation between the preoperative parameters, including PSA-based parameters, clinical stage, and histological findings of biopsy specimens, and the pathological stage was analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for local extent of disease. RESULTS: Seventy-six (66.6%) patients had organ confined cancer and 38 (33.4%) patients had extraprostatic cancer. Of the 38 patients with extraprostatic cancer, four had seminal vesicle involvement, while, none had pelvic lymph node involvement. Biopsy Gleason score, PSA, PSA-alpha1-antichymotrypsin (PSA-ACT), PSA-density (PSAD), PSA-transition zone density, PSA-ACT density, and PSA-ACT transition zone (TZ) density were significantly higher and percent free PSA was lower in the patients with organ confined cancer than those with extraprostatic cancer (P < 0.01). PSAD showed the largest area under the ROC curve (AUC) among those parameters (AUC = 0.732). Sixty-eight (74.7%) of 91 patients with T2 on endorectal MRI had organ confined cancer, while 15 (65.2%) of 23 patients with T3 had extraprostatic cancer (P < 0.01). Multivariate logistic regression analysis indicated that Gleason score (> or =7 vs. < or =6), endorectal MRI findings, and PSAD were significant predictors of extraprostatic cancer (P < 0.01). CONCLUSIONS: The present study demonstrated that preoperative PSAD was the most valuable predictor among PSA-based parameters for extraprostatic disease in patients with clinically localized prostate cancer. The combination of PSAD, endorectal MRI findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy.     

前列腺移行带特异抗原密度检测前列腺癌的临床观察

目的　评价前列腺移行带特异抗原密度 (PSAT)检测前列腺癌 (PCa)的临床价值。　方法　用酶免法测定 30例PCa及 88例良性前列腺增生症 (BPH)患者血清PSA水平 ,用经直肠前列腺B超测定患者总前列腺体积及移行带体积 ,并计算PSA密度 (PSAD)及PSAT值。　结果　PSA在 4～ 10ng/ml时 ,PCa和BPH患者PSAD值分别为 0 .2 6± 0 .11、0 .13± 0 .0 6 ,两组间相比差别具有显著性意义 (P <0 .0 1) ;PSAT值则分别为 1.0 4± 0 .70、0 .2 1± 0 .13 ,两组间相比差别具有显著性意义 (P <0 .0 1)。若选择PSAD =0 .15作为判断患者是否需穿刺活检的标准 ,将有 2 7%的PCa漏诊 ,而若选择PSAT =0 .35作为判断患者是否需穿刺活检的标准 ,只有 9%的PCa漏诊 (P <0 .0 1)。　结论　PSAT是一种新的有效的检测PCa的方法 ,PSA在 4～ 10ng/ml范围时 ,用PSAT检测PCa较用PSAD更精确。     

The value of prostatic specific antigen density in the early diagnosis of prostate cancer

In order to differentiate benign from malignant prostatic lesions, 42 patients were evaluated using the prostate specific antigen density (PSAD) test. All patients were evaluated with PSA determination, digital rectal examination (DRE), transrectal ultrasonography (TRUS) and ultrasound-guided prostatic biopsies. PSA was analyzed by the I-MX ABBOT assay. PSAD was determined by dividing the serum PSA by the volume of the prostate. Prostatic biopsies identified cancer in 3 of the 42 patients (6.38%). It is concluded that PSAD is valuable for the early diagnosis of localized prostatic carcinoma, especially when there are negative findings from DRE and/or TRUS.     

Comparison of value of free-to total prostate specific antigen, prostate specific antigen density and prostate specific antigen density of transition zone for diagnosis of prostate cancer in patients with a PSA level of 4.1-10 ng/ml

PURPOSE: We evaluated the utility of free-to total PSA (F/T PSA) ratio, PSA density (PSAD) and PSA density of the transition zone (PSATZ) in diagnosis of prostate cancer with intermediate PSA level (4.1-10 ng/ml). PATIENTS AND METHODS: Between January 2000 and December 2003, systematic prostate biopsies were performed on 178 patients with intermediate PSA level. The clinical values of F/T PSA ratio, PSAD and PSATZ for the detection of prostate cancer were compared by using receiver operating characteristic (ROC) curves. RESULTS: Overall, 57 of the 178 (32%) patients had prostate carcinoma. The ROC curve analysis showed PSAD and PSATZ were superior to F/T PSA ratio in patients with intermediate PSA level. In patients with total prostate volume greater than 30 cm3, the area under the ROC curve for F/T PSA ratio was greater than that for PSAD and PSATZ. CONCLUSIONS: PSAD and PSATZ were more powerful predictors of prostate cancer than F/T PSA ratio in patients with intermediate PSA level. While F/T PSA ratio was effective for diagnosis of prostate cancer in prostate volume greater than 30 cm3.     

Significance of re-measurement of prostate specific antigen before prostate biopsy

To examine the natural change of prostate-specific antigen (PSA), we compared two PSA values, the first value with which we decided to perform prostate biopsy and the value obtained by remeasurement just before biopsy. To exclude cases with extremely high PSA, we examined 288 cases in which PSA was less than 50 ng/ml for comparison. Of the 288 cases, 93 were diagnosed with prostate cancer (CaP). The interval between the two PSA measurements was 1-90 days (average of 31.4 days). The first and second values were an average of 13.0 and 11.7 ng/ml, respectively, and the second value was significantly lower than the first value. When we divided them into CaP cases and non-CaPthe two cases, a significant difference between PSA values was found only in the non-CaP cases. Moreover, in the non-CaP cases with some clinical symptoms, the difference in PSA was marked between the first and second values, which averaged 11.2 and 9.2 ng/ml, respectively. When we decide to perform a biopsy, we should recognize that PSA sometimes is lower on re-measurement. Particularly in symptomatic cases, it is worth re-measuring PSA, which may save unnecessary biopsies.     

Prostate specific antigen density correlates with features of prostate cancer aggressiveness

PURPOSE: An increased prostate specific antigen density (serum prostate specific antigen divided by prostate volume) is an established parameter to help determine the need to perform prostate biopsies. A man with a high prostate specific antigen and a normal size prostate gland is more likely to have cancer than a man with the same prostate specific antigen and a large gland. Prostate specific antigen in relation to prostate size should also reflect the volume of cancer in the gland. One group defined clinically unimportant prostate cancer as tumor volume less than 0.5 cc, organ confined disease and Gleason less than 7. Another group noted that at the time of biopsy, a prostate specific antigen density less than 0.15 ng/ml/cc combined with low risk clinical tumor features predicted insignificant cancer. There are limited published validating data on the association of prostate specific antigen density with the criteria for prostate cancer aggressiveness. We tested the association of prostate specific antigen density with features of tumor aggressiveness in a screened and in a nonscreened cohort of patients with clinically localized prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: The screened patient cohort included 1,280 patients with screen detected prostate cancer treated from 1990 to 2002 at Washington University, and the nonscreened cohort included 382 patients treated from 2003 to 2004 at Northwestern University. We recorded the clinical and pathological tumor parameters in a prospective database. Parameters evaluated were pathological tumor stage, Gleason sum, tumor volume, biochemical progression and the previously mentioned 2 criteria for clinically unimportant cancers. We grouped patients into 4 prostate specific antigen density categories of less than 0.1, 0.1 to 0.14, 0.15 to 0.19 and greater than 0.19 ng/ml/cc. RESULTS: There was a significant trend for worsening clinicopathological prognostic features as prostate specific antigen density increased. There were 357 (82%), 283 (75%), 171 (75%) and 192 (55%) men with organ confined disease with clear surgical margins if prostate specific antigen density was less than 0.1, 0.1 to 0.14, 0.15 to 0.19 and greater than 0.19 ng/ml/cc, respectively (p <0.001). There were 86 (20%), 102 (27%), 64 (28%) and 157 (45%) men with a Gleason sum greater than 7 when grouped into each increasing PSA density category, respectively (p <0.001). There were 91 (21%), 91 (25%), 74 (33%) and 157 (46%) men with a total cancer volume greater than 0.5 cc when grouped into each increasing PSA density category, respectively (p <0.001). Prostate specific antigen velocity was greater than 2 ng/ml per year in 11%, 30%, 27% and 46% of men if prostate specific antigen density was less than 0.1, 0.1 to 0.14, 0.15 to 0.19 and greater than 0.19 ng/ml/cc, respectively (p <0.001). CONCLUSIONS: Prostate specific antigen density measurements are useful in helping to determine the aggressiveness of clinically localized prostate cancer, and can be used as an adjunct in predicting insignificant cancer and outcomes after local therapy.     

血清前列腺健康指数在前列腺癌诊断中预测活检结果价值的Meta分析

目的:系统评价血清前列腺健康指数(PHI)在前列腺癌(PCa)诊断中预测前列腺穿刺活检的临床价值。方法:检索PubMed(1966~2014年)、中国学术期刊全文数据库(CNKI,1982~2014年),维普期刊资源整合服务平台(1989~2014年)、Cochrane图书馆(1999~2014年)等数据库,检索年限均从建库至2014年2月,收集数据库中血清PHI在PCa诊断中预测活检结果的相关文献;制定相关文献的纳入、排除标准及检索策略,并对纳入文献进行数据提取和质量评价;采用MetaDise 1.4软件进行Meta分析。结果:共检索到相关文献64篇,排除52篇,符合纳入标准的12篇文献进行Meta分析,其中PCa病例组为1 430例,正常或前列腺增生对照组为2 159例。各研究之间存在异质性。按照随机效应模型计算,血清PHI检测在PCa诊断中预测前列腺穿刺活检结果的合并敏感性、特异性、阳性似然比、阴性似然比、诊断比值比、汇总受试者工作特征曲线下面积SROC、Q*指数分别为:55.1%(95%CI:0.525~0.577)、71.5%(95%CI:0.695~0.734)、2.379(95%CI:1.922~2.943)、0.515(95%CI:0.428~0.619)、5.268(95%CI:3.870~7.170)、0.757 8、0.699 9。结论:血清PHI检测在PCa诊断方面能够起到一定的辅助诊断作用,可以成为一种新型的可预测前列腺穿刺活检结果的检测方法。     

Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening

PURPOSE: We identified age adjusted prostate specific antigen and prostate specific antigen velocity cut points for prostate cancer biopsy. MATERIALS AND METHODS: A cohort of 33,643 men was retrieved from the Duke Prostate Center database. Of this group 11,861 men with 2 or more prostate specific antigen values within 2 years were analyzed for age adjusted prostate specific antigen and prostate specific antigen velocity performance in cancer risk assessment using a receiver operating characteristic curve. RESULTS: In the 11,861 men prostate cancer prevalence was 273 (8.0%), 659 (14.9%) and 722 (17.9%) in the groups of men 50 to 59 years old, 60 to 69 and 70 years old or older. In prostate cancer groups median prostate specific antigen and prostate specific antigen velocity in men 50 to 59 vs 70 years old or older were 5.6 vs 8.1 ng/ml and 1.37 vs 1.89 ng/ml per year (<0.0001). In men 50 to 59 years old the sensitivity and specificity were 82.1% and 80.7% at prostate specific antigen 2.5 ng/ml, and 84.3% and 72.4% at prostate specific antigen velocity 0.40 ng/ml per year, higher than those in men 70 years old or older at prostate specific antigen 4.0 ng/ml or prostate specific antigen velocity 0.75 ng/ml per year. Decreasing the prostate specific antigen cut point to 2.0 ng/ml and the prostate specific antigen velocity cut point to 0.40 ng/ml per year in men 50 to 59 years old improved the cancer detection rate but decreased the positive predictive value. CONCLUSIONS: Current biopsy guidelines (prostate specific antigen 4.0 ng/ml or greater, or prostate specific antigen velocity 0.75 ng/ml or greater per year) underestimated cancer risk in men 50 to 59 years old. Prostate specific antigen and prostate specific antigen velocity cut points should be age adjusted. In men 50 to 59 years old prostate specific antigen and prostate specific antigen velocity cut points could be decreased to 2.0 ng/ml and 0.40 ng/ml per year, respectively. Factors of age, sensitivity, specificity, positive predictive value and cancer prevalence are critical for obtaining the desired balance between cancer detection and negative biopsy.