前列腺特异抗原及其密度测定在前列腺癌

为探讨前列腺特异抗原（PSA）及前列腺特异抗原密度（PSAD）的临床应用价值,用放射免疫分析法测定了28例前列腺癌（Pca)及80例良性前列腺增生（BPH）患者的治疗前,后PSA含量,其中18例Pca及50例BPH患者同时测定了PSAD,结果PSA诊断Pca的灵敏度,特异性和准确度分别为85．7％,80．0％和81．4％,在鉴别Pca和BPH上PSAD优于PSA,使假阳性率由PSA的20％降到6％,但在临床应用中要注意结合其它检查进行综合分析。治疗后定期检测血清PSA对早期发现局部复发或转移,判断疗效和估测预后均有重要价值。     

前列腺特异抗原的酶联免疫分析

用本室纯化的人前列腺特异抗原免疫ＢＡＬＢ／ｃ小鼠，经淋巴细胞杂交瘤技术，建立了４株体外稳定分泌抗人前列腺特异抗原的杂交瘤细胞株，分别命名为ＱＷ２、ＱＷ４、ＱＷ７和ＱＷ８。将杂交瘤细胞注入同系小鼠腹腔制备腹水，用ＥＬＩＳＡ方法测得腹水抗体效价为１０６，其中ＱＷ８的抗体滴度最高。ＱＷ８腹水经５０％硫酸铵沉淀后包被酶标板，建成双抗体夹心ＥＬＩＳＡ，标准曲线线性良好，灵敏度为１．０μｇ／Ｌ血清稀释曲线，回收率及批内、批间变异系数测定表明，该方法的准确性和精密度均符合质量控制要求。检测８１名５０岁以下正常男性血清，ＰＳＡ均值为１．０５±０．７３μｇ／Ｌ，１０例临床确诊为前列腺癌患者的血清ＰＡＳ均值为３６．５±２．３μｇ／Ｌ明显高于正常值。     

前列腺特异性膜抗原为靶标治疗激素难治性前列腺癌的研究进展

激素难治性前列腺癌（hormone refractory prostate cancer,HRPC）是近年来前列癌预后差的主要原因,而前列腺特异性膜抗原（prostate specific membrane antigen,PSMA）因在HRPC高特异性表达,而在其它良性病变组织如炎性病变和正常脏器组织等低水平表达或不表达而备受关注,成为HRPC靶向治疗的主要靶标,现将以PSMA为靶标的免疫治疗、基因治疗和内放射靶向治疗方面的研究和进展进行综述。     

化学发光免疫法检测前列腺特异性抗原的临床应用

目的 利用化学发光免疫法定量检测前列腺特异性抗原(PSA),分析其在临床诊断前列腺癌中的应用情况.方法 将60例前列腺癌患者设为A组,60例良性前列腺增生患者设为B组,60例健康体检者设为C组,对三组受试者血清中总前列腺特异性抗原(tPSA),游离前列腺特异性抗原(fPSA)进行化学发光免疫法检测,并分析其水平差异.结果 经检测,A组和B组的tPSA含量显著高于C组,而且A组tPSA含量显著高于B组,差异显著,存在统计学意义(P＜0.05);另外A组fPSA/tPSA比值低于B组,差异有统计学意义(P＜0.05).结论 对PSA进行化学发光免疫法检测,具有较高的临床诊断价值,可为前列腺癌临床诊断提供可靠的参考依据.     

前列腺特异性抗原单克隆抗体的研制及其初步鉴定

本研究利用从正常男性精液中提取纯化的前列腺特异性抗原免疫小鼠，建立了２株可持续稳定分泌抗前列腺特异性抗原单克隆抗体的杂交瘤细胞株，命名为Ｐ１３和Ｐ２６。此２株杂交瘤细胞在体外连续传代培养半以上，冻存后复苏仍可保持抗体分泌能力，利用所制备的单克隆抗体对良性前列腺肥大，前列腺癌，乳腺癌，胃癌，食道癌和卵巢癌病人的病理切片标本进行免疫线化测定，证明其有一定的前列腺特异性。     

前列腺特异抗原免疫放射分析反应的动力学研究

本文着重对前列腺特异抗原（ＰＳＡ）的免疫放射分析的反应时间进行研究。实验采用两步，一为固定第一步时间，改变第二步反应时间，另一为固定第二步时间，改变第一步反应时间，观察反应的变化。结果表明，第一步反应０．５小时以后，标准和质控的ｃｐｍ已相对恒定，０．５小时的最大结合率为５８．７％，与６小时的最大结合率５５．８％相比，差异不显著。第二步反应，从１小时到６小时，结合率随时间的增加而升高。１小时的结合率为４６．３％，与６小时的结合率７２．２％相比，差异显著。此结果将有助于对ＰＳＡ的临床检测提供一个最适宜的反应时间。     

多囊卵巢综合征患者血清前列腺特异抗原水平

研究多囊卵巢综合征（PCOS）患者血清前列腺特异抗原（PSA）是否升高。正常对照组50名,PCOS组40例,分别测定血清PSA、睾酮（T）、性激素结合球蛋白（SHBG）、硫酸脱氢表雄酮（DHEA-S）水平,对两组测定值进行统计学分析。正常对照组血清PSA值为3.56±0.44pg/mL,PCOS组为15.64±3.36pg/mL,两组值有显著性差异（P〈0.01）。血清PSA值与T、DHEA-S值之间有弱的正相关关系（分别为r=0.467P〈0.01;r=0.205,P〈0.05）;与SHBG值之间有弱负相关关系（r=-0.260,P〈0.05）。PCOS患者血清PSA水平高于正常人,PSA可作为女性雄激素增高的标志物而在临床应用。     

The Profile of Prostate Epithelial Cytokines and its Impact on Sera Prostate Specific Antigen Levels

The aim of this study was determined the expression of pro inflammatory cytokines in prostate epithelial cells. Furthermore, we analysed the relation between these cytokines and sera PSA levels according the three groups: 0–4, 4–20 and >20 ng/mL. The study was carried out in five normal prostate (NP), 27 benign prostate hyperplastic (BPH) and 18 prostate cancer (PC). Immunohistochemical and Western blot analysis was performed. Serum levels of PSA were assayed by Immulite autoanalyser. The western Blotting analysis revealed an immunoexpression of IL-1α, IL-6 and TNFα in BPH and PC. IL-1α, was absent in NP. Immunohistochemical analysis showed significant high optical density to IL-1α and IL-6 in cancer epithelial cells (19.45 ± 3.25 and 26.2 ± 3.19) compared to normal cells (1.73 ± 1.51 and 4.83 ± 2.65). While, TNFα optical densities were not significant in NP (12.03 ± 2.9), BPH (9.87 ± 3.85) and PC (13.34 ± 2.34). The different profiles of cytokines according sera PSA levels showed a high immunoexpression of the profile (IL-6+, IL-1α+) in BPH patients with PSA between 0–4 and 4–20 ng/mL. However, PC patients with sera PSA between 4 and 20 ng/mL, showed a significant high immunoexpression of the profile (IL-6+, IL-1α−). This data demonstrate a locally production of pro-inflammatory cytokines by prostate epithelial cells and a cross talk between PSA and these cytokines in prostate pathologies.     

TRFIA法检测血清F-PSA在前列腺癌诊断中的应用

探讨血清游离PSA(F-PSA)、总PSA(T-PSA)和游离/总(F/T)PSA比值测定对良恶性前列腺疾病鉴别诊断的价值. 采用全自动时间分辨荧光免疫分析法(TRFIA)进行检测. T-PSA在2-20ng/mL范围内的患者共86例, 根据术后病检结果分为两组: 前列腺增生(BPH)症组68例, 前列腺癌组18例, 分析比较两组患者血清F-PSA、T-PSA和F/T PSA比值.结果是: ①前列腺癌组的F-PSA、T-PSA和前列腺增生组的F-PSA、T-PSA皆无显著性差异(P＞0.05), 但F/T PSA比值, 在前列腺癌组明显低于前列腺增生组(P＜0.01).②以F/T PSA=0.18作为诊断阈值, F/T PSA比值对前列腺癌诊断的灵敏度、特异性和阳性预测值分别为85%、72.5%、43.6%.结论是: F/T PSA比值测定有利于前列腺癌与前列腺增生症的鉴别诊断; 当T-PSA在2-20ng/mL范围时, 选用0.18作为诊断阈值有较大的临床应用价值.     

前列腺特异抗原化学发光免疫分析方法的建立及初步应用

建立的前列腺特异抗原(PSA)化学发光免疫分析(CLIA)使用2株抗PSAMcAb,一株McAb包被微孔板,另一株McAb与HRP连接。底物是鲁米诺/H2O2/对碘苯酚系统的双抗体夹心一步法,测定范围0.5～64ng/mL,最低检出值为0.13ng/mL,平均回收率为100.6%,批内和批间CV分别小于8.3%和11.5%,正常参考值小于3.5ng/mL。1000份血清临床考核,与参比试剂盒临床符合率一致,具有同等的临床诊断价值。     

肿瘤标志物fPSA的临床应用及其初步评估

为对游离前列腺特异性抗原(fPSA)/总前列腺特异性抗原(tPSA)比值在临床应用中的价值进行评估, 本文应用电化学发光免疫测定法, 检测了38例Pca、68例BPH患者以及43名无前列腺疾病的正常男子血清tPSA和fPSA含量, 并计算fPSA/tPA的比值.结果表明单独以血清tPSA大于4.0μg/L作为诊断Pca的标准,其灵敏度和特异性分别为84.2%、75.0%.若以血清fPSA/tPSA小于0.13作为诊断Pca的限定值,当血清tPSA小于2.0μg/L时,fPSA/tPSA比值的灵敏度和特异性分别为100.0%、57.0%;当血清tPSA大于20.0μg/L时,fPSA/tPSA比值的灵敏度和特异性分别为62.1%、66.7%, 而当血清tPSA水平在2-20μg/L时, fPSA/tPSA比值的灵敏度和特异性分别为93.6%、89.9%.结果提示fPSA/tPSA比值对tPSA水平在2-20μg/L这组人群前列腺癌诊断的准确率可以大大提高,而对此以外的人群并无太大价值.     

人前列腺特异抗原（hPSA）的纯化及放射免疫分析的建立

本文介绍前列腺特异抗原的纯化，免疫动物得到特异性抗ＰＳＡ抗体，并建成放射免疫分析。方法简便快速，灵敏度较高，准确性及重复性良好。与国外相应试剂盒比较有良好的相关性。本分析各项质量控制指标均符合ＲＩＡ的质量控制要求     

Utility of Free/Total Prostate Specific Antigen (f/t PSA) Ratio in Diagnosis of Prostate Carcinoma

The discovery that PSA exists in serum in both free and complexed forms led to development of immunoassays specific for different PSA forms. This helped in measuring free PSA in the presence of PSA-ACT (PSA-α antichymotrypsin), hence it was possible to calculate the percent free PSA or free to total PSA ratio, measurement of which was helpful in reducing the number of unnecessary biopsies significantly, while maintaining a high clinical sensitivity for detection of cancer. The study was performed on 103 consecutive male patients (mean age 68 ± 10.8 years SD) comprising of 90 patients with benign disease (87%) and 13 prostate carcinoma patients (13%), who had histologically proven prostate cancer. Patients with total PSA between 2–25 ng/ml were included in the study. 30 normal healthy males with age 58 ± 10 years, served as control. Serum total PSA and free PSA were analyzed using streptavidin biotin EIA method (M/s Roche Diagnostics, Germany). The mean total PSA in normal healthy control subjects was 1.86 ± 1.07 ng/ml. It was increased significantly in diseased condition. Its mean concentration in carcinoma patients was 12.6 ± 5.3 ng/ml and in benign patients it was 6.3 ± 4.6 ng/ml. The free to total PSA ratio in all the three groups was significantly different (p Combination of this ratio cutoff with other parameters like serum total PSA, DRE and TRUS helped in increasing the sensitivity of the test and this also helped in reducing the number of unnecessary biopsies. In 103 men who were biopsied, 13 (12.6%) prostatic carcinoma were identified. Among these 13 cancer patients, 9 patients had abnormal findings in DRE.7 individuals out of these 9, also had free to total PSA ratio lower than 0.16 and would have been biopsied and diagnosed anyway. If we use only f/t PSA ratio less than 0.16, to decide whom to biopsy, we would have biopsied and diagnosed 11/13 cases i.e. sensitivity of 85% but If we decide to biopsy those patients who had abnormal DRE and those who had low f/t PSA ratio, we could identify 13/13 carcinoma i.e. 100% sensitivity.Combining the f/t PSA ratio with total PSA, DRE and TRUS findings could help in reducing the number of unnecessary biopsies. 37 patients who were negative for malignancy having total PSA in the range of 5–20 ng/ml, normal DRE and TRUS findings, have been biopsied but with combination of total PSA in the range of 5–20 ng/ml, normal findings in digital rectal examination and TRUS and f/t PSA ratio more than 0.16 (cutoff), we could have avoided 16 biopsies which were unnecessary that means there was 43% reduction in unnecessary biopsies.     

翁沥通胶囊在前列腺特异性抗原处于灰区前列腺穿刺活检中的应用价值研究

目的 探讨翁沥通胶囊在前列腺特异性抗原处于灰区(4～10ng/mL)范围的患者前列腺穿刺活检临床决策中的应用价值.方法 回顾性分析前列腺特异性抗原处于灰区、直肠指诊无异常的患者91例,按其是否使用翁沥通胶囊进行治疗分为两组:翁沥通治疗组(使用翁沥通治疗并未立即行前列腺穿刺活检,简称治疗组,n=44)和翁沥通未治疗组(未...     

Role of Prostate Volume in the Early Detection of Prostate Cancer in a Cohort with Slowly Increasing Prostate Specific Antigen

Purpose

To investigate the relationship between prostate volume and the increased risk for being diagnosed with prostate cancer (PCa) in men with slowly increasing prostate specific antigen (PSA).

Materials and Methods

A cohort of 1035 men who visited our hospital''s health promotion center and were checked for serum PSA levels more than two times between January 2001 and November 2011 were included. Among them, 116 patients had a change in PSA levels from less than 4 ng/mL to more than 4 ng/mL and underwent transrectal ultrasound guided prostate biopsy. Median age was 55.9 years and 26 (22.4%) had PCa. We compared the initial PSA level, the last PSA level, age, prostate volume, PSA density (PSAD), PSA velocity, and follow-up period between men with and without PCa. The mean follow-up period was 83.7 months.

Results

Significant predictive factors for the detection of prostate cancer identified by univariate analysis were prostate volume, follow-up period and PSAD. In the multivariate analysis, prostate volume (p<0.001, odds ratio: 0.890) was the most significant factor for the detection of prostate cancer. In the receiver operator characteristic curve of prostate volume, area under curve was 0.724. At the cut-off value of 28.8 mL for prostate volume, the sensitivity and specificity were 61.1% and 73.1% respectively.

Conclusion

In men with PSA values more than 4 ng/mL during the follow-up period, a small prostate volume was the most important factor in early detection of prostate cancer.     

Nomogram for Prediction of Prostate Cancer with Serum Prostate Specific Antigen Less than 10 ng/mL

Although prostate-specific antigen (PSA) is a very useful screening tool, prostate biopsy is still necessary to confirm prostate cancer (PCA). However, it is reported that PSA is associated with a high false-positive rate and prostate biopsy also has various procedure-related complications. Therefore, the authors have devised a nomogram, which can be used to estimate the risk of PCA, using available clinical data for men with a serum PSA less than 10 ng/mL. Prostate biopsies were obtained from 2,139 patients from January 1998 to March 2011. Of them, 1,171 patients with a serum PSA less than 10 ng/mL were only included in this study. Patient age, PSA, free PSA, prostate volume, PSA density and percent free PSA ratio were analyzed. Among 1,171 patients, 255 patients (21.8%) were diagnosed as PCA. Multivariate analyses showed that patient age, prostate volume, PSA and percent free PSA had statistically significant relationships with PCA (P < 0.05) and were used as nomogram predictor variables. The area under the (ROC) curve for all factors in a model predicting PCA was 0.759 (95% CI, 0.716-0.803).

Graphical Abstract

相似文献   

The Relationship of Baseline Prostate Specific Antigen and Risk of Future Prostate Cancer and Its Variance by Race

Purpose

Several studies suggest that a baseline prostate specific antigen (PSA) measured in young men predicts future risk of prostate cancer. Considering recent recommendations against PSA screening, high-risk populations (e.g. black men, men with a high baseline PSA) may be particularly vulnerable in the coming years. Thus, we investigated the relationship between baseline PSA and future prostate cancer in a black majority–minority urban population.

412例前列腺癌患者血清前列腺特异抗原游离与总量比值及骨转移的分析

目的分析前列腺癌(Pca)患者血清前列腺特异抗原游离(FPSA)与总(TPSA)比值(F/T)的结果及骨转移的特点。方法对412例Pca患者术前血清TPSA、FPSA含量和F/T比值及99mTC-MDPECT全身骨骼显像分为二组进行分析。结果无骨转移组为25.5%(105/412例);有骨转移组为74.5%(307/412)。307例Pca骨转移组患者,共有2907个转移病灶,97.5%(2834/2907)显示为"热区"病灶,2.5%显示为"冷区"病灶(73/2907)。有Pca骨转移组血清TPSA、FPSA和F/T分别是97.9±59.4μg/L,10.2±8.1μg/L和0.09±0.04;无ca骨转移组29.6%(16/54),分别是24.8±23.0μg/L,4.4±3.4μg/L和0.12±0.05;二组有显著性差异(P0.01)。TPSA与骨转移程度呈负相关(r=-0.487,P0.05)。当PSA10μg/L,骨转移率为2.6%;当PSA 10～20μg/L,为10.5%;PSA 21～50μg/L,为52.6%;PSA 51～100μg/L,为92.7%;PSA100μg/L,为100%。F/T比值与骨转移程度呈负相关(r=-0.641,P0.05)。F/T0.15者,有84%的Pca患者有骨转移;F/T0.10者,100%的患者有骨转移。结论血清F/T比值小于0.15者,必要时行ECT全身骨骼显像。骨转移的好发部位依次是盆骨、椎骨和肋骨。     

血清PSA结合病理分级预测前列腺癌骨转移

探讨血清PSA结合前列腺癌病理分级预测前列腺癌骨转移价值.对202例新诊断的前列腺癌患者, 以同位素全身骨扫描为金标准分为骨转移和非骨转移组, 分析血清PSA水平、病理分级和同位素骨扫描结果的关系.PSA RIA检测结果: 血清PSA＜10μg/L和PSA＜20μg/L病理分级中、高度分化者骨转移的发生率为7%和6%, 两者无统计学差异; PSA＜20μg/L病理分级低度分化者和血清20μg/L＜PSA＜100μg/L者,骨转移的发生率为33%和39%, 两组无统计学差异; PSA＞100μg/L者骨转移发生率为80%.建议排除对没有骨痛、血清PSA＜10μg/L和PSA＜20μg/L病理分级中、高度分化者和PSA＞100μg/L者行同位素骨扫描.