PSA对社区老年男性前列腺癌筛查的临床意义和分析

目的：探讨应用血清前列腺特异性抗原（PSA）在社区50岁以上男性人群中行前列腺癌筛查的临床意义。方法：采用化学发光免疫分析技术检测自2008年7月-2009年7月广州市荔湾区逢源和彩虹两个社区3021名50岁以上的男性血清PsA。对于PSA≥14.0ng／mL前列腺癌可疑病例进行前列腺穿刺活检以确诊。结果：筛查中血清PSA≥4．0ng/mL者占7．0％（210／3021）,其中前列腺癌发现率6．0％（18／210）,且随着年龄的增加和血清PSA浓度的增加,前列腺癌发病增高。结论：用血清PSA在社区老年男性人群中筛查前列腺癌是可行的,可以早期发现前列腺癌,筛查可为这些患者提供有效的治疗机会。     

经腹膜外途径腹腔镜行前列腺癌根治术的临床探讨

由于人口老年化的增高,生活习惯、饮食结构的改变,中国前列腺癌的发病率逐年增加。随着医疗诊断水平的提高,特别是应用前列腺特异性抗原(prostate specific antigen,PSA)进行筛查和普及前列腺穿刺活检,越来越多的早期前列腺癌被发现[1]。早期前列腺癌的最佳治疗手段是前列腺癌根治术。近     

前列腺癌防治中的早期诊断与基因治疗问题

1　前列腺癌的早期诊断　　国内前列腺癌的发病率逐年升高 ,“早期诊断”技术的提高是其原因之一 (当然还有很多其他的发病因素 )。而早期诊断、早期治疗又是提高治疗效果的重要一环。在早期诊断的手段上 ,近年来国内前列腺特异性抗原 (PSA)测定的广泛开展 ,为其提供了有效的早期诊断的信息 ,为了提高阳性 (PSA)诊断率 ,新近又开展了 PSA密度 (PSAD)及游离 PSA(f PSA)测定及其与总 PSA(TPSA)比例等方法的应用 ,最近 PSA与前列腺移行带校准值 (PSATZ)的测定、复合 PSA(CPSA)测定及与 TPSA比例测定均对诊断与鉴别诊断有帮助…     

前列腺癌生物标志物研究进展

前列腺癌是男性常见恶性肿瘤,严重危害男性健康.目前针对不同分期的前列腺癌治疗后,患者生存存在差异.早期前列腺癌生存率高,预后较好.中晚期前列腺癌生存率低,预后较差.直肠指检配合血清前列腺特异性抗原(PSA)检测是目前公认的早期前列腺癌筛查方法.然而PSA特异性差,大量前列腺癌患者被过度诊断及治疗.同时针对中晚期前列腺癌...     

应用前列腺特异性抗原筛查前列腺癌的意义

目的:探讨应用血清前列腺特异性抗原(PSA)行前列腺癌筛查的临床意义。方法:对4 848名50岁以上男性常规体检检测血清PSA,发现前列腺癌患者33例(筛查组),与同期临床诊治的28例前腺癌患者(临床组)进行对比,比较两组年龄分布、PSA值、临床分期、G leason评分和治疗方法。结果:筛查人群中PSA阳性(PSA≥4ng/m l)者461名,检出率为9.5%,其中确诊前列腺癌者33例,占筛查者的6.8‰。筛查组年龄为(73.2±8.0)岁,与临床组比较差异无显著性意义;筛查组PSA≥20 ng/m l者占42.4%,临床组占71.5%,两组比较差异有显著性意义;筛查组中(A+B)期占69.7%,临床组中(A+B)期占35.7%,P<0.01;筛查组接受根治性前列腺切除者16例(48.5%),临床组6例(21.4%)。结论:应用血清PSA筛查能早期诊断前列腺癌,可为患者提供更佳的治疗机会。     

前列腺癌的血清标志物

前列腺癌是男性常见的恶性肿瘤。在欧美国家已占男性肿瘤死因的首位。我国近年来的发病率也明显升高。前列腺癌的早期常无明显症状,待症状出现时常已进入进展期。所以早期诊断非常重要。由于血液检查简单易行,研究血清中的早期诊断标志物有着重要意义。血清中前列腺癌特畀性抗原（PSA）的发现对前列腺癌的筛查、辅助诊断和疗效监测有着重要价值;对PSA在血内存在的多种形式的检查进一步提高它的临床意义。     

前列腺特异性抗原在前列腺癌筛查中的作用

目的探讨应用前列腺特异性抗原诊断前列腺癌。方法对经手术病理或自动活检枪行系统穿刺活检病理证实的一组患者进行分析,探讨PSA在术前前列腺癌筛查中的作用。结果 164例前列腺患者中,PSA诊断前列腺癌敏感性90.8%,特异性13.1%,诊断符合率43.9%,阳性预测值40.7%,阴性预测值68.4%。结论 PSA可作为前列腺癌患者筛查的主要指标。     

PSA灰区前列腺癌MR表现二例并文献复习

前列腺特异性抗原（PSA）是目前临床最重要、应用最广泛的前列腺癌筛查手段之一,然而,当PSA值为4～10μg/L时,即所谓的“PSA灰区”,其诊断前列腺癌特异性及敏感性较低。需进一步行前列腺穿刺活检明确诊断,增加了过度穿刺的机会,如何提高这一PSA水平区域的前列腺癌的正确诊断率是早期前列腺癌诊治工作的重要部分。报告现报告本院泌尿外科2015年收治的2例低PSA型前列腺癌,并复习相关文献予以讨论,以期提高灰区值患者前列腺癌诊断率。     

前列腺特异抗原（PSA）与前列腺癌及前列腺增生的相关性研究

目前前列腺癌的发病率逐年升高，“早期诊断”技术的提高是其中原因之一。前列腺特异抗原(PSA)测定的广泛开展为其早期诊断提供了有效信息。近年来又开展了总PSA(T-PSA)及游离PSA(F-PSA)测定，RPSA与T-PSA比值等方法来提高前列腺癌的诊断率。现将我院近年来应用微粒子酶免法测定的183例正常男性，63例前列腺增生患者和45     

P504S/AMACR在前列腺癌患者血清中的表达及其意义

目的:研究血清P504S/AMACR在前列腺癌筛查和早期诊断中的价值.方法:应用酶联免疫吸附试验(ELISA法),测定30例未经治疗的前列腺癌和20例未经治疗的前列腺增生患者血清P504S/AMACR水平.结果:(1) 前列腺癌组血清P504S/AMACR质量浓度[(4.12±0.24)ng·m1-1]明显高于前列腺增生组[(1.52±0.47)ng·m1-1],差异具有统计学意义(P<0.01).(2) 前列腺癌患者血清P504S/AMACR质量浓度与Gleason评分无关(P>0.05).(3) 前列腺癌患者血清P504S/AMACR质量浓度与PSA质量浓度无关(P=0.392).结论:初步证实检测P504S/AMACR在前列腺癌患者血清中的水平,可辅助PSA应用于前列腺癌的筛查,提高前列腺癌的早期诊断率.P504S/AMACR有望成为有效的前列腺癌瘤标之一.     

前列腺特异性抗原密度在前列腺癌筛选中的应用

本文对8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)进行研究显示,两者平均值分别为0.734和0.085(P<0.001)。7例PSAD>0.2者均为前列腺癌;其中3例PSA<10ng/ml,1例<2.8ng/ml。而15例PSAD<0.1者无1例前列腺癌;其中7例PSA>2.8ng/ml。表明PSA轻中度增高或正常时,PSAD不失为一项前列腺癌早期筛选诊断的有效指标。     

血清前列腺特异抗原测定及其对前列腺疾病的诊断

目的：根据前列腺疾病患者血清前列腺特异抗原（ＰＳＡ）水平，从中筛选前列腺癌，并对各种前列腺疾病进行初步诊断。方法：血清ＰＳＡ水平用酶联免疫法测定。结果：经病理检查证实，癌组ＰＳＡ水平显著高于其余各组；此法筛选前列腺癌敏感度达９１．１８％，特异性为７９．６７％；良性前列腺增生组ＰＳＡ水平随年龄的增加而升高。结论：血清ＰＳＡ可作为筛选前列腺癌的指标，结合临床经直肠指诊、超声诊断及活检，可对疾病做出明确诊断。     

Prostate cancer: diagnostic and therapeutic strategies with emphasis on the role of PSA

Prostate cancer is the most common cancer in man and the second most common cause of death. The disease is uniquely heterogeneous, and includes tumors with moderate or full differentiation that could progress rather slowly, and tumors with poor differentiation that could have a rapid growth and extensive spread beyond the confines of the prostate. In the latter group of patients, and if they are not treated, the cancer becomes incurable and the long-term survival is compromised. The commonly accepted strategy among urologists at present is aimed at early detection of prostate cancer in order to provide curative local therapy. The recognition of prostate specific antigen (PSA) as a serum marker specific for prostate cancer has made this strategy possible. We herein provide an overview on the contemporary diagnostic and therapeutic strategies for prostate cancer, with emphasis on the role of prostate PSA. We also discuss the therapeutic options for localized disease.     

前列腺按摩1小时内监测前列腺特异性抗原的临床意义

目的探讨前列腺特异性抗原（PSA）在早期筛查前列腺癌中的临床意义。方法对正常人组、Ⅲ型前列腺炎组、前列腺增生组各30例患者行按摩前、按摩1h内及按摩24h后的PSA监测。结果正常人组、Ⅲ型前列腺炎组、前列腺增生组与自身对照比较按摩前与按摩1h内PSA值差异无统计学意义（P〉0．05）;按摩前、按摩1h内与按摩24h后PSA值比较差异均有统计学意义（P〈0．01）。结论前列腺按摩1h内及时抽血测定对PSA值无影响,门诊病人有针对性实施PSA监测对筛查早期前列腺癌具有重要的临床意义。     

Comparative efficiency of prostate-specific antigen screening strategies for prostate cancer detection

CONTEXT: Despite widespread use of serum prostate-specific antigen (PSA) testing to detect prostate cancer, the relative effectiveness of different PSA screening strategies is unknown. OBJECTIVE: To compare prostate cancer mortality, PSA testing rates, and biopsy rates using various PSA screening strategies, including the standard strategy of annually testing men aged 50 through 75 years. DESIGN AND SETTING: A Monte-Carlo simulation based on a Markov model was used to simulate the natural history of prostate cancer using different starting ages, testing intervals, and PSA thresholds for prostate biopsy. Age-specific PSA levels and prostate biopsy detection probabilities were determined from population data and surgical series. MAIN OUTCOME MEASURES: Numbers of prevented prostate cancer deaths, PSA tests, and prostate biopsies per 1000 men aged 40 through 80 years, compared among 7 different strategies vs no screening. RESULTS: Compared with annual PSA testing beginning at age 50 years, the strategy of PSA testing at ages 40 and 45 years followed by biennial testing beginning at age 50 years was estimated to simultaneously reduce prostate cancer mortality and number of PSA tests and biopsies performed per 1000 men. Specifically, compared with no screening, the standard strategy prevents 3.2 deaths, with an additional 10,500 PSA tests and 600 prostate biopsies, while the earlier but less frequent strategy prevents 3.3 deaths, with an additional 7500 PSA tests and 450 prostate biopsies. Strategies that lowered the PSA threshold for prostate biopsy to below 4.0 ng/mL or strategies that used age-specific PSA levels were not more efficient than use of a PSA threshold of 4.0 ng/mL. These 2 findings remained true under all sensitivity analyses performed to test assumptions of the model. CONCLUSION: Recognizing that the efficacy of PSA screening is unproved, the standard strategy of annual PSA screening beginning at age 50 years appears to be less effective and more resource intensive compared with a strategy that begins earlier but screens biennially instead of annually. JAMA. 2000;284:1399-1405.     

前列腺癌集团筛查的病理特征及与血清前列腺特异性抗原的关系

目的　探讨人群中前列腺癌的活检病理学特征及与血清前列腺特异性抗原 (PSA)的关系。方法　应用Elisa方法对长春市 12 0 2 7名男性血清PSA进行了检测及前列腺癌集团筛查 ,对血清PSA值 >4 0 μg/L和有尿路阻塞症状的男性经直肠超声引导下系统性行前列腺 6点穿刺活检 ,应用统计学软件SPSS 10 0进行病理分析。结果　 12 0 2 7名对象对 15 8例进行了前列腺活检穿刺 ,其中 137例血清PSA值 >4 0 μg/L ,2 1例血清PSA值 <4 0 μg/L ,但是有尿道阻塞症状。在 15 8例活检组织中 ,有 2 5 9%为前列腺癌 ,其中中分化癌和低分化癌分别占 6 1%和 34%。 4 1例前列腺癌患者的血清PSA值与Gleason评分间存在明显的线性正相关关系 (r =0 32 9,P <0 0 5 ) ,前列腺癌患者血清PSA值与 6点活检标本前列腺癌阳性点数间存在明显的线性正相关关系 (r =0 4 2 5 ,P =0 0 0 6 )。结论　中分化癌是人群中前列腺癌的最常见类型。应用血清PSA进行前列腺癌集团筛查对前列腺癌早期发现具有重要意义。血清PSA值不仅和前列腺癌的病理分级而且和肿瘤的范围有关系。     

Current and projected annual direct costs of screening asymptomatic men for prostate cancer using prostate-specific antigen

BACKGROUND: Concern over the cost of screening for asymptomatic prostate cancer by means of prostate-specific antigen (PSA) testing has played an important role in PSA screening policy. However, little is known about the true costs of current PSA screening in Canada and how costs may change in the future. METHODS: The authors performed a cost identification study from the perspective of provincial ministries of health. They used data from published reports, hospital discharge data, claims data from several provinces, a laboratory survey, a national survey of knowledge, attitudes and beliefs about screening, a provincial cancer registry and expert opinion to estimate current first-year screening costs. Using demographic data from Statistics Canada and various scenarios regarding changes in screening patterns, the authors derived estimates of the future costs of PSA screening. RESULTS: In 1995 PSA screening cost an estimated $45 million (range $40 million to $84 million). Treatment accounted for over 61% of total costs, whereas screening, diagnosis and staging accounted for 35%. Screening all eligible men in Canada in 1995 would have cost $317 million (range $356 million to $691 million), more than the costs of all prostate cancer care in that year. Annual recurrent screening for all eligible men in 2005 would cost $219 million (range $208 million to $412 million). Projections from existing trends suggest that annual costs of PSA screening in 2000 are likely to increase from the estimated $45 million to approximately $66 million (range $59 million to $126 million). INTERPRETATION: PSA screening is costly, but even universal screening would consume a smaller share of national health expenditures than previous studies have suggested. Costs attributable to PSA screening may increase in the future owing to changes in utilization patterns and demographic shifts.     

前列腺特异性抗原在前列腺癌诊治中的变化和意义

探讨前列腺特异性抗原（PSA）在前列腺癌诊治中的变化及意义。采用双抗体放射免疫分析法测定78例前列腺良、恶性病变患者血清PSA含量，观察31例前列腺癌患者内分泌治疗后PSA变化。结果：前列腺癌组与前列腺增生症组比较，血清PSA差异有极显著性意义（P＜0．01）。前列腺癌临床各期两两比较，血清PSA有极显著性差异（P＜0．01）或显著性差异（P＜0．05）。各组分化程度不同的前列腺癌相比较，血清PSA均无显著性差异（P＞0．05）。前列腺癌患者中核素骨扫描提示癌骨转移与未提示骨转移两组血清PSA比较有极显著性差异（P＜0．01）。血清PSA明显异常可以预测骨转移的概率．血清PSA的动态变化与临床病情演变基本一致。结论：采用双抗体放射免疫分析法进行血清PSA测定在前列腺癌诊治中是一个较敏感而有价值的指标。血清PSA检测与核素骨扫描联合应用对于前列腺癌的诊断以及了解疾病演进会有很大的帮助。     

磁共振成像动态增强扫描在前列腺癌诊断中的价值

目的通过绘制时间信号强度曲线,探讨磁共振成像(MRI)快速序列动态增强在前列腺癌诊断及鉴别诊断中的价值,并观察前列腺特异抗原(PSA)在诊断前列腺癌与增生中的作用。方法对5例无泌尿系症状患者、经病理证实的前列腺癌13例患者及前列腺增生36例患者行MR平扫、动态增强及延迟扫描,测量并计算病灶和正常组织的相对信号强度值,并绘制正常周围带、前列腺癌与增生三者的时间信号强度曲线。同时观察比较癌与增生患者的PSA值。结果正常周围带轻度强化,并缓慢上升至晚期达峰值;36例前列腺增生患者早期明显强化并逐渐上升至中晚期达峰值后缓慢下降;13例前列腺癌患者9例早期明显强化,并快速下降,4例T2WI像上弥漫性病灶呈现中晚期强化。前列腺癌尤其是晚期癌患者的PSA值明显高于增生患者。结论正常周围带、前列腺癌及前列腺增生的动态强化方式明显不同,结合PSA可对前列腺癌的诊断与鉴别诊断起到积极作用。