Relationship between prostate specific antigen and indexes of prostate volume in Japanese men

PURPOSE: We determined the relationship between serum prostate specific antigen (PSA) and indexes of prostate volume in Japanese men, and compared that relationship with the one in white men. MATERIALS AND METHODS: Data on a clinical cohort of 535 Japanese men with at least moderate lower urinary tract symptoms (LUTS) and clinical benign prostatic hyperplasia were examined. PSA, and total and transition zone prostate volume were related to age and linear regression analyses were performed to analyze the relationship between PSA and volume indexes. RESULTS: The group of 535 men with a median age of 68 years had a median serum PSA of 1.5 ng/ml, and a median total and transition zone volume of 26.8 and 8.8 ml, respectively. PSA, total prostate volume and transition zone volume increased almost linearly with age. On univariate regression with age with each successive decade total prostate volume increased by 10.65% (95% CI 5.4 to 16.2), transition zone volume increased by 20.84% (95% CI 11.84 to 30.56) and the transition zone index increased by 3.1% (95% CI 1.66 to 4.57). On multivariate analysis the PSA-total prostate volume relationship was statistically independent of age. The study suggests that Japanese men might produce or release more PSA per unit prostate volume than white men. CONCLUSIONS: Japanese men with LUTS and clinical benign prostatic hyperplasia but no evidence of prostate cancer might produce and/or release more PSA per unit prostate volume than white men. To our knowledge the cutoffs for PSA and prostate volume to predict the response to LUTS therapy and the development of complications in Japanese men are unknown. Future studies in Japanese men are needed to identify these cutoffs.     

Performance of prostate‐specific antigen mass in estimation of prostate volume in Japanese men with benign prostate hyperplasia

Objectives: Obese men with benign prostate hyperplasia might have lower serum prostate‐specific antigen because of hemodilution, resulting in underestimation of total prostate volume by serum prostate‐specific antigen. The aim of this study was to compare the performance of prostate‐specific antigen mass as the absolute amount of prostate‐specific antigen protein secreted into circulation with that of serum prostate‐specific antigen in the prediction of total prostate volume. Methods: A total of 1517 men with serum prostate‐specific antigen up to 10 ng/mL, including 1425 with biopsy‐proven benign prostate hyperplasia, were enrolled in this study. Height and weight were used to estimate body mass index, body surface area and plasma volume. Prostate‐specific antigen mass was calculated as serum prostate‐specific antigen multiplied by plasma volume. The association between serum prostate‐specific antigen or prostate‐specific antigen mass and transrectal ultrasound‐measured total prostate volume were evaluated by Pearson's correlation coefficient (Υ), linear regression analyses and receiver operating characteristic curves. Results: Serum prostate‐specific antigen had an inverse relationship with plasma volume, decreasing as plasma volume increased, after adjustment of total prostate volume. Larger total prostate volume per serum prostate‐specific antigen was found in men with higher body mass index or plasma volume. Among all participants, the correlation (Υ = 0.456) between prostate‐specific antigen mass and total prostate volume was apparently stronger than that (Υ = 0.442) between serum prostate‐specific antigen and total prostate volume. Prostate‐specific antigen mass outperformed serum prostate‐specific antigen at estimating total prostate volume cut‐off values of 30 and 40 mL. These findings were more significant in men aged ≥60 years. Conclusions: Prostate‐specific antigen mass performs better than serum prostate‐specific antigen in estimating TPV, especially in men aged ≥60 years.     

The effect of dutasteride on the peripheral and transition zones of the prostate and the value of the transition zone index in predicting treatment response

PURPOSE: We determined the effects of dutasteride on transition and peripheral zone volume, and the clinical value of the transition zone index in men with benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 2,802 men 50 years or older with diagnosed benign prostatic hyperplasia, American Urological Association symptom index score 12 or greater, total prostate volume 30 cc or greater, prostate specific antigen 1.5 ng/ml or greater and 10 ng/ml or less, and peak urinary flow rate 15 ml per second or less were randomized to receive 0.5 mg dutasteride daily or placebo for 2 years. Total prostate and transition zone volume was measured with transrectal ultrasound at baseline and 4 times during the 2-year period. Peripheral zone volume (total prostate volume minus transition zone volume) and the transition zone index (transition zone volume/total prostate volume) were calculated. Patients were stratified into tertiles according to baseline total prostate and transition zone volume, and the transition zone index. RESULTS: At 24 months dutasteride significantly decreased total prostate volume from baseline (p <0.0001). There were similar decreases in transition and peripheral zone volume (approximately 25%). In men receiving placebo high baseline total prostate and transition zone volume, and transition zone index were associated with poor 2-year outcomes, ie a low peak urinary flow rate, high American Urological Association symptom index scores, and an increased frequency of acute urinary retention and benign prostatic hyperplasia related surgery. Improvements in outcomes with dutasteride vs placebo were greatest in men with the highest baseline total prostate and transition zone volume, and transition zone index. In men with low (30 to less than 42 cc) and intermediate (42 to less than 58 cc) baseline total prostate volume the benefits of dutasteride therapy were only significant in the intermediate (0.4 to less than 0.55) and high (0.55 to less than 1.0) transition zone index tertiles. CONCLUSIONS: Total prostate and transition zone volume, and the transition zone index are directly related to benign prostatic hyperplasia progression. The transition zone index may add value to transition zone volume alone for predicting outcomes. Dutasteride decreased transition and peripheral zone volume equally, supporting a known therapeutic role in benign prostatic hyperplasia and a possible preventive role in prostate cancer.     

良性前列腺增生症发生急性尿潴留的相关因素分析

目的:应用临床常用指标,探讨BPH发生急性尿潴留(AUR)的相关因素。方法:回顾分析538例BPH患者相关资料。分为曾发生AUR(A组)260例,从未发生AUR(B组)278例。分别比较两组间在年龄(AGE)、前列腺总体积(PV)、前列腺移行区体积(TZV)、移行区指数(TZI)和前列腺特异抗原(PSA)、游离前列腺特异抗原(F-PSA)、游离与总前列腺特异抗原比值(F/T-PSA)等指标上的差异性。结果:A组平均PV、TZV和PSA值皆明显高于B组,上述3个指标在两两组间差异有统计学意义,且PSA与PV、TZV均有正相关性。结论:PV、TZV及PSA可作为预测BPH发生AUR的良好指标。     

Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia.

To evaluate the usefulness of serum prostate specific antigen in the preoperative staging of prostate cancer we examined tumor volume and differentiation, as well as benign prostatic hyperplasia volume to determine their influence on serum antigen levels. Serum prostate specific antigen was measured in 350 men with clinically localized prostate cancer and preoperatively in 72 men with documented benign prostatic hyperplasia. Although the mean antigen levels increased with advancing pathological stage, the usefulness of prostate specific antigen to predict pathological stage for an individual patient was limited: 1 of 102 men (0.9%) with prostate specific antigen levels of less than 2.8 ng./ml. had positive lymph nodes and 5 of 5 men with levels of greater than 100 ng./ml. had either seminal vesicle or lymph node involvement. However, for the majority of men (greater than 70%) with prostate specific antigen values between these 2 extremes the antigen levels did not accurately predict pathological stage. Because serum prostate specific antigen levels correlated with morphometrically determined tumor volume (r equals 0.535, p less than 0.01) they should, in fact, be predictive of pathological stage. However, most men with prostate cancer also have varying degrees of benign prostatic hyperplasia tissue in the gland producing prostate specific antigen. We have found that serum prostate specific antigen does not correlate with the volume of benign hyperplasia within the gland (r equals 0.21, p greater than 0.05). In addition, immunohistochemical studies have suggested that the lack of correlation between pathological stage and serum prostate specific antigen might be explained by a decrease in the production of antigen with increasing histological grade. Our findings of a negative correlation (r equals -0.37, p less than 0.01) between serum prostate specific antigen levels and Gleason score adjusted for tumor volume confirmed this suggestion. Consequently, serum prostate specific antigen levels do not reflect tumor burden and pathological stage accurately in individual patients for 2 reasons: 1) the unpredictable contribution from the benign prostatic hyperplasia component of the gland and 2) the decreasing production of prostate specific antigen by higher grade lesions as tumor volume increases.     

Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml.

PURPOSE: Serum prostate specific antigen (PSA) is widely used as a guide to initiate prostatic biopsies and to follow men older than 50 years old with and without prostate cancer. However, benign prostatic hyperplasia (BPH) is a common cause of serum PSA values between 2 and 10 ng./ml. A better understanding of the relationships among serum PSA, prostate cancer and BPH is important. MATERIALS AND METHODS: A total of 875 men underwent radical prostatectomy at our institution between December 1984 and January 1997. Of these men 784 had a serum PSA of 2 to 22 ng./ml., including 579 with the largest cancer located in the peripheral zone of the prostate. Of the 579 men 406 had serum PSA followups for greater than 3 years after radical prostatectomy. We examined Pearson correlations (R2) between preoperative serum PSA, and the volume of Gleason grades 4/5 and 3 to 1 cancer in 784 men, separating peripheral zone from transition zone cancers. We used broken line regression with break points of 7 and 9 ng./ml. preoperative PSA to summarize the relationship of each PSA doubling to 5 different morphological variables in 579 men with peripheral zone cancer. A 9 ng./ml. break point was used for prostate weight. Trend summaries with a local regression line for the relationships between 6 morphological variables and PSA were superimposed on full scatterplots of the 579 men with PSA less than 22 ng./ml. Cox proportional hazard models were used to examine 5-year PSA failure-free probabilities based on 406 men with minimal PSA followups greater than 3 years at break points of 7 to 9 ng./ml. PSA. RESULTS: Pearson correlation between cancer volume and preoperative serum PSA in 875 men was weak (r2 = 0.27) and driven by large cancers with serum PSA greater than 22 ng./ml. For peripheral zone cancer the overall R2 x 100 for 641 men with low and high grade cancer was 10% and only 3% for low grade cancer, that is almost no PSA produced by these peripheral zone cancers enters the serum. All morphological variables changed at rates of doubtful medical significance below a PSA of 7 to 9 ng./ml. but at rates that were significantly worse above 9 ng./ml. R2 for these relationships was never greater than 15%. Large individual morphological variations at all levels of PSA emphasize the serious limitation of PSA as a predictor of prostate cancer morphology. Below 9 ng./ml. prostate weight increased by 21% for each doubling of PSA but above 9 ng./ml. the increase was only 4.8%. CONCLUSIONS: Preoperative serum PSA has a clinically useless relationship with cancer volume and grade in radical prostatectomy specimens, and a limited relationship with PSA cure rates at preoperative serum PSA levels of 2 to 9 ng./ml. Trend summaries for prostate weight on broken line regression showed that below 9 ng./ml. BPH is a strong contender for the cause of PSA elevation, constituting the primary cause of the over diagnosis of prostate cancer.     

Relationship between prostate specific antigen density, microvessel density and prostatic volume in benign prostatic hyperplasia and advanced prostatic carcinoma

The aim of this study was to investigate the relationship between prostate specific antigen density and prostate volume with microvessel density in patients with benign prostatic hyperplasia and advanced prostatic carcinoma. Sixty-eight patients with benign prostatic hyperplasia and 11 patients with advanced prostatic carcinoma participated in the study. The paraffin blocks of all patients were stained with CD34 by the standard immunohistochemical technique and microvessel density, prostate specific antigen density and prostatic volume were determined. In patients with benign prostatic hyperplasia the mean microvessel density, mean prostate specific antigen density and mean prostatic volume were 74±89±22.73, 0.12±0.10 and 59.97±27.0 ml, respectively. There was no correlation between prostate specific antigen density and mean prostatic volume or microvessel density (r=0.079 and −0.095, respectively). In patients with advanced prostatic carcinoma the mean microvessel density, mean prostate specific antigen density and mean prostatic volume were 147.90±47.55, 0.63±0.41 and 54.00±22.42 ml, respectively. In this group, while there was a good correlation between prostate specific antigen density and microvessel density (r=0.785), no significant correlation was found between prostatic volume and microvessel density (r=−0.07). There was significant statistical difference in patients with advanced prostatic carcinoma compared to patients with benign prostatic hyperplasia in terms of mean microvessel density (p<0.0001). The findings that there was no correlation between prostatic volume and MVD either in benign prostatic hyperplasia or in prostatic carcinoma suggest that microvessel development is not correlated with prostatic volume but may be correlated with morphology.     

手术治疗的良性前列腺增生患者年龄与血清PSA、PSAD的关系分析

目的探讨手术治疗的良性前列腺增生（BPH）患者年龄与血清前列腺特异性抗原（PSA）及前列腺特异性抗原密度（PSAD）的关系。方法选取手术治疗的BPH患者共369例,按年龄段分为4组,对其血清PSA进行检测,并计算PSAD值,分析年龄和血清PSA、PSAD的关系。结果随年龄的增长,手术治疗的BPH患者PSA呈现逐渐增加趋势;而PSAD在各组间基本保持不变。结论手术治疗的BPH患者血清PSA值与患者年龄有显著的相关性,而PSAD却相对保持恒定。     

Comparison of prostate and transition zone volume measured by the ellipsoid and planimetric methods with transrectal ultrasonography before seed implantation of prostate cancer

Abstract:   A total of 122 men who were diagnosed with localized prostatic cancer underwent transrectal ultrasound and the volumes of their prostates and transitional zones were obtained using the planimetric method and the ellipsoid method. Mean age was 64.2 ±13.4 (48.2–85.8), and mean preimplant prostate specific antigen was 6.01 ± 2.35 mg/mL (0.92–15.5). The clinical stage was T1c in 70 patients, T2a in 46 and T2b in 6. Prostatic volumes and transitional zone volumes obtained by the planimetric method were 18 % and 39% greater than those obtained by the ellipsoid method, respectively. There were significant differences between the volumes obtained by the two different methods. However, there was a good correlation between the prostatic volume and the transitional zone volume obtained by both the ellipsoid method (r = 0.851) and the planimetric method (r = 0.908). The regression line of the prostate volume between these two methods was calculated as .     

The relationship of prostate specific antigen levels and residual tumor volume in stage A prostate cancer.

Preoperative serum prostate specific antigen correlates well with morphometrically determined prostate tumor volume in prostatectomy specimens. However, since prostate specific antigen is produced by hyperplastic as well as malignant prostatic epithelium, the contribution of hyperplastic epithelium (benign prostatic hyperplasia) to serum prostate specific antigen interferes with the ability of serum prostate specific antigen to predict tumor volume in individual patients. We wondered if the removal of benign prostatic hyperplasia tissue would increase the correlation between prostate specific antigen and tumor volume, and, thus, make prostate specific antigen a more accurate predictor of residual cancer volume after transurethral resection of the prostate. A total of 67 patients with clinical stage A cancer underwent radical retropubic prostatectomy (22, or 33%, with stage A1 and 45, or 67%, with stage A2 disease), and had pre-radical prostatectomy measurement of serum prostate specific antigen and morphometric determination of residual cancer volume in the radical prostatectomy specimen. The correlation between serum prostate specific antigen and residual cancer volume for all 67 patients was 0.66, and for stages A1 and A2 disease it was 0.64 and 0.70, respectively. All stage A1 cancer patients with a serum prostate specific antigen value of 1 ng./ml. or less had residual tumor volumes of less than 0.5 cc and all stage A cancer patients with a serum prostate specific antigen value of more than 10 ng./ml. had residual tumor volumes of greater than 0.5 cc. Of the patients 51% had levels of 1 to 10 ng./ml. and serum prostate specific antigen was not useful to predict residual tumor volume in this group. Serum prostate specific antigen measurements may be helpful in stage A1 cancer patients with levels of 1 ng./ml. or less, or greater than 10 ng./ml. in choosing the most appropriate therapy.     

Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia

PURPOSE: To investigate how prostatectomy for patients with benign prostate hyperplasia (BPH) affected the serum prostate-specific antigen (PSA) levels. METHODS: In 193 patients who underwent prostatectomy for BPH, serum PSA levels were measured before and three months after the operation. The total prostate weight measured by transrectal ultrasonography (TRUS) and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in PSA levels after the operation. RESULTS: The transition zone volume measured by TRUS could well estimate the weight of the surgical specimen in patients who underwent subcapsular prostatectomy and transurethral resection of the prostate. The concentration of preoperative serum PSA showed a significant correlation with the prostatic volume and with the transition zone volume. Removal of 1 g of BPH tissue reduced serum PSA levels by an average of 0.18 ng/mL. The change in serum PSA levels after the prostatectomy correlated with the total prostatic gland volume and with the transition zone volume. CONCLUSIONS: The elevated PSA levels in patients with BPH were caused by the enlargement of the transition zone. After the resection of the adenoma, PSA levels should be expected to decrease to the normal range.     

Prostate-specific antigen,prostate volume and transition zone volume in Japanese patients with histologically proven benign prostatic hyperplasia

The relationship among age, prostate-specific antigen (PSA) level andprostate volume in Japanese patients with lower urinary tract symptoms(LUTS) and histologically proven benign prostatic hyperplasia (BPH) wasexamined in order to assess the utility of PSA as a predictor of prostatevolume. Two hundred eighteen patients with LUTS were confirmed to haveBPH by histological examination for the reason of elevated PSA and/orabnormal digital rectal examination finding. Correlation among PSA,prostate volume and transition zone volume were analyzed in patientsclassified into age-stratified groups. Prostate volume increased with age.Mean serum PSA increased with age, and the correlation of PSA and prostatevolume was determined to be statistically significant in each cohort of age.A correlation coefficient ranged from 0.315 to 0.439. In patients with LUTSand clinical BPH, serum PSA increased with age and was related to prostatevolume. PSA might be useful for therapeutic decision making for patientswith symptomatic BPH.     

良性前列腺增生患者前列腺体积和移行区体积随年龄变化的调查

目的:调查良性前列腺增生(BPH)患者各年龄段前列腺总体积(TPV)、前列腺移行区体积(TZV),计算TZV与TPV的比值即移行区指数(TZI)的数值。分析年龄与上述指标的相关性。方法:经直肠B超测量1 563例BPH患者前列腺和前列腺移行区最大左右径、前后径和上下径,根据公式分别计算出TPV、TZV以及TZI。分析年龄与前列腺体积各参数的相关性。结果:BPH患者各年龄组TPV、TZV和TZI值分别为:50~59岁年龄组TPV(32.27±15.76)ml、TZV(9.55±7.98)ml、TZI 0.28±0.13;60~69岁年龄组TPV(40.93±17.45)ml、TZV(14.94±11.83)ml、TZI 0.34±0.16;70~79岁年龄组TPV(46.56±20.31)ml、TZV(19.54±19.25)ml、TZI 0.39±0.16;80~89岁年龄组TPV(47.85±26.63)ml、TZV(20.40±16.78)ml、TZI 0.41±0.19。BPH患者的TPV、TZV与年龄成显著正相关性(r1=0.232,r2=0.256,P均<0.01),TZV与年龄的相关系数要高于TPV与年龄的相关系数。结论:BPH患者的TPV、TZV值随着年龄的增长而增加,但是TZV增长的幅度要高于TPV增长的幅度,前列腺增生以移行区增生最为显著,并且我国BPH患者的移行区指数与其他人种之间可能存在不同。     

Mass screening of prostate cancer in a Chinese population：the relationship between pathological features of prostate cancer and serum prostate specific antigen

Aim: To investigate the pathological features of the prostate biopsy through mass screening for prostate cancer in a Chinese cohort and their association with serum prostate specific antigen (PSA). Methods: A total of 12027 Chinese men in Changchun were screened for prostate cancer by means of the serum total prostate specific antigen tPSA test (by Elisa assay). Transrectal ultrasound-guided systematic six-sextant biopsies were performed on those whose serum tPSA value was > 4.0 ng/mL and those who had obstructive symptoms (despite their tPSA value) and were subject to subsequent pathological analysis with the aid of the statistic software SPSS 10.0 (SPSS. Inc., Chicago. USA). Results: Of the 12027 cases, 158 (including 137 patients whose serum tPSA values were 4.0 ng/mL and 21 patients [serum tPSA < 4.0 ng/mL] who had obstructive symptoms) undertook prostate biopsy. Of the 158 biopsies, 41 cases of prostatic carcinoma were found (25.9 %, 41/158). The moderately differentiated carcinoma and poorly differentiated carcinoma accounted for 61% and 34%, respectively. A significant linear positive correlation between the serum tPSA and the Gleason scores in the 41 cases of prostatic carcinoma (r = 0.312, P < 0.01) was established. A significant linear positive correlation between the serum tPSA value of the 41 prostatic carcinoma and the positive counts of carcinoma in sextant biopsies was established (r = 0.406, P < 0.01), indicating a significant linear relationship between serum tPSA and the size of tumor. Conclusion: This study was the first to conduct mass screening for prostate cancer by testing for serum tPSA values and the first to investigate the pathological features of prostate cancer in a cohort of Chinese men. Our results reveal that the moderately differentiated carcinoma is the most common type of prostate cancer. This study also has shown that the serum tPSA value in prostate cancer is associated with the Gleason score and the size of tumor.     

Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia

The relationship between the serum values of prostate specific antigen (PSA) and the extent of histological prostatitis was investigated in 42 patients undergoing transurethral resection of the prostate for benign hyperplasia (BPH) without clinical evidence of prostatitis. Histological prostatitis was divided into three groups: acute, chronic-active, and chronic-inactive inflammation. The extent of histological prostatitis was expressed as the number of prostatic acinar and ductal glands with inflammatory infiltrate per total number of glands (%). The serum PSA values significantly correlated with the extent of acute and chronic-active prostatitis (correlation coefficient r = 0.765 and 0.656, P < 0.01). A relationship between PSA values and the extent of chronic-inactive prostatitis was not found. In the immunohistochemical study, prostatic epithelial cells with acute and chronic-active inflammation showed negative staining for PSA antigen. These results indicate that histological acute and chronic-active prostatitis is considered an important factor for inducing the high increase in serum PSA values via the leak phenomenon. © 1994 Wiley-Liss, Inc.     

前列腺结石与良性前列腺增生患者前列腺体积的相关性研究

目的探讨前列腺结石与前列腺增生症患者前列腺体积的相关性。方法回顾性分析本院2012年1月至2013年12月出院诊断为良性前列腺增生的患者392例,根据经直肠前列腺彩超结果将患者分为前列腺结石阴性组与阳性组,比较两组的年龄、前列腺特异性抗原(PSA)、前列腺总体积、内腺体积以及各经线之间有无差别。结果结石阴性组与结石阳性组前列腺总体积(TPV)、总体积宽径(TPV-b)、内腺体积宽径(TZV-b)差别有统计学意义(P0.05);结石阴性组与结石阳性组的年龄、内腺体积(TZV)、血清总PSA(TPSA)密度以及其他各经线差别无统计学意义(P0.05)。结论前列腺结石与前列腺增生程度存在一定的内在关系,结石有可能促进前列腺组织的增生。     

Relationship of prostate-specific antigen and prostate volume in patients with biopsy proven benign prostatic hyperplasia

BACKGROUND: Emerging data suggest a direct correlation between prostate-specific antigen (PSA) and prostate volume in patients with lower urinary tract symptoms (LUTS) and clinical evidence of benign prostatic hyperplasia (BPH). We attempt to confirm that a similar correlation exists between PSA and prostate volume in patients with biopsy-proven BPH. METHODS: Over a 5 year period, 2,270 patients were confirmed to have BPH as the only histological diagnosis after evaluation with serum PSA, trans-rectal ultrasound (TRUS) biopsy, and prostate volume measurement. PSA and prostate volume were statistically analyzed by age-stratified cohorts, including multiple regression analysis and assessment of correlation using the Pearson correlation coefficient (r). RESULTS: Mean PSA and prostate volume increased with each advancing cohort of age, and the correlation of PSA and prostate volume was determined to be statistically significant (P < 0.001) in each cohort with a correlation coefficient ranging from 0.33 to 0.41. CONCLUSIONS: We confirm that the relationship between PSA and prostate volume in a large series of patients with biopsy-proven BPH provides a comparable correlation to data for patients with LUTS and clinical BPH. As such, PSA represents a valuable approximation of prostate volume, and may prove to be clinically useful in the management of patients with BPH.     

前列腺增生症患者合并前列腺炎对血清PSA的影响

目的前列腺增生患者合并前列腺炎症对血清前列腺特异性抗原的影响。方法研究对象为在本院就诊,行经尿道前列腺电切术的前列腺增生71例患者,术前均经B超或CT、MRI诊断为前列腺增生,术后病理确诊为前列腺增生合并炎症。术前评估项目包括：年龄、前列腺体积、血清PSA、残余尿量、最大尿流率、国际前列腺症状评分（IPSS）、生活质量评分、尿中白细胞数、肌酐及术后病理诊断。纳入前列腺体积和年龄等因素的同时,分析前列腺腺周炎症、前列腺腺体炎症及基质炎症是否影响血清PSA浓度。结果前列腺体积（t=5.10）、基质炎症（χ2=10.35）、尿路感染（χ2=10.00）与血清PSA升高有关。结论血清PSA值与前列腺增生患者年龄及前列腺体积有关,前列腺炎的基质炎症与尿路感染也是前列腺增生患者血清PSA升高的危险因素。     

Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men

BACKGROUND: We aim to establish the normal pattern of prostate volume change with age to provide a baseline from which accelerated prostate growth might be identified in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). METHODS: In a community-based study, prostate volume was determined at baseline and after 2.1 and 4.2 years in men without prostate cancer. A bivariate multilevel growth curve model was used to estimate the pattern of change of prostate volume with age. RESULTS: The average percentage increase of total prostate volume and transition zone volume per year of follow-up was 2.2% and 3.5%, respectively. The final model showed that prostate volume was related to age only. The future prostate volume of an individual can be predicted based on his age and known history of prostate volume. The model was also used to calculate time needed for the prostate volume to increase with a certain percentage, for men with different baseline prostate volume values at different ages. CONCLUSIONS: This method establishes normal prostate volume values by age using prostate volume history in men without prostate cancer. The model provides baseline data from which disease progression might be detected.     

Influence of prostate volume and percent free prostate specific antigen on prostate cancer detection in men with a total prostate specific antigen of 2.6 to 10.0 ng/ml

PURPOSE: Percent free prostate specific antigen and prostate specific antigen density have been independently shown to increase the specificity of prostate cancer screening in men with prostate specific antigen levels between 4.1 and 10.0 ng/ml. Recent data suggest the total prostate specific antigen cutoff for performing a biopsy should be 2.6 ng/ml. We assessed the influence of percent free prostate specific antigen and prostate volume on cancer detection in men with a prostate specific antigen between 2.6 and 10.0 ng/ml. MATERIALS AND METHODS: From 1991 to 2005 all transrectal ultrasound guided prostate biopsies (5,587) for abnormal digital rectal examination and/or increased age specific prostate specific antigen were evaluated. A total of 1,072 patients with a prostate specific antigen between 2.6 and 10.0 ng/ml and any percent free prostate specific antigen were included in study. The cancer detection rate was calculated for each percent free prostate specific antigen/volume stratum. RESULTS: Prostate cancer was detected in 296 patients (27.6%). The mean age and prostate specific antigen of the patients with benign pathology and prostate cancer were similar. Mean percent free prostate specific antigen was 17.5% and 14.1% (p>0.05), and the mean volume was 62.0 and 46.0 cc (p=0.001), respectively. The strongest risk factors for a positive biopsy were percent free prostate specific antigen (odds ratio 0.004, p<0.001), volume (OR 0.977, p<0.001) and digital rectal examination (OR 1.765, p=0.007), but not total prostate specific antigen (p=0.303). When stratified by volume and percent free prostate specific antigen, distinct risk groups were identified. The probability of detecting cancer inversely correlated with prostate volume and percent free prostate specific antigen. CONCLUSIONS: In men with prostate specific antigen levels between 2.6 and 10.0 ng/ml, the probability of detecting cancer was inversely proportional to prostate volume and percent free prostate specific antigen. This table may assist in predicting patient risk for harboring prostate cancer.