血清游离PSA和游离/总PSA在前列腺癌诊断中的价值

探讨游离前列腺特异性抗原(FPSA)和游离/总前列腺特异性抗原比值(F/T PSA)在前列腺癌(PC)和良性前列腺增生(BPH)鉴别诊断中的价值.采用美国DPC公司的酶放大化学发光仪测定89名正常志愿者、85例PC患者和97例BPH患者血清FPSA和TPSA水平,并计算F/T PSA的比值.结果表明正常男性(41～88岁)组血清FPSA和TPSA水平与青年组相比明显升高,老年组升高特别明显(P＜0.01),直线相关统计分析表明,年龄与血清FPSA和TPSA水平有显著正相关性(FPSA/年龄:r为0.49～0.51,P＜0.01;TPSA/年龄:r为0.44～0.45,P＜0.01);PC组和BPH组血清FPSA、TPSA水平明显高于对照组(P＜0.01),而PC组F/T PSA比值则明显低于BPH组和对照组(P＜0.01).血清TPSA＜4.0、4.0～10.0和＞10.0μg/L的BPH患者分别占65.0%、30.9%和4.1%,PC患者分别为5.9%、20.0%和74.1%,经卡方检验,两组间患者的分布差别有极显著性意义(P＜0.01);F/T PSA比值的分段研究显示,在TPSA灰色区,F/T PSA 0.1,提示PC可能性较大(88.9%),而F/T PSA＞0.25时,表明PC可能性很小(6.1%).提示40岁以上正常男性血清FPSA和TPSA水平随年龄升高而增加,并与年龄呈明显的正相关;约30.9%的BPH与20.0%的PC患者血清TPSA水平存在重叠,F/T PSA比值的应用可以明显提高TPSA在灰色区鉴别诊断PC的特异性.     

TPSA、 FPSA、 FPSA/TPSA和Ferr检测对于前列腺癌的诊断价值

目的 探讨总前列腺相关抗原（TPSA）、游离前列腺相关抗原（FPSA）、FPSA/TPSA比值和铁蛋白单独检测和联合检测对于前列腺癌的诊断价值.方法 检测94例前列腺癌组患者、103例前列腺增生组患者和104名对照组血清TPSA、FPSA和Ferr的含量.结果 TPSA、FPSA、FPSA/TPSA和Ferr中,作为单独区分前列腺增生（BPH）和前列腺癌（PCA）最好指标为FPSA/TPSA,诊断灵敏性和特异性分别为82.3％和59.8％;最差的为FPSA,诊断灵敏性和特异性分别为69.3％和52.1％.单独指标区分诊断能力难以同时满足临床灵敏性和特异性的需要;利用二元Logistic回归分析FPSA、TPSA、FPSA/TPSA和Ferr的联合检测,灵敏性和特异性分别为72.6％和79.8％.结论 TPSA、FPSA、FPSA/TPSA和Ferr的联合检测可提高对BPH和PCA的诊断价值,可作为辅助诊断方法应用于临床.     

SI、TPSA及FPSA检测对前列腺癌的诊断价值

目的 探讨血清铁(serum iron,SI)、总前列腺特异性抗原(total prostate specific Antigen,TPSA)及游离前列腺特异性抗原(free prostate specific antigen,FPSA)单独及联合检测在前列腺癌诊断中的意义.方法 选取2014年1月到2017年12月我院泌尿外科的前列腺增生(benign prostate hyperplasia,BPH)及前列腺癌(prostate cancer,PCA)患者各140例.通过两点终点法检测血清中SI,化学发光法检测血清中FPSA、TPSA的含量,并与140例健康体检者进行比较.结果 BPH组、PCA组和HG(health group,HG)组三组中SI、TPSA、FPSA基于非参数秩和检验(Wilcoxon test)进行两组间比较:SIHG vs PCA、SIHG vs BPH 、TPSAHG vs PCA 、TPSAHG vs BPH、FPSAHG vs BPH(P均＜0.001),SI、TPSA可作为HG与BPH、PCA鉴别诊断指标;利用二元Logistic回归结合ROC (receiver operating curve)曲线对FPSA、TPSA和SI的联合检测进行分析,其诊断价值优于任何单项指标,当其临界值(cut off)为0.936时,曲线下面积(area under curve,AUC)达到0.782,约登指数(Youden index)为0.457,灵敏度和特异性分别为62.9％和82.9％;区分HG和PCA最好单项指标为TPSA,诊断灵敏度和特异性分别为45.0％和97.1％.结论 SI、TPSA及FPSA联合检测提高了前列腺癌的诊断能力,可作为辅助诊断方法应用于临床.     

推荐PSA差值指标替代比值测定鉴别诊断良恶性前列腺疾病临床应用的初评

检测总前列腺特异抗原(TPSA)是早期发现与诊断前列腺癌(PCa)不可缺少的首选标志物[1], 而游离前列腺特异抗原(FPSA)测定对前列腺增生症(BPH)有较高的阳性率[2].由于上述任何单项检测对BPH或PCa患者均可伴有不同程度的重叠升高, 给临床鉴别诊断带来误漏诊因素.因此, FPSA/TPSA比值测定是目前国内实验室通用的惟一鉴别指标.本文以绝对差值(即差值=TPSA值-FPSA值)替代FPSA/TPSA比值, 并分析对良、恶性前列腺疾病鉴别诊断及疗效观察和预后监测(复发或转移)的效果, 现将结果与分析报道如下.     

前列腺癌患者血清T-PSA、F-PSA水平和F/T比值变化及临床意义

目的:观察前列腺癌患者(PCa)血清总前列腺特异抗原(T-PSA)、游离前列腺特异抗原(F-PSA)和F-PSA/T-PSA比值(F/T值)变化,探讨其临床意义。方法: 用MEIA法检测121例PCa患者和554例良性前列腺增生(BPH)患者术前及其中82例PCa患者和396例BPH患者术后血清T-PSA、F-PSA水平,并计算F/T值。结果: 术前PCa患者T-PSA与F-PSA明显高于BPH患者,F/T比值明显低于BPH患者,两组间差异均显著(P＜0.01)。术后两组患者T-PSA、F-PSA水平较术前明显降低,F/T值则明显升高,与术前结果比较,差异均显著(P＜0.01)。在T-PSA＜10.0 μg/L范围,PCa患者占33.9%,BPH患者占85.5%,两组患者结果存在交叉。F/T值＜0.16时,PCa患者占83.5%,BPH患者占6.5%,两组差异显著(P＜0.01),F/T值＜0.16时诊断的灵敏度、特异性、阳性预示值、阴性预示值分别为83.5%、86.7%、81.1%、88.2%。结论: PCa和BPH患者手术前后血清T-PSA、F-PSA水平及F/T值均有明显变化。以F/T比值＜0.16作为PCa诊断临界值,可有效提高早期PCa诊断的特异性和敏感性,减少不必要的活检。     

标本采集及贮存条件对血清TPSA和FPSA测定的影响

大量的文献报道探讨前列腺周围环境的变化对血清TPSA和FPSA测定的影响.如: 前列腺按摩、膀胱镜检查、前列腺活检、直肠B超和尿潴留以及细菌性前列腺炎症等. 本文旨在着重探讨标本采集及贮存条件对血清TPSA和FPSA测定结果的影响.     

电化学发光免疫分析F/T PSA比值对前列腺癌早期诊断的观察

目的:观察前列腺特异性抗原游离与总量比值(F/T PSA比值)对前列腺癌(PCa)早期诊断的价值.方法:采用电化学发光免疫分析技术检测136例正常健康男性、98例前列腺增生(BPH)患者和99例前列腺癌(PCa)患者血清的T-PSA和F-PSA,并求出F/T PSA比值,然后进行统计学分析.结果:正常对照组、BPH组PCa组的T-PSA、F-PSA及F/TPSA比值分别为:1.43±1.13、0.44±0.34、0.36±0.15;7.84±6.08、1.88±1.37、0.26±0.08;23.95±21.12、3.52±3.41、0.16±0.08,上述各组三项指标两两之间比较均有显著性差异(P＜0.001).PCa组根据T-PSA检测值＜4.0μg/L、4.0～10.0μg/L、＞10μg/L分为三组,显示T-PSA、F-PSA组间两两比较均有显著性差异(P＜0.001),但F/TPSA比值相比较无显著性差异(P＞0.05).正常对照组与PCa组T-PSA＜4μg/L三项检测指标比较示T-PSA和F/TPSA比值均有显著性差异(P＜0.001),而F-PSA之间比较无显著性差异(P＞0.05).将F/T PSA比值分为＜0.10、0.11～0.15、0.16～0.2、0.21～0.25、0.26～0.30以及＞0.31以上六个截点,显示在0.20截点以内PCa患者占有率为74.51%.结论:F/T PSA比值的检测对血清T-PSA＜4μg/L、4～10μg/L以及＞10μg/L的患者在诊断PCa中均有良好的临床价值,特别当T-PSA处于较低水平状态下做到早期诊断PCa显得尤为重要.     

血清PSA RIA在前列腺癌患者手术前后的临床应用价值

目的 :探讨血清前列腺特异性抗原 (PSA)在前列腺癌 (PC)患者手术前后的临床应用价值。方法 :采用放射免疫分析 (RIA)对 35例正常人及 4 8例PC患者在手术前后进行血清PSA测定。结果 :术前检测PC组 4 6例阳性 ,PC与正常组PSA测定值分别为 5 4 4 7± 4 3 5 2ng/ml与 1 72± 1 14ng/ml(p <0 0 0 1) ,对PC检测的灵敏度 95 8% ,特异性 95 %。其中 2 3例患者在确诊PC前患有前列腺增生 (BPH)时血清PSA水平为 6 2 3±2 94ng/ml,在确诊PC时血清PSA水平上升至 5 6 84± 4 8 12ng/ml(p <0 0 0 1)。术后观察PSA在 3～ 6个月降为正常 ,患者均已生存 4年以上 ,一般情况良好 ,术后PSA无明显变化者均在 2年内先后死亡 ,其中 8例为全身骨转移。结论 :血清PSARIA检测对PC术前诊断及术后评估患者的预后具有良好的应用价值     

血清PSA和性激素六项联合检测与前列腺良恶性疾病的关系

为探讨血清前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、f/t PSA及性激素六项在前列腺疾病中的应用价值,用放射免疫法(RIA)测定72例前列腺增生(BPH)患者和40例前列腺癌(Pca)患者血清中的PSA、fPSA、f/t PSA及性激素六项[睾酮(T)、孕酮(P)、雌二醇(E2)、垂体泌乳素(PRL)、促黄体生成素(LH)、促卵泡成熟激素(FSH)]水平.结果表明,BPH组的性激素T、E2、PRL、LH、FSH水平均明显低于Pca组,Pca组中P水平明显低于BPH组;BPH组fPSA、f/t PSA比值均明显高于Pca组.提示前列腺良恶性疾病(BPH和Pca)与激素水平失调有关,血清tPSA、fPSA均是诊断Pca和BPH的重要指标,与血清f/t PSA联合测定,可提示哪些患者需要进行前列腺TRUS,并可提高Pca早期检出率.     

动态观察PSA和F PSA/PSA对诊断前列腺癌的临床价值

为了评价游离前列腺抗原（F PSA）／前列腺抗原（PSA）比值和PSA动态变化（年变化率）在前列腺癌诊断中的应用价值。本文应用ELISA追踪检测PSA在4～10μg／L范围患者在不同时段内PSA水平，并与正常人进行对照，利用ROC曲线，评价FPSA／PSA比值和PSA年变化率两项指标在前列腺癌诊断时的预示价值。结果表明：前列腺癌患者的FPSA／PSA比值和PSA年变化率与非前列腺癌组之间具有显著性差异（P〈0．001），当FPSA／PSA比值的临床判断值为0．21时，诊断灵敏度为93．5％，特异性为91.4％；当PSA年变化率的临床判断值为0．85％。诊断灵敏度为82．6％，诊断特异性为97．9％。前列腺增生患者FPSA／PSA比值与正常人之间无显著性差异（P〉0．05），而PSA年变化率与正常人比较具有显著性差异（P＜0．001）。提示FPSA／PSA比值和PSA年变化率有助于PSA在4～10μg／L范围的患者前列腺癌的诊断。     

PSA、cPSA检测和骨显像对前列腺癌早期骨转移的诊断价值

目的:分析前列腺特异性抗原(PSA)、复合前列腺特异性抗原(cPSA)联检和核素全身骨显像对前列腺癌早期骨转移的诊断价值.方法:选择152例患者(其中74例为临床确诊的前列腺癌患者,78例为良性前列腺疾病患者),全部进行血清PSA、cPSA检测,并同时对74例临床确诊的前列腺癌患者进行核素全身骨显像.另选择正常健康查体男性90例检测血清PSA、cPSA结果作为对照组.并计算cPSA/PSA比值.结果:前列腺癌患者血清PSA、cPSA检测结果及cPSA/PSA比值显著高于良性前列腺疾病患者及正常健康男性.其中,骨转移阳性显像组血清PSA、cPSA水平及cPSA/PSA比值显著高于非骨转移显像组,检测存在显著性差异(P＜0.05).结论:当PSA＞20μg/L、cPSA＞10μg/L、cPSA/PSA＞0.80时,发生前列腺癌骨转移的可能性较大,应常规做核素全身骨显像,可早期、全面地发现前列腺癌骨转移.     

Polymorphisms in the vitamin D receptor gene, ultraviolet radiation, and susceptibility to prostate cancer

Ultraviolet radiation (UVR) exposure may protect against prostate cancer development via a mechanism involving vitamin D. The vitamin D receptor (VDR) gene is therefore a candidate susceptibility factor for prostate cancer. This possibility has been previously investigated with conflicting results. We examined the association of VDR genotypes (variants at the CDX-2, Fok1, and Taq1 sites), haplotypes, and genotype combinations with risk by studying 368 prostate cancer and 243 benign prostatic hypertrophy (BPH) patients. CDX-2, Fok1, and Taq1 genotype and haplotype frequencies were not significantly different in cancer and BPH patients. As the impact of VDR polymorphisms may depend on UVR exposure, we studied associations of variants with risk in men stratified into low (below median) and high (above median) cumulative exposure/year groups. In men with UVR exposure above the median (1,100 hr/year), CDX-2 GA and AA (odds ratios [OR] = 2.11 and 2.02, respectively) and Fok1 ff (OR = 2.91) were associated with increased prostate cancer risk. No associations were observed for Taq1 genotypes. Of the genotype combinations, relative to all other CDX-2 and Taq1 and combinations, GGTT (P = 0.022, OR = 0.30), and relative to all other Fok1 and Taq1 combinations, FFTT (P = 0.026, OR = 0.35) were associated with reduced prostate cancer risk in the presence of the main effects. None of the other two- or three-genotype combinations was associated with risk. These data indicate that VDR variants influence prostate cancer risk and that this association is dependent on the extent of UVR exposure.     

Distribution and secretory pathways of prostate specific antigen,alpha1-antichymotrypsin and prostate secretory granules in prostate cancers

Using 19 radical prostatectomy specimens, we studied the histological distribution of free prostate specific antigen (PSA), total PSA, alpha1-antichymotrypsin (ACT) and prostate secretory granules (PSG) in both normal and cancerous cells of the prostate. After glutaraldehyde fixation, numerous fine eosinophilic droplets of PSG could be found mainly in the apical portions of normal acinous epithelial cells, but was markedly decreased in cancer cells. With antibodies against free PSA, normal acinous cells were granularly positive in the apical portion of the epithelium, which corresponded to the PSG, whereas cancer cells were diffusely positive. With antibodies against ACT, normal duct cells and cancer cells were often positive, but few normal acinous cells were positive. Presumably, these findings indicate that free PSA is secreted into the lumen as PSG in normal glands, but not by the same pathway in cancers where free PSA appears to accumulate due to a decrease of PSG, then leak into the blood producing complexed PSA to some extent in the cytoplasm. One factor analysis of variance (ANOVA) on the correlation of tumor differentiation or Gleason score with serum values of total PSA, free PSA and a free/total PSA ratio demonstrated no significant links. Elucidation of secretory mechanisms should provide better comprehension of various PSA indices for prostate cancer screening.     

Genetic analyses supporting colorectal,gastric, and prostate cancer syndromes

Colorectal cancer (CRC), prostate cancer (PrC), and gastric cancer (GC) are common worldwide, and the incidence is to a certain extent dependent on genetics. We have recently shown that in families with more than one case of CRC, the risk of other malignancies is increased. We therefore suggested the presence of not yet described CRC syndromes. In this study, we have searched for genetic susceptibility loci for potential cancer syndromes involving CRC combined with PrC and/or GC. We have performed SNP (single‐nucleotide polymorphism)‐based linkage analyses in 45 families with CRC, PrC, and GC. In the regions with suggested linkage, we performed exome and association haplotype analyses. Five loci generated a high logarithm of odds (HLOD) score >2, suggestive of linkage, in chromosome bands 1q31‐32, 1q24‐25, 6q25‐26, 18p11‐q11, and Xp11. Exome analysis detected no potential pathogenic sequence variants. The haplotype association study showed that one of the top five haplotypes with the lowest P value in the chromosome band 6q25 interestingly was found in the family which contributed the most to the increased HLOD at that locus. This study supports a suggested hereditary cancer syndrome involving CRC and PrC and indicates a location at 6q25. The impact of this locus needs to be confirmed in additional studies.     

Tyrosine kinase A, autonomic and transmitter receptors, but not innervation, are upregulated in the aging rat prostate

In the mature rat ventral prostate, epithelial proliferation is accompanied by significant upregulation of tyrosine kinase A, alpha1B and muscarinic acetylcholine M2 receptors as well as the synaptic vesicle-associated membrane proteins synaptobrevin and SV2 as compared with immature prostate tissue. The adrenergic receptors beta1, alpha2A and alpha1 were also up-regulated and translocated in mature rat prostate tissue. Expression of the Schwann cell/axonal marker S100 remained unchanged. These results are suggestive of a marked increase in metabolic activity, calcium influx and autonomic receptor expression in the aging prostate. These changes were not accompanied by an increase in the number of axons.     

Prostate cancer: towards the standardization and synthesis of morphology, genetics, and prognosis

Prostate cancer research and diagnosis is undergoing a revolution in our understanding of the disease process and standardization of diagnostic criteria. Although great progress has been made, there remain many areas of uncertainty and debate. The revolution towards a synthesis of pathology with genetic changes and prognostic models is only just beginning. This supplement presents the opinions and findings of leading international experts in histopathology and prostate research dealing with subjects ranging from aetiology, basic anatomy and morphology to prognostic models, genetic changes and new drug treatments. We hope that this exciting and rapidly changing field will capture the imagination of both experienced and trainee pathologists to advance the field in both research and diagnosis.