PSA≤4 ng/ml的高级别前列腺癌患者行前列腺癌根治术后PSA随访结果比预计差

为了解不同ＰＳＡ水平患者的前列腺穿刺或根治标本中前列腺癌分级好坏( <4级和≥ 4级 )对根治手术后 10年的ＰＳＡ预测的影响 ,作者对 1989～ 2 0 0 1年间 2 2 5 4例局灶前列腺癌行根治术的患者进行不同ＰＳＡ水平及不同Ｇｌｅａｓｏｎ评分的分层比较。结果发现 :术前ＰＳＡ升高、分化好 (Ｇｌｅａｓｏｎ评分≤ 6分 )的前列腺癌患者预计 10年的ＰＳＡ随访结果ＰＳＡ有明显下降。这种趋势在术前ＰＳＡ升高、分化差 (Ｇｌｅａｓｏｎ评分≥ 7分 )的前列腺癌患者中也有所体现 ,但分化差的前列腺癌患者若术前ＰＳＡ≤ 4ｎｇ/ｍｌ,则预后很差 ,明…     

前列腺体积和游离PSA百分比对总PSA2.6-10.0ng／ml男性前列腺癌检测的影响

在总PSA4.1-10.0ng／ml男性的研究中已经发现游离PSA百分比和PSA密度能独立地增加前列腺癌筛查的特异性。新近研究提示行前列腺穿刺活检的总PSA临界值为2．6ng／ml。作者分析了游离PSA百分比和前列腺体积对总PSA2.6-10.0ng／ml男性前列腺癌检测的影响。     

PSA早期诊断前列腺癌的评价

ＲＡ已成为前列腺癌最有价值的肿溜标记物。ＰＳＡ能否成为早期诊断和筛选前列腺癌的手段，是人们目前关注的焦点。本文就近年来有关研究资料进行综述，并介绍运用ＢＡ诊断前列腺癌的一些改进方法。     

外周血PSA mRNA早期诊断前列腺癌转移

用反转录聚合酶链式反应 (ＲＴ ＰＣＲ)检测前列腺癌 (ＰＣａ)患者外周血ＰＳＡｍＲＮＡ ,以早期诊断前列腺癌转移 ,报告如下。资料和方法　ＰＣａ患者 14例。年龄 5 0～ 80岁 ,平均 6 7岁。ＪＷＰ分期 :Ａ期 2例 ,Ｂ期 5例 ,Ｃ期 3例 ,Ｄ期 4例。对照组包括 :ＢＰＨ患者 15例 ,年龄 5 5～83岁 ,平均 6 5岁 ;非癌患者 10例 ,男 5例 ,女 5例 ,年龄 2 8～ 5 5岁 ,平均 37岁。ＰＣａ患者通过血清ＰＳＡ测定、直肠指诊、ＣＴ、同位素骨扫描进行诊断 ,并在术前 1周、指诊后 2周采血。所有病例均经病理检查。采集静脉血 5ｍｌ,肝素抗凝 ,密度梯度…     

游离PSA对前列腺癌检测的新进展

前列腺特异性抗原（ＰＳＡ）作为前列腺癌（Ｐｃａ）的癌标已有十几年，其最大局限性在于不能明确区分良性前列腺疾病与Ｐｃａ。为提高其特异性与敏感性，最近对游离ＰＳＡ的百分率进行了研究。本文就近年来的有关研究资料进行综述。     

血清PSA检测应用前后前列腺癌患者临床特点分析

目的评价北京友谊医院开展PSA检测前后前列腺癌患者的临床诊疗特点。方法回顾295例前列腺癌患者的临床资料,分析患者年龄、前列腺总体积、临床症状、临床分期、肿瘤Gleason分级以及治疗方法。PSA检测方法应用之前组117例（A组）,PSA检测应用之后组178例（B组）,采用t检验及X^2检验分析变量之间的相关性。结果与A组相比较,B组确诊为前列腺癌的患者平均年龄增加（P〈0.01）,前列腺总体积增大（P〈0.01）,肿瘤分期中位于晚期的肿瘤（T3＋T4期）的患者比例增加（P〈0.01）。Gleason分级5-7分的中分化肿瘤比例增加,接受前列腺癌根治手术比例增加（P〈0.01）,而接受去势手术比例减少（P〈0.01）。以下尿路症状为主诉的患者比例两组均较高。站论PSA检测应用后确诊前列腺癌患者的年龄趋于老年化,肿瘤恶性度增高,前列腺总体积增大,但肿瘤分化趋向于较高Gleason评分。早期应用PSA检测能够提高临床前列腺癌的早期诊断率。     

不同PSA相关肿瘤标志物在前列腺癌中的诊断价值

【摘要】〓目的〓探讨不同血清前列腺特异抗原(PSA)相关肿瘤标志物在前列腺癌中的临床价值。方法〓回顾我院2011年1月至2014年12月入院治疗的300例疑似前列腺癌患者的临床资料。上述患者入院后经直肠实施前列腺穿刺活检术后,将患者分为前列腺癌与非前列腺癌两组,其中前列腺癌88例,非前列腺癌212例(前列腺增生138例,前列腺炎78例)。对比两组患者的F-PSA/T-PSA、PSAD与(F-PSA/T-PSA)/PSAD水平,评估上述指标对于前列腺癌的诊断价值。结果〓两组患者检测F-PSA/T-PSA、PSAD与(F-PSA/T-PSA)/PSAD结果显示,组间差异具统计学意义(P<0.05)。不同PSA指标相同敏感度情况下,(F-PSA/T-PSA)/PSAD对于前列腺癌的诊断特异性最高,差异具统计学意义(P<0.05)。结论〓PSA相关肿瘤标志物检测中,(F-PSA/T-PSA)/PSAD的水平变化对前列腺癌早期诊断具较高特异性。     

以PSA为基础的前列腺癌筛查研究的探讨

以PSA为基础的前列腺癌筛查一直是泌尿外科学界争论的焦点之一。尽管PSA筛查可以发现早期前列腺癌,但是这些前列腺癌肿瘤细胞往往生长缓慢,疾病临床进展缓慢,仅会威胁小部分患者生命。因此PSA筛查不可避免地造成了这些前列腺癌的过度诊断和治疗,并引发了穿刺、治疗过程中的一系列并发症,包括性功能障碍,尤其是否可以降低前列腺癌特异性的死亡率一直受到广泛关注。本文就近年前列腺癌筛查研究进行了对比分析。     

PSA〈2．5ng／ml的前列腺癌的特性

国外前列腺癌防治试验的数据指出：在PSA〈4ng／ml及直肠指检正常的男性人群中,仍有,15％的个体在前列腺穿刺中发现患有前列腺癌。在更低的PSA水平（PSA〈2．5ng／ml）的人群中前列腺癌的肿瘤特性如何,目前尚缺乏足够的资料。Meeks等选取2003年至2008年间的1278名患者作为抽样人群,     

PSA时代pTxN0前列腺癌的淋巴结清扫范围对前列腺癌患者的预后没有影响

近期的研究提示，前列腺癌患者中淋巴结清扫范围对肿瘤的准确分期很有必要。在只对明显增大的淋巴结进行有限切除的情况下，如果病理结果阴性，则有将肿瘤分期低估的可能。作者在耻骨后前列腺癌根治术（RRP）患者中对切除的淋巴结数量进行分析，以确定其对pTxN0前列腺癌患者肿瘤进展和癌特异性生存率的影响。     

Longitudinal PSA changes in men with and without prostate cancer: assessment of prostate cancer risk

BACKGROUND: To determine longitudinal PSA changes over a period of 10 years in patients with and without prostate cancer. METHODS: Serial PSA measurements performed over 10 years were evaluated in 353 men who eventually developed prostate cancer and in 2.462 participants of a screening program without prostatic malignancy. RESULTS: In men with cancer, mean tPSA increased from 2.28 ng/ml at 10 years before diagnosis to 6.37 ng/ml at the time of postive biopsy (PSA velocity: 0.409 ng/ml/year). PSA velocity was significantly associated with Gleason scores and pathologic stage. In the benign group (n=2.462), mean tPSA increased from 1.18 to 1.49 ng/ml over a period of 10 years (PSA velocity of 0.03 ng/ml/year). Of the subjects with tPSA levels of 2 ng/ml or less, 2 years prior to cancer diagnosis, 11.4% had tPSA values of more than 4 ng/ml at the time of biopsy. Of the 972 men with tPSA below 1 ng/ml 2 years before the most recent measurement was obtained, 966 (99.4%) had no evidence of prostate cancer 2 years later, while six were found to have malignancies (0.6%). CONCLUSIONS: Longitudinal PSA changes in men with and without prostate cancer are significantly different. Annual testing may not be required in men with baseline tPSA levels of 1 ng/ml or below, whereas in patients with levels higher than 1 ng/ml, it seems to be indicated because of the significant percentage of men presenting with tPSA levels of more than 4 ng/ml two years later.     

前列腺癌患者粒子植入治疗后血清PSA变化的观察

目的探讨前列腺癌患者粒子植入治疗后血清PSA变化规律.方法前列腺癌患者13例.临床分期：T1cN0M08例,T2aN0M05例;Gleason评分：5分4例,6分9例;血清PSA 2.8～14.6 ng/ml,平均8.2 ng/ml.采用125I粒子植入治疗,治疗剂量D90为140～155 Gy.术后定期复查血清PSA,观察其变化规律.结果13例患者随访3～23个月.术后1、2、3、6、9、12、15、18及21个月血清PSA中位值为6.7、5.0、2.7、1.6、1.2、0.9、0.8、0.8及0.7 ng/ml.分别为术前血清PSA中位数的72%、51%、29%、20%、13%、11%、9%、9%及8%.术后1个月30%患者血清PSA有波动.结论前列腺癌粒子植入治疗后患者血清PSA下降缓慢,早期有波动.术后1年尤其术后3个月内血清PSA下降相对较快.     

前列腺癌组织中E-cadherin表达及与PSA的关系

目的　探讨前列腺癌组织中上皮型钙粘附素 (E cadherin)表达及与PSA的关系。　方法　采用免疫组织化学染色法检测 5 6例前列腺癌组织标本E cadherin的表达 ,分析表达水平与总PSA(T PSA)、游离PSA(F PSA)及F/T值的关系。　结果　E cadherin正常表达 2 4例 ( 43 % ) ,异常表达3 2例 ( 5 7% ) ,E cadherin表达缺失与肿瘤恶性程度及分期呈正相关 (P <0 .0 1) ,与患者T PSA、F PSA无明显相关性 ,而与F/T值呈正相关 (P <0 .0 1)。　结论　E cadherin可作为判断前列腺癌恶性程度及预后的指标之一     

Clinical features of prostate cancer patients younger than 50 years: Report of seven cases

BACKGROUND: The incidence of prostate cancer increases with age and latent cancer is common in older men. But clinical prostate cancer is rare in men aged < 50 years. METHODS: Between 1988 and 2000, we studied seven cases of prostate cancer in men aged under 50 years. The clinicopathological results included: the first sign or symptom; prostate-specific antigen (PSA) at the time of diagnosis; existence of abnormal digital rectal examination (DRE); the differentiation of the cancer and Gleason score; and the outcome of treatment. RESULTS: Six cases were diagnosed as stage D2. One case was diagnosed as stage B2 and the patient underwent radical prostatectomy. None of the cases were detected by mass screening. The PSA at diagnosis was < 10 ng/mL in only one case and that patient underwent radical prostatectomy. Six cases were diagnosed pathologically as poorly differentiated adenocarcinoma. The only patient who survived more than 5 years underwent radical prostatectomy. CONCLUSION: Six of seven cases of prostate cancer were detected at advanced stage. Only one case was thought to be curable and this patient's cancer was detected by chance occult blood test. Because young prostate cancer patients are potential candidates for radical prostatectomy and the sensitivity of PSA might be higher in young men, high-risk groups could be screened by PSA.     

PSA doubling time versus PSA velocity to predict high-risk prostate cancer: data from the Baltimore Longitudinal Study of Aging

Background

Our group has previously shown that prostate-specific antigen (PSA) velocity (PSAV) is associated with the presence of life-threatening prostate cancer. Less is known about the relative utility of pretreatment PSA doubling time (PSA DT) to predict tumor aggressiveness.

Objective

To compare the utility of PSAV and PSA DT for the prediction of life-threatening prostate cancer.

Design, setting, and participants

From the Baltimore Longitudinal Study of Aging, we identified 681 men with serial PSA measurements.

Measurements

Receiver operating characteristic analysis was used to evaluate the relationship between PSAV, PSA DT, and the presence of high-risk disease.

Results and limitations

Within the period of 5 yr prior to diagnosis, PSAV was significantly higher among men with high-risk or fatal prostate cancer than men without it. By contrast, PSA DT was not significantly associated with high-risk or fatal disease. On multivariate analysis, including age, date of diagnosis, and PSA, the addition of PSAV significantly improved the concordance index from 0.85 to 0.88 (p < 0.001), whereas PSA DT did not.

Conclusions

These data suggest that PSAV is more useful than PSA DT in the pretreatment setting to help identify those men with life-threatening disease.     

Prostate-specific antigen (PSA) kinetics in untreated, localized prostate cancer: PSA velocity vs PSA doubling time

OBJECTIVE

To compare the accuracy of prostate‐specific antigen (PSA) velocity (PSAV) vs PSA doubling time (DT) for predicting the repeat biopsy results in men with localized prostate cancer on active surveillance (AS), as the utility of PSAV vs PSADT in untreated prostate cancer has not been well studied.

PATIENTS AND METHODS

Eligible patients had favourable‐risk localized prostate cancer (T1/2a, PSA level ≤15 ng/mL, Gleason score ≤3 + 4, and percentage positive biopsy cores ≤50%), and consented to AS between 2002 and 2005. Repeat biopsies were taken after 18–24 months, with adverse histology defined as any of: primary Gleason grade ≥4, >50% cores positive, or initial Gleason score 3 + 3 upgraded to ≥3 + 4. Using all PSA values for the 2 years preceding repeat biopsy, the PSAV and PSADT were calculated using linear regression and the log‐slope method (DT = ln2/slope), respectively.

RESULTS

In all, 199 patients were assessable; the median PSAV and PSADT were 0.71 ng/mL/year and 5.29 years, respectively. Fifty‐three patients (27%) had adverse histology on repeat biopsy. On univariate analyses, PSAV (P < 0.001) and PSADT (P = 0.019) were associated with adverse histology. The area under the receiver operating characteristic curve for predicting adverse histology was 0.70 and 0.63 for PSAV and PSADT, respectively. The mean difference was 0.07 (95% confidence interval 0.03–0.12; P < 0.001).

CONCLUSIONS

PSAV is more accurate than PSADT for predicting adverse histology on repeat biopsies. These data suggest that PSAV should be used in preference to PSADT to describe PSA kinetics in untreated, localized prostate cancer.     

PSA及PSAD测定对前列腺癌的诊断价值

应用双抗体夹心酶标免疫法对无选择性２０１例无明显良性前列腺增生（ＢＰＨ）症状的４５岁以上男性进行血清前列腺特异抗原（ＰＳＡ）及前列腺特异抗原密度（ＰＳＡＤ）测定，并以慢性前列腺炎１４例，ＢＰＨ已作前列腺切除１１例作为对照。结果发现：ＰＳＡ随年龄增大而增高，至７０岁以后未再继续增高。ＰＳＡ＞４μｇ／Ｌ者２２例，其中１１例在Ｂ超引导下作前列腺穿刺活检，１０例为ＢＰＨ，１例为前列腺癌。ＰＳＡ及ＰＳＡＤ对鉴别ＢＰＨ与前列腺癌价值不大，ＢＰＨ手术后ＰＳＡ逐步下降至正常     

血清／尿PSA比值对血清PSA处于“灰区”中前列腺癌的诊断价值

目的探讨血清前列腺特异性抗原（sPSA）与尿前列腺特异性抗原（uPSA）比值（s／uPSA）对血清PSA处于诊断“灰区”—sPSA于4．0～10．0ng／ml（放射免疫法范围）前列腺癌的诊断价值。方法选择血清PSA（sPSA）于诊断“灰区”的共191例前列腺疾病患者，采用放射免疫方法检测其尿PSA（uPSA）水平，根据前列腺活检结果分为前列腺癌组（PCa组，n=76）和良性前列腺增生症组（BPH组，n=115），比较两组s／uPSA比值以及两组间sPSA和s／uPSA比值的受试者运算特性曲线（ROC）面积。结果BPH组与PCa组的sPSA分别为（5．20±1．09）ng／ml和（6．41±2．12）ng／ml，uPSA分别（3．57±0．97）ng／ml和（2．17±0．61）ng／ml，sPSA和uPSA在BPH组与PCa组两者间差别均无统计学意义（t=0．91，t=1．24，P〉0．05）;BPH组与PCa组的s／uPSA分别为（2．32±0．61）和（4．13±1．09），PCa组s／uPSA比值明显高于BPH组，差别具有统计学意义（t=4．17，P〈O．01）。s／uPSA比值和sPSA的ROC曲线下面积分别为0．836和0．703。在保持95％敏感性时，s／uPSA比值和sPSA的特异性分别为77．1％和39．6％。结论在血清PSA值4．0～10．0ng／ml范围内，s／uPSA比值较sPSA更好地检出前列腺癌：在保持同一敏感性时，s／uPSA较sPSA具有更高的特异性。     

PSA,PSAD诊断前列腺癌的临床意义

采用放射免疫分析方法测定２０例前腺癌病人的血清前列腺特异抗原（ＰＳＡ）和前列腺特异抗原密度（ＰＳＡＤ），以３８例前列腺增生症作为对照，评价二者对前列腺癌的诊断价值，探讨其与临床分期和病理分级的关系。结果ＰＳＡ界限值定为４μｇ／Ｌ时，其诊断敏感度为８５．０％，特异度为３９．５％，准确度为５５．２％。ＰＳＡ界限值为１０μｇ／Ｌ时，敏感度８０．０％，特异度７６．３％，准确度为７７．６％。用ＰＳＡＤ诊断前列腺癌，敏感度为８５．０％，特异度为７８．９％，准确度为８１．０％。结果显示ＰＳＡＤ可更有效地诊断前列腺癌。ＰＳＡ与临床分期成正相关，而ＰＳＡＤ与临床分期成负相关。ＰＳＡ与病理分级有一定关系。