前列腺特异性抗原相关指标检测对于前列腺癌与良性前列腺增生鉴别诊断的意义

目的 探讨前列腺特异性抗原相关指标检测在前列腺癌(PCa)与良性前列腺增生(BPH)鉴别诊断中的作用.方法 对5家医院107例PCa患者和319例BPH患者的血清总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)、结合前列腺特异性抗原(c-PSA)、f-PSA/t-PSA和c-PSA/t-PSA的差异进行分析比较.结果 PCa和BPH患者中,血清t-PSA处于4～20 μw,/L区间者分别达到68.2%和32.9%.血清t-PSA、f-PSA和c-PSA以及f-PSA/t-PSA和c-PSA/t-PSA在PCa组和BPH组之间差异均有统计学意义(P<0.05).只有f-PSA/t-PSA和c-PSA/t-PSA在PCa和BPH组内各年龄组之间差异无统计学意义(P>0.05),结果相对稳定.血清t-PSA在4-20μg/L区间时,以f-PSA/t-PSA<0.16作为诊断PCa的指标,诊断PCa的敏感度、特异度、阳性预测值和阴性预测值分别是89.0%、78.0%、60.7%和94.6%,以c-PSA/t-PSA>0.84作为诊断PCa的指标时,分别是91.8%、81.3%、66.3%和96.1%.结论 PCa和BPH患者血清t-PSA在4～20μg/L区间存在较大重叠.在此区间,f-PSA/t-PSA<0.16和c-PSA/t-PSA>0.84可作为诊断PCa较为理想的标准.     

血清c-PSA结合用PSA的c/t比率以提高前列腺癌诊断特异性

目的研究复合前列腺特异性抗原(c-PSA)及相关指标在鉴别诊断前列腺癌和良性前列腺增生中的应用价值。提高前列腺癌诊断特异性。方法分析研究60例男性,经B超、病理诊断证实18例为前列腺癌(PCa),27例为良性前列腺增生(BPH),25例为正常对照组。Bayer ACS:180化学发光法测得c-PSA、t-PSA,计算c-PSA/t-PSA比值(c/t)。结果t检验比较PCa和BPH组的c-PSA、t-PSA、C/T和年龄值,前两者P<0.001,后两者P>0.05。分别计算PCa和BPH组的c-PSA、t-PSA的直线相关系数r,PCa组r为0.9812,PCa组回归方程为c-PSA=0.9354×t-PSA-2.91,高度相关。BPH组r仅为0.4109。在100%敏感性时,c-PSA3.75μg/L、t-PSA4.0μg/L、c/t=0.65、c-PSA7.5μg/L c/t0.65的特异性分别为42.3%、38.5%、36.5%、75.0%。结论前列腺癌c-PSA比BPH对t-PSA相关度高。在保持灵敏度100%时,若结合c-PSA7.5μg/L c/t0.65两个指标,将明显提高特异性到75.0%。     

Ⅳ型前列腺炎与前列腺特异性抗原的关系

目的 探讨Ⅳ型前列腺炎与前列腺特异性抗原(PSA)的关系. 方法回顾性分析245例前列腺疾病患者的临床病理资料,患者平均年龄68(32～87)岁,均无前列腺癌和穿刺活检史,均行PSA、全身骨扫描、磁共振成像(MRI)和前列腺穿刺活检.结果 245例经病理证实为良性前列腺增生(BPH)118例(48%)、BPH合并Ⅳ型前列腺炎(CP)127例(52%).BPH组患者f-PSA、t-PSA、f/t-PSA平均值分别为(1.70±1.70)、(9.40±8.10)ng/ml和0.19±0.09;合并CP组平均值分别为(2.83±4.37)、(16.87±20.51)ng/ml和0.20±0.14,2组比较差异有统计学意义(P＜0.05).多元线性回归分析结果显示t-PSA(P＜0.001)、f-PSA(P=0.003)和f/t-PSA(P=0.04)是BPH和CP最相关的指标.通过ROC曲线确定上述敏感指标的界值,以f-PSA≥0.85为界值诊断Ⅳ型前列腺炎的敏感度为77%,特异度为25%,ROC曲线下面积为0.60(P=0.014);t-PSA≥4.00 ng/ml为界值诊断Ⅳ型前列腺炎的敏感度为94%,特异度为20%,ROC曲线下面积为0.65(P=0.014);f/t-PSA≤0.16为界值诊断Ⅳ型前列腺炎的敏感度为56%,特异度为64%,ROC曲线下面积为0.61(P=0.003).结论 Ⅳ型前列腺炎是PSA升高的原因之一,以血清PSA作为前列腺癌的筛选指标时,应充分考虑前列腺炎的影响.对前列腺活检标本的病理报告,应包括对前列腺炎症的详细描述.     

f-PSA/t-PSA比值在良性前列腺增生和前列腺癌鉴别诊断中的应用

目的：探讨血清总前列腺特异性抗原（t-PSA）及游离前列腺特异性抗原（f-PSA）在BPH和PCa患者中的表达，评价t-PSA与f-PSA／tPSA在BPH和PCa鉴别诊断中的应用价值。方法：对经直肠超声引导下前列腺穿刺活检诊断为BPH和PCa的患者，结合其术前的t-PSA及f-PSA检测结果，进行回顾性分析和统计。结果：在t—PSA％4．0μg／L的患者中，f-PSA／t—PSA〈0．16者共6例（BPH3例；PCa 3例），〉0．16者共20例（BPH13例；PCa例7）；4．0≤t—PsA〈10．0μg／L的患者中，f-PSA／t—PSA〈0．16者共17例（BPH5例；PCa 12例），〉0．16者共24例（BPH21例；PCa3例）；10．0≤t—PSA〈100μg／L的患者中，f-PSA／t-PSA〈0．16者共49例（BPH19例；PCa30例），〉0．16者共31例（BPH22例；PCa9例）；t—PSA≥100μg／L的患者16例，均为PCa，f-PSA／t—PSA比值均〈0．16。结论：BPH患者随年龄增长t—PSA逐渐升高，但f-PsA／t—PSA值差异无统计学意义（P〉0．05），而不同年龄的PCa患者t-PSA、f-PSA及f-PSA／t-PSA值均差异无统计学意义（P〉0．05）；t-PSA水平在4．0～10．0ug／L的PCa患者和t—PSA在10～100μg／L的PCa患者相比，其f-PSA／t—PSA比值差异无统计学意义（P〉0．05）；对于4．0≤t—PSA〈10．0的患者，结合f-PSA／t-PSA〈0．16，能更有效地区别BPH和PCa（P〈0．05），但是，对于t—PSA％4．0μg／L的PCa患者来说，f-PSA/t-PSA比值对其与BPH的鉴别意义不大（P〉0．05）。     

血清游离PSA百分率在前列腺癌诊断盲区的价值评价

目的 探讨血清游离前列腺特异性抗原（prostate specific antigen，PSA）百分率在血清总PSA（totalPSA，t—PSA）介于4．0—20．0ng／mL时对前列腺癌（prostate cancer，Pca）的诊断价值。方法用化学发光法测定94例t-PSA介于4．0-20．0ng／mL的未治前列腺疾病患者血清游离PSA（free PSA，f-PSA），其中良性前列腺增生（benign prostatic hyperplasia，BPH）患者77例，Pca患者17例，并计算其f-PSA百分率（f／t-PSA）。结果 t-PSA介于4．0-20．0ng／mL时，Pca组f／t—PSA明显低于BPH组（P〈0.01）。以f／t—PSA为0．18、0．22为界值时其诊断Pca的敏感度为83．9％、94．1％，特异度为75．2％、63．7％，阳性预测值为42．5％、37．1％，阴性预测值为95．4％、98．3％。结论 t-PSA介于4．0-20．0ng／mL诊断盲区时，f／t-PSA对诊断Pca有较好的临床价值，以0．22为界值其敏感度达94．1％，阴性预测值达98．3％。     

前列腺特异性抗原升高的组织病理学基础

目的 探讨前列腺特异性抗原(PSA)与前列腺结节增生、Ⅳ型前列腺炎及前列腺癌之间的关系,探讨PSA升高的病理学基础.方法 有完整临床病理资料的前列腺疾病504例患者,均无前列腺癌和穿刺活检史,均行PSA、全身骨扫描、MRI和前列腺穿刺活检.直肠B超引导下以18G自动穿刺活检枪行双侧叶6-13点法前列腺穿刺活检.对患者穿刺的病理标本按前列腺结节增生、前列腺癌以及Ⅳ型前列腺炎病理诊断标准进行评价.结果 504例患者经病理证实前列腺癌185例(37%),Ⅳ型前列腺炎109例(21%),前列腺增生210例(42%).3组总PSA(t-PSA)分别为27.6(0.4～7116)、10.6(0.2～168)和9.2(0.3～60)ng/ml,3组间比较差异有统计学意义(P＜0.01);f-PSA分别为3.5(0.1～3356)、1.7(0.1～42)和1.5(0.06～15.8)ng/ml,3组间比较差异有统计学意义(P＜0.001);f/t-PSA分别为0.14(0＜0.94)、0.17(0.04～0.91)和0.16(0.02～0.75).3组间比较差异有统计学意义(P=0.019);3组间年龄、B超、直肠指诊结果比较差异无统计学意义(P＞0.05).前列腺癌分级与f-PSA(r=0.33,P＜0.001)、t-PSA(r=0.27,P＜0.001),f/t-PSA(r=0.22,P=0.003)具有显著相关性;多元线性回归分析发现前列腺癌分级与f-PSA(t=-2.34,P=0.02),t-PSA(t=2.77,P=0.006),f/t-PSA(t=3.97,P＜0.001)具有显著相关性.前列腺癌临床分期间f-PSA和t-PSA差异有统计学意义(P＜0.001).210例前列腺增生患者若按腺体增生为主和间质增生为主2类比较,t-PSA和f-PSA差异均有统计学意义(P＜0.05).多元线性回归分析发现t-PSA足前列腺增生病理结节类型最相关的指标,t-PSA≥2.5 ng/ml,确定腺体增生为主型前列腺增生的敏感性为96%,特异性为20%(P＜0.05).Ⅳ型前列腺炎109例和前列腺增生210例,2组间比较f-PSA,t-PSA,f/t-PSA差异有统计学意义(P＜0.05).通过ROC曲线确定前列腺癌敏感指标的界值:f-PSA≥0.85 ng/ml,t-PSA≥4 ng/ml和f/t-PSA≤0.16(P＜0.05).结论 血清PSA升高的病理基础为任何破坏前列腺上皮血屏障的病变;任何形成前列腺上皮增生,分泌更多PSA的病变;其中以破坏前列腺上皮血屏障最重要.     

ROC曲线分析比较tPSA、fPSA／tPSA和PSAD在PSA灰区前列腺癌诊断中的价值

目的 ROC曲线分析探讨前列腺特异性抗原密度(PSAD)、总PSA(tPSA)和游离PSA/总PSA(fPSA/tPSA)3者在PSA灰区前列腺癌(PCa)中的临床诊断价值.方法 同顾性分析tPSA在4～10ng/ml之间的前列腺增生(BPH)患者75例和前列腺癌患者31例.化学发光法测定血清tPSA和fPSA,经直肠超声(TRUS)测定前列腺体积,计算fPSA/tPSA和PSAD.比较BPH组和PCa组间tPSA、PSAD和fPSA/tPSA各指标的差异,分析各指标在ROC曲线卜的面积、各指标的诊断特异性及敏感性.结果 PCa组与BPH组tPSA差异无统计学意义(P＞0.05),PCa组fPSA/tPSA比值较BPH组降低(P＜0.01),PSAD值较BPH组升高(P＜0.05).ROC曲线下的面积从大到小为fPSA/tPSA＞PSAD＞tPSA.在诊断敏感性相同的情况下,fPSA/tPSA比值诊断特异性高于PSAD的诊断特异性.当fPSA/tPSA临界值取0.16时,诊断前列腺癌的灵敏度和特异性为67.7%和79.7%,PSAD临界值取0.12时,其灵敏度和特异性为61.3%和62.7%.结论 当tPSA在诊断灰区时,PSAD和fPSA/tPSA可以提高前列腺癌的诊断特异性和敏感性,fPSA/tPSA较PSAD有更高的诊断价值.     

前列腺特异性抗原≤4.0μg/L前列腺癌的诊断

目的:评价直肠指检(DRE)、经直肠超声(TRUS)、游离前列腺特异性抗原/总前列腺特异性抗原(fPSA/t-PSA)、前列腺特异性抗原密度(PSAD)对前列腺特异性抗原(PSA)≤4.0μg/L PCa的诊断价值。方法:回顾性分析1996年4月至2012年12月解放军总医院超声科PSA≤4.0μg/L的前列腺穿刺患者共343例,年龄30~91岁。将患者按PSA含量0.0~1.0μg/L、1.1~2.0μg/L、2.1~3.0μg/L、3.1~4.0μg/L分为4组,评价DRE、TRUS、f-PSA/t-PSA、PSAD在不同PSA水平下PCa患者中的诊断价值,同时按年龄分为5组:≤49岁、50~59岁、60~69岁、70~79岁、≥80岁,评价不同PSA水平下不同年龄患者PCa的检出率。结果:343例患者中,共检出PCa 65例,检出率19.0%。PSA含量0.0~1.0μg/L、1.1~2.0μg/L、2.1~3.0μg/L、3.1~4.0μg/L时PCa的检出率分别为16.28%(21/129)、17.17%(17/99)、21.82%(12/55)、25.00%(15/60)。PSA≤2.0μg/L时,f-PSA/t-PSA比值在PCa和非PCa患者中没有明显差异(P0.05),而PSA2.0μg/L时有明显差异(P0.05)。而PSAD值在PCa组与非PCa组中分别为(0.09±0.16)μg/L/ml、(0.06±0.07)μg/L/ml,没有明显差异(P0.05)。随着PSA含量的升高,PCa的检出率相应升高,各年龄段的检出率没有明显差异(P0.05)。结论:当PSA含量在2.1~4.0μg/L时,若DRE/TRUS异常,则应引起重视,定期随访,监测PSA变化;若f-PSA/t-PSA≤0.15,伴或不伴DRE/TRUS异常,均应该行前列腺穿刺活检,以明确诊断。而对于PSA在0.0~2.0μg/L时,DRE、TRUS、f-PSA/t-PSA比值和PSAD均不能有效诊断PCa。     

前列腺特异抗原测定的临床意义

对7例前列腺癌(PCa)、97例前列腺增生(BPH)和21例正常人进行血清前列腺特异抗原(PSA)测定。结果显示,7例PCa患者PSA均明显增高(31.78±7.73ng/ml);97例BPH患者中30例(30.92%)PSA值>4.00ng/ml,其中16例PSA>10.00ng/ml。两者比较差异极显著(P<0.001)。提示:PSA可作为PCa的诊断指标之一。     

前列腺特异性抗原联合肿瘤异常蛋白对前列腺癌的诊断价值

目的:探讨前列腺特异性抗原(PSA)水平、游离PSA/总PSA(F/T)比值及肿瘤异常蛋白(TAP)3种肿瘤相关指标单独或联合诊断早期前列腺癌(PCa)的临床价值。方法:随机选取2016年10月～2017年10月安徽医科大学第一附属医院泌尿外科收治的120例PCa患者(PCa组)和192例良性前列腺增生患者(BPH组)为研究对象。所有纳入研究者均行血清PSA、游离PSA(f-PSA)及TAP水平的检测,并计算F/T比值。比较两组PSA水平、F/T比值以及TAP含量分布的差异,分析这3种指标单独或联合对PCa辅助诊断或早期诊断的灵敏度、特异度及准确度。结果:PCa组患者的血清PSA水平高于BPH组(P0.001),而F/T比值小于BPH组(P0.001)。PCa组的TAP阳性表达率明显高于BPH组(P0.001)。PSA诊断PCa的灵敏度、特异度及准确度分别为85.83%、39.06%及57.05%,TAP诊断PCa的灵敏度、特异度和准确度分别为92.5%、49.48%和66.03%,PSA联合TAP诊断PCa的灵敏度、特异度和准确度分别为80.80%、67.19%和72.12%,其特异度和准确度高于单独PSA或TAP对PCa的诊断。TAP对PSA介于4～10 ng/ml灰区内PCa的诊断灵敏度高于F/T比值,特异度及准确度均低于F/T比值,但约登指数高于F/T比值。结论:PSA联合TAP诊断PCa具有灵敏度、特异度和准确度高的特点,对PCa的早期筛查及诊断具有一定临床价值。     

前列腺特异抗原对前列腺癌诊断和疗效监测的价值探讨

目的 探讨前列腺特异抗原(tPSA)、游离PSA(fPSA)以及fPSA/tPSA在前列腺癌(PCa)诊断和疗效监测中的临床价值。方法 采用全自动化学发光免疫分析仪测定36例正常人、42例前列腺增生(BPH)和44例前列腺癌患者tPSA、fPSA,并计算fPSA/tPSA比值。同时,对29例前列腺癌患者术后tPSA、fPSA进行动态监测。结果 fPSA/tPSA对PCa诊断的特异性为88.1％,诊断指数为0.79,显著高于单独tPSA(P<0.05)。结论 fPSA/tPSA的引入提高了对PCa诊断的特异性,动态监测是提示肿瘤是否转移与复发最理想的指标。     

Combining free and total prostate specific antigen assays from different manufacturers: the pitfalls

OBJECTIVES: We investigated the impact of interchanging free prostate specific antigen (f-PSA) concentrations from 10 different assays over a reference total PSA (t-PSA) on predicting prostate histology with free-to-total PSA ratios (f/t-PSA). METHODS: Archival sera from 80 t-PSA- and age-matched pairs of histologically confirmed prostate cancer (PCA) and benign prostatic hyperplasia (BPH) patients with t-PSA levels between 2 and 25 microg/l were investigated. Serum aliquots were analyzed for t- and f-PSA using a reference method (Access, Beckmann-Coulter Hybritech) and 10 commercially available f-PSA assays. Passing Bablok and linear regression were performed to investigate the interassay agreement between f-PSA assays. To compare diagnostic performance, ROC curves for PCA detection were calculated for the 10 f/t-PSA combinations using the reference t-PSA as denominator. Sensitivities, specificities and f/t-PSA cut-offs were calculated for varying points of the ROC curve. RESULTS: Despite good correlation of all 10 f-PSA assays with the reference method 4 showed significantly lower mean f-PSA levels. For f/t-PSA as a predictor of prostate histology, areas under the ROC curve (AUC) varied between 0.65 and 0.71 and, if compared to the reference method (AUC=0.70), were significantly lower in three cases. Ensuring 80% specificity, sensitivities ranged between 34% and 54% (reference method: 53%) and f/t-PSA cutpoints differed considerably depending on the f-PSA assay used (range: 0.15-0.24; reference: 0.15). Similar variations were noted at 95% specificity and 80% and 95% sensitivity. CONCLUSIONS: Arbitrary combinations of f- and t-PSA assays should not be used to calculate f/t-PSA ratios unless adequate studies have validated the diagnostic performance and cut-offs of that particular assay choice.     

良性前列腺增生合并慢性前列腺炎的临床特点分析

目的:探讨良性前列腺增生(BPH)合并慢性前列腺炎(CP)患者的临床特点。方法:将行经尿道前列腺电切术(transurethral resection of the prostate,TURP),术后病理诊断证实为BPH的患者120例,按是否合并CP分为单纯BPH组(简称单纯组,75例)和BPH合并CP组(简称合并组,45例)。结合术前经直肠超声检查及f-PSA、t-PSA、f-PSA/t-PSA检测结果,并根据公式计算出前列腺总体积(TPV)、PSA密度(PSAD),进行统计和分析。结果:单纯组患者,随着年龄或前列腺体积的增加,f-PSA及t-PSA均呈上升趋势,差异有统计学意义(P<0.05),但f-PSA/t-PSA值及PSAD差异无统计学意义(P>0.05)。合并组患者,随着年龄的增加,f-PSA及t-PSA各组间比较差异有统计学意义(P<0.05),随着前列腺体积的增加,f-PSA及t-PSA各组间比较差异有统计学意义(P<0.05),均呈上升趋势,但f-PSA/t-PSA值及PSAD各组间比较差异无统计学意义(P>0.05)。合并组患者较单纯组患者的f-PSA、t-PSA及PSAD有所上升,差异有统计学意义(P<0.05),但f-PSA/t-PSA值变化不大,差异无统计学意义(P>0.05)。通过对各项指标做ROC工作曲线分析发现,f-PSA、t-PSA、PSAD 3项指标的曲线下面积分别为0.644、0.628、0.624,均介于0.5至0.7之间。结论:BPH患者常合并CP,临床中f-PSA、t-PSA升高,同时伴PSAD升高的BPH患者,应考虑合并前列腺炎的可能性大,上述3个指标作为诊断BPH伴CP的依据有一定的意义,但并不是十分可靠。     

Value of free prostate-specific antigen (Hybritech Tandem-R) in symptomatic patients consulting the urologist

INTRODUCTION: Prostate-specific antigen (PSA) is a widely used tumor marker in the detection and follow-up of adenocarcinoma of the prostate. Selection of candidates for prostate biopsies is hampered by the lack of specificity resulting in a large number of unnecessary biopsies. The intention of our study was to compare the percent free PSA (f-PSA; Hybritech Tandem-R) with total PSA and age-specific PSA reference values to evaluate the clinical benefit in detecting patients with prostate cancer (PC) in a selected group of patients consulting the urologist. The question was whether cutoff points are influenced by this selection of patients. METHODS: A total of 188 patients, 114 with benign prostate hyperplasia (BPH) and 74 with PC were selected. It is a selected group of patients consulting the urologist. Diagnosis was confirmed in the BPH and PC groups by either ultrasound-guided biopsy or transurethral resection of the prostate or suprapubic adenomectomy or cystoprostatectomy. Total PSA (t-PSA) and f-PSA of all patients were measured before any manipulation by Tandem-R assay for f-PSA and Tandem-E assay for t-PSA (Hybritech). Mean values of age, prostate volume, t-PSA, f-PSA, percent f-PSA were compared in patients with BPH and PC by Mann-Whitney U test. The sensitivity and specificity of t-PSA and age-specific PSA were compared to the sensitivities and specificities of different cutoff points of percent f-PSA. RESULTS: The mean value of t-PSA, f-PSA and percent f-PSA in patients with BPH (n = 114) and PC (n = 74) were statistically significantly different. At PSA levels between 4 and 10 ng/ml 19% of negative biopsies could be avoided by the use of percent f-PSA (cutoff point 25%). There was no additional benefit of age-specific PSA. At a PSA of <4 ng/ml 6 of 7 PCs could be diagnosed by percent f-PSA (cutoff point 25%), whereas only 1 patient would be diagnosed by age-specific PSA. CONCLUSION: Percent f-PSA seems to decrease the biopsy rate at PSA levels from 4 to 10 ng/ml without missing a relevant number of cancers and to increase the detection rate at PSA <4 ng/ml. Our data indicate that it might be necessary to choose high cutoff points (25%; Tandem-E and R assay, Hybritech) in a selected study population consulting the urologist with large glands and a high prevalence of disease. However, this situation is not comparable to testing of screening populations. No benefit of age-specific PSA could be observed in this study.     

Dual monoclonal antibody immunoassay for free prostate-specific antigen

Prostate-specific antigen (PSA) is the most important tumor marker for early detection and monitoring of prostate cancer (PCa) patients. PSA is also elevated in many patients with benign prostatic hyperplasia (BPH). The study of the serum PSA forms, free PSA (f-PSA) and PSA complexed with α₁-antichymotrypsin (PSA-ACT), may improve the discrimination between PCa and BPH. An immunoassay specific for f-PSA is reported with very low cross-reactivity (0.7%) to PSA-ACT. Serum specimens from BPH and PCa patients (determined by biopsy) with PSA levels from <1 to >100 ng/ml were tested. No f-PSA was detected in serum specimens from normal females (N = 50). Low levels (0–0.3 ng/ml) were detected in specimens from healthy males (N = 60). In specimens from PCa and BPH patients, the f-PSA to total PSA ratio (f/t) was found to range from 1% to higher than 60%. While maintaining an 80% sensitivity for cancer, the f/t ratio improved specificity to approximately 80%, as compared to 55% for total PSA alone. The receiver operating characteristics (ROC) curve analysis of the f/t ratio displayed a greater area under the plot (0.84) compared to total PSA alone (0.745). The results demonstrate that the f/t ratio significantly increases specificity for PCa detection compared to total PSA alone, showing the potential clinical value of the f-PSA immunoassay. © 1996 Wiley-Liss, Inc.     

晚期前列腺癌内分泌治疗后血清PSA、f-PSA含量的变化

目的探讨前列腺癌(PCa)患内分泌治疗后前列腺特异抗原(PSA)、游离前列腺特异抗原与总前列腺特异抗原比值(f／tPSA)变化的临床意义。方珐测定PCa患内分泌治疗前及治疗后1、3、6个月血清PSA、游离前列腺特异抗原(f-PSA)变化。砖杲治疗后1个月与治疗前相比血清PSA下降明显，治疗后6个月较治疗后1个月血清PSA下降亦有显意义；治疗后患血清f-PSA水平明显下降。f／tPSA值的变化无显意义。结论血清PSA、f-PSA可作为判断PCa内分泌治疗效果的标准．如血清PSA、f-PSA复又升高提示肿瘤复发。     

Improved Discrimination of Prostate Cancer and Benign Prostatic Hyperplasia by Means of the Quotient of Free and Total PSA

The value of t-PSA (total prostate specific antigen) and of the quotient of free and t-PSA (% f-PSA) for the discrimination of BPH (benign prostatic hyperplasia) and PC (prostate cancer) as well as possible influencing factors were subject to examination under study conditions.The sera of 210 patients (131 BPH, 79 PC patients) were examined by means of the Immulite® test; thereof 76 male patients (47 BPH, 29 PC patients) were found to have a t-PSA-value between 4 and 10 ng/ml (grey area).Apart from the age and the findings of rectal digital examination, we recorded the prostate volume, indications of non-specific increases in PSA and for PC patients also the TNM-G stage.For patients with prostate cancer the quotient of f- and t-PSA was significantly lower (median: 0.08) than compared to patients with BPH (median: 0.22) (p<0.001). Also in the grey area the quotient was significantly lower in patients with malignant diagnosis (median: 0.12) than for patients with a non-malignant diagnosis (median: 0.21) (p<0.001).ROC curves were prepared in order to compare the capability of discrimination of the two parameters. At this point, the better discrimination potential of the quotient in the grey area became evident. Due to the fact that priority was given to the detection of carcinoma, the threshold value was defined at a level at which high sensitivity (90%) is existent in combination with an acceptable specificity (approx. 50%). The resultant values are for the total PSA area 0.21, for the grey area 0.19 as a cut-off.Neither the age, nor the prostate volume, nor urinary tract infections had any influence upon the quotient. There was also no correlation between the stage or the grading of the tumour and the percentage of the f-PSA.The quotient alleviates the discrimination between BPH and PC, in particular in the diagnostically problematic grey area. Thus, it can serve as an aid for the decision "biopsy or re-biopsy". As there is currently no standardized method for the application of % f-PSA, there is a requirement for further examination under homogeneous criteria.     

磁共振扩散加权成像ADC值结合PSA检测在前列腺癌术前评估中的作用

目的 探讨磁共振(MR)扩散加权成像ADC 值结合血清PSA检测在前列腺癌术前评估中的应用价值. 方法经穿刺活检证实的局限性前列腺癌患者47例.年龄56～86岁.临床分期A期2例,B期18例,C期27例.高分化(2～4)1例,中分化(5～7)23例,低分化(8～10)23例.血清t-PSA为1.41～603.16 ng/ml,f-PSA为0.10～12.29 ng/ml.F/T比值0.01～0.36,行MR扩散加权检查,扩散敏感系数800 s/mm2.按病理结果将前列腺分为癌区和非癌区.测量每个分区及整个腺体的ADC值,并与血清t-PSA、f-PSA、F/T比值进行相关性分析. 结果 47例患者前列腺癌区和非癌区ADC值分别为(1.29±0.28)×10-3、(1.78±0.32)×10-3mm2/s,组问差异有统计学意义(t=13.58,P＜0.01).癌区ADC值与t-PSA、f-PSA呈负相关(γ=0.353,P＜0.01;γ=-0.401,P＜0.01),与F/T比值呈负相关(r=-0.123,P＞0.05). 结论癌区ADC值与t-PSA、f-PSA呈负相关,ADC值结合PSA有可能在术前对肿瘤进行更准确地定位和术前评估.     

单纯前列腺上皮内瘤回顾性分析(附142例病例分析)

目的通过对前列腺上皮内瘤(PIN)临床资料分析,探讨PIN的生物特性及应对策略。方法对31例无前列腺癌PIN(NPCaPIN)改变患者(其中1级23例,2、3级8例)的临床资料(包括患者血清PSA、fPSA/tPSA、PSA密度等区域计数资料以及穿刺标本免疫组织化学染色结果)进行回顾性分析,以同期确诊为前列腺癌(PCa)、良性前列腺增生(BPH)患者资料作为对照,分析低级别PIN(LGPIN)和高级别PIN(HGPIN)改变之间及NPCaPIN临床特征与PCa、BPH患者临床特征的差异。结果LGPIN和HGPIN改变的患者之间血清PSA水平和年龄存在差异(P<0.05);LGPIN和PCa患者之间血清PSA水平、前列腺体积、fPSA存在显著差异(P<0.01),PSA密度、fPSA/tPSA比值存在差异(P<0.05),和BPH患者之间各项均无明显差异;HGPIN改变和PCa患者之间前列腺体积、fPSA水平和年龄存在差异(P<0.05),和BPH患者之间血清PSA水平差异显著(P<0.01),fPSA/tPSA比值和年龄(P<0.05)存在差异;NPCaPIN和PCa患者之间血清前列腺体积、fPSA水平和年龄、血清PSA水平、PSA密度存在显著差异(P<0.01),和BPH患者之间fPSA/tPSA比值(P<0.05)存在差异。P63、AE1、AE3、P504S、PSA免疫组织化学结果NPCaPIN组类似于BPH而完全异于PCa。结论LGPIN的临床和病理特征与BPH相似,而HGPIN的临床和病理方面具有一定的前列腺恶性肿瘤特征,需要积极的临床追踪观察。