血清PSA与前列腺癌病理分级临床分期相关性研究

目的：探讨前列腺癌患者血清PSA与前列腺癌病理分级和临床分期的相关性。方法：前列腺手术前检测PSA，术后经病理检查确诊为前列腺癌患者42例，根据苏木素－伊红染色切片中肿瘤的组织学形态，结合临床资料分别进行病理分级，临床分期，采用Spearman等级相关分析分析PSA与前列腺癌病理分级和临床分期的关系。结果：PSA值与前列腺癌的病理分级有关，与前列腺癌临床分期间的关系目前尚无肯定的结论。结论：PSA值不仅是前列腺癌的一个筛选指标，而且可能是判断前列腺癌预后的一个有意义的指标。     

血清PSA与前列腺癌病理分级的相关性

目的 探讨血清前列腺特异性抗原（PSA）与前列腺癌（PCa）病理组织学分级的相关性。方法前列腺手术前检测血清PSA，术后经病理检查确诊为前列腺癌患者58例。根据苏木素一伊红切片中肿瘤的组织学形态进行病理分级。采用Spearman等级相关分析PSA与前列腺癌病理分级的关系。结果血清PSA值与前列腺癌的病理分级呈正相关。结论血清PSA与前列腺癌组织学分级问的相关性可能协助判断前列腺癌分级及预后。     

血清PSA与前列腺癌分级、分期的关系

前列腺特异性抗原(prostate-specific antigen,PSA)自前列腺上皮分泌后,以高浓度储存于导管腔内,极少部分通过组织屏障进入血循环,成为血清PSA。随着前列腺癌G leason评分(G leason score,GS)的升高,组织的恶性度升高,组织屏障受破坏加重,同时组织中血管分布更丰富,更多的PSA漏(leakage)到和/或转运(transport)到周围血循环中,导致血清PSA水平升高。分期越晚,血清PSA水平越高。可将血清PSA与GS、临床分期等影响分期的因素联合起来预测前列腺癌患者的最终病理分期。     

前列腺癌血清PSAD与原位PSA的相关性研究

目的 :探讨前列腺癌患者血清前列腺特异抗原密度 (PSAD)与组织原位PSA表达的关系。方法 :参照Gleason标准对 2 5例前列腺腺癌组织进行分级 ,用免疫组织化学SP法检测前列腺癌组织中PSA ,术前 1周用化学发光分析法测定血清PSA浓度及经腹B超测定前列腺体积 ,二者之比为PSAD。结果 :5例高分化肿瘤全部呈强阳性 ;13例中分化肿瘤中 ,4例呈强阳性 ,9例呈弱阳性 ;7例低分化肿瘤中 ,1例呈强阳性 ,3例呈弱阳性 ,3例阴性。 2 5例腺癌PSAD为 0 .36～ 1.5 3(U =0 .75 )。不同分化的癌组织的PSA表达强度差异有显著性意义(P <0 .0 5 ) ,高、中分化组的血PSAD与低分化组差异有显著性意义 (P <0 .0 5 ) ,不同PSA表达强度的患者血PSAD差异无显著性意义 (P >0 .0 5 )。结论 :癌组织中蛋白酶的破坏造成PSA漏出增多 ,可能与血PSAD升高有关。癌组织PSA的免疫组织化学反应强度不能用于解释血PSAD的变化     

血清PSA、游离PSA与良性前列腺增生临床的相关性研究

目的分析血清前列腺特异性抗原(PSA)及游离前列腺特异性抗原(fPSA)与良性前列腺增生(BPH)临床的相关性。方法应用化学发光微粒子免疫分析法(CMIA)对BPH患者血清PSA、fPSA进行检测。结果入选的40例患者病理均为BPH。PSA>4ng/ml者,术后随访1～3个月,平均2.5个月,PSA值均降至0.02ng/ml以下,可除外前列腺癌(PCa)病例。PSA<4ng/ml者16例(40%),4～10ng/ml者14例(35%),>10ng/ml者10例(25%);fPSA>0.934ng/ml者22例(55%)。血清PSA、fPSA水平与前列腺总体积(PV)、前列腺移行区体积(TZV)、年龄及国际前列腺症状评分(IPSS)呈正相关。结论本组血清fPSA与PV、TZV、年龄、IPSS评分有更强相关性。BPH患者血清PSA、fPSA水平升高的相关因素与前列腺总体积及移行区增大、高龄及高IPSS评分有关。     

血清PSA及PSA密度与前列腺癌分级分期的关系

目的：提高前列腺癌（PCa）的诊断水平。方法：回顾了60例经穿刺活检确诊PCa患者的临床资料。结果：60例PCa患者中,血清T—PSA含量、F-PSA含量、F／T分别与PCaGleason分级、临床分期均呈正相关,F／T与PCaGleason分级、临床分期均无显著相关。结论：PCa患者的血清T—PSA、F—PSA和PSAD与Gleason分级和临床分期存在相关,提示可能通过检测血清T—PSA、F-PsA和PSAD预测PCa恶性程度及预后,有利于PCa的筛查及制定合理的治疗方案。     

血清PSA、PSAD结合病理分级对前列腺癌骨转移的诊断价值

PCa是老年男性常见的恶性肿瘤之一,随着社会老龄化、人们生活方式的改变以及新的诊断技术的应用,近年来我国PCa的发病率呈显著上升趋势,由于PCa早期症状不太典型,故在首次就诊时约有2/3患者已有远处转移,尤其是骨转移[1].而准确的临床分期对于制定合理的治疗方案和判断预后有非常重要的意义.     

血清PSA与Gleason分级及临床分期的相关性研究

目的探讨前列腺癌患者血清PSA与前列腺癌患者Gleason分级和临床分期的相关性。方法经穿刺病理检查确诊为前列腺癌患者112例。采用Spearman等级相关分析来研究穿刺前检测血清PSA与前列腺癌的病理分级、临床分期以及前列腺体积的关系。结果PSA值与前列腺癌的病理分级、临床分期及前列腺体积有相关性。结论PSA值不仅是前列腺癌的筛选指标，而且对前列腺癌进展的评估及预测有重要意义。     

穿刺前列腺癌Gleason评分与血清PSA的相关性分析

目的:探讨穿刺前列腺癌Gleason评分与血清PSA水平的相关性。方法:收集我院2011年5月~2014年6月经前列腺穿刺确诊为前列腺癌且临床资料完整的患者标本81例,对其穿刺组织的Gleason评分与血清PSA水平进行Spearman等级相关性分析。结果:前列腺癌组织Gleason评分与患者血清PSA水平呈正相关(r=0.347,P0.01),PSA值越高,Gleason评分越高。结论:前列腺癌患者血清PSA水平与Gleason评分相关。     

前列腺癌患者血清PSA、AR表达、Gleason评分和临床分期的相关性研究

目的 探讨前列腺癌患者血清前列腺特异抗原（PSA）、雄激素受体（AR）表达、Gleason评分和临床分期之间的相关性。方法回顾性分析我院55例前列腺癌患者的临床、病理和免疫组化资料。结果TPSA、FPSA值与Gleason评分、临床分期呈正相关,TPSA、FPSA、AR表达强度以及Gleason评分均与临床分期呈正相关（相关系数分别为：0．419,0．385,0．376,0．514）,其中G1eason评分与临床分期的相关性最高。随着TPSA值的升高,对晚期Pca的判断价值明显增大．以TPSA≥30ng／ml为标准判断晚期Pca的准确性较高。结论TPSA、FPSA值、AR表达强度以及Gleason评分值与临床分期有正相关关系,它们可以作为进行临床分期时需综合考虑的因素：TPSA≥30ng／ml可以作为判断晚期Pca有价值的标准。     

The Value of PSA,Free-to-total PSA Ratio and PSA Density in the Prediction of Pathologic Stage for Clinically Localized Prostate Cancer

Objective: The ability of prostate-specific antigen (PSA), free/total PSA and PSA density to predict the pathologic stage in prostate cancer has not been clear yet. In this study, we evaluated the value of PSA subgroups in the prediction of pathologic stage after radical prostatectomy. Methods: A total of 42 subjects 55–78-years-old who underwent radical retropubic prostatectomy were included in the study. Preoperative PSA, free/total PSA and PSA density (PSAD) values were compared according to the pathologic stages of radical prostatectomy specimens. Receiver operating characteristics (ROC) curves were measured for each parameter. Results: The clinical stage that was estimated for all patients was between T1N0M0 and T2bN0M0. Pathologic examination revealed organ-confined disease in 18 patients. The area under curve (AUC) for organ confinement was 0.553 for PSA, 0.446 for free/total PSA ratio and 0.706 for PSAD. Cut-off values providing the best sensitivity and specificity in ROC analysis for PSA, free/total PSA and PSAD were 7.1, 0.15, and 0.17, respectively (likelihood ratio: 0.9, 1 and 2). The positive predictive values at these cut-off values were 0.54, 0.56, and 0.70, respectively. Only PSAD cut-off values was found statistically borderline significant for predicting organ-confined disease. Conclusion: While PSAD is more helpful than PSA and free/total PSA ratio for prediction of organ-confined disease, none of these parameters are significant predictor of pathologic stage for clinically localized prostate cancer.     

Current usefulness of free/total PSA ratio in the diagnosis of prostate cancer at an early stage

The aim of our study was to evaluate five different free/total PSA (f/t PSA) kits for the diagnosis of early stage prostate cancer. We compared the PSA density and the f/t PSA ratio to differentiate between benign prostatic hyperplasia (BPH) and prostate cancer. This prospective study included a total of 120 patients with suspected prostate cancer (PSA between 4 and 15 ng/ml) observed over a period of 30 months. All patients had a blood test as well as a prostate biopsy prior to inclusion. Serum immunoassay total-PSA (t PSA) and free-PSA (f PSA) were carried out using five different assay kits: IMX Abbott (A), Kryptor Brahms (B), Immulite DPC (D), IRMA Immunotech (I) and IRMA DiaSorin (S). The results were compared to determine sensitivity, specificity, threshold values, and to differentiate between BPH and cancer. No difference was found between assay reproducibility and variation in the assays, however, only a slight variation was observed in the mean t PSA values, whereas a significant difference was found with f/t PSA. Receiver operating curves were generated for t-PSA and f/t PSA. The area under the curves did not show any significant differences for either t PSA or f/t PSA. A low comparative variability between the five kits tested for tPSA was observed, which suggest that the f/t PSA ratio has no current usefulness in the initial diagnosis of prostate cancer, particularly in patients with larger prostates. Furthermore, no prognostic value was found for surgically positive margins in radical prostatectomy. The named authors wrote this article with the participation of the Members of the Normandy Urological Association     

PSA、ECT骨显像诊断前列腺癌骨转移的临床价值

目的 :探讨前列腺特异抗原 (PSA)、发射型计算机断层扫描 (ECT)骨显像诊断前列腺癌骨转移的临床价值。方法 :对 6 7例 (骨转移组 4 4例 ,非骨转移组 2 3例 )前列腺癌病人的PSA、ECT与骨转移的关系进行回顾性分析。　结果 :ECT骨显像诊断前列腺癌骨转移的敏感性 91.6 7% ,骨显像表现为单个核素浓聚灶的病人 6例 ,仅 2例为前列腺癌骨转移。骨转移组与非骨转移组的PSA值差异有显著性 (87.2 8μg/Lvs 2 5 .37μg/L ,P <0 .0 1) ;PSA与骨转移的程度正相关 ,PSA <10 μg/L ,骨转移率为 0 ;PSA 10～ 2 0 μg/L ,骨转移率 7.6 9% ;PSA 2 0～ 6 0 μg/L ,骨转移率5 3.33% ;PSA 6 0～ 10 0 μg/L ,骨转移率 91.6 7% ;PSA >10 0 μg/L ,骨转移率 10 0 %。 　结论 :ECT骨显像对前列腺癌骨转移有较高的敏感性 ,但对单个转移灶诊断的特异性不高。对未经治疗的前列腺癌病人 ,PSA <10 μg/L ,前列腺癌骨转移的可能性极小 ;PSA >10 0 μg/L者 ,骨转移的可能性极大     

fPSA/tPSA比值优化前列腺癌早期诊断作用的研究

目的 :探讨游离前列腺特异性抗原 /总前列腺特异性抗原 (fPSA/tPSA)比值在优化tPSA早期诊断前列腺癌(PCa)中的作用。　方法 :以长春市 5 0岁以上PCa集团普查中tPSA在 4 .0～ 2 0 .0 μg/L范围、并接受前列腺活检的1 87例受检者为研究对象 ,测定tPSA、fPSA含量 ,应用SPSS 1 0 .0软件对不同区间fPSA/tPSA比值进行统计学分析。结果 :①tPSA在 4 .0～ 1 0 .0 μg/L、1 0 .0～ 2 0 .0 μg/L区间时 ,PCa检出率分别为1 8.1 %、2 2 .5 %。②ROC曲线分析显示不同区间时fPSA/tPSA比值的曲线下面积 (AUC)均大于tPSA (P <0 .0 5 )。③fPSA/tPSA比值取 0 .2 5为界值时 ,tPSA在 4 .0～ 1 0 .0 μg/L、1 0 .0～ 2 0 .0 μg/L两区间诊断PCa的敏感度分别为90 .5 %和 87.5 % ,可以分别避免 2 6 .7%和 1 1 .3%的人群进行活检。　结论 :在集团普查中 ,fPSA/tPSA比值在tPSA为 4 .0～ 2 0 .0 μg/L时可以提高检测PCa的特异性 ,减少不必要的活检。     

PAP、PSA与前列腺癌的诊断

本院从1992年7月至1996年9月收治经病理检查证实的前列腺癌52例,均行直肠指检(DRE)、B超、血清前列腺酸性磷酸酶(PAP)和前列腺特异抗原(PSA)检查,其诊断前列腺癌阳性率分别为78.8％、50.0％、61.5％、84..％。PSA阳性率明显高于其它检查(P<0.005)。若结合DRE、TRUS则诊断前列腺癌之敏感性达到96.2％。经直肠前列腺穿刺活检31例,穿刺阳性率为87.1％。PAP、PSA升高患者的比例与前列腺癌的分期、肿瘤细胞分化程仅具相关性。因此,PAP、PSA对前列腺癌的诊断、临床分期、判断预后有较大价值。     

Cerebrospinal Fluid Prostate Specific Antigen (CSF PSA) in Prostate Cancer Patients with Lower Spine Metastasis

Aim: In this prospective study, our aim was to investigate the CSF PSA levels and CSF/Serum PSA ratios in patients with prostate cancer with lower spine metastasis. Methods: The study involved patients with prostate cancer (n = 15), benign prostatic hyperplasia (n = 17) and non-prostatic disease (n = 9). Serum and CSF were obtained prior to spinal anesthesia for urological surgery. Total PSA levels in the serum and CSF were measured by electrochemiluminescence immunoassay. The results were tested statistically using the Mann–Whitney U test. Results: The mean serum PSA levels were 20.36 ng/ml in the prostate cancer patients, 5.37 ng/ml in the BPH patients and 0.76 ng/ml non-prostatic disease. The mean CSF PSA levels in groups were 0.127, 0.051 and 0.027 ng/ml, respectively. The mean CSF PSA/serum PSA ratios in groups were 0.007, 0.018 and 0.042, respectively. This result is statistically significant (P < 0.001).Conclusions: Although mean serum PSA and CSF PSA levels in the patients with cancer of the prostate and lower spine metastasis are higher than those in the others, the mean CSF PSA/serum PSA ratio is lower. However, clinical usefulness of CSF PSA value and CSF PSA/ Serum PSA ratio can be limited because CSF PSA values are usually very low, and CSF PSA/Serum PSA ratio of 4 prostate cancer patients are as high as 1 BPH patient.     

复合PSA及相关指标在前列腺癌诊断中的应用

目的 :研究复合前列腺特异性抗原 (CPSA)在前列腺癌诊断中的应用价值。　方法 :总PSA(TPSA)值在0 .2～ 2 1.9μg/L的血清值共 15 2例 ,病理诊断证实 2 1例为前列腺癌 ,131例为前列腺增生。Bayer化学发光法测得TPSA、游离PSA(FPSA)和CPSA ,计算FPSA/TPSA比值。比较前列腺增生和前列腺癌CPSA、TPSA和FPSA/TPSA比值的ROC曲线下面积。通过Logistic回归分析判断 3者诊断前列腺癌准确性的差异。　结果 :CPSA、TPSA、FPSA/TPSA比值的曲线下面积分别为 0 811、0 799和 0 376。在保持 95 %敏感性时 ,CPSA、TPSA和FPSA/TPSA比值的特异性分别为 6 2 .0 %、5 7.0 %和 4 7%。Logistic回归分析确定CPSA是最好的前列腺癌诊断指标。　结论 :TPSA值在 0～ 2 0 μg/L时 ,CPSA和TPSA均较FPSA/TPSA比值更好地检出前列腺癌 ,且CPSA略优于TPSA。在保持同一敏感性时 ,CPSA较TPSA具有更高的特异性     

前列腺特异性抗原集团普查是前列腺癌早期诊治的最佳途径

为在我国实现前列腺癌早期发现、早期诊断与治疗的目的 ,对 5 0岁以上男性进行PSA集团普查 ,以集团普查癌与临床前列腺癌进行对比分析 ,证明只有通过人群普查才能发现早期前列腺癌并为病人提供根治的机会。同时探讨了前列腺癌的治疗现状与存在的问题 ,对前列腺癌未来研究方向进行了展望     

Prostate-Specific Antigen (PSA) Isoform p2PSA in Combination with Total PSA and Free PSA Improves Diagnostic Accuracy in Prostate Cancer Detection

Background

Novel markers for prostate cancer (PCa) detection are needed. Total prostate-specific antigen (tPSA) and percent free prostate-specific antigen (%fPSA = tPSA/fPSA) lack diagnostic specificity.

Objective

To evaluate the use of prostate-specific antigen (PSA) isoforms p2PSA and benign prostatic hyperplasia–associated PSA (BPHA).

Design, setting, and participants

Our study included 405 serum samples from the Rotterdam arm of the European Randomised Study of Screening for Prostate Cancer and 351 samples from the Urology Department of Innsbruck Medical University.

Measurements

BPHA, tPSA, fPSA, and p2PSA levels were measured by Beckman-Coulter Access Immunoassay. In addition, the Beckman Coulter Prostate Health Index was calculated: phi = (p2PSA/fPSA) × √(tPSA).

Results and limitations

The p2PSA and phi levels differed significantly between men with and without PCa. No difference in BPHA levels was observed. The highest PCa predictive value in both cohorts was achieved by phi with areas under the curve (AUCs) of 0.750 and 0.709, a significant increase compared to tPSA (AUC: 0.585 and 0.534) and %fPSA (AUC: 0.675 and 0.576). Also, %p2PSA (p2PSA/fPSA) showed significantly higher AUCs compared to tPSA and %fPSA (AUC: 0.716 and 0.695, respectively). At 95% and 90% sensitivity, the specificities of phi were 23% and 31% compared to 10% and 8% for tPSA, respectively. In both cohorts, multivariate analysis showed a significant increase in PCa predictive value after addition of p2PSA to a model consisting of tPSA and fPSA (increase in AUC from 0.675 to 0.755 and from 0.581 to 0.697, respectively). Additionally, the specificity at 95% sensitivity increased from 8% to 24% and 7% to 23%, respectively. Furthermore, %p2PSA, phi, and the model consisting of tPSA and fPSA with or without the addition of p2PSA missed the least of the tumours with a biopsy or pathologic Gleason score ≥7 at 95% and 90% sensitivity.

Conclusions

This study shows significant increases in PCa predictive value and specificity of phi and %p2PSA compared to tPSA and %fPSA. p2PSA has limited additional value in identifying aggressive PCa (Gleason score ≥7).