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。     

血清PSA、FPSAR与前列腺癌病理分级、临床分期的相关性研究

目的 :探讨前列腺癌病人血清前列腺特异抗原 (PSA)、血清游离前列腺特异抗原百分率 (FPSAR)与前列腺癌病理分级、临床分期的相关性。　方法 :分别检测经病理检查确诊为前列腺癌的 4 2例病人血清PSA、FPSAR ,并根据标本苏木精 伊红染色切片中肿瘤的组织学形态及临床资料对病人分别进行病理分级、临床分期。采用Spearman等级相关分析 ,分析PSA、FPSAR与前列腺癌病理分级、临床分期的关系。 　结果 :前列腺癌病人PSA值越高 ,癌症恶性程度越高 ,PSA值与前列腺癌病理改变呈明显正相关性 (P <0 .0 5 ) ,而与前列腺癌的临床分期无相关性 (P >0 0 5 ) ;前列腺癌病人FPSAR值与前列腺癌病理改变呈正相关 ,与病人临床分期呈负相关 (P <0 .0 5 )。结论 :与PSA值相比 ,FPSAR值预测前列腺癌的病理分级、临床分期和预后可能更为准确     

血清前列腺特异性抗原及直肠指检与前列腺癌的相关性研究

目的 分析血清PSA、直肠指检(DRE)与前列腺癌检出率、临床分期以及病理分级的相关性. 方法 回顾性分析1997年1月至2010年12月796例PSA、DRE和病理结果完整患者的前列腺穿刺活检资料,采用Spearman相关性研究分析PSA和DRE与前列腺癌相关指标间的关系,进一步将PSA及DRE分组后进行比较. 结果 PSA与前列腺癌检出率、临床分期及病理分级相关(r=0.537,P＜0.0001;r=0.365,P＜0.0001;r=0.556,P＜0.0001);DRE结果与前列腺癌诊断率及病理分级有相关性(r=0.212,P＜0.0001;r=0.126,P=0.02).分组分析显示不同PSA水平组中前列腺癌检出率、前列腺癌分期以及Gleason评分差异有统计学意义(P＜0.05).而在相同PSA水平时,只有PSA 10.0 ～ 19.9 μg/L组和20.0～99.9μg/L组中DRE阳性和阴性患者的前列腺癌检出率差异有统计学意义(P＜0.05).相同PSA组中不同DRE结果患者的前列腺癌分期以及Gleason评分差异无统计学意义(P＞0.05). 结论 PSA水平与前列腺癌的检出率、肿瘤分期及Gleason评分有显著相关性,DRE结果仅在部分PSA水平患者中影响肿瘤检出率.     

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。     

前列腺癌患者术前分期分级偏低的相关危险因素

目的 探讨前列腺癌根治术患者术前分期分级偏低的相关危险因素。方法 对55例前列腺癌根治术患者手术前后分期分级的资料进行比较，分析术前临床分期低于术后病理分期的危险因素。结果 55例患者术前临床分期T1～T250例，其中21例术后病理分期为T3～T4，占42％。26例术前穿刺活检病理Gleason评分2-6分者中11例术后病理分级为7-10分，占42％。Logisatic回归分析筛选出血清PSA（P＝0．0159)及前列腺穿刺阳性针数的百分率(P＝0．0013)是预测术前临床分期低于术后病理分期的危险因素。结论 对于临床分期为T1～T2而血清PSA≥20ng／ml或前列腺穿刺阳性针数≥50％的患者应考虑到临床分期偏低的可能。     

PSA值增高患者前列腺液细胞学检查的临床意义

目的研究PSA值增高患者的前列腺液脱落细胞学检查诊断前列腺癌的临床价值。方法 86例PSA值增高的患者在行经直肠前列腺穿刺活检前获取前列腺液,进行瑞氏染色和脱落细胞学分级,并行前列腺液中的白细胞计数。同时比较不同的细胞学病理分级的患者之间年龄、PSA值、前列腺总体积（TPV）和获取的前列腺液体积的差异。用Spearman相关分析和非参数检验分析白细胞与患者年龄、PSA、前列腺体积等的关系。结果在脱落细胞学分级1~4级与5级之间PSA值比较有显著性差异。前列腺液的体积和白细胞总数与前列腺体积呈显著性相关,非前列腺癌患者比前列腺癌患者的前列腺体积、白细胞密度和总数显著增高,且血清PSA值与前列腺液中白细胞密度存在正相关性。结论前列腺液脱落细胞学检查是诊断前列腺癌的一种有效方法,尤其是在患者具有较高的PSA值的时候,具有无创性及较高的敏感性和特异性。非前列腺癌患者的PSA值增高可能与前列腺液中的白细胞增高有关。     

粘着斑蛋白、雄激素受体在前列腺癌中的表达及相关性研究

目的:检测粘着斑蛋白(VCL)和雄激素受体(AR)在良性前列腺增生(BPH)和前列腺癌(PCa)中的表达情况,并分析其与PCa不同临床分期、病理分级、PSA水平之间的相互关系。方法:采用免疫组化法检测18例BPH组织,38例PCa组织中VCL、AR的表达。并分析两者在BPH、PCa中的表达差异,在PCa不同临床分期、病理分级、初次PSA检测水平的表达差异,以及两者之间的相关性。结果:VCL在PCa中的表达较BPH组织增多,AR表达在BPH、PCa中无明显差异;VCL、AR在PCa组织中的表达与肿瘤临床分期、病理分级密切相关,与PSA值无明显关系;VCL、AR在PCa组织中的表达存在正相关。结论:VCL在BPH、PCa的表达具有差异性,可以作为前列腺良、恶性疾病鉴别诊断的一个潜在指标;AR、VCL随PCa进展表达逐步下降,两者存在正相关,两者结合可以成为PCa进展的诊断、预后评价指标。     

前列腺癌血清PSA、f/tPSA与Gleason评分、临床分期的相关性研究

目的 探讨前列腺癌病人血清PSA、f/tPSA（血清游离PSA与总PSA的比值）与前列腺癌Gleason评分、临床分期的相关性.方法 查阅我院1998年1月～2005年6月归档的前列腺癌病历资料,建立临床资料数据库,对归档病理切片进行Gleason评分.采用Spearman等级相关分析,分析血清PSA、f/tPSA与前列腺癌Gleason评分、临床分期的关系.结果 269例前列腺癌中,前列腺癌PSA值与Gleason评分呈正相关（r=0.361,P＜0.01）,与前列腺癌临床分期呈正相关（r=0.586,P＜0.01）;f/tPSA与Gleason评分有弱负相关（r=-0.128,P=0.035）,与前列腺癌临床分期呈负相关（r=-0.226,P＜0.01）.结论 血清PSA、f/tPSA与前列腺癌预后密切相关的指标临床分期和Gleason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。     

前列腺特异抗原联合分级对前列腺癌患者分期的预测

目的探讨血清前列腺特异抗原(PSA)联合分级对前列腺癌患者的分期进行预测的方法。方法回顾分析我院泌尿外科187例穿刺活检诊断为前列腺癌患者的临床资料。采用等级相关分析、秩和检验、逐步判别多因素分析方法,分析血清PSA水平、游离PSA百分比(FPSA/TPSA值)与Gleason评分(GS)、分期的关系。结果前列腺癌患者GS越高,血清PSA水平越高(r=0.369,P<0.001)。分期越晚,血清PSA、GS越高(r=0.398,0.530,P均<0.001)。FPSA/TPSA值与分期不相关(P>0.70),但当PSA≤10μg/L时,FPSA/TPSA值与分期呈负相关(r=-0.600,P<0.05)。当PSA>20μg/L时,67%~87%的患者可能为C或D期。用PSA、GS预测分期的公式为x=-3.488+0.041×PSA+0.428×GS。结论血清PSA水平与GS呈正相关。血清PSA水平、GS分别与分期呈正相关。当PSA≤10μg/L时,FPSA/TPSA值与分期呈负相关。运用判别公式x=-3.488+0.041×PSA+0.428×GS可以预测前列腺癌患者的分期。     

前列腺跨膜上皮抗原在前列腺癌组织中的表达及与PSA的关系

目的 探讨前列腺癌组织中前列腺跨膜上皮抗原(STEAP)表达及与前列腺特异性抗原(PSA)的关系.方法 采用免疫组织化学染色法检测65例前列腺癌(其中T1 9例、T2 14例、T317例、T4 25例,高分化癌37例、中分化癌12例、低分化癌16例)组织标本中STEAP的表达,引入阳性灰度值概念判定染色强度;分析STEAP表达水平与肿瘤分期、分级、血清PSA及游离PSA/总PSA(f/t PSA)比值的关系.结果 65例患者血清PSA值为(27.65±8.34)ng/ml,f/t PSA为0.15±0.04.STEAP阳性表达63例,其中T1 7例、T2 14例、T3 17例、T4 25例,高分化癌37例、中分化癌11例、低分化癌15例.T1、T2、T3、T4前列腺癌组织中STEAP表达平均阳性灰度值(Gs)分别为26.8%、45.6%、62.3%、76.5%,高、中、低分化癌组织中STEAP表达平均Gs分别为71.2%、52.8%、34.4%.STEAP表达与肿瘤分期呈正相关(r=0.67,P<0.01);随着Gleason评分的增高,STEAP表达逐渐降低(P<0.01);STEAP表达与患者血清PSA无明显相关性(r=0.21,P>0.05),而与f/t PSA比值呈负相关(r=-0.83,P<0.01).结论 STEAP可作为判断前列腺癌浸润深度、分化程度的指标之一.     

The clinical potential of pretreatment serum testosterone level to improve the efficiency of prostate cancer screening

OBJECTIVES: The aim of the present study was to evaluate the clinical value of the pretreatment serum testosterone (T) level as a potential predictor of prostate cancer risk in screening for prostate cancer. MATERIALS AND METHODS: The subjects were 420 patients suspected of having prostate cancer who underwent prostate biopsy, and whose pretreatment T levels were recorded. We checked for association between the presence of prostate cancer and the following clinical factors: pretreatment serum T level, age, pretreatment prostate-specific antigen (PSA) level, digital rectal examination findings, ratio of free to total PSA, prostate volume, and PSA density (PSAD). RESULTS: Overall, there was no significant difference in mean pretreatment T level between patients diagnosed with cancer (3.9+/-2.4 ng/ml) and patients diagnosed with benign prostate disease (BPD; 3.7+/-1.7 ng/ml); diagnosis was based on prostate biopsy. However, among patients with PSA <10 ng/ml, the pretreatment T level was significantly higher in patients diagnosed with prostate cancer (4.2+/-2.6 ng/ml) than in patients diagnosed with BPD (3.6+/-1.4 ng/ml) (p=0.007); a similar trend was observed among patients with PSAD <0.15 ng/ml/cc. Multivariate analysis indicated that pretreatment T level was an independent significant predictor of positive prostate biopsy (p=0.020). Additionally, the serum T level was significantly lower in patients with a Gleason score >or=7 (3.7+/-2.1 ng/ml) versus a score <7 (4.2+/-1.7 ng/ml) (p=0.030). Also, serum T levels were significantly higher in well-differentiated prostate cancer (4.8+/-2.1 ng/ml) versus moderately differentiated (3.8+/-1.3 ng/ml) or poorly differentiated (3.7+/-1.4 ng/ml) (p<0.01). CONCLUSIONS: Among relatively low-risk patients, serum T level was an independent significant predictor of positive prostate biopsy, suggesting that the efficiency of prostate cancer screening can be improved by including measurement of serum T level.     

Usefulness of extension of disease as a prognostic factor in relapsed prostate cancer patients of stage D

OBJECTIVE: The prognosis of prostate cancer has been evaluated by clinical stage or pathological grade. PSA parameters including PSA density and PSA doubling time have not always precisely reflected the prognosis of prostate cancer. The aim of this study was to evaluate PSA parameters and extension of disease (EOD) grade as prognostic factors for relapsed prostate cancer. METHODS: The relationship between PSA parameters or EOD grade, and survival of 29 stage D patients with relapsed prostate cancer after initial hormone therapy was examined. RESULTS: Only EOD grade was an independent prognostic factor, even for cause-specific survival period and survival period after relapse. CONCLUSION: EOD grade was a significant prognostic factor, and in particular, very useful as a prognostic factor for patients with bone metastasis. PSA value was not always associated with tumor volume, and therefore it is not an independent prognostic factor.     

The role of the complexed-to-total prostate-specific antigen ratio in predicting the final pathological stage of clinically localized prostate cancer

OBJECTIVES: To examine the association between the complexed-to-total (C:T) prostate-specific antigen (PSA) ratio and prostate cancer pathological stage to assess whether the C:T PSA ratio may predict the final pathological stage in patients with clinically localized prostate cancer. PATIENTS AND METHODS: In a prospective study, 101 men with clinically localized prostate cancer underwent a staging pelvic lymphadenectomy and radical prostatectomy. Total PSA (tPSA) and PSA complexed to alpha(1)-antichymotrypsin (cPSA) were measured from preoperative plasma and were correlated with the clinical and pathological stage, and with surgical margin status. The pathological stage was determined as organ-confined (n=59) and extracapsular extension (n=42). RESULTS: The distributions of tPSA and cPSA were significantly different in men with locally confined and those with locally extended disease. This finding was not observed for the C:T PSA ratio. The area under the receiver operating characteristic (ROC) curve to predict the final pathological stage was significantly greater for tPSA (0.684) and cPSA (0.677) than for the C:T PSA ratio (p<0.032). TPSA (0.685) and cPSA (0.670) also showed areas under the ROC curve greater than that of the C:T PSA ratio (0.542) (p<0.05) for prediction of positive surgical margins. CONCLUSIONS: Our results show that the C:T PSA ratio does not improve the performance of total PSA for predicting the final pathological stage in patients with clinically localized prostate cancer.     

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.