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.     

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。     

f-PSA/t-PSA和c-PSA/t-PSA比值对于前列腺癌与良性前列腺增生鉴别诊断意义的多中心研究

目的 探讨f-PSA/t-PSA和c-PSA/t-PSA比值在前列腺癌(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)进行检测,计算f-PSA/t-PSA和c-PSA/t-PSA,对f-PSA/t-PSA和c-PSA/t-PSA在鉴别PCa和BPH中的作用进行比较.结果 血清t-PSA处于4-20ng/ml区间时,以f-PSA/t-PSA＜0.16作为诊断PCa的标准,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的标准时,分别是91.8%、81.3%、66.3%和96.1%.f-PSA/t-PSA＜0.16和c-PSA/t-PSA＞0.84两项标准诊断PCa的敏感度和阴性预测值无统计学差异(P＞0.05),但c-PSA/t-PSA＞0.84诊断PCa其特异度和阳性预测值显著高于f-PSA/t-PSA＜0.16的标准(P＜0.05).结论 血清t-PSA在4～20ng/ml区间时,f-PSA/t-PSA＜0.16和c-PSA/t-PSA＞0.84都可以为PCa的诊断提供帮助,但c-PSA/t-PSA＞0.84诊断PCa的特异度和阳性预测值好于f-PSA/t-PSA＜0.16的标准.     

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％。     

抗炎治疗后亚临床型前列腺炎患者血清PSA变化及其临床意义

目的 探讨抗炎治疗后亚临床型前列腺炎患者血清PSA变化及其临床意义.方法 直肠指检阴性的亚临床型前列腺炎患者136例.实验窒检查PSA 4.2～49.7(14.0±7.8)ng/ml.136例予抗炎治疗后2周复查PSA并在B超引导下行前列腺穿刺活检.评估抗炎治疗前后PSA、PSA密度(PSAD)、游离/结合PSA(f/t PSA)及其变化(△PSA、△PSAD、△f/t PSA),受试者工作特征(ROC)曲线分析抗炎前后各参数对前列腺癌的诊断效力.采用SPSS 11.0软件对组间行t检验.结果 136例穿刺活检诊断为前列腺癌33例.良性病变103例.抗炎治疗前后相比:PSA由(14.0±7.8)ng/ml降至(10.4±7.7)ng/ml、PSAD从(0.24±0.12)ng·ml1·ml~(-1)降至(0.18±0.12)ng·ml~(-1)·ml 1、f/t PSA从0.23±0.08降至0.16±0.07,治疗前后比较差异均有统计学意义(P＜0.05).△PSA、△PSAD和△f/tPSA分别为(-3.59±4.34)ng/ml、(-0.10±0.09)ng·ml-1·ml-1及-0.06±0.05.抗炎治疗前PSA、PSAD和f/t PSA诊断前列腺癌ROC曲线下面积分别为0.288、0.642和0.504,△PSA、APSAD和△f/tPSA诊断前列腺癌ROC曲线下面积分别为0.910、0.957和0.983,与治疗前比较差异均有统计学意义(P值均＜0.01).结论 亚临床型前列腺炎伴有PSA增高者经抗炎治疗2周后血清PSA明显下降;利用抗炎治疗后△PSA、APSAD、△f/t PSA可提高前列腺癌的诊断率,减少不必要的前列腺穿刺活检.     

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.     

建立预测中国人前列腺重复穿刺活检阳性的数学模型

目的:建立可以预测国人经直肠超声引导下重复穿刺活检阳性的数学模型。方法:170例在首次穿刺活检诊断为前列腺良性病变的患者行重复穿刺。记录并分析患者的年龄、前列腺体积、血清PSA、游离PSA(f-PSA)/总PSA(t-PSA)、PSA上升速度、PSA密度(PSAD)、直肠指检(DRE)、首次穿刺病理结果等相关因素。将变量通过逐步回归建立回归方程,在此基础上建立重复穿刺活检阳性的危险评分数学模型。该模型的预测价值通过受试者工作曲线下面积来评估。结果:170例前列腺重复穿刺活检的患者中,前列腺癌的穿刺检出率为31.8%(54/170)。建立的数学模型影响因素包括:患者的年龄、前列腺体积、PSA、f-PSA/t-PSA、PSA上升速度、PSAD、DRE、首次穿刺结果是否为上皮内瘤变。该模型预测价值较高,曲线下面积为82.4%,大于患者PSAD、前列腺体积、PSA上升速度、f-PSA/t-PSA、DRE等单因素的66.9%、72.6%、69.6%、69.3%、58.5%。结论:该数学模型是临床多因素综合分析基础上建立的,可以很好地预测前列腺重复穿刺活检阳性的概率。     

前列腺液中B7-H3分子表达对t-PSA灰区内炎性PSA升高的鉴别诊断价值

目的 探讨前列腺液(EPS)中B7-H3分子对血清t-PSA灰区(4～10 ng/ml)内炎性PSA升高患者的鉴别诊断价值.方法 选择2009年12月至2010年4月收治的全部慢性前列腺炎(CP)患者和t-PSA灰区内行前列腺穿刺活检患者共116例,年龄19～80岁,平均40岁.CP 91例,年龄19～49岁,平均31岁.其中慢性细菌性前列腺炎(II型)11例、慢性炎症性非细菌前列腺炎(IIIA型)26例、慢性非炎症性非细菌前列腺炎(IIIB型)54例.t-PSA灰区内接受经直肠超声引导下前列腺穿刺活检患者25例,年龄62～80岁,平均71岁,t-PSA(7.21±2.60)ng/ml.其中穿刺病理结果阳性5例,Gleason评分6分2例、7分2例、8分1例;阴性20例,其中伴炎症细胞浸润11例.采用经直肠按摩法提取EPS.酶联免疫吸附法检测各组EPS B7-H3水平.健康男性对照11例,年龄24～46岁,平均30岁.既往无泌尿系不适症状及手术史.结果 对照组、II型组、IIIA型组、IIIB型组EPS中B7-H3水平依次为(49.81±11.54)、(19.33±13.90)、(17.67±15.76)、(25.14±13.44)ng/ml,穿刺阳性组、阴性不伴炎症组、阴性伴炎症组分别为(26.30±16.32)、(30.23±18.42)、(10.11±5.42)ng/ml.CP各组EPS B7-H3水平均低于对照组,差异有统计学意义(P＜0.01).II型组和IIIA型组间差异无统计学意义(P＞0.05),但均显著低于IIIB型组,差异有统计学意义(P＜0.05).穿刺阴性伴炎症组EPS中B7-H3水平与II型组、IIIA型组比较差异无统计学意义(P＞0.05),但显著低于穿刺阳性组及阴性不伴炎症组,差异有统计学意义(P＜0.05).EPS B7-H3表达检测在t-PSA灰区内诊断炎性PSA升高患者的ROC曲线下面积为0.883(P=0.001),当EPS B7-H3值≤16.24 ng/ml时,诊断敏感性为78.6%,特异性为81.8%.结论 EPS B7-H3表达检测可能成为t-PSA灰区内鉴别诊断炎性PSA升高的新指标,从而减少不必要的前列腺穿刺活检.

Abstract：

Objective To investigate the value of B7-H3 in expressed prostatic secretions (EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone (4-10 ng/ml). Methods One hundred and sixteen patients from the ages of 19 to 80 years (mean, 40 years) were stu-died. In the group there were 91 chronic prostatitis (CP) patients (mean age 31 years, 19-49 years), including 11 chronic bacterial prostatitis (type II) patients, 26 inflammatory nonbacterial prostatitis (IIIA) patients and 54 noninflammatory nonbacterial prostatitis (IIIB) patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients (mean age 71 years, 62-80 years) with t-PSA in gray zone (7.21±2.60 ng/ml). Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays (ELISA) were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years (24-46 years) were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery.Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81±11.54, 19.33±13.90, 17.67±15.76, 25.14±13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, noninflammatory negative biopsy and inflammatory negative biopsy groups were 26.30±16.32, 30.23±18.42, 10.11±5.42 ng/ml, respectively. The highest levels were found in the control group (P<0.01). Compared to the IIIB, B7-H3 levels in II and IIIA groups were significantly lower (P<0.05). There was no significantly difference between II and IIIA groups (P>0.05). The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups (P<0.05). But no significant differences were found among inflammatory negative biopsy, II and IIIA groups (P>0.05). Receiver operating curve (AUC=0.883, P=0.001) utilizing EPS B7-H3 levels≤16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a specificity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy.     

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）。     

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.     

Effect of NIH-IV prostatitis on free and free-to-total PSA

OBJECTIVE: To examine the effect of asymptomatic prostatic inflammation (NIH category IV prostatitis) on total PSA (tPSA), free serum PSA (fPSA) and the ratio of free-to-total prostate specific antigen (%fPSA). The role of free and %fPSA as a diagnostic tool for distinguishing between cancer and non-malignant diseases of the prostate was also investigated. MATERIAL AND METHODS: In a retrospective study 1090 prostate biopsies performed between January 2000 and September 2003 were evaluated and the levels of serum total and free PSA as well as the f/tPSA ratio were determined in samples obtained immediately before biopsy. 404 patients with full clinical and histological records were included in the study. All patients underwent 6 or 8 core primary prostate needle biopsies. RESULTS: A total of 404 patients were included in the analysis. 100 prostate cancer (PCa) (24.8%), 137 NIH-IV prostatitis (33.9%) and 143 patients with benign prostatic hyperplasias (BPH) (35.4%) were identified. 24 (5.9%) patients presented with both PCa and prostatitis on histology and were excluded from further analysis. The mean (median) levels of tPSA, fPSA and %fPSA were 11.94 ng/ml (8.0), 1.31 ng/ml (1.07) and 0.15 (0.14) for NIH-IV prostatitis; 11.94 ng/ml (8.35), 1.54 ng/ml and 0.13 (0.11) for prostate cancer; and 8.19 ng/ml (7.0), 1.48 ng/ml (1.03) and 0.18 (0.15) for BPH. No significant difference was found in tPSA levels between PCa and prostatitis (p = 0.32), while the difference in tPSA levels between PCa and BPH was significant (p = 0.007). Free PSA alone had no diagnostic power in distinguishing PCa from prostatitis (p = 0. 37) and BPH (p = 0. 61). By contrast, the f/tPSA ratio showed significant between-group differences (PCa versus prostatitis (p = 0. 011), PCa versus BPH (p = 0.0001). CONCLUSIONS: Chronic asymptomatic prostatitis NIH category IV has similar effects on total PSA and free PSA levels in serum as PCa. fPSA alone cannot distinguish prostate cancer from non-malignant inflammatory disease of the prostate. The ratio of free-to-total PSA is significantly different in PCa and NIH category IV prostatitis.     

PSA相关标志物在前列腺癌诊断中的价值

目的 探讨在前列腺特异抗原(prostate specific antigen,PSA)灰区(PSA 4～10ng/mL)患者中,血清总PSA及游离PSA比值(f/tPSA)、前列腺特异性抗原密度(PSAD)和(f/t) PSA/PSAD值对穿刺病理结果的诊断价值.方法 回顾2008年1月至2016年3月本院接受经直肠超声(transrectal ultrasound,TRUS)引导下前列腺穿刺的患者929例,对其中249例PSA 4～ 10 ng/mL患者的临床资料进行了整理分析.根据病理结果,分为前列腺癌组(PCa组)38例(15.26％),前列腺增生组(BPH组)211例(84.74％).对患者年龄、tPSA、f/tPSA、体积、PSAD、(f/t) PSA/PSAD值进行统计学分析.结果 两组患者的年龄水平比较差异无统计学意义(P＞0.05);在f/tPSA、体积、(f/t) PSA/PSAD水平,BPH组大于PCa组;在tPSA、PSAD水平,PCa组大于BPH组,差异均有统计学意义(P＜0.05).PCa组患者中f/tPSA或PSAD异常者32例,占84.21％:BPH组中f/tPSA或PSAD异常者110例,占52.13％,差异有统计学意义(X2=13.52,P ＜0.005).结论 f/tPSA和PSAD异常对PSA灰区的患者是否行前列腺穿刺具有指导意义.如果f/tPSA和PSAD结果相矛盾,f/tPSA联合PSAD、PSAD联合(f/t) PSA/PSAD的诊断价值相对较高.     

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     

慢性前列腺炎在前列腺增生症发病与进展中的作用探讨

目的 探讨慢性前列腺炎在前列腺增生症发病与进展中的可能作用.方法 回顾性分析本院2011年5月至2014年12月期间因前列腺增生就诊患者356例,根据术后病理结果分为前列腺增生并慢性前列腺炎组及单纯性前列腺增生组,统计分析两组临床特征,包括:年龄(Age)、前列腺体积(PV)、PSA、IPSS评分、是否合并急性尿潴留(AUR).结果 前列腺增生并慢性前列腺炎121/356例(34.0％),发生急性尿潴留48/121例(39.7％);单纯前列腺增生235/356例(66.0％),发生尿潴留60/235例(25.5％).两组对比年龄差别无统计学意义(P＞0.05);但前列腺增生合并慢性前列腺炎组较单纯前列腺增生组PV、PSA、IPSS评分、尿潴留发生率均高,差别具有统计学意义(P＜0.05).结论 前列腺增生合并慢性前列腺炎通常具有更大的体积、更高的PSA及IPSS评分、更易发生尿潴留.因此,前列腺慢性炎症在前列腺增生的发病、进展中可能起作用.     

组蛋白去乙酰化酶在前列腺癌组织中表达的意义

目的 研究组蛋白去乙酰化酶(HDAC)在前列腺癌(PCa)组织中表达的意义。 方法 经病理确诊PCa组织标本37例,患者年龄57 ～ 88岁,平均73岁。穿刺前t-PSA 3.13～2000 ng/ml,中位数81.69 ng/ml。Gleason评分≤7分13例,＞7分24例。以27例良性前列腺增生(BPH)组织标本为对照组,患者年龄52～84岁,平均69岁。穿刺前t-PSA 1.11～55.07 ng/ml,中位数10.93 ng/ml。应用蛋白质印迹法和比色法酶活性试剂盒检测HDAC在PCa和BPH组织中的表达及活性,比较PCa和BPH组织中酶活性差异,分析PCa组织中HDAC表达水平与血清PSA和Gleason评分的相关性。 结果 PCa组织中HDAC1、HDAC2、HDAC3和HDAC4表达率分别为57％、68％、84％和73％,PCa组织中HDAC活性（平均A值0.725）明显高于BPH组织（平均A值0.451）,2组比较差异有统计学意义（P＜0.05）;PCa组织中HDAC表达与血清PSA、Gleason评分无相关性。 结论 PCa 组织中存在HDAC表达水平升高和酶活性增强,提示HDAC可能成为治疗PCa的新靶点。     

The correlation between serum prostate specific antigen levels and asymptomatic inflammatory prostatitis

Introduction Asymptomatic inflammatory prostatitis is a common pathological finding in patients with benign prostatic hyperplasia (BPH). In the present study, we evaluated the correlation between serum prostate specific antigen (PSA) level and extent and aggressiveness of inflammation in surgical specimens of patients who underwent to surgery for BPH without any evidence of clinical prostatitis. Methods Histological sections of the prostatic tissues of 52 patients were scored for the extent of inflammation and aggressiveness of inflammation, using the four point scale designed by Irani et al. Extent of inflammation is graded from 0 to 3 according to the degree of invasion of inflammatory cells in prostate tissue. Aggressiveness of inflammation is graded from 0 to 3 according to the degree of contact or disruption of prostatic glandular epithelium by inflammatory cells. The serum PSA levels in different inflammation grades were compared. Results There was a significant correlation between inflammation and aggressiveness scores (r = 0.39, P < 0.01). Median PSA levels in grades 1, 2 and 3 extent of inflammation were 2.4, 5.2 and 5.7 ng/ml, respectively. There was not any significant difference between these grades for PSA. Furthermore, median PSA levels in grades 1, 2 and 3 aggressiveness of inflammation were 4.4, 4.8 and 8.7 ng/ml, respectively. There was a significant difference between grades of aggressiveness of inflammation and PSA levels. Conclusion High serum PSA levels may correlate with asymptomatic inflammatory prostatitis with high aggressiveness score in BPH patients without clinical prostatitis.     

良性前列腺增生并发前列腺炎患者前列腺液白细胞介素水平与前列腺特异性抗原的相关性研究

目的研究良性前列腺增生(BPH)并发前列腺炎患者的前列腺液白细胞介素水平和前列腺特异性抗原(PSA)的相关性。方法回顾本院2014年7月到2018年1月本院收治的115例良性前列腺增生患者的临床资料,分析其并发前列腺炎的情况、前列腺液白细胞介素水平、总PSA(TPSA)和游离PSA(FPSA)及FPSA/TPSA。结果115例BPH患者中有76例并发前列腺炎,其中I级炎症37例、II级炎症25例、III级炎症13例。III级炎症组的炎症范围、炎症程度均显著高于I级、II级炎症组,差异均有统计学意义(P<0.05)。III级炎症组的IL-2、IL-6、IL-8、IL-10均显著高于I级炎症组、II级炎症组,差异均有统计学意义(P<0.01)。III级炎症组的TPSA、FPSA显著高于I级炎症组、II级炎症组,差异均有统计学意义(P<0.01);三组的FPSA/TPSA比较,差异无统计学意义(P>0.05)。经Pearson直线相关法分析,BPH并发前列腺炎患者的前列腺液IL-2与PSA、FPSA均无显著相关性(P>0.05);前列腺液IL-6、IL-8、IL-10与TPSA、FPSA均呈显著正相关(P<0.05)。结论BPH并发前列腺炎是患者PSA升高的危险因素,且患者前列腺液的IL-6、IL-8、IL-10水平与PSA存在良好的相关性,临床可据此进行BPH并发前列腺炎的诊断和治疗,以提高临床疗效。