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.

The value of different serum prostate specific antigens in the differential diagnosis of prostate cancer and benign prostate hyperplasia

Objective To study the value of a series of indexes derived from prostate specific antigens (PSA) in differential diagnosis of prostate cancer (PCa) and benign prostate hyperplasia (BPH). Methods The difference in serum total PSA (t-PSA), free PSA (f-PSA), combined PSA (c-PSA), fPSA/c-PSA and c-PSA/t-PSA between 107 cases of PCa and 319 cases of BPH from 5 hospitals was compared. Results The percentage of patients with serum t-PSA between 4-20 μ/L was 68.2% and 32.9% in PCa and BPH respectively. The difference in t-PSA,f-PSA, c-PSA,f-PSA/t-PSA and c-PSA/t-PSA was statistically significant between PCa and BPH (P<0.05 ). f-PSA/t-PSA and c-PSA/t-PSA had no statistically significant difference among various age groups (P>0.05), indicating that the two indexes were not fluctuant with age. When serum t-PSA was 4-20 μg/L, the sensitivity, specificity, positive predictive value, and negative predictive value of f-PSA/t-PSA <0. 16 to PCa were 89.0% ,78.0% ,60.7% and 94.6% respectively,and those of c-PSA/t-PSA >0.84 to PCa were 91.8% ,81.3% ,66.3% and 96.1% ,respectively. Conclusion The value of serum t-PSA was overlapped in the interval of 4 to 20 μg/L between PCa and PSA. f-PSA/t-PSA <0.16 and c-PSA/t-PSA >0.84 may be good standards in diagnosis of PCa.