TURP对BPH患者血清PSA水平的影响

目的:通过经尿道前列腺电切术(TURP)的BPH患者血清前列腺特异抗原(PSA)的近、远期变化,探讨TURP前后PSA变化的价值及PSA变化与切除程度的相关性。方法:前瞻性队列研究209例接受TURP的BPH患者术前、术后5天、术后1个月、术后3个月、术后半年的血清PSA水平变化及PSA变化与切除程度的相关性。结果:术前PSA水平为(9.82±9.60)μg/L,术后5天为(5.40±4.04)μg/L,术后1个月为(3.5±3.15)μg/L,术后3个月为(2.56±1.13)μg/L,术后半年为(3.47±1.04)μg/L。术后5天与术前相比,PSA下降约(4.42±8.78)μg/L,术后1个月降至术前的35%,5段时间PSA水平互相对比,差异均有统计学意义(P0.01)。PSA4μg/L组PSA下降后仍高于PSA≤4μg/L组。TURP的实际切除质量与应该切除质量相减的均数±标准差,总样本为(-0.941±9.56)μg/L,PSA≤4μg/L组为(0.13±10.53)μg/L,PSA4μg/L组为(-3.83±5.41)μg/L。PSA的变化与切除程度呈正相关(P0.01,R=0.91),并且PSA≤4μg/L组与PSA4μg/L组PSA的变化均与切除程度呈正相关(P0.01,1=0.986,R2=0.924),两组间差别无统计学意义。结论:PSA在TURP后呈下降趋势,于1个月左右降至正常水平,并且TURP切除的范围越足够,PSA下降的幅度越大。术后长期随访BPH患者TURP后血清PSA水平,能减少前列腺癌的误诊及漏诊。对于监测术前PSA4μg/L的BPH患者应以其术后自身PSA基线为准,衡量其前列腺穿刺活检的指征及前列腺癌的诊断。

Effect of TURP on PSA level in the serum of BPH patients

Objective：Through short and long term changes of PSA in BPH patients serum after TURP, to explore the value of PSA change before and after TURP and the relation with the degree of resection. Method： Prospective analysis of 209 cases of BPH patients PSA by TURP with the changes of serum PSA levels before surgery, five days, one month, three months, six months postoperatively and the correlation with the degree of resec tion. Result：We considered preoperative PSA〉4μg/L as high PSA group and PSA≥4 μg/L as low PSA group. The results of PSA at five time points were as follows： preoperative PSA level was （9.82±9.60）μg/L; postoperative five days was （5.40±4.04） μg/L, postoperative one month was （3. 5± 3. 15） μg/L, postoperative three months was （2.56±1.13） μg/L, postoperative six months was （3.47±1.04） μg/L. The postoperative five days＇ PSA level declined （4.42±8.78） μg/L compared with preoperative condition, and 35% drop occurred one month postoperatively. The level of PSA showed significantly different （P〈0.01） among the above five time points. The changes of PSA with the removal degree has positive correlation （P〈0.01, R=0.91）. Moreover, there was posi- tive crrelation between the changes of PSA and the removal degree in two groups （P〈0.01, R1 = 0. 986, R2 0. 924）. The difference between two groups was not significant. Conclusion.. It turned downward trend in PSA af- ter TURP and reduced to normal levels in about a month. The more resected tissue by TURP is, the more greatly the level of PSA decreased. Monitoring serum PSA levels at postoperative long-term follow-up of BPH patients after TURP can reduce misdiagnosis and missed diagnosis of prostate cancer. For those BPH patients whose PSA〉 4μg/L preoperatively, the diagnostic standard of prostate cancer and biopsy should be based on their own postoperative level.