前列腺癌患者血清前列腺特异抗原水平与Gleason评分相关性分析

目的 分析前列腺癌患者血清中前列腺特异性抗原(PSA)水平、游离前列腺特异抗原与总前列腺特异抗原的比值(f-PSA/t-PSA)与Gleason评分的相关性，探讨血清PSA水平在前列腺癌诊断和鉴别中的临床应用价值。 方法 回顾性分析2014年6月—2015年9月在绍兴市人民医院泌尿外科治疗的109例前列腺癌患者的临床资料，所有患者均在B超引导下经直肠前列腺活检确诊为前列腺癌，根据患者的临床资料统计有无家族遗传史，并依据癌症TNM分类标准统计患者的临床分期，统计不同分类患者血清PSA平均水平，评价患者血清PSA、f-PSA/t-PSA水平与前列腺病理组织的Gleason评分的相关性。 结果 有家族患病史患者的平均血清PSA水平为(323.59±267.15)ng/ml，远高于没有家族史的患者(198.11±100.22)ng/ml，P＜0.05；不同TNM临床分期患者的血清PSA水平差异较大，Ⅰ期患者的血清PSA水平最低，平均为(6.28±4.08)ng/ml,Ⅳ期最高，为(459.08±123.01)ng/ml；前列腺癌患者血清PSA水平与前列腺组织病理切片的Gleason评分呈正相关(r=0.367,P＜0.001)。低分化癌患者的平均血清f-PSA/t-PSA为0.145±0.017,中分化癌患者为0.225±0.021,高分化癌患者为0.345±0.104,前列腺癌病理组织的Gleason评分与血清f-PSA/t-PSA成负相关(r=-0.378，P=0.008)。 结论 血清前列腺素特异抗原与前列腺组织Gleason评分具有相关性，对前列腺癌的早期临床诊断和治疗有重要意义，应列入前列腺癌的筛查方案。 

Correlation between PSA level and Gleason score in prostate cancer

Objective To analyze the correlation between serum PSA level,free prostate specific antigen/total rostate specific antigen(f-PSA/t-PSA) and Gleason score in prostate cancer,and to investigate the value of PSA in the diagnosis and identification of prostate cancer. Methods The clinical data of 109 cases of prostate cancer patients who were treated in urology of Shaoxing City People’s Hospital from June 2014 to September 2015 were retrospectively analyzed,and all patients were diagnosed as prostate cancer with the help of prostate biopsy guided by ultra-B.Patients were divided into different groups according to the clinical data,with/without family genetic history,and on the basis of Cancer TNM classification.The serum PSA level of patients in different family history and clinical stage was analyzed,and the correlation between serum PSA level,f-PSA/t-PSA and Gleason score in prostate cancer was evaluated. Results The mean serum PSA level of patients with a family history of prostate cancer was(323.59±267.15)ng/ml,higher than that of no family history,(198.11±100.22)ng/ml,P<0.05,and the difference was statistically significant.The serum PSA level in patients with different clinical stages were quite different,lowest in Ⅰ period,(6.28±4.08)ng/ml,highest in Ⅳ period(459.08±123.01)ng/ml.The serum PSA level of prostate cancer was positively correlated with prostate tissue biopsy Gleason score(r=0.367,P＜0.001).Mean serum free/total prostate-specific antigen in patients with poorly differentiated carcinoma was 0.145±0.017,differentiation of carcinoma was 0.225±0.021,well differentiated carcinoma was 0.345±0.104,and prostate cancer pathological Gleason score was negative correlated to serum f-PSA/t-PSA(r=-0.378,P=0.008). Conclusion The serum prostaglandin specific antigen was correlated with Gleason score,and serum PSA level was important for the clinical diagnosis and treatment of prostate cancer,and it should be included in the screening program for prostate cancer.