Roehrborn C G, McConnell J D, Lieber M, Kaplan S, Geller J, Malek G H, Castellanos R, Coffield S, Saltzman B, Resnick M, Cook T J, Waldstreicher J
Department of Urology, University of Texas Southwestern Medical Center at Dallas, 75235-9110, USA.
Urology. 1999 Mar;53(3):473-80. doi: 10.1016/s0090-4295(98)00654-2.
Prostate-specific antigen (PSA) is produced exclusively in the prostate gland and is currently the most useful clinical marker for the detection of prostate cancer. In this report, we examine whether serum PSA is also a predictor of important benign prostatic hyperplasia (BPH)-related outcomes, acute urinary retention (AUR), and the need for BPH-related surgery.
Three thousand forty men were treated with either placebo or finasteride in a double-blind, randomized study of 4-year duration. Serum PSA was measured at baseline, and baseline prostate volume was measured in a 10% subset of 312 men. Probabilities and cumulative incidences of AUR and BPH-related surgery, as well as reduction in risk of events with finasteride, were calculated for the entire patient population, stratified by treatment assignment, baseline serum PSA, and prostate volume.
The risk of either needing BPH-related surgery or developing AUR ranged from 8.9% to 22.0% during the 4 years in placebo-treated patients stratified by increasing prostate volume and from 7.8% to 19.9% when stratified by increasing serum PSA. In comparison with symptom scores, flow rates, and residual urine volume, receiver operating characteristic curve analyses showed that serum PSA and prostate volume were the most powerful predictors of spontaneous AUR in placebo-treated patients (area under the curve 0.70 and 0.81, respectively). Finasteride treatment reduced the relative risk of needing surgery or developing AUR by 50% to 74% and by 43% to 60% when stratified by increasing prostate volume and serum PSA, respectively.
Serum PSA and prostate volume are powerful predictors of the risk of AUR and the need for BPH-related surgery in men with BPH. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers in predicting the risk of BPH-related outcomes and choosing therapy for BPH.
前列腺特异性抗原（PSA）仅由前列腺产生，是目前检测前列腺癌最有用的临床标志物。在本报告中，我们研究血清PSA是否也是重要的良性前列腺增生（BPH）相关结局、急性尿潴留（AUR）以及BPH相关手术需求的预测指标。
在一项为期4年的双盲、随机研究中，3040名男性接受了安慰剂或非那雄胺治疗。在基线时测量血清PSA，并在312名男性的10%亚组中测量基线前列腺体积。计算了整个患者群体中AUR和BPH相关手术的概率和累积发生率，以及非那雄胺治疗使事件风险降低的情况，并按治疗分配、基线血清PSA和前列腺体积进行分层。
在安慰剂治疗的患者中，按前列腺体积增加分层时，4年内需要进行BPH相关手术或发生AUR的风险在8.9%至22.0%之间；按血清PSA增加分层时，风险在7.8%至19.9%之间。与症状评分、流速和残余尿量相比，受试者工作特征曲线分析表明，血清PSA和前列腺体积是安慰剂治疗患者自发性AUR的最有力预测指标（曲线下面积分别为0.70和0.81）。非那雄胺治疗分别按前列腺体积增加和血清PSA增加分层时，将需要手术或发生AUR的相对风险降低了50%至74%和43%至60%。
血清PSA和前列腺体积是BPH男性发生AUR风险和BPH相关手术需求的有力预测指标。了解基线血清PSA和/或前列腺体积是帮助医生和决策者预测BPH相关结局风险并选择BPH治疗方法的有用工具。
