Nam R K, Diamandis E P, Toi A, Trachtenberg J, Magklara A, Scorilas A, Papnastasiou P A, Jewett M A, Narod S A
Division of Urology, Department of Diagnostic Imaging, Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada.
J Clin Oncol. 2000 Mar;18(5):1036-42. doi: 10.1200/JCO.2000.18.5.1036.
We hypothesize that serum human glandular kallikrein-2 (hK2) levels predict the presence of prostate cancer among men prescreened by prostate-specific antigen (PSA).
We conducted a cross-sectional study of 324 men who had no history of prostate cancer and who were referred for prostate biopsy. PSA and hK2 levels were measured using specific nonisotopic immunometric techniques. Cases were patients who were diagnosed with adenocarcinoma of the prostate from biopsy, and controls were patients who had no evidence of cancer from biopsy. The odds ratio for detection of prostate cancer was determined for hK2 measurements, controlling for age, total-PSA level, digital rectal examination, and symptoms of urinary obstruction.
Of 324 men, 159 (49.1%) had cancer. Mean hK2 levels and hK2:free-PSA ratios were significantly higher in cases than in controls (1.18 v 0.53 ng/mL, respectively, for hK2, P =.0001; 1.17 v 0.62 for hK2:free-PSA ratio, P =.0001). The crude odds ratio for prostate cancer detection for patients in the highest quartile of hK2 level was 5.83 (95% confidence interval [CI], 2.8 to 12.1; P =.0001) compared with patients in the lowest quartile. The adjusted odds ratio was 6.72 (95% CI, 2.9 to 15.6; P =.0001). Similarly, the crude and adjusted odds ratios for prostate cancer detection using the hK2:free-PSA ratio were 7.36 (95% CI, 3.6 to 15.1; P =.0001) and 8.06 (95% CI, 3. 7 to 17.4; P =.0001), respectively. These odds ratios were higher than that observed for prostate cancer detection by total-PSA level (2.73; P =.03).
Among men prescreened with PSA for prostate cancer, patients with high hK2 measurements have a five- to eight-fold increase in risk for prostate cancer, adjusting for PSA level and other established risk factors. hK2 measurements may be a useful adjunct to PSA in improving patient selection for prostate biopsy.
我们假设血清人腺激肽释放酶-2（hK2）水平可预测经前列腺特异性抗原（PSA）初筛的男性是否患有前列腺癌。
我们对324名无前列腺癌病史且被转诊接受前列腺活检的男性进行了一项横断面研究。采用特异性非同位素免疫测定技术测量PSA和hK2水平。病例为经活检诊断为前列腺腺癌的患者，对照为经活检无癌症证据的患者。在控制年龄、总PSA水平、直肠指检和尿路梗阻症状的情况下，确定hK2测量值检测前列腺癌的比值比。
324名男性中，159名（49.1%）患有癌症。病例组的平均hK2水平和hK2:游离PSA比值显著高于对照组（hK2分别为1.18对0.53 ng/mL，P = 0.0001；hK2:游离PSA比值为1.17对0.62，P = 0.0001）。hK2水平处于最高四分位数的患者与最低四分位数的患者相比，检测前列腺癌的粗比值比为5.83（95%置信区间[CI]，2.8至12.1；P = 0.0001）。调整后的比值比为6.72（95% CI，2.9至15.6；P = 0.0001）。同样，使用hK2:游离PSA比值检测前列腺癌的粗比值比和调整后的比值比分别为7.36（95% CI，3.6至15.1；P = 0.0001）和8.06（95% CI，3.7至17.4；P = 0.0001）。这些比值比高于通过总PSA水平检测前列腺癌所观察到的比值比（2.73；P = 0.03）。
在经PSA初筛前列腺癌的男性中，hK2测量值高的患者患前列腺癌的风险增加五至八倍，调整了PSA水平和其他既定风险因素后依然如此。hK2测量值可能是PSA的一种有用辅助手段，有助于改善前列腺活检患者的选择。
