Lee S E, Kwak C, Park M S, Lee C H, Kang W, Oh S J
Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
Urology. 2000 Dec 20;56(6):1007-10. doi: 10.1016/s0090-4295(00)00837-2.
To further improve the use of prostate-specific antigen (PSA) as a screening test for prostate cancer in Asian countries, we sought to establish the normal distribution of serum PSA values in Korean men, because, until recently, studies conducted to establish normal serum PSA values have involved few Asian populations.
Between May 1995 and June 1997, 5805 healthy Korean men 30 to 79 years old who visited our hospital for a routine health checkup were entered into a prospective study of early screening for prostate cancer. All men underwent detailed clinical examinations, including a digital rectal examination and serum PSA determination. All men who were more than 50 years old with abnormal digital rectal examination findings and/or an elevated serum PSA level (greater than 4.0 ng/mL) also underwent transrectal ultrasound-guided sextant biopsy. Four were found to have cancer and were excluded from the analysis.
The median serum PSA concentration (5th to 95th percentile range) was 0.8 ng/mL (0.2 to 1.8) for patients 30 to 39 years old (n = 1382); 0.8 ng/mL (0.2 to 2.0) for patients 40 to 49 years old (n = 1776); 0.9 ng/mL (0.2 to 2.4) for those 50 to 59 years old (n = 1775); 1.0 ng/mL (0.2 to 3.9) for men 60 to 69 years old (n = 746); and 1.3 ng/mL (0.5 to 6.3) for patients 70 to 79 years old (n = 122). The serum PSA concentration correlated with age (P <0.001), with an increase by approximately 1.2% annually, although the statistical correlation was weak (r = 0.16). Almost no change occurred in the median serum PSA value in patients 50 years old or younger; a gradual increase was observed in patients older than 50. In those 50 years old or older, the median and 95th percentile serum PSA values for Korean men were lower than those for white men.
Contrary to earlier observations that the serum PSA level strongly correlates with age, the influence of age on serum PSA was found to be weaker in this study. Moreover, the results also demonstrated that the distribution of the serum PSA level differs along ethnic lines. The cutoff value for serum PSA in mass screening for prostate cancer should be adjusted in nonwhite races.
为了进一步改善前列腺特异性抗原（PSA）在亚洲国家作为前列腺癌筛查检测方法的应用，我们试图确定韩国男性血清PSA值的正态分布，因为直到最近，为确定正常血清PSA值而开展的研究涉及的亚洲人群很少。
在1995年5月至1997年6月期间，5805名年龄在30至79岁之间来我院进行常规健康检查的韩国健康男性被纳入一项前列腺癌早期筛查的前瞻性研究。所有男性均接受了详细的临床检查，包括直肠指检和血清PSA测定。所有年龄超过50岁且直肠指检结果异常和/或血清PSA水平升高（大于4.0 ng/mL）的男性还接受了经直肠超声引导的六分区活检。有4人被发现患有癌症并被排除在分析之外。
30至39岁患者（n = 1382）的血清PSA浓度中位数（第5至95百分位数范围）为0.8 ng/mL（0.2至1.8）；40至49岁患者（n = 1776）为0.8 ng/mL（0.2至2.0）；50至59岁患者（n = 1775）为0.9 ng/mL（0.2至2.4）；60至69岁男性（n = 746）为1.0 ng/mL（0.2至3.9）；70至79岁患者（n = 122）为1.3 ng/mL（0.5至6.3）。血清PSA浓度与年龄相关（P <0.001），每年约增加1.2%，尽管统计相关性较弱（r = 0.16）。50岁及以下患者的血清PSA中位数几乎没有变化；50岁以上患者则观察到逐渐升高。在50岁及以上人群中，韩国男性的血清PSA中位数和第95百分位数低于白人男性。
与早期观察到的血清PSA水平与年龄密切相关相反，本研究发现年龄对血清PSA的影响较弱。此外，结果还表明血清PSA水平的分布因种族而异。在前列腺癌群体筛查中，血清PSA的临界值应在非白种人中进行调整。
