Wolff J M, Brehmer B, Borchers H, Rohde D, Jakse G
Department of Urology, University of Rostock, E-Heydemann Str. 6, 18055 Rostock, Germany.
Anticancer Res. 2000 Nov-Dec;20(6D):4981-3.
At present PSA is Considered to be the leading screening test for prostate cancer. We determined whether in men 60 to 79 year old with a serum prostate specific antigen (PSA) within age specific PSA reference ranges prostate biopsy could be safely eliminated.
We retrospectively analysed all 60-79 year old men who had undergone radical perineal prostatectomy (RPP) for prostate cancer (CaP) at our institution. All patients had undergone prostate biopsy following an abnormal rectal examination and/or PSA greater than 4.0 ng/ml. We compared our results using the standard reference range of 0 to 4.0 ng/ml with those we had obtained using the age specific PSA reference ranges of Oesterling et al.
204 men between 60-69 years and 67 men between 70-76 years had undergone RPP for CaP. Applying age specific PSA reference ranges 56 CaP would have been overlooked. Of those 46% had a favourable histology. Taken together 54% of the cancers overlooked had an unfavourable histology.
In contrast to previous reports of unfavourable histological characteristics in only 5-24% of missed cancers, applying age specific PSA reference ranges, 54% of missed cancers in our patients exhibited an unfavourable histology. We therefore conclude that age specific PSA reference ranges did not safely eliminate the need for prostate biopsy in our study population.
目前，前列腺特异性抗原（PSA）被认为是前列腺癌的主要筛查检测方法。我们确定了对于年龄在60至79岁、血清前列腺特异性抗原（PSA）在特定年龄的PSA参考范围内的男性，是否可以安全地免去前列腺活检。
我们回顾性分析了在我们机构接受根治性会阴前列腺切除术（RPP）治疗前列腺癌（CaP）的所有60至79岁男性。所有患者在直肠检查异常和/或PSA大于4.0 ng/ml后均接受了前列腺活检。我们将使用0至4.0 ng/ml的标准参考范围得到的结果与使用奥斯特林等人的特定年龄PSA参考范围得到的结果进行了比较。
204名60至69岁的男性和67名70至76岁的男性接受了RPP治疗CaP。应用特定年龄的PSA参考范围，56例CaP会被漏诊。其中46%的组织学结果良好。综合来看，漏诊的癌症中有54%的组织学结果不良。
与之前报道的仅5 - 24%的漏诊癌症具有不良组织学特征不同，应用特定年龄的PSA参考范围时，我们患者中54%的漏诊癌症表现出不良组织学特征。因此，我们得出结论，在我们的研究人群中，特定年龄的PSA参考范围并不能安全地免去前列腺活检的必要性。
