Erdem Erim, Atsü Necmettin, Akbal Cem, Bilen Cenk Y, Ergen Ali, Ozen Haluk
Hacettepe University Medical Faculty, Department of Urology, Turkey.
Int Urol Nephrol. 2002;34(4):519-23. doi: 10.1023/a:1025685718493.
Curative therapy and extended period of disease free survival for patients with prostate cancer is possible only if the radical prostatectomy is performed when the disease is organ confined. It has been shown that combined use of local clinical stage, Gleason score of transrectal needle biopsy and serum PSA can accurately predict the final pathological stage in men undergoing radical prostatectomy. Recently the free/total PSA (F/T PSA) has been shown to improve the specificity of serum PSA level in early detection prostate cancer. In this study the utility of F/T PSA ratio in prediction the final pathological features of the prostate cancer was investigated.
52 patients who had undergone radical prostatectomy were included in this study with mean age of 63 (ranging from 49 to 73). According to the pathologic features of the tumors, patients were classified as organ confined in 37 (%71), specimen-confined in 39 (%75) and as with favorable pathology which was defined as organ confined or specimen confined with Gleason score lower than 7, 39 (%75) patients.
Neither total PSA levels nor F/T PSA values correlate significantly with the pathological characteristics of the tumor. The logistic regression analysis showed that the biopsy Gleason score was the only variable that was able to predict the pathology of the tumor (p < 0,05).
As a conclusion Gleason score of the needle biopsy specimen is the most predictive factor of the final pathological outcome. F/T PSA ratio did not provide additional information about predicting pathological stage.
只有在疾病局限于器官内时进行根治性前列腺切除术，前列腺癌患者才有可能获得治愈性治疗并延长无病生存期。研究表明，联合使用局部临床分期、经直肠穿刺活检的 Gleason 评分和血清 PSA 可准确预测接受根治性前列腺切除术男性的最终病理分期。最近，游离/总 PSA（F/T PSA）已被证明可提高血清 PSA 水平在早期检测前列腺癌中的特异性。在本研究中，对 F/T PSA 比值在预测前列腺癌最终病理特征方面的效用进行了研究。
本研究纳入了 52 例接受根治性前列腺切除术的患者，平均年龄为 63 岁（范围为 49 至 73 岁）。根据肿瘤的病理特征，患者被分类为 37 例（71%）器官局限型、39 例（75%）标本局限型以及 39 例（75%）具有良好病理特征（定义为器官局限或标本局限且 Gleason 评分低于 7）的患者。
总 PSA 水平和 F/T PSA 值均与肿瘤的病理特征无显著相关性。逻辑回归分析表明，活检 Gleason 评分是唯一能够预测肿瘤病理的变量（p < 0.05）。
总之，穿刺活检标本的 Gleason 评分是最终病理结果的最具预测性的因素。F/T PSA 比值在预测病理分期方面未提供额外信息。
