Wu Tony T, Huang Jong-Khing
Division of Urology, Kaohsiung Veterans General Hospital, and Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
Urol Int. 2004;72(3):208-11. doi: 10.1159/000077116.
To determine the role of prostate-specific antigen (PSA) level and age-specific PSA reference ranges for detecting prostate cancer in Chinese.
We retrospectively reviewed the medical records of all 50- to 79-year-old men who had their first-time prostatic biopsy done at our institute between January 1998 and December 2000. We evaluated the effect on biopsy rate and cancer detection if the PSA cutoff was shifted from 4.0 ng/ml to the age-specific reference ranges. Also, we tried to develop age-adjusted PSA cutoffs for Chinese.
Among 1,236 men enrolled, 252 (20.4%) were diagnosed as prostate cancers. The positive predictive value was 22.2% for PSA >4.0 ng/ml. Using the traditional age-specific PSA reference ranges 134 (10.8%) biopsies could be avoided but five (1.98%) cancers would be missed. We proposed age-specific PSA reference ranges for Chinese as: 0-4.0 ng/ml for men in their 50s and 0-6.0 ng/ml for men between 60 and 79 years. Had we used these alternative cutoffs, 150 (12.1%) biopsies could be saved, of them 3 were cancers.
The age-specific PSA reference ranges may help to avoid 12% of biopsies but 1.2% of prostate cancers would have gone undetected. Among population with low incidence of prostate cancer as Chinese, minimizing unnecessary biopsies might be more important issue than maximizing cancer detection rate.
确定前列腺特异性抗原（PSA）水平及年龄特异性PSA参考范围在中国前列腺癌检测中的作用。
我们回顾性分析了1998年1月至2000年12月期间在我院首次接受前列腺活检的所有50至79岁男性的病历。我们评估了如果将PSA临界值从4.0 ng/ml调整为年龄特异性参考范围对活检率和癌症检测的影响。此外，我们试图为中国人制定年龄调整后的PSA临界值。
在纳入的1236名男性中，252人（20.4%）被诊断为前列腺癌。PSA>4.0 ng/ml时的阳性预测值为22.2%。使用传统的年龄特异性PSA参考范围可避免134例（10.8%）活检，但会漏诊5例（1.98%）癌症。我们提出中国人的年龄特异性PSA参考范围为：50多岁男性为0 - 4.0 ng/ml，60至79岁男性为0 - 6.0 ng/ml。如果使用这些替代临界值，可节省150例（12.1%）活检，其中3例为癌症。
年龄特异性PSA参考范围可能有助于避免12%的活检，但会有1.2%的前列腺癌未被检测到。在前列腺癌发病率较低的中国人群中，尽量减少不必要的活检可能比提高癌症检测率更重要。
