Chen Zhao-dian, Wei Si-ming, Cai Song-liang
Department of urology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Zhonghua Wai Ke Za Zhi. 2004 May 22;42(10):593-5.
To study significance and limitations of the ratio of free to total prostate specific antigen (f/t PSA) in differential diagnosis between prostate cancer and benign prostatehyperplasia (BPH) with total PSA (tPSA) levels between 4 and 10 ng/ml.
We analysed retrospectively 180 prostate cancer and BPH patients who were diagnosed and treated in our hospital from October 1998 to October 2002 and had serum tPSA levels between 4 and 10 ng/ml. Of the 180 patients, 36 (20%) were histologically confirmed as prostate cancer and 144 (80%) BPH. The tPSA and free PSA (fPSA) in serum were measured by micropartical enzyme immunoassay. Prostate volume was measured by transabdominal ultrasonography. We chose Student's t-test for comparison between prostate cancer and BPH groups. The correlation between prostate volume and f/t PSA was analyzed using Pearson's correlation coefficient.
The mean values of tPSA and f/t PSA were 6.75 ng/ml and 0.17 in patients with prostate cancer, 6.48 ng/ml and 0.25 in patients with BPH. The mean value of tPSA wasn't significantly different between patients with prostate cancer and BPH (P > 0.05). However, the mean value of f/t PSA of patients with prostate cancer was significantly lower than that of patients with BPH (P < 0.01). Furthermore, there were significant and positive correlation between prostate volume and f/t PSA in both groups with prostate cancer and BPH (prostate cancer group's correlation coefficient (r = 0.50, P < 0.01); BPH group (r = 0.24, P < 0.01). There was significant difference in f/t PSA between prostate cancer and BPH patients with prostate volumes more than 40 cm(3) (P < 0.05), but not between these two groups with prostate volumes more than 40 cm(3) (P > 0.05).
The f/t PSA is significant in differential diagnosis between prostate cancer and BPH with tPSA levels between 4 and 10 ng/ml. But prostate volume has an effect on f/tPSA. The f/tPSA has diagnostic value of differentiation only when the prostate volume is less than 40 cm(3).
研究总前列腺特异性抗原（tPSA）水平在4至10 ng/ml之间时，游离前列腺特异性抗原与总前列腺特异性抗原比值（f/t PSA）在前列腺癌与良性前列腺增生（BPH）鉴别诊断中的意义及局限性。
回顾性分析1998年10月至2002年10月在我院诊断并治疗的180例前列腺癌和BPH患者，其血清tPSA水平在4至10 ng/ml之间。180例患者中，36例（20%）经组织学确诊为前列腺癌，144例（80%）为BPH。采用微粒酶免疫分析法测定血清中的tPSA和游离PSA（fPSA）。经腹部超声测量前列腺体积。采用学生t检验对前列腺癌组和BPH组进行比较。使用Pearson相关系数分析前列腺体积与f/t PSA之间的相关性。
前列腺癌患者的tPSA和f/t PSA平均值分别为6.75 ng/ml和0.17，BPH患者分别为6.48 ng/ml和0.25。前列腺癌患者与BPH患者的tPSA平均值无显著差异（P>0.05）。然而，前列腺癌患者的f/t PSA平均值显著低于BPH患者（P<0.01）。此外，前列腺癌组和BPH组中前列腺体积与f/t PSA均存在显著正相关（前列腺癌组相关系数（r=0.50，P<0.01）；BPH组（r=0.24，P<0.01）。前列腺体积大于40 cm³的前列腺癌患者与BPH患者之间的f/t PSA存在显著差异（P<0.05），但前列腺体积大于40 cm³的这两组之间无显著差异（P>0.05）。
tPSA水平在4至10 ng/ml之间时，f/t PSA在前列腺癌与BPH的鉴别诊断中具有重要意义。但前列腺体积对f/t PSA有影响。仅当前列腺体积小于40 cm³时，f/t PSA才有鉴别诊断价值。
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