Gilbert Scott M, Cavallo Christina B, Kahane Hillel, Lowe Franklin C
Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Urology. 2005 Mar;65(3):549-53. doi: 10.1016/j.urology.2004.10.064.
To determine whether a prostate-specific antigen (PSA) level of 2.0, 2.5, or 4.0 ng/mL is the most appropriate cutpoint for determining the need for prostate biopsy. It has been suggested that the PSA cutpoint of 4.0 ng/mL is inappropriate because the rate of prostate cancer detection is similar in patients with lower PSA values. Some investigators have recommended a 2.6-ng/mL cutpoint. Others have recommended a cutpoint of 2.0 ng/mL.
A total of 36,316 prostate biopsies submitted to DIANON Systems from January 1, 1997 through December 31, 2001 were reviewed. These biopsy specimens also had DIANON PSA test results available that had been performed within 6 months of the biopsy date. These biopsies were stratified according to the PSA level within the 6 months before the time of biopsy, and the prostate cancer detection rate was determined for the stratified PSA levels.
The detection rate of prostate cancer varied according to the PSA level. The incidence of prostate cancer was similar for the groups with less than 2.0 ng/mL and 2.0 to 2.5 ng/mL (18.67% and 21.89%, respectively). Also, the groups with 2.5 to 4.0 ng/mL and 4.0 to 10.0 ng/mL had similar cancer detection rates (27.48% and 30.08%, respectively).
The prostate cancer detection rate for a PSA level between 2.5 and 4.0 ng/mL was similar (27.48%) to that for the PSA range of 4.0 to 10.0 ng/mL (30.08%). The absolute cutpoint used to determine the need to evaluate a patient for prostate cancer by biopsy is not clear; however, many studies have suggested that 2.5 ng/mL may be a more appropriate cutpoint than 4.0 ng/mL.
确定2.0、2.5或4.0 ng/mL的前列腺特异性抗原（PSA）水平是否是决定是否需要进行前列腺活检的最合适切点。有人认为4.0 ng/mL的PSA切点不合适，因为PSA值较低的患者中前列腺癌的检出率相似。一些研究者推荐2.6 ng/mL的切点。另一些人则推荐2.0 ng/mL的切点。
回顾了1997年1月1日至2001年12月31日提交给DIANON系统的36316例前列腺活检病例。这些活检标本还具备在活检日期前6个月内进行的DIANON PSA检测结果。根据活检前6个月内的PSA水平对这些活检病例进行分层，并确定分层后的PSA水平的前列腺癌检出率。
前列腺癌的检出率因PSA水平而异。PSA水平低于2.0 ng/mL和2.0至2.5 ng/mL的组中前列腺癌的发生率相似（分别为18.67%和21.89%）。此外，2.5至4.0 ng/mL和4.0至10.0 ng/mL的组中癌症检出率相似（分别为27.48%和30.08%）。
PSA水平在2.5至4.0 ng/mL之间的前列腺癌检出率（27.48%）与PSA范围在4.0至10.0 ng/mL之间的检出率（30.08%）相似。用于决定是否通过活检评估患者是否患有前列腺癌的绝对切点尚不清楚；然而，许多研究表明，2.5 ng/mL可能比4.0 ng/mL是更合适的切点。
