Chybowski F M, Keller J J, Bergstralh E J, Oesterling J E
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
J Urol. 1991 Feb;145(2):313-8. doi: 10.1016/s0022-5347(17)38325-8.
Presently, the standard staging evaluation of prostate cancer includes digital rectal examination, measurement of serum tumor markers and a radionuclide bone scan. To evaluate the ability of local clinical stage, tumor grade, serum acid phosphatase, serum prostatic acid phosphatase (PAP) and serum prostate specific antigen (PSA) to predict bone scan findings, a retrospective review of 521 randomly chosen patients (mean age 70 years, range 44 to 92 years) with newly diagnosed, untreated prostate cancer was performed. Local clinical stage, tumor grade, acid phosphatase, PAP and PSA all correlated positively with bone scan findings (p less than 0.0001). Using receiver operating characteristic curves, however, PSA had the best over-all correlation with bone scan results. The median serum PSA concentration in patients with a positive bone scan was 158.0 ng./ml., whereas men with a negative bone scan had a median serum PSA level of 11.3 ng./ml. (p less than 0.0001). Using multivariate logistic regression analysis, local clinical stage, tumor grade, acid phosphatase and PAP were evaluated in combination with PSA to assess whether these parameters increased the ability of PSA alone to predict bone scan findings. None of these clinical parameters, irrespective of the combination used, contributed appreciably to the predictive power of PSA alone. A probability plot with 95% confidence intervals was constructed that allows the practicing urologist to estimate on an individual basis the probability of a positive bone scan for any given serum PSA value. The most significant finding of this study, however, was the negative predictive value of a low serum PSA concentration for bone scan findings. In 306 men with a serum PSA level of 20 ng./ml. or less only 1 (PSA 18.2 ng./ml.) had a positive bone scan (negative predictive value 99.7%). This finding would suggest that a staging radionuclide bone scan in a previously untreated prostate cancer patient with a low serum PSA concentration may not be necessary.
目前，前列腺癌的标准分期评估包括直肠指检、血清肿瘤标志物检测和放射性核素骨扫描。为了评估局部临床分期、肿瘤分级、血清酸性磷酸酶、血清前列腺酸性磷酸酶（PAP）和血清前列腺特异性抗原（PSA）预测骨扫描结果的能力，对521例随机选择的新诊断、未治疗的前列腺癌患者（平均年龄70岁，范围44至92岁）进行了回顾性研究。局部临床分期、肿瘤分级、酸性磷酸酶、PAP和PSA均与骨扫描结果呈正相关（p小于0.0001）。然而，使用受试者工作特征曲线分析发现，PSA与骨扫描结果的总体相关性最佳。骨扫描阳性患者的血清PSA浓度中位数为158.0 ng/ml，而骨扫描阴性患者的血清PSA水平中位数为11.3 ng/ml（p小于0.0001）。使用多因素逻辑回归分析，将局部临床分期、肿瘤分级、酸性磷酸酶和PAP与PSA联合评估，以确定这些参数是否能增强PSA单独预测骨扫描结果的能力。无论采用何种组合，这些临床参数均未对PSA单独的预测能力有显著贡献。构建了一个带有95%置信区间的概率图，使泌尿外科医生能够根据个体情况，针对任何给定的血清PSA值估计骨扫描阳性的概率。然而，本研究最显著的发现是低血清PSA浓度对骨扫描结果的阴性预测价值。在306例血清PSA水平为20 ng/ml或更低的男性中，只有1例（PSA为18.2 ng/ml）骨扫描呈阳性（阴性预测值为99.7%）。这一发现表明，对于血清PSA浓度较低的未经治疗的前列腺癌患者，进行分期放射性核素骨扫描可能没有必要。
