Coakley Fergus V, Chen Irene, Qayyum Aliya, Westphalen Antonio C, Carroll Peter R, Hricak Hedvig, Chen Mei-Hsiu, Kurhanewicz John
Department of Urology, The University of California at San Francisco, San Francisco, CA, USA.
BJU Int. 2007 Jan;99(1):41-5. doi: 10.1111/j.1464-410X.2006.06515.x.
To investigate the validity of prostate-specific antigen (PSA) as a tumour marker in men with clinically localized prostate cancer who have selected watchful waiting, by determining if serial PSA level measurements are correlated with findings of malignancy or benign prostatic hyperplasia (BPH) at serial endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI).
We retrospectively identified 69 men with biopsy-proven prostate cancer being managed by watchful waiting, who underwent serial endorectal MRI/MRSI and who had contemporaneous serial PSA measurements. The mean (range) follow-up was 392 (294-571) days. A panel of three experienced readers reviewed the initial and follow-up MRI/MRSI studies, and classified findings of prostate cancer as stable or progressive. Another reader assessed BPH by calculating total gland and central gland volumes on all studies.
At the follow-up MRI/MRSI, 51, 17 and one patient had stable, progressive, or unevaluable prostate cancer, respectively. The mean PSA velocity was significantly greater in patients with radiologically progressive disease (1.42 vs 0.42 ng/mL/year, P = 0.04). A PSA velocity of >0.75 ng/mL/year identified those with radiologically progressive disease with a true-positive fraction of 0.71 and a false-positive fraction of 0.39. PSA levels were not correlated with changes in total or central gland volumes (P > 0.05).
In men with clinically localized prostate cancer who select watchful waiting, serial PSA levels are correlated with findings of malignancy but not BPH at serial endorectal MRI/MRSI, suggesting that PSA is a useful longitudinal tumour marker in this population.
通过确定连续前列腺特异性抗原（PSA）水平测量值与连续直肠内磁共振成像（MRI）和磁共振波谱成像（MRSI）检查中恶性肿瘤或良性前列腺增生（BPH）的结果是否相关，来研究PSA作为选择观察等待的临床局限性前列腺癌男性患者肿瘤标志物的有效性。
我们回顾性纳入了69例经活检证实为前列腺癌且接受观察等待治疗的男性患者，这些患者接受了连续直肠内MRI/MRSI检查，并同期进行了连续PSA测量。平均（范围）随访时间为392（294 - 571）天。由三名经验丰富的阅片者组成的小组对初始和随访的MRI/MRSI研究进行评估，并将前列腺癌的结果分类为稳定或进展。另一名阅片者通过计算所有研究中的前列腺总体积和中央腺体体积来评估BPH。
在随访的MRI/MRSI检查中，分别有51例、17例和1例患者的前列腺癌为稳定、进展或无法评估。放射学上疾病进展的患者平均PSA速度显著更高（1.42对0.42 ng/mL/年，P = 0.04）。PSA速度>0.75 ng/mL/年可识别出放射学上疾病进展的患者，真阳性率为0.71，假阳性率为0.39。PSA水平与前列腺总体积或中央腺体体积的变化无关（P > 0.05）。
在选择观察等待的临床局限性前列腺癌男性患者中，连续PSA水平与连续直肠内MRI/MRSI检查中的恶性肿瘤结果相关，但与BPH无关，这表明PSA是该人群中一种有用的纵向肿瘤标志物。
