12682名直肠指检正常、前列腺特异抗原（PSA）水平较低（≤4 ng/ml）且游离PSA百分比临界值分别为15%和20%的男性中前列腺癌的患病率及临床意义

Prevalence and clinical significance of prostate cancer among 12,682 men with normal digital rectal examination, low PSA levels (< or =4 ng/ml) and percent free PSA cutoff values of 15 and 20%.

作者信息

Pepe Pietro, Panella Paolo, Savoca Francesco, Cacciola Antonio, D'Arrigo Letterio, Dibenedetto Giuseppe, Pennisi Michele, Aragona Francesco

机构信息

Urology Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy.

出版信息

Urol Int. 2007;78(4):308-12. doi: 10.1159/000100833.

DOI:10.1159/000100833

PMID:17495487

Abstract

AIM

To report prevalence and clinical relevance of T1c prostate cancers (PCa) in a selected population of men with serum prostate-specific antigen (PSA) levels < or =4 ng/ml enrolled in a multicenter case-finding protocol.

PATIENTS AND METHODS

A number of 16,298 men, aged 40-75 years, from the urology units they had been referred to, in most cases (81.6%) for lower urinary tract symptoms, were evaluated. Eighty percent of them had PSA < or =4 ng/ml and about 40% PSA < or =2.5 ng/ml. Patients with PSA < or =2.5 ng/ml and PSA between 2.6 and 4 ng/ml and with percent free PSA < or =15 and < or =20%, respectively, were eligible for biopsy; 28 patients refused it, and 11 patients were excluded from the study because of an abnormal digital rectal examination. Among 403 biopsied men, 82 had PSA < or =2.5 ng/ml (group A) and 321 PSA between 2.6 and 4 ng/ml (group B).

RESULTS

A PCa was found in 109 cases (27.0%): 21 in group A and 88 in group B. 48 (44%) of the 109 patients with a PCa underwent radical prostatectomy: all cancers had a volume >0.5 cm(3), and 41% had a final Gleason sum > or =7; the PCa was organ confined in 34 patients (70.8%) and locally advanced in 14 patients (29.1%), and in 12 patients (25%) positive surgical margins were found.

CONCLUSIONS

Using percent free PSA thresholds of 15 and 20%, 25.6% of the men with PSA < or =2.5 ng/ml and 27.4% of the men with PSA between 2.6 and 4 ng/ml were found to have a PCa, respectively. Most of these cancers, when submitted to radical prostatectomy, were found to be clinically significant. As these cancers are mostly organ confined, these patients are ideal candidates for curative nerve-sparing surgery.

摘要

目的

报告参与多中心病例筛查方案的血清前列腺特异性抗原（PSA）水平≤4 ng/ml 的特定男性人群中 T1c 期前列腺癌（PCa）的患病率及其临床相关性。

患者与方法

对来自泌尿外科的 16298 名年龄在 40 - 75 岁的男性进行了评估，大多数患者（81.6%）因下尿路症状前来就诊。其中 80%的患者 PSA≤4 ng/ml，约 40%的患者 PSA≤2.5 ng/ml。PSA≤2.5 ng/ml 以及 PSA 在 2.6 至 4 ng/ml 之间且游离 PSA 百分比分别≤15%和≤20%的患者符合活检条件；28 名患者拒绝活检，11 名患者因直肠指检异常被排除在研究之外。在 403 名接受活检的男性中，82 名患者 PSA≤2.5 ng/ml（A 组），321 名患者 PSA 在 2.6 至 4 ng/ml 之间（B 组）。

结果

109 例（27.0%）发现患有 PCa：A 组 21 例，B 组 88 例。109 例 PCa 患者中有 48 例（44%）接受了根治性前列腺切除术：所有癌症体积均>0.5 cm³，41%的患者最终 Gleason 评分≥7；34 例（70.8%）患者的 PCa 局限于器官内，14 例（29.1%）为局部进展期，12 例（25%）患者手术切缘阳性。

结论

采用游离 PSA 百分比阈值 15%和 20%时，PSA≤2.5 ng/ml 的男性中分别有 25.6%、PSA 在 2.6 至 4 ng/ml 之间的男性中有 27.4%被发现患有 PCa。这些癌症中的大多数在接受根治性前列腺切除术后被发现具有临床意义。由于这些癌症大多局限于器官内，这些患者是保留神经的根治性手术的理想候选者。