Hosseini Seyyed Yousof, Moharramzadeh Massood, Ghadian Ali Reza, Hooshyar Hassan, Lashay Ali Reza, Safarinejad Mohammah Reza
Urology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Atomic Energy Organization, Nuclear Research Center, Radioisotope Production Section, Tehran, Iran.
Int J Urol. 2007 May;14(5):406-11. doi: 10.1111/j.1442-2042.2006.01729.x.
To report the results from an Iranian large population-based randomized study of screening using prostate-specific antigen (PSA) to detect prostate cancer.
A total of 3758 Iranian men older than 40 years were mass checked by PSA-based screening. Men with an abnormal digital rectal examination (DRE) and serum total PSA level of greater than 4 ng/mL, underwent transrectal ultrasonography (TRUS)-guided extended prostate biopsy.
The PSA value (mean +/- standard deviation, SD) in all men without prostate cancer was 1.6 +/- 1.1 ng/mL and in those with cancer 18 +/- 44.8 ng/mL (P = 0.001). PSA values increased with age. In those aged 40-49, 50-59, 60-69 and > or = 70 years, the mean +/- SD PSA values were 1.3 +/- 0.7, 1.4 +/- 0.8, 1.8 +/- 1 and 2.2 +/- 1.6 ng/mL, respectively. Among the screened men, 323 (8.6%) had a serum PSA concentration greater than 4 ng/mL. Of patients who underwent prostate biopsy (230, 71.2%), 129 (positive predictive value, 56.1%) had prostate cancer. Additionally, nine cancers were detected among 16 patients with PSA of less than 4 ng/mL who had a doubtful DRE finding. The overall cancer detection rate was 3.6%; 1.4% at 40-49, 1.6% at 50-59, 4.2% at 60-69 and 12.9% at >/=70 years. Conventional systematic sextant biopsies, which accounted for six of the 10 cores in our biopsy scheme, detected 98 (71%) of the cancers.
The Iranian male population develops prostate cancer quite commonly if their serum PSA levels are greater than 4.0 ng/mL. In this study, 65.9% of the detected cancers were clinically significant. The conventional systematic sextant technique may be inappropriate for detection of all prostate cancers. The results need to be confirmed in other randomized trials.
报告一项基于伊朗大规模人群的使用前列腺特异性抗原（PSA）进行前列腺癌筛查的随机研究结果。
共有3758名40岁以上的伊朗男性接受了基于PSA的筛查。直肠指检（DRE）异常且血清总PSA水平大于4 ng/mL的男性接受经直肠超声（TRUS）引导下的扩大前列腺活检。
所有无前列腺癌男性的PSA值（均值±标准差，SD）为1.6±1.1 ng/mL，患癌男性的PSA值为18±44.8 ng/mL（P = 0.001）。PSA值随年龄增长而升高。在40 - 49岁、50 - 59岁、60 - 69岁和≥70岁的男性中，PSA均值±SD分别为1.3±0.7、1.4±0.8、1.8±1和2.2±1.6 ng/mL。在接受筛查的男性中，323人（8.6%）血清PSA浓度大于4 ng/mL。在接受前列腺活检的患者中（230人，71.2%），129人（阳性预测值为56.1%）患有前列腺癌。此外，在16名PSA小于4 ng/mL但DRE检查结果可疑的患者中检测到9例癌症。总体癌症检出率为3.6%；40 - 49岁为1.4%，50 - 59岁为1.6%，60 - 69岁为4.2%，≥70岁为12.9%。在我们的活检方案中占10个核心中的6个的传统系统性六分区活检检测到了98例（71%）癌症。
如果伊朗男性血清PSA水平大于4.0 ng/mL，其患前列腺癌的情况相当常见。在本研究中，65.9%的检测到的癌症具有临床意义。传统的系统性六分区技术可能不适用于检测所有前列腺癌。结果需要在其他随机试验中得到证实。
