Stapleton Alan M F, Johns Richard L, Kopsaftis Tina, Tamblyn David J, Pinnock Carole B
Urology Research, Repatriation General Hospital, Adelaide, South Australia.
Aust Fam Physician. 2008 Jan-Feb;37(1-2):84-8.
The main benefit of prostate specific antigen (PSA) testing is to help detect prostate cancer at an early, curable stage. Delays between the first abnormal PSA test and biopsy can undermine that benefit, but have not yet been studied. We investigated delays before biopsy together with associated PSA increases as an indicator of disease progression.
We identified 241 patients with a primary care referral because of an elevated PSA result (>4 ng/mL) and no previous prostate biopsy. Prostate specific antigen results and intervals between PSA testing, specialist clinic referral, appointment and biopsy were stratified by age.
Median times between first abnormal PSA, referral, consultation and biopsy were modest but associated with increases in PSA. Extended delays (>20 months) between first abnormal PSA and referral occurred in 25% of younger men. A PSA result less than 10 ng/mL was the best predictor of a delay to refer.
Rising PSA and possible cancer progression during investigation for prostate cancer suggest that prompt care is advisable.
前列腺特异性抗原（PSA）检测的主要益处在于有助于在早期可治愈阶段检测出前列腺癌。首次PSA检测异常与活检之间的延迟可能会削弱这一益处，但尚未得到研究。我们将活检前的延迟以及相关的PSA升高作为疾病进展的指标进行了调查。
我们确定了241例因PSA结果升高（>4 ng/mL）且此前未进行过前列腺活检而被初级保健转诊的患者。前列腺特异性抗原结果以及PSA检测、专科门诊转诊、预约和活检之间的间隔按年龄分层。
首次PSA异常、转诊、会诊和活检之间的中位时间适中，但与PSA升高有关。25%的年轻男性在首次PSA异常与转诊之间出现了较长延迟（>20个月）。PSA结果低于10 ng/mL是延迟转诊的最佳预测指标。
在前列腺癌检查期间PSA升高以及可能的癌症进展表明，宜进行及时治疗。
