Bratslavsky Gennady, Fisher Hugh A G, Kaufman Ronald P, Voskoboynik Diana, Nazeer Tipu, Mian Badar M
Division of Urology, Albany Medical College and Stratton VA Medical Center, Albany, NY 12208, USA.
Urol Oncol. 2008 Mar-Apr;26(2):166-70. doi: 10.1016/j.urolonc.2007.05.030. Epub 2007 Nov 26.
To determine the relationship of total PSA (tPSA), percent free PSA (%fPSA), and complexed PSA (cPSA) with prostate cancer detection and the diagnosis of poorly-differentiated cancers in the contemporary era.
We retrospectively reviewed the clinical and pathological records of 292 men who met the following inclusion criteria: (1) tPSA 2.5 to 10 ng/ml; (2) initial biopsy only; (3) extended biopsy scheme (>or=10 peripheral zone cores); (4) no previous prostate surgeries. The ability of PSA-related markers to detect cancer was determined by area under the receiver operating characteristics curve analysis (AUC-ROC). Various clinically relevant % fPSA cutoffs and cPSA ranges were analyzed to determine the association with poorly-differentiated cancers.
Cancer was detected in 126 (43%) men, with mean Gleason score of 7. The cancer detection rates for various cutoffs of tPSA, cPSA and % fPSA were very similar. On ROC analysis for cancer diagnosis, the AUCs for tPSA, % fPSA, and cPSA were 0.53, 0.54, and 0.52, respectively. Men with % fPSA <15 were more likely to have poorly-differentiated cancer than those with % fPSA >or=15 (66% vs. 41%, P < 0.005). Similarly, cPSA ranges (2-4, 4.1-6, and >6) were associated with the detection of poorly-differentiated cancers (37%, 57%, and 80% P < 0.003).
With the use of extended prostate sampling in the contemporary screening population, the addition of cPSA and % fPSA does not enhance the diagnostic performance of tPSA. However, the significant association between cPSA and poorly-differentiated cancers suggests that this may be a more useful initial test for prostate cancer screening.
确定总前列腺特异性抗原（tPSA）、游离前列腺特异性抗原百分比（%fPSA）和复合前列腺特异性抗原（cPSA）与当代前列腺癌检测及低分化癌诊断之间的关系。
我们回顾性分析了292名男性的临床和病理记录，这些男性符合以下纳入标准：（1）tPSA为2.5至10 ng/ml；（2）仅初次活检；（3）扩展活检方案（≥10个外周带组织芯）；（4）既往无前列腺手术史。通过受试者操作特征曲线下面积分析（AUC-ROC）确定PSA相关标志物检测癌症的能力。分析了各种临床相关的%fPSA临界值和cPSA范围，以确定与低分化癌的关联。
126名（43%）男性检测出癌症，平均Gleason评分为7分。tPSA、cPSA和%fPSA不同临界值的癌症检测率非常相似。在癌症诊断的ROC分析中，tPSA、%fPSA和cPSA的AUC分别为0.53、0.54和0.52。%fPSA<15的男性比%fPSA≥15的男性更有可能患有低分化癌（66%对41%，P<0.005）。同样，cPSA范围（2 - 4、4.1 - 6和>6）与低分化癌的检测相关（37%、57%和80%，P<0.003）。
在当代筛查人群中采用扩展前列腺采样时，增加cPSA和%fPSA并不能提高tPSA的诊断性能。然而，cPSA与低分化癌之间的显著关联表明，这可能是一种更有用的前列腺癌筛查初始检测方法。
