评估血清睾酮与前列腺特异性抗原比值作为前列腺癌风险的预测指标。

Evaluation of the serum testosterone to prostate-specific antigen ratio as a predictor of prostate cancer risk.

机构信息

Department of Urology, Vall d'Hebron Hospital, Autonoma University of Barcelona, Spain.

出版信息

BJU Int. 2010 Feb;105(4):481-4. doi: 10.1111/j.1464-410X.2009.08761.x. Epub 2009 Aug 13.

DOI:10.1111/j.1464-410X.2009.08761.x

PMID:19681902

Abstract

OBJECTIVE

To analyse the ratio of serum testosterone (sT) to prostate-specific antigen (PSA) as a predictor of prostate cancer risk, as low levels of sT have been related to a greater risk of prostate cancer, and its ratio with serum PSA level was recently proposed as a new tool to increase the specificity of PSA.

PATIENTS AND METHODS

In all, 439 consecutive men with a normal digital rectal examination and a serum PSA level of 4.1-20 ng/mL had a transrectal ultrasonography-guided biopsy using a 10-core scheme, with an additional 1-8 cores according to prostate volume and patient age. The sT level was determined before the procedure using a chemiluminescent assay, and the ratio of sT to PSA (sT/PSA) was calculated after transforming sT measurements from ng/dL to ng/mL. The percentage free PSA (%fPSA) and PSA density were also included in this analysis.

RESULTS

The overall cancer detection rate was 42.1%. The median sT level was 469 ng/dL in men with cancer and 499 ng/dL in those without (P = 0.521). The median sT/PSA was 0.68 and 0.74, respectively (P = 0.215). However, the median %fPSA was 14 in men with cancer and 17 in men without (P < 0.001) and the median PSA density was 0.22 and 0.16, respectively (P < 0.001). The multivariate analysis confirmed the independent predictive value only for %fPSA (odds ratio 0.94, 95% confidence interval 0.91-0.98) and PSA density (5.8, 3.42-19.8).

CONCLUSION

These results do not support the use of sT/PSA for predicting the risk of prostate cancer and to increase the specificity of PSA.

摘要

目的

分析血清睾酮（sT）与前列腺特异性抗原（PSA）的比值作为前列腺癌风险的预测指标，因为低水平的 sT 与前列腺癌风险增加有关，并且其与血清 PSA 水平的比值最近被提出作为一种新的工具来提高 PSA 的特异性。

患者和方法

总共对 439 名接受直肠指检和血清 PSA 水平为 4.1-20ng/mL 的连续男性进行了经直肠超声引导下的活检，采用 10 核方案，根据前列腺体积和患者年龄增加 1-8 核。sT 水平在进行该程序前使用化学发光测定法确定，并且 sT/PSA（sT/PSA）的比值在将 sT 测量值从 ng/dL 转换为 ng/mL 后计算。在该分析中还包括游离 PSA（%fPSA）和 PSA 密度。

结果

总体癌症检出率为 42.1%。癌症患者的中位 sT 水平为 469ng/dL，非癌症患者为 499ng/dL（P=0.521）。中位 sT/PSA 分别为 0.68 和 0.74（P=0.215）。然而，癌症患者的中位 %fPSA 为 14，非癌症患者为 17（P<0.001），并且中位 PSA 密度分别为 0.22 和 0.16（P<0.001）。多变量分析仅证实了 %fPSA（比值比 0.94，95%置信区间 0.91-0.98）和 PSA 密度（5.8，3.42-19.8）的独立预测价值。