Hua Li-xin, Qiao Di, Song Ning-hong, Feng Ning-han, Yang Jie, Zhang Jie-xiu, Chen Jian-gang, Zhang Wei, Sui Yuan-geng, Wu Hong-fei
Department of Urological Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Zhonghua Zhong Liu Za Zhi. 2009 Sep;31(9):705-9.
To evaluate the clinical significance of prostate-specific antigen (PSA) screening in early detection of prostate cancer in Chinese men.
PSA screening was performed in 8562 asymptomatic men who had been enrolled for health checkup and all were > or = 50 years old. Prostate biopsy was recommended for those with a serum PSA level > or = 4.0 ng/ml. The pathological and clinical features of the patients with prostate cancer detected by the PSA screening were compared with that of 82 clinically diagnosed prostate cancer patients during the same period.
Of the 8562 asymptomatic men, 719 had PSA levels > or = 4.0 ng/ml and biopsy was performed in 295 of them. Fifty-eight prostate cancers were detected. The biopsy rate was 41.0% and positive detection rate was 19.7%. The overall age distribution in the screening group and the clinical groups was not significantly different (P = 0.176). However, 41.4% (24/58) of the patients in screening group were > 75 years old, and significantly more than that in the clinical group (25.6%, P = 0.0491). The proportion of the patients with PSA levels > or = 20 ng/ml in the screening group was significantly less than that in the patients of the clinical group (44.8% vs. 75.6%, P = 0.0002). Whether in the patients whose age was > 75 years old (P < 0.05) or < or = 75 years old (P = 0.0002), the patients in the screening group had significantly lower Gleason scores < 7 (60.3% vs. 34.1%, P = 0.002), more T1 or T2 tumor (87.9% vs. 26.8%, P < 0.0001) and more chance to receive radical prostatectomy (50.0% vs. 18.3%, P < 0.0001) than the patients in the clinical group did. However, the distributions of PSA levels at diagnosis and biopsy Gleason scores were not significantly different between the above mentioned two groups (P > 0.05).
Prostate-specific antigen (PSA) screening is useful for early detection of prostate cancer in Chinese men aged > or = 50 years. The patients detected by PSA screening usually show a lower PSA level, Gleason scores and early clinical stage disease, and have more chance for radical prostatectomy than the clinically diagnosed patients.
评估前列腺特异性抗原（PSA）筛查在中国男性早期前列腺癌检测中的临床意义。
对8562名年龄≥50岁、参加健康体检且无症状的男性进行PSA筛查。对于血清PSA水平≥4.0 ng/ml的男性建议进行前列腺活检。将PSA筛查检测出的前列腺癌患者的病理和临床特征与同期82例临床诊断的前列腺癌患者进行比较。
在8562名无症状男性中，719人的PSA水平≥4.0 ng/ml，其中295人进行了活检。检测出58例前列腺癌。活检率为41.0%，阳性检出率为19.7%。筛查组和临床组的总体年龄分布无显著差异（P = 0.176）。然而，筛查组中41.4%（24/58）的患者年龄>75岁，显著高于临床组（25.6%，P = 0.0491）。筛查组中PSA水平≥20 ng/ml的患者比例显著低于临床组患者（44.8%对75.6%，P = 0.0002）。无论是年龄>75岁（P < 0.05）还是≤75岁（P = 0.0002）的患者，筛查组患者的Gleason评分<7的比例显著更低（60.3%对34.1%，P = 0.002），T1或T2期肿瘤更多（87.9%对26.8%，P < 0.0001），接受根治性前列腺切除术的机会更多（50.0%对18.3%，P < 0.0001）。然而，上述两组在诊断时的PSA水平分布和活检Gleason评分无显著差异（P > 0.05）。
前列腺特异性抗原（PSA）筛查有助于≥50岁中国男性早期前列腺癌的检测。PSA筛查检测出的患者通常表现出较低的PSA水平、Gleason评分和早期临床疾病阶段，且比临床诊断患者有更多接受根治性前列腺切除术的机会。
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