Urology Unit, Cannizzaro Hospital, Catania, Italy.
Prostate Cancer Prostatic Dis. 2010 Dec;13(4):316-9. doi: 10.1038/pcan.2010.29. Epub 2010 Aug 17.
To evaluate prostate cancer (PCa) detection and incidence of pathologically insignificant PCa (pIPCa) tumour using percent-free PSA (%f-PSA) in patients with total PSA ≤ 10 ng ml(-1). From February 2002 to October 2009, 14,453 patients (median 60.5 years) were enrolled in a case-finding protocol for the early diagnosis of PCa. Indications to biopsy were suspicious digital rectal examination; PSA >10 ng ml(-1); PSA ≤ 2.5 ng ml(-1), included between 2.6-4 and 4.1-10 ng ml(-1) with %f-PSA <15, <20 and <25%, respectively. A median of 18 and 26 cores in case of primary and repeated biopsy were determined; 2123 men underwent prostate biopsy, of whom 1589 (74.8%) had a PSA ≤ 10 ng ml(-1). A PCa was found in 777 (36.6%) and in 35 (23.3%) patients at primary and repeated biopsy: 459 and 26 men had PSA ≤ 10 ng ml(-1) and 419 and 26 patients underwent surgery, respectively, 244 (58.3%) and 18 (69.2%) had an organ-confined PCa with a pIPCa incidence equal to 1.4 and 7.7%, respectively. Cancer detection rate of 28.8% in patients with PSA ≤ 10 ng ml(-1) associated with a low incidence of pIPCa should induce to introduce %f-PSA in screening programmes to reduce the risk of overdiagnosis.
评估总 PSA 水平≤10ng/ml 的患者中游离 PSA 百分比（%f-PSA）在前列腺癌（PCa）检测和病理意义不显著的 PCa（pIPCa）肿瘤发生率中的作用。从 2002 年 2 月至 2009 年 10 月，14453 例患者（中位年龄 60.5 岁）被纳入一项用于早期诊断 PCa 的病例发现方案。活检的适应证包括可疑的直肠指检、PSA＞10ng/ml、PSA 水平在 2.5ng/ml 以下，分别在 2.6-4ng/ml、4.1-10ng/ml 之间，%f-PSA ＜15%、＜20%和＜25%。原发性和重复活检的中位数分别为 18 和 26 针；2123 例男性接受了前列腺活检，其中 1589 例（74.8%）PSA 水平≤10ng/ml。777 例（36.6%）和 35 例（23.3%）患者在原发性和重复活检中发现了 PCa：459 例和 26 例患者 PSA 水平≤10ng/ml，分别有 419 例和 26 例患者接受了手术，244 例（58.3%）和 18 例（69.2%）患者的 PCa 局限于器官内，相应的 pIPCa 发生率分别为 1.4%和 7.7%。PSA 水平≤10ng/ml 的患者中癌症检出率为 28.8%，pIPCa 的发生率较低，这提示我们应该在筛查项目中引入%f-PSA，以降低过度诊断的风险。
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