Weber J P, Oesterling J E, Peters C A, Partin A W, Chan D W, Walsh P C
Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Urol. 1989 Apr;141(4):987-92. doi: 10.1016/s0022-5347(17)41083-4.
This study was designed to investigate the relationship of serum prostate-specific antigen to prostatic size and hormonal stimulation. Seven patients with benign prostatic hyperplasia were treated for six months with nafarelin acetate and then followed for an additional six months. Nafarelin acetate is a potent luteinizing-hormone-releasing hormone agonist which causes reversible testosterone deprivation resulting in involution of the prostate. During therapy and follow up, serum prostate-specific antigen correlated with: 1) serum testosterone (p less than 0.001); 2) quantity of prostatic epithelium (p less than 0.001); and 3) prostatic size (p less than 0.05). Before therapy, serum prostate-specific antigen (mean +/- SD) was 0.43 +/- 0.2 ng./ml. per gram of epithelium. This did not change significantly after six months of androgen deprivation (0.48 +/- 0.36), although the ratios of prostate-specific antigen to testosterone and to prostatic size each changed significantly. Despite testosterone levels in the castrate range at six months, five of seven patients had serum prostate-specific antigen concentrations above the female range and three of seven patients had prostatic biopsies containing columnar epithelium which stained positively for prostate-specific antigen. These results demonstrate that serum prostate-specific antigen is related to prostatic size, prostatic epithelial weight, and testosterone stimulation. However, prostatic size is not a good predictor of serum prostate-specific antigen because there is tremendous variation in the relative amount of epithelium in a prostate; in this study the ratio of prostatic size to epithelial weight varied threefold. Furthermore, although testosterone determines prostatic size and amount of prostatic epithelium, it may not totally control prostate-specific antigen production.
本研究旨在探讨血清前列腺特异性抗原与前列腺大小及激素刺激之间的关系。7例良性前列腺增生患者接受醋酸那法瑞林治疗6个月，然后再随访6个月。醋酸那法瑞林是一种强效的促黄体生成素释放激素激动剂，可导致可逆性睾酮缺乏，从而使前列腺萎缩。在治疗及随访期间，血清前列腺特异性抗原与以下因素相关：1）血清睾酮（p<0.001）；2）前列腺上皮数量（p<0.001）；3）前列腺大小（p<0.05）。治疗前，血清前列腺特异性抗原（均值±标准差）为每克上皮0.43±0.2 ng/ml。雄激素剥夺6个月后，这一数值无显著变化（0.48±0.36），尽管前列腺特异性抗原与睾酮及前列腺大小的比值均有显著变化。尽管6个月时睾酮水平处于去势范围，但7例患者中有5例血清前列腺特异性抗原浓度高于女性范围，7例患者中有3例前列腺活检显示含有柱状上皮，其前列腺特异性抗原染色呈阳性。这些结果表明，血清前列腺特异性抗原与前列腺大小、前列腺上皮重量及睾酮刺激有关。然而，前列腺大小并非血清前列腺特异性抗原的良好预测指标，因为前列腺上皮相对量存在巨大差异；在本研究中，前列腺大小与上皮重量的比值变化了3倍。此外，尽管睾酮决定前列腺大小及前列腺上皮数量，但它可能并不能完全控制前列腺特异性抗原的产生。
