Ross Talisa, Ahmed Kamran, Raison Nicholas, Challacombe Ben, Dasgupta Prokar
Guy's Hospital, King's College London, London, UK.
Int J Clin Pract. 2016 Nov;70(11):950-959. doi: 10.1111/ijcp.12883. Epub 2016 Sep 27.
Prostate specific antigen is a marker for prostate cancer and a key diagnostic tool, yet when to refer patients with a borderline PSA is currently unclear. This review describes how to assess a patient with borderline PSA and provides an algorithm for management.
Current literature on reference values, factors affecting PSA, indications for referral, non-invasive investigations and the role of MRI were reviewed. Medline and EMBASE were searched using MeSH terms.
The literature suggests that a PSA of over 1.5 ng/mL should be used as a cut-off to consider further testing for all age groups. There is strong evidence to show that adjuncts are useful when interpreting PSA results, most notably percentage free PSA and proPSA. Considerable weighting should also be given to the ERSPC risk calculator when deciding when to refer. Multi-parametric MRI is valuable in closely examining suspicious lesions to reduce the number of negative biopsies. MRI fusion biopsy (TRUS, transrectal ultrasonography or transperineal) should be considered over standard TRUS biopsy to detect more clinically significant disease.
Management of borderline PSA is not straightforward. A cut-off of 1.5 ng/mL should be used in conjunction with digital rectal exam, risk calculation and PSA adjuncts. Imaging and biopsy should utilise mpMRI to achieve improved diagnosis of clinically significant prostate cancer, with fewer unnecessary investigations.
前列腺特异性抗原是前列腺癌的标志物和关键诊断工具，但目前尚不清楚何时应转诊前列腺特异性抗原处于临界值的患者。本综述描述了如何评估前列腺特异性抗原处于临界值的患者，并提供了一种管理算法。
对有关参考值、影响前列腺特异性抗原的因素、转诊指征、非侵入性检查以及磁共振成像作用的当前文献进行了综述。使用医学主题词在Medline和EMBASE中进行检索。
文献表明，对于所有年龄组，应将前列腺特异性抗原超过1.5 ng/mL作为进一步检查的临界值。有强有力的证据表明，在解释前列腺特异性抗原结果时，辅助指标很有用，最显著的是游离前列腺特异性抗原百分比和前列腺特异性抗原前体。在决定何时转诊时，也应充分考虑欧洲前列腺癌筛查随机对照试验风险计算器。多参数磁共振成像对于仔细检查可疑病变以减少阴性活检数量很有价值。与标准经直肠超声活检相比，应考虑使用磁共振成像融合活检（经直肠超声或经会阴）以检测更多具有临床意义的疾病。
前列腺特异性抗原处于临界值的管理并不简单。1.5 ng/mL的临界值应与直肠指检、风险计算和前列腺特异性抗原辅助指标结合使用。成像和活检应利用多参数磁共振成像来更好地诊断具有临床意义的前列腺癌，同时减少不必要的检查。
