使用前列腺特异性抗原密度来提高前列腺特异性抗原在检测前列腺癌中的敏感性。

The use of prostate specific antigen density to improve the sensitivity of prostate specific antigen in detecting prostate carcinoma.

作者信息

Bretton P R, Evans W P, Borden J D, Castellanos R D

机构信息

Southwest Florida Urologic Associates, Fort Myers 33901.

出版信息

Cancer. 1994 Dec 1;74(11):2991-5. doi: 10.1002/1097-0142(19941201)74:11<2991::aid-cncr2820741116>3.0.co;2-r.

DOI:10.1002/1097-0142(19941201)74:11<2991::aid-cncr2820741116>3.0.co;2-r

PMID:7525040

Abstract

BACKGROUND

Prostate specific antigen (PSA) is useful as a tumor marker for monitoring patients with prostate cancer after definitive therapy. Limitations have been noted when PSA was used for the early detection of prostate cancer. The use of prostate specific antigen density [PSAD = PSA (ng/ml)/prostate volume (cc)] has been suggested to differentiate benign from malignant prostate disease.

METHODS

A retrospective analysis of 559 men who underwent transrectal prostate ultrasound and biopsy for an abnormal PSA value (> 4.0 ng/ml) and/or an abnormal prostate gland by digital rectal examination (DRE) was performed. Prostate specific antigen density evaluation was performed on all men, and its utility for diagnosing prostate cancer was compared with those of PSA and DRE.

RESULTS

Two hundred, sixty seven (47%) of the 559 men had positive biopsies for prostate cancer. Sixty-one men had PSA levels of less than 4.0 ng/ml, and 17 (27.8%) of these men had positive biopsies for prostate cancer. No patient with a normal DRE had a positive biopsy regardless of the prostate specific antigen density (PSAD) value. PSAD was not more useful than PSA alone in detecting prostate cancer in this group. Two hundred, seventy-seven men had PSA values between 4.1 and 10.0 ng/ml, and 110 (40.0%) had positive biopsies for prostate cancer. For this group as a whole, the mean PSA values of the positive and negative biopsy groups showed no significant difference. The mean PSAD was significantly different (P < 0.0001) between the positive and negative biopsy groups. Two hundred, twenty-one men had PSA values of greater than 10.0 ng/ml, and 140 (63%) had positive biopsies for prostate cancer. Prostate specific antigen density was no more useful than PSA alone in distinguishing men with positive or negative biopsies for prostate cancer in the entire group. In the subset of patients with a normal DRE, (including no benign prostatic hyperplasia) the mean PSAD appeared useful (P < 0.004) in distinguishing the positive from the negative biopsy groups, whereas the mean PSA was not.

CONCLUSION

These results suggest that PSAD is useful in discriminating prostate cancer in men with normal DRE and PSA levels between 4.1 and 10.0 ng/ml.

摘要

背景

前列腺特异性抗原（PSA）作为一种肿瘤标志物，可用于在确定性治疗后监测前列腺癌患者。但在用于前列腺癌的早期检测时，其局限性已被注意到。有人建议使用前列腺特异性抗原密度[PSAD = PSA（纳克/毫升）/前列腺体积（立方厘米）]来区分前列腺良性疾病和恶性疾病。

方法

对559名因PSA值异常（>4.0纳克/毫升）和/或直肠指检（DRE）发现前列腺异常而接受经直肠前列腺超声检查和活检的男性进行回顾性分析。对所有男性进行前列腺特异性抗原密度评估，并将其诊断前列腺癌的效用与PSA和DRE的效用进行比较。

结果

559名男性中有267名（47%）前列腺活检呈前列腺癌阳性。61名男性的PSA水平低于4.0纳克/毫升，其中17名（27.8%）男性前列腺活检呈阳性。无论前列腺特异性抗原密度（PSAD）值如何，DRE正常的患者活检均无阳性结果。在该组中，PSAD在检测前列腺癌方面并不比单独使用PSA更有用。277名男性的PSA值在4.1至10.0纳克/毫升之间，其中110名（40.0%）前列腺活检呈阳性。对于整个该组，活检阳性组和阴性组的平均PSA值无显著差异。活检阳性组和阴性组之间的平均PSAD有显著差异（P < 0.0001）。221名男性的PSA值大于10.0纳克/毫升，其中140名（63%）前列腺活检呈阳性。在整个组中，前列腺特异性抗原密度在区分前列腺活检阳性或阴性男性方面并不比单独使用PSA更有用。在DRE正常的患者亚组（包括无良性前列腺增生）中，平均PSAD在区分活检阳性组和阴性组方面似乎有用（P < 0.004），而平均PSA则不然。