O'Donoghue J M, Rogers E, Grimes H, McCarthy P, Corcoran M, Bredin H, Given H F
Department of General Surgery, University College Hospital, Galway, Ireland.
Br J Radiol. 1993 Aug;66(788):672-6. doi: 10.1259/0007-1285-66-788-672.
Carcinoma of the prostate is the commonest malignancy of the genitourinary tract in the male and is frequently associated with metastatic bone disease. Serial isotope bone scans for screening secondary deposits are not cost-effective. We have evaluated the serum prostate markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) as an alternative to conventional serial bone scanning in 129 patients with newly diagnosed prostate cancer over a period of 3 years. Although serum PSA did not reflect local tumour burden at presentation, it was significantly elevated in those who presented with stage D disease (p < 0.01). 45 patients presented de novo with metastatic bone deposits and a further 18 patients developed metastases during the study period. The sensitivity of PSA in detecting secondary deposits at presentation for levels in excess of 100 micrograms/l was 93.75%, the positive predictive value 95.7% and the negative predictive value for levels less than 5 micrograms/l was 90.6%. During the follow-up period the sensitivity was 94.4%, the positive predictive value 100% and the negative predictive value 100%, with a median lead time of 3 months in predicting metastases in the 18 patients with progressive disease. When compared with PAP, PSA was found to be a statistically superior marker of bone metastases both at presentation and follow-up (p < 0.05). We recommend that PAP measurements are no longer necessary and should be replaced by PSA, and that serial serum PSA estimations should determine the need for future isotope bone scans in the patient with established prostate cancer.
前列腺癌是男性泌尿生殖道最常见的恶性肿瘤，常伴有骨转移疾病。用于筛查继发性骨转移的系列同位素骨扫描不具有成本效益。在3年时间里，我们对129例新诊断为前列腺癌的患者评估了血清前列腺标志物前列腺特异性抗原（PSA）和前列腺酸性磷酸酶（PAP），以替代传统的系列骨扫描。虽然血清PSA在初诊时不能反映局部肿瘤负荷，但在出现D期疾病的患者中显著升高（p<0.01）。45例患者初诊时即有骨转移，另有18例患者在研究期间发生转移。PSA检测初诊时超过100微克/升水平的继发性骨转移的敏感性为93.75%，阳性预测值为95.7%，低于5微克/升水平的阴性预测值为90.6%。在随访期间，敏感性为94.4%，阳性预测值为100%，阴性预测值为100%，在预测18例进展性疾病患者的转移时，中位提前期为3个月。与PAP相比，发现PSA在初诊和随访时都是骨转移的统计学上更优的标志物（p<0.05）。我们建议不再需要检测PAP，而应由PSA替代，并且系列血清PSA测定应确定已确诊前列腺癌患者未来是否需要进行同位素骨扫描。
