van Andel G, Vleeming R, Kurth K, de Reijke T M
Department of Urology, University of Amsterdam, The Netherlands.
Semin Surg Oncol. 1995 Jan-Feb;11(1):36-45. doi: 10.1002/ssu.2980110106.
Transrectal ultrasonography (TRUS), digital rectal examination (DRE), and quantification of serum prostate-specific antigen (PSA) are accepted and evaluated methods for detecting prostate cancer. Positive predictive values (PPV) of DRE and TRUS are low, and only slightly enhanced when used in combination with PSA. PSA lacks sufficient sensitivity and specificity to be used alone as a screening test for prostate cancer. The parameters PSA-density and PSA-velocity make PSA a better tumor marker, but they are not reliable on an individual basis. Age-specific reference ranges have the potential to make PSA a more sensitive tumor marker for men less than 60 years of age and a more specific one for men beyond 60 years. With currently available diagnostic methods approximately 10% of patients undergoing transurethral or open resection of the prostate for presumed benign prostatic hyperplasia will have carcinoma detected in the histologic material. In 392 patients successively treated in our clinic for presumed BPH and thoroughly investigated to exclude prostatic carcinoma (DRE, TRUS, biopsy when PSA > 4 ng/ml or PSA-D > 0.15), the tumor was found incidentally in 4%. Another finding in this study was the detection of prostatic carcinoma by random biopsy in patients without a palpable or visible tumor by imaging and without PSA increase (> 4 ng/ml). Biopsies were performed because of a hypoechoic zone in the opposite lobe which turned out to be negative. Such tumors cannot be properly classified in the current TNM system. Treatment options for patients with incidental prostatic carcinoma are age- and stage-dependent. Patients less than 60 years old may be treated with a curative approach, irrespective of the T category (T1a or T1b); patients with a life expectancy longer than 10 years and a pT1b incidental carcinoma likewise should be offered a curative therapy.
经直肠超声检查（TRUS）、直肠指诊（DRE）以及血清前列腺特异性抗原（PSA）定量检测是公认的用于检测前列腺癌的方法。DRE和TRUS的阳性预测值较低，与PSA联合使用时仅略有提高。PSA单独用作前列腺癌筛查试验时，缺乏足够的敏感性和特异性。PSA密度和PSA速度参数使PSA成为更好的肿瘤标志物，但就个体而言并不可靠。特定年龄的参考范围有可能使PSA对于60岁以下男性成为更敏感的肿瘤标志物，而对于60岁以上男性成为更具特异性的标志物。使用目前可用的诊断方法，大约10%因假定为良性前列腺增生而接受经尿道或开放性前列腺切除术的患者，其组织学材料中会检测出癌。在我们诊所连续治疗的392例假定为良性前列腺增生且经过全面检查以排除前列腺癌的患者（DRE、TRUS，当PSA>4 ng/ml或PSA-D>0.15时进行活检）中，偶然发现肿瘤的比例为4%。该研究的另一个发现是，在影像学检查未发现可触及或可见肿瘤且PSA未升高（>4 ng/ml）的患者中，通过随机活检检测到前列腺癌。活检是因为对侧叶出现低回声区，但结果为阴性。此类肿瘤在当前的TNM系统中无法得到恰当分类。偶然发现前列腺癌的患者的治疗方案取决于年龄和分期。60岁以下的患者无论T分期（T1a或T1b）如何，都可以采用根治性治疗方法；预期寿命超过10年且为pT1b偶然癌的患者同样应接受根治性治疗。
