el-Galley R E, Petros J A, Sanders W H, Keane T E, Galloway N T, Cooner W H, Graham S D
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Urology. 1995 Aug;46(2):200-4. doi: 10.1016/s0090-4295(99)80194-0.
Prostate-specific antigen (PSA) has become the most useful serum tumor marker in the diagnosis and screening of prostate adenocarcinoma. The currently cited reference range of normal (0 to 4.0 ng/mL monoclonal) lacks both the sensitivity and specificity to be universally accepted as a screening test, and alternatives to serum PSA have been proposed, such as PSA density, PSA velocity, and age-adjusted PSA. Age-adjusted PSA takes into account the facts that as men grow older the prostate enlarges and that screening should have maximum sensitivity in younger men and maximum specificity in older men.
A population of 4,710 men with no known history of prostate adenocarcinoma underwent 5,629 examinations by transrectal ultrasound of the prostate (TRUS) from 1987 to 1994. This population consists of Mobile Urology Group, Mobile, Alabama, and Emory University, Atlanta, Georgia, patient databases. We have examined our data to determine the sensitivity, specificity, and positive predictive values for normal range PSA (0 to 4 ng/mL) versus age-specific PSA values.
A total of 2040 patients had an abnormal digital rectal examination (DRE) and 3581 procedures were performed for an elevated PSA and a normal DRE. Biopsies were performed in 2,657 patients with 945 (35.6%) positive for cancer. Criteria for biopsy included elevated PSA (more than 4 mg/mL), PSA density more than 0.15 abnormal DRE, or suspicious TRUS. Patients were grouped according to decade: group 1 (ages 40 to 49 years, n = 183), group 2 (ages 50 to 59 years, n = 1018), group 3 (ages 60 to 69 years, n = 2358), and group 4 (ages 70 to 79 years, n = 1687).
Use of the age-specific range for PSA increases the sensitivity in younger men more likely to benefit from treatment, and decreases the biopsy rate in older patients who may not be candidates for aggressive treatment. Age-adjusted PSA is the most valuable for patients over the age of 70 years of whom 22% would be spared TRUS with biopsy.
前列腺特异性抗原（PSA）已成为前列腺腺癌诊断和筛查中最有用的血清肿瘤标志物。目前引用的正常参考范围（0至4.0 ng/mL单克隆）缺乏作为筛查试验被普遍接受的敏感性和特异性，因此有人提出了血清PSA的替代指标，如PSA密度、PSA速率和年龄校正PSA。年龄校正PSA考虑到随着男性年龄增长前列腺会增大这一事实，以及筛查在年轻男性中应具有最大敏感性而在老年男性中应具有最大特异性。
1987年至1994年，对4710名无前列腺腺癌已知病史的男性进行了5629次经直肠超声前列腺检查（TRUS）。该人群包括阿拉巴马州莫比尔市的莫比尔泌尿外科小组和佐治亚州亚特兰大市的埃默里大学的患者数据库。我们检查了数据，以确定正常范围PSA（0至4 ng/mL）与年龄特异性PSA值的敏感性、特异性和阳性预测值。
共有2040例患者直肠指检（DRE）异常，3581例因PSA升高且DRE正常而进行了检查。对2657例患者进行了活检，其中945例（35.6%）癌症阳性。活检标准包括PSA升高（超过4 mg/mL）、PSA密度超过0.15、DRE异常或TRUS可疑。患者按十年分组：第1组（40至49岁，n = 183），第2组（50至59岁，n = 1018），第3组（60至69岁，n = 2358），第4组（70至79岁，n = 1687）。
使用年龄特异性PSA范围可提高年轻男性的敏感性，他们更有可能从治疗中获益，并降低老年患者的活检率，这些老年患者可能不适合积极治疗。年龄校正PSA对70岁以上患者最有价值，其中22%的患者可避免进行TRUS活检。
