Wolff J M, Boeckmann W, Effert P J, Handt S, Jakse G
Department of Urology, Rheinisch-Westfäliche Technische Hochschule, Medizinische Fakultät, Aachen, Germany.
Br J Urol. 1995 Jul;76(1):41-6. doi: 10.1111/j.1464-410x.1995.tb07829.x.
To compare the efficacy of two tests, prostatic-specific antigen (PSA) and the PSA/prostate volume ratio (PSAD), as diagnostic and staging markers to discriminate patients with benign prostatic hyperplasia (BPH) from patients with cancer of the prostate (CaP).
Prostate gland volumes were estimated in 60 patients with BPH and 88 patients with clinically organ-confined CaP by performing transrectal ultrasonography (TRUS) and using the prolate ellipse formula. Serum PSA concentration was determined using an enzyme immunoassay. In patients with BPH, the prostates were removed either by transurethral resection or retropubic prostatectomy. Patients with CaP underwent laparoscopic pelvic lymphadenectomy followed by radical perineal prostatectomy. PSAD was calculated by relating the serum PSA level to the TRUS-estimated prostate volume.
The median PSA level was 4.4 ng/mL in patients with BPH, 9.3 ng/mL in patients with CaP-NO disease and 24 ng/mL in those with CaP-N+ disease. However, imposing a PSA limit of 4 ng/mL for the diagnosis of CaP gave a positive predictive value of only 64.8%, whereas a limit of 10 ng/mL gave a positive predictive value of 71.4%. In contrast, the median PSAD was 0.086 ng/mL/cm3 in patients with BPH, but was 0.295 ng/mL/cm3 in patients with NO-disease and 0.775 ng/mL/cm3 in those with N(+)-disease. With a limit of 0.15 ng/mL/cm3 the positive predictive value of PSAD was 81%. Furthermore, a limit of 0.6 ng/mL/cm3 revealed a positive predictive value of 81% for the diagnosis of metastatic lymph node involvement.
There was a considerable overlap of PSA concentrations in patients with BPH and CaP, and PSA was not sufficiently accurate to distinguish between them. In contrast, PSAD enhanced the discrimination between BPH and CaP and may provide additional information about the status of the lymph nodes in patients with CaP.
比较前列腺特异性抗原（PSA）和PSA/前列腺体积比（PSAD）这两种检测方法作为诊断和分期标志物，用于鉴别良性前列腺增生（BPH）患者与前列腺癌（CaP）患者的疗效。
通过经直肠超声检查（TRUS）并使用椭圆体公式，对60例BPH患者和88例临床局限于器官内的CaP患者的前列腺体积进行估算。采用酶免疫测定法测定血清PSA浓度。BPH患者通过经尿道切除术或耻骨后前列腺切除术切除前列腺。CaP患者先接受腹腔镜盆腔淋巴结清扫术，然后进行根治性会阴前列腺切除术。PSAD通过将血清PSA水平与TRUS估算的前列腺体积相关联来计算。
BPH患者的PSA中位数水平为4.4 ng/mL，CaP无转移疾病患者为9.3 ng/mL，CaP有转移疾病患者为24 ng/mL。然而，将PSA限值设定为4 ng/mL用于诊断CaP时，阳性预测值仅为64.8%，而限值为10 ng/mL时，阳性预测值为71.4%。相比之下，BPH患者的PSAD中位数为0.086 ng/mL/cm³，无转移疾病患者为0.295 ng/mL/cm³，有转移疾病患者为0.775 ng/mL/cm³。当限值为0.15 ng/mL/cm³时，PSAD的阳性预测值为81%。此外，限值为0.6 ng/mL/cm³时，对于诊断转移性淋巴结受累的阳性预测值为81%。
BPH患者和CaP患者的PSA浓度有相当大的重叠，PSA不足以准确区分两者。相比之下，PSAD增强了对BPH和CaP的鉴别能力，并可能为CaP患者的淋巴结状态提供额外信息。
