Hammerer P, Huland H
Urologische Universitätsklinik, Hamburg-Eppendorf.
Urologe A. 1995 Jul;34(4):283-9.
The use of prostate-specific-antigen in the early detection of prostatic carcinoma combined with digital-rectal examination results in a 2-3 times increase in prostatic carcinoma detection rate. 2/3 of PSA detected prostatic carcinoma are organ confined vs 40% of those which are detected by digital-rectal examination. 15-35% of all operated localized prostatic carcinoma have a normal PSA. A biopsy is indicated in men with a life expectancy of more than 10 years when the PSA value is above 10 ng/ml and/or digital-rectal examination is suspicious. This concerns only 2% of all men at the age older than 50 years. In 90% of all men older than 50 years the PSA is normal as well as the digital-rectal examination. In 4% of these the result of PSA and digital-rectal examination is false negative that means 4% have prostatic carcinoma. However, repeated digital-rectal examination and PSA determination on a yearly basis detects most of these overlooked prostatic carcinoma which still are organ confined in about 90% of the cases. In men with a minimal elevated PSA-value of 4-10 ng/ml, 25% will have a prostatic carcinoma regardless of the finding on digital-rectal examination. The indication to do a biopsy can be specified by the use of age specific PSA cut-off-levels and most likely in future by determining the free PSA vs the complex-bound PSA. Controversy exists about the usefulness of PSA-density and PSA-velocity.
将前列腺特异性抗原用于前列腺癌的早期检测并结合直肠指检，可使前列腺癌的检出率提高2至3倍。通过前列腺特异性抗原检测出的前列腺癌中，三分之二为器官局限性癌，而通过直肠指检检测出的此类癌症为40%。所有接受手术的局限性前列腺癌患者中，15%至35%的患者前列腺特异性抗原水平正常。对于预期寿命超过10年、前列腺特异性抗原值高于10纳克/毫升和/或直肠指检结果可疑的男性，建议进行活检。这仅涉及所有50岁以上男性中的2%。在所有50岁以上的男性中，90%的人的前列腺特异性抗原以及直肠指检结果均正常。其中4%的人的前列腺特异性抗原和直肠指检结果为假阴性，即这4%的人患有前列腺癌。然而，每年重复进行直肠指检和前列腺特异性抗原检测，可发现大多数这些被漏诊的前列腺癌，其中约90%的病例仍为器官局限性癌。对于前列腺特异性抗原值轻度升高至4至10纳克/毫升的男性，无论直肠指检结果如何，25%的人会患有前列腺癌。活检的指征可通过使用年龄特异性前列腺特异性抗原临界值来确定，未来很可能通过测定游离前列腺特异性抗原与复合结合前列腺特异性抗原的比例来确定。关于前列腺特异性抗原密度和前列腺特异性抗原速度的实用性存在争议。
