Colberg J W, Smith D S, Catalona W J
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Urol. 1993 Mar;149(3):507-9. doi: 10.1016/s0022-5347(17)36130-x.
Various authors have recommended different values for the upper limit of normal for the monoclonal prostate specific antigen (PSA) assay (for example 4.0 ng./ml. or less by the manufacturer Hybritech or 2.8 ng./ml. or less by others). To our knowledge, no studies have examined the prevalence and pathological extent of prostate cancer detectable by needle biopsy in ambulatory volunteers with PSA levels in the range of 2.9 to 4.0 ng./ml. We evaluated 121 volunteers by rectal examination and transrectal ultrasonography with PSA levels in that range. We performed ultrasound-directed needle biopsy of the prostate if abnormal findings were present on either examination. The prevalence of detectable prostate cancer in this group was 7.2% (8 of 111). All 8 patients had pathologically organ confined cancer, and only 2 had suspicious findings on rectal examination but all had abnormal or suspicious ultrasound findings. We believe that the 7.2% yield from ultrasonography and biopsy in patients with a PSA level of 2.9 to 4.0 ng./ml. is too low to justify further invasive evaluation. Rather, we recommend careful followup and monitoring of these patients with serial PSA measurements and rectal examination, and advise performance of ultrasonography and biopsy if the rectal examination becomes suspicious for cancer or the PSA level increases above 4.0 ng./ml.
不同作者对单克隆前列腺特异性抗原（PSA）检测正常上限推荐了不同数值（例如，Hybritech公司认为正常上限为4.0 ng/ml或更低，其他一些公司则认为是2.8 ng/ml或更低）。据我们所知，尚无研究调查过PSA水平在2.9至4.0 ng/ml范围内的门诊志愿者经针吸活检可检测出的前列腺癌患病率及病理范围。我们对121名PSA水平处于该范围的志愿者进行了直肠指检和经直肠超声检查。若任一检查发现异常，则对前列腺进行超声引导下针吸活检。该组中可检测出的前列腺癌患病率为7.2%（111例中有8例）。所有8例患者的癌症在病理上均局限于器官内，只有2例在直肠指检时有可疑发现，但所有人在超声检查中均有异常或可疑发现。我们认为，对于PSA水平在2.9至4.0 ng/ml的患者，超声检查和活检7.2%的阳性率过低，不足以证明进一步进行侵入性评估是合理的。相反，我们建议对这些患者进行仔细的随访，通过连续的PSA测量和直肠指检进行监测，并建议如果直肠指检怀疑有癌症或PSA水平升至4.0 ng/ml以上，则进行超声检查和活检。
