Aziz D C, Barathur R B
OncQuest, Division of Specialty Laboratories, Santa Monica, California 90404.
J Clin Lab Anal. 1993;7(5):283-92. doi: 10.1002/jcla.1860070509.
To establish the value of serum prostate-specific antigen (PSA) and prostate-specific antigen per unit volume of prostate gland (PSAD) in detecting prostate carcinoma (CaP) in a hypothetical screening algorithm, a meta-analysis of the sensitivities, specificities, predictive values and likelihood ratios were combined from the published data.
Journal articles identified by a MEDLINE database search from 1988 to October 1992, using prostate-specific antigen as a key word were used to calculate the distribution of PSA in healthy men, men with benign prostatic hyperplasia (BPH) and men with prostate carcinoma (CaP).
Only studies that contained the specified serum PSA values and patient outcomes were included.
The distributions of the serum PSA were plotted versus serum PSA for healthy men (2567), men with BPH (798) and men with CaP (835) from the abstracted data. Prostate volume distributions were estimated from the published transrectal ultrasound (TRUS) calculations.
Hypothetical cohorts of 1,000 men between the ages of 60 and 70 years were screened using three different screening decision algorithms. Using a serum PSA cutoff of 3.0 ng/ml for referral for transrectal biopsy, 59 of 80 (74%) CaP would be detected and 21 (26%) would be missed. 209 transrectal biopsies would be performed, and 150 (72%) of them would be negative for CaP. Using a serum PSA cutoff of 4.0 ng/ml, 52 of 80 (65%) CaP would be detected and 28 (35%) would be missed. 146 transrectal biopsies would be performed, and 94 (64%) of them would be unnecessary. Using a cutoff of 2.0 ng/ml for serum PSA and 0.1 ng/ml/cc for PSAD, 55 of 80 (69%) of the cancers would be detected and 25 (31%) would be missed. Only 84 transrectal biopsies would be performed, and 29 (35%) of them would be negative for cancer.
This algorithm maximizes the number of cancers detected (true-positive cases) and at the same time reduces the number of false-positive cases, minimizing the number of patients who would have to receive an unnecessary transrectal biopsy, compared to using a serum PSA cutoff of 3.0 or 4.0 ng/ml.
为确定在一种假设的筛查算法中血清前列腺特异性抗原（PSA）及单位前列腺体积前列腺特异性抗原（PSAD）在检测前列腺癌（CaP）方面的价值，对已发表数据中的敏感性、特异性、预测值及似然比进行了荟萃分析。
使用前列腺特异性抗原作为关键词，通过对1988年至1992年10月的MEDLINE数据库搜索确定的期刊文章，用于计算PSA在健康男性、良性前列腺增生（BPH）男性和前列腺癌（CaP）男性中的分布情况。
仅纳入包含特定血清PSA值及患者结局的研究。
根据提取的数据绘制健康男性（2567例）、BPH男性（798例）和CaP男性（835例）的血清PSA分布与血清PSA的关系图。前列腺体积分布根据已发表的经直肠超声（TRUS）计算结果进行估算。
使用三种不同的筛查决策算法对1000名年龄在60至70岁之间的男性进行假设队列筛查。以血清PSA阈值3.0 ng/ml作为经直肠活检的转诊标准，80例CaP中可检测出59例（74%），漏诊21例（26%）。将进行209次经直肠活检，其中150例（72%）CaP检测结果为阴性。以血清PSA阈值4.0 ng/ml作为标准，80例CaP中可检测出52例（65%），漏诊28例（35%）。将进行146次经直肠活检，其中94例（64%）为不必要的活检。以血清PSA阈值2.0 ng/ml及PSAD阈值0.1 ng/ml/cc作为标准，80例癌症中可检测出55例（69%），漏诊25例（31%）。仅需进行84次经直肠活检，其中29例（35%）CaP检测结果为阴性。
与使用血清PSA阈值3.0或4.0 ng/ml相比，该算法可使检测出的癌症数量（真阳性病例）最大化，同时减少假阳性病例数量，将必须接受不必要经直肠活检的患者数量降至最低。
