Partin A W, Criley S R, Subong E N, Zincke H, Walsh P C, Oesterling J E
Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Urol. 1996 Apr;155(4):1336-9.
Age-specific prostate specific antigen (PSA) references ranges have been suggested to account for the age-dependent nature of the serum PSA concentration. It has been hypothesized that reference ranges of 0 to 2.5 ng./ml.serum PSA (40-49 years), 0 to 3.5 ng./ml. (50-59 years), 0 to 4.5 ng./ml. (60 to 69 years) and 0 to 6.5 ng./ml. (70 to 79 years) would detect fewer (potentially insignificant) prostate cancers in older men and more (potentially curable) cancers in younger men.
To investigate the pathological stage of tumors that would be affected by the use of age-specific PSA references ranges, we reviewed the medical records for 4,597 men with clinically localized (stage T1c, T2, or T3a) prostate cancer, with an average age of 62 +/- 7 years (range 38 to 76), who underwent radical prostatectomy between 1984 and 1994 at our institutions. Favorable pathological results were defined as organ-confined disease or capsular perforation with a Gleason score of less than 7, and unfavorable pathological results were defined as capsular perforation with a Gleason score of 7 or more, seminal vesicle invasion or lymph node involvement.
Overall, 18% of the men had PSA levels less than the standard PSA reference range (4.0 ng./ml.) compared to 22% when using the age-specific ranges. There were 74 more cancers detected in men younger than 60 years with the use of age-specific ranges, of which 81% had favorable pathological results. Among the men 60 years or older, 191 of 252 cancers (76%) not detected by using age specific ranges less than 3% were also stage T1c and 95% of these undetected T1c cancers were of favorable pathological status. Of those cancers not detected in older men with the age-specific ranges were of favorable pathological status. Of those cancers not detected in older men with age-specific ranges less than 3% were also stage T1c and 95% of these undetected T1c cancers were of favorable pathological status. Age-specific PSA reference ranges increased the potential for detection of prostate cancer by 18% in the younger men and decreased the detection by 22% in the older men.
Among these men with clinically localized prostate cancer, age specific PSA references ranges increased the detection of more potentially curable tumors in young men and decreased the detection of less advanced tumors in the older men compared to the standard reference range of 4.0 ng./ml. Among older men with nonpalpable (stage T1c) tumors age-specific PSA references ranges would have detected fewer tumors. However, 95% of these "missed" tumors would have had favorable pathological findings.
已有人提出特定年龄的前列腺特异性抗原（PSA）参考范围，以考虑血清PSA浓度随年龄变化的特性。据推测，参考范围为0至2.5 ng/ml血清PSA（40 - 49岁）、0至3.5 ng/ml（50 - 59岁）、0至4.5 ng/ml（60至69岁）和0至6.5 ng/ml（70至79岁），在老年男性中能检测出更少（可能无意义）的前列腺癌，而在年轻男性中能检测出更多（可能可治愈）的癌症。
为研究使用特定年龄PSA参考范围会影响的肿瘤病理分期，我们回顾了1984年至1994年间在我们机构接受根治性前列腺切除术的4597例临床局限性（T1c、T2或T3a期）前列腺癌男性患者的病历，这些患者平均年龄为62±7岁（范围38至76岁）。良好的病理结果定义为器官局限性疾病或Gleason评分小于7的包膜穿孔，不良的病理结果定义为Gleason评分为7或更高的包膜穿孔、精囊侵犯或淋巴结受累。
总体而言，18%的男性PSA水平低于标准PSA参考范围（4.0 ng/ml），而使用特定年龄范围时这一比例为22%。使用特定年龄范围时，60岁以下男性中多检测出74例癌症，其中81%具有良好的病理结果。在60岁及以上男性中，252例未被特定年龄范围检测出的癌症中有191例（76%）为T1c期，这些未被检测出的T1c期癌症中95%具有良好的病理状态。在老年男性中未被特定年龄范围检测出的那些癌症具有良好的病理状态。在老年男性中未被特定年龄范围检测出的那些癌症中，不到3%为T1c期，这些未被检测出的T1c期癌症中95%具有良好的病理状态。特定年龄的PSA参考范围使年轻男性中前列腺癌的检测可能性增加了18%，而使老年男性中的检测减少了22%。
在这些临床局限性前列腺癌男性患者中，与4.0 ng/ml的标准参考范围相比，特定年龄的PSA参考范围增加了年轻男性中更多潜在可治愈肿瘤的检测，减少了老年男性中较早期肿瘤的检测。在老年男性中，对于不可触及（T1c期）肿瘤，特定年龄的PSA参考范围检测出的肿瘤会更少。然而，这些“漏诊”肿瘤中有95%会有良好的病理表现。
