Huncharek M, Muscat J
Department of Radiation Oncology, Massachusetts General Hospital, Cox-B, Harvard Medical School, Boston, MA 02114, USA.
Abdom Imaging. 1996 Jul-Aug;21(4):364-7. doi: 10.1007/s002619900083.
The standard staging evaluation for prostate cancer includes digital rectal examination, measurement of serum tumor markers, and radionuclide bone scan. In many institutions, abdominal/pelvic computed tomography (CT) scan or nuclear magnetic resonance imaging (MRI) is performed. We retrospectively reviewed 425 cases of newly diagnosed, untreated adenocarcinoma of the prostate to evaluate the ability of serum prostate-specific antigen (PSA) to predict results of staging abdominal pelvic CT.
The medical records of 425 newly diagnosed, untreated prostate cancer patients were reviewed. The following information was collected on a standard data form: age, clinical stage based on digital rectal exam, method of diagnosis, histological grade, serum PSA level, and results of abdominal pelvic CT including adenopathy and abnormalities of the upper urinary tract. The results of this review were tabulated and analyzed with regard to the ability of serum PSA level to predict positive results of abdominal pelvic CT.
The mean PSA level of the study group was 22.1 ng/ml. Fourteen patients (3.6%) presented with a positive abdominal/pelvic CT (12 with adenopathy, one with a renal cell tumor, and one with an adrenal metastasis). Eleven of these (79%) had serum PSA levels of 30.0 ng/ml or greater, ranging from 30.0 to 234 ng/ml. No patient with a positive study presented with a normal serum PSA level. Two patients with a positive study had a serum PSA level between 4.1 and 10.0 ng/ml (0.6%), and one had a PSA level between 10.1 and 20 ng/ml (0.3%).
We conclude that in asymptomatic patients with newly diagnosed, untreated prostate cancer and serum PSA levels of less than 20 ng/ml the likelihood of positive findings on abdominal/pelvic CT is extremely low (<1.0%). Abdominal/pelvic CT does not appear necessary in this setting. With 200,000 cases of newly diagnosed prostate cancer each year in the United States, elimination of staging abdominal/pelvic CT in these patients could reduce medical expenditures for prostate cancer management by $20-50 million per year.
前列腺癌的标准分期评估包括直肠指检、血清肿瘤标志物测定及放射性核素骨扫描。在许多机构中，还会进行腹部/盆腔计算机断层扫描（CT）或核磁共振成像（MRI）检查。我们回顾性分析了425例新诊断的未经治疗的前列腺腺癌病例，以评估血清前列腺特异性抗原（PSA）预测腹部盆腔CT分期结果的能力。
回顾了425例新诊断的未经治疗的前列腺癌患者的病历。通过标准数据表格收集以下信息：年龄、基于直肠指检的临床分期、诊断方法、组织学分级、血清PSA水平以及腹部盆腔CT结果，包括淋巴结病和上尿路异常情况。对此次回顾的结果进行列表整理，并就血清PSA水平预测腹部盆腔CT阳性结果的能力进行分析。
研究组的平均PSA水平为22.1 ng/ml。14例患者（3.6%）腹部/盆腔CT检查结果为阳性（12例有淋巴结病，1例有肾细胞肿瘤，1例有肾上腺转移）。其中11例（79%）血清PSA水平为30.0 ng/ml或更高，范围在30.0至234 ng/ml之间。没有血清PSA水平正常的患者检查结果为阳性。2例检查结果为阳性的患者血清PSA水平在4.1至10.0 ng/ml之间（0.6%），1例PSA水平在10.1至20 ng/ml之间（0.3%）。
我们得出结论，对于新诊断的未经治疗且血清PSA水平低于20 ng/ml的无症状前列腺癌患者，腹部/盆腔CT检查发现阳性结果的可能性极低（<1.0%）。在此情况下，腹部/盆腔CT检查似乎没有必要。在美国，每年有20万例新诊断的前列腺癌病例，对这些患者取消腹部/盆腔CT分期检查每年可为前列腺癌治疗节省2000万至5000万美元的医疗费用。
