Marks L S, Dorey F J, Rhodes T, Shery E D, Rittenhouse H, Partin A W, deKernion J B
Department of Surgery/Urology, UCLA School of Medicine, Urological Sciences Research Foundation, USA.
J Urol. 1996 Sep;156(3):1035-9.
We studied the long-term effects of adenomectomy on serum levels of prostate specific antigen (PSA) in men with benign prostatic hyperplasia (BPH).
A consecutive series of 82 men undergoing adenomectomy for BPH between 1990 and 1992 was studied. PSA levels were determined before and serially after operation for as long as 5 years.
Mean PSA decreased from 4.6 ng/ml. preoperatively to 0.7 ng./ml. 6 months postoperatively. These low levels were maintained throughout the 5-year observation period. The PSA decrease correlated with grams of tissue removed (r = 0.54, p < 0.001) and averaged 0.11 ng./ml./gm. Postoperatively mean PSA velocity was 0.01 ng./ml. per year, that is essentially flat, and it was not influenced by patient age, race, type of operation, grams of tissue removed, baseline PSA, PSA density of T1a lesions (7). One to 5 years after adenomectomy 6 of the 82 men had invasive prostatic carcinoma, and PSA levels and velocities remained low.
These data support the concept of transition zone primacy in determining serum PSA. Furthermore, they suggest a possible need for a modified reference range when using PSA to screen for prostatic carcinoma in the estimated 3 million men alive in the United States who previously underwent adenomectomy for BPH.
我们研究了前列腺腺瘤切除术对良性前列腺增生（BPH）男性血清前列腺特异性抗原（PSA）水平的长期影响。
对1990年至1992年间连续82例行前列腺腺瘤切除术治疗BPH的男性患者进行了研究。术前及术后连续5年测定PSA水平。
平均PSA水平从术前的4.6 ng/ml降至术后6个月的0.7 ng/ml。在整个5年观察期内，这些低水平一直维持。PSA的下降与切除组织的克数相关（r = 0.54，p < 0.001），平均每克组织下降0.11 ng/ml。术后平均PSA速度为每年0.01 ng/ml，基本呈平稳状态，且不受患者年龄、种族、手术类型、切除组织克数、基线PSA、T1a病变的PSA密度影响。前列腺腺瘤切除术后1至5年，82名男性中有6人发生浸润性前列腺癌，PSA水平及速度仍保持较低。
这些数据支持了移行带在决定血清PSA方面起主要作用的概念。此外，这表明对于在美国估计300万曾因BPH接受过前列腺腺瘤切除术的男性，在使用PSA筛查前列腺癌时可能需要修改参考范围。
