Yamazaki H, Suzuki Y, Madarame A, Katoh N, Masuda F, Endo K
Department of Urology, Jikei Daisan Hospital, Tokyo, Japan.
Nihon Hinyokika Gakkai Zasshi. 1996 Mar;87(3):702-9. doi: 10.5980/jpnjurol1989.87.702.
Determinations of serum levels of prostate specific antigen (PSA) are widely used for the detection of prostate cancer, but have not demonstrated sufficient sensitivity and specificity to be useful in urological practice. In order to enhance the diagnostic value of serum PSA, we studied the distribution of serum PSA levels by age in urological patients without clinical evidence of prostate cancer and determined clinical PSA reference values by age decades.
The study included a total of 590 male patients aged 40 to 89 years who visited our urological clinic complaining of voiding symptoms from January 1991 to October 1994, but had no clinically evident prostate cancer. We defined patients to be without clinical evidence of prostate cancer if they had negative test results in digital rectal examination, ultrasonography, and serum PSA assay, or had positive test results in one or more of these tests but had a nonmalignant prostate biopsy. Serum PSA levels were measured by E-Test Tosoh II (AIA-PACK PA, normal range; 0 to 5.3 ng/ml). The patients were grouped by age decades and serum PSA values were given as percentiles.
Analyzed by Pearson's correlation coefficient, serum PSA levels were correlated significantly with patient age (r = 0.24, p < 0.001). Prostatic volume was correlated weakly but significantly with patient age (r = 0.12, p = 0.005), and PSA density was also correlated significantly with patient age (r = 0.20, p < 0.001). Thus, serum PSA levels were demonstrated to increase with advancing patient age. Factors other than benign prostatic hypertrophy were also suggested to explain the increase in serum PSA levels in older patients. With the 95th percentile for serum PSA as the upper limit, the clinical PSA reference values by age decades were determined to be 2.6 ng/ml for patients aged 40 to 49 years, 5.0 ng/ml for 50 to 59 years, 7.5 ng/ml for 60 to 69 years, 10.1 ng/ml for 70 to 79 years, and 12.4 ng/ml for 80 to 89 years.
We found a significant increase in serum PSA levels with advancing patient age. Thus, it is appropriate to have serum PSA reference values by age decades. Prospective clinical trials are necessary to define the usefulness of the PSA reference values by patient age in urological practice.
血清前列腺特异性抗原（PSA）水平测定广泛用于前列腺癌检测，但在泌尿外科实践中其敏感性和特异性尚不足以发挥作用。为提高血清PSA的诊断价值，我们研究了无前列腺癌临床证据的泌尿外科患者血清PSA水平的年龄分布，并按年龄段确定了临床PSA参考值。
该研究共纳入590例年龄在40至89岁之间的男性患者，这些患者于1991年1月至1994年10月因排尿症状前来我院泌尿外科就诊，但无明显的前列腺癌临床表现。若患者直肠指检、超声检查及血清PSA检测结果均为阴性，或上述检查一项或多项结果为阳性但前列腺活检为非恶性，则定义为无前列腺癌临床证据。血清PSA水平采用E-Test Tosoh II（AIA-PACK PA，正常范围：0至5.3 ng/ml）进行检测。患者按年龄段分组，血清PSA值以百分位数表示。
经Pearson相关系数分析，血清PSA水平与患者年龄显著相关（r = 0.24，p < 0.001）。前列腺体积与患者年龄呈弱但显著的相关性（r = 0.12，p = 0.005），PSA密度也与患者年龄显著相关（r = 0.20，p < 0.001）。因此，血清PSA水平随患者年龄增长而升高。除良性前列腺增生外的其他因素也被认为可解释老年患者血清PSA水平的升高。以血清PSA的第95百分位数为上限，各年龄段的临床PSA参考值确定为：40至49岁患者为2.6 ng/ml，50至59岁为5.0 ng/ml，60至69岁为7.5 ng/ml，70至79岁为10.1 ng/ml，80至89岁为12.4 ng/ml。
我们发现血清PSA水平随患者年龄增长显著升高。因此，按年龄段确定血清PSA参考值是合适的。有必要进行前瞻性临床试验，以确定患者年龄相关的PSA参考值在泌尿外科实践中的实用性。
