Egawa S, Suyama K, Kawakami T, Ohori M, Kuwao S, Hirokado K, Hirano S, Uchida T, Yokoyama E, Koshiba K
Department of Urology, Kitasato University School of Medicine, Japan.
Nihon Hinyokika Gakkai Zasshi. 1995 Dec;86(12):1711-9. doi: 10.5980/jpnjurol1989.86.1711.
Determination was made of serum PSA in the early detection of prostate cancer in a population of 1,227 men aged 55 years or older who visited a "human dock". "Human dock" is a unique health examination facility open to public in Japan. Recommendation for biopsy was made based solely on this parameter when its value exceeded 2.0 ng/ml in IMx immunoenzymetric assay (Dinabot Co.). Of these, 162 (13.2%) had elevated values. The proportion of males with serum PSA greater than 4.0 ng/ml was only 3.6%. Of the 109 males who underwent ultrasound guided biopsies, 17 cancers were detected, the cancer detection rate thus being 1.4%. Most of these cases (82.4%) were clinically localized cancers. Eight patients with cancer had serum PSA levels below 4.0 ng/ml including 6 less than 3.0 ng/ml. Radical prostatectomy was conducted on 14 patients. All had histologic features of clinically significant cancer and 64.3% were pathologically confined. Oriental elderly males appear to have lower serum PSA than western counterparts. The optimal cutoff of serum PSA for early detection should be examined further in oriental male populations. Differences in the incidence of prostate cancer between ethnic groups may have been overestimated in previous studies owing in part to unawareness by the physician and general public. Though the application of PSA for early detection will likely disclose greater numbers of prostate cancers in Japan, whether early detection reduces mortality by minimizing risk of death from cancer remains a point to be clarified.
对1227名年龄在55岁及以上前往“人体码头”的男性进行了血清前列腺特异性抗原（PSA）检测，以早期发现前列腺癌。“人体码头”是日本一家向公众开放的独特健康检查机构。当IMx免疫酶测定法（Dinabot公司）检测的PSA值超过2.0 ng/ml时，仅基于该参数进行活检推荐。其中，162人（13.2%）的PSA值升高。血清PSA大于4.0 ng/ml的男性比例仅为3.6%。在109名接受超声引导活检的男性中，检测到17例癌症，癌症检出率为1.4%。这些病例大多（82.4%）为临床局限性癌症。8例癌症患者的血清PSA水平低于4.0 ng/ml，其中6例低于3.0 ng/ml。14例患者接受了根治性前列腺切除术。所有患者均具有临床显著癌症的组织学特征，64.3%在病理上局限。东方老年男性的血清PSA似乎低于西方男性。对于东方男性人群，应进一步研究血清PSA用于早期检测的最佳临界值。以往研究可能部分由于医生和公众的忽视，高估了不同种族之间前列腺癌发病率的差异。尽管在日本应用PSA进行早期检测可能会发现更多的前列腺癌，但早期检测是否通过降低癌症死亡风险来降低死亡率仍有待明确。
