Gustafsson O, Norming U, Gustafsson S, Eneroth P, Aström G, Nyman C R
Department of Urology, Karolinska Institute at Stockholm Söder Hospital, Sweden.
Br J Urol. 1996 Mar;77(3):433-40. doi: 10.1046/j.1464-410x.1996.89120.x.
To investigate the possible relationship between serum levels of prostate specific antigen (PSA), dihydrotestosterone (DHT), testosterone, sexual-hormone binding globulin (SHBG) and tumour stage, grade and ploidy in 65 cases of prostate cancer diagnosed in a screening study compared to 130 controls from the same population.
PATIENTS, SUBJECTS AND METHODS: From a population of 26,602 men between the ages of 55 and 70 years, 2400 were selected randomly and invited to undergo screening for prostate cancer using a digital rectal examination, transrectal ultrasonography and PSA analysis. Among the 1782 attendees, 65 cases of prostate cancer were diagnosed. Each case was matched with two control subjects of similar age and prostate volume from the screening population. Frozen serum samples were analysed for PSA, DHT, testosterone and SHBG, and compared to the diagnosis and tumour stage, grade and ploidy. Comparisons between these variables, and multivariate and regression analyses were performed.
There were significant differences in PSA level with all variables except tumour ploidy. DHT levels were slightly lower in patients with prostate cancer but the difference was not statistically significant. There was a trend towards lower DHT values in more advanced tumours and the difference for T-stages was close to statistical significance (P = 0.059). Testosterone levels were lower in patients with cancer than in the control group, but the differences were not significant. There was no correlation between testosterone levels, tumour stage and ploidy, but the differences in testosterone level in tumours of a low grade of differentiation compared to those with intermediate and high grade was nearly significant (P = 0.058). The testosterone/DHT ratio tended to be higher in patients with more advanced tumours. SHBG levels were lower in patients with cancer than in controls but the differences were not statistically significant. There were no systematic variations of tumour stage, grade and ploidy. Multivariate analysis showed that if the PSA level was known, then DHT, testosterone or SHBG added no further information concerning diagnosis, stage, grade or ploidy. Regression analysis on T-stage, PSA level and DHT showed an inverse linear relationship between PSA and DHT for stage T-3 (P = 0.035), but there was no relationship between PSA and testosterone.
PSA was of value in discriminating between cases and controls and between various tumour stages and grades, but no statistically significant correlation was found for ploidy. If PSA level was known, no other variable added information in individual cases. Within a group, DHT levels tended to be lower among cases and in those with more advanced tumours. There was an inverse relationship between tumour volume, as defined by PSA level, and 5 alpha-reductase activity, as defined by DHT level, and the testosterone/DHT ratio. This trend was most obvious with T-stage. No systematic variation were found in the levels of testosterone or SHBG.
在一项筛查研究中确诊的65例前列腺癌患者与来自同一人群的130名对照者中，研究血清前列腺特异性抗原（PSA）、双氢睾酮（DHT）、睾酮、性激素结合球蛋白（SHBG）水平与肿瘤分期、分级及倍体之间可能存在的关系。
患者、研究对象与方法：在年龄介于55至70岁的26602名男性人群中，随机选取2400人，邀请他们接受前列腺癌筛查，采用直肠指检、经直肠超声检查及PSA分析。在1782名参与者中，确诊了65例前列腺癌。每例患者与筛查人群中年龄及前列腺体积相似的两名对照者进行匹配。对冷冻血清样本进行PSA、DHT、睾酮及SHBG分析，并与诊断结果、肿瘤分期、分级及倍体进行比较。对这些变量进行比较，并进行多变量及回归分析。
除肿瘤倍体外，PSA水平与所有变量之间均存在显著差异。前列腺癌患者的DHT水平略低，但差异无统计学意义。在更晚期肿瘤中，DHT值有降低趋势，T分期的差异接近统计学意义（P = 0.059）。癌症患者的睾酮水平低于对照组，但差异不显著。睾酮水平、肿瘤分期及倍体之间无相关性，但低分化肿瘤与中高分化肿瘤相比，睾酮水平差异接近显著（P = 0.058）。在更晚期肿瘤患者中，睾酮/DHT比值往往更高。癌症患者的SHBG水平低于对照组，但差异无统计学意义。肿瘤分期、分级及倍体无系统性变化。多变量分析显示，如果已知PSA水平，那么DHT、睾酮或SHBG并未提供有关诊断、分期、分级或倍体的更多信息。对T分期、PSA水平及DHT进行回归分析显示，对于T-3期，PSA与DHT之间呈负线性关系（P = 0.035），但PSA与睾酮之间无关系。
PSA在区分病例与对照以及不同肿瘤分期和分级方面具有价值，但未发现与倍体存在统计学显著相关性。如果已知PSA水平，在个体病例中其他变量并未提供更多信息。在一组中，病例组及更晚期肿瘤患者的DHT水平往往较低。由PSA水平定义的肿瘤体积与由DHT水平定义的5α-还原酶活性及睾酮/DHT比值之间呈负相关。这种趋势在T分期中最为明显。未发现睾酮或SHBG水平有系统性变化。
