Alivizatos G, Deliveliotis C, Mitropoulos D, Raptides G, Louras G, Karayiannis A, Becopoulos T, Dimopoulos A M
Urology Department of Athens Medical School, Sismanoglio Hospital, Greece.
Urology. 1996 Dec;48(6A Suppl):71-5. doi: 10.1016/s0090-4295(96)00614-0.
For patients with prostate specific antigen (PSA) values of 4-10 ng/mL, some urologists perform prostatic biopsies depending upon the findings of digital rectal examination (DRE) and transrectal ultrasonography (TRUS), and others perform biopsies on most of these men regardless of the findings of DRE and TRUS. The purpose of this study was to examine whether the information given by the measurement of the ratio of free to total (F/T) PSA can alter decision-making on prostatic biopsy.
One hundred and two (102) men with PSA values between 4 and 10 ng/mL, were included in this study. All men were examined with DRE and TRUS; a F/T PSA ratio was also measured, and six prostatic biopsies were taken from each patient.
In 102 men who were biopsied, 22 (21.5%) prostatic carcinomas were identified. Among these 22 cancer patients, 13 had abnormal findings in DRE and/or TRUS and would have been biopsied and diagnosed anyway. If we use only the F/T PSA ratio (cut-off value 0.20) to decide whom to biopsy, we would have diagnosed 16/22 cancers; the difference between these two procedures was not statistically significant (P = 0.17). If we decide to biopsy those patients who have abnormal findings in DRE and/or TRUS and those who have a F/T PSA ratio < 0.20, we would diagnose 20/22 cancers (P = 0.05) and at the same time, reduce the unnecessary biopsies from 80 to 41 (48%). With a PSA value between 4 and 10 ng/mL and no findings in DRE and TRUS and at the same time with a F/T PSA ratio > or = 0.20, we would have to perform biopsies in 20.5 men to find one cancer. On the other hand, in patients with suspicious findings in DRE and/or TRUS and a F/T PSA ratio < 0.20, in every two men that we biopsy we would find one cancer.
We believe that among patients with PSA values between 4 and 10 ng/mL after performing DRE and TRUS, the additional information of F/T PSA ratio can help since it increases the number of cancers detected and reduces the number of unnecessary biopsies.
对于前列腺特异性抗原（PSA）值在4 - 10 ng/mL的患者，一些泌尿科医生根据直肠指检（DRE）和经直肠超声检查（TRUS）的结果进行前列腺活检，而另一些医生则对大多数此类患者进行活检，无论DRE和TRUS的结果如何。本研究的目的是检验游离PSA与总PSA比值（F/T PSA）测定所提供的信息是否能改变前列腺活检的决策。
本研究纳入了102名PSA值在4至10 ng/mL之间的男性。所有男性均接受了DRE和TRUS检查；同时测量了F/T PSA比值，并对每位患者进行了6次前列腺活检。
在接受活检的102名男性中，发现了22例（21.5%）前列腺癌。在这22例癌症患者中，13例在DRE和/或TRUS检查中有异常发现，无论如何都会接受活检并被诊断出来。如果仅使用F/T PSA比值（临界值0.20）来决定哪些患者需要活检，我们将诊断出16/22例癌症；这两种方法之间的差异无统计学意义（P = 0.17）。如果我们决定对DRE和/或TRUS检查有异常发现以及F/T PSA比值< 0.20的患者进行活检，我们将诊断出20/22例癌症（P = 0.05），同时将不必要的活检从80次减少到41次（48%）。对于PSA值在4至10 ng/mL之间、DRE和TRUS检查无异常发现且F/T PSA比值≥0.20的患者，我们需要对20.5名男性进行活检才能发现1例癌症。另一方面，对于DRE和/或TRUS检查有可疑发现且F/T PSA比值< 0.20的患者，每活检2名男性就能发现1例癌症。
我们认为，在进行DRE和TRUS检查后PSA值在4至10 ng/mL之间的患者中，F/T PSA比值的额外信息是有帮助的，因为它增加了检测到的癌症数量并减少了不必要的活检次数。
