移行区前列腺特异性抗原密度：一种预测前列腺癌的新有效参数。

Prostate specific antigen density of the transition zone: a new effective parameter for prostate cancer prediction.

作者信息

Zlotta A R, Djavan B, Marberger M, Schulman C C

机构信息

Department of Urology, Erasme Hospital, University Clinics of Brussels, Belgium.

出版信息

J Urol. 1997 Apr;157(4):1315-21.

PMID:9120930

Abstract

PURPOSE

Use of prostate specific antigen (PSA) density to enhance the predictive value of detecting prostate cancer at intermediate PSA levels has been limited due to contradictory results in large scale studies. Most PSA leakage from the benign prostate into the serum comes from the transition zone. Therefore, in patients with benign prostatic hyperplasia (BPH) and prostate cancer with a serum PSA of less than 10 ng/ml. we studied and compared the values of PSA density of the total prostate and the transition zone. We examined the ability of PSA density of the transition zone to enhance prostate cancer detection in patients with intermediate PSA levels.

MATERIALS AND METHODS

The volumes of the entire prostate and of the transition zone were determined by transrectal ultrasound. PSA density for both regions was calculated in 88 patients with histologically confirmed prostate cancer (radical prostatectomy), and 74 with BPH and histologically proved benign disease.

RESULTS

Average total prostate PSA density plus or minus standard deviation was 0.12 +/- 0.07 and 0.22 +/- 0.12 ng./ml./cc in patients with BPH and prostate cancer, respectively, while average PSA density of the transition zone was 0.21 +/- 0.13 and 1.02 +/- 0.70 ng./ml./cc, respectively (p < 0.0001). If a total prostate PSA density of 0.15 had been chosen, the cancer would have been missed in 34% of the patients compared to 10% if a cutoff value of 0.35 for PSA density of the transition zone had been chosen (p < 0.001). Overall, in patients with a PSA of 0.25 to 10.0 ng./ml. the sensitivity and specificity of PSA density of the transition zone for predicting prostate cancer at a 0.35 cutoff value were 90 and 93%, respectively, compared to 94 and 89%, respectively, for those with a PSA of 4 to 10 ng./ml.

CONCLUSIONS

In our study PSA density of the transition zone was much more accurate in predicting prostate cancer than was total prostate PSA density for PSA levels of less than 10 ng./ml. With respect to the high sensitivity and specificity, if confirmed in large prospective studies, including patients seen for early diagnosis, PSA density of the transition zone could become a routine tool for urologists in the prediction of prostate cancer in men with a PSA of 4 to 10 ng./ml.

摘要

目的

由于大规模研究结果相互矛盾，使用前列腺特异性抗原（PSA）密度来提高在中等PSA水平时检测前列腺癌的预测价值受到限制。大部分从良性前列腺漏入血清的PSA来自移行带。因此，对于血清PSA低于10 ng/ml的良性前列腺增生（BPH）患者和前列腺癌患者，我们研究并比较了整个前列腺和移行带的PSA密度值。我们检验了移行带PSA密度在中等PSA水平患者中提高前列腺癌检测的能力。

材料与方法

经直肠超声测定整个前列腺和移行带的体积。计算了88例经组织学证实为前列腺癌（根治性前列腺切除术）患者以及74例BPH且经组织学证实为良性疾病患者这两个区域的PSA密度。

结果

BPH患者和前列腺癌患者的平均总前列腺PSA密度±标准差分别为0.12±0.07和0.22±0.12 ng./ml./cc，而移行带的平均PSA密度分别为0.21±0.13和1.02±0.70 ng./ml./cc（p<0.0001）。如果选择总前列腺PSA密度为0.15，34%的患者会漏诊癌症，而如果选择移行带PSA密度的临界值为0.35，漏诊率为10%（p<0.001）。总体而言，对于PSA为0.25至10.0 ng./ml的患者，移行带PSA密度在临界值为0.35时预测前列腺癌的敏感性和特异性分别为90%和93%，而对于PSA为4至10 ng./ml的患者，敏感性和特异性分别为94%和89%。