Lodding P, Aus G, Bergdahl S, Frösing R, Lilja H, Pihl C G, Hugosson J
Urology Division, Sahlgrenska University Hospital, Ostra, Göteborg, Sweden.
J Urol. 1998 Mar;159(3):899-903.
We defined the yield and nature of prostate cancer in the setting of population based, randomized prostate specific antigen (PSA) guided screening in men with PSA levels between 3 and 4 ng./ml. who were 50 to 65 years old at the time of randomization.
Sextant biopsies were performed in 243 men with PSA of 3 to 4 ng./ml. Therapy decisions were based on core cancer length, histological grade and life expectancy.
Of the men 32 (13.2%) had prostate cancer constituting 23% of all of the 137 prostate cancers to data detected in the first round of our screening study. Age and PSA were similar in men with and without prostate cancer. Men with prostate cancer had significantly lower free PSA and free-to-total PSA ratio, and higher PSA density. Cancer was clinical stage T1c in 27 cases and stage T2 in 5. Hypoechoic areas were noted at transrectal ultrasound in 10 cases. Digital rectal examination and transrectal ultrasound were normal in 21 cases (66%). To date 14 patients have undergone prostatectomy. Surgical specimens showed a mean tumor volume of 1.8 cc (range 0.6 to 4.4) and significant amounts of high grade tumor were present in only 3 cases. Margins were positive in 5 cases, and pathological stage was pT2 in 8 cases and pT3 in 6.
By lowering the PSA cutoff from 4 to 3 ng./ml. an increase in cancer detection by 30% was achieved. While the addition of free-to-total ratio and PSA density may reduce the number of biopsies by about 15% with sensitivity maintained at 90%, systematic sextant biopsies were necessary in most of these mean as 66% of the tumors were negative on transrectal ultrasound and digital rectal examination. The majority of these cancers were clinically significant and suitable for curative treatment. If therapy decisions are based on the pathological findings of the biopsies, the risk of treating insignificant cancers seems low.
我们在基于人群的随机前列腺特异性抗原（PSA）引导筛查背景下，对随机分组时年龄在50至65岁、PSA水平在3至4 ng/ml的男性中前列腺癌的检出率及性质进行了界定。
对243例PSA为3至4 ng/ml的男性进行了六分区活检。治疗决策基于癌灶长度、组织学分级和预期寿命。
这些男性中，32例（13.2%）患有前列腺癌，占我们第一轮筛查研究中截至目前所检测到的137例前列腺癌总数的23%。患前列腺癌和未患前列腺癌的男性在年龄和PSA方面相似。患前列腺癌的男性游离PSA和游离PSA与总PSA比值显著更低，PSA密度更高。27例癌症为临床T1c期，5例为T2期。经直肠超声检查发现10例有低回声区。21例（66%）直肠指检和经直肠超声检查正常。截至目前，14例患者接受了前列腺切除术。手术标本显示平均肿瘤体积为1.8 cc（范围0.6至4.4），仅3例存在大量高级别肿瘤。5例切缘阳性，8例病理分期为pT2，6例为pT3。
将PSA临界值从4 ng/ml降至3 ng/ml，癌症检出率提高了30%。虽然增加游离PSA与总PSA比值和PSA密度可使活检数量减少约15%，同时敏感性维持在90%，但在大多数这些男性中仍需进行系统性六分区活检，因为66% 的肿瘤经直肠超声检查和直肠指检均为阴性。这些癌症大多数具有临床意义，适合进行根治性治疗。如果根据活检的病理结果做出治疗决策，治疗无意义癌症的风险似乎较低。
