Lin D W, Gold M H, Ransom S, Ellis W J, Brawer M K
Department of Urology, University of Washington, Veteran's Affairs Medical Center and Northwest Prostate Institute, Seattle 98116, USA.
J Urol. 1998 Jul;160(1):77-81; discussion 81-2. doi: 10.1016/s0022-5347(01)63036-2.
Among the new approaches to enhance the performance of prostate specific antigen (PSA) testing in a biopsy population is the use of the free-to-total PSA as well as the transition zone density, which is calculated by dividing the PSA by the transition zone volume. We compare these manipulations of the PSA to PSA alone in a biopsy population.
We evaluated 917 consecutive men who underwent ultrasound guided biopsy for an elevation in serum PSA or abnormality on digital rectal examination. Total PSA was measured using the Tandem-E or Tandem-R method. Prostate gland volume and transition zone were measured with ultrasound and calculated using the prolate ellipsoid formula.
In the overall PSA range 276 men had carcinoma (30.0% of the population), while in the PSA 4.0 to 10.0 ng./ml. range 141 of 477 had cancer (29.6%). Receiver operating characteristics analysis and analysis of variance were performed. In the overall PSA series the Tandem total PSA performed as well as any PSA index to predict carcinoma. In the restricted range of total PSA 4.0 to 10.0 ng./ml. total PSA density as well as transition zone density were more predictive than PSA alone. In both PSA ranges the volume of benign glands was significantly larger than in the prostates exhibiting carcinoma. There was no statistically significant difference in outcomes of analyses between different investigators or different sites of investigation (Veterans Affairs versus university based hospitals).
In this biopsy population transition zone PSA density did not add to the information available with total PSA and gland volume. Neither investigator nor site bias contributed to the failure of transition zone PSA density or PSA density to predict prostatic carcinoma.
在提高活检人群中前列腺特异性抗原（PSA）检测性能的新方法中，包括使用游离PSA与总PSA的比值以及移行区密度，移行区密度通过将PSA除以移行区体积来计算。我们在活检人群中将这些PSA的处理方法与单独使用PSA进行比较。
我们评估了917名连续接受超声引导活检的男性，这些男性因血清PSA升高或直肠指检异常而接受检查。使用Tandem-E或Tandem-R方法测量总PSA。用超声测量前列腺体积和移行区，并使用长椭球体公式进行计算。
在整个PSA范围内，276名男性患有癌症（占总人群的30.0%），而在PSA为4.0至10.0 ng/ml的范围内，477名中有141名患有癌症（29.6%）。进行了受试者操作特征分析和方差分析。在整个PSA系列中，Tandem总PSA在预测癌症方面与任何PSA指标表现相当。在总PSA为4.0至10.0 ng/ml的受限范围内，总PSA密度以及移行区密度比单独使用PSA更具预测性。在两个PSA范围内，良性腺体的体积均显著大于患有癌症的前列腺。不同研究者或不同研究地点（退伍军人事务部医院与大学附属医院）之间的分析结果没有统计学上的显著差异。
在这个活检人群中，移行区PSA密度并未增加总PSA和腺体体积所提供的信息。研究者偏差和研究地点偏差均未导致移行区PSA密度或PSA密度无法预测前列腺癌。
