Zlotta A R, Djavan B, Petein M, Susani M, Marberger M, Schulman C C
Department of Urology, Erasme Hospital, University Clinics of Brussels, Belgium.
J Urol. 1998 Dec;160(6 Pt 1):2089-95. doi: 10.1097/00005392-199812010-00040.
Prostate specific antigen (PSA) density of the transition zone, which is the density of serum PSA related to the volume of the transition zone, has been recently demonstrated to enhance prostate cancer prediction in patients with intermediate PSA levels. We further investigated the usefulness of PSA-transition zone for predicting extraprostatic extension in clinically localized prostate cancer.
Measuring the transition zone of the prostate by ultrasound using the prolate ellipsoid method, PSA-transition zone values were calculated prospectively in 198 patients with clinically localized prostate cancers and serum PSA less than 10.0 ng./ml. who underwent radical retropubic prostatectomy. The ability of PSA-transition zone to predict extracapsular disease in the surgical specimen was compared to Gleason score, serum PSA, PSA density of the total prostate and percent free PSA using univariate or multivariate analysis as well as receiver operating characteristics curves.
A total of 104 patients (52.5%) had pathologically organ confined prostate cancer while 94 of 198 (47.5) had extracapsular disease. PSA-transition zone levels were significantly higher in extracapsular disease than organ confined cancers (0.84 versus 0.42 ng./ml./cc, p <0.00001). Using multivariate analyses PSA-transition zone and Gleason score were the most significant predictors of extracapsular disease. The area under the curve was larger for PSA-transition zone (0.825) than any other parameter (p <0.004 versus PSA density and p <0.001 versus PSA, percent free PSA or Gleason score). A cutoff of 1.00 ng./ml./cc for PSA-transition zone provided 95.1% specificity and 28.8% sensitivity for predicting extracapsular disease. Probability plots using the best combination of independent variables for predicting extraprostatic extension were developed.
These data demonstrate that the use of the PSA-transition zone may be of additional value for indicating which patients with clinically localized prostate cancer and PSA less than 10.0 ng./ml. are at high risk for extracapsular disease.
移行区前列腺特异性抗原（PSA）密度，即与移行区体积相关的血清PSA密度，最近已被证明可增强对PSA水平处于中等范围患者的前列腺癌预测能力。我们进一步研究了PSA-移行区在预测临床局限性前列腺癌患者前列腺外侵犯方面的实用性。
采用长椭圆形法通过超声测量前列腺的移行区，前瞻性地计算了198例临床局限性前列腺癌且血清PSA低于10.0 ng/ml并接受耻骨后根治性前列腺切除术患者的PSA-移行区值。使用单因素或多因素分析以及受试者工作特征曲线，将PSA-移行区预测手术标本中包膜外疾病的能力与Gleason评分、血清PSA、总前列腺PSA密度和游离PSA百分比进行比较。
共有104例患者（52.5%）病理检查显示前列腺癌局限于器官内，而198例中的94例（47.5%）有包膜外疾病。包膜外疾病患者的PSA-移行区水平显著高于局限于器官内的癌症患者（0.84对0.42 ng/ml/cc，p<0.00001）。使用多因素分析，PSA-移行区和Gleason评分是包膜外疾病的最显著预测因素。PSA-移行区的曲线下面积（0.825）大于任何其他参数（与PSA密度相比p<0.004，与PSA、游离PSA百分比或Gleason评分相比p<0.001）。PSA-移行区的临界值为1.00 ng/ml/cc时，预测包膜外疾病的特异性为95.1%，敏感性为28.8%。绘制了使用预测前列腺外侵犯的最佳独立变量组合的概率图。
这些数据表明，对于临床局限性前列腺癌且PSA低于10.0 ng/ml的患者，使用PSA-移行区可能在指示哪些患者有包膜外疾病高风险方面具有额外价值。
