前列腺特异性抗原灰区的前列腺癌临床资料分析

Clinical analysis of prostate cancer in PSA grey zone

目的分析前列腺特异性抗原(PSA)灰区(4～10 ng/ml)与前列腺癌的关系,探索如何提高灰区PSA水平的前列腺癌活检诊断率。方法对2004年3月至2005年3月间,PSA介于灰区、接受前列腺穿刺活检的72例病人资料进行回顾分析。包括肛指检查、IPSS评分、经直肠超声(TRUS)检查、PSA密度(PSAD)、游离/总PSA(F/T)比值以及病理学酶标检查。结果穿刺组织病理学检查证实为前列腺癌14例(19.2%),平均年龄(74.2±2.4)岁,IPSS(12.9±4.5),PSAD(0.29±0.04),F/T(0.11±0.02)。GS评分≤6共9例,GS=7共2例,GS≥8共3例。肛指有结节3例,无结节11例。TRUS低回声区2例,等回声区2例,回声不均6例,回声均匀4例。前列腺尖部穿刺阳性率占51.4%。结论PSAD和F/T在PSA灰区的前列腺癌和前列腺增生两组间有明显差别;PSA灰区范围内,前列腺尖部是前列腺癌的高发部位。

Objective To analyze the clinical data of prostate cancer whose PSA was in grey zone （4-10 ng/ml）. Methods From Mar.2004 to Mar 2005, 72 patients whose PSA Level lied between 4-10 ng/ml were enrolled in this study, several items including digital rectal examination, IPSS, TRUS, PSAD, FIT and pathological enzymatic examination were analyzed. Results 14 patients （19.2%） were diagnosed as prostate cancer with the proof of pathological results. Mean age （74.2±2.4）, IPSS（12.9±4.5）, PSAD（0.29±0.04）, F/T（0.11±0.02）. 9 cases with Gleason score less than 6,2 cases equal to 7 and 3 cases more than 8. Three cases had prostate nodule by DRE, and 2 cases had lower resonance in TRUS, 2 cases with equal resonance, 6 cases with irregular resonance during TRUS. Prostate apex was thought as the most common location for cancer. Conclusion PSAD and FIT might be the surrogate marker for prostate cancer in grey zone compared with other items, the most possible lesion for prostate cancer is apex.