PSA、F/TPSA及PSAD在前列腺癌诊断中的意义

Role of PSA, F/TPSA and PSAD in diagnosis of prostate cancer

目的探讨血清前列腺特异抗原(PSA),血清游离PSA及总PSA比值(F/TPSA)及前列腺特异性抗原密度(PSAD)在前列腺癌(PCa)诊断中的意义。方法对674例正常健康体检男性,245例良性前列腺增生症(BPH)及81例PCa患者PSA、F/TPSA及PSAD值的差异进行分析、比较。结果PCa组血清PSA及PSAD高于BPH组及正常对照组;而F/TPSA值低于BPH组及正常对照组,差异均有显著性。PSA处于4～10μg/L时,BPH、PCa组间PSA差异无显著性,PCa组F/T显著低于BPH组,PSAD显著高于BPH组。用F/T≤0.15、PSAD≥0.18诊断PCa阈值的敏感性为83.3%和85.9%,特异性为75.1%和76.8%。结论PSA>4μg/L作为筛选PCa的临界值存在一定缺陷;当PSA为4～10μg/L诊断灰区时,F/T与PSAD对诊断前列腺癌有较好的价值。

[Objective] To investigate the diagnostic value of the ratio of FPSA and TPSA in prostate cancer （PCa）. [Methods] The serum TPSA and FPSA levels of 326 patients （81 patients with PCa, 245 patients with BPH） and 674 healthy men as normal control were determined, and the ratio of F/T was calculated. [Results] TPSA and PSAD of PCa were significantly higher than of BPH and normal control, F/T of PCa was significantly lower than of BPH and normal control. When TPSA in 4- 10 μg/L, the difference of TPSA between PCa and BPH was not significant, but F/T of PCa were significantly lower than of BPH, PSAD of PCa were significantly higher than of BPH. When F/T≤0.15 or PSAD≥0.18 used as the standard of diagnose PCa, sensitivity and specificity were 83.3%, 85.9% and75.1%, 76.8%, respectively. [Conclusion] It sounds unreasonable as PSA〉4 μg/L is regarded as a reasonable critical value for the diagnosis of prostate carcinoma. When PSA level between 4 μg/L and 10 μg/L, F/T ratio and PSAD are of significant value to differentiate PCa from BPH patients.