TPSA、F／T及PSAD在前列腺癌诊断中的意义

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

目的探讨血清中总前列腺特异性抗原（TPSA）、血清游离PSA（FPSA）与TPSA比值（F／T）及PSA密度（PSAD）在前列腺癌诊断中的意义。方法对50例健康体检男性、467例良性前列腺增生症（BPH）及116例前列腺癌患者TPSA、F／T及PSAD值的差异进行分析、比较。结果血清TPSA值前列腺癌组（53．26±33．10）高于BPH组（8．12±9．70）及对照组（1．51±1．17）；PSAD值前列腺癌组[（1．59±1．46）ng·ml^-1·cm^-3]高于BPH组[（0．14±0．17）ng·ml^-1·cm^-3]及对照组[（0．08±O．07）ng·ml^-1·cm^-3]；而F／T值前列腺癌组（0．22±0．16）低于BPH组（0．27±0．15）及对照组（0．36±0．14），差异均有统计学意义（P值均〈0．01）。PSA处于4～10ng／ml时，前列腺癌组F／T（0．18±0．13）显著低于BPH组（0．27±0．14）（P〈0．05）；前列腺癌组PSAD[（0．21±0．07）ng·ml^-1·cm^-3]显著高于BPH组[（0．11±0．06）ng·ml^-1·cm^-3]（P〈0．001）。取F／T值0．16、PSAD值0．15ng·ml^-1·cm^-3为临界值时，F／T、PSAD值灵敏度、特异度及阳性预测值分别为81．6％、78．2％、96．1％和53．8％、76．9％、97．9％，诊断效率最高。结论F／T、PSAD是诊断前列腺癌的良好指标，当PSA为4-10ng／ml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 serum TPSA, the ratio of free PSA（FPSA） and TPSA（F/T） and PSAD in prostate cancer（PCa）. Methods The serum TPSA and PSAD levels and the ratio of F/T of 467 patients with BPH, 116 patients with PCa and 50 healthy men as normal control were determined, analyzed and compared. Results Serum TPSA of PCa （53.26±33.10） were significantly higher than that of BPH （8.12±9.70） （P 〈0.01）, and normal control （1.51±1.17） （P 〈0.01）; Serum PSAD of PCa [（1.59±l.46） ng＇ml-l＇cm-3] were significantly higher than that of BPH [（0.14±0.17） ng·ml^-l·cm^-3] （P 〈0.01）, and normal control [（0.08±0.07） ng·ml^-1·cm^-3] （P 〈0.01）; F/T of PCa （0.22±0.16） was significantly lower than that of BPH （0.27±0.15） and normal control （0.36±0.14） （P 〈0.01）. When TPSA was limited specificity at 4 10 ng/ml, F/T of PCa （0.18±0.13） were significantly lower than that of BPH （0.27±0.14）, （P 〈0.05）, PSAD of Pca [（0.21±0.07） rig. m1^-1. cm^-3] were significantly higher than that of BPH [（0.11±0.06） ng·ml^-1·cm^-3], （P 〈 0.001）. When F/T was 0.16, PSAD used 0.15 as the critical value, the sensitivity, specificity of diagnostic value and positive prediction value were 81.6 %, 78.2 %, 96.1% and 53.8 %, 76.9 %, 97.9 %, respectively; And the diagnostic efficiency was the highest. Conclusion F/T and PSAD have valuable role as the diagnose marker of PCa. When PSA level between 4 ng/ml and 10 ng/ml, F/T ratio and PSAD are of significant value to differentiate PCa from BPH patients.