前列腺特异抗原异常患者抗感染药物治疗后血清指标的变化及其意义

Effects of antibiotic therapy on prostate-specific antigen(PSA) change in the differential diagnosis among patients with abnomal PSA

目的观察前列腺穿刺患者穿刺前行抗生素治疗后的血清总前列腺特异抗原(prostate-specificantigen,PSA)和游离PSA(fPSA)水平变化,评价其变化对预测前列腺癌是否具有一定意义。方法 2006年1月至2009年12月间共80例4ng/mL<PSA<20ng/mL的患者入组并被安排行前列腺穿刺活检术。采用随机法选出治疗组和对照组各40例。治疗组每天接受可乐必妥500mg、维持2周的药物治疗,对照组不接受可乐必妥治疗。两组于2周后均行经会阴前列腺穿刺,在穿刺当日晨所有患者行PSA和fPSA测定。分析两组中PSA较穿刺前2周变化情况及与穿刺病理结果间的关系。结果在治疗组中PSA显著下降(P=0.030),对照组不明显。治疗组fPSA/tPSA比值和PSAD在治疗前后也具有显著性差异,而对照组中变化均不明显。治疗组中病理证实为前列腺癌的亚组中,PSA变化不明显,而增生和炎症亚组中变化明显。PSA变化率对诊断前列腺癌有一定意义,其最佳临界点为-5.65%,灵敏度为64.3%,特异度为88.5%。结论在PSA特定升高的患者中,抗感染治疗后PSA的变化对鉴别前列腺癌和前列腺良性病变有一定的意义,可帮助更准确地选择前列腺穿刺活检病例和提高诊断准确率。

Objective To observe the change in total and free prostate-specific antigen（PSA） levels after antibiotic treatment,and to evalute the clinical significance of PSA change in the diagnosis of prostate cancer.Methods A total of 80 consecutive patients with 4 ng/mLPSA20 ng/mL scheduled for prostate biopsy were included in this prospective study.Totally 40 patients（treatment group） were then put on medical treatment with levofloxacin 500 mg qd during the routine waiting period of a 2-week procedure.Randomly selected 40 patients（control group） did not receive this treatment.tPSA and fPSA tests were repeated before the procedure.The change of PSA values was compared between the two groups and among the histological subgroups in treatment group.Results In treatment group,the decrease of PSA was significant（P=0.03）,while it did not happen in control group.There was significant difference in the fPSA/tPSA ratio and PSAD in treatment group before and after the therapy.The difference of fPSA values was unremarkable for both groups.In histologically determined cancer cases of treatment group,the difference between pre-and post-procedure PSA level was not significant,while in benign prostatic hyperplasia and prostatitis cases it was significant.PSA value change（PSA-Vch） had certain significance for the diagnosis of prostate cancer,and the best critical point was-5.65 with sensitivity and specificity of 64.3% and 88.5%.Conclusions In some suspicious cases with increased PSA,observing the change of PSA after antibiotic treatment for a time might improve the prostate cancer detection rate and decrease the unnecessary prostate biopsy.