前列腺特异性抗原异常者经抗生素治疗后变化幅度对前列腺癌的诊断价值

The prostate cancer diagnosis value of prostate-specific antigen change quantity before and after antibiotic treatment in patients with abnormal prostate-specific antigen

目的 探讨前列腺特异性抗原（PSA）、游离前列腺特异性抗原（FPSA）水平经抗生素治疗后变化幅度对前列腺癌诊断的价值.方法 对85例PSA升高的患者进行抗生素治疗（左氧氟沙星静脉滴注1周）.治疗前后均检测PSA、FPSA,患者均进行前列腺穿刺活检.分析治疗前后PSA、FPSA的变化与穿刺活检阳性的关系.结果 治疗后PSA和FPSA均较治疗前明显下降[（5.82± 1.61） μg/L比（7.71±1.32）μg/L、（0.80±0.14） μg/L比（0.98±0.17） μg/L],差异均有统计学意义（P＜0.05）.85例患者中穿刺活检阳性10例.治疗后,PSA未下降（8例）、下降幅度＜10％（27例）、下降幅度10％～ 30％（24例）、下降幅度31％～ 50％（18例）、下降幅度＞50％（8例）进行分组,其中穿刺活检阳性分别为1例（1/8）、4例（14.8％,4/27）、3例（12.5％,3/24）、2例（2/18）,0例.结论 对于PSA异常患者抗生素治疗后能够引起PSA的下降,PSA小幅下降并不意味前列腺癌的风险消失,而抗生素治疗后PSA下降幅度大于50％的患者患前列腺癌的风险降低,可予严密观察.对于不能耐受或不愿意接受前列腺穿刺活检的患者,抗生素治疗前后PSA的变化幅度对前列腺癌有辅助诊断意义.

Objective To investigate the prostate cancer diagnosis value of prostate-specific antigen （PSA） and free prostate-specific antigen （FPSA） change quantity before and after antibiotic treatment in patients with abnormal PSA.Methods Eighty-five patients with elevated PSA were selected,and the patients were treated with antibiotic （levofloxacin intravenous drip for 1 week）.The PSA and FPSA levels were detected before and after treatment.All of the patients underwent prostate needle puncture biopsy.The relation between the PSA,FPSA change quantity before and after treatment and the puncture biopsy positive rate were analyzed.Results The PSA and FPSA levels after treatment were significantly lower than those before treatment：（5.82 ± 1.61） μ g/L vs.（7.71 ± 1.32） μ g/L and （0.80 ± 0.14） μ g/L vs.（0.98 ± 0.17） μ g/L,there were statistical differences （P 〈 0.05）.In 85 patients,10 cases were puncture biopsy positive.After treatment,no PSA change was in 8 cases,PSA decreased 〈 10% was in 27 cases,PSA decreased 10%-30% in 24 cases,PSA decreased 31%-50% was in 18 cases,and PSA decreased 〉 50% was in 8 eases,and puncture biopsy positive were 1 case （1/8）,4 cases （14.8%,4/27）,3 cases （12.5%,3/24）,2 cases （2/18）,0case,respectively.Conclusions The PSA can decrease after antibiotic treatment in patients with abnormal PSA,and small decrease of PSA does not mean that the risk of prostate cancer disappears,but the PSA decrease 〉 50% after antibiotic treatment means the risk of prostate cancer decreases,which may be closely observed.In patients unable to tolerate or unwilling to accept the prostate needle puncture biopsy,the PSA change quantity before and after antibiotic treatment can help to diagnose prostate cancer.