以PSA筛查为基础前列腺癌早期诊断与治疗的研究

Early diagnosis and treatment of prostate cancer based on PSA screening

目的:了解扬州地区60岁以上老年男性前列腺特异性抗原(PSA)水平,探讨PSA筛查与前列腺癌早期诊断与治疗之间的联系。方法:制定详细的入选与排除标准,选取扬州地区2020年5-7月体检的60岁以上老年男性3102例,均具有完整随访信息。采用化学发光酶免疫分析法检测体检者血清PSA水平,对符合前列腺癌穿刺标准者,进行B超引导下经会阴前列腺组织穿刺活检并进行Gleason评分。结果:随着年龄的增加,PSA水平异常的比例明显增高(P<0.01)。共有62名老年人接受了前列腺穿刺活检,其中PSA在4~10 ng/mL 38人,穿刺诊断为癌14人(36.8%);PSA>10 ng/mL 24人,穿刺诊断为癌15个(62.5%)。随着PSA水平的升高,前列腺穿刺阳性的比例升高(P<0.05)。对穿刺阳性对象的肿瘤分期发现,随着PSA的升高,肿瘤的Gleason评分越高,危险系数越大(P<0.05)。结论:随年龄增加,PSA呈现上升趋势,且PSA水平升高,前列腺癌的发生可能性越大,恶性程度也随之增加。对于老年男性建议进行早期、定期PSA检查。

Objective:To investigate the level of prostate specific antigen(PSA)in elderly men over 60 years old in Yangzhou,and explore the relationship between PSA screening and early diagnosis and treatment of prostate cancer.Methods:The detailed inclusion and exclusion criteria was formulated,and 3102 elderly men over 60 years old who underwent physical examination in Yangzhou from May to July 2020 with complete follow-up information were selected.The serum PSA level was detected by chemiluminescent enzyme immunoassay.The patients who met the prostate cancer puncture criteria were subjected to transperineal prostate biopsy guided by B-ultrasound,and Gleason score was performed.Results:With the increase of age,the proportion of abnormal PSA level increased significantly(P<0.01).A total of 62 elderly patients underwent prostate biopsy,of which 38 patients had PSA between 4-10 ng/mL,and 14 patients(36.8%)were diagnosed as cancer;PSA>10 ng/mL in 24 cases,and 15(62.5%)cases were diagnosed as cancer by puncture.With the increase of PSA level,the proportion of positive prostate puncture increased(P<0.05).According to the tumor staging of puncture positive subjects,with the increase of PSA,the higher the Gleason score of tumor and the greater the risk coefficient(P<0.05).Conclusions:With the increase of age,PSA shows an upward trend,and the higher the level of PSA,the greater the possibility of prostate cancer,and the higher the degree of malignancy.Early and regular PSA examination is recommended for elderly men.