结合前列腺特异性抗原在前列腺癌诊断中的临床价值

Diagnostic value of cPSA for prostatic cancer

目的探讨结合前列腺特异性抗原(cPSA)在前列腺癌中的临床诊断意义。方法用化学发光免疫分析法检测前列腺癌(Pca)25例,前列腺增生(BPH)30例及正常对照组30例的血清总前列腺特异性抗原(tPSA)、cPSA和游离前列腺特异性抗原(fPSA)的浓度;计算f/tPSA比值并对tPSA、f/tPSA、cPSA进行统计学比较和ROC曲线分析。结果cPSA、tPSA在BPH组、Pca组分别与正常对照组比较均存在显著性差异(p<0.005),若以cPSA15.75ng/ml作为截断点诊断Pca,其敏感性、特异性、阳性预测值、实验有效率各参数均比较理想,分别为79.17%,92.86%,90.48%,88.46%。另tPSA,cPSA,fPSA三者在ROC曲线下的面积分别为tPSA>cPSA>f/tPSA。结论cPSA在鉴别前列腺增生和前列腺癌中具有较大的临床价值,建议临床以cPSA15.75ng/ml作为截断点,这能大幅度地提高cPSA对前列腺癌的检出率,减少或避免不必要的前列腺活检。

Objective To explore the value of serum cPSA in the diagnosis of prostatic cancer. Methods Serumlevels of fPSA and tPSA in patients with benign prostatic hyperplasia (BPH), prostatic cancer (Pca) and healthycontrols with no evidence of malignancy on biopsy were measured by IMMULITE, and serum levels of cPSA weremeasured by ACS-180, calculate f/tPSA Ratio. Results tPSA and cPSA were both significantly discriminated betweenthe cases of BPH, Pca and healthy controls. Using 15.75ng/ml as the cutoff value of cPSA in the diagnosis of prostaticcancer, the sensitivity, specificity, positive predictive value, and effective rate of experiments perform very well, theyare 79.17% ,92.86%,90.48%,88.46% respectively .The areas under receiver operating characteristic (ROC-AUCs) for tPSA, cPSA, f/tPSA ratio among BPH, Pca and healthy controls were indistinguishable (tPSA>cPSA>f/tPSA). Conclusions cPSA performs well in terms of the discimination of BPH and Pca. The use of 15.75ng/ml ascutoff value of CPSA may improve the diagnostic specificity of prosatic cancer and may also save numbers ofunnecessary biopsies.