前列腺癌集团筛查的病理特征及与血清前列腺特异性抗原的关系

Pathological features of prostate cancer in Chinese cohort detected through mass screening and their relationships with serum prostate specific antigen

目的 探讨人群中前列腺癌的活检病理学特征及与血清前列腺特异性抗原 (PSA)的关系。方法 应用Elisa方法对长春市 12 0 2 7名男性血清PSA进行了检测及前列腺癌集团筛查 ,对血清PSA值 >4 0 μg/L和有尿路阻塞症状的男性经直肠超声引导下系统性行前列腺 6点穿刺活检 ,应用统计学软件SPSS 10 0进行病理分析。结果 12 0 2 7名对象对 15 8例进行了前列腺活检穿刺 ,其中 137例血清PSA值 >4 0 μg/L ,2 1例血清PSA值 <4 0 μg/L ,但是有尿道阻塞症状。在 15 8例活检组织中 ,有 2 5 9%为前列腺癌 ,其中中分化癌和低分化癌分别占 6 1%和 34%。 4 1例前列腺癌患者的血清PSA值与Gleason评分间存在明显的线性正相关关系 (r =0 32 9,P <0 0 5 ) ,前列腺癌患者血清PSA值与 6点活检标本前列腺癌阳性点数间存在明显的线性正相关关系 (r =0 4 2 5 ,P =0 0 0 6 )。结论 中分化癌是人群中前列腺癌的最常见类型。应用血清PSA进行前列腺癌集团筛查对前列腺癌早期发现具有重要意义。血清PSA值不仅和前列腺癌的病理分级而且和肿瘤的范围有关系。

Objective To investigate the pathological features of the prostate biopsy through mass screening for prostate cancer in Chinese cohort and their relationships with serum prostate specific antigen (PSA). Methods ELISA was used to measured the serum PSA in 12 027 Chinese men aged 50 and over in Changchun, Jilin Province. Transrectal ultrasound guided six-sextant biopsy was performed on 137 cases with the serum PSA value >4.0 μg/L and 21 cases with the serum PSA <4.0 μg/L but with urethral obstructive symptoms. Pathological analysis was done with the aid of statistic software SPSS 10.0. Results Of the 158 biopsies, 41 cases of prostatic carcinoma were found (25.9%, 41/158). The moderately differentiated carcinoma and poorly differentiated carcinoma accounted for 61% and 34% respectively. In these 41 cases of prostate cancer, a significant linear positive correlation between the serum PSA and the Gleason score ( r =0.329, P <0.05) and a significant linear positive correlation between the serum PSA and the positive counts of carcinoma in six-sextant biopsy ( r =0.425, P =0.006) were found. Conclusion The moderately differentiated carcinoma is the most common type of prostate cancer. The approach of mass screening opens a new avenue for the early detection of prostate cancer. Serum PSA value is not only associated with the pathological grading but also with the extension of tumor.