Early diagnosis of prostate cancer using free/total prostate specific antigen ratio: a population based screening data

Aim: To evaluate the use of free/total prostate specific antigen ratio (fPSA/tPSA ratio) in improving the early diagnosis of prostate cancer. Methods: The fPSA/tPSA ratio in the serum was analyzed in 187 men with tPSA ranging between 4.0 and 20.0 μg/L. All of them underwent ultrasound guided sextant prostatic biopsy. The results were calculated by SPSS 10.0 software. Results: (1) When the tPSA was within the ranges of 4.0 - 10.0 and 10.0 -20.0 μg/L, the prostate cancer detection rate was 18.1 % and 22.5 %, respectively; (2) The area under the curve (AUC) was bigger in fPSA/tPSA than in tPSA (P<0.05) in all the men; (3) When the cut off value of fPSA/tPSA ratio was set at 0.25 and the tPSA at 4.0 - 10.0 μg/L and 10.0 - 20.0 μg/L, the diagnostic sensitivity of tPSA was 90.5 % and 87.5 %, respectively. Thus at the tPSA ranges of 4.0 - 10.0 and 10.0 - 20.0 μg/L, 26.7 % and 11.3 % of biopsies could be avoided, respectively. Conclusion: The use of fPSA/tPSA ratio can improve the prostate cancer detection rate and reduce unnecessary biopsies when tPSA is within the range of 4.0 - 20.0 μg/L.

Analysis of results related to the percent free prostate specific antigen among men without prostate diseases in Xi'an area

To measure the percent of free prostate specific antigen （fPSA） among men without prostate diseases in Xi＇an area, and to study the relationship of percent fPSA with age and pathological grade, clinical stage of prostate cancer （PCa） with percent fPSA, and to analyze the difference between the data in China and the.overseas data to determine appropriate reference range for Chinese male. Methods： A total of 713 participants were enrolled into the study, with PSA, fPSA in serum measured and the percent fPSA calculated. Out of 713 cases, 679 without prostate diseases were divided into 5 groups by age, and then the relationships of PSA, fPSA and percent fPSA with age were studied, respectively. The relationship of pathological grade and clinical stage with percent fPSA of the 34 participants with PCa was also studied. With the help of the related data of men without prostate disease, the appropriate reference range for Chinese male was established. Results： The increases in PSA or fPSA were correlated with age, while there was no significant correlation between age and percent fPSA. The percent fPSA was also correlated with pathological grade and clinical stage of PCa. The percent fPSA of men without prostate disease in Xi＇an area was significandy lower than that in the related overseas data. The reference range of percent fPSA for Chinese male was≥ 15%. Conclusion： Percent fPSA might be more useful than PSA in the detection of prostate cancer. As the percent fPSA is decreased, the pathological grade is decreased, and the clinical stage is increased, the malignant degree is increased. The reference range of ≥15% is more appropriate for Chinese male.

Endorectal Magnetic Resonance Imaging and Spectroscopy Are Useful for Selecting Candidates for Biopsy among Patients with Persistently Elevated Prostate Specific Antigen

Objective: To evaluate the efficacy of endorectal Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spetroscopic Imaging (MRSI) combined with total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) in selecting candidates for biopsy. Subjects and Methods: 246 patients with elevated tPSA (median: 7.81 ng/ml) underwent endorectal MRI and MRSI before Transrectal Ultrasound (TRUS) biopsy (10 peripheral + 2 central cores);patients with positive biopsies were treated with radical intention;those with negative biopsies were followed up and underwent MRSI before each additional biopsy if tPSA rose persistently. Mean follow-up: 27.6 months. We compared MRI, MRSI, tPSA, and fPSA with histopathology by sextant and determined the association between the Gleason score and MRI and MRSI. We determined the most accurate combination to detect prostate cancer (PCa) using receiver operating curves;we estimated the odds ratios (OR) and calculated sensitivity, specificity, and positive and negative predictive values. Results: No difference in tPSA was found between patients with and without PCa (p = 0.551). In the peripheral zone, the risk of PCa increased with MRSI grade;patients with high-grade MRSI had the greatest risk of PCa over time (OR = 328.6);the model including MRI, MRSI, tPSA, and fPSA was more accurate (Area under Curve: AUC = 95.7%) than MRI alone (AUC = 85.1%) or fPSA alone (AUC = 78.1%), but not than MRSI alone (94.5%). In the transitional zone, the model was less accurate (AUC = 84.4%). The association (p = 0.005) between MRSI and Gleason score was significant in both zones. Conclusions: MRSI is useful in patients with elevated tPSA. High-grade MRSI lesions call for repeated biopsies. Men with negative MRSI may forgo further biopsies because a significantly high Gleason lesion is very unlikely.

Total and free prostate-specific antigen indexes in prostate cancer screening:value and limitation for Japanese populations

Aim:To assess the efficacy and limitation of free/total prostate-specific antigen ratio(f/tPSA)at a single institution in Japan,focusing on the avoidance of pointless prostate biopsies.Methods:In total,631 men between 44 and 93 years old(mean 69.8 years)with elevated PSA underwent power-Doppler ultrasoundgraphy-guided transrectal 10-core prostate biopsies at Niigata Cancer Center Hospital,and their histological features were investigated with total PSA (tPSA)and f/tPSA.Results:PCa was detected in 126 of 134 patients(94.3%)with tPSA of 26 ng/mL or higher.The detection rate was 59.4% for tPSA of 21-25 ng/mL,followed by 39.2% for 16-20 ng/mL,30.0% for 11-15 ng/mL, 20.0% for 4.1-10 ng/mL and 7.6% for≤4.0 ng/mL,f/tPSA of the PCa group was significantly lower than that of non-malignamt disorders in any tPSA ranges(mean 0.122 vs.0.160,P<0.001).Receiver-operating characteristics analyses showed that f/tPSA(AUC:0.664)performed more valuably than tPSA(AUC:0.559)in patients with tPSA between 3.0-10 ng/mL(P<0.01).Although f/tPSA of 0.250 for the cut-off value might miss 1.8% PCa patients,it potentially spares 9.2% of unnecessary biopsies.Conclusion:f/tPSA is more valuable compared with tPSA alone for the prediction of the occurrence of PCa.We recommend 0.250 as the cut-off value for f/tPSA in PCa screening for Asian men having so-called grey-zone tPSA.(Asian J Androl 2006 Jul;8:429-434)

Differentiation of lethal and non lethal prostate cancer： PSA and PSA isoforms and kinetics

Prostate-specific antigen （PSA） testing for the early diagnosis of prostate cancer has led to a decrease in cancer mortality. However, the high prevalence of low-grade prostate cancer and its long natural history, competing causes of death in older men and treatment patterns of prostate cancer, have led to dramatic overtreatment of the disease. Improved markers of prostate cancer lethality are needed to reduce the overtreatment of prostate cancer that leads to a reduced quality of life without extending life for a high proportion of men. The PSA level prior to treatment is routinely used in multivariable models to predict prostate cancer aggressiveness. PSA isoforms and PSA kinetics have been associated with more aggressive phenotypes, but are not routinely employed as part of prediction tools prior to treatment. PSA kinetics is a valuable marker of lethality post treatment and routinely used in determininE the need for salva=e theraov.

t-PSA及其衍生指标PHI和PI-RADS评分对前列腺癌诊断效能的评价

目的探讨总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)占t-PSA的百分比(f-PSA/t-PSA%)、前列腺健康指数(PHI)和前列腺影像及报告数据系统(PI-RADS)评分对前列腺癌的诊断效能。方法选取2022年7月—2024年2月吉林大学第一医院经病理检查确诊的前列腺疾病患者277例,按病理诊断分为良性疾病组(143例)、前列腺癌组(134例),按t-PSA水平分为t-PSA<20 ng·mL^(-1)组(147例,其中良性疾病100例、前列腺癌47例)、t-PSA≥20 ng·mL^(-1)组(130例,其中良性疾病43例、前列腺癌87例)。检测所有患者血清t-PSA、f-PSA和前列腺特异性抗原同源异构体2(p2PSA),计算f-PSA/t-PSA%,并进行PIRADS评分。采用Logistic回归分析评估前列腺癌发生的影响因素。采用受试者工作特征(ROC)曲线评价各项指标诊断前列腺癌的效能。结果前列腺癌组t-PSA和PHI显著高于良性疾病组(P<0.001),f-PSA/t-PSA%显著低于良性疾病组(P<0.001);PI-RADS评分≥4分所占比例高于良性疾病组(P<0.001)。t-PSA、f-PSA/t-PSA%、PHI和PI-RADS评分诊断前列腺癌的曲线下面积(AUC)分别为0.752、0.633、0.913、0.881。PHI和PI-RADS评分是前列腺癌发生的独立危险因素[比值比(OR)值分别为1.035、2.520,95%可信区间(CI)分别为1.021~1.049、1.672~3.800,P<0.001]。在t-PSA<20 ng·mL^(-1)组中,与良性疾病患者比较,前列腺癌患者PHI和PI-RADS评分≥4分所占比例均显著升高(P<0.001),f-PSA/t-PSA%降低(P<0.05),t-PSA水平差异无统计学意义(P>0.05)。在t-PSA≥20 ng·mL^(-1)组中,与良性疾病患者比较,前列腺癌患者t-PSA水平、PHI和PI-RADS评分≥4分所占比例均显著升高(P<0.001),f-PSA/t-PSA%差异无统计学意义(P>0.05)。t-PSA、f-PSA/t-PSA%、PHI和PI-RADS评分单项检测诊断t-PSA<20 ng·mL^(-1)前列腺癌的AUC分别为0.561、0.611、0.836、0.834;4项指标联合检测的AUC最高,为0.900;单项检测诊断t-PSA≥20 ng·mL^(-1)前列腺癌的AUC分别为0.822、0.520、0.963、0.875,联合检测中t-PSA+f-PSA/t-PSA%+PHI和t-PSA+f-PSA/t-PSA%+PHI+PI-RADS评分的AUC分别为0.970、0.972。结论对于t-PSA<20 ng·mL^(-1)的患者,t-PSA、f-PSA/t-PSA%、PHI和PIRADS评分联合检测可提高前列腺癌的检出率。对于t-PSA≥20 ng·mL^(-1)的患者,PHI是诊断前列腺癌较好的指标,t-PSA、f-PSA/t-PSA%和PHI联合检测可提升诊断效能。

腹腔镜前列腺癌根治术对局限性前列腺癌的影响

目的探究腹腔镜前列腺癌根治术对局限性前列腺癌患者尿动力学及血清游离前列腺特异抗原百分率(FPSAR)的影响。方法选择局限性前列腺癌患者87例,随机数表法分为研究组与对照组。研究组患者44例给予腹腔镜前列腺癌根治术治疗;对照组患者43例给予开放性前列腺癌根治术治疗,观察2组术后国际前列腺症状评分(IPSS)、尿控率、尿动力学指标和FPSAR水平差异。结果术后,2组IPSS评分、膀胱顺应性(BC)、逼尿肌不稳定(DI)率、残余尿量(PVR)、前列腺特异抗原(t-PSA)、游离前列腺特异抗原(f-PSA)水平均降低,最大尿流率(Qmax)、最大尿流率时逼尿肌压力(Pdet at Qmax)、FPSAR均升高(P<0.05)。研究组IPSS评分、BC、DI、PVR水平均低于对照组,Qmax、Pdet at Qmax水平均高于对照组(P<0.05),2组t-PSA、f-PSA、FPSAR水平比较,差异无统计学意义(P>0.05)。研究组术后1个月、2个月、3个月、4个月尿控率均显著高于对照组(P<0.05)。结论腹腔镜前列腺癌根治术治疗局限性前列腺癌,可有效改善尿动力学指标,提高FPSAR水平,治疗效果较好。

良性前列腺增生患者临床参数间的相关性分析及方法学评价

目的探讨良性前列腺增生患者的前列腺体积、患者年龄、血清总前列腺特异性抗原(TPSA)、血清游离前列腺特异性抗原(FPSA)、前列腺特异性抗原密度(PSAD)的相互关系,同时通过患者年龄预测前列腺体积(PV)大小的准确性。研究胶乳免疫比浊法检测血清TPSA、FPSA水平与电化学发光法比较的可行性和实用性。方法收集172例患者的临床资料进行统计学分析,总结患者年龄、前列腺体积、TPSA、FPSA及PSAD的相关性,并使用受试者特征ROC曲线分析血清TPSA、FPSA预测前列腺体积的准确性。用两种方法同时检测血清TPSA和FPSA,比较其相关性、偏差和阴阳性符合率。结果患者TPSA,FPSA,PV随年龄增高而增大(r=0.318、0.325、0.511,P均<0.01),TPSA和FPSA也随PV增大而增高(r=0.279、0.368,P均<0.01)。与TPSA相比,FPSA与患者年龄、PV的相关性更强。TPSA水平<4ng/mL时,对于前列腺体积30~49mL、50~79mL和>80mL 3组,TPSA预测的AUC为0.621、0.708、0.913,最佳临界值分0.7、1.98、2.37ng/mL;FPSA预测的AUC为0.682、0.711、0.832,最佳临界值为0.37、0.56、0.81ng/mL。电化学发光法与胶乳免疫比浊法检测TPSA、FPSA相关性良好(r=0.986、0.975,P均<0.01);两种方法检测TPSA结果和FPSA结果的一致性良好;二者的阳性符合率、阴性符合率和总符合率分别为98.63%和90.54%、93.94%和96.94%、96.51%和94.18%,Kappa值为0.930、0.850(P均<0.01)。其精密度,线性范围和参考区间验证均符合标准。结论患者年龄、前列腺体积、TPSA水平、FPSA水平之间有显著的相关关系。血清TPSA和FPSA作为临床上独立预测PV的简便可行的因子具有较高准确性,其中FPSA预测的准确性更高。胶乳免疫比浊法与电化学发光法比较一致性较好,胶乳免疫比浊法可以作为检测TPSA和FPSA水平的推荐方法。

MRI功能成像联合血清学对鉴别前列腺病变性质的临床意义

目的探讨MRI功能成像联合血清学对鉴别前列腺病变性质的临床意义。方法回顾性选取2021年7月至2023年7月延安市人民医院收治的疑似前列腺癌(PCa)患者120例,均为男性,均行3.0T MRI常规扫描、弥散加权成像(DWI)扫描、磁共振波谱(MRS)成像扫描及病理检查。根据病理结果,将患者分为PCa组(53例)及良性组(67例)。PCa组年龄(63.19±4.72)岁,良性组年龄(61.75±4.54)岁。比较两组血清游离前列腺特异性抗原(fPSA)水平、总前列腺特异性抗原(tPSA)水平、MRI功能成像结果、病理结果及不同检查方式的诊断效能。采用独立样本t检验和χ^(2)检验。结果PCa组血清fPSA、tPSA水平均高于良性组(均P<0.05);MRI常规扫描诊断灵敏度为69.81%(37/53)、特异度为83.58%(56/67)、准确率为77.50%(93/120),DWI诊断灵敏度为75.47%(40/53)、特异度为88.06%(59/67)、准确率为82.50%(99/120),MRS诊断灵敏度为73.58%(39/53)、特异度为86.57%(58/67)、准确率为80.83%(97/120),血清学诊断灵敏度为71.70%(38/53)、特异度为86.57%(58/67)、准确率为80.00%(96/120),联合诊断灵敏度为94.34%(50/53)、特异度为83.58%(56/67)、准确率为88.33%(106/120);联合诊断灵敏度、阳性预测值均高于MRI功能成像、血清学单独应用,漏诊率低于MRI功能成像、血清学单独应用(均P<0.05)。结论MRI功能成像联合血清学对PCa具有一定诊断价值,可作为临床鉴别前列腺病变性质的有效检查方式。

精子相关抗原9联合PSAD、fPSA/tPSA比值诊断PSA灰区前列腺癌的临床研究

目的:研究尿液中精子相关抗原9(SPAG9)含量联合血清中前列腺特异性抗原密度(PSAD)、游离前列腺特异性抗原(fPSA)/总PSA(tPSA)比值诊断PSA灰区前列腺癌的价值。方法:选择2018年1月—2022年12月期间在南通市第二人民医院门诊或住院收治的血清PSA水平处于灰区(4~10 ng/mL)的309例患者作为研究对象,根据前列腺穿刺术的病理结果分为前列腺癌组58例和前列腺良性组251例(对照组)。所有患者均在术前留取尿液并检测SPAG9含量,测定血清PSAD、fPSA、tPSA,计算fPSA/tPSA比值,比较两组间临床资料的差异,采用Logistic回归分析确定前列腺癌的相关因素,绘制受试者工作特征(ROC)曲线、计算曲线下面积(AUC)并分析各指标对前列腺癌的诊断价值。结果:前列腺癌组和对照组间患者的体质量、tPSA、白细胞计数、血红蛋白、血小板计数、总胆红素、白蛋白、肌酐、尿酸、前列腺体积的差异均无统计学意义(P>0.05);前列腺癌组患者的年龄、尿液SPAG9含量、血清fPSA/tPSA比值、PSAD均高于对照组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,尿液SPAG9含量、血清fPSA/tPSA比值、PSAD是前列腺癌的影响因素;ROC曲线分析显示,尿液SPAG9含量、血清fPSA/tPSA比值、PSAD单独及联合均能诊断前列腺癌,3项指标联合的诊断效能理想,灵敏度和特异度分别为80.00%和80.88%。结论:尿液SPAG9可作为诊断PSA灰区前列腺癌的标志物,尿液SPAG9与血清fPSA/tPSA比值、PSAD联合检测对PSA灰区前列腺癌具有较好的诊断效能。

血清TPSA、FPSA水平及其比值对前列腺癌的诊断价值及其与根治术后生化复发的相关性分析

目的探讨血清总前列腺特异抗原、血清游离前列腺特异抗原水平及其比值对前列腺癌的诊断价值及其与根治术后生化复发的相关性。方法选择前列腺癌患者(均行前列腺癌根治术)113例作为癌症组,前列腺增生患者100例作为增生组,选择同期体检健康者78例作为对照组。检测癌症组术前、增生组、对照组的血清TPSA、FPSA水平,并计算FPSA/TPSA值,分析TPSA、FPSA、FPSA/TPSA对前列腺癌的诊断价值;对113例前列腺癌患者根据术后是否发生生化复发分为生化复发组(31例)和非生化复发组(82例),收集并比较两组临床病理因素资料,采用Logstic回归分析其与前列腺癌根治术后生化复发的相关性。结果癌症组血清TPSA、FPSA水平显著高于增生组和对照组,增生组高于对照组,以及FPSA/TPSA值显著低于增生组和对照组,增生组低于对照组(P<0.05);受试者工作特征曲线结果表明,TPSA、TPSA、FPSA/TPSA对前列腺癌诊断有较好的敏感性和特异性;两组患者年龄、体重指数差异无统计学差异(P>0.05),生化复发组精囊侵犯阳性率、切缘阳性率、T2/T3分期阳性率、Gleason评分、血清TPSA和FPSA水平以及FPSA/TPSA值显著高于非生化复发组(P<0.05);Logstic回归分析得出,精囊侵犯、切缘阳性、病理分期加重、高Gleason评分、高水平TPSA和FPSA、低FPSA/TPSA比值是前列腺癌根治术后生化复发的高风险因素。结论前列腺癌患者血清TPSA、FPSA水平显著升高,FPSA/TPSA比值显著降低,血清TPSA、FPSA水平检测联合FPSA/TPSA比值对前列腺癌有较高的诊断价值,可作为临床前列腺癌筛查方式,同时血清TPSA、FPSA水平升高及FPSA/TPSA比值降低也是前列腺根治术后生化复发的高风险因素。

Percent free prostate-specific antigen is effective to predict prostate biopsy outcome in Chinese men with prostate-specific antigen between 10.1 and 20.0 ng ml^-1

Percent free prostatic-specific antigen （%fPSA） has been introduced as a tool to avoid unnecessary biopsies in patients with a serum PSA level of 4.0-10.0 ng ml^-1, however, it remains controversial whether %fPSA is effective in PSA range of 10.1-20.0 ng ml^-1 in both Chinese and Western population. In this study, the diagnostic performance of %fPSA and serum PSA in predicting prostate cancer （PCa） and high-grade PCa （HGPCa） was analyzed in a multi-center biopsy cohort of 5915 consecutive Chinese patients who underwent prostate biopsy in 22 hospitals across China from January 1, 2010 to December 31, 2013. The indication for biopsy was PSA〉4.0 ng ml^-1 or/and suspicious digital rectal examination. Total and free serum PSA determinations were performed by three types of electrochemiluminescence immunoassays with recalibration to the World Health Organization standards. The diagnostics accuracy of PSA, %fPSA and %fPSA in combination with PSA （%fPSA ＋ PSA） was determined by the area under the receivers operating characteristic curve （AUC）. %fPSA was more effective than PSA in men aged ≥60 years old. The AUC was 0.584 and 0.635 in men aged ≥60 years old with a PSA of 4.0-10.0 ng ml^-1 and 10.1-20.0 ng ml^-1, respectively. The AUC of %fPSA was superior to that of PSA in predicting HGPCa in patients ≥60 years old in these two PSA range. Our results indicated that %fPSA is both statistically effective and clinical applicable to predict prostate biopsy outcome in Chinese patients aged ≥60 years old with a PSA of 4.0-10.0 ng ml^-1 and 10.1-20.0 ng ml^-1.

动态增强磁共振成像联合血清游离前列腺特异性抗原检测对前列腺癌的诊断价值

目的 探究动态增强磁共振成像(Dynamic contrast-enhanced-MRI,DCE-MRI)联合血清游离前列腺特异性抗原(Free prostate-specific antigen, fPSA)检测在前列腺癌中的诊断价值。方法 收集2019年01月-2023年11月于郑州市金水区总医院就诊的60例疑似前列腺癌患者,同期选取60例体检健康者作为健康组,根据手术或病理活检结果,将60例疑似前列腺癌患者分为前列腺癌组(28例)、良性组(32例),分析前列腺癌患者DCE-MRI声像图特征,比较3组DCE-MRI定量参数、血清fPSA水平,比较不同分化程度患者入院时DCE-MRI定量参数、血清fPSA水平,采用Pearson法分析相关性,通过ROC曲线分析联合诊断价值。结果 三组入院时速率常数(Rate constant, Kep)、容积运转常数(Volume operation constant, Ktans)及血管外细胞外容积分数(Extravascular extracellular volume fraction, Ve)值及血清fPSA水平比较:前列腺癌组>良性组>健康组(P<0.05);低、中分化癌患者入院时Ve、Ktrans、Kep及血清fPSA水平高于高分化癌者(P<0.05);入院时Ve、Ktrans、Kep及血清fPSA水平均与Gleason评分呈正相关(P<0.05);入院时Ve、Ktrans、Kep、血清fPSA水平单独及联合诊断前列腺癌的AUC均>0.6,但各指标联合诊断前列腺癌的AUC最高(P<0.05)。结论 DCE-MRI、血清fPSA水平联合诊断在前列腺癌中诊断敏感度、特异度均高于单独诊断,可为临床诊断前列腺癌提供可靠依据。

Prostate-specific antigen-based population screening for prostatecancer： current status in Japan and future perspective in Asia

In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testing remains very low compared with Western countries, and the benefits of population-based screening remain unclear. This review describes the current status of population screening and diagnosis for prostate cancer in Japan and discusses the efficacy of population screening for the Asian population. Since the 1990s, screening systems have been administered by each municipal government in Japan, and decreases in the prostate cancer mortality rate are expected in some regions where the exposure rate to PSA screening has increased markedly. A population-based screening cohort revealed that the proportion of metastatic disease in cancer detected by screening gradually decreased according to the increased exposure rate, and a decreasing trend in the proportion of cancer with high serum PSA levels after population screening was started. The prognosis of the prostate cancer detected by population screening was demonstrated to be more favorable than those diagnosed outside of the population screening. Recent results in screening cohorts demonstrated the efficacy of PSA. These recent evidences regarding population-based screening in Japan may contribute to establishing the optimal prostate cancer screeninK system in Asian individuals.

血清PSA、FPSAR与前列腺癌病理分级、临床分期的相关性研究

目的 :探讨前列腺癌病人血清前列腺特异抗原 (PSA)、血清游离前列腺特异抗原百分率 (FPSAR)与前列腺癌病理分级、临床分期的相关性。 方法 :分别检测经病理检查确诊为前列腺癌的 4 2例病人血清PSA、FPSAR ,并根据标本苏木精 伊红染色切片中肿瘤的组织学形态及临床资料对病人分别进行病理分级、临床分期。采用Spearman等级相关分析 ,分析PSA、FPSAR与前列腺癌病理分级、临床分期的关系。 结果 :前列腺癌病人PSA值越高 ,癌症恶性程度越高 ,PSA值与前列腺癌病理改变呈明显正相关性 (P <0 .0 5 ) ,而与前列腺癌的临床分期无相关性 (P >0 0 5 ) ;前列腺癌病人FPSAR值与前列腺癌病理改变呈正相关 ,与病人临床分期呈负相关 (P <0 .0 5 )。结论 :与PSA值相比 ,FPSAR值预测前列腺癌的病理分级。

罗氏MODULAR E170全自动电化学发光免疫分析仪性能验证

目的按ISO15189要求验证新检测系统——罗氏电化学分析系统的分析性能。方法对甲胎蛋白(AFP),癌胚抗原(CEA),总前列腺特异性抗原(TPSA),游离前列腺特异性抗原(FPSA),铁蛋白(FERR)5个检测系统的精密度、正确度、分析测量范围和参考区间,TPSA和FPSA功能灵敏度进行验证,并对2个测量池分别选取1个指标进行携带污染实验。结果部分项目批内或批间变异系数(CV)大于厂家说明书提供的精密度参数,但满足肿瘤标志物临床应用的指导原则中对精密度的基本要求;对配套定值血清测定值与靶值之间的差异无统计学意义,分析测量范围与厂家提供范围一致;携带污染小。结论检测系统的基本性能与厂家提供的资料一致,也符合肿瘤标志物临床应用指导原则的要求,可将经过评价的检测系统用于常规工作。

fPSA/tPSA比值优化前列腺癌早期诊断作用的研究

目的 :探讨游离前列腺特异性抗原 /总前列腺特异性抗原 (fPSA/tPSA)比值在优化tPSA早期诊断前列腺癌(PCa)中的作用。 方法 :以长春市 5 0岁以上PCa集团普查中tPSA在 4 .0～ 2 0 .0 μg/L范围、并接受前列腺活检的1 87例受检者为研究对象 ,测定tPSA、fPSA含量 ,应用SPSS 1 0 .0软件对不同区间fPSA/tPSA比值进行统计学分析。结果 :①tPSA在 4 .0～ 1 0 .0 μg/L、1 0 .0～ 2 0 .0 μg/L区间时 ,PCa检出率分别为1 8.1 %、2 2 .5 %。②ROC曲线分析显示不同区间时fPSA/tPSA比值的曲线下面积 (AUC)均大于tPSA (P <0 .0 5 )。③fPSA/tPSA比值取 0 .2 5为界值时 ,tPSA在 4 .0～ 1 0 .0 μg/L、1 0 .0～ 2 0 .0 μg/L两区间诊断PCa的敏感度分别为90 .5 %和 87.5 % ,可以分别避免 2 6 .7%和 1 1 .3%的人群进行活检。 结论 :在集团普查中 ,fPSA/tPSA比值在tPSA为 4 .0～ 2 0 .0 μg/L时可以提高检测PCa的特异性 ,减少不必要的活检。

抗生素及非甾体类消炎药对ⅢA型前列腺炎血清PSA及游离PSA的影响

目的:探讨炎症性慢性骨盆疼痛综合征(ⅢA)患者经过抗生素及非甾体类消炎药治疗的血清前列腺特异性抗原(PSA)水平及游离PSA百分率(F-PSAR)的变化。方法:ⅢA型前列腺炎患者228例,应用抗生素及非甾体类消炎药治疗4周,测定患者治疗前、治疗结束后4周及8周的血PSA水平及F-PSAR,分析治疗前后血PSA水平及F-PSAR的变化。结果:在228例ⅢA型前列腺炎患者中,血PSA治疗前为(3.51±3.03)μg/L,治疗后第4周为(2.75±2.84)μg/L,较治疗前显著下降(P<0.05);而F-PSAR由治疗前0.25±0.05升至0.27±0.03。其中PSA≥4μg/L的患者占28.5%(65/228),在PSA≥4μg/L的患者中,PSA由治疗前(6.24±1.93)μg/L降至治疗结束后第4周(4.58±2.99)μg/L(P<0.05),PSA下降的幅度为(32.9±36.1)%;治疗后PSA<4μg/L患者占27.7%(18/65),F-PSAR由治疗前(16±9)%升至治疗结束后第4周(22±11)%(P<0.05),F-PSAR上升幅度为(51.4±25.8)%。上述指标在治疗后4周和治疗后8周差异无显著性(P>0.05)。结论:慢性前列腺炎亦是血PSA升高的原因之一。在明确前列腺炎的诊断后,可以给予有效的抗感染及抗炎治疗,能显著降低血PSA水平及提高F-PSAR。

FPSA／TPSA与PSAD在PSA灰区患者中前列腺癌诊断价值的比较

目的:比较FPSA/TPSA、PSAD在PSA灰区中对前列腺癌的诊断价值。方法:回顾性总结2007年1月至2011年1月TPSA在4～10ng/mL之间的415例患者,测定其血清TPSA、FPSA,经直肠B超测定前列腺体积,所有患者均经前列腺穿刺活检诊断为53例前列腺癌(PCa)及362例前列腺增生(BPH)。计算FPSA/TPSA、PSAD,通过统计学方法比较FPSA/TPSA、PSAD在灰区诊断PCa的价值。结果:PCa组的FPSA/TPSA较BPH组降低(P<0.001),PCa组的PSAD较BPH组升高(P<0.001)。TPSA、FPSA/TPSA、PSAD在ROC曲线下的面积从大到小依次是PSAD>FPSA/TPSA>TPSA。当FPSA/TPSA和PSAD临界值分别为0.16和0.15时,诊断PCa的敏感性和特异性分别是81.1%和60.2%,66.0%和87.0%。结论:FPSA/TPSA、PSAD的测定能显著提高灰区PCa诊断的敏感性和特异性,且PSAD诊断价值高于FPSA/TPSA。

f/tPSA比值和cPSA值在血清PSA水平中度升高时对前列腺癌的诊断作用(英文)

目的 探讨血清前列腺特异性抗原 (PSA)水平中度升高时 (4.0～ 10 .0ng/ml) ,游离PSA(fPSA)与总PSA(tPSA)比值 (f/tPSA)和结合PSA(cPSA)在前列腺癌 (PCa)诊断中的作用及区分PCa和前列腺增生(BPH)的能力。方法 采用酶联免疫荧光分析方法 ,在 2 8例PCa患者和 33例BPH患者中 ,选择tPSA值在 4 .0～10 .0ng/ml范围的血清标本 ,分别检测、计算fPSA和cPSA ,分析tPSA、f/tPSA、cPSA的临床意义。结果 当血清tP SA在 4 .0～ 10 .0ng/ml时 ,f/tPSA比值在PCa和BPH两组患者中有非常显著性差异 (P <0 .0 1) ,明显地提高了PCa诊断的特异性 ;而cPSA在PCa和BPH两组患者中无显著差别 (P >0 .0 5 )。结论 当血清tPSA在 4 .0～ 10 .0ng/ml时 ,在区分、诊断PCa和BPH上 ,f/tPSA比值明显优于tPSA ,而cPSA并不优于tPSA。