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.

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)

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.

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.

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.

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。

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。

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。

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。

血清PSA、FPSA/TPSA与ACP联合检测对前列腺癌诊断的意义

目的:探讨血清PSA、FPSA、FPSA/TPSA与ACP联合检测在前列腺癌诊断中的临床意义。方法:用化学发光法检测前列腺癌(PC)与良性前列腺增生(BPH)患者血清中的PSA和FPSA,计算FPSA/TPSA比值;用速率法检测前列腺疾病患者血清中的酸性磷酸酶(ACP)含量,并与正常人群进行比较。结果:PC组血清PSA、FPSA和ACP水平显著高于BPH组和对照组(P<0.01),BPH组又显著高于对照组(P<0.01);PC组FPSA/TPSA比值显著低于BPH组和对照组(P<0.01)。结论:联合检测PSA、FPSA、FPSA/TPSA与ACP可有效地提高诊断PC的特异性和灵敏度;血清ACP检测可用于PC转移患者的诊断和术后监测。

联合检测TPSA、FPSA、FPSA/TPSA对前列腺癌的诊断价值

目的 探讨血清中总前列腺特异性抗原（TPSA）、游离前列腺特导性抗原（FPSA）及FPSA/TPSA比值在前列腺疾病诊断中的价值.方法 采用全自动电化学发光分析技术,检测45例健康男性,40例前列腺增生（BPH）患者和32例前列腺癌（PCa）患者血清中的TPSA和FPSA含量,计算FPSA/TPSA比值,并进行统计学分析.结果 BPH组及PCa组的TPSA和FPSA值均显著高于正常对照组,而PCa组FPSA/TPSA比值显著低于正常对照组和BPH组.当TPSA值在4.1～60.0 ng/mL时,BPH和PCa出现交叉重叠现象,单靠TPSA一项指标难以提高PCa诊断率.BPH组的FPSA/TPSA很少〈0.11,PCa组的FPSA /TPSA很少〉0.20.由此,FPSA /TPSA比值的测定可用于BPH和PCa的鉴别诊断.结论 联合检测血清中TPSA、FPSA的含量及FPSA/TPSA比值,可大大提高PCa的诊断率,对PCa早期诊断及鉴别诊断有重要意义.

PSA、PSAD、fPSA在前列腺癌诊断中的应用

目的：测定１６例前列腺癌（ＰＣａ）和３３例前列腺增生（ＢＰＨ）患者血清前列腺特异性抗原（ＰＳＡ），前列腺特异抗原密度（ＰＳＡＤ）及游离前列腺特异抗原（ｆＰＳＡ）。方法：采用放射免疫法。结果：显示ＰＳＡＤ对ＰＣａ诊断敏感度高而特异阳性预测值低，而ＰＳＡＤ及ｆＰＳＡ／ｔＰＳＡ比值（即参数百分率）是提高ＰＣａ和ＢＰＨ鉴别诊断阳性率的一种较好指标。结论：本实验结果在实际临床应用中有重要意义。

无前列腺疾病男性fPSA百分比正常参考值范围分析

目的研究年龄对男性游离前列腺特异性抗原(free prostate specific antigen,fPSA)百分比的影响及fPSA百分比与前列腺癌病理分级及临床分期的关系,并探讨适合于中国人的fPSA百分比参考值范围。方法选择无前列腺疾病男性679例,按年龄不同分为5组,测定血清PSA、fPSA并计算fPSA百分比,研究年龄与PSA、fPSA、fPSA百分比相关性。另选34例经病理证实的前列腺癌(PCa)患者,研究fPSA百分比与前列腺癌病理分级及临床分期的关系。结合无前列腺疾病男性的fPSA百分比,确定适合于中国人的fPSA百分比参考值范围。结果PSA、fPSA与年龄呈正相关(r值分别为0.608和0.534,P<0.001),fPSA百分比与年龄无关。fPSA百分比与前列腺癌病理分级及临床分期相关(r值分别为0.427和-0.332,P<0.05)。以无前列腺疾病男性第5百分位上的fPSA百分比值(13.6%)及试剂盒上与多数文献报告fPSA百分比值为参考,选取10%、15%及20%3个值作为鉴别值。当参考值范围为≥15%时,诊断前列腺癌的敏感性为94.1%,特异性高达89.7%。如参考值范围为≥10%时,特异性虽为97.4%,但敏感性仅为70.6%。如参考值范围为≥20%时,敏感性亦为94.1%,但有253例无前列腺疾病男性为假阳性,特异性仅为62.8%。适合于中国人的fPSA百分比正常参考值范围为≥15%。结论fPSA百分比不受年龄因素影响,临床价值优于PSA。随着前列腺癌患者fPSA百分比降低,其病理分化程度降低,临床分期增加,恶性程度增高。适合于中国人的fPSA百分比正常参考值范围为≥15%。

血清FPSA/TPSA比值在前列腺癌鉴别诊断中的应用

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)比值在鉴别诊断前列腺癌中的应用价值。方法:随机选取我院2005年1月-2006年8月住院的前列腺炎患者44例,良性前列腺增生42例,前列腺癌患者54例,排除前列腺疾病的健康体检者63例,测定血清TPSA和FPSA,并计算FPSA/TP-SA比值。应用SPSS10.0软件进行统计学分析。结果:FPSA/TPSA比值界值为≤1.8时对前列腺癌鉴别诊断与只检测TPSA相比在敏感性相近的情况下特异性明显提高(TPSA特异性为57.5%,FPSA/TPSA特异性为81.3%)。结论:FPSA/TPSA比值在敏感性相近的情况可明显提高前列腺癌鉴别诊断的特异性,是较为理想的前列腺癌鉴别诊断新指标。

fPSA%、PSAD、proGRP水平对前列腺癌及骨转移的诊断价值

目的探讨血清前列腺特异性抗原(PSA)、游离PSA/总PSA(fPSA%)、胃泌素释放肽前体(proGRP)及PSA密度(PSAD)单独以及联合检测在前列腺癌及骨转移诊断中的临床价值。方法回顾性分析我院的108例前列腺癌(PCa)患者(观察组)及25例前列腺增生(BPH)患者(对照组)资料,将观察组分为无骨转移(NBM)和骨转移(BM)两个亚组。检测所有研究对象的血清PSA、fPSA、proGRP,并根据检查结果计算fPSA%、PSAD值,采用受试者工作特性曲线(ROC)分析fPSA%、PASD、proGRP及联合检测(fPSA%+PSAD+proGRP)在PCa诊断中的价值。结果观察组fPSA%的中位水平明显低于BPH组,PSAD、PSA、proGRP的中位水平明显高于BPH组(均P<0.05)。fPSA%、PSAD、proGRP及三者联合在诊断PCa时受试者工作特征曲线的曲线下面积(AUC)分别为0.755、0.721、0.715、0.809,联合检测诊断能力最佳,每个指标诊断能力均有显著性差异(P<0.001)。NBM组fPSA%、PSAD、proGRP的AUC值分别为0.690、0.676、0.660,反映诊断早中期PCa的能力,采用诊断界值,有助于早期诊断早期治疗。NBM组PSA(AUC=0.585,P=0.148)的诊断能力无统计学意义(P>0.05)。BM组fPSA%、PSAD、proGRP的AUC值分别为:0.905、0.894、0.863,反映诊断晚期PCa的能力,采用诊断界值,有助于预测、减少或者延迟骨转移发生。BM组PSA的AUC值最大(AUC=0.926),在四种单一指标中诊断能力最佳。结论fPSA%、PSAD、proGRP在临床上对于PCa、特别对早期PCa的诊断有较高的临床价值。三项指标联合检测对于PCa的诊断能力有明显提高。随着TNM分期的发展,肿瘤标志物fPSA%、PSAD和proGRP的诊断能力更明显。

血清PSA和FPSA/PSA比值在前列腺癌诊断中的意义

目的探讨PSA、FPSA及FPSA／PSA比值这三项指标对前列腺癌早期诊断的意义。方法采用ELISA方法分别对正常对照组43例，BPH组45例，Pc组50例进行PSA、FPSA的检测及FPSA／PSA比值的计算。结果三组的各项指标均存在差异，BPH组和PC组病例在血PSA水平各阶段所占比例及相应FPSA／PSA比值差异均有显著性。结论PSA的灵敏度较高，但特异性较低，当PSA水平在0-10μG／L时，PC难以与BPH区分，测定PSA、FPSA同时求出FPSA／PSA比值，可以提高PC的诊断率及PC和BPH的鉴别诊断率，同时FPSA／PSA比值的灵敏度、特异性均优于血PSA和FPSA的单测结果。

血清PSA、fPSA/tPSA在前列腺癌诊断中的临床意义

目的:研究血清PSA(prostate-specific an tigen,前列腺特异性抗原)、fPSA/tPSA(free-PSA/total-PSA,游离前列腺特异性抗原与总前列腺特异性抗原比值)在前列腺癌诊断中的临床意义。方法:回顾性分析26例前列腺增生患者和18例前列腺癌患者血清PSA、fPSA/tPSA值,并用统计学方法计算出PSA、fPSA/tPSA值在前列腺增生和前列腺癌患者中的差异。结果:前列腺增生和前列腺癌患者PSA、fPSA/tPSA值比较,差异有统计学意义(P<0.01),当PSA介于4-10ng/mL时,两组患者的PSA水平无统计学意义(P>0.05),但fPSA/tPSA有统计学意义(P<0.01)。结论:前列腺癌患者血清PSA明显升高,fPSA/tPSA显著降低,当血清PSA介于4-10ng/mL时,PSA对前列腺癌诊断无意义,但fPSA/tPSA有一定价值。