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.

血清t-PSA、f-PSA、f-PSA/t-PSA比值及铁蛋白检测在前列腺癌诊断中的临床价值

目的:探析血清总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)、f-PSA/t-PSA及铁蛋白检测在诊断前列腺癌(PC)中的应用效果。方法:选取2021年2月—2023年1月盘锦市中心医院收治的疑似PC患者148例为研究对象,按照病理诊断结果分为PC组71例与前列腺增生组77例。所有研究对象均进行t-PSA、f-PSA、铁蛋白检验,并将临床病理诊断的结果作为金标准,计算、对比单一检验和联合检验在诊断PC的诊断效能,t-PSA、f-PSA、f-PSA/t-PSA、铁蛋白水平。结果:联合检验诊断PC的准确率、特异度、敏感度、阳性预测值、阴性预测值均高于单一的t-PSA、f-PSA、f-PSA/t-PSA、铁蛋白检验,差异具有统计学意义(P<0.05);PC组t-PSA、f-PSA、铁蛋白水平高于正常前列腺增生组,f-PSA/t-PSA低于前列腺增生组,差异具有统计学意义(P<0.001)。结论:t-PSA、f-PSA、f-PSA/t-PSA、铁蛋白检验均可用于PC的诊断中,但实施联合检验能够提升诊断效能,临床应用价值高,建议采纳。

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。

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、f-PSA/t-PSA在前列腺癌诊断中的意义

目的探讨血清PSA、f-PSA/t-PSA在前列腺癌(PCa)诊断中的意义。方法回顾性分析51例前列腺癌与44例前列腺良性增生(BPH)患者血清PSA、f-PSA/t-PSA值在前列腺癌鉴别诊断中的意义。结果 PCa与BPH两组患者间PSA、f-PSA/t-PSA有显著差异(p<0.01)。当PSA介于4.0～10.0μg/L之间,两组患者间PSA水平无显著性差异(p>0.05),而f-PSA/t-PSA有显著性差异(p<0.01)。且PSA介于4.0～10.0μg/L之间,f-PSA/t-PSA分别为0.10、0.16、0.25时,对PCa诊断的灵敏度为37.3%、77.1%、95.4%;特异性为96.9%、82.8%、53.2%。结论 PCa患者PSA显著升高,f-PSA/t-PSA则显著降低。而PSA介于4.0～10.0μg/L之间,PSA无诊断意义,选择f-PSA/t-PSA为0.16作为临界值,对PCa的诊断有较高的灵敏度和特异性。

BALP与f-PSA/t-PSA联合检测对前列腺癌骨转移诊断价值的研究

目的评价BALP与f-PSA/t-PSA单独及联合在诊断前列腺癌(Pca)发生骨转移时的意义及应用价值。方法56例前列腺癌患者中经骨扫描和3个月随访CT发现有35例存在多发生骨转移灶。ELISA方法检测患者血清中的BALP、PSA及f-PSA浓度。结果骨转移组外周血BALPt、-PSA水平均显著高于未发生骨转移前列腺癌对照组(P<0.05),相反f-PSA/t-PSA比值显著低于未发生骨转移对照组。在骨转移诊断的敏感性和特异性的比较中,f-PSA/t-PSA比值<0.15诊断的敏感度最高,可以达到85.7%,但是其特异度只有47.6%;而f-PSA/t-PSA+BALP敏感度最低为62.9%,但是可以提高特异度达到76.2%。结论联合检测BALP+f-PSA/t-PSA可以提高单独应用BALP在诊断前列腺癌发生骨转移中诊断特异度。BALP+f-PSA/t-PSA检测可尽早、全面地发现前列腺癌患者全身骨转移。

抗人游离前列腺特异性抗原(f-PSA)单克隆抗体的制备及应用

目的建立产生抗人游离前列腺特异抗原单克隆抗体(f-PSA m Ab)的细胞株,获得抗体后建立抗人f-PSA化学发光免疫分析法(CLIA)并进行应用。方法采用杂交瘤技术获得2株稳定分泌抗f-PSA m Ab的细胞株,将细胞株用转瓶扩大培养并将上清液采用亲和纯化法获得抗体,ELISA测定抗体效价、特异性及表位,表面等离子共振法测抗体亲和力;建立双抗体夹心CLIA,采用标准曲线定量法对该体系进行分析性能评估,同时对426例临床血清样本进行检测[其中130例的总PSA水平在(4～10) ng/mL,为"诊断灰区"],评价该试剂与罗氏试剂的检测一致性。结果获得抗人f-PSA m Ab的杂交瘤细胞株(f-10-1、f-14-1)。用f-10-1和f-14-1建立的CLIA的检测范围为(0. 1～30) ng/mL,灵敏度为0. 05 ng/mL,检测结果的相对偏差均在±5%内,与癌胚抗原(CEA)、甲胎蛋白(AFP)及结合态PSA(c-PSA)无交叉反应,该试剂与罗氏试剂相关系数达到0. 99,灰区样本阳性符合率、阴性符合率、总符合率均高于90%。结论成功制备了抗人f-PSA m Ab,建立了特异性定量检测人f-PSA的双抗体夹心CLIA。

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。

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。

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。

血清t-PSA、f-PSA/t-PSA、DRE及TRUS对前列腺癌的诊断价值分析

目的探讨前列腺特异抗原(t-PSA)、游离PSA与总PSA比值(f-PSA/t-PSA)、直肠指诊(DRE)和直肠超声(TRUS)诊断前列腺癌(PCa)的价值。方法回顾性分析经病理诊断的31例PCa患者和34例前列腺增生(BPH)患者的血清PSA水平、f-PSA/t-PSA比值、DRE和TRUS的检测结果。结果 ROC曲线分析结果显示t-PSA和f-PSA/t-PSA对PCa的诊断敏感性分别为67.7%和77.4%,特异性分别为58.8%和73.5%,曲线下面积(AUC)分别能达到0.659和0.808。而DRE和TRUS对PCa的诊断敏感性分别为58.1%和51.6%,特异性分别为82.3%和73.5%。联合f-PSA/t-PSA与DRE或TRUS检测,对PCa的诊断敏感性分别上升到87.1%和83.9%,3项指标联合可提高诊断敏感性至90.3%。结论 f-PSA/t-PSA比t-PSA更适合用于临床PCa的诊断,联合f-PSA/t-PSA,TRUS和DRE检查可明显提高临床PCa的检出率。

PSAmRNA与f-PSA/t-PSA联合检测对前列腺癌诊断价值的研究

目的探讨PSAmRNA与f-PSA/t-PSA联合检测在前列腺癌早期诊断中的应用价值。方法 RT-PCR检测前列腺癌(PCa)、良性前列腺增生(BPH)患者及健康对照者外周血中PSAmRNA的水平,应用ELISA方法检测患者血清中的f-PSA及t-PSA浓度。结果 40例PCa标本中PSAmRNA阳性率(80%)及f-PSA/t-PSA比值与正常对照组比较均具有显著性差异(P<0.05)。f-PSA/t-PSA比值<0.15诊断的敏感度最高(87.5%),但是其特异度只有72%,联合检测PSAmRNA和f-PSA/t-PSA比值将特异性提高至97.7%。结论联合检测外周血PSA、PSAmRNA是一种早期发现PCa,判断其临床变化过程、分期、预计复发和评价疗效的方法。

纳米金放大SPR技术检测前列腺癌肿瘤标志物free PSA

表面等离子体激元共振(surface plasmon resonance,SPR)是一种基于芯片表面折射率变化的光学检测技术,具有快速、灵敏、免标记等优点,可实时在线地跟踪固液界面反应,在蛋白及核酸等生物分子检测方面具有广阔的应用前景。但是,传统的SPR检测方法难以检测低分子量、超低浓度的生物分子。纳米金具有密度大、介电常数大、良好的生物相容性等特点,因此,基于纳米金放大的SPR技术既可以保持生物分子的生物活性,又可以有效突破传统SPR中检测限的限制。游离前列腺特异性抗原(free prostate-specific antigenf,-PSA)是一种常用于前列腺癌早期诊断的标志物,但由于其在血清中的浓度非常低,给前列腺癌的早期诊断造成困难。本论文利用基于纳米金放大的SPR技术,设计竞争型免疫模式实现了f-PSA的超灵敏检测。