BACKGROUND Prostate cancer is the second most common cancer among men worldwide,and prostate-specific antigen(PSA)is often used in clinical practice to screen for prostate cancer.Normal total PSA(tPSA)level initially ...BACKGROUND Prostate cancer is the second most common cancer among men worldwide,and prostate-specific antigen(PSA)is often used in clinical practice to screen for prostate cancer.Normal total PSA(tPSA)level initially excludes prostate cancer.Here,we report a case of prostate cancer with elevated free PSA density(fPSAD).CASE SUMMARY A patient diagnosed with benign prostatic hyperplasia underwent prostatectomy,and the postoperative pathological results showed acinar adenocarcinoma of the prostate.The patient is currently undergoing endocrine chemotherapy.CONCLUSION We provide a clinical reference for diagnosis and treatment of patients with normal tPSA but elevated fPSAD.展开更多
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...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.展开更多
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...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)展开更多
BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods...BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.展开更多
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 ant...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.展开更多
文摘BACKGROUND Prostate cancer is the second most common cancer among men worldwide,and prostate-specific antigen(PSA)is often used in clinical practice to screen for prostate cancer.Normal total PSA(tPSA)level initially excludes prostate cancer.Here,we report a case of prostate cancer with elevated free PSA density(fPSAD).CASE SUMMARY A patient diagnosed with benign prostatic hyperplasia underwent prostatectomy,and the postoperative pathological results showed acinar adenocarcinoma of the prostate.The patient is currently undergoing endocrine chemotherapy.CONCLUSION We provide a clinical reference for diagnosis and treatment of patients with normal tPSA but elevated fPSAD.
文摘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.
文摘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)
文摘BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.
文摘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.
