Contemporary use of complexed PSA and calculated percent free PSA for early detection of prostate cancer: Impact of changing disease demographics
Contemporary use of complexed PSA and calculated percent free PSA for early detection of prostate cancer: Impact of changing disease demographics
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DOI：
10.1016/s0090-4295(01)00953-0
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发表时间：
2001-06-01
期刊：
影响因子：
2.1
通讯作者：
Veltri, RW
中科院分区：
文献类型：
--
作者：
Miller, MC;O'Dowd, GJ;Veltri, RW
目标.评估复合前列腺特异性抗原（cPSA）、总PSA（tPSA）和计算的游离/总PSA（f/tPSA）比值在使用当代患者队列区分良性疾病和前列腺癌（CaP）中的诊断性能。使用Bayer Immuno-I系统测定cPSA、tPSA和fPSA计算值。为了验证我们计算出的合适的PSA比率，我们还使用Abbott AxSYM免疫测定系统回顾性地测量了1990年至1997年期间从362名临床和活检证实的良性前列腺增生（n = 179）或CaP（n = 183）男性中获得的存档预处理血清中的fPSA。tPSA、cPSA和计算的拟合PSA比值的诊断效用使用当代测试人群进行评估，该人群包括1999年6月至2000年6月期间前瞻性收集的3006名男性血清，这些男性最近在美国各地的临床实践中接受了泌尿科医生的系统性活检。该当代患者样本的活检诊断为无恶性肿瘤证据（n = 1857）或CaP（n = 1149）。所有血清样本的tPSA值在2.0和20.0 ng/mL之间。在352名男性的回顾性研究人群中，测量的与计算的适合PSA比值的Pearson相关系数为0.9130。测量和计算的f/t PSA比值的受试者工作特征曲线下面积（ROC-AUC）无法区分（分别为69.6%和69.2%）。在当代人群中（In = 3006），tPSA、cPSA和计算的f/t PSA比值的ROC-AUC分别为52.2%、53.9%和58.4%。我们还使用已发表的tPSA（大于4.0 ng/mL）、cPSA（大于3.8 ng/mL）和f/t PSA比值（大于15%和大于25%）临界值，在tPSA反射范围为2 - 20 ng/mL和2 - 10 ng/mL时，比较了诊断性能。我们发现cPSA和Wt PSA比值（大于25%临界值）均优于tPSA，并且在活检保留和癌症遗漏方面产生了相似的结果。计算的Wt PSA比值和cPSA在区分良性疾病和CaP的特异性改善方面表现同样良好。与单独使用tPSA相比，Wt PSA比率和cPSA提供了临床益处，例如增加了不必要的活检的节省，并且延迟癌症检测的风险程度可控。泌尿学57：1105-1111，2001。(C)2001年，Elsevier Science Inc.
Objectives. To assess the diagnostic performance of complexed prostate-specific antigen (cPSA), total PSA (tPSA), and calculated free/total PSA (f/t PSA) ratios in the differentiation of benign disease from prostate cancer (CaP) using a contemporary patient cohort.Methods. The cPSA, tPSA, and calculated fPSA values were determined using the Bayer Immuno-I system. To validate our calculated fit PSA ratio, we also retrospectively measured fPSA using the Abbott AxSYM immunoassay system in archival pretreatment sera obtained between 1990 and 1997 from 362 men with clinically and biopsy-confirmed benign prostatic hyperplasia (n = 179) or CaP (n = 183). The diagnostic utility of tPSA, cPSA, and the calculated fit PSA ratio was assessed using a contemporary test population consisting of sera prospectively collected between June 1999 and June 2000 from 3006 men who had recently undergone a systematic biopsy by urologists in clinical practices throughout the United States. This contemporary patient sample had biopsy diagnoses of either no evidence of malignancy (n = 1857) or CaP (n = 1149). All serum samples had tPSA values between 2.0 and 20.0 ng/mL.Results. The measured versus calculated fit PSA ratios had a Pearson's correlation coefficient of 0.9130 in the retrospectively studied population of 352 men. The areas under the receiver operating characteristic curves (ROC-AUCs) for the measured and calculated f/t PSA ratios were indistinguishable (69.6% versus 69.2%, respectively). In the contemporary population In = 3006), the ROC-AUC for tPSA, cPSA, and the calculated f/t PSA ratio was 52.2%, 53.9%, and 58.4%, respectively. We also compared the diagnostic performance using published cutoffs for tPSA (greater than 4.0 ng/mL), cPSA (greater than 3.8 ng/mL), and the f/t PSA ratio (greater than 15% and greater than 25%) in tPSA reflex ranges of 2 to 20 ng/mL and 2 to 10 ng/mL. We found that both cPSA and the Wt PSA ratio (greater than 25% cutoff) outperformed tPSA and yielded similar results in terms of biopsies spared and cancers missed.Conclusions. The calculated Wt PSA ratio and cPSA perform equally well in terms of the improvement of specificity in the discrimination of benign disease and CaP. The Wt PSA ratio and cPSA provide clinical benefits over the use of tPSA alone, such as an increased sparing of unnecessary biopsies performed with a manageable degree of risk of delayed cancer detection. UROLOGY 57: 1105-1111, 2001. (C) 2001, Elsevier Science Inc.