PROSTATE-SPECIFIC ANTIGEN AS A SERUM MARKER FOR ADENOCARCINOMA OF THE PROSTATE
PROSTATE-SPECIFIC ANTIGEN AS A SERUM MARKER FOR ADENOCARCINOMA OF THE PROSTATE
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DOI：
10.1056/nejm198710083171501
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发表时间：
1987-10-08
影响因子：
158.5
通讯作者：
REDWINE, E
中科院分区：
文献类型：
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作者：
STAMEY, TA;YANG, N;REDWINE, E
为了比较血清标志物前列腺特异性抗原（PSA）和前列腺酸性磷酸酶（PAP）的临床有用性，我们通过放射免疫测定法对来自699名患者（其中378名患有前列腺癌）的2200份血清样本进行了测量。127例新诊断的未经治疗的前列腺癌患者中有122例PSA升高，包括12例未被怀疑的早期疾病患者中的7例和所有115例晚期疾病患者。PSA水平随着临床分期的进展而增加，并与肿瘤的估计体积成正比。只有57名癌症患者的PAP浓度升高，与肿瘤体积的相关性较低。86%的良性前列腺增生患者PSA升高，14%的良性前列腺增生患者PAP升高。在接受根治性前列腺切除术治疗癌症后，PSA通常会降至无法检测的水平，半衰期为2.2天。如果最初升高，PAP在24小时内降至正常水平，但始终保持可检测性。在6例患者术后通过重复测量，PSA -而不是PAP -似乎是有用的检测残留和早期复发的肿瘤和监测放射治疗的反应。前列腺按摩可使PSA和PAP水平增加约1.5至2倍。针吸活检和经尿道电切术均显著增加。我们的结论是，PSA是更敏感的检测前列腺癌比PAP，可能会更有用的监测反应和治疗后复发。然而，由于PSA和PAP都可能在良性前列腺增生中升高，因此这两种标记物都不是特异性的。
To compare the clinical usefulness of the serum markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), we measured them by radioimmunoassay in 2200 serum samples from 699 patients, 378 of whom had prostatic cancer. PSA was elevated in 122 of 127 patients with newly diagnosed, untreated prostatic cancer, including 7 of 12 patients with unsuspected early disease and all of 115 with more advanced disease. The PSA level increased with advancing clinical stage and was proportional to the estimated volume of the tumor. The PAP concentration was elevated in only 57 of the patients with cancer and correlated less closely with tumor volume. PSA was increased in 86 percent and PAP in 14 percent of the patients with benign prostatic hyperplasia. After radical prostatectomy for cancer, PSA routinely fell to undetectable levels, with a half-life of 2.2 days. If initially elevated, PAP fell to normal levels within 24 hours but always remained detectable. In six patients followed postoperatively by means of repeated measurements, PSA - but not PAP - appeared to be useful in detecting residual and early recurrence of tumor and in monitoring responses to radiation therapy. Prostate massage increased the levels of both PSA and PAP approximately 1.5 to 2 times. Needle biopsy and transurethral resection increased both considerably. We conclude that PSA is more sensitive than PAP in the detection of prostatic cancer and will probably be more useful in monitoring responses and recurrence after therapy. However, since both PSA and PAP may be elevated in benign prostatic hyperplasia, neither marker is specific.