The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer.
The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer.
复制标题
前列腺特异性抗原在新诊断前列腺癌患者分期中的应用。
DOI：
10.1001/jama.1993.03500010067033
复制
发表时间：
1993
期刊：
影响因子：
--
通讯作者：
F. Lowe
中科院分区：
文献类型：
--
作者：
J. E. Oesterling;S. Martin;E. Bergstralh;F. Lowe
目的
评估在新诊断的未经治疗的前列腺癌患者的分期评价中获得放射性核素骨扫描的必要性。这一决定是根据前列腺特异性抗原（PSA）水平。
设计
回顾性审查。
参与者
回顾了1989年1月至1990年12月在明尼苏达州罗切斯特的马约诊所接受评估的2064例前列腺癌患者的病历。852例新诊断、未经治疗且就诊时血清PSA浓度低于20.0 μ g/L的患者组成了研究人群。
主要观察指标
与使用血清PSA浓度预测骨扫描结果相关的假阴性结果率。
结果
561名患者的血清PSA浓度为10.0微克/L或更低;只有3名患者的骨扫描结果异常，1名患者的扫描结果不确定。在467名PSA值为8.0微克/升或更低（参考范围上限的两倍）的男性中，没有人的骨扫描结果异常或不确定。当血清PSA值≤ 8.0 μ g/L时，骨扫描结果异常的假阴性率为0%;当临界值为10.0 μ g/L时，假阴性率为0.5%。所有PSA临界值小于20.0微克/升的假阴性结果率的95%置信上限小于2%。
结论
对于新诊断的未经治疗的前列腺癌患者，血清PSA浓度为10.0 μ g/L或更低，并且没有骨骼症状，分期放射性核素骨扫描似乎没有必要。这种临床情况适用于39%的新诊断的前列腺癌患者。由于每年有超过130 000个新病例被诊断出来，每年大约有50 000名患者受到影响。如果为这些患者取消600美元的分期骨扫描，将对该国的医疗保健系统产生重大的经济节省。
OBJECTIVE
To assess the need for obtaining radionuclide bone scans in the staging evaluation of patients with newly diagnosed, untreated prostate cancer. This determination was made on the basis of presenting prostate-specific antigen (PSA) levels.
DESIGN
Retrospective review.
PARTICIPANTS
The medical records of 2064 consecutive patients with prostate cancer who were evaluated at the Mayo Clinic in Rochester, Minn, from January 1989 through December 1990 were reviewed. Eight hundred fifty-two patients with newly diagnosed, untreated disease and a serum PSA concentration less than 20.0 micrograms/L at presentation comprised the study population.
MAIN OUTCOME MEASURE
The rate of false-negative results associated with using the serum PSA concentration to predict bone scan findings.
RESULTS
Five hundred sixty-one patients had a serum PSA concentration of 10.0 micrograms/L or less; only three had an abnormal bone scan result, and one had an indeterminate scan result. Of the 467 men whose PSA value was 8.0 micrograms/L or less (two times the upper limit of the reference range), none had bone scan results that were either abnormal or indeterminate. The rate of false-negative results for an abnormal bone scan result was 0% with a serum PSA value of 8.0 micrograms/L or less and 0.5% with a cutoff level of 10.0 micrograms/L. The 95% upper confidence limit for the rate of false-negative results for all PSA cutoff levels less than 20.0 micrograms/L was less than 2%.
CONCLUSIONS
For patients with newly diagnosed, untreated prostate cancer, a serum PSA concentration of 10.0 micrograms/L or less, and no skeletal symptoms, a staging radionuclide bone scan does not appear to be necessary. This clinical situation applies to 39% of all patients presenting with newly diagnosed prostate cancer. Since more than 130,000 new cases are diagnosed each year, approximately 50,000 patients are affected annually. If the $600 staging bone scan were eliminated for these patients, a significant economic savings to the health care system in this country would be effected.