PROSTATE SPECIFIC ANTIGEN IN THE STAGING OF LOCALIZED PROSTATE-CANCER - INFLUENCE OF TUMOR DIFFERENTIATION, TUMOR VOLUME AND BENIGN HYPERPLASIA
PROSTATE SPECIFIC ANTIGEN IN THE STAGING OF LOCALIZED PROSTATE-CANCER - INFLUENCE OF TUMOR DIFFERENTIATION, TUMOR VOLUME AND BENIGN HYPERPLASIA
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DOI：
10.1016/s0022-5347(17)40079-6
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发表时间：
1990-04-01
影响因子：
6.6
通讯作者：
WALSH, PC
中科院分区：
文献类型：
--
作者：
PARTIN, AW;CARTER, HB;WALSH, PC
为了评估血清前列腺特异性抗原在前列腺癌术前分期中的作用，我们检查了肿瘤体积和分化程度，以及良性前列腺增生体积，以确定其对血清抗原水平的影响。测定了350例临床局限性前列腺癌患者和72例良性前列腺增生患者的血清前列腺特异性抗原。虽然平均抗原水平随着病理分期的进展而增加，但前列腺特异性抗原预测个体患者病理分期的有用性有限：102名男性中有1名（0.9%）前列腺特异性抗原水平低于2.8 ng。ml.淋巴结阳性，5名男性中有5名的水平大于100 ng。ml.有精囊或淋巴结受累。然而，对于大多数前列腺特异性抗原值在这两个极端之间的男性（大于70%），抗原水平不能准确预测病理分期。因为血清前列腺特异性抗原水平与形态计量学确定的肿瘤体积相关（r = 0.535，p <0.01），它们实际上应该是病理分期的预测。然而，大多数前列腺癌患者的腺体中也有不同程度的良性前列腺增生组织，产生前列腺特异性抗原。我们发现血清前列腺特异性抗原与前列腺内良性增生的体积无关（r = 0.21，p> 0.05）。此外，免疫组化研究表明，病理分期和血清前列腺特异性抗原之间缺乏相关性，可能是由于抗原的产生随着组织学分级的增加而减少。我们发现血清前列腺特异性抗原水平与经肿瘤体积校正的Gleason评分呈负相关（r =-0.37，p <0.01），证实了这一观点。因此，血清前列腺特异性抗原水平不能准确反映个体患者的肿瘤负荷和病理分期，原因有二：1）腺体的良性前列腺增生成分的不可预测的贡献，2）随着肿瘤体积的增加，较高级别病变的前列腺特异性抗原产生减少。
To evaluate the usefulness of serum prostate specific antigen in the preoperative staging of prostate cancer we examined tumor volume and differentiation, as well as benign prostatic hyperplasia volume to determine their influence on serum antigen levels. Serum prostate specific antigen was measured in 350 men with clinically localized prostate cancer and preoperatively in 72 men with documented benign prostatic hyperplasia. Although the mean antigen levels increased with advancing pathological stage, the usefulness of prostate specific antigen to predict pathological stage for an individual patient was limited: 1 of 102 men (0.9%) with prostate specific antigen levels of less than 2.8 ng./ml. had positive lymph nodes and 5 of 5 men with levels of greater than 100 ng./ml. had either seminal vesicle or lymph node involvement. However, for the majority of men (greater than 70%) with prostate specific antigen values between these 2 extremes the antigen levels did not accurately predict pathological stage. Because serum prostate specific antigen levels correlated with morphometrically determined tumor volume (r equals 0.535, p less than 0.01) they should, in fact, be predictive of pathological stage. However, most men with prostate cancer also have varying degrees of benign prostatic hyperplasia tissue in the gland producing prostate specific antigen. We have found that serum prostate specific antigen does not correlate with the volume of benign hyperplasia within the gland (r equals 0.21, p greater than 0.05). In addition, immunohistochemical studies have suggested that the lack of correlation between pathological stage and serum prostate specific antigen might be explained by a decrease in the production of antigen with increasing histological grade. Our findings of a negative correlation (r equals -0.37, p less than 0.01) between serum prostate specific antigen levels and Gleason score adjusted for tumor volume confirmed this suggestion. Consequently, serum prostate specific antigen levels do not reflect tumor burden and pathological stage accurately in individual patients for 2 reasons: 1) the unpredictable contribution from the benign prostatic hyperplasia component of the gland and 2) the decreasing production of prostate specific antigen by higher grade lesions as tumor volume increases.