Serum prostate-specific antigen discriminates weakly between men with benign prostatic hyperplasia and patients with organ-confined prostate cancer.
Serum prostate-specific antigen discriminates weakly between men with benign prostatic hyperplasia and patients with organ-confined prostate cancer.
复制标题
血清前列腺特异性抗原对患有良性前列腺增生的男性和患有器官局限性前列腺癌的患者的区分很弱。
作者：
P. Sershon;M. Barry;J. E. Oesterling
为了确定血清前列腺特异性抗原 (PSA) 是否可以在治疗有症状的良性前列腺增生 (BPH) 之前识别那些患有器官局限性前列腺癌的患者，我们回顾性检查了两组男性的术前血清 PSA 水平。第 1 组由 187 名连续患者组成，这些患者的组织学诊断为 BPH，根据经尿道前列腺电切术 (TURP) 标本的完整病理分析确定。第 2 组包括 198 名连续患者，这些患者经组织学证实为器官局限性前列腺癌，根据耻骨后根治性前列腺切除术标本的阶梯切片分析确定。第 1 组的中位血清 PSA 值为 3.9 ng/ml（范围 0.2-55 ng/ml），而第 2 组的中位血清 PSA 水平为 5.9 ng/ml（范围 0.4-58 ng/ml）。尽管这种差异具有统计显着性 (p < 0.001)，但第 1 组的血清 PSA 值的分布与第 2 组的分布有相当大的重叠。对于两组，PSA 值均低于 10.0 ng/ml（第 1 组：90%；第 2 组：73%）。用于区分 BPH 男性和器官局限性前列腺癌患者的 PSA 对数值的受试者工作特征曲线下面积为 0.66（95% 置信区间：0.60-0.72）； “完美”测试的面积为 1.0，而“无信息价值”测试的面积为 0.5。这些发现表明，血清 PSA 区分 BPH 男性和器官局限性前列腺癌患者的能力有限。因此，一些选择非 TURP 治疗的有症状 BPH 患者尽管通过血清 PSA 测定进行了评估，但仍可能患有临床上显着的前列腺癌。
To determine if serum prostate-specific antigen (PSA) can identify those patients harboring an organ-confined prostate cancer prior to treatment for symptomatic benign prostatic hyperplasia (BPH), we examined retrospectively the preoperative serum PSA level for two groups of men. Group 1 consisted of 187 consecutive patients with a histologic diagnosis of BPH as determined from complete pathologic analysis of the transurethral resection of the prostate (TURP) specimen. Group 2 included 198 consecutive patients with histologically confirmed organ-confined prostate cancer as determined from step-section analysis of the retropubic radical prostatectomy specimen. The median serum PSA value for group 1 was 3.9 ng/ml (range 0.2-55 ng/ml), whereas the median serum PSA level for group 2 was 5.9 ng/ml (range 0.4-58 ng/ml). Although this difference was statistically significant (p < 0.001), the distribution of serum PSA values for group 1 overlapped considerably with the distribution for group 2. For both groups, there was a clustering of PSA values below 10.0 ng/ml (group 1: 90%; group 2: 73%). The area under the receiver operating characteristic curve for log PSA values to discriminate men with BPH from patients with organ-confined prostate cancer was 0.66 (95% confidence interval: 0.60-0.72); a 'perfect' test has an area of 1.0, whereas a test with 'no information value' has an area of 0.5. These findings suggest that serum PSA has only a modest ability to distinguish men with BPH from patients with organ-confined prostate cancer. As a result, some symptomatic BPH patients choosing a non-TURP therapy may harbor a clinically significant prostate cancer despite being evaluated with a serum PSA determination.