Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening.
Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening.
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DOI：
10.1001/jama.1995.03530150038031
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发表时间：
1995-10
期刊：
影响因子：
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通讯作者：
W. Catalona;Deborah S. Smith;R. Wolfert;T. J. Wang;H. Rittenhouse;T. Ratliff;R. B. Nadler
中科院分区：
文献类型：
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作者：
W. Catalona;Deborah S. Smith;R. Wolfert;T. J. Wang;H. Rittenhouse;T. Ratliff;R. B. Nadler
目的探讨测定血清游离前列腺特异性抗原(PSA)百分率以提高血清PSA水平在4.1~10.0 ng/mL男性前列腺癌筛查中的特异性。设计采用一种研究方法对具有不同前列腺大小和直肠指诊结果的男性冷冻血清中的游离PSA进行回顾性、非随机分析。在大学中心设置普通社区前列腺癌门诊筛查项目。患者年龄在50岁以上的男性113例，其中99%为白人，血清PSA浓度在4.1~10.0 ng/mL之间，其中63例经组织学证实为良性前列腺增生症，30例前列腺癌合并腺体增大，20例前列腺癌患者的腺体大小正常。所有研究志愿者都接受了前列腺超声检查和活检。主要观察指标血清中游离PSA的百分比和保持至少90%的前列腺癌检测灵敏度的游离PSA截断值的百分比。结果正常大小的前列腺癌患者游离PSA的中位数为9.2%，增大的前列腺癌患者为15.9%，前列腺增生症患者为18.8%。在腺体增大和明显良性腺体的男性中，游离PSA截止值的百分比更高。在有明显良性腺体肿大的男性中，游离PSA截止值为23.4%或更低时，至少可以检测到90%的癌症，并且可以消除31.3%的阴性活检。结论在血清总PSA水平升高的男性中，测定游离血清PSA百分比可提高前列腺癌筛查的特异性，并可减少不必要的前列腺活检，对癌症的发现率影响最小；然而，需要进一步的研究来确定最佳的临界值。PSA筛查的最终评估还必须考虑当前治疗改善筛查发现的前列腺癌预后的能力。
OBJECTIVE To evaluate measurement of percentage of free prostate-specific antigen (PSA) in serum to improve the specificity of prostate cancer screening in men with serum PSA levels between 4.1 and 10.0 ng/mL. DESIGN Retrospective, nonrandomized analysis using a research assay for measuring free PSA in frozen serum from men with a spectrum of prostate sizes and digital rectal examination results. SETTING General community outpatient prostate cancer screening program at a university center. PATIENTS One hundred thirteen men aged 50 years or older, 99% of whom were white, with serum PSA concentrations of 4.1 to 10.0 ng/mL, including 63 men with histologically confirmed benign prostatic hyperplasia, 30 with prostate cancer with an enlarged gland, and 20 with cancer with a normal-sized gland. All study volunteers had undergone prostatic ultrasonography and biopsy. MAIN OUTCOME MEASURES Percentage of free PSA in serum and percentage of free PSA cutoff that maintained at least 90% sensitivity for prostate cancer detection. RESULTS Median percentage of free PSA was 9.2% in men with cancer and a normal-sized gland, 15.9% in men with cancer and an enlarged gland, and 18.8% in men with benign prostatic hyperplasia (P < .001). The percentage of free PSA cutoff was higher in men with an enlarged gland and in those with a palpably benign gland. In men with an enlarged, palpably benign gland, a free PSA cutoff of 23.4% or lower detected at least 90% of cancers and would have eliminated 31.3% of negative biopsies. CONCLUSIONS Measurement of percentage of free serum PSA improves specificity of prostate cancer screening in selected men with elevated total serum PSA levels and can reduce unnecessary prostate biopsies with minimal effects on the cancer detection rate; however, further studies are needed to define optimal cutoffs. Final evaluation of PSA screening also must consider the ability of current treatments to improve the prognosis of screen-detected prostate cancer.