Evaluation of proprostate specific antigen for early detection of prostate cancer in men with a total prostate specific antigen range of 4.0 to 10.0 ng/ml
Evaluation of proprostate specific antigen for early detection of prostate cancer in men with a total prostate specific antigen range of 4.0 to 10.0 ng/ml
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DOI：
10.1097/01.ju.0000086940.10392.93
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发表时间：
2003-09-01
影响因子：
6.6
通讯作者：
Veltri, RW
中科院分区：
文献类型：
--
作者：
Khan, MA;Partin, AW;Veltri, RW
目的：在当代筛查人群中，前列腺特异性抗原（PSA）的主要缺点是其相对缺乏特异性，特别是在4至10 ng/ml的范围内，其中25%的时间发现前列腺癌。ProPSA是游离PSA（fPSA）的衍生物，由截短形式（例如[-2]proPSA、[-4]proPSA或全长[-7]proPSA）组成。越来越多的证据表明，proPSA与前列腺癌优先相关。本研究的目的是确定前列腺特异性抗原是否可以影响早期前列腺癌的检测。材料和方法：对从93名进行系统性12芯前列腺活检（总PSA范围4.0至10.0 ng/ml）的男性获得的存档血清样品测定游离PSA百分比、总PSA和3种形式的proPSA（Hybritech Tandem Assays Beckman Coulter Access，Beckman Coulter，Inc.，Brea，加州）。测定游离PSA、单个proPSA形式（[-2]、[-4]和[-7]或proPSA总和）和衍生物的累积总和。在接受评估的93名男性中，41名（44%）有前列腺癌的证据（76% Gleason 5/6，19% Gleason 7和5% Gleason 8）。前列腺体积的测量是在系统的12芯活检检测前列腺癌。结果进行了分析，采用单因素和多因素logistic回归（LR）非参数统计方法。结果如下：使用单变量LR，fPSA、fPSA百分比（%fPSA）、proPSA总和百分比和前列腺体积显著（p < 0.05）区分前列腺癌患者和良性疾病患者。然而，应用逐步后向多变量LR，保留了总PSA、%fPSA和sum-proPSA，并生成了曲线下面积为76.6%的接收者操作特征曲线。在90%的灵敏度下，这3个变量共同实现了44%的前列腺癌检测特异性。单独而言，3个保留变量的特异性为23%（总PSA），33%（%fPSA）和13%（sum-proPSA）。结论：与单个PSA分子形式测量的结果相比，总PSA为4至10 ng/ml的男性中，sum-proPSA，总PSA和%fPSA组合提高了早期前列腺癌检测的特异性。
Purpose: In contemporary screening populations a major drawback of prostate specific antigen (PSA) is its relative lack of specificity, especially in the range of 4 to 10 ng/ml, where prostate cancer is found 25% of the time. ProPSA is a derivative of free PSA (fPSA) consisting of the truncated forms (eg [-2]proPSA, [-4]proPSA or the full-length [-7]proPSA). There is increasing evidence that proPSA is associated preferentially with prostate cancer. The objective of this study was to determine whether proPSA can influence the detection of early prostate cancer.Materials and Methods: Archival serum samples obtained from 93 men who underwent a systematic 12-core prostate biopsy (total PSA range 4.0 to 10.0 ng/ml) were assayed for percent free PSA, total PSA and the 3 forms of proPSA (Hybritech Tandem Assays Beckman Coulter Access, Beckman Coulter, Inc., Brea, California). Free PSA, the cumulative sum of individual proPSA forms ([-2], [-4] and [-7], or sum-proPSA) and derivatives were determined. Of the 93 men assessed 41 (44%) had evidence of prostate cancer (76% Gleason 5/6, 19% Gleason 7 and 5% Gleason 8). Prostate volume was measured at systematic 12-core biopsy for the detection of prostate cancer.Results were analyzed using univariate and multivariate logistic regression (LR) nonparametric statistical methods. Results: Using univariate LR, fPSA, percent fPSA (%fPSA), percent sum-proPSA and prostate volume significantly (p < 0.05) differentiated men with prostate cancer from those with benign disease. However, applying stepwise backward multivariate LR, total PSA, %fPSA and sum-proPSA were retained and generated a receiver operator characteristic curve with an area under the curve of 76.6%. At 90% sensitivity these 3 variables collectively achieved a specificity of 44% for the detection of prostate cancer. Individually, the 3 retained variables had a specificity of 23% (total PSA), 33% (%fPSA) and 13% (sum-proPSA).Conclusions: Sum-proPSA, total PSA and %fPSA in combination improve the specificity of early prostate cancer detection in men with a total PSA of 4 to 10 ng/ml compared with the results of individual PSA molecular forms measured.