Can complexed prostate specific antigen enhance prostate cancer detection in Japanese men?
Can complexed prostate specific antigen enhance prostate cancer detection in Japanese men?
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DOI：
10.1016/j.eururo.2003.11.022
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发表时间：
2004-07-01
期刊：
影响因子：
23.4
通讯作者：
Miki, T
中科院分区：
文献类型：
--
作者：
Okihara, K;Ukimura, O;Miki, T
背景资料：本研究的目的是确定是否拜耳复合PSA（cPSA）和体积参考cPSA可以提高日本男性前列腺癌的检测方法：共214名日本男性的血清总PSA（tPSA）值范围为1.2 ng/ml至4600 ng/ml的两个机构参加。在所有病例中获得tPSA、游离PSA、PSA-α-1-抗凝乳蛋白酶（PSA-ACT）和cPSA（ADVIA-Centaur）的血清样本。此外，在所有接受超声引导前列腺活检（六分仪和两个额外的移行区活检）的病例中确定总腺体（TGV）以及移行区体积（TZV）。活检结果与以下参数相关：tPSA，cPSA，PSA-ACT，游离总（F/T）PSA比值，2个复合总（C/T）PSA比值和6个体积参考参数。非容量参考变量的受试者工作特征曲线下面积最高的是cPSA（0.736），其次是PSA-ACT（0.735）、tPSA（0.722）、F/T PSA比值（0.613）和C/T PSA比值（0.591）。将tPSA与4.0 ng/ml的临界值进行比较，cPSA为2.8 ng/ml的临界值检测到1例阳性活检患者，减少了1例癌症漏诊病例和8例假阳性病例。在tPSA为4.00 - 10.00 ng/ml（n = 116）的男性中，当灵敏度为85%-95%时，tPSA和cPSA之间或cPSA和PSA-ACT之间的相应特异性无显著差异。当灵敏度为90%-95%时，根据移行区体积调整的PSA-ACT的相应特异性显示最佳性能。在tPSA <4.0 ng/ml的人群中，cPSA的特异性最好，与PSA-ACT和F/T PSA相比，其敏感性在80%~ 90%之间，差异有统计学意义。结论：Bayer cPSA可替代总PSA作为初筛检测，与PSA-ACT相比，cPSA可提高癌症检出率。然而，cPSA在区分tPSA在4.00和10.00 ng/ml之间的男性癌症和非癌症病例中没有提供额外的价值。(C)2003 Elsevier B. V.保留所有权利。
Backgrounds: The aim of this study is to ascertain whether Bayer complexed PSA (cPSA) and volume referenced cPSA could enhance the detection of prostate cancer in Japanese men.Methods: A total of 214 Japanese men whose serum total PSA (tPSA) values ranged from 1.2 ng/ml to 4600 ng/ml were enrolled from two institutions. Serum samples for tPSA, free PSA, PSA-alpha-1-antichymotripsin (PSA-ACT) and cPSA (ADVIA-Centaur) were obtained in all cases. In addition, total gland (TGV) as well as transition zone volume (TZV) were determined in all cases who underwent untrasound guided prostate biopsy (sextant and two additional transition zone biopsies). Biopsy outcome was correlated to the following parameters: tPSA, cPSA, PSA-ACT, free to total (F/T) PSA ratio, 2 complex to total (C/T) PSA ratios and 6 volume referenced parameters.Results: Prostate cancer was detected in 85 of 214 patients (40%). The area under the receiver operating characteristic curve in non-volume referenced variables was highest for cPSA (0.736), followed by PSA-ACT (0.735), tPSA (0.722), F/T PSA ratio (0.613) and C/T PSA ratio (0.591). Comparing tPSA with the cutoff value of 4.0 ng/ml, the cutoff value with a 2.8 ng/ml of cPSA detected one more positive biopsy patient, decreasing one more cancer missed case and 8 more false positive cases. At sensitivities of 85% to 95% in men with tPSA between 4.00 and 10.00 ng/ml (n = 116), there were no significant differences in the corresponding specificities between tPSA and cPSA, or between cPSA and PSA-ACT At sensitivities of 90% to 95%, the corresponding specificities of PSA-ACT adjusted for transition zone volume revealed best performance. As for the performance in men with a tPSA less than 4.0 ng/ml, the specificities of cPSA performed best, and differed significantly from PSA-ACT and F/T PSA at sensitivities of 80% to 90%.Conclusion: Bayer cPSA could replace the first screening test by total PSA and can enhance cancer detection, compared with PSA-ACT. However, cPSA did not provide additional value in differentiating cancer from non-cancer cases in men with a tPSA between 4.00 and 10.00 ng/ml. (C) 2003 Elsevier B.V. All rights reserved.