游离/总前列腺特异性抗原(f/t PSA)比值在前列腺癌诊断中的应用

摘要

PSA以游离和复杂形式存在于血清中，这一发现导致了针对不同PSA形式的特异性免疫分析的发展。这有助于在PSA- act (PSA-α因此，可以计算游离PSA或游离PSA与总PSA的比值，这有助于显著减少不必要的活检次数，同时保持对癌症检测的高临床敏感性。研究对象为103名男性患者(平均年龄68±10.8岁)，其中90名良性疾病患者(87%)和13名前列腺癌患者(13%)，这些患者经组织学证实为前列腺癌。PSA值在2 - 25ng /ml之间的患者被纳入研究。正常健康男性30例，年龄58±10岁为对照组。采用链霉亲和素生物素EIA法(M/s Roche Diagnostics, Germany)分析血清总PSA和游离PSA。健康对照组PSA平均值为1.86±1.07 ng/ml。在患病情况下显著增加。其在肿瘤患者中的平均浓度为12.6±5.3 ng/ml，在良性患者中为6.3±4.6 ng/ml。自由PSA与总PSA比值在三组中均有显著差异(p结合该比值临界值与血清总PSA、DRE和TRUS等其他参数，有助于提高检测的敏感性，也有助于减少不必要的活检次数。103例男性活检中，13例(12.6%)确诊为前列腺癌。 Among these 13 cancer patients, 9 patients had abnormal findings in DRE.7 individuals out of these 9, also had free to total PSA ratio lower than 0.16 and would have been biopsied and diagnosed anyway. If we use only f/t PSA ratio less than 0.16, to decide whom to biopsy, we would have biopsied and diagnosed 11/13 cases i.e. sensitivity of 85% but If we decide to biopsy those patients who had abnormal DRE and those who had low f/t PSA ratio, we could identify 13/13 carcinoma i.e. 100% sensitivity.Combining the f/t PSA ratio with total PSA, DRE and TRUS findings could help in reducing the number of unnecessary biopsies. 37 patients who were negative for malignancy having total PSA in the range of 5–20 ng/ml, normal DRE and TRUS findings, have been biopsied but with combination of total PSA in the range of 5–20 ng/ml, normal findings in digital rectal examination and TRUS and f/t PSA ratio more than 0.16 (cutoff), we could have avoided 16 biopsies which were unnecessary that means there was 43% reduction in unnecessary biopsies.

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