前列腺特异性抗原及其相关指标在前列腺癌鉴别诊断中的应用价值

摘要

hyperplasia (BPH) and prostate cancer (PCa), especially in the patients with TPSA 4-25 ng/ml.Methods: Retrospective analysis of the postoperative pathological results of 189 prostatic patients undergoing transurethral prostatic resection and transrectal prostate biopsy treatment in Department of Urology, Chongqing County, Dianjiang County, and Department of Urology, First Affiliated Hospital of Chongqing Medical University January 2012 and December 2014. The values of TPSA, FPSA, and the prostate volume were collected, respectively. The values of FPSA/TPSA and PSAD were calculated and analyzed statistically.Results: The values of TPSA in all the patients before the surgery were more than 4ng/ml. The postoperative pathological results suggested that 44 cases for PCa, 145 cases for BPH. There was no significant difference in TPSA, while significant difference in FPSA, FPSA/TPSA, prostate volumes and PSAD(P<0.01) between the BPH group and the PCa group. When the value of TPSA was between 4 and 25 ng/ml, the BPH group has significantly higher values in FPSA, FPSA/TPSA, and PSA volumes, and significantly lower value in PSAD compared with the PCa group(P<0.01). However, no significant difference was found in the value of TPSA between the two groups(P=0.057). Conclusion: There was some defects when PSA>4 ng/ml as the critical value to screen PCa. When the value of TPSA was more than 4ng/ml, to detect value of TPSA combined with values of FPSA/TPSA and PSAD was significantly better than TPSA in differential diagnosis of PCa and BPH.%目的：探讨血清前列腺特异抗原(PSA)及其相关指标，包括血清游离PSA(fPSA)与总PSA(tPSA)比值(fPSA/tPSA)和前列腺特异性抗原密度(PSAD)在良性前列腺增生(BPH)和前列腺癌(PCa)鉴别诊断中的应用价值。方法：回顾性分析189例前列腺病患者行1期经尿道前列腺电切术＋经直肠前列腺穿刺术治疗的术后病理结果资料，并将其分为PCa组和BPH组，对两组患者血清PSA、FPSA指标、前列腺体积以及fPSA/tPSA和PSAD值进行统计学分析。结果：术前189例患者PSA均＞4 ng/ml，术后病理提示44例为PCa，145例为BPH。PCa组和BPH组TPSA无显著性差异；fPSA、fPSA/tPSA、前列腺体积及PSAD差异显著。在TPSA诊断灰区(4.0～25 ng/ml)中，BPH组fPSA、fPSA/tPSA值和前列腺体积显著高于PCa组，PSAD显著低于PCa组，两组的TPSA无显著性差异。结论：PSA＞4 ng/ml作为筛选PCa的临界值存在一定缺陷；在TPSA处于4.0～25 ng/ml时，TPSA＞4 ng/ml与fPSA/tPSA≤0.15、PSAD≥0.16联合应用时对PCa和BPH的诊断鉴别综合价值明显优于单用TPSA。