前列腺特异抗原倍增时间对前列腺癌的预测作用.docVIP

前列腺特异抗原倍增时间对前列腺癌的预测作用 　　作者：林若飞　王小燕　卓文利　谢星　张林林　吴卫真　 作者单位：350025　福州，南京军区福州总医院泌尿外科(林若飞、卓文利、谢星、张林林、吴卫真)，药学科(王小燕) 　　【摘要】 目的　用前列腺特异抗原倍增时间(PSADT)值来预测低危前列腺癌中需要进一步治疗的高危前列腺癌。方法　选择79例前列腺癌确诊病例，之前没有接受任何治疗，至少连续2次PSA的检测值有上升的趋势。PSADT的计算需2个PSA值，且间隔时间3个月以上。结果　79例前列腺癌中有47例(59.3%)低危前列腺癌，32例(40.7%)高危前列腺癌。两组间年龄的比较无统计学差异。在高危和低危前列腺癌患者中PSADT均值分别为12.70个月和25.00个月，差异有统计学意义(P=0.001)。在高危前列腺癌中28例(87.5%)患者PSADT少于12个月，低危前列腺癌中只有12例(25.6%)PSADT少于12个月。PSADT为12个月预测高危和低危前列腺癌有高敏感性(74%)和特异性(88%)。结论　PSADT可以预测高危前列腺癌，PSADT少于12个月的患者前列腺组织Gleason评分高，为高危前列腺癌，需要进一步治疗。 　　【关键词】 前列腺肿瘤;　前列腺特异性抗原;　危险性评估;　敏感性与特异性 　　【Abstract】　Objective　To evaluate the value of serum prostate-specific antigen (PSA) doubling time (PSADT) to differentiate patients with high-grade prostate cancer who require more aggressive therapy from those with low-grade cancer.Methods　Of 79 patients with confirmed prostate cancer were selected.They had not received any previous treatment for prostate cancer and had at least 2 consecutive serum PSA tests with a rising trend.The PSADT was calculated in patients with 2 serum PSA levels measured with an interval more than 3 months.Results　Of 79 patients with prostate cancer,47(59.3%) had low-grade and 32 (40.7%) had high-grade tumors.There was no difference in age between the two groups.The median PSADT in patients with high-grade and low-grade tumors were 12.50 months and 25.00 months，P=0.001.A total of 28 patients with high-grade tumors (87.5%) had a PSADT less than 12 months，while only 12 of those with low-grade tumors (25.6%) had a PSADT less than 12 months.A PSADT cut off of 12 months provided a sensitivity of 74% and a specificity of 88% for differentiation of high-grade from low-grade cancers.Conclusions　PSADT can identify patients with high-grade tumors.Men with a short PSADT (12 months) were at a higher risk of harboring a high-grade prostate cancer who require more aggressive therapy. 　　【Key words】　Prostatic neoplasms;　Prostate-specific antigen;　Risk assessment;　Sensitivity and s