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題名 | Differentiation of Prostate Adenocarcinoma from Benign Prostatic Hyperplasia Using Prostate Specific Antigen Density (PSAD)=利用前列腺特異抗原密度來區分前列腺癌與良性前列腺肥大 |
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作者 | 余宏政; 賴明坤; Yu, Hong-jeng; Lai, Ming-kuen; |
期刊 | 中華民國泌尿科醫學會雜誌 |
出版日期 | 19970300 |
卷期 | 8:1 1997.03[民86.03] |
頁次 | 頁22-27 |
分類號 | 416.275 |
語文 | eng |
關鍵詞 | 前列腺癌; 前列腺特異抗原; 前列腺特異抗原密度; Prostate cancer; Prostate specific antigen; Prostate specific antigen density; |
中文摘要 | 為評估前列腺特異抗原密度( PSAD )是否可增加前列列特異抗原( PSA )用於 區分前列腺癌與良性前列腺肥大的價值,我們利用從民國 82 年 4 月到民國 85 年 1 月在 臺大醫院泌尿部接受前列腺手術的病人來作回溯性分析。 在 517 例 PSA 值小於 50ng/mL 的病人中有 50 例經病理診斷為前列腺癌,而另外 467 例則為良性前列腺肥大, 這兩組病 人其 PSA 與 PSAD 的平均值都有顯著的差異性( P 值都小於 0.001 )。若根據 PSA 值將 這些病人細分為 4 組( PSA: 0-4.0ng/mL; 4.1-10.0ng/mL; 10.1-20.0ng/mL; 20.1-50.0ng/mL )來作分析, 則在 PSA 為 4.1-10.0ng/mL 及 10.1-20.0ng/mL 這兩組病 人, PSAD 區分前列腺癌及良性列腺肥大的能力明顯優於 PSA, 至於在另二組病人( PSA 0-4.0ng/ml 與 20.1-50.0ng/ml ),PSA 與 PSAD 則無此差別。 根據上述的結果,我們再進一步分析使用 PSAD 於血清 PSA 值為 4.1-20.0ng/mL 的病人時 , 其區分前列腺癌與良性前列腺肥大症的敏感性( sensitivity )與特異性( specificity ), 若以 PSAD 值為 0.15 為分界點,則其敏感性為 85% 而特異性為 22%, 若將( PSAD 值提高到 0.20,則其敏感性為 80% 而特異性為 48%,由這個研究結果,我們 認為對於血清 PSA 值介於 4.1-20.0ng/ml 間的病人而言,使用 PSAD 來區分前列腺癌與良 性前列腺肥大的能力雖然優於 PSA,但是其偏低的特異性卻阻礙了其臨床上的實用價值。 |
英文摘要 | To evaluate if prostate specific antigen density (PSAD), the ratio of serum PSA level to volume of prostate, can enhance the ability of PSA in differentiating prostatic adenocarcinoma (PCa) from benign prostatic hyperplasia (BPH), a retrospective study was conducted on patients having undergoing prostatic operations in our institution between April 1993 and Janurary 1996 of the 517 patients with a preoperative serum PSA level<50ng/mL, 50 were documented to be PCa and 467 were to be BPH. There were significant differences in both the mean PSA (20.5 vs. 7.2ng/mL, P<0.001) and the mean PSAD (0.94 vs. 0.21, P<0.001) values between patients with PCa and those with BPH. These patients were then divided into 4 groups according to their serum PSA levels (PSA: 0-4.0 ng/mL; 4.1-10.0ng/mL; 10.1-20.0ng/mL; and 20.1-50.0ng/mL) and patients with PCa and those with BPH were compared in each group with respect to the values of PSA and PSAD. PSAD was significantly better than PSA in differentiating PCa from BPH in the group with a serum PSA level of 4.1 to 10.0ng/mL (P<0.0001 vs. P=0.69) and in that with a serum PSA level of 10.1 to 20.0ng/mL(P<0.0001 vs. P=0.82). Subsequently, the diagnostic efficacy of PSAD in distinguishing PCa from BPH in patients with a serum PSA of 4.1 to 20.0ng/mL was evaluated. By using PSAD of 0.15 as a cutoff point, the sensitivity in differentiating PCa from BPH was 85%, the specificity was 22%, and the positive predictive value was 9%. Raising the cutoff value to 0.20 resulted inasensitivity of 80%, a specificity of 48% and a positive predictive value of 12%. We conclude from this study that although PSAD could better discriminate between PCa and BPH in patients with a serum PSA of 4.1 to 20.0ng/mL than PSA, its clinical value when used alone is limited by its imperfect specificity and positive predictive value. |
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