前列腺增生症相关下尿路症状与各临床影响因素关系的研究

目的 探讨不同的临床因素与前列腺增生症(BPH)相关下尿路症状(LUTS)之间的关系,了解影响BPH有关LUTS的危险因素.方法 对2003年7月至2009年10月收治的548例前列腺增生症患者的资料进行回顾性研究.分析不同年龄、病史、最大尿流率(Qmx)、前列腺总体积、移行区体积、移行区指数、总PSA、游总比(f/tPSA)、组织炎症对IPSS值的影响,并进行多元线性回归分析.结果 年龄、移行带体积、Qmax、PSA及前列腺组织炎症对IPSS评分影响显著.随着年龄增大和移行带体积的增加,IPSS值变大;随着最大尿流率的减少,IPSS值显著增加(P＜0.05).当PSA ≥4 ng/mL时,IPSS值要显著大于＜4 ng/mL组(P＜0.05),但是介于4～10 ng/mL组和≥10 ng/mL组的IPSS评分并无差异(P＞0.05).合并前列腺组织炎症患者的IPSS值要显著高于非炎症组(P＜0.05).进一步通过多元线性回归分析,发现所有可能影响IPSS评分的因素中,Qmax和前列腺组织炎症与IPSS评分密切相关(β=-0.807,5.736;P＜0.001).结论 前列腺组织炎症和Qmax对下尿路症状的影响最显著.其他的临床因素如患者年龄、移行带体积和PSA值对BPH患者的下尿路症状影响有限,经过多因素回归分析发现并无显著性.     

BPH患者年龄、睾酮水平、体重指数、前列腺体积及血清前列腺特异性抗原的关系分析

目的:探讨研究BPH患者年龄、睾酮水平、体重指数(BMI)、前列腺体积以及血清前列腺特异性抗原(PSA)之间的关系。方法:回顾性分析2013年2月~2014年9月天津医科大学第二医院泌尿外科333例有下尿路症状并经手术治疗后病理诊断为BPH的患者临床资料,采用SPSS19.0软件总结并分析患者年龄、睾酮水平、体重指数(BMI)、前列腺体积以及血清PSA、f/t之间关系。结果:333例患者平均年龄为(68.93±7.061)岁,平均前列腺体积为(81.06±42.034)ml;平均睾酮值为(3.42±1.761)ng/dl;平均BMI为(23.915±3.291)kg/m2;平均PSA值(5.90±4.666)ng/ml;平均fPSA值(1.059±1.023)ng/ml,f/t平均值(0.191±0.097)。对患者年龄分组后显示睾酮水平随年龄增长而降低(F=20.113,P0.001),BMI水平随年龄增长无明显相关性(F=1.500,P=0.215)。前列腺体积、血清PSA值随患者年龄增长而增加(F=2.792,P=0.041;F=2.978,P=0.032),而f/t值随着年龄的增加而降低(F=11.91,P=0.01);对体积进行分组后血清PSA值随前列腺体积增加而升高(F=24.028,P0.001);对体重指数分组后血清PSA值随体重指数增加无明显变化(F=0.735,P=0.532)。应用Spearman相关分析比较显示PSA、fPSA值均与体积正相关(r=0.494,P0.001;r=0.369,P0.001),然而f/t值与前列腺体积无明显相关性(r=0.05,P=0.363);而PSA、fPSA值均与睾酮呈负相关(r=-0.138,P=0.012;r=-0.188,P=0.001);PSA、fPSA、f/t值与BMI均无明显相关性(r=0.039,P=0.475;r=0.009,P=0.863;r=0.039,P=0.478)。结论:BPH患者血清PSA水平和前列腺体积随患者年龄增长而增加,睾酮水平随年龄增长而降低,BMI水平随年龄增长无明显变化;患者血清PSA与前列腺体积正相关,与睾酮水平呈负相关,而与BMI无明显相关性;f/t值随着年龄的增长逐渐下降,而与前列腺体积、BMI无明显相关性。     

血清PSA、游离PSA与良性前列腺增生临床的相关性研究

目的分析血清前列腺特异性抗原(PSA)及游离前列腺特异性抗原(fPSA)与良性前列腺增生(BPH)临床的相关性。方法应用化学发光微粒子免疫分析法(CMIA)对BPH患者血清PSA、fPSA进行检测。结果入选的40例患者病理均为BPH。PSA>4ng/ml者,术后随访1～3个月,平均2.5个月,PSA值均降至0.02ng/ml以下,可除外前列腺癌(PCa)病例。PSA<4ng/ml者16例(40%),4～10ng/ml者14例(35%),>10ng/ml者10例(25%);fPSA>0.934ng/ml者22例(55%)。血清PSA、fPSA水平与前列腺总体积(PV)、前列腺移行区体积(TZV)、年龄及国际前列腺症状评分(IPSS)呈正相关。结论本组血清fPSA与PV、TZV、年龄、IPSS评分有更强相关性。BPH患者血清PSA、fPSA水平升高的相关因素与前列腺总体积及移行区增大、高龄及高IPSS评分有关。     

血清PSA与良性前列腺增生临床病理的相关性研究

目的分析血清前列腺特异性抗原(PSA)与良性前列腺增生(BPH)临床病理的相关性。方法回顾性分析561例有下尿路梗阻症状经手术治疗后病理诊断为BPH的患者资料。年龄(68.3±6.3)岁,术前国际前列腺症状评分(IPSS)21.1±7.4,生活质量评分(QoL)4.5±0.8,尿流率(7.3±3.3)ml/s,前列腺体积(69.8±36.8)ml,剩余尿(81.9±105.8)ml,血清PSA值＜4 ng/ml者247例(44.0%),4～10 ng/ml者223例(39.8%)、＞10 ng/ml者91例(16.2%)。结果血清PSA水平与患者年龄、IPSS、QoL、最大尿流率、剩余尿量无明显相关性(r=0.08、0.03、0.06、0.04、0.09,P＞0.05),而与前列腺体积呈显著正相关(r=0.42,p＜0.01)；血清PSA水平升高与前列腺体积(F=93.45,P＜0.05)及尿潴留发生率(x~2=59.1,P＜0.01)间有统计学意义。BPH组织标本中以腺体增生为主(x~2=16.14,P＜0.01)或伴有梗死病灶(x~2=36.06,P＜0.01)患者的血清PSA水平明显升高。结论50%以上接受手术治疗的BPH患者血清PSA水平升高,前列腺体积增大、尿潴留以及表现为腺体增生为主或伴有梗死灶的BPH是血清PSA水平升高的主要原因。     

新疆维吾尔族、汉族前列腺增生症患者血清PSA、PSAD及前列腺体积比较

目的探讨新疆维、汉民族不同年龄段前列腺增生症患者血清PSA、PSAD及前列腺体积的差异及它们之间的相关性。方法总结5年来前列腺增生症住院患者,其中汉族150例,维吾尔族114例,在检查治疗前行放免法检测血清PSA,经腹超声测量前列腺体积,并分别计算患者的PSAD,按照不同年龄段进行血清PSA、PSAD及前列腺体积的比较。结果维、汉民族各年龄段血清PSA及PSAD差异无显著性(P＜0．05)。血清PSA及前列腺体积均随年龄增长而增高,且它们之间关系呈正相关。两民族前列腺体积在60岁组和80岁组差异显著(P＜0．05),维吾尔族明显高于汉族。结论两民族前列腺增生症患者间血清PSA、PSAD差异无显著性,且与前列腺体积一样随年龄增长而增高。PSAD是更可靠的诊断指标。     

血清前列腺特异性抗原检测预测良性前列腺增生并发急性尿潴留的应用价值

目的 探讨血清前列腺特异性抗原(PSA)检测预测良性前列腺增生(BPH)并发急性尿潴留(AUR)的应用价值,为BPH并发AUR的临床治疗和预后提供参考.方法 选取本院2013年1月～ 2014年12月收治住院治疗的289例BPH患者的临床资料,其中并发AUR者183例(AUR组),未并发AUR者106例(非AUR组).比较两组患者总血清前列腺特异性抗原(tPSA)、tPSA/年龄、前列腺体积(PV)及PSA密度(PSAD)水平的差异;分析两组患者不同tP-SA、PV及PSAD水平的分布率.结果 AUR组tPSA、tPSA/年龄、PV及PSAD均大于非AUR组,两组比较差异均有显著性统计学意义(P＜0.01).Sperman's相关性分析表明,tPSA、tP-SA/年龄及PSAD间存在正相关性(r=0.921,P＜0.05);tPSA与PV间呈正相关性(r=0.920,P ＜0.05).随着tPSA、PV及PSAD水平的逐渐增加,AUR的发生率逐渐升高.结论 PSA的检测可作为BPH并发AUR的预测指标,值得临床推广应用.临床检测中应结合tPSA/年龄、PV及PSAD等结果综合考虑.     

前列腺癌、前列腺增生症患者血清骨保护素测定的临床价值

目的探讨前列腺癌（PCa）患者和前列腺增生（BPH）症患者血清中骨保护素（OPG）浓度的差异以及前列腺癌患者骨保护素浓度与血清前列腺特异性抗原（PSA）水平、前列腺体积是否具有相关性。方法采用双抗体夹心酶免法（ELISA）测定40例前列腺癌患者及40例前列腺增生患者血清OPG浓度,同时采集PCa患者的前列腺体积及PSA值。比较PCa患者及BPH患者血清OPG浓度的差异以及前列腺癌患者中OPG浓度与PSA、前列腺体积之间有无相关性。结果 PCa患者的血清OPG浓度平均值水平〔（14 900.19±5 168.65）pg/mL〕显著高于BPH组〔（10 457.87±4 786.29）pg/mL〕,差异有显著性意义（P〈0.01）。PCa患者血清OPG浓度与PSA值及前列腺体积之间均无明显相关性（r分别为=0.221、0.138,P均〉0.1）。结论血清OPG浓度对鉴别PCa和BPH有重要临床价值,PCa患者血清OPG浓度与血清PSA值及前列腺体积无明显相关性。     

良性前列腺增生患者前列腺体积和移行区体积随年龄变化的调查

目的:调查良性前列腺增生(BPH)患者各年龄段前列腺总体积(TPV)、前列腺移行区体积(TZV),计算TZV与TPV的比值即移行区指数(TZI)的数值。分析年龄与上述指标的相关性。方法:经直肠B超测量1 563例BPH患者前列腺和前列腺移行区最大左右径、前后径和上下径,根据公式分别计算出TPV、TZV以及TZI。分析年龄与前列腺体积各参数的相关性。结果:BPH患者各年龄组TPV、TZV和TZI值分别为:50~59岁年龄组TPV(32.27±15.76)ml、TZV(9.55±7.98)ml、TZI 0.28±0.13;60~69岁年龄组TPV(40.93±17.45)ml、TZV(14.94±11.83)ml、TZI 0.34±0.16;70~79岁年龄组TPV(46.56±20.31)ml、TZV(19.54±19.25)ml、TZI 0.39±0.16;80~89岁年龄组TPV(47.85±26.63)ml、TZV(20.40±16.78)ml、TZI 0.41±0.19。BPH患者的TPV、TZV与年龄成显著正相关性(r1=0.232,r2=0.256,P均<0.01),TZV与年龄的相关系数要高于TPV与年龄的相关系数。结论:BPH患者的TPV、TZV值随着年龄的增长而增加,但是TZV增长的幅度要高于TPV增长的幅度,前列腺增生以移行区增生最为显著,并且我国BPH患者的移行区指数与其他人种之间可能存在不同。     

手术治疗的良性前列腺增生患者年龄与血清PSA、PSAD的关系分析

目的探讨手术治疗的良性前列腺增生（BPH）患者年龄与血清前列腺特异性抗原（PSA）及前列腺特异性抗原密度（PSAD）的关系。方法选取手术治疗的BPH患者共369例,按年龄段分为4组,对其血清PSA进行检测,并计算PSAD值,分析年龄和血清PSA、PSAD的关系。结果随年龄的增长,手术治疗的BPH患者PSA呈现逐渐增加趋势;而PSAD在各组间基本保持不变。结论手术治疗的BPH患者血清PSA值与患者年龄有显著的相关性,而PSAD却相对保持恒定。     

前列腺特异性抗原异常患者前列腺液细胞学检查的临床分析

目的 研究PSA值增高患者前列腺液脱落细胞学检查诊断前列腺癌的临床分析及前列腺液中白细胞状态对血清PSA的影响.方法 130例PSA值增高患者在行经直肠前列腺穿刺活检前,行直肠指检按摩获取前列腺液,进行瑞氏染色和脱落细胞学分级,并行前列腺液中的白细胞计数.方差分析PSA水平在不同脱落细胞学分级之间的差异,采用Spearman相关分析检验前列腺液体积、白细胞密度和白细胞总数与患者的tPSA、fPSA、年龄、前列腺体积的相关性,行t检验或Wilcoxon 秩和检验比较前列腺癌和非前列腺癌组tPSA、fPSA、年龄、前列腺液体积、前列腺液中的白细胞密度、白细胞总数、前列腺体积的差异. 结果 病理学结果显示前列腺癌77例(59.2％),非前列腺癌53例(40.8％).脱落细胞分级Ⅰ ～Ⅴ级分别为28例(21.5％),32例(24.6％),22例(16.9％),36例(27.7％),12例(9.2％).脱落细胞学检查特异性为100％.在PSA≥20 μg/L的患者中,具有较高的敏感性(10/16,62.5％).在脱落细胞学分级Ⅰ～Ⅳ级之间PSA值差异无统计学意义(P＞0.05),Ⅰ～Ⅳ级与Ⅴ级之间PSA值比较差异有统计学意义(P＜0.05).前列腺液体积和白细胞总数与前列腺体积呈显著性相关,非前列腺癌患者的前列腺体积、白细胞密度和总数显著高于前列腺癌患者,且其血清PSA值与前列腺液中的白细胞密度呈正相关性. 结论 PSA值增高患者行前列腺液脱落细胞学检查诊断前列腺癌是一种有效的方法,尤其在患者PSA值较高时.非前列腺癌患者的PSA值增高可能与前列腺液中的白细胞增高有关.     

Repeat prostate biopsy in the prostate, lung, colorectal and ovarian cancer screening trial

OBJECTIVE: To determine patterns of repeat prostate biopsy in a cohort of men undergoing prostate cancer screening who have a negative initial biopsy. SUBJECTS AND METHODS: The Prostate, Colorectal, Lung, and Ovarian (PLCO) cancer screening trial is an ongoing study the prostate component of which consists of six annual screens with measurements of prostate-specific antigen (PSA) level and a digital rectal examination (DRE). The diagnostic follow-up of positive screening results is done by the subject's healthcare provider outside the purview of the PLCO. We analysed the experience of repeat biopsy in men in the PLCO with an initial negative biopsy. Men were divided by indication for initial biopsy into those with suspicious PSA levels and those with suspicious DRE findings. RESULTS: The probability of having a repeat biopsy within 3 years of initial biopsy was 43% for 1736 men with suspicious PSA levels and 13% for 1025 men with suspicious DRE findings. Rates of third and fourth biopsy after a previous negative biopsy were similar to the initial repeat biopsy rate in PSA-positive men. Most men had a repeat biopsy only after having an additional round of screening. The PSA level and PSA velocity determined after initial biopsy were independent risk factors for a repeat biopsy, both in PSA-positive and DRE-positive men. High-grade prostatic intraepithelial neoplasia was a risk factor for repeat biopsy before any repeat PSA or DRE testing. CONCLUSION: The experience of this cohort should be generally representative of patterns of care for repeat biopsy in men undergoing periodic screening. These data can provide context to the debate over optimum practices for repeat biopsy.     

Prostate-specific antigen density: The role in benign prostate hyperplasia,prostate intraepithelial neoplasm,organ-confined prostate carcinoma and advanced prostate carcinoma

To determine the relative role of prostate-specific antigen density (PSAD) in the early detection of prostate cancer and to assess the hypothesis that PSAD offers significant advantages over prostate-specific antigen (PSA) alone in the evaluation of patients with benign (BPH), pre-malignant (PIN) and malignant prostatic diseases, we studied retrospectively 149 patients who were evaluated with either prostatic biopsies or by surgical means. Mean PSAD was calculated to be 0.1 for BPH patients; 0.09 for PIN-1 patients; 0.1 for PIN-2 patients; 0.51 for organ-confined prostatic carcinoma (CaP) patients and 1.7 for advanced CaP patients. Although we could not be able to differentiate BPH from PIN-1 and PIN-2 by using PSAD alone (p>0.05), there were statistically significant differences between BPH versus localized CaP, PIN-2 versus localized CaP and localized CaP versus advanced CaP (p<0.05). In conclusion we suggest that the information provided by PSAD is superior to absolute PSA values in the differentiation between BPH and CaP but PSAD was not able to add more information on differentiating BPH from pre-malignant conditions.     

Ventral prostate predominant l, a novel mouse gene expressed exclusively in the prostate

BACKGROUND: Despite the region-specific nature of human prostate disease, there is a paucity of information regarding the molecular basis of prostate regionalization and patterning. To elucidate genetic mechanisms that underlie prostate growth and development, we investigated differential gene expression in mouse prostate lobes. METHODS: mRNA differential display analysis was used to identify differentially expressed genes during development of ventral, anterior, and dorsolateral prostate lobes. Differential gene expression was confirmed by Northern blot analysis and RT-PCR. RESULTS: A novel gene, Ventral prostate predominant1 (Vpp1) was identified. Vpp1 mRNA was evident in all lobes but accumulated predominantly in the ventral prostate, and was detected on postnatal day 7 through adulthood exclusively in the prostate gland. The steady-state level of Vpp1 mRNA decreased markedly in response to castration, suggesting androgen regulation of Vpp1 expression. Analysis of TRAMP tumors demonstrated a dramatic decrease in the level of Vpp1 mRNA. CONCLUSIONS: The spatial distribution and early postnatal onset of Vpp1 expression is consistent with a role for this gene in prostate regionalization. The absolute prostate specificity of Vpp1 expression may allow this gene to serve as a paradigm to study the molecular basis of gene expression that is restricted exclusively to the prostate gland.     

Nitroimidazoles in the canine prostate,vagina, and urethra

Diffusion of metronidazole and tinidazole in canine prostatic secretion was studied and compared to the diffusion of metronidazole into the canine vagina. This particular comparison was made because prostatic secretion represents an acidic environment in contrast to the canine vagina which has a basic pH. Metronidazole reached significantly higher concentrations in the prostatic secretion (PS) than in plasma (P). No differences were found in the concentrations of tinidazole in P and PS. Plasma and prostatic interstitial fluid (PIF) concentrations of both drugs showed no differences either. However, the PS/P and PIF/P ratios of metronidazole were significantly higher than the corresponding ratios of tinidazole. Metronidazole concentrations in the canine vagina and urethra were significantly lower than the plasma concentrations, possibly because of the basic pH environment. These findings suggest a possible advantage in using metronidazole over tinidazole in aerobic and Trichomonas vaginalis prostatitis and vaginitis in acidic environments. However, clinical studies comparing the two drugs should be carried out in order to establish if this is of clinical importance.     

聚集素在前列腺正常、增生、癌组织中的表达及意义

目的　通过检测聚集素 (Clusterin)在前列腺正常、增生、癌变组织中的表达 ,探讨其与前列腺疾病发生发展的关系。　方法　采用免疫组织化学染色法检测 12例正常前列腺组织、15例良性前列腺增生组织 (BPH)、5 6例前列腺癌标本中Clusterin的表达水平。　结果　 3种组织中Clusterin的阳性及弱阳性表达率为 81% (67/83 ) ,其中前列腺正常、增生、癌组织中阳性及弱阳性表达率分别为17% (2 /12 )、73 % (11/15 )、96% (5 4/5 6)。前列腺癌组织中Clusterin表达水平明显高于前列腺正常 (t=8 82 ,P <0 0 1)及增生 (t =7 63 ,P <0 0 1)组织 ,且在癌组织中与肿瘤病理分级 (r =0 64 9,P <0 0 1)、临床分期 (r=0 60 9,P <0 0 1)呈正相关。　结论　Clusterin可能通过抗凋亡机制在前列腺癌的生物特性中发挥着重要的作用     

Obesity, serum prostate specific antigen and prostate size: implications for prostate cancer detection

PURPOSE: Obesity has been associated with lower serum testosterone, theoretically resulting in decreased PSA production. Obesity has also been associated with prostatic enlargement, making the detection of existent cancer more difficult. Together these findings would result in an apparent protective effect of obesity on prostate cancer risk due to technical detection issues unrelated to cancer biology. We examined the association between BMI, and PSA and prostate weight in a cohort of men undergoing RP. MATERIALS AND METHODS: We evaluated the association of BMI with prostate weight and PSA using linear regression, adjusting for patient age at RP, year of RP, race, and pathological stage and grade in 1,414 men treated with RP between 1988 and 2004 at the 5 equal access medical centers that comprise the Shared Equal Access Regional Cancer Hospital Database. RESULTS: On multivariate analysis increasing BMI was associated with increasing prostate weight but only in men younger than 63 years and not in men 63 years or older (p-trend <0.001 and 0.44, respectively). In men younger than 63 years mean multivariate adjusted prostate weight +/- SE in those with a BMI of less than 25 vs 30 to 34.9 kg/m was 33.8 +/- 1.4 vs 41.4 +/- 1.6 gm. There was no significant association between BMI and preoperative PSA (p-trend = 0.70). CONCLUSIONS: In a cohort of men undergoing RP obesity was associated with larger prostate size but only in younger men. There was no association between BMI and PSA. Assuming equal PSA, the degree of prostatic enlargement observed in younger obese men in this study would be expected to result in a modest decrease in the odds of detecting prostate cancer in a contemporary series of PSA screened men due to the decreased sensitivity of cancer detection related to larger prostate size. Obesity may appear protective for prostate cancer in younger men due to technical issues unrelated to cancer biology.     

不同前列腺组织中雄激素受体的表达研究

目的:研究雄激素受体(AR)在正常前列腺、良性前列腺增生(BPH)和前列腺癌(PCa)组织中的表达,探讨AR与BPH和PCa的关系。方法:采用实时定量PCR、免疫荧光和组织蛋白电泳方法,分析15例正常前列腺、20例BPH与40例PCa标本中AR的表达情况。结果:实时定量PCR和组织蛋白电泳检测BPH组织与正常前列腺组织中AR的表达量差异无统计学意义(P>0.05)。但免疫荧光检测发现BPH组织中AR蛋白表达量增高。3种方法检测PCa组织中AR表达量较正常前列腺组织和BPH组织增高(P<0.05)。高分化PCa的AR表达比低分化PCa高(P<0.05)。随着临床分期的增高,AR的表达降低(P<0.05),激素非依赖性前列腺癌(HRPC)组织中AR表达最低。结论:AR在PCa组织中的表达较正常前列腺和BPH组织中增高,AR的表达与PCa的分级、分期相关。