前列腺特异性抗原的检测对前列腺癌及前列腺增生的诊断意义

目的　探讨血清总前列腺特异性抗原 (t PSA)、游离PSA (f PSA)、PSA密度 (PSAD )及其f PSA/t PSA比值对前列腺癌 (PCa)及前列腺增生 (BPH )的诊断价值。方法　采用酶联免疫分析方法 (ELISA )检测未经治疗的 62例BPH患者和 2 4例PCa患者血清f PSA、t PSA水平 ,并计算f PSA/t PSA值和PSAD ,对检测结果进行统计学处理。结果　BPH组与PCa组的f PSA、t PSA水平均明显高于对照组 (P <0 .0 1) ;前列腺癌组的f PSA /t PSA值明显小于对照组及前列腺癌增生组 (P <0 .0 1) ;PCa组PSAD明显大于对照组和BPH组 (P <0 .0 1)。结论　检测f PSA/t PSA和PSAD比单一检测f PSA、t PSA可显著提高对PCa诊断的特异性及符合率 ,对前列腺体积较大的BPH和PCa患者 ,检测PSAD更有意义     

尿液前列腺癌基因-3在前列腺癌诊断中的临床价值

[目的]探讨尿液中前列腺癌基因-3(prostate cell antigen 3,PCA3)对前列腺癌的诊断价值.[方法]收集119例前列腺癌(prostate cancer,PCa)患者和207例前列腺增生(benign prostatic hyperplasia,BPH)患者前列腺按摩后尿液,采用反转录聚合酶链反应技术,分析PCA3基因在PCa和BPH患者尿液中的表达情况,并与血中前列腺特异性抗原(prostate specific of antigen,PSA)进行应用价值的比较.[结果]尿PCA3 mRNA阳性104例,其中PCa100例、BPH 4例.尿PCA3 mRNA诊断PCa的敏感度、特异性、准确率、阳性预测值(PPV)、阴性预测值(NPV)、阳性似然比(+LR)、阴性似然比(-LR)分别为84.03％、98.07％、92.94％、96.15％、91.44％、43.49、0.16;血PSA诊断PCa的检出率为48.92％(113/231),明显低于尿PCA3 mRNA诊断PCa的检出率96.15％(100/104),差异有统计学意义(P＜0.01).此外,PSA位于灰色区域4～10ng/ml77例,病理结果显示PCa 8例,BPH 69例,PCa检出率10.39％;尿PCA3 mRNA阳性7例,其中PCa 6例、BPH 1例,PCa检出率85.71％;尿PCA3 mRNA诊断PCa的敏感度和特异性分别为75.00％和98.55％.[结论]与血PSA相比,尿PCA3 mRNA诊断PCa敏感度稍低,但具有很好的特异性和阳性预测值,对于首次活检阴性而尿PCA3 mRNA阳性的患者意义重大,提示可能需要重复穿刺活检.在PSA介于灰色区域4～10ng/ml时,穿刺结果阳性率较低(10.39％),尿PCA3 mRNA诊断PCa的特异性达98.55％,可协助判断是否需要穿刺活检.     

游离前列腺特异性抗原与总前列腺特异性抗原比值在前列腺癌鉴别诊断中的应用

 目的 探讨游离前列腺特异性抗原（fPSA）与总前列腺特异性抗原（tPSA）比值在前列腺癌（PCa）鉴别诊断中的意义。方法 采用电化学免疫发光技术对86例前列腺良性增生（BPH）45例PCa患者和60例健康男性体检者（正常对照组）血清fPSA和tPSA同时进行测定，并计算出fPSA／tPSA，进行统计分析。结果 BPH、PCa组tPSA水平明显高于正常对照组（P＜0.05）。PCa组和BPH组的血清tPSA差异亦有统计学意义，但当tPSA在4.0 ~ 10.0 μg／L范围时，PCa组血清fPSA／tPSA比值却明显低于BPH组（P＜0.01）。把fPSA／tPSA比值划分成8个区间，当fPSA／tPSA比值15 ％作为诊断灰区PCa诊断的临界值时，诊断的敏感性、特异性、阳性预测值、阴性预测值及正确诊断指数分别为72.8 %、67.5 %、62.5 %、82.2 %、50.2 %。结论 当血清tPSA处于诊断灰区时，联合检测fPSA／tPSA比值可明显提高tPSA对PCa早期诊断的特异性。     

前列腺癌与前列腺增生患者血清游离PSA和总PSA的改变

背景与目的:血清总前列腺特异性抗原(totalprostate-specificantigen,TPSA)被认为是目前诊断前列腺癌(carcinomaofprostate,PCa)的最佳肿瘤标记物,游离前列腺特异性抗原(freeprostatespecificantigen,FPSA)与TPSA的比值(FPSA/TPSA)可以提高其诊断PCa的特异性。本研究比较PCa与前列腺增生(benignprostatehyperplasia,BPH)患者血清TPSA及FPSA/TPSA比值水平,为临床诊断PCa提供参考。方法:用酶联免疫法检测66例BPH患者、29例BPH合并急性尿潴留(acuteurinaryretention,AUR)患者及22例PCa患者的血清TPSA、FPSA值,并对三组患者的血清TPSA及FPSA/TPSA的差异进行比较分析。结果:BPH患者血清TPSA(4.10±1.39)μg/L、BPH合并AUR患者血清TPSA(15.50±3.34)μg/L与PCa患者血清TPSA(55.00±13.50)μg/L之间均有显著性差异(P<0.05)。但三组患者血清TPSA在<4.0μg/L、4.0～10.0μg/L、>10.0μg/L区间存在重叠,BPH合并AUR患者与PCa患者重叠更为明显;BPH患者和BPH合并AUR者的FPSA/TPSA值无显著性差别(P>0.05),但与PCa患者比较均有显著性差异(P<0.05);三组患者FPSA/TPSA水平在<0.15、0.15～0.25、>0.25区间均存在重叠。结论:TPSA、FPSA/TPSA在BPH患者、BPH合并AUR患者和PCa患者中均存在重叠。血清TPSA、FPSA/TPSA水平临床上     

PSAT 在前列腺穿刺活检中的意义

目的:探讨前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义。方法:对120例患者行前列腺穿刺活检,其中PSA≥4ng/ml者105例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者15例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果:120例患者中经前列腺穿刺诊断为前列腺癌(PCa)63例,活检阳性率52.5,其中15例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,前列腺小细胞癌2例,腺癌4例,良性前列腺增生8例;42例>20ng/ml者中32例为PCa,活检阳性率76.2;63例PSA4-20ng/ml者中24例为PCa,活检阳性率38.1;29例PSA4-10ng/ml者中10例为PCa,活检阳性率34.5。血清PSA4-20ng/ml患者,PSAD≥0.13或PSAT≥0.15时,敏感性均为100,特异性为20.5或17.9,阳性预测值为43.6或42.9,可避免12.7(8/63)或11.1(7/63)阴性穿刺结果。血清PSA4-20ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为11.18±4.49和10.05±4.29ng/ml(P=0.318);PSAD分别为0.45±0.33和0.26±0.15(P=0.003);PSAT分别为0.94±0.65和0.43±0.24(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.576、0.676和0.77,PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P<0.05)。结论:PSA4-20ng/ml时,PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

f/T-PSA比值和PSA密度对TPSA灰区前列腺癌的诊断意义

目的探讨游离前列腺特异抗原/总前列腺特异抗原(fPSA/TPSA,f/T)比值和TPSA灰区前列腺特异抗原密度(PSAD)(4.0~10.0ng/m l)对诊断前列腺癌的临床意义。方法回顾性分析TPSA在灰区的38例前列腺癌和56例良性前列腺增生症血清PSA相关检测结果,将两组患者f/T比值和PSAD值进行对比分析。结果两组患者TPSA值无显著性差异(P=0.337);f/T比值(P=0.001)和PSAD值(P=0.012)有显著性差异。f/T比值在前列腺癌患者中较低,而PSAD值较高。当f/T比值和PSAD分别以0.15和0.16作为临界值时,其诊断前列腺癌的灵敏度和特异度分别为81.6%和75.0%、65.8%和57.1%。结论f/T比值和PSAD对TPSA灰区的前列腺癌的诊断有重要的临床意义。     

联合检测TPSA、FPSA、FPSA/TPSA对前列腺癌的诊断价值

目的探讨血清中总前列腺特异性抗原(TPSA)、游离前列腺特导性抗原(FPSA)及FPSA/TPSA比值在前列腺疾病诊断中的价值。方法采用全自动电化学发光分析技术,检测45例健康男性,40例前列腺增生(BPH)患者和32例前列腺癌(PCa)患者血清中的TPSA和FPSA含量,计算FPSA/TPSA比值,并进行统计学分析。结果 BPH组及PCa组的TPSA和FPSA值均显著高于正常对照组,而PCa组FPSA/TPSA比值显著低于正常对照组和BPH组。当TPSA值在4.1~60.0 ng/mL时,BPH和PCa出现交叉重叠现象,单靠TPSA一项指标难以提高PCa诊断率。BPH组的FPSA/TPSA很少0.11,PCa组的FPSA/TPSA很少0.20。由此,FPSA/TPSA比值的测定可用于BPH和PCa的鉴别诊断。结论联合检测血清中TPSA、FPSA的含量及FPSA/TPSA比值,可大大提高PCa的诊断率,对PCa早期诊断及鉴别诊断有重要意义。     

游离PSA与总PSA比值在临床诊断中的意义

 前列腺特异性抗原检测是目前公认的前列腺癌 (Pca)鉴别、评估的重要指标。我们将Pca、前列腺增生 (BPH)患者的血清进行总前列腺特异性抗原 (T PSA)和游离前列腺特异性抗原 (F PSA)测定 ,并计算F/T比值 ,从中筛选前列腺癌。现将结果报道如下：     

血清PSA联合PSAD检测对前列腺癌的诊断价值

目的:探讨血清前列腺特异抗原（PSA）、前列腺特异抗原密度（PSAD）对前列腺癌的诊断价值。方法:检测经病理确诊的57例前列腺癌、125例前列腺增生患者的血清PSA。经直肠超声测定其前列腺的体积（PV）并计算PSAD。结果:前列腺癌组患者的PSA、PSAD明显高于前列腺增生组(P<0.05)。PSA值在4.1-10.0,10.1-20.0,>20.0ng/ml区间时PCa诊断率分别为8.8%,36.8%,54.4%。前列腺癌组的ROC曲线图中PSAD的AUC值（0.682）高于PSA的AUC值（0.601）,当取PSAD≥0.18ng/（ml·cm3）时,敏感性为84.5%,特异性为78.6%。比较58例重复穿刺患者的PSA、PSAD,只有PSAD差异有统计学意义(P<0.05)。结论:PSA动态监测结合PSAD是重复穿刺的重要参考指标,PSAD是PSA对前列腺癌诊断的有益补充。     

血清PSA、PSAD、ALP联合检测对前列腺癌骨转移的临床诊断价值

目的 探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)、碱性磷酸酶(ALP)联合检测对前列腺癌(PCa)骨转移的诊断价值.方法 回顾性分析98例PCa患者的临床资料,根据是否发生骨转移分为骨转移组(n=56)和非骨转移组(n=42).检测患者的血清PSA、PSAD、ALP水平,分析3项指标单独及联合检测对PCa骨转移的诊断价值.结果 98例PCa患者中,56例患者发生骨转移,骨转移率为57.1％.骨转移组患者的PSA和PSAD值均高于非骨转移组,差异均有统计学意义(P<0.05).ALP+PSA+PSAD联合诊断PCa骨转移的灵敏度(98.34％)、阳性预测值(90.53％)、阴性预测值(92.33％)及约登指数(73.84)均高于PSA、PSAD、ALP单独诊断的结果.结论 血清PSA、PSAD、ALP联合检测对于PCa骨转移具有较高的诊断价值,值得临床推广应用.     

Cumulative Probability of Prostate Cancer Detection Using the International Prostate Symptom Score in a Prostate-specific Antigen-based Population Screening Program in Japan

The International Prostate Symptom Score (IPSS) is often used as an interview sheet for assessing lower urinary tract symptoms (LUTS) at the time of prostate-specific antigen (PSA) testing during population-based screening for prostate cancer. However, the relationship between prostate cancer detection and LUTS status remains controversial. To elucidate this relationship, the cumulative probability of prostate cancer detection using IPSS in biopsy samples from patients categorized by serum PSA levels was investigated. The clinical characteristics of prostate cancer detected using IPSS during screening were also investigated. A total of 1,739 men aged 54-75 years with elevated serum PSA levels who completed the IPSS questionnaire during the initial population screening in Kanazawa City, Japan and underwent systematic transrectal ultrasonography-guided prostate biopsy between 2000 and 2013 were enrolled in the present study. Of the 1,739 men, 544 (31.3%) were diagnosed with prostate cancer during the observation period. The probability of cancer detection at 3 years in the entire study population was 27.4% and 32.7% for men with IPSS≤7 and those with IPSS≥8, respectively; there was no statistically significant difference between groups. In men with serum PSA levels of 6.1 to 12.0ng/mL at initial screening, the probability of cancer detection was significantly higher in men with IPSS≤7 than in those with IPSS≥8. There were no significant differences in clinical characteristics between groups of patients stratified by IPSS. These findings indicate that the use of IPSS for LUTS status evaluation may be useful for prostate cancer detection in the limited range of serum PSA levels.     

Do the risk factors of age,family history of prostate cancer or a higher prostate specific antigen level raise anxiety at prostate biopsy?

To date, little is known of the impact knowledge of personal risk factors has on anxiety in men undergoing biopsy tests for prostate cancer. This analysis explores anxiety scores of men at higher risk due to age, family history of prostate cancer and a higher prostate specific antigen (PSA) level when proceeding from PSA test to prostate biopsy. A prospective cohort of 4198 men aged 50–69 years with a PSA result of >3 ng/ml was studied, recruited for the Prostate testing for cancer and Treatment study (ProtecT). Anxiety scores at the time of biopsy were lower in older men (p < 0.001). No age group showed an increase in anxiety as the men proceeded from PSA testing to biopsy, although older men did not show the same level of decrease in anxiety as younger men (p = 0.035). There was no difference in anxiety scores at biopsy between men with or without a family history of prostate cancer (p = 0.68), or between those with a raised PSA of 10–<20 ng/ml compared to a PSA result of 3–<10 ng/ml (p = 0.46). Change in scores since the initial PSA test appeared unaffected by family history (p = 0.995) or by PSA result (p = 0.76). Within the context of a research study, the increased risk of prostate cancer through older age, having a family history of prostate cancer, or having a significantly elevated PSA level appears to have no detrimental effect on men’s anxiety level when proceeding to biopsy.     

Head to Head Comparison of the Chun Nomogram,Percentage Free PSA and Primary Circulating Prostate Cells to Predict the Presence of Prostate Cancer at Repeat Biopsy

Background: The limitations of total serum PSA values remain problematic, especially after an initial negative prostate biopsy. In this prospective study of Chilean men with a continued suspicion of prostate cancer due to a persistently elevated total serum PSA, abnormal digital rectal examination and initial negative prostate biopsy were compared with the use of the on-line Chun nomagram, detection of primary malignant circulating prostate cells (CPCs) and free percent PSA to predict a positive second prostate biopsy. We hypothesized that men negative for circulating prostate cells have a small risk of clinically significant prostate cancer and thus may be conservatively observed. Men positive for circulating prostate cells should undergo biopsy to confirm prostate cancer. Materials and Methods: Consecutive men with a continued suspicion of prostate cancer underwent 12 core TRUS prostate biopsy; age, total serum PSA and percentage free PSA and Chun nomagram scores were registered. Immediately before biopsy an 8ml blood simple was taken to detect primary mCPCs. Mononuclear cells were obtained by differential gel centrifugation and identified using double immunostaining with anti-PSA and anti-P504S. Biopsies were classifed as cancer/no-cancer, mCPC detecton test as negative/positive and the total number of cells/8ml registered. Areas under the curve (AUC) for percentage free PSA, Chun score and CPCs were calculated and compared. Diagnostic yields were calculated with reference to the number of possible biopsies that could be avoided and the number of clinically significant cancers that would be missed. Results: A total of 164 men underwent a second biopsy; 41 (25%) had cancer; the AUCs were 0.65 for free PSA, 0.76 for the Chun score and 0.87 for CPC detection, the last having a significantly superior prediction value (p=0.01). Using cut off values of free PSA <10%, Chun score >50% and ≥1 CPC detected, CPC detection had a higher diagnostic yield. Some 4/41 cancers complied with the criteria for active surveillance, free PSA and the Chun score missed a higher number of significant cancers when compared with CPC detection. Conclusions: Primary CPC detection outperformed the use of free PSA and the Chun nomagram in predicting clinically significant prostate cancer at repeat prostate biopsy.     

Comparison of the Formula of PSA,Age, Prostate Volume and Race Versus PSA Density and the Detection of Primary Malignant Circulating Prostate Cells in Predicting a Positive Initial Prostate Biopsy in Chilean Men with Suspicion of Prostate Cancer

Background: Combining risk factors for prostate cancer into a predictive tool may improve the detection ofprostate cancer while decreasing the number of benign biopsies. We compare one such tool, age multiplied byprostate volume divided by total serum PSA (PSA-AV) with PSA density and detection of primary malignantcirculating prostate cells (CPCs) in a Chilean prostate cancer screening program. The objectives were not only todetermine the predictive values of each, but to determine the number of clinically significant cancers that wouldhave been detected or missed. Materials and Methods: A prospective study was conducted of all men undergoing12 core ultrasound guided prostate biopsy for suspicion of cancer attending the Hospital DIPRECA and Hospitalde Carabineros de Chile. Total serum PSA was registered, prostate volumecalculated at the moment of biopsy,and an 8ml blood simple taken immediately before the biopsy procedure. Mononuclear cells were obtained fromthe blood simple using differential gel centrifugation and CPCs identified using immunocytchemistry with anti-PSA and anti-P504S. Biopsy results were classed as positive or negative for cancer and if positive the Gleasonscore, number of positive cores and percent infiltration recorded. Results: A total of 664 men participated, ofwhom 234 (35.2%) had cancer detected. They were older, had higher mean PSA, PSA density and lower PSA-AV.Detection of CPCs had high predictive score, sensitivity, sensibility and positive and negative predictive values,PSA-AV was not significantly different from PSA density in this population. The use of CPC detection avoidedmore biopsies and missed fewer significant cancers.Conclusions: In this screening population the use of CPCdetection predicted the presence of clinically significant prostate cancer better than the other parameters. Thehigh negative predictive value would allow men CPC negative to avoid biopsy but remain in follow up. Theformula PSA-AV did not add to the predictive performance using PSA density.     

Hyperinsulinaemia: a prospective risk factor for lethal clinical prostate cancer

Previous studies have suggested that hyperinsulinaemia and other components of metabolic syndrome are risk factors for clinical prostate cancer. This prospective study tested the hypothesis that hyperinsulinaemia and other components of metabolic syndrome are risk factors for lethal clinical prostate cancer. The clinical, haemodynamic, anthropometric, metabolic and insulin profile at baseline in men who had died from clinical prostate cancer during follow-up was compared with the profile of men who were still alive at follow-up. If the hypothesis is true, men with an unfavourable prognosis would have a higher profile at baseline than those with a favourable prognosis. A total of 320 patients in whom clinical prostate cancer, stages T2–3, had been diagnosed were consecutively included in the study during 1995–2003. Height, body weight, waist measurement, hip measurement and blood pressure were determined. Body mass index and waist/hip ratio (WHR) were calculated. Blood samples were collected to determine triglycerides, total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, uric acid, alanine aminotransferase and fasting plasma insulin level. The prostate gland volume was measured using transrectal ultrasound. The annual benign prostatic hyperplasia (BPH) growth rate was calculated. The diagnosis of prostate cancer was established using transrectal ultrasound-guided automatic needle biopsy of the prostate gland. All patients with clinical prostate cancer were followed up until their death or until the study was terminated on 31 December 2003. At follow-up, 54 patients had died from prostate cancer and 219 were still alive. The results showed that the men who died of clinical prostate cancer during the follow-up period were older (P < 0.001), had a larger prostate gland volume (P < 0.001), a faster BPH growth rate (P < 0.001), a higher prevalence of type 2 diabetes (P < 0.035) and treated hypertension (P < 0.023), a higher stage (P < 0.001) and grade (P = 0.028) of clinical prostate cancer, a higher prostate-specific antigen (PSA) level (P < 0.001) and a higher PSA density (P < 0.001) at baseline than men still alive with clinical prostate cancer at follow-up. These men also had a lower HDL-cholesterol level (P = 0.027), a higher fasting plasma insulin level (P = 0.004), a higher WHR (P = 0.097) of borderline significance and a higher uric acid level (P = 0.079) of borderline significance. Eliminating the effect on mortality of higher stage and grade of the clinical prostate cancer and PSA at baseline, the following statistically significant correlations remained: a higher fasting plasma insulin level (P = 0.010) and a lower HDL-cholesterol level of borderline significance (P = 0.065). In conclusion, hyperinsulinaemia and five other previously established components of metabolic syndrome are shown to be prospective risk factors for deaths that can be ascribed to prostate cancer. These findings confirm previous study, which indicate that prostate cancer is a component of metabolic syndrome. Moreover, these data indicate that hyperinsulinaemia and other metabolic disorders precede deaths caused by prostate cancer. Thus, our data support the hypothesis that hyperinsulinaemia is a promoter of clinical prostate cancer. Furthermore, our data suggest that the insulin level could be used as a marker of prostate cancer prognosis and tumour aggressiveness, regardless of the patient’s prostate cancer stage, cancer grade and PSA level.     

Extended use of P504S Positive Primary Circulating Prostate Cell Detection to Determine the Need for Initial Prostate Biopsy in a Prostate Cancer Screening Program in Chile

Background: To determine the frequency of primary circulating prostate cells (CPC) detection accordingto age and serum PSA levels in a cohort of men undergoing screening for prostate cancer and to determinethe diagnostic yield in those men complying with the criteria for prostate biopsy. Materials and Methods: Aprospective study was carried out to analyze all men evaluated in a hospital prostate cancer screening program.Primary CPCs were obtained by differential gel centrifugation and detected using standard immunocytochemistryusing anti-PSA, positive samples undergoing a second process with anti-P504S. A malignant primary CPC wasdefined as PSA+ P504S+, and a test positive if 1 cell/4ml was detected. The frequency of primary CPC detectionwas compared with age and serum PSA levels. Men with a PSA >4.0ng/ml and/or abnormal rectal examinationunderwent 12 core prostate biopsy, and the results were registered as cancer/no-cancer and compared with thepresence/absence of primary CPCs to calculate the diagnostic yield. Results: A total of 1,117 men participated;there was an association of primary CPC detection with increasing age and increasing serum PSA. Some 559 menunderwent initial prostate biopsy of whom 207/559 (37.0%) were positive for primary CPCs and 183/559 (32.0%)had prostate cancer detected. The diagnostic yield of primary CPCs had a sensitivity of 88.5%, a specificity of88.0%, and positive and negative predictive values of 78.3% and 94.9%, respectively. Conclusions: The use ofprimary CPCs for testing is recommended, since its high negative predictive value could be used to avoid prostatebiopsy in men with an elevated PSA and/or abnormal DRE. Men positive for primary CPCs should undergoprostate biopsy. It is a test that could be implemented in the routine immunocytochemical laboratory.     

Predictive Value of Neutrophil to Lymphocyte Ratio in the Diagnosis of Significant Prostate Cancer at Initial Biopsy: A Comparison with Free Percent Prostate Specific Antigen,Prostate Specific Antigen Density and Primary Circulating Prostate Cells

Introduction: An elevated serum PSA is the only biomarker routinely used in screening for prostate cancer to indicate a prostate biopsy. However, it is not specific for prostate cancer and the neutrophil/lymphocyte ratio has been suggested as an alternative. We present a prospective study of men with an elevated PSA and compare the neutrophil/lymphocyte ratio, free percent PSA, PSA density and the presence of circulating prostate cells to detect clinically significant prostate cancer at first biopsy. Patients and Methods: Prospective study of consecutive men with a PSA 4-10 ng/ml referred for initial prostate biopsy, the results were compared with the neutrophil/lymphocyte ratio, free percent PSA and PSA density. Circulating prostate cells (CPCs) were detected using immunocytochemistry. The blood sample was taken immediately before the prostate biopsy. Results: 1,223 men participated, 38% (467) of whom had prostate cancer detected, of these 322 were clinically significant. The area under the curves were for neutrophil/lymphocyte ratio, free percent PSA, PSA density and CPC detection were 0.570, 0.785, 0,620 and 0.844 respectively. Sensitivity/specificity were 0.388/0.685, 0.419/0.897, 0.598/0.624 and 0.966/0.786 respectively. The neutrophil/lymphocyte ratio did not differentiate between benign and malignant disease. Conclusions: The neutrophil/lymphocyte ratio did not discriminate between benign and malignant prostatic disease in patients with a PSA between 4-10ng/ml.     

Baseline prostate-specific antigen measurements and subsequent prostate cancer risk in the Danish Diet,Cancer and Health cohort

AimAlthough prostate-specific antigen (PSA) screening reduces mortality from prostate cancer, substantial over-diagnosis and subsequent overtreatment are concerns. Early screening of men for PSA may serve to stratify the male population by risk of future clinical prostate cancer.Methods and materialCase–control study nested within the Danish ‘Diet, Cancer and Health’ cohort of 27,179 men aged 50–64 at enrolment. PSA measured in serum collected at cohort entry in 1993–1997 was used to evaluate prostate cancer risk diagnosed up to 14 years after. We identified 911 prostate cancer cases in the Danish Cancer Registry through 31st December 2007 1:1 age-matched with cancer-free controls. Aggressive cancer was defined as ?T3 or Gleason score ?7 or N1 or M1. Statistical analyses were based on conditional logistic regression with age as underlying time axis.ResultsTotal PSA and free-to-total PSA ratio at baseline were strongly associated with prostate cancer risk up to 14 years later. PSA was grouped in quintiles and free-to-total PSA ratio divided in three risk groups. The incidence rate ratio for prostate cancer was 150 (95% confidence interval, 72–310) among men with a total PSA in the highest quintile (>5.1 ng/ml) compared to the lowest (<0.80 ng/ml). The risk of aggressive cancer was highly elevated in men with a PSA level in the highest quintile. The results indicate that one-time measurement of PSA could be used in an individualised screening strategy, sparing a large proportion of men from further PSA-based screening.     

Value of free-to-total prostate-specific antigen ratio for detection and staging of prostate cancer

Background. We aimed to evaluate the clinical usefulness of measurement of the free-to-total (F/T) ratio of prostate-specific antigen (PSA) for the differentiation of prostate cancer from benign prostate hyperplasia (BPH) and for the staging of prostate cancer. Values for PSA density (PSAD) and PSAD adjusted to the transition zone volume (PSAD-T) were also evaluated in patients with mildly elevated PSA levels (4.1–10 ng/ml). Methods. Total and free PSA and the F/T ratio were determined in 80 men with prostate cancer and 48 men BPH before treatment. PSA levels were measured with a chemiluminescent enzyme immunoassay. Results. Patients with prostate cancer had a significantly lower F/T ratio than those with BPH. A cut-off value of 14% for the F/T ratio provided a positive predictive value of 81.6% and a negative predictive value of 65.4%. The F/T ratio did not differ between patients with clinically localized and metastatic prostate cancer. In patients with a PSA value of 4.1–10 ng/ml, a cut-off value of 14% for the F/T ratio provided a sensitivity of 66.7% and a specificity of 76.2%. Sixty percent of the missed cancer in patients with an F/T value of 14% or more could be rescued using the PSAD value. Conclusion. Measurement of the F/T PSA ratio has good sensitivity and specificity in distinguishing prostate cancer from BPH, especially in patients with a PSA level of 4.1–10 ng/ml. However, compared with serum PSA level, the F/T PSA ratio is not valuable for the clinical staging of prostate cancer. Received: June 23, 1999 / Accepted: September 22, 1999