CAJ | 학술논문

目的探讨应用前列腺特异抗原(PSA)筛查诊断前列腺癌的临床意义.方法对年龄≥50岁的8562例男性体检者进行PSA筛查,对血清PSA≥4.0 ng/ml者建议进行经直肠前列腺系统活检,活检病理确诊为前列腺癌的患者人选筛查组,记录其临床病理特点,并与同时期临床诊治的82例前列腺癌患者(临床组)进行比较.结果在8562例进行血清PSA筛查的男性中,有719例血清PSA水平≥4.0 ng/ml,其中295例接受经直肠前列腺系统活检,共检出前列腺癌58例,活检率和活检阳性率分别为41.0%和19.7%.虽然两组患者的年龄分布差异无统计学意义(P=0.176),但筛查组中有41.4%(24/58)的患者年龄＞75岁,明显高于临床组(25.6%,P=0.0491).筛查组中血清PSA水平≥20.0 ng/ml的患者所占的比例为44.8%,明显低于临床组(75.6%,P＜0.0001).筛查组中活检Gleason评分＜7分的患者所占的比例为60.3%,明显高于临床组(34.1%,P=0.0020).筛查组中临床分期为T1和T2期(局限期)患者所占的比例为87.9%,明显高于临床组(26.8%,P＜0.0001).筛查组中接受根治性前列腺切除术的患者所占的比例为50.0%,明显高于临床组(18.3%,P＜0.0001).在年龄≤75岁的患者中,筛查组患者诊断时的血清PSA水平、活检Gleason评分和临床分期均显著低于临床组(均P＜0.05);在年龄＞75岁的患者中,筛查组患者的临床分期也明显低于临床组(P=0.0002),但两组诊断时血清PSA水平和活检Gleason评分的差异并无统计学意义(均P＞0.05).结论应用血清PSA在我国50岁以上男性中进行前列腺筛查是有效的.筛查出的前列腺癌患者在血清PSA水平、活检Gleason评分、临床分期以及根治性切除的机会等方面均较临床组有明显优势.
목적 탐토응용전렬선특이항원(PSA)사사진단전렬선암적림상의의.방법 대년령≥50세적8562례남성체검자진행PSA사사,대혈청PSA≥4.0 ng/ml자건의진행경직장전렬선계통활검,활검병리학진위전렬선암적환자인선사사조,기록기림상병리특점,병여동시기림상진치적82례전렬선암환자(림상조)진행비교.결과 재8562례진행혈청PSA사사적남성중,유719례혈청PSA수평≥4.0 ng/ml,기중295례접수경직장전렬선계통활검,공검출전렬선암58례,활검솔화활검양성솔분별위41.0%화19.7%.수연량조환자적년령분포차이무통계학의의(P=0.176),단사사조중유41.4%(24/58)적환자년령＞75세,명현고우림상조(25.6%,P=0.0491).사사조중혈청PSA수평≥20.0 ng/ml적환자소점적비례위44.8%,명현저우림상조(75.6%,P＜0.0001).사사조중활검Gleason평분＜7분적환자소점적비례위60.3%,명현고우림상조(34.1%,P=0.0020).사사조중림상분기위T1화T2기(국한기)환자소점적비례위87.9%,명현고우림상조(26.8%,P＜0.0001).사사조중접수근치성전렬선절제술적환자소점적비례위50.0%,명현고우림상조(18.3%,P＜0.0001).재년령≤75세적환자중,사사조환자진단시적혈청PSA수평、활검Gleason평분화림상분기균현저저우림상조(균P＜0.05);재년령＞75세적환자중,사사조환자적림상분기야명현저우림상조(P=0.0002),단량조진단시혈청PSA수평화활검Gleason평분적차이병무통계학의의(균P＞0.05).결론 응용혈청PSA재아국50세이상남성중진행전렬선사사시유효적.사사출적전렬선암환자재혈청PSA수평、활검Gleason평분、림상분기이급근치성절제적궤회등방면균교림상조유명현우세.
Objective To evaluate the clinical significance of prostate-specific antigen(PSA)screening in early detection of prostate cancer in Chinese men.Methods PSA screening was performed in 8562 asymptomatic men who had been enrolled for health checkup and all were ≥50 years old.Prostate biopsy was recommended for those with a serum PSA level≥4.0 ng/ml.The pathological and clinical features of the patients with prostate cancer detected by the PSA screening were compared with that of 82 clinically diagnosed prostate cancer patients during the same period.Results Of the 8562 asymptomatic men,719 had PSA levels ≥4.0 ng/ml and biopsy was performed in 295 of them.Fifty-eight prostate cancers were detected.The biopsy rate was 41.0% and positive detection rate was 19.7%.The overall age distribution in the screening group and the clinical groups was not significantly different(P = 0.176).However,41.4%(24/58)of the patients in screening group were ＞75 years old,and significantly more than that in the clinical group(25.6%,P = 0.0491).The proportion of the patients with PSA levels ≥20 ng/ml in the screening group was significantly less than that in the patients of the clinical group(44.8% vs.75.6%,P = 0.0002).Whether in the patients whose age was ＞ 75 years old(P ＜ 0.05)or ≤75 years old (P = 0.0002),the patients in the screening group had significantly lower Gleason scores ＜ 7(60.3% vs.34.1%,P =0.002),more T1 or T2 tumor(87.9% vs.26.8%,P ＜0.0001)and more chance to receive radical prostatectomy(50.0% vs.18.3%,P ＜ 0.0001)than the patients in the clinical group did.However,the distributions of PSA levels at diagnosis and biopsy Gleason scores were not significantly different between the above mentioned two groups(P ＞ 0.05).Conclusion Prostate-specific antigen (PSA)screening is useful for early detection of prostate cancer in Chinese men aged ≥ 50 years.The patients detected by PSA screening usually show a lower PSA level,Gleason scores and early clinical stage disease,and have more chance for radical prostatectomy than the clinically diagnosed patients.