中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
2期
127-131
,共5页
刘俊%胡卫列%宋波%吕军%聂海波%王尉%赵永斌%张利朝%张小明%肖远松%沈文%张长征%郭飞%吴实坚%汪帮琦
劉俊%鬍衛列%宋波%呂軍%聶海波%王尉%趙永斌%張利朝%張小明%肖遠鬆%瀋文%張長徵%郭飛%吳實堅%汪幫琦
류준%호위렬%송파%려군%섭해파%왕위%조영빈%장리조%장소명%초원송%침문%장장정%곽비%오실견%왕방기
前列腺肿瘤%癌%前列腺特异抗原%前列腺活检%抗生素治疗
前列腺腫瘤%癌%前列腺特異抗原%前列腺活檢%抗生素治療
전렬선종류%암%전렬선특이항원%전렬선활검%항생소치료
Prostatic neoplasms%Carcinoma%Prostate specific antigen%Prostate biopsy%Antibiotic treatment
目的 探讨单纯PSA升高患者前列腺穿刺活检前行抗生素治疗能否剔除炎症所致PSA升高的影响.方法 100例PSA 4 ～ 10 μg/L、f/t PSA＜ 0.25,而直肠指检与经直肠前列腺B超检查无异常的患者,接受环丙沙星(500 mg/次,2次/d)口服3周.抗生素治疗前后分别进行PSA及相关参数的测定,100例均行经直肠前列腺系统12针穿刺活检.分析治疗前后PSA及相关参数的变化与活检结果的关系. 结果 抗生素治疗3周后,91例tPSA下降,治疗前后平均tPSA分别为(6.5±1.2)和(5.1±1.2) μg/L(P ＜0.01),平均下降20.9％.穿刺阳性与阴性患者分别为15例和85例,穿刺阳性患者抗生素治疗前、后的tPSA分别为(6.9±1.4)、(5.8±1.7) μg/L,PSA密度(PSAdensity,PSAD)分别为(0.18±0.09)、(0.15±0.09) mg/L2；穿刺阴性患者抗生素治疗前、后的tPSA分别为(6.4±1.1)、(5.0±1.1)μg/L,PSAD分别为(0.16±0.05)、(0.13±0.04)mg/L2,两组患者抗生素治疗后tPSA与PSAD均明显下降(P＜0.05),但两组间tPSA与PSAD变化值比较差异无统计学意义(P＞0.05).91例tPSA下降患者中13例(14.3％)穿刺阳性,9例tPSA升高或未变化患者中2例(22.2％)穿刺阳性(P＞0.05).17例tPSA降至＜4 μg/L,其中3例(17.6％)穿刺阳性.6例抗生素治疗后tPSA为4～ 10 μg/L,而f/tPSA＞0.25,其中1例穿刺阳性.7例tPSA下降幅度＞50％,其穿刺均为阴性. 结论 单纯PSA异常患者抗生素治疗可使tPSA下降,tPSA小幅下降或治疗后PSA相关参数降至正常范围并不意味着患前列腺癌风险的消失,而tPSA大幅度下降(＞50％)患者患前列腺癌的风险降低,可予严密观察,不进行或推迟进行前列腺穿刺活检.
目的 探討單純PSA升高患者前列腺穿刺活檢前行抗生素治療能否剔除炎癥所緻PSA升高的影響.方法 100例PSA 4 ～ 10 μg/L、f/t PSA＜ 0.25,而直腸指檢與經直腸前列腺B超檢查無異常的患者,接受環丙沙星(500 mg/次,2次/d)口服3週.抗生素治療前後分彆進行PSA及相關參數的測定,100例均行經直腸前列腺繫統12針穿刺活檢.分析治療前後PSA及相關參數的變化與活檢結果的關繫. 結果 抗生素治療3週後,91例tPSA下降,治療前後平均tPSA分彆為(6.5±1.2)和(5.1±1.2) μg/L(P ＜0.01),平均下降20.9％.穿刺暘性與陰性患者分彆為15例和85例,穿刺暘性患者抗生素治療前、後的tPSA分彆為(6.9±1.4)、(5.8±1.7) μg/L,PSA密度(PSAdensity,PSAD)分彆為(0.18±0.09)、(0.15±0.09) mg/L2；穿刺陰性患者抗生素治療前、後的tPSA分彆為(6.4±1.1)、(5.0±1.1)μg/L,PSAD分彆為(0.16±0.05)、(0.13±0.04)mg/L2,兩組患者抗生素治療後tPSA與PSAD均明顯下降(P＜0.05),但兩組間tPSA與PSAD變化值比較差異無統計學意義(P＞0.05).91例tPSA下降患者中13例(14.3％)穿刺暘性,9例tPSA升高或未變化患者中2例(22.2％)穿刺暘性(P＞0.05).17例tPSA降至＜4 μg/L,其中3例(17.6％)穿刺暘性.6例抗生素治療後tPSA為4～ 10 μg/L,而f/tPSA＞0.25,其中1例穿刺暘性.7例tPSA下降幅度＞50％,其穿刺均為陰性. 結論 單純PSA異常患者抗生素治療可使tPSA下降,tPSA小幅下降或治療後PSA相關參數降至正常範圍併不意味著患前列腺癌風險的消失,而tPSA大幅度下降(＞50％)患者患前列腺癌的風險降低,可予嚴密觀察,不進行或推遲進行前列腺穿刺活檢.
목적 탐토단순PSA승고환자전렬선천자활검전행항생소치료능부척제염증소치PSA승고적영향.방법 100례PSA 4 ～ 10 μg/L、f/t PSA＜ 0.25,이직장지검여경직장전렬선B초검사무이상적환자,접수배병사성(500 mg/차,2차/d)구복3주.항생소치료전후분별진행PSA급상관삼수적측정,100례균행경직장전렬선계통12침천자활검.분석치료전후PSA급상관삼수적변화여활검결과적관계. 결과 항생소치료3주후,91례tPSA하강,치료전후평균tPSA분별위(6.5±1.2)화(5.1±1.2) μg/L(P ＜0.01),평균하강20.9％.천자양성여음성환자분별위15례화85례,천자양성환자항생소치료전、후적tPSA분별위(6.9±1.4)、(5.8±1.7) μg/L,PSA밀도(PSAdensity,PSAD)분별위(0.18±0.09)、(0.15±0.09) mg/L2；천자음성환자항생소치료전、후적tPSA분별위(6.4±1.1)、(5.0±1.1)μg/L,PSAD분별위(0.16±0.05)、(0.13±0.04)mg/L2,량조환자항생소치료후tPSA여PSAD균명현하강(P＜0.05),단량조간tPSA여PSAD변화치비교차이무통계학의의(P＞0.05).91례tPSA하강환자중13례(14.3％)천자양성,9례tPSA승고혹미변화환자중2례(22.2％)천자양성(P＞0.05).17례tPSA강지＜4 μg/L,기중3례(17.6％)천자양성.6례항생소치료후tPSA위4～ 10 μg/L,이f/tPSA＞0.25,기중1례천자양성.7례tPSA하강폭도＞50％,기천자균위음성. 결론 단순PSA이상환자항생소치료가사tPSA하강,tPSA소폭하강혹치료후PSA상관삼수강지정상범위병불의미착환전렬선암풍험적소실,이tPSA대폭도하강(＞50％)환자환전렬선암적풍험강저,가여엄밀관찰,불진행혹추지진행전렬선천자활검.
Objective To analyze the effect of antibiotic treatment on prostate specific antigen (PSA) derivations in patients with and without prostate cancer and to further determine if the changes of PSA values after antibiotic treatment could help to exclude inflammation in the differential diagnosis of an abnormal PSA. Methods A total of 100 patients with lower urinary tract symptoms,a PSA level of 4 to 10 μg/L,free PSA/total PSA (fPSA/tPSA) ratio ＜ 0.25,and a negative digital rectal examination and transrectal ultrasonography were enrolled in this study.All patients received 500 mg of ciprofloxacin twice a day for 3 weeks.Free and total PSA values were measured before and after antibiotic treatment.All the patients were then scheduled for 12-core prostate biopsy. Results The mean tPSA value was (6.5 ± 1.2) and (5.1 ± 1.2) μg/L respectively before and after antibiotic treatment ( P ＜ 0.01 ).Ninety-one patients (91.0％) showed tPSA reduction after antibiotic therapy,of which 13 ( 14.3％ ) had prostate cancer on biopsy.In 17 cases (18.7％) post-treatment tPSA was less than 4 μg/L.Three of the 17 cases (17.6％)had prostate cancer on biopsy.In 6 of the 100 men post-treatment tPSA was between 4 and 10 μg/L and the fPSA/tPSA ratio was above 0.25.One of these cases had prostate cancer on biopsy.Seven cases had a ＞50％ reduction in PSA levels with no positive biopsy results.Although mean total PSA and PSAD decreased after treatment in both groups,the reductions within these parameters were not significantly different between patients with and without prostate cancer (P ＞ 0.05).Furthermore,no differences emerged in terms of the changes of other PSA derivations including fPSA and fPSA/tPSA ( P ＞ 0.05 ). Conclusions The PSA levels may change with long-term antibiotic treatment in patients with elevated PSA values.A decrease in PSA after antibiotic treatment does not rule out the presence of prostate cancer even if PSA decreases to a normal level.But a ＞ 50％ reduction in PSA levels may be associated with a decreasing risk of prostate cancer,which may allow a postponement of prostate biopsy in selected patients.
