Dergiler / Üroloji Bülteni / 1999 / Cilt: 10 - Sayı: 3
Prostat spesifik antijen (PSA) düzeyi 4 ile 20 ng/ml arasında olan hastalarda serbest/total PSA oranı ile biyopsi sonuçları arasındaki ilişki
- Dergi
- Üroloji Bülteni
- Sayfa
- 151–154
- DOI
- —
Özet
Benign prostat hiperplazisi ve prostat kanseri aynmmda serbest/total prostat spesifik antijen (PSA) oranihin etkinliginin ara§tirilmasi.\/-/asfa/ar\/e Yontem: Ya§lan 55 ile 85 yil arasmda degi§en (ortalama, 66.1 ±5.9 yil) ve PSA degerleri 4 ile 20 hg/ml arasmda olan 53 hasta calismaya alindi. Her hastadan transrektal ultrason esliginde 6 kadran prostat biyopsisi alindi. Hastalar biyopsi sonuclarma gore benign prostat hiperplazisi (BPH) ve prostat kanseri (PCa) olarak iki gruba ayrildi. BPHve PCa plan hastalarda yas, prostat volumu, total PSA dGzeyi, serbest PSA duzeyi ve serbest/total (s/t) PSA orani karsilastmldi. Bulgular: Biyopsi sonuclarma gore 36 (% 67.9) hastada BPH, 17 (% 32.1) hastada PCa saptandi. Total PSA degeri 4 ile 2'Q, ng/ml arasmda olan gruptaki BPH ve PCa hastalannda t-PSA (p= 0.0122), s-PSA (p= 0.0372) ve s/t PSA orarii (p= 0,000) arasmdaki fark istatistiksel olarak anlamli iken, t-PSA degeri 4 ile 10 ng/ml arasmda olan grupta yalnizca s-PSA (p= 0.0028) ve s/t PSA orani (p= 0.0002) farkli idi. PSA duzeyi 4-20 ng/ml olan grupta s/t PSA orani < 20 olarak almdigida PCa icin duyarlilik % 100, ozgulluk % 50 ve pozitif belirleyicilik-degeri % 48.6 olarak saptandi. Serbest/total PSA orani < 0.15 olarak alindigmda ise PCa icin duyarlilik % 70.8, ozgulluk % 91.6 ve pozitif belirleyicilik degeri % 70 olarak bulundu. Total PSA degeri 4-10 ng/ml olan 45 hastada ise, s/t PSA orani < 0.20 olarak alindigmda PCa icin duyarlilik % 100, ozgulluk % 48.4 ve pozitif belirleyicilik degeri % 41.4 olarak belirlendi. s/t PSA orani <0.15 olarak alindigmda ise kasilik gelen degerler, sirasiyla % 58.3, % 90.1 ve % 70 olarak bulundu. Sonug: Total PSA degerinin 10 ng/ml'nin uzerinde bulunmasi PCa olasiligmi arttirmaktadir. Buna karsin t-PSA degeri 10 ng/ml'nin altinda olan hastalarda s-PSA ve s/t PSA orani gibi ek parametreler gereklidir. Serbest/t PSA orani <20 olarak alindigmda turn kanser olgulan yakalanirken % 50 hastaya biyopsi yapma geregi ortadan kalkmaktadir. Ancak, henuz BPH ve PCa aymmda kesin bir s/t PSA orani vermek mumkun degildir. Daha genis hasta gruplarmi iceren cali§malara gerek vardir.
Abstract
Relationship Between Free/Total PSA Ratio And Prostate Biopsy Results In Patients With PSA Levels Between 4 And 20 nglml- Objective: To investigate the efficacy of free/total PSA ratio in discrimination of benign prostatic hyperplasia and prostate 'cancer. Patients and Methods: A total of 53 patients, 55 to 85 years of age (mean, 66.1+5.9 years) with PSA levels between 4 and 20 ng/ml toere included into the study. Each patient underwent sextant prostate biopsy under transrectal ultrasound guidance. The patients were divided into two groups as benign prostatic hyperplasia (BPH) and prostate cancer (PCa) according to the biopsy findings. The groups were then compared with respect to age, prostate volume, total PSA level, free PSA level and free/total (f/t) PSA ratio. Results: Biopsies revealed BPH in 36 patients (67.9 %) and prostate cancer in 17 (32.1 %). For patients with PSA levels between 4 and 20 ng/ml, t-PSA (p= 0.0122), f-PS A (p= 0.0372) and f/t PSA ratios (p= 0.000) were significantly different in BPH and PCa patients, whereas the differences were noted in only f-PS A (p= 0.0028) and f/t PSA ratio (p= 0.0002) in patients with PSA levels between 4 and 10 ng/ml. In patients with 4-20 ng/ml total PSA levels and a cutoff level oj"< 0.20 for f/t PSA ratio, the sensitivity, specificity and positive predictive value for PCa were 100 %, 50 % and 48.6 %, respectively .When the cutoff level was considered as £ 0.15, the corresponding values were noted as 70.8 %, 91.6 % and 70 %, respectively. For 45 patients with PSA levels between 4 and 10 ng/ml, the sensitivity, specificity and positive predictive value of f/t PSA ratio for the diagnosis of prostate cancer were 100 %, 48.4 % and 41.4 %, respectively, with a cutoff level o/< 0.20; and 58.3 %, 90.1 % and 70 %, respectively with a cutoff level o/< 0.15. Conclusion: Although greater than 10 ng/ml PSA levels are highly suggestive of prostate cancer, additional parameters such as f-PS A or f/t PSA, are necessary for patients with abnormal but beloxo 10 ng/ml PSA levels. With a cutoff level of < 20 for f/t PSA, all patients with cancer can be identified and yet 50 % are spared of biopsy. However, it is not possible to give a definite f/t PSA ratio for the differentiation of BPH and PCa and the issue deserves further studies on larger groups of patients.