【作者】 薛学义；

【导师】 曹林升；

【作者基本信息】 福建医科大学 ， 外科学， 2008， 硕士

【摘要】 目的:了解福州市区老年男性前列腺疾病的发病情况及与前列腺特异性抗原(PSA)、前列腺体积(PV)的关系,以探讨在福州市区PSA在前列腺癌诊断中的价值,确定在福州市区PSA具体的参考值。方法:根据病例入选标准,从2006年12月至2007年12月,我们对福州市区1234名老年男性进行直肠指检(DRE)和血PSA测定,然后对其中PSA＞4.0ng/ml者进行了随访复查,检查项目包括PSA和经直肠前列腺超声检查,并行经直肠前列腺穿刺活检。对穿刺结果中前列腺癌患者和前列腺增生患者PSA、PV值的比较,并对不同PSA值中前列腺癌患者和前列腺增生患者的例数进行了比较。结果:符合纳入标准共收集1234例资料,排除62例,其中PSA＞4.0ng/ml者146例(11.83%),共有126例得到随访,并接受了经直肠超声引导下“10点法”前列腺穿刺活检,其中101例被病理检查证实为前列腺增生,25例被证实为前列腺癌。我们发现,随着年龄的增长PSA明显增大,50～59岁为5.5±4.1 ng/ml、60～69岁为6.8±8.2 ng/ml、70～79岁为8.6±15.2 ng/ml,但是到了70岁以后PSA变化不是很大;101例前列腺增生患者中,PSA测定值为(8.4±14.2)ng/ml,而25例前列腺癌患者中,PSA测定值明显增高,为(29.3±17.5)ng/ml,两组相比PSA差别有统计学意义(t=6.2810,P＜0.05);101例前列腺增生患者中,所测PV值为(32.61±16.19)ml,而25例前列腺癌患者所测PV值为(36.13±12.73)ml,二者大小相比变化不大,无明显统计学意义(P＞0.05)。比较不同PSA浓度与前列腺癌发生率的关系,PSA＞10ng/ml时其前列腺癌的发生率显著高于4ng/ml＜PSA＜10ng/ml组。结论:在福州市区,前列腺特异性抗原是诊断前列腺癌的重要瘤标,前列腺“10点法”穿刺活检是诊断前列腺癌有效方法。对PSA＜4.0ng/ml的患者应密切随访复查,并建议行经直肠前列腺穿刺活检。对PSA高于10ng/ml时应高度警惕前列腺癌的发生。更多还原

【Abstract】 Purpose: To study the value of prostate-specific antigen(PSA) for the diagnosis of prostate cancer(Pca) in aged men in FuZhou area by investigating the relationship among the aged men with disease of prostate, PSA and prostate volume(PV).Methods: From December of 2006 to December of 2007, Digital rectal examination(DRE) and PSA measure were performed in 1234 men( over 50 years) in FuZhou area , and further examinations including transrectal ultrasound(TRUS), PV and prostate biophy were performed in the patients with PSA>4 ng/ml. PSA and PV between the group of Benign prostate hyperplasia (BPH) and Pca were compared, and PSA level in different patients was also compared.Results: We investigated 1234 old men in all, and 146 men with PSA level over 4 ng/ml were found. 126 men in these 146 cases were followed up, and were accepted "10 spot" prostate biopsy through TRUS. BPH was diagnosed in 101 men and PCa was diagnosed in 25 men by prostate biopsy. We found that the concentration of PSA was higher following the age increasing, PSA in 50-59 year group is 5.5±4.1 ng/ml, 60-69 is 6.8±8.2 ng/ml, 70-79 is 8.6±15.2 ng/ml, but after 70 it has only a little change. There was no relationship between patient age and PSA(P>0.05), but the prostate volume had a significant correlation with age(P<0.05) . PSA levels had significant difference between the groups of BPH and PCa (resepectily 8.4±14.2ng/ml and 29.3±17.5 ng/ml ) ( t= 6.2810,P<0.05 ) ,but prostate volums(resepectily 32.61±16.19ml and 36.13±12.73ml) had no significant difference (P>0.05) . Pca incidence in PSA>10ng/ml group was higher than in PSA>4.0ng/ml (P<0.05) .Conclusions: In FuZhou area, PSA was an important tumor marker for prostate cancer. "10 spot" prostate biopsy was an effective method in the diagnosis of prostate cancer. The patients of PSA over 4.0ng/ml should be followed-up closely. For them, prostate biopsy was recommended. When the concentration of PSA is more than 10ng/ml, we should be on guard against prostate carcinogenesis.更多还原