Serbest/total PSA oranı ve PSA dansitesinin prostat kanserini öngörmedeki etkinlikleri

Year 2013, Volume: 8 Issue: 3, 49 - 55, 01.08.2013

Binhan Kağan Aktaş Süleyman Bulut Mehmet Zeynel Keskin Cevdet Serkan Gökkaya Cüneyt Özden Mehmet Murat Baykam Ali Memiş

Abstract

Giriş: Serbest/total s/t prostat spesifik antijen PSA oranı ve PSA dansitesinin PSAD tek tek ve kombine olarak prostat kanserini öngörmedeki etkinliklerinin araştırılması. Gereç ve Yöntemler: Çalışmamıza PSA değeri 2.5-10 ng/ml iken transrektal ultrasonografi eşliğinde prostat biyopsisi alınan, parmakla rektal muayene bulguları normal ve PSA düzeyini etkileyecek herhangi bir girişim, aktif enfeksiyon veya ilaç kullanım öyküsü olmayan 439 hasta dahil edildi. Tüm hastaların biyopsi öncesi total PSA, serbest PSA, yaş, prostat hacmi değerleri ve biyopsi sonrası patoloji raporları tarandı. Serbest PSA’nın sPSA total PSA’ya tPSA bölünmesiyle s/t PSA oranı ve tPSA’nın prostat hacmine bölünmesiyle PSAD elde edildi. Sınır değerler s/t PSA oranı için %20, PSAD için %15 olarak alındı. Hastalar patoloji sonucuna göre BPH ve prostat kanseri olarak iki gruba ayrıldı. Bulgular: Hastaların ortalama yaş, tPSA, sPSA, prostat hacmi, s/t PSA oranı, PSAD değerleri sırasıyla 64 ± 8.4 yıl, 6.3 ± 1.93 ng/ml, 1.28 ± 0.77 ng/ml, 56.5 ± 25.9 ml, % 20.2 ± 9.7 ve % 13.6 ± 7.5’ti. Gruplar arasında yaş p=0.311 ve tPSA p=0.691 açısından fark saptanmazken, sPSA p=0.002 , prostat hacmi p=0.001 , s/t PSA oranı p=0.002 ve PSAD p=0.001 anlamlı derecede farklı olarak bulundu. s/t PSA oranının duyarlılığı %73, özgüllüğü %45, pozitif öngörü değeri PÖD %21, negatif öngörü değeri NÖD %89 ve doğruluğu %50 olarak bulundu. PSAD’nin ise duyarlılığı %57, özgüllüğü %74, PÖD %31, NÖD %89 ve doğruluğu %71 olarak bulundu. Bu iki PSA parametresi kombine kullanıldığında duyarlılık %50, özgüllük %79, PÖD %33, NÖD %88 ve doğruluk %74 olarak saptandı. Sonuç: s/t PSA oranı ve PSAD’nin kombine olarak kullanımı, prostat kanserini öngörmede bu parametrelerin tek tek kullanımlarından daha etkilidir

Keywords

Prostat kanseri , PSA dansitesi , s/t PSA oranı

Efficacy of percent free PSA and PSA density in the prediction of prostate cancer

Abstract

Objective: We aimed to evaluate predictive abilities of percent free prostate specific antigen PSA and PSA density PSAD in the diagnosis of prostate cancer, alone and in combination. Materials and Methods: 439 patients who had trans-rectal ultrasound guided prostate biopsy and with a PSA value between 2.5 and 10 ng/ml, normal digital rectal examination findings, and without any history of an intervention, active infection or drug use that would affect PSA levels were included in our study. All patients’ pre-biopsy total PSA tPSA , free PSA fPSA , age, prostate volume and biopsy pathology reports were reviewed. We obtained percent free PSA by dividing fPSA to tPSA and obtained PSAD by dividing tPSA to prostate volume. The cut-off value for percent free PSA was 20% and 15% for PSAD. According to pathology results, the patients were divided into two groups as BPH and prostat cancer. Results: The mean age, tPSA, fPSA, prostate volume, percent free PSA, PSAD values of the patients were; 64 ± 8.4 year, 6.3 ± 1.93 ng/ml, 1.28 ± 0.77 ng/ml, 56.5 ± 25.9 ml, 20.2% ± 9.7 and 13.6% ± 7.5, respectively. Between the two groups, fPSA p=0.002 , prostate volume p=0.000 , percent free PSA p=0.002 and PSAD p=0.001 were significantly different while age p=0.311 and tPSA p=0.691 were not. Sensitivity of percent free PSA was 73%, specificity 45%, positive predictive value PPV 21%, negative predictive value NPV 89% and accuracy 50%. Sensitivity of PSAD was 57%, specificity 74%, PPV 31%, NPV 89% and accuracy 71%. Sensitivity of using both parameters in combination was 50%, specificity 79%, PPV 33%, NPV 88% and accuracy 74%. Conclusion: In the prediction of prostate cancer, using percent free PSA and PSAD in combination is more efficient than using these parameters alone.

Keywords

Prostate cancer , PSA density , percent free PSA

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