Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.
目的 应用判别分析探讨不同指标对前列腺癌预测诊断中的应用价值。 方法 收集2008年1月－2011年9月经直肠超声检查并行经直肠超声引导下经会阴前列腺穿刺活检术，具有前列腺特异性抗原（PSA）、超声图像特征的941例患者以及其中含有血流阻力指数（RI）指标的200例患者的临床资料，采用最近距离及极大似然判别分析两种方法分别拟合患者年龄、血清PSA、经直肠前列腺超声声像图特征以及RI指标预测前列腺癌。 结果 最近距离判别分析显示RI对前列腺癌的判别无临床意义。联合患者年龄、超声检查和血清PSA值，判别结果提示超声、超声+年龄、年龄+超声+PSA三种判别的灵敏度逐渐增加。年龄+超声+PSA联合指标的灵敏度为88.89%，其错判率在20.00%以内。 结论 年龄+超声+PSA联合指标的极大似然判别分析可提高前列腺癌的诊断预测水平，避免前列腺穿刺给患者带来的痛苦，并给临床医生的临床诊断提供参考，有较好的应用价值。
目的 观察与分析体重异常老年男性血清前列腺特异性抗原（T-PSA）与生长激素（GH）水平及影响因素。 方法 以2009年1月－2012年6月，血清GH＜5 ng/mL、血清T-PSA＜4.5 ng/mL的老年男性共296例作为观察对象，依据体质量指数分为低体重组、正常体重组、超重组及肥胖组。依据年龄分为60～64、65～69、70～74及≥75岁四组。测定296例入选对象的血清T-PSA及GH并进行分析。 结果 随着年龄增长，血清T-PSA、GH渐增高。≥75岁年龄组血清T-PSA高于其他三组，差异无统计学意义（P＞0.05）。≥75岁年龄组血清GH高于其他三组，差异有统计学意义（P＜0.01）。超重组及肥胖组血清T-PSA低于正常体重组，差异有统计学意义（P＜0.01）。低体重组血清T-PSA稍低于正常体重组，差异无统计学意义（P＞0.05）。肥胖组血清GH低于超重及正常体重组，差异无统计学意义（P＞0.05）。低体重组血清GH低于正常体重组，差异无统计学意义（P＞0.05）。单因素相关分析显示血清T-PSA与年龄、GH正相关；与BMI负相关；与收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）及血脂不相关。血清GH与年龄、T-PSA、SBP、DBP正相关；与BMI、FPG及血脂不相关。校正年龄、BMI后，血清T-PSA与GH仍呈正相关。 结论 随着年龄增长，老年男性血清T-PSA、GH渐增高。老年男性非肢端肥大症者血清T-PSA与血清GH水平及BMI有关联，血清GH水平较高者，血清T-PSA也较高；血清T-PSA与BMI负相关。