PSAVm은 전립선암군과 양성군 사이에 통계학적으로 유의한 차이가 있었 다. 특히 처음에 시행한 PSA가 2.5-10ng/ml인 경우에는 PSA를 추적 검사하였을 때, PSA 자체만으로 비교하는 것에 비해 PSAVm이 전립선암과 양성 질환을 구 별하는데 유용할 것으로 생각된다. 따라서 PSA가 2.5-10ng/ml일 때, PSAVm을 계산하여 전립선 생검을 결정하는데 참고한다면 불필요한 생검을 줄일 수 있을 것으로 생각한다.
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- ABSTRACT -
The Usefulness of Short-term Prostate-specific Antigen Velocity before Prostate Biopsy in Predicting
Prostate Cancer
Jong Tak Park
Department of Medical Sciences The Graduate School, Ajou University
(Supervised by Professor Se Joong Kim)
Objective: This study was performed to investigate whether a short-term follow-up prostate-specific antigen (PSA) measurement before prostate biopsy is useful in predicting the presence of prostate cancer in patients undergoing prostate biopsy.
Materials and Methods: From January 2004 to May 2008, 670 patients underwent transrectal ultrasound-guided prostate biopsy for either an elevated PSA or abnormal digital rectal examination. The initial PSA (PSA1) was measured at the first outpatient visit. The second PSA (PSA2) was measured the evening before prostate biopsy. Only the patients with the time interval
20 reductase inhibitor intake were excluded. The short-term PSA velocity (PSAVm) was defined as {(PSA2—PSA1 / interval (days)}×30. Prostate volume (PV), PSA1, PSA2 and PSAVm were compared between the patients with prostate cancer and benign histology. A receiver operating characteristics (ROC) curve was used to analyze the performance of PSAVm in the screening of prostate cancer.
Results: Of the 362 patients who fulfilled the entry criteria, 365 prostate biopsy was performed and prostate cancer was detected in 105 patients (29.0%). The PSAVm in patients with benign histology and prostate cancer was -1.18±4.08ng/ml/month and 0.02±2.97ng/ml/month, respectively, and the difference was statistically significant (p=0.002). The area under the ROC curve (AUC) for PSAVm was 0.604. We divided the patients into halves according to their PSA1 or PV and compared the PSAVm between patients with benign histology and prostate cancer. The difference was statistically significant in the upper half PSA group (PSA1≥6.7ng/ml, p<0.001), but not significant in the lower half PSA group (PSA1<6.7ng/ml, p=0.922). Also, the difference was statistically significant in the upper half PV group (PV≥43ml, p=0.007), but not significant in the lower half PV group (PV<43ml, p=0.074).
When PSA1 is 2.5-10ng/ml, PV and PSAVm were significantly different between patients with benign histology and prostate cancer (p<0.001, p=0.049).
When PSA1 is 10-20ng/ml, PV, PSA1, PSA2 and PSAVm were significantly different between patients with benign histology and prostate cancer (p=0.009, p=0.038, p<0.001, p=0.001). When PSA1 is 10-20ng/ml, 33 cases (47.1%) were diagnosed as prostate cancer. PSAVm was not significantly different according to the administration of antibiotics or alpha blockers.
Conclusions: The PSAVm before prostate biopsy is useful in predicting prostate histology and can reduce the number of negative prostate biopsy.
Especially, when the initial PSA is 2.5-10ng/ml, PSAVm is more useful than simple PSA measurement in predicting prostate histology.
Key words: Prostate-specific antigen, prostate biopsy, prostate cancer