An Investigation Of Serum PSA Level And Relationship Between Its Indexes And Prostate Diseases At Different Age Groups

[Background]Prostatic adenocarcinoma (PCA) is the most important malignant tumor in male, and its incidence in the United States has become a main medical problems of male patient. China has a low incidence rate of prostate cancer in the past,but in recent years, along with the social aging, people lifestyle changing and the application of new diagnostic technology, the risk of prostate cancer is obviously increasing and has grown serious impacts on people's life and health.Prostate specific antigen (PSA) was discovered in the late 1960s. PSA first came into clinical use in 1980s. At present.it has become a widely used tumor marker for prostate cancer screening and clinical diagnosis. In China, since the early 1990s, the value of serum PSA has been gradually applied and become a routine today for urologist to diagnose prostate cancer. Application of PSA has led to a fundamental change or a revolution in diagnosis, staging and therapeutic monitoring of prostate cancer. Many of early prostate cancers,which are difficult to detect, have been received diagnosis and effective treatment timely. However, numerous studies have shown that serum PSA is much influenced by a number of factors such as age, prostate volume. PSA has a racial difference, and so does PSAD.That each of the study results is of inconsistence attracted scholars with great interest to research age-specific PSA reference range, the relationship between race and PSA. There is a lack of a large sample survey reports of domestic healthy population about age-specific analysis of regional and ethnic differences. In recent years, PSA density (PSAD), PSA velocity (PSAV), and free PSA ratio (F/T PSA) had been proposed, which improve the detection rate reduced the false positive rate and unnecessary biopsies of the early prostate cancer (particularly TPSA in 4-10ng/mL).Section I of this study aimed to come to understand PSA,PV and PSAD level of Chinesemen, find out relationship between PSA, PV, PSAD levels and age through a large sample, establish the Chinese age-specific PSA reference range, and improve the clinical diagnosis of prostate cancer with PSA reference value. In sectionⅡof this study.we collected about 441 cases with BPH and 147 patients with PCA who were in Affiliated Hospital of Qingdao University Medical College from January 2006 to January 2009.In three diagnostic ranges (TPSA 0-4ng/mL, TPSA 4-10ng/mL and TPSA> 10 ng/mL), we compare the serum total prostate-specific antigen (TPSA), free PSA (FPSA), PSA ratio (F/T) and prostate specific antigen density (PSAD) in benign prostate hyperplasia (BPH) and prostate cancer (PCA), to improve the diagnostic value of prostate cancer. Part IAGE-SPECIFIC DISTRIBUTION OF PSA AND ITS CORRELATION WITH PV AND PSAD:A STUDY IN A HEALTHY CHINESE MALE POPULATION[Objective]To further improve the use of prostate-specific antigen(PSA) as a screening test for prostate cancer,we sought to establish age-specific distribution of serum prostate-specific antigen (PSA) levels in healthy Chinese men, because, until recently, studies conducted to establish normal serum PSA values have involved few Chinese populations.[Methods]Between June 2007 and June 2010.3516 healthy Chinese men aged 32 to 89 years, residing in Ji-nan and Qing-dao City of China, who had undergone a routine health examination were recruited to this study of early screening for prostate cancer. All objects who had no symptoms of lower urinary tract irritation and obstruction,and no history of prostate disease, underwent detailed clinical examinations, including a serum PSA determination, a digital rectal examination and Transabdominal Ultrasound(TAUS).The 3516 participants were separated into six groups according to age: 132 (3.8%) were during 30 to 39 years old,432 (12.3%) during 40 to 49 years old,528 (15.0%) during 50 to 59 years old,612 (17.4%) during 60 to 69 years old,996 (28.3%) during 70 to 79 years old and 816 (23.2%) during 80 to 89 years old,respectively. All men who were found abnormal digital rectal examination and/or an elevated serum PSA level (greater than 4.0ng/mL) underwent transrectal sextant biopsy. No prostate cancer was found.The descriptive statistics, including the mean,median 95th percentiles of the serum PSA level distribution, were calculated for each 10-year age group. Correlation analyses were made to calculate the r values to evaluate the association between age and serum PSA level. We used the Statistical Analysis System statistical package, SPSS for Windows, version 11.5, on a personal computer to analyze the data. For all analyses, Significance was assumed if p< 0.05.[Results]1. With age growth, the median, mean of prostate specific antigen (TPSA) and prostate volume (PV) were increasing unceasingly,the median and mean of PSAD change in every age-specific group. The serum PSA concentration had an increase of approximately 1.7% annually. The mean serum of PSA concentration is 0.80 ng/mL (95th percentile 1.08) for men 30 to 39 years old (n=132),0.97 ng/mL (95 thpercentile 1.39) for men 40 to 49 years old (n= 432),1.08 ng/mL (95th percentile 1.66) for men 50 to 59 years old (n= 528),1.39 ng/mL (95th percentile 3.08) for men 60 to 69 years old (n= 612), and 1.61 ng/mL (95th percentile 4.52) for men 70 to 79 years old (n=996), and 1.98 ng/mL (95th percentile 4.97) for men 80 to 89 years old (n=816),respectively.2. The PSA value and PV have correlation with age(r=0.240, p<0.01; r=0.365, p<0.01 respectively).The PSAD had no correlation with age(r=0.007, p=0.700>0.05).There is significantly correlation between PV and TPSA(r=0.646,p<0.01). 3. Using match sample t-test analysis, we compare the age-specific distribution of PSA in our study with that in Taiwan.There is statistically significant(t=6.663, p<0.01).If compared with healthy people in Xi'an or Beijing,there is not of significant difference (t=0.234,p>0.05;t= 1.181, p>0.05,respectively).There is a significant difference,if compare with BPH population in Shanghai (t=4.940, p<0.01).4. Compared with Europe and the United States,the age-specific distribution of PSA in our study is lower.There is statistic difference comparing with the health groups in the white,the black,Latino,Japanese and South Korean respectively (t=6.994, p<0.01;t=5.416, p<0.05;t= 4.249,p<0.05;t=4.379, p<0.05 and t= 4.532, p<0.05 respectively).[Conclusion]1. In healthy Chinese male population, serum prostate specific antigen (TPSA) and prostate volume (PV) increase gradually with age. The relevance of PV and TPSA is tighter than that of age and TPSA.2. Our findings suggest that the distribution of the serum PSA level in Chinese men differs from that in different regions populations and other races. Moreover, the percentage of PSA-positive men in China was significantly lower than that in others. Additional study will be needed to determine whether a race-specific reference value of serum PSA may be the most appropriate way to screen the general Chinese male population for prostate cancer. PartⅡTHE CONTRAST STUDIES OF SERUM PSA AND RELATED INDEXES IN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER[Objective]In order to improve the diagnostic value of PSA in prostate cancer,we carry out contrast studies of serum total prostate-specific antigen (TPSA), free PSA (FPSA), PSA ratio (F/T) and prostate specific antigen density (PSAD) in benign prostate hyperplasia (BPH) and prostate cancer (PCA).[Methods]we collected about 441 cases with BPH and 147 patients with PCA who were in Affiliated Hospital of Qingdao University Medical College from January 2006 to January 2009.In three diagnostic sections (TPSA 0 4ng/mL, TPSA 4-1Ong/mL and TPSA>10ng/mL), we compared the serum total prostate-specific antigen (TPSA), free PSA (FPSA), PSA ratio (F/T) and prostate specific antigen density (PSAD) in benign prostate hyperplasia (BPH) and prostate cancer (PCA),respectively, to improve the diagnostic value of prostate cancer.[Results]1. In BPH group:. The linear correlation analysis shows that age has positive correlation with TPSA, FPSA, PV. and Correlation coefficient is 0.189,0.205 and 0.315 respectively(p<0.01). Age has no correlation with F/T and PSAD. The correlation coefficient is 0.030,-0.021 (p= 0.534,0.666). In PCA group:The linear correlation analysis shows that patient's age has no statistically significant (p =0.624,0.132,0.898,0.347,0.927) when comparing with TPSA, FPSA, PV, F/T and PSAD.2. In BPH group and PCA group,the mean±standard deviation of TPSA, FPSA, PV, F/T, PSAD were significantly different between the two groups and has statistic significant(P less than 0.01):The values of TPSA, FPSA, PSAD in PCA group were significantly higher than that in BPH group,whereas,The values of PV, F/T was significantly lower than that in the BPH group3. In the low value area outside Gray area(TPSA 0～4ng/mL):There is not significant difference of TPSA,F/T and PSAD.In Gray area(TPSA 4 10ng/mL);There is significant difference of F/T and PS AD,but there is not significant difference of TPSA.In the high value area outside Gray area(TPSA> 10 ng/mL):There is significant difference of TPSA and PSAD,but there is not significant difference of F/T.[Conclusion]Serum TPSA is still the specific tumor mark of PCA.Combined determination of TPSA,F/T and PSAD can enhance the detection rate, reduce the false positive rate and unnecessary biopsies of the early prostate cancer (particularly TPSA is in 4～10ng/mL). [Background]The results show that matrix metalloproteinase-2 (MMP-2) is a main protease, which is a critical component of vascular basement membrane hydrolysis of collagenⅣ.can degrade extracellular matrix (ECM), and participate in multi- kinds of malignant tumor in invasion and metastasis. CXC chemokine receptor 4 (CXCR4) and its specific ligand stromal cell-derived growth factor compose the biological axis which may promote the release of matrix metalloproteinases(MMP) and plays an important role in tumor proliferation, invasion, angiogenesis and metastasis process. However, both co-expression of MMP-2/CXCR4 in renal clear cell carcinoma (RCCC) tissues and its correlation studies had been less reported in domestic populations. The purpose of this study is to investigate the role of MMP-2 and CXCR4 in development, invasion and metastasis of renal cell carcinoma through detecting the co-expression of MMP-2 and CXCR4 by immunohistochemical method. [Objective]To investigate the expression of matrix metalloproteinase-2 (MMP-2) and CXC chemokine receptor 4(CXCR4) in renal clear cell carcinoma (RCCC) tissues and their relationship with clinicopathological characteristics.[Methods]The expression of MMP-2 and CXCR4 in 79 renal clear cell carcinoma tissues and 43 normal renal tissues were immunohistochemically detected by PV-6000 technique.[Results]The positive rates of MMP-2 and CXCR4 in 79 renal clear cell carcinoma tissues was significantly different from those in 43 normal renal tissues (x2=36.520,45.009,p<0.01). Furthermore, the expression of MMP-2 and CXCR4 in renal clear cell carcinoma tissues had a significant relationship with tumor'clinical stage and lymph node metastasis(x2=3.978-5.657, p<0.05) but not with genders and ages of patients and differentiation of cancer (x2=0.000-2.321, p>0.05). The positive expression of MMP-2 was positively correlated with that of CXCR4 in renal clear cell carcinoma (r=0:561, p<0.01).[Conclusion]The expression of MMP-2 and CXCR4 in renal clear cell carcinoma tissues indicates that it is significantly related with tumor'happening, development, metastasis and clinicopathologic parameters, and maybe it plays an important role in the progression of renal clear cell carcinoma.