Hacı Hasan ESEN, Mustafa Cihat AVUNDUK

Prostat adenokarsinomlarında PSA değerlerinin Gleason Skor ve klinik evre ile ilişkisi

Amaç: Prostat adenokarsinomlarında PSA değerlerinin, Gleason skor ve klinik evre ile ilişkisini değerlendirmek. Yöntem: Çalışmamızda 68 prostat adenokarsinomu (PACa) olgusu ile 55 benign protat hiperplazisi (BPH) olgusu incelendi. Histolojik grade olarak Gleason skor (GS) kullanıldı. Olgular WHO ve TNM sınıflamasına göre evrelendirildi. Olguların total (t) ve serbest-PSA (s-PSA) değerleri ölçüldü. Bulgular: Ortalama serum t-PSA değerleri: PACa olguları 67.09±5.32 ng/ml iken BPH’da 4.70±1.02 ng/ml olarak bulundu. Gri Zon aralığında 11 PACa ile 24 BPH olgusu bulunmaktadır. Bu olgularda t-PSA, s-PSA ve yaş arasında bir fark tespit edilemeyip, s-PSA/t-PSA oranı anlamlı derecede farklı bulunmuştur. 0.18 sınır değeri için spesifite % 92, sensitivite % 82’dir. Gri zon aralığında olan 9 PACa olgusunun 8 tanesi lokalize evrede, 1 tanesi metastatik evrede tespit edilmiştir. Bu PSA aralığında 7 olgunun GS’si 7’den düşük iken sadece 2 olgunun GS’si 7-10 aralığında tespit edildi. Lokalize evrede olgularında ortalama serum t-PSA seviyesi: 44.8±6.76 ng/ml iken metastatik evrede 120.2±8.65 ng/ml olarak tespit edildi. Sonuç: Serum t-PSA düzeyi parametresinin kullanımı faydalı bir belirteçtir. PSA; Prostat karsinomu (PCa) tanısında, evrelemesinde, histolojik grade’i tahmin etmede, izlemde ve rekürrenslerin belirlenmesinde iyi bir göstergedir. s-PSA/t-PSA oranı, t-PSA değeri 4,1-10 ng/ml düzeyinde olan (Gri zon) benign ve malign olguları ayırmada son derece yararlı bir parametredir. GS’nin kullanılması, PCa’lı olgularda progresyonu ve sağ kalımı belirlemede iyi ve güvenilir bir göstergedir.

The relation between PSA values and Gleason Score and clinical phase in prostate adenocarcinoma

Objective: The evaluation of relation between PSA values and Gleason Score and clinical phase in prostate adenocarcinoma. Methods: In this study, 68 prostate adenocarcinoma (PACa) and 55 benign prostatic hyperplasia (BPH) cases were examined. Gleason Score (GS) was used as histological grading. They were graded according to WHO and TNM classifiying. The total and free PSA values of the cases were measured. Results: While the mean serum total-PSA (t-PSA) value was 67.091±5.32 ng/ml in cases with PACa, it was 4.701±1.02 ng/ml in cases with BPH. 11 PACa, 24 BPH existed in Grey Zone. There was no difference between t-PSA, free-PSA (f-PSA) and ages, but s-PSA and f-PSA rate was significantly different. The specificity was 92% and sensivity 82% for 0.18 limit value. 8 of 9 PACa cases in t-PSA 0-10 ng/ml were in localised phase and one in metastatic phase. While the GS of these 7 cases were lower than 7, the GS of two cases were at 7-10 interval. We determined the mean serum t-PSA level as 44.8±6.76 ng/ml in the localised phase and 120.2±8.65 ng/ml in metastatic phase. Conclusion: The use of Serum t-PSA level parameter is a helpful determinant. It is a fine determinant in diagnosing and grading prostate carcinoma (PCa), guessing histological grades, following and determining reccurence. It is a helpful parameter to distinguish benign and malign cases whose f-PSA/t-PSA rate and t-PSA value are at 4,1-10 ng/ml level (Grey zone). The use of GS is a good and reliable determinant in establishing the progress and surviving of the cases with PCa.

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1. Smith Genel Üroloji. Editörler; Emil A. Tanagha, Jack W. McAninch. Çeviri editörü; Gürkan Kazancı. Nobel Tıp Kitapevleri. 1999. 410-33
2. Rosai J: Ackerman’s Surgical Pathology: Male reproductive system; Prostate and Seminal vesicles. 9.th, Mosby, St. Louis, 2004; 1361-1411.
3. Kirby RS, Christmas TJ, Brawer MK. Prostate Cancer Mosby. 2nd Ed 2001 1-76.
4. Cher ML, Bianco FJ Jr, Lam JS, Davis LP, Grignon DJ, Sakr WA, et al. Limited role of radionuclide bone scintigraphy in patients with prostate specifi cantigen elevations after radical prostatectomy. J Urol 1998;160:1387-91.
5. Oesterling JE, Jacobsen SJ, Klee GG, Pettersson K, Piironen T, Abrahamsson PA, et al. Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios. J Urol 1995;154:1090-5.
6. Daher R, Beaini M. Prostate-specific antigen and new related markers for prostate cancer. Clin Chem Lab Med 1998;36:671-81
7. Bjork T, Bjartell A, Abrahamsson PA, Hulkko S, di Sant'Agnese A, Lilja H. Alpha 1-antichymotrypsin production in PSA-producing cells is common in prostate cancer but rare in benign prostatic hyperplasia. Urology 1994;43:427-34
8. Bangma CH, Kranse R, Blijenberg BG, Schroder FH The value of screening tests in the detection of prostate cancer. Part II: Retrospective analysis of free/total prostate-specific analysis ratio, age-specific reference ranges, and PSA density. Urology 1995;46:779-84.
9. Bangma CH, Kranse R, Blijenberg BG, Schroder FH The value of screening tests in the detection of prostate cancer. Part I: Results of a retrospective evaluation of 1726 men. Urology 1995;46:773-8.
10. Stenman UH, Hakama M, Knekt P, Aromaa A, Teppo L, Leinonen J. Serum concentrations of prostate specific antigen and its complex with alpha 1-antichymotrypsin before diagnosis of prostate cancer. Lancet 1994;344:1594-8.
11. Leinonen J, Lovgren T, Vornanen T, Stenman UH Double-label time-resolved immunofluorometric assay of prostate-specific antigen and of its complex with alpha 1-antichymotrypsin. Clin Chem 1993;39:2098-103.
12. Vashi AR, Wojno KJ, Henricks W, England BA, Vessella RL, Lange PH, et al. Determination of the "reflex range" and appropriate cutpoints for percent free prostate-specific antigen in 413 men referred for prostatic evaluation using the AxSYM system. Urology 1997;49:19-27.
13. Christensson A, Bjork T, Nilsson O, Dahlen U, Matikainen MT, Cockett AT, et al. Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol 1993;150:100-5.
14. Prestigiacomo AF, Lilja H, Pettersson K, Wolfert RL, Stamey TA. A comparison of the free fraction of serum prostate specific antigen in men with benign and cancerous prostates: the best case scenario. J Urol 1996;156:350-4.
15. Gleason DF Classification of prostatic carcinomas. Cancer Chemother Rep 1966;50:125-8.
16. Bailar JC 3rd, Mellinger GT, Gleason DF Survival rates of patients with prostatic cancer, tumor stage, and differentiation--preliminary report. Cancer Chemother Rep 1966;50:129-36.
17. Allsbrook WC Jr, Mangold KA, Johnson MH, Lane RB, Lane CG, Epstein JI Interobserver reproducibility of Gleason grading of prostatic carcinoma: general pathologist. Hum Pathol 2001;32:81-8.
18. Epstein JI, Carmichael M, Partin AW, Walsh PC. Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with 5 years of followup. J Urol 1993;149:1478-81.
19. Smith JA Jr, Seaman JP, Gleidman JB, Middleton RG. Pelvic lymph node metastasis from prostatic cancer: influence of tumor grade and stage in 452 consecutive patients. J Urol 1983;130:290-2.
20. Brawer MK, Botswick DG Invasion in prostate cancer: J Urol 1993 146:788-93.
21. Peterson RO, Fisher ER, Sharkley DA, p53 immunoreaktivitiy in human prostate cancer. J Urol 1995 61:710-6
22. Van Veldhuizen PJ, Sadasivan R, Garcia F, Austenfelt MS, Stephens RL. Mutant p53 expression in prostate cancer, Prostate 1993,22: 23.