PSA Level and Result of Prostate Biopsy in 10 Years in Maharaj

The Thai Journal of UROLOGY
9
Vol. 33 No. 1 June 2012
PSA Level and Result of Prostate Biopsy
in 10 Years in Maharaj Nakorn
Chiang Mai Hospital.
Chatchawan Udomphot, Banakit Lojanapiwat,
Jakkrit Jun-U
π‘æπ∏åµâπ©∫—∫
Division of Urology, Department of Surgery, Faculty of Medicine, Chiang Mai University
Abstract
Introduction: Incidence of prostate cancer in Asia is less frequent than Europe and United States. There is
no clearly defined incidence of prostate cancer in Thailand due to no nationwide screening campaign or lack
of data registry in the past. We studied PSA level and prostate biopsy result in Maharaj Nakorn Chiang Mai
hospital in the past 10 years for patient education.
Patient and Medthod: 913 patients who underwent prostate-specific antigen (PSA) test and prostate
biopsies from January 2002 to Dec 2011 were recruited. Patients with urinary tract infection and acute urinary
retention were excluded. The indications of prostate biopsy were abnormal digital rectal examination or
abnormal PSA level. Percent of positive biopsy and sensitivity and specificity were recorded in different PSA
level.
Results: Total number 913 patients. PSA level <4 ng/ml was found in 71 patients and detection rate of
prostate cancer was 9.9% with sensitivity 97.85% and specificity 10.05%. PSA level 4-10 ng/ml was found
in 322 patients and detection rate of prostate cancer was 16.8% with sensitivity 82.21% and specificity
55.88%. PSA level more than 10 ng/ml was found in 520 patients and detection rate of prostate cancer was
51.0% with sensitivity 81.29% and specificity 56.56%.
Conclusion: Increasing PSA level is associated with increasing prostate cancer incidence. PSA level is
acceptable for screening and diagnosis of prostate cancer in Thailand. This information is important for
patient education.

«“√“√ ¬Ÿ‚√
10
ªï∑’Ë 33 ‡≈à¡∑’Ë 1 ¡‘∂ÿπ“¬π 2555
∫∑π”
¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡’Õÿ∫—μ‘°“√≥å∑’Ë·μ°μà“ß°—πμ“¡
·μà≈–æ◊Èπ∑’Ë„π‚≈° ‚¥¬À√—∞Õ‡¡√‘°“ æ∫¡“°‡ªìπÕ—π¥—∫ 1
„πÕ—μ√“ 156.9 „πª√–™“°√ 100,000 §π[1] „πª√–‡∑»
‰∑¬æ∫ºŸâªÉ«¬¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°„πÕ—μ√“ 5.5 μàÕª√–™“°√
100,000 ‚¥¬æ∫Ÿß‡ªìπÕ—π¥—∫’Ë¢Õß‚√§¡–‡√Áß„πºŸâ™“¬ ‚¥¬
∑—Ë«‰ª¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°æ∫‰¥âπâÕ¬„πºŸâ™“¬∑’Ë¡’Õ“¬ÿπâÕ¬°«à“
40 ªï ·μàÕÿ∫—μ‘°“√≥åŸß¢÷Èπμ“¡Õ“¬ÿ∑’ˇæ‘Ë¡¢÷Èπ‚¥¬‡©æ“–„π
ºŸâ™“¬∑’ËÕ“¬ÿ¡“°°«à“ 50 ªï¢÷Èπ‰ª[2]
„πª√–‡∑»‰∑¬¬—߉¡à¡’°“√»÷°…“Õÿ∫—μ‘°“√≥å¡–‡√Áß
μàÕ¡≈Ÿ°À¡“°„π·μà≈–¿Ÿ¡‘¿“§Õ¬à“ß™—¥‡®π Õ“®‡π◊ËÕß®“°
ª√–™“™πà«π„À≠ଗ߉¡à‰¥â¡’°“√§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
Õ¬à“ß∑—Ë«∂÷ß ¥—ßπ—Èπ °“√«‘π‘®©—¬¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°à«π„À≠à
®÷߇°‘¥®“°ºŸâªÉ«¬∑’Ë¡’Õ“°“√ªí“«–º‘¥ª°μ‘À√◊Õ®“°°“√μ√«®
√à“ß°“¬ª√–®”ªï ·≈â«®÷߉¥â√—∫°“√μ√«®‡æ‘Ë¡‡μ‘¡ ‚¥¬°“√‡®“–
™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°ºà“π∑“ß∑«“√Àπ—° (Transrectal biopsy
of prostate) μ“¡¢âÕ∫àß™’È ´÷ËßÕâ“ßÕ‘ß®“°°“√»÷°…“¢Õßμà“ß
ª√–‡∑»[3]
ºŸâ«‘®—¬®÷߉¥â∑”°“√»÷°…“∂÷ßÕÿ∫—μ‘°“√≥å¡–‡√ÁßμàÕ¡≈Ÿ°
À¡“°„πºŸâªÉ«¬∑’ˉ¥â√—∫°“√‡®“–™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°ºà“π∑“ß
∑«“√Àπ—°„π √æ.¡À“√“™π§√‡™’¬ß„À¡à ‡æ◊ËÕ‡ªìπ¢âÕ¡Ÿ≈„π°“√
„À⧫“¡√Ÿâ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°‡∫◊ÈÕßμâπ·°àºŸâªÉ«¬ ·≈–‡ªìπ·π«
∑“ß„π°“√∑”°“√»÷°…“‡æ‘Ë¡‡μ‘¡‡æ◊ËÕ°“√æ‘®“√≥“ª√—∫‡ª≈’ˬπ
¢âÕ∫àß™’È„π°“√‡®“–™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°ºà“π∑“ß∑«“√Àπ—°„Àâ
‡À¡“–¡°—∫¿“æª√–™“°√ ·≈–Õÿ∫—μ‘°“√≥åμ“¡®√‘ߢÕß
ª√–‡∑»‰∑¬„πÕπ“§μ
ºŸâªÉ«¬·≈–«‘∏’°“√∑”«‘®—¬
√Ÿª·∫∫°“√«‘®—¬
°“√»÷°…“¬âÕπÀ≈—ß (Retrospectivestudy) ¢âÕ¡Ÿ≈®“°
‡«™√–‡∫’¬π¢Õß‚√ß欓∫“≈¡À“√“™π§√‡™’¬ß„À¡à μ—Èß·μà
1 ¡.§. 2545 - 31 ∏.§. 2554 ‚¥¬√«∫√«¡ºŸâªÉ«¬∑ÿ°√“¬∑’Ë
‰¥â√—∫°“√‡®“–™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°∑“ß∑«“√Àπ—° ∑’Ë¡’º≈‡≈◊Õ¥
§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“° (Prostatic specific antigen,
PSA) ·≈–√“¬ß“πº≈™‘Èπ‡π◊ÈÕ∑“ß欓∏‘«‘∑¬“
‡°≥±å§—¥‡¢â“ (inclusion criteria)
ºŸâªÉ«¬∑ÿ°√“¬∑’ˉ¥â√—∫°“√‡®“–™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°∑“ß
∑«“√Àπ—° (Transrectal ultrasound biopsy of prostate)
„πÀâÕߺà“μ—¥‚√ß欓∫“≈¡À“√“™π§√‡™’¬ß„À¡à μ—Èß·μà 1 ¡.§.
2545 - 31 ∏.§. 2554 ∑’Ë¡’º≈‡≈◊Õ¥§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°
À¡“° (Prostatic specific antigen, PSA) ·≈–√“¬ß“π
º≈™‘Èπ‡π◊ÈÕ∑“ß欓∏‘«‘∑¬“
¢âÕ∫àß™’È„π°“√‡®“–™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°∑“ß∑«“√Àπ—°
(Transrectal ultrasound biopsy of prostate)
1. §—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°„πºŸâªÉ«¬™“¬∑’Ë¡’Õ“¬ÿ
>45 ªï ·≈–™à«ßÕ“¬ÿ§ß‡À≈◊Õ¡“°°«à“ 10 ªï ·≈– PSA
>4 ng/ml À√◊Õ
2. Abnormal Digital Rectal Examination ‚¥¬
‰¡à§”π÷ß∂÷ߺ≈ PSA ·≈–Õ“¬ÿ
‡°≥±å§—¥ÕÕ° (exclusion criteria)
1. ºŸâªÉ«¬∑’Ë¡’°“√μ‘¥‡™◊ÈÕ∑“߇¥‘πªí“«–
2. ºŸâªÉ«¬∑’Ë¡’¿“«–ªí“«–§—Ëß (acute urinary reten-
tion)
º≈°“√»÷°…“
ºŸâªÉ«¬ 913 √“¬ ∑’ˇ¢â“‰¥â°—∫‡°≥±å§—¥‡¢â“ ¡’Õ“¬ÿ√–À«à“ß
44-93 ªï ‡©≈’ˬ 67.9 ªï §à“‡©≈’ˬ PSA ‡∑à“°—∫ 85.4 ng/ml
(0.4-5000 ng/ml) (μ“√“ß∑’Ë 1)
ºŸâªÉ«¬ 326 √“¬ §‘¥‡ªìπ√âÕ¬≈– 35.7 ‰¥â√—∫°“√«‘π‘®©—¬
«à“‡ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“° ‚¥¬·∫àßμ“¡ªï∑’Ë»÷°…“ (μ“√“ß∑’Ë
2, √Ÿª∑’Ë 1) √âÕ¬≈–¢Õß°“√μ√«®«à“‡ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
„π·μà™à«ß¢Õß√–¥—∫ PSA §à“ Sensitivity ·≈– Specificity
¢Õß°“√μ√«® (·¥ß„πμ“√“ß∑’Ë 3, √Ÿª∑’Ë 2)
®”π«πºŸâªÉ«¬„π°“√»÷°…“·≈–¡’¢âÕ¡Ÿ≈§√∫∑—ÈßÀ¡¥
913 §π ‚¥¬®”π«πºŸâªÉ«¬∑’Ë»÷°…“‡æ‘Ë¡¢÷Èπ‡√◊ËÕ¬Ê∑ÿ°ªï ∑—Èß®“°
∞“π¢âÕ¡Ÿ≈„π√–∫∫“√π‡∑»¡“°¢÷Èπ ·≈–®”π«πºŸâªÉ«¬∑’Ë
‡¢â“√—∫°“√§—¥°√Õß‚√§¡“°¢÷Èπ¥â«¬ ¥—ßμ“√“ß∑’Ë 2 ·≈–√Ÿª∑’Ë
1 ®”π«πºŸâªÉ«¬‡æ‘Ë¡®“° 26 §π„πªï 2002 ‡ªìπ 230 §π
μ“√“ß∑’Ë 1 Demographic data
Variable
Age (years) 44 - 93
(mean) (67.9)
PSA (ng/ml) 0.4 - 5000
(mean) (85.4)

The Thai Journal of UROLOGY
11
Vol. 33 No. 1 June 2012
‡¡◊ËÕ·∫àß·¬°ºŸâªÉ«¬ÕÕ°μ“¡™à«ß PSA ¥—ßμ“√“ß∑’Ë 3
æ∫«à“∑’˧à“PSA <4 ng/ml ¡’®”π«πºŸâªÉ«¬ 71 §π ‡ªìπ¡–‡√Áß
μàÕ¡≈Ÿ°À¡“° 9.9% ¥â«¬ sensitivity ∑’ËŸß∂÷ß 97.85% ·≈–
specificity 10.05% ‚¥¬™à«ß PSA 4-10 ng/ml ¡’®”π«π
ºŸâªÉ«¬Ÿß∑’Ëÿ¥∂÷ß 322 §π ‡π◊ËÕß®“°‡ªìπ™à«ß∑’˺ŸâªÉ«¬¡“√—∫°“√
§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡“°∑’Ëÿ¥‚¥¬‡ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°
À¡“° 16.8% ∑’Ë Sensitivity 82.21% ·≈– Specificity
55.88% ‡¡◊ËÕ§à“ PSA Ÿß¢÷Èπ®”π«πºŸâªÉ«¬≈¥≈ßμ“¡≈”¥—∫
‚¥¬™à«ß PSA 50-100 ng/ml ¡’®”π«πºŸâªÉ«¬πâÕ¬∑’Ëÿ¥‡æ’¬ß
49 §π ·μàº≈‡ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°°≈—∫Ÿß∂÷ß 83.7% ¥â«¬
Sensitivity 34.36% ·≈– Specificity ∑’ËŸß∂÷ß 99.66%
‡π◊ËÕß®“°ºŸâªÉ«¬∑’Ë¡“√—∫°“√μ√«®∑’Ë§à“ PSA 50-100 ng/ml
π—Èπ‡°◊Õ∫∑—ÈßÀ¡¥¡“μ√«®‡¡◊ËÕ¡’Õ“°“√ ‡™àπ Lower urinary
tract symptom (LUTS) à«π PSA >100 ng/ml π—Èπ ®”π«π
ºŸâªÉ«¬°≈—∫Ÿß¢÷ÈπÕ’°∂÷ß 111 §π ‚¥¬μ√«®æ∫«à“‡ªìπ¡–‡√Áß
μàÕ¡≈Ÿ°À¡“°∑—ÈßÀ¡¥ 100% ∑’Ë specificity 100% ·≈–
sensitivity 34.05% ‚¥¬∑—ÈßÀ¡¥¡’Õ“°“√μà“ßÊ π”¡“ ‡™àπ
LUTS, ªí“«–‰¡àÕÕ° (acute urinary retention), ªí“«–
’πÈ”≈â“߇π◊ÈÕ, ·≈–à«πÀπ÷Ëß¡“μ√«®°—∫·æ∑¬å·ºπ°Õ◊Ëπ¥â«¬
Õ“°“√∑“ß°√–¥Ÿ° (Skeletal Relate Event) ‡™à𠪫¥°√–¥Ÿ°
μà“ßÊ, °√–¥Ÿ°À—°™π‘¥¡’欓∏‘¿“æ (pathological fracture),
À√◊Õ·¡â°√–∑—ËßÕ—¡æ“μ§√÷Ëßμ—«≈à“ß®“°‰¢—πÀ≈—ß∂Ÿ°°¥∑—∫
(paraplegia from spinal cord compression)
ªï ®”π«π (√“¬) BPH (√“¬) PCa √“¬ (%)
2002 26 17 9 (34.6)
2003 21 6 15 (71.4)
2004 14 11 3 (21.4)
2005 25 15 10 (40.0)
2006 55 35 20 (36.4)
2007 66 54 12 (18.2)
2008 120 72 48 (40.0)
2009 158 92 66 (41.8)
2010 198 129 69 (34.8)
2011 230 156 74 (32.2)
Total 913 587 326 (35.7)
μ“√“ß∑’Ë 2 º≈¢Õß TRUS-Biopsy Prostate „πªï 2002-2011
BPH: Benign Prostatic Hyperplasia
PCa: Prostate Cancer
„πªï §.». 2011 ‚¥¬—¥à«π¢Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°‰¡à·μ°
μà“ß°—πÕ¬à“ß™—¥‡®π ‡π◊ËÕß®“°ªí®®ÿ∫—π¡’°“√§—¥°√Õß¡–‡√Áß
μàÕ¡≈Ÿ°À¡“°‡æ‘Ë¡¡“°¢÷Èπ°«à“„πÕ¥’μ ¥—ß®”π«πºŸâªÉ«¬∑’ˇæ‘Ë¡
¢÷Èπ„π·μà≈–ªïμ“¡≈”¥—∫
√Ÿª∑’Ë 1 °√“ø·¥ßº≈¢Õß TRUS biopsy prostate ∑’Ë«‘π‘©—¬‡ªìπ BPH ·≈– Prostate cancer „πªï §.». 2002-2011

«“√“√ ¬Ÿ‚√
12
ªï∑’Ë 33 ‡≈à¡∑’Ë 1 ¡‘∂ÿπ“¬π 2555
°√“ø‡âπ BPH ·≈– PCa μ—¥°—π∑’Ë PSA ª√–¡“≥
30 ng/ml ·¥ß∂÷ß‚Õ°“∑’Ë®–μ√«®æ∫¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
¡“°°«à“ 50% ‡¡◊ËÕ PSA >30 ng/ml ·≈–‡¡◊ËÕ PSA >90
ng/ml æ∫«à“‡ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“° 100%
‡¡◊ËÕ®”·π°º≈ TRUS biopsy prostate μ“¡Õ“¬ÿ ·≈–
§à“ PSA ¥—ßμ“√“ß∑’Ë 4 æ∫«à“„π°≈ÿà¡∑’ˇªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
Õ¬Ÿà„π™à«ßÕ“¬ÿ 45-93 ªï Õ“¬ÿ‡©≈’ˬ∑’Ë 69.8 ªï à«π°≈ÿà¡∑’ˉ¡à„™à
¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°Õ¬Ÿà„π™à«ßÕ“¬ÿ 44-90 ªï Õ“¬ÿ‡©≈’ˬ∑’Ë 66.8
ªï ´÷Ëß·μ°μà“ß°—πÕ¬à“ß¡’π—¬”§—≠∑“ß∂‘μ‘ (p-value <0.001)
·≈–°≈ÿà¡∑’ˇªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡’§à“ PSA Õ¬Ÿà„π™à«ß
0.7-5,000 ng/ml ‚¥¬¡’§à“‡©≈’ˬ∑’Ë 165.3 ng/ml à«π°≈ÿà¡
∑’ˉ¡à„™à¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡’§à“ PSA Õ¬Ÿà„π™à«ß 0.4-83
ng/ml §à“‡©≈’ˬ∑’Ë 11.6 ng/ml ´÷Ëß·μ°μà“ß°—πÕ¬à“ß¡’π—¬”§—≠
∑“ß∂‘μ‘Õ’°‡™àπ°—π (p-value <0.001) ®÷ß√ÿª‰¥â«à“‚Õ°“∑’Ë®–
μ√«®æ∫¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°Ÿß¢÷Èπ‡¡◊ËÕÕ“¬ÿ¡“°¢÷Èπ ·≈–§à“
PSA Ÿß¢÷Èπ
‡¡◊ËÕπ”¢âÕ¡Ÿ≈∑—ÈßÀ¡¥¡“§”π«≥∑“ß∂‘μ‘‚¥¬„™â Stu-
dent t-test („™â”À√—∫‡ª√’¬∫‡∑’¬∫¢âÕ¡Ÿ≈∑’ˇªìπ§à“‡©≈’ˬ) ‰¥â
º≈¥—ßμ“√“ß∑’Ë 5 §◊Õ Sensitivity 68.1% ·≈– Specificity
84.3% à«π Positive predictive value 81% ·≈– Nega-
tive predictive value 56.4%
∫∑«‘®“√≥å
®“°º≈°“√»÷°…“æ∫«à“„πºŸâªÉ«¬∑’Ë¡’ PSA <4 ·≈–
4-10 ng/ml æ∫§«“¡™ÿ°¢Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°∑’Ë 9.9 ·≈–
16.8% μ“¡≈”¥—∫ ´÷ËßπâÕ¬°«à“μà“ߪ√–‡∑» ‚¥¬º≈°“√»÷°…“
„πμà“ߪ√–‡∑» æ∫«à“§«“¡™ÿ°∑’Ë 20 ·≈– 25% μ“¡≈”¥—∫
”À√—∫ºŸâªÉ«¬∑’Ë¡’§à“ PSA >10 ng/ml ¡’§«“¡™ÿ°¡–‡√ÁßμàÕ¡
PSA (ng/ml) N P Ca (%) Sensitivity (%) Specitivity (%)
< 4 71 7 (9.9) 97.85 10.05
4 - 10 322 54 (16.8) 82.21 55.88
> 10 - 20 238 53 (22.3) 65.34 87.90
> 20 - 50 122 60 (49.2) 46.93 98.64
> 50 - 100 49 41 (83.7) 34.36 99.66
>100 111 111 (100) 34.05 100
Total N = 913 326 (35.7) 68.1 84.3
μ“√“ß∑’Ë 3 ‡¡◊ËÕ·∫àß·¬°ºŸâªÉ«¬ÕÕ°μ“¡™à«ß§à“ PSA
√Ÿª∑’Ë 2 °√“ø·¥ß§«“¡—¡æ—π∏å√–À«à“ß§à“ PSA ·≈–º≈¢Õß TRUS biopsy prostate
Percentage
(%)
100
90
80
70
60
50
40
30
20
10
0
PSA
Level
(ng/ml)
PSA level and result of TRUS biopsy
0
<4 4-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 >100
BPH
PCa

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Vol. 33 No. 1 June 2012
Variable Cancer N=326 BPH N=587 p-value
Age (years) 45 - 93 44 - 90
mean (SD) 69.8 (8.4) 66.8 (7.9) <0.001
PSA (ng/ml) 0.7 - 5000 0.4 - 83
mean (SD) 165.3 (304.3) 11.6 (10.1) <0.001
μ“√“ß∑’Ë 4 º≈¢Õß TRUS biopsy prostate ‡¡◊ËÕ®”·π°μ“¡Õ“¬ÿ ·≈–§à“ PSA
Sensitivity (%) Specificity (%) PPV (%) NPV (%)
PSA 68.1 84.3 81 56.4
(95%CI) (47.7-54.2) (82.1-86.6) (78.8-83.8) (53.3-59.7)
μ“√“ß∑’Ë 5 Sensitivity ·≈– specificity ¢Õß PSA „π°“√§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
√Ÿª∑’Ë 4 ROC curve (Receiver Operating Characteristic curve)
√Ÿª∑’Ë 3 Dot plot graph ·¥ß∂÷ß°≈ÿà¡∑’ˇªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡’§à“ PSA ∑’ËŸß¡“°°«à“°≈ÿà¡∑’ˉ¡à‡ªìπ¡–‡√ÁßÕ¬à“ß™—¥‡®π
PSA between cancer and BPH
0=BPH, 1=CA
0
PSA
0500 1000 1500 2000
1
Area Under Curve = 0.8195
1-Specificity
sensitivity
0.00 0.25 050 0.75 1.00
0.00 0.25 0.50 0.75