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

Vol. 33 No. 1 June 2012
T he T hai Journal of
UROLOGY
9
π‘æπ∏åµâπ©∫—∫
PSA Level and Result of Prostate Biopsy
in 10 Years in Maharaj Nakorn
Chiang Mai Hospital.
Chatchawan Udomphot, Banakit Lojanapiwat,
Jakkrit Jun-U
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.
Division of Urology, Department of Surgery, Faculty of Medicine, Chiang Mai University
«“√ “√
10
∫∑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∫‰¥âπÕâ ¬„πºŸ™â “¬∑’¡Ë Õ’ “¬ÿπÕâ ¬°«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 ¡ –‡√Á ß
μàÕ¡≈Ÿ°À¡“°„π·μà≈–¿Ÿ¡‘¿“§Õ¬à“ß™—¥‡®π Õ“®‡π◊ËÕß®“°
ª√–™“™π à«π„À≠à¬ß— ‰¡à‰¥â¡°’ “√§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
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®÷߇°‘¥®“°ºŸªâ «É ¬∑’¡Ë Õ’ “°“√ªí “«–º‘¥ª°μ‘À√◊Õ®“°°“√μ√«®
√à“ß°“¬ª√–®”ªï ·≈â«®÷߉¥â√∫— °“√μ√«®‡æ‘¡Ë ‡μ‘¡ ‚¥¬°“√‡®“–
™‘πÈ ‡π◊ÕÈ μàÕ¡≈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«¬∑’Ë ‰¥â√∫— °“√‡®“–™‘Èπ‡π◊ÈÕμàÕ¡≈Ÿ°À¡“°ºà“π∑“ß
∑«“√Àπ—°„π √æ.¡À“√“™π§√‡™’¬ß„À¡à ‡æ◊ÕË ‡ªìπ¢âÕ¡Ÿ≈„π°“√
„À⧫“¡√Ÿ¡â –‡√ÁßμàÕ¡≈Ÿ°À¡“°‡∫◊ÕÈ ßμâπ·°àºªŸâ «É ¬ ·≈–‡ªìπ·π«
∑“ß„π°“√∑”°“√»÷°…“‡æ‘¡Ë ‡μ‘¡‡æ◊ÕË °“√æ‘®“√≥“ª√—∫‡ª≈’¬Ë π
¢âÕ∫àß™’È „π°“√‡®“–™‘πÈ ‡π◊ÕÈ μàÕ¡≈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√∫— °“√‡®“–™‘πÈ ‡π◊ÕÈ μàÕ¡≈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)
ºŸªâ «É ¬∑ÿ°√“¬∑’Ë ‰¥â√∫— °“√‡®“–™‘πÈ ‡π◊ÕÈ μàÕ¡≈Ÿ°À¡“°∑“ß
∑«“√Àπ—° (Transrectal ultrasound biopsy of prostate)
¬Ÿ‚√
ªï∑’Ë 33 ‡≈à¡∑’Ë 1 ¡‘∂ÿπ“¬π 2555
„πÀâÕߺà“μ—¥‚√ß欓∫“≈¡À“√“™π§√‡™’¬ß„À¡à μ—ßÈ ·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°“√‡®“–™‘πÈ ‡π◊ÕÈ μàÕ¡≈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. ºŸªâ «É ¬∑’¡Ë ¿’ “«–ªí “«–§—ßË (acute urinary retention)
º≈°“√»÷°…“
ºŸªâ «É ¬ 913 √“¬ ∑’‡Ë ¢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)
ºŸªâ «É ¬ 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«πºŸªâ «É ¬∑’»Ë °÷ …“‡æ‘¡Ë ¢÷πÈ ‡√◊ÕË ¬Ê∑ÿ°ªï ∑—ßÈ ®“°
∞“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)
(mean)
PSA (ng/ml)
(mean)
44 - 93
(67.9)
0.4 - 5000
(85.4)
Vol. 33 No. 1 June 2012
T he T hai Journal of
„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¡
¢÷πÈ „π·μà≈–ªïμ“¡≈”¥—∫
μ“√“ß∑’Ë 2 º≈¢Õß TRUS-Biopsy Prostate „πªï 2002-2011
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)
BPH: Benign Prostatic Hyperplasia
PCa: Prostate Cancer
UROLOGY
‡¡◊ËÕ·∫àß·¬°ºŸâªÉ«¬ÕÕ°μ“¡™à«ß PSA ¥—ßμ“√“ß∑’Ë 3
æ∫«à“∑’§Ë “à PSA <4 ng/ml ¡’®”π«πºŸªâ «É ¬ 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
ºŸªâ «É ¬ Ÿß∑’ Ë ¥ÿ ∂÷ß 322 §π ‡π◊ÕË ß®“°‡ªìπ™à«ß∑’ºË ªŸâ «É ¬¡“√—∫°“√
§—¥°√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√«®∑’˧“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—πÈ ®”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)
√Ÿª∑’Ë 1 °√“ø· ¥ßº≈¢Õß TRUS biopsy prostate ∑’Ë«‘π‘©—¬‡ªìπ BPH ·≈– Prostate cancer „πªï §.». 2002-2011
11
12
¬Ÿ‚√
«“√ “√
μ“√“ß∑’Ë 3 ‡¡◊ËÕ·∫àß·¬°ºŸâªÉ«¬ÕÕ°μ“¡™à«ß§à“ PSA
PSA (ng/ml)
N
<4
71
4 - 10
322
> 10 - 20
238
> 20 - 50
122
> 50 - 100
49
>100
111
Total
N = 913
P Ca (%)
7 (9.9)
54 (16.8)
53 (22.3)
60 (49.2)
41 (83.7)
111 (100)
326 (35.7)
ªï∑’Ë 33 ‡≈à¡∑’Ë 1 ¡‘∂ÿπ“¬π 2555
Sensitivity (%)
97.85
82.21
65.34
46.93
34.36
34.05
68.1
Specitivity (%)
10.05
55.88
87.90
98.64
99.66
100
84.3
Percentage
(%)
PSA level and result of TRUS biopsy
100
90
80
70
60
50
40
30
20
10
0
BPH
PCa
PSA
Level
(ng/ml)
0
<4
4-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 >100
√Ÿª∑’Ë 2 °√“ø· ¥ß§«“¡ —¡æ—π∏å√–À«à“ß§à“ PSA ·≈–º≈¢Õß TRUS biopsy prostate
°√“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%
‡¡◊ÕË ®”·π°º≈ TRUS biopsy prostate μ“¡Õ“¬ÿ ·≈–
§à“ PSA ¥—ßμ“√“ß∑’Ë 4 æ∫«à“„π°≈ÿ¡à ∑’‡Ë ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
Õ¬Ÿà„π™à«ßÕ“¬ÿ 45-93 ªï Õ“¬ÿ‡©≈’¬Ë ∑’Ë 69.8 ªï à«π°≈ÿ¡à ∑’Ë ‰¡à„™à
¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°Õ¬Ÿà„π™à«ßÕ“¬ÿ 44-90 ªï Õ“¬ÿ‡©≈’¬Ë ∑’Ë 66.8
ªï ´÷ßË ·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¡
∑’Ë ‰¡à „™à¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡’§à“ PSA Õ¬Ÿà „π™à«ß 0.4-83
ng/ml §à“‡©≈’¬Ë ∑’Ë 11.6 ng/ml ´÷ßË ·μ°μà“ß°—πÕ¬à“ß¡’π¬— ”§—≠
∑“ß ∂‘μÕ‘ °’ ‡™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 Student 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% ·≈– Negative 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“¡≈”¥—∫ ´÷ßË πâÕ¬°«à“μà“ߪ√–‡∑» ‚¥¬º≈°“√»÷°…“
„πμà“ߪ√–‡∑» æ∫«à“§«“¡™ÿ°∑’Ë 20 ·≈– 25% μ“¡≈”¥—∫
”À√—∫ºŸâªÉ«¬∑’Ë¡’§à“ PSA >10 ng/ml ¡’§«“¡™ÿ°¡–‡√ÁßμàÕ¡
Vol. 33 No. 1 June 2012
T he T hai Journal of
UROLOGY
13
μ“√“ß∑’Ë 4 º≈¢Õß TRUS biopsy prostate ‡¡◊ËÕ®”·π°μ“¡Õ“¬ÿ ·≈–§à“ PSA
Variable
Cancer N=326
BPH N=587
Age (years)
45 - 93
44 - 90
mean (SD)
69.8 (8.4)
66.8 (7.9)
PSA (ng/ml)
0.7 - 5000
0.4 - 83
mean (SD)
165.3 (304.3)
11.6 (10.1)
p-value
<0.001
<0.001
2000
μ“√“ß∑’Ë 5 Sensitivity ·≈– specificity ¢Õß PSA „π°“√§—¥°√Õß¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°
Sensitivity (%)
Specificity (%)
PPV (%)
PSA
68.1
84.3
81
(95%CI)
(47.7-54.2)
(82.1-86.6)
(78.8-83.8)
NPV (%)
56.4
(53.3-59.7)
0
500
PSA
1000
1500
PSA between cancer and BPH
0
0=BPH, 1=CA
1
sensitivity
0.25 0.50
0.75
√Ÿª∑’Ë 3 Dot plot graph · ¥ß∂÷ß°≈ÿà¡∑’ˇªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°¡’§à“ PSA ∑’Ë Ÿß¡“°°«à“°≈ÿà¡∑’Ë ‰¡à‡ªìπ¡–‡√ÁßÕ¬à“ß™—¥‡®π
0.00
Area Under Curve = 0.8195
0.00
0.25
050
1-Specificity
0.75
1.00
√Ÿª∑’Ë 4 ROC curve (Receiver Operating Characteristic curve)
14
«“√ “√
≈Ÿ°À¡“° Ÿß∂÷ß 51% ´÷Ëß„°≈⇧’¬ß°—∫º≈°“√»÷°…“¢Õßμà“ß
ª√–‡∑»∑’Ëæ∫§«“¡™ÿ°∑’Ë 42-64%[4-6]
à«π§à“ PSA ®“°°“√»÷°…“π’È¡’ Sensitivity 68.1%
Specificity 84.3% ´÷ßË „°≈⇧’¬ß°—∫°“√»÷°…“¢Õß Mistry and
Cable[12] ∑’Ë 72.1% ·≈– 93.2% μ“¡≈”¥—∫ à«πPositive
Predictive Value (PPV) 81% Ÿß°«à“Mistry and Cable[12]
∑’Ë 25.1% ‚¥¬Mistry and Cable[12] ¬—߉¥â∑”°“√»÷°…“º≈
°“√μ√«® digital rectal examination (DRE) ¡’ Sensitivity
53.2% Specificity 83.6% ·≈– PPV 17.8% ´÷ßË °“√»÷°…“
π’È ‰¡à “¡“√∂‡°Á∫¢âÕ¡Ÿ≈‰¥â‡π◊ÕË ß®“°‡ªìπ Retrospective study
ª√–°Õ∫°—∫º≈°“√μ√«® DRE ¢÷Èπ°—∫ºŸâμ√«®·μà≈–∑à“π ´÷Ëß
DRE ‡æ’¬ßÕ¬à“߇¥’¬«„Àâº≈º‘¥æ≈“¥‰¥â∂ß÷ 23-45%[3] ∑—ßÈ π’È
°“√„™âÀ≈“¬ parameter √à«¡°—π¬àÕ¡ àߺ≈„À⡧’ «“¡·¡àπ¬”
„π°“√μ√«®¡“°¢÷πÈ
ªí®®—¬∑’¡Ë º’ ≈μàÕ§à“ PSA Ÿß¢÷πÈ [3,4] ‡™àπ Õ“¬ÿ ‡™◊ÕÈ ™“μ‘
’º«‘ ‚√§¢ÕßμàÕ¡≈Ÿ°À¡“°‡Õ߇™àπ Prostate cancer, BPH,
Prostatitis. °“√∑”À—μ∂°“√μàÕμàÕ¡≈Ÿ°À¡“°‡™àπ Prostate
massage, Prostate biopsy, TUR-P. √«¡∂÷ß Prostate
trauma ¥â«¬, ¿“«–ªí “«–§—Ëß (AUR), √«¡∂÷ß°“√À≈—Ëß
πÈ”Õ ÿ®‘ §«√μ√«® PSA À≈—ß®“°À≈—ßπÈ”Õ ÿ®‘Õ¬à“ßπâÕ¬ 2
«—π ªí®®—¬∑’Ë¡’º≈∑”„Àâ PSA μË” ‡™àπ 5-alpha reductase
inhibitor ≈¥ PSA ≈ß 50% ¿“¬À≈—߉¥â√—∫¬“π“π 6 ‡¥◊Õπ
¢÷Èπ‰ª
¥âßπ—Èπ°àÕπæ‘®“√≥“μ√«® PSA μâÕߧ”π÷ß∂÷ßªí®®—¬
μà“ßÊ ¥—ß°≈à“«¥â«¬∑ÿ°§√—ßÈ ‡æ◊ÕË „Àâ ‰¥â§“à PSA ∑’Ë„°≈⇧’¬ß§«“¡
®√‘ß¡“°∑’ Ë ¥ÿ ·≈–®“°¢âÕ¡Ÿ≈„π°“√»÷°…“π’æÈ ∫«à“ ¡’ª√–™“°√
∑’Ë¡’ PSA >100 ng/ml ∂÷ß 111 §π„πª√–™“°√∑’ˇªìπ¡–‡√Áß
μàÕ¡≈Ÿ°À¡“°∑—ÈßÀ¡¥ 326 §π §‘¥‡ªìπ 34%
¬—ßæ∫Õ’°«à“ª√–™“°√∑’Ë¡’§à“ PSA >90 ng/ml º≈
¬Ÿ‚√
ªï∑’Ë 33 ‡≈à¡∑’Ë 1 ¡‘∂ÿπ“¬π 2555
TRUS-biopsy prostate ‡ªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“° 100%
(117 §π) ·≈–„π°≈ÿà¡π’È∑’Ë¡’Õ“¬ÿμ—Èß·μà 75 ªï¢÷Èπ‰ª ¡’®”π«π
∂÷ß 49 §π„π 117 §π (41.9%) ∑—ÈßÀ¡¥Õ¬Ÿà„π°≈ÿà¡√–¬–∑’Ë 2
¢÷Èπ‰ª (>T2c)[3] ´÷Ëß„Àâ°“√√—°…“‚¥¬ Androgen deprivation therapy ∑—ÈßÀ¡¥
‡π◊ÕË ß®“°°“√μ√«® TRUS biopsy prostate Õ“®¡’
º≈·∑√°´âÕπ‡°‘¥¢÷πÈ ‰¥â[7,8] „π°≈ÿ¡à ºŸªâ «É ¬ ŸßÕ“¬ÿ[9,10] ·≈–
¡’ ‚√§ª√–®”μ—«Õ¬Ÿ·à ≈â« √à“ß°“¬‰¡à·¢Áß·√ßæÕ∑’®–ºà“μ—¥À√◊Õ
√—∫√—ß ’√—°…“‰¥â ‡¡◊ËÕμ√«®æ∫§à“ PSA ∑’Ë Ÿß¡“° À“°ºŸâªÉ«¬
°≈ÿà¡π’ȇªìπ¡–‡√ÁßμàÕ¡≈Ÿ°À¡“° ·≈–®–æ‘®“√≥“„Àâ°“√√—°…“
·∫∫æ√âÕߌÕ√å‚¡π‡æ»™“¬ (androgen deprivation therapy) Õ¬Ÿà·≈â« °“√μ√«® TRUS biopsy prostate „πºŸâªÉ«¬
°≈ÿà¡π’È¡’§«“¡®”‡ªìπÀ√◊Õ‰¡à §ß‡ªìπ∑’ËμâÕß»÷°…“‡æ‘Ë¡‡μ‘¡°—π
μàÕ‰ª[11]
‡æ◊Ë Õ „Àâ ‰¥â º ≈μ√«®¡–‡√Á ß μà Õ ¡≈Ÿ ° À¡“°∑’Ë ‡ ∑’Ë ¬ ßμ√ß
·¡àπ¬”¡“°¢÷Èπ°“√„™â§à“ PSA Õ¬à“߇¥’¬«‰¡à‡æ’¬ßæÕ §«√
Õ“»—¬°“√μ√«® parameter Õ◊ËπÊ√à«¡¥â«¬ ‡™àπ PSA
velocity, PSA density ´÷Ëß°“√»÷°…“π’È ‰¡à “¡“√∂∑”‰¥â
‡π◊ËÕß®“°¢âÕ¡Ÿ≈‰¡à‡æ’¬ßæÕ
∫∑ √ÿª
Õÿ∫—μ‘°“√≥å¡–‡√ÁßμàÕ¡≈Ÿ°À¡“°‡æ‘Ë¡¢÷Èπμ“¡§à“ PSA
∑’Ë Ÿß¢÷Èπ ·≈–Õ“¬ÿ∑’ˇæ‘Ë¡¢÷Èπμ“¡≈”¥—∫ º≈°“√»÷°…“‡æ◊ËÕ‡ªìπ
¢âÕ¡Ÿ≈·°àºªŸâ «É ¬™“«‰∑¬°àÕπæ‘®“√≥“μ√«®™‘πÈ ‡π◊ÕÈ μàÕ¡≈Ÿ°À¡“°
¢âÕ®”°—¥¢Õß°“√»÷°…“
‡π◊ËÕß®“°‡ªìπ°“√»÷°…“¢âÕ¡Ÿ≈¬âÕπÀ≈—ß (Retrospective study) ´÷ßË ¡’¢Õâ ¡Ÿ≈∫“ß à«π¢“¥À“¬‰ª ∑”„Àâ®”π«π°“√
»÷°…“≈¥≈߉ª
Vol. 33 No. 1 June 2012
T he T hai Journal of
UROLOGY
‡Õ° “√Õâ“ßÕ‘ß
1. Center for Disease Control and Prevention. Prostate Cancer Statistics [Internet]. 2011 [cited 2012 Mar 20]. Available from: http://
www.cdc.gov/cancer/prostate/statistics/
2. «“√ “√‚√§¡–‡√Áß.«—§´’π¡–‡√ÁßμàÕ¡≈Ÿ°À¡“° [Õ‘π‡∑Õ√å‡πÁμ]. 2554 [‡¢â“∂÷߇¡◊ÕË 10 ¡’π“§¡ 2555].‡¢â“∂÷߉¥â®“°: http://thaicancerj.wordpress.com/
2011/09/11/prostatecancervaccine/
3. Carter HB, Aallaf ME, Partin AW. Diagnosis and staging of prostate cancer. In: Wein AJ editor. Campbell-Walsh Urology 9th ed.
Philadelphia: Elseview Saunders 2006: p.2912-31.
4. Medscape References. Prostate-Specific Antigen Testing [Internet]. 2012 [cited 2012 Mar 20]. Available from: http://emedicine.
medscape.com/article/457394-overview
5. The Journal of Young Investigators. Sensitivity and Specificity in Prostate Cancer Screening Methods and Strategies [Internet].
2012 [cited 2012 Mar 20]. Available from: http://www.jyi.org/research/re.php?id=931
6. PSA and Prostate Cancer [Internet]. 2012 [cited 2012 Mar 20]. Available from: http://www.swog.org/Visitors/Download/Clinical%20Trials/
PCPT_PSA_Summary.pdf
7. Kakehi Y, Naito S. Complication rates of ultrasound-guided prostate biopsy: a nation-wide survey in Japan. Int J Urol 2008; 15(4):
319-21.
8. Lee SH, Chen SM, Ho CR, Chang PL, Chen CL, Tsui KH. Risk factors associated with transrectal ultrasound guided prostate needle
biopsy in patients with prostate cancer. Chang Gung Med J 2009; 32(6):623-7.
9. Planelles Gomez J, Beltran Armada JM, Alonso Hernandez S, Tarin Planes M, Beamud Cortes M, Gil Salom M. Value of transrectal
FNA in the diagnosis of prostate cancer in elderly patients. Actas Urol Esp 2008 May; 32(5):485-91.
10. Bott SR, Foley CL, Bull MD, Reddy CC, Freeman A, Montgomery BS, et al. Are prostatic biopsies necessary in men aged > or =80
years? BJU Int 2007 Feb; 99(2):335-8.
11. Jang JY, Kim YS. Is prostate biopsy essential to diagnose prostate cancer in the older patient with extremely high prostate-specific
antigen? Korean J Urol Feb; 53(2):82-6.
12. Mistry K, Cable G. Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate
carcinoma. J Am Board Fam Pract 2003 Mar-Apr; 16(2):95-101.
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