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中華民國泌尿科醫學會雜誌

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篇名 前列腺特定抗原(PSA)與前列腺癌近年之發展
卷期 6:3
並列篇名 Recent Advances in Prostate Specific Antigen (PSA) and Prostate Cancer
作者 于大雄朱燦銘
頁次 139-146
關鍵字 前列腺特定抗原前列腺癌prostate specific antigenprostate cancerTSCI
出刊日期 199509

中文摘要

前列腺特定抗原(PSA)為一已經定性清楚之人類前到腺特定醣蛋白。目前研究已證實前列腺特定抗原為前到腺癌最有效之免疫組織標記,也為前列腺癌期別判定、追蹤和早期偵測腫瘤復發最有用之血清檢測。前列腺特定抗原最大臨床價值為協助早期前列腺癌之偵測。近期研究顯示以前列腺特定抗原為基礎作為老人早期局限性前列腺癌篩選是一可被接受、可行且可靠之方法。前列腺特定抗原篩選之準確度如同乳房攝影對乳房癌之診斷。其經濟效應與其它癌症篩選檢查相同。雖然以前列腺特定抗原作為協助早期前列腺癌之偵測是否可增加病人之存活仍待進一步證實,一般人都同意五十歲以上男性年度體檢應包括前列腺特定抗原檢查和肛門指診。至於高危險群病人則應自四十歲開始。對於無症狀且指診、前列腺特定抗原檢查皆陰性者只要接受年度定期前列腺特定抗原檢查和肛門指診。男性若出現指診陰性而前列腺特定抗原升高者,或指診有懷疑異常者,不論其前列腺特定抗原是否增高,皆應進一步從事經直腸超音波檢查並對可看到之病灶進行切片。當前列腺癌仍局限於腺體內被診斷出來且給予適時之治療時其治癒率最高。健康的亞洲男性(日本)血清前列腺特定抗原值較白人為低,但也具篩檢前列腺癌之價值。雖然在台灣目前前列腺癌尚未成為一極嚴重之癌症,但隨著國民壽命逐年升高,前列腺癌將成為老年男性的一大疾病。對於年齡超過五十歲以上之男性,我們應考慮將規劃周全的以前列腺特定抗原為基本之早期診斷前列腺癌計劃列入健康保險之一環。

英文摘要

Prostate-specific antigen (PSA) is a well characterized human prostate specific glycoprotein. PSA has been shown to be the most effective immunohistologic marker for prostate cancer, and the most useful serologic test in staging and monitoring prostate cancer and in early detection of recurrent disease. The greatest clinical value of PSA is as an aid for early detection of prostate cancer. Recent studies have indicated that PSA-based screening of older population for organ-confined early stage prostate cancer is an acceptable, practical and reliable modality. The accuracy of PSA screening is in the same range as the mammogram. The cost-effectiveness of PSA is comparable to other cancer screening tests. Although the increase in the patient’s survival due to PSA-based detection of early prostate cancer remains to be documented, it is generally agreed that the PSA test along with digital rectal examination (DRE) should be included in the annual physical examination for men 50 years of age or older. High-risk individuals are urged to commence at 40. Asymptomatic men who have both a negative DRE and normal PSA blood test need only to continue an annual DRE and PSA check up. Men who have a negative DRE and elevated PSA, and all of those who have a suspicious DRE regardless of PSA results, should undergo further diagnostic work-up, such as transrectal ultrasonography with biopsy of visible lesions. The cure rate is high with timely treatment when prostate cancer is detected while it is still confined to the prostate. Serum PSA in healthy Asian (Japanese) men is generally lower than that for similarly aged white men, and has been shown also to be of value as a screening test. Although prostate cancer is not treated as yet a serious cancer issue in Taiwan, with people longevity increases, the incidence of prostate cancer is Likely to become a major problem of aged population. A carefully designed PSA-based early detection program of prostate cancer should be considered as an integral part of health program for elder males older than 50 years of age.

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