60세 이상에서 연령특이적 전립선특이항원 참고치의 적용으로 간과되는 종양의 병리학적 특성
Pathologic Characteristics of Prostate Cancers Missed by Application of the Age-specific Prostate-specific Antigen Reference in Men over Sixties
정성진, 한준현, 장인호, 유지형, 한병규, 홍성규, 변석수, 이상은,
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정성진 ( Jeong Seong-Jin )
분당서울대학교병원 비뇨기과
한준현 ( Han Jun-Hyun )
분당서울대학교병원 비뇨기과
장인호 ( Chang In-Ho )
분당서울대학교병원 비뇨기과
유지형 ( Yu Ji-Hyeong )
분당서울대학교병원 비뇨기과
한병규 ( Han Byoung-Kyu )
분당서울대학교병원 비뇨기과
홍성규 ( Hong Sung-Kyu )
분당서울대학교병원 비뇨기과
변석수 ( Byun Seok-Soo )
분당서울대학교병원 비뇨기과
이상은 ( Lee Sang-Eun )
분당서울대학교병원 비뇨기과
KMID : 0358320070480080809
Abstract
Purpose: To examine the pathologic characteristics of prostate cancers missed by application of the age-specific prostate-specific antigen(PSA) reference in Korean men over sixties in clinical practice based on PSA cutoff 3.0ng/ml.
Materials and Methods: We made retrospective analysis of 1,063 patients aged between 60-79 who had had transrectal ultrasonography(TRUS)- guided biopsy due to the rise of PSA over 3.0ng/ml or abnormal findings in digital rectal examination(DRE) or TRUS. Age-specific PSA reference was set at 3.9ng/ml for 60s and 5.4ng/ml for 70s.
Results: Prostate cancer was detected in 34.3%(365/1,063) as a whole, and 31.5% in 60s, and 39.5% in 70s according to the age. When age-specific reference 3.9ng/ml was applied to 60s, 20(9.6%) cancers were missed compared with clinical cutoff value(3.0ng/ml). When age-specific reference 5.4ng/ml was applied to 70s, 23(16.0%) cancers were missed. On the average, 43(12.2%) of cancers were missed in 60s and 70s. Of 43 missed cancers, 39(90.7%) were with normal DRE and TRUS. Of these cancers, 16(41.0%) were clinically insignificant on biopsy, but only 7(22.6%) were insignificant in the pathologic examination of 31 radical prostatectomy specimens.
Conclusions: In our clinical practice based on PSA cutoff 3.0ng/ml, most cancers missed by application of age-specific reference are clinically significant. But, considering the positive effect of age-specific reference on avoidance of unnecessary biopsies, large prospective study is needed to evaluate the efficacy of age-specific reference in Korean men over sixties.
키워드
Prostate cancer; Prostate-specific antigen; Age
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