بررسی ارﺗﺒﺎط زﻣﺎن دو ﺑﺮاﺑﺮ شدن آنتی‌ژن اختصاصی پروستات ﺑﺎ درﺟﻪ وﺧﺎﻣﺖ ﺗﻮﻣﻮر ﺑﺪﺧﯿﻢ ﭘﺮوﺳﺘﺎت

زمینه و هدف: سرطان پروستات دومین علت مرگ مرتبط با سرطان‌های مردان در جهان است. آنتی‌ژن اختصاصی پروستات (psa) از ﻣﻬﻤﺘﺮیﻦ ﻧﺸﺎﻧﮕﺮﻫﺎی ﺳﺮﻃﺎن ﭘﺮوﺳﺘﺎت بوده و ﺟﻬﺖ افزایش ویژگی و ﮐﺎﻫﺶ ﺑﯿﻮﭘﺴﯽ‌ﻫﺎی ﻏﯿﺮﺿﺮوری از پارامترهای وابسته به آن مانند زﻣﺎن دو ﺑﺮاﺑﺮ ﺷﺪن psa استفاده می‌شود. در ایﻦ ﻣﻄﺎﻟﻌﻪ ارﺗﺒﺎط ﻣﯿﺎن ایﻦ ﻓﺎﮐﺘﻮر و درﺟﻪ وﺧﺎﻣﺖ سرطان ﭘﺮوﺳﺘﺎت مورد بررسی قرار گرفت.روش بررسی: در ایﻦ ﻣﻄﺎﻟﻌﻪ گذشته‌نگر داده‌های افرادی که در فاصله زمانی سال‌های 1388 تا 1395 ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن اﻣﺎم‌ﺧﻤﯿﻨﯽ (ره) تهران مراجعه و تحت ﺑﯿﻮﭘﺴﯽ ﺗﺮاﻧﺲ‌رﮐﺘﺎل قرار گرفته بودند، گردآوری ﺷﺪ. زﻣﺎن دو ﺑﺮاﺑﺮ ﺷﺪن آنتی‌ژن اختصاصی پروستات (psadt) در اﻓﺮادی که دارای دو آزمایش متوالی سطح psa ﺑﺎ ﻓﺎﺻﻠﻪ زﻣﺎﻧﯽ ﺑﯿﺶ از ﺳﻪ ﻣﺎه ﺑودند، همچنین درجه ﮔﻠﯿﺴﻮن (gleason score) اوﻟﯿﻪ و ﺛﺎﻧﻮیﻪ در بیوپسی‌های ﻣﺜﺒﺖ از ﻧﻈﺮ سرطان ﻣﺸﺨﺺ ﮔﺮدیﺪ. سپس بیماران براساس نتایج پاتولوژی به دو گروه با گرید بالا و پایین تقسیم شدند.یافته‌ها: از ﻣﺠﻤﻮع ﺗﻌﺪاد 1712 ﭘﺮوﻧﺪه ﺑﯿﻮﭘﺴﯽ انجام شده در طی سال‌های 1388 تا 1396، 547 مورد (32/3%) دارای ﺳﺮﻃﺎن ﭘﺮوﺳﺘﺎت بودند که 73 ﻧﻔﺮ واﺟﺪ ﺷﺮایﻂ وارد ﻣﻄﺎﻟﻌﻪ شدﻧﺪ. با توجه به نتایج به‌دست آمده، میانگین psadt در افراد با درجه بدخیمی پایین 14/9±16/1 ماه و در افراد با درجه بدخیمی بالا 14/2±9/8 ماه بود. اختلاف معناداری بین دو گروه در psadt وجود داشت (0/004=p). fisher rsquo;s exact test اﺧﺘﻼف ﻣﻌﻨاداری ﺑﯿﻦ دو ﮔﺮوه بیماران از ﻧﻈﺮ ﻣﯿﺰان زﻣﺎن دو ﺑﺮاﺑﺮ ﺷﺪن هفت ﻣﺎه به‌دست آورد (0/01=p).نتیجه‌گیری: در مطالعه ما نقطه برش (cut-off point) هفت ماه با بیشترین درستی قادر به تمیز درجه بدخیمی بالا و پایین در بیماران بود.

Investigation of the relationship between prostate specific antigen doubling time and the severity of a malignant tumor of the prostate

Background: Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancerrelated mortality among men. Prostatespecific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSArelated parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated.Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasoundguided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with highgrade and lowgrade tumor (GS<7 considered as lowgrade and GS>7 considered as highgrade tumor).Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with highgrade and lowgrade malignancy (mean ±SD PSADT, 9.8 ±14.2 vs. 16.1 ±14.9 respectively, P=0.004). Considering the seven months as the cutoff point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).Conclusion: In our study, PSADT cutoff of 7 months provided the greatest accuracy for differentiation between lowgrade and highgrade malignancy, and PSADT has acceptable accuracy for the diagnosis of highgrade tumors.