SA检测在前列腺癌早期筛查中的重要性课件

ImportanceofprostatecancerearlymassscreeningusingPSA

PSA检测在前列腺癌早期筛查中的重要性

ShanghaiAilexMedicineCo.,LtdJiajunQin2009.08.AoLee，TaiwanTheprostateispartofthemalereproductivesystemItsmajorfunctionistosecreteafluidtonourishsemenduringintercourseTheprostateisaboutthesizeofawalnut，butitcangrowwithageItislocatedbelowtheurinarybladder,infrontoftherectumsurroundingtheurethra(thecanalforthedischargeofurinethatextendsfromtheurinarybladdertotheoutside)PCaOverviewProstateCancerBladderProstateGlandUrethraItisadisorderedandabnormalcellgrowthInprostatecancer,asinothertypesofcancer,cellsgrowoutofcontrolandformtumorsIfthetumoriswithinthegland,thecancerissaidtobelocalizedandcurableIfthecancerescapestheglanditisconsideredincurablePCa

(ProstateCancer)TheincidenceofPCaworld-wide,age-standardizedusingtheWorldStandardPopulation

QuinnMandBabbP.BJUInternational2002;90:162-173.TheinternationalincidenceofPCa:age-standardizedusingWorldStandardPopulationQuinnMandBabbP.BJUInternational2002;90:162-173.ComparisonofPCa’sMRandIRIncidenceRateMortalityRateMR:IR*World25.38.20.32NorthAmerica119.915.80.13Asia4.72.70.57China1.6

1.0

0.63JClinOncol2006;24:2137–50.MorbidityandMortalityRatesofPCa

increaseinChinaIn1985,theage-adjustedmorbidityandmortalityratesofPCainBeijingwere2.41and1.19/100,000malesrespectively.

In1995,theywere4.55and2.36/100,000

malesrespectively.InBeijing,

themorbidityrateofPCahasincreasedabout2.3timesfrom1985to1995.GuFangliu.ChineseJUrology1997,18(1):58~62.GuFangliu.JPracticalMedicine2000,16(12):977~8.DuShufa,etal.JHygieneResearch1997,26(5):356~9.

StandardizedIncidences(SI)ofPCainShanghai(1990-2000,1/100,000)ShaoCX,etal.ChineseJHealthStatistics2005,32:321ZhangW,etal.ChineseJCancer,2004,23:555.Tumor2003,23(6):532.RanksofurologicalcancersamongTop10malecancersinShanghai(1998-2000)

Cancer199819992000PCa997Bladder778Kidney>10>1010

ShaoCX,etal.ChineseJHealthStatistics2005,32:321ZhangW,etal.ChineseJCancer,2004,23:555.Tumor2003,23(6):532.Age-adjustedincidenceratesofPCainChinafrom1993-1997.SimH.G.andChengC.W.S.EurJCancer2005;41:834-845.ProstatecancerinChinesemigrants

CookL.S.etal.JUrol1999;161:152-155.DifferentMorbidityandMortalityamongChineseinDifferentAreas

ChineselivingindifferentareashavequitedifferentincidencesofPCa,withonehigherthananotherbyseveraltimes.FactorsInfluencingIncidenceofPCaRacialdifferenceEnviromentalfactorsDietaryintakeFatRedMeatVegetableSoyBean

CausesforLowIncidenceofPCa

inChineseMalesAsmajorconstituentofChinesediet,SoyproductscontainhighquantitiesofPhyto-estrogenthatcansuppresscancergrowth.LowfatandlowanimalmeatintraditionalChinesefoods.RelativelylongerCAGpolymorphicrepeatlengthforARgeneforChinesemales.ShorterCAGrepeatsareassociatedwithhigherincidenceandearlieronsetofPCa.ThePCaincidenceofChinese:Reallysolow?Reasons:Thepatientsinearlystageofprostatecancerdonotseethedoctorbecauseoflackingsymptoms;Traditionaldigitalrectalexaminationandimagemethodresultin100%stageAprostatecancermisseddiagnosis;Thereisnodifficultyinurinationinthepatientswith

Gleasonscore8-10,thediagnosiswouldbemadeby

routinephysicalexamination,thesepatientsaccount

for20%.

LiX.M.,ZhaoX.J.etal.InterUrol&Nephr.2004;36:541-548.TheprevalenceofPCaisnotsolowinChineseasreported!Earlydetectionbeforethecancerescapes

thegland

becomesveryimportant!Thetop10cancersinChinawere:lungcancer,stomachcancer,livercancer,colon/rectumcancer,esophaguscancer,Prostatecancerwasinadditiontothetop10cancer.

-----«YearbookofChineseJournalofClinicalOncology»2006,9Age-adjustedincidenceandmortalityofcancerinChineseAmericans

IncidenceMortalityMR：IR*

Prostatecancer*80.48.90.11

lungcancer*52.346.60.89

colon/rectumcancer*52.218.20.35

livercancer*23.319.90.85

stomachcancer*18.311.00.60FromtheCaliforniaCancerRegistry(2000–2002),CACancerJClin2007;57:190–205.MR/IR,mortality-to-incidencerateratio.WhatisPSA?PSAformexisting

inbloodFreePSAPSA-ACTComplexPSA-α2MComplex（noimmunoreactivity）TherelationshipbetweenPSAvalueandpositiveratiobybiopsyPSA值(ng/ml)活检阳性率(%)PSA

threshold4.0ng/mlPercentagesofBPHandPCapatientsindifferentPSAlevel(BPH=810,PCa=103)

TPSA(ng/ml)<44-10>10

BPH%(n)71.7(581)22.1(179)6.2(50)

PCa%(n)10.7(11)17.5(18)71.8(74)

ZhouL.Q.,etal.ChineseJUrol,2002,23(6):354.CausesforIncreaseofMorbidityandMortalityRatesofPCainChina

ThelifespanofChineseincreasesto70yrsformaleand74yrsforfemale.Thediagnosticlevelisincreased.ChinesedietisrelativelywesternizedwithdevelopmentofChinaeconomy.BriefSummary

ChineselivingindifferentareashavequitedifferentincidencesofPCa,withonehigherthananotherbyseveraltimes.ThequickincreaseofPCaincidenceofChinesemenisduetolongerlifespan,theincreaseddiagnosticlevelandwesternizedChinesediet.Diet,enviromentfactorsmayhavesomeeffectsonPCa.死亡率减少36%JemalA,etal.Cancerstatistics,2009.CACancerJClin,inpress.PCaCancermortalitytrendofUS（Male）VarianceofdeathtollfromPCa,betweenUSandJapan（people）（year）About3times约10倍的差USJapan厚生劳动省人口动态统计年报・美国癌登录

Japan

USPositiverateofscreening 5-10% 70-80%Metastatic

PCa

about30%

≤5%ThedifferenceofPCascreeningrateandmetastaticPCamorbilitybetweenJapanandUS20%PCamortality

candecreasedbyPSA

screening

！VarianceofPCamortalityinTyrol,Austrinia根据PSA・直肠诊断PCa免费提供PSA诊察2005年的实测死亡率比预测值降低了54%（人）（年）（黒石哲生、他：日本のがん死亡の将来予測．がん・統計白書―罹患/死亡/予後―2004（大島明、黒石哲生、田島和雄、編）、pp219-234、篠原出版新社、2004．）AnticipationofdeathtollfromPCaUSAJapanHowdoesearlyPSAdetectionhelp?Survivalrateat5yearsis99%forthosewhosecancerisstilljustintheprostategland(localized);Survivalrateat5yearsforthosewhosecancerhasspreadbeyondthegland(latediagnosis)isonly31%.Uptonow,PSAplaysanimportantroleinmassscreeningforPCa.Age-specificreferencerangeofPSAWhichisthebetterPSAstandard・・・・各年龄段相同的标准值各年龄段不同的标准值・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・Age-adjustedPSA

threshold,recommendedbyJapaneseurologicalinstituteAge

standard50-64 3.0ng/ml65-69 3.5ng/ml≥70 4.0ng/ml(ItoK,etal.Urology56,2000)ExperientialPSAthresholdManydoctorsarenowusingthefollowingrangeswithsomevariations:0-2.5islow;2.6-10isslightlyelevated;10-19.9ismoderatelyelevated;

≥20issignificantlyelevated.HowtogetareliablePSAreferencestandard?OurmassscreeningplanforPCaCooperatewithAcademicianGuoYinlu（郭应禄）,ProfZhaoXuejian（赵雪俭）etc,

applynationalresearchprojectaboutPSAscreening;CarryoutPSAscreeningprojectinpartnerhospitals;Reportallexperimentdatatocorrelativeorganization,becausethisvaluabledatacanbeusedtoemendPSAreferencethreshold.PCaScreeningflowAge＞45yearsPSAdetectionAge-adjustedPSAthresholdAbnormalNormalDREPSA≤1.0ng/mL：3yearslaterPSA1.0～4.0ng/mL：1yearlaterTRUS-guidedbiopsyDREetc.

Whatequipmentwe’lluseinPSAscreening?

省钱

省时

省力

省心

AIA

(AutomatedImmunoassayAnalyzer)1.LyophilizedReagentsTheuniqueimmunelyophilizedReagentsoftheworld!试剂有效期达一年一次定标三月有效

AdvantagesOfAIA2.Three-In-OneReagentCupＰＡ５５固相抗体酶标抗体铝珀纸(项目,批号)缓冲液粉末

3.Top-TopDetectingMethod

TraditionalMethodTop-TopMethod

4.Dual-WavelengthDetectingSystemS为主波长(4MU),R为补正波长(内部标准荧光物质)5.TransformVelocityIntoConcentrati