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Aktuelle Urol 2007; 38(2): 137-143
DOI: 10.1055/s-2006-944308
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Beeinflusst das „Blutplasmavolumen” die Validität von PSA-Tests?

Theoretische Überlegung und klinische DatenanalyseDoes Plasmatic Dilution Influence the Validity of PSA-Tests?Theoretical Considerations and Clinical DataD.  Rohde1, 2, 3 , V.  Mihelcic2
  • 1Urologische Klinik, Klinikum Darmstadt
  • 2Universitätsklinikum Aachen, Urologische Klinik (ehedem)
  • 3J. W. Goethe Universität, Fachbereich Medizin, Frankfurt/Main
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Publication History

Publication Date:
28 March 2007 (online)

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Zusammenfassung

Fragestellung: Lässt sich die Validität eines PSA-basierten Tests verbessern, indem die gemessene Serumkonzentration um den Verdünnungseffekt des individuellen Blutplasmavolumens Vp (oder anderer Körperflüssigkeitsvolumina) korrigiert wird? Materialien und Methoden: Retrospektive Datenanalyse an Patienten mit Prostataadenomektomie (n = 32) oder radikaler Prostatektomie (n = 60) (pT1 - 4 N0 M0). Berechnung von PSA-Density (PSAD) und zwei neuen PSA-basierten Parametern, die das individuelle Vp (nach der von Sprenger modifizierte Retzlaff-Formel) als Korrekturfaktor des t-PSA berücksichtigten (mPSAVp, mPSADVp). Analyse der Testvaliditäten von t-PSA, mPSAVp, PSAD und mPSADVp (ROC-Kurvenanalyse, Sensitivität, Spezifität, positiver (PPV) und negativer (NPV) Vorhersagewert). Ergebnisse: Tumorstadium und PSA-Werte waren positiv korreliert. Bezogen auf den gesamten t-PSA Bereich (n = 92; 0,1 - 88,4 µg/l) war die Trennschärfe von PSAD (AUC = 0,803) und mPSADVp (AUC = 0,806) signifikant besser (p ≤ 0,003), als von t-PSA und mPSAVp (AUC = 0,531), um zwischen P-CA und BPH zu unterscheiden. Im Graubereich (4,0 - 10,0 µg/l) diskriminierten t-PSA (AUC = 0,663), mPSAVp (AUC = 0,694) und PSAD (AUC = 0,931) als Test grundsätzlich besser; mPSADVp ergab die höchste AUC (0,947). Die Korrektur um Vp ergab damit insgesamt tendenziell bessere AUC-Werte, ohne dass (bisher) Signifikanzniveau erreicht wurde. Schlussfolgerungen: Die Berücksichtigung von Volumina ist der plausibelste Weg, um die Testvalidität von t-PSA zu steigern. Eine präoperativ verbesserte Bestimmung des Prostatavolumens und seiner benignen und malignen Partialvolumina, sowie eine exakte Berechnung der individuellen Verteilungsvolumina für das t-PSA Molekül im Organismus könnten helfen, die Trennschärfe des t-PSA zu optimieren und kurable Karzinome frühzeitig(er) zu entdecken.

Abstract

Purpose: The aim of this study is to improve the validity of PSA-based tests by considerations of the dilutions caused by the individual plasmatic blood volume (or other relevant body fluids). Materials and Methods: Retrospective analyses of patients who underwent adenomectomy (n = 32) or radical prostatectomy (pT1 - 4 N0 M0; n = 60) were carried out. We calculated the PSA density (PSAD) and two new PSA-based parameters (mPSAVp, mPSADVp) that converted t-PSA concentration and PSAD with regard to individual Vp (according to Sprenger's modified Retzlaff formula). Comparative statistics of receiver operating characteristics (ROC-) curves, AUC, sensitivity, specificity, positive and negative predictive values for t-PSA, mPSAVp, PSAD and mPSADVp were performed. Results: PSA was positively correlated with local tumour stage. With regard to the whole range of t-PSA (n = 92; 0.1 - 88.4 µg/L) the diagnostic selection between prostate carcinoma (CaP) and benign disease (BPH) was significantly improved by PSAD (AUC = 0.803) and mPSADVp (AUC = 0.806) (p ≤ 0.003) compared to t-PSA und mPSAVp (AUC = 0.531). Within the range of 4.0 - 10.0 µg/L PSA, the areas under the ROC curves were much better for t-PSA (AUC = 0.663), mPSAVp (0.694) and PSAD (0.931) in gereral; mPSADVp provided the best AUC (0.947). However, although considering Vp does demonstrate better AUCs, this tendency does not reach the level of significance (yet). Conclusions: The most conclusive way to improve PSA test validity is to adjust PSA to different “volumes”. Therefore, elaborated devices for a better preoperative investigation of the whole volume of the prostate gland and its distinct partial volumes (such as carcinoma or benign tissues), as well as applied knowledge on the distribution and kinetics of PSA in body fluids, might substantially help to optimise the detection of curable patients with unknown carcinoma of the prostate.

Schlüsselwörter

Prostatakarzinom - PSA - ROC-Kurven - Sensitivität - Spezifität - Testvalidität

Key words

carcinoma of the prostate - ROC curves - PSA - sensitivity - specificity - test validity

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Priv.-Doz. Dr. Detlef Rohde

Klinikum Darmstadt Urologische Klinik

Grafenstr. 9

64278 Darmstadt

Phone: 06151-107-6985

Email: detlef.rohde@klinikum-darmstadt.de