Y HQC V | £ T NAM THANG 8 - SO D A C BIET / 2013
NGHIEN cCnj MOT SO YEU TO ANH HUONG DEN NONG DO PSA d B$NH NHAN TANG S A N LANH TINH TUYEN TIEN LIET D l i u TRj TAI KHOA NGOAI TIET NIEU BENH VIEN DA KHOA T I N H THAI BINH
Vu Sffn', Tran Van Nam^
TOM TAT:
€)at van die & muc t i e u : ngoai ung t h i / tuyen tien liet ( T H ) , cdn cd mpt so benh khac cua TTL cQng lam tSng nong dp PSA. Vi ly do neu tren, chung tdi nghien cdXi de tai nay nham muc tieu: 1/xac dmh ndng dp PSA d nhuTig benh nhan du'dc phau thuat tSng sinh lanh tinh tuyen tien liet tai benh vien Oa khoa tinh Thai Binh; 2/tim hieu mpt so yeu to anh hu'dng den nong do PSA d nhu'ng benh nhan tang sinh lanh tinh tuyen tien liet dieu tri tai benh vien Da khoa tinh Thai Binh.
Doi tu'dng & phu'dng phap: nghien cuTu cat ngang cd phan tich 109 tru'dng hdp du'dc phau thuat vdi chan doan tru'dc mo va ket qua giai phau benh ly la tang sinh lanh tinh TTL.
Nhuhg tru'dng hdp ung thu" TTL, hoac nghi ngd ung thu'TTL du'dc loai bd khdi nghien cOru nay.
Ket qua nghl§n cihi: gia tri trung binh PSA: 11,8 ± 15,5 ng/ml; gia b i trung binh PSAD:
0,18 ± 0,15. Tu'dng quan Spearman cho thay nong do PSA cd mdi tu'dng quan thuan chat che vdi khoi lu'dng tuyen b'en liet (r = 0,46; p <
0,001). Tinh trang tang sinh lanh tinh TTL cd kem theo viem TTL lam tang nong dp PSA, s i / khac biet cd y nghTa thdng ke vdi OR = 3,7; Q : 1,5 - 8,9; p < 0,05. Tinh trang nhiem khuan nu'dc tieu lam tang nong do PSA, su" khac biet cd y nghia thong ke vdi OR = 3,3; Q : 1,4 - 7,9; p < 0,05.
Tinh trang bi tieu cap ti'nh phai dat thdng tieu lam tang nong do PSA, sif khac biet cd y nghia thong 'DgiKocY Thai Binh
' Benh vi^n Da khoa Tinh Thai Binh Phkn bi?n khoa hpc: PGS.TS. Tran Van Hinh
ke vdi vdi OR = 2,5; CI: 1,1 - 6,3; p < 0,05. Tuoi ddi cua benh nhan anh hu'dng khong ro rang den nong dd PSA, sii khac biet khdng cd y nghTa thong ke vdi vdi p_trend > 0,05.
Ket l u | n . 1/Ve nong dd PSA toan phan:
Nong dp PSA toan phan trong huyet thanh cao hdn mu'c binh thu'dng. Gia t n trung binh nong dp PSA la 11,8 ± 15,5 ng/ml. Hau het ddi tu'dng nghien cu'u cd PSAD du'di 0,57 (chiem 96,3 % ) ; gia trj trung binh PSAD la 0,18 ± 0,15. 2A/e anh hu'dng ciia mdt so yeu to den nono dd PSA toan phan; tuoi ddi cua benh nhan anh hu'dng khong rd rang den su" thay ddi nong dp PSA (su' khac biet khdng cd y nghTa thong ke vdi p > 0,05);
khoi lu'dng TTL tang, viem tuyen ben liet, nhiem khuan nu'dc tieu, tinh trang dat thdng tieu la nhu'ng yeu td lam tang nong dp PSA (sif khac biet cd y nghia thong ke vdi p < 0,05).
Tu" khoa: tang sinh lanh tinh tuyen tien liet, khang nguyen dac hieu tuyen tien Net.
S U M M A R Y
STUDY ON SOME FACTORS RELATED TO PSA LEVELS IN PATIENTS WITH BENIGN PROSTATIC
HYPERPLASIA TREATED AT THAI BINH PROVINCE GENERAL HOSPITAL Introduction & objective: In addition to prostate cancer, a number of other prostate diseases can also increase PSA levels. For that reason we studied with the aim to: 1/determine the concentration of PSA in patients undergoing
183
Hpl NGH! KHOA HQC L A N THCf VII, H 6 | TlfeT NigU - T H A N HQC VI$T NAM (VUNA) surgery benign hyperplasia of prostate at Thai
Binh Province General Hospital; 2/ldentify several factors affecting PSA levels in patients with benign hyperplasia of prostate treated i r Thai Binh Provincial General Hospital.
Patients & m e t h o d : t h e cross-sectional study on 109 cases with preoperative and pathology diagnosis as benign hyperplasia of prostate in urological surgery. Cases of prostate cancer or suspected prostate cancer were excluded from this study.
Results: the average PSA: 11.8 ± 15.5 ng / ml; the average PSAD: 0.18 ± 0.15. Spearman correlations showed that PSA levels correlated closely with the prostate volume (r = 0:46, p
<0.001). Benign hyperplasia of prostate combined with prostatibs increases PSA levels (Statistically difficult with OR = 3.7, Q : 1.5 - 8.9, p <0.05).
Urinary tract infection increases PSA levels (Statistically different with OR = 3.3, CI: 1.4 - 7.9, p <0.05). Status of acute urinary retention that needs for catheter insertion causes an increase of PSA levels (Statistically different with OR = 2.6, a ; 1.1 - 6.3, p <0.05). Age of affected patients did not affect clearly the PSA levels (the difference was not statistically significant with the p > 0.05).
C o n c l u s i o n : 1/The total serum PSA:
concentration of total serum PSA is higher than normal. The average PSA concentration is 11.8 ± 15.5 ng/ml; most of the study subjects has PSA density lower ttian 0:57 (96.3%). The average PSA density is 0:18 ± 0:15. 2/Influence of some factors related to total PSA levels in serum: age affectse not clearly the change of PSA concentration (the difference was not statistically significant with p > 0.05). increasd prostate volumed, prostatitis, urinary tract infections, catheter insertion are factors that increase PSA
levels (the difference is statistically significant with p<0.05).
Keywords: Benign prostatic hyperplasia (BPH); prostatic specific antigen (PSA).
I- O A T V A N OE
NhfJng nam gan day ngudi ta coi dinh luong PSA (prostatic specific antigen) trong huyet thanh la mdt ky thu^t hihi hieu de phat hi?n sdm ung thu tuyen tien liet [10]. Tuy nhien, ngoai ung thu tuyen tien liet (TTL), cdn cd mpt sd benh khac cua TTL cQng lam tang ndng dp PSA [4]. [8], [9]. Tai khoa Ngoai tiet nieu benh vien Da khoa tinh Thai Binh chung tdi nhan thay hau het cac benh nhan ducrc chan doan tSng sinh lanh tinh TTL cd ndng dp PSA cao hem binh thudng. Vi ly do neu tren. chiing tdi nghien ciru de tai nay nham muc tieu:
1. Xac dinh ndng dp PSA d nhung benh nhan duac phau thuat tang sinh lanh tinh tuyen tien Het tai benh vien Da khoa tinh Thai Binh.
2. Tim hieu mot sd yeu td anh hudng den ndng dp PSA 6 nhimg benh nhan tang sinh lanh tinh tuyen tien liet dieu tri tai benh vien Da khoa tinh Thai Binh.
II- o 6 l TUONG VA PHJONG PHAP NGHIEN CCrU
Nghien curu cat ngang cd phan tich 109 trudng hpp ducrc phau thuat vdi chan doan trudc md va ket qua giai phdu benh ly la tang sinh lanh tinh TTL, tai khoa ngoai Tiet nieu benh vien Da khoa tinh Thai Binh tir 4/2012 den 4/2013. Nhihig trudng hgp ung thu TTL, hoac nghi ngd ung thu TTL duac loai bo khdi nghien cuu nay.
Y HQC VI$T NAM THANG 8 - SO OAC BIET / 2013 III- KET Q O A N G H I E N CCTU
3.1. Xac dinh nong do PSA cua nhdm phau thuat
Bang 1: Ndng dp PSA cua nhdm phau thuat (n = 109) Nhom nong do PSA
< 4 nq/ml 4nq/ml den < 10 nq/ml
> 10 nq/ml
[ 1 1
Tonq 1 n 31 35 43 109
»/o 28,4 32,2 39,4 100 I Gia hi tmng binli ndng dp PSA: 11.8 ± 15.5 ng/ml; Ndng dp PSA thap nhat: 0,34 ng/ml; Ndng ap cao nh4t: 100 ng/ml; Nhdm cd ndng dp PSA>10 ng/mi la 43 trudng hop (39.4%).
Bang 2: Ty trpng PSA cua nhdm phau thuat ( n = 109) Nhom PSAD
<0,15
>0,15 den < 0,21
> 0,21 - < 0,57
>0,57
Tonq
n 58 10 37 4 109
«/o 53,2
9,2 33,9 3,7 100,0 Hau het doi tu<?ng nghien ciru co PSAD dual 0.57 (chiem 96,3 % ) ; Gia tri trung binh PSAD: 0,18 ± 0.15; PSAD thjp nhjt: 0.001 ng/ml; PSAD cao nhit: 0,90; Co 2 tnicmg hgp tPSA 100 ng/ml. nhimg PSAD la 0.8 va 0.9.
3.2. Yeu to lien quan den nong do PSA ciia nhom phau thuat Bang 3 : Anh huong ciia the tich TTL den nong do PSA (n = 109)
N
Nong do PSA toan phan
Gia tri trunq binh Thap nhat
4.0±3.2 1.60
< 0,001 21.9±24.1
11.9±15.5
The tich tuydn ti^n liet cang tSng thi nong do PSA toan phan trong huyet thanh cang cao, sir khac biet co y nghia th6ng ke voi p < 0,001.
Bang 4: Anh huong ciia tinh trang viem TTL den nong do PSA (n ^ 109)
K£t qua GPBL
Co viem Khonq viem
n
49 60
Nonq do PSA (ng/ml)
> 10 < 10 S.lutinq j % is.iironq ' %
28 , 57,1 1 21 1 42,9 16 i 26,7 , 44 1 73,3
OR [95»/oCI)
3,7 [1,5-8,9]
P
0,001 1 1 Co 49 tmong hop (chi^m 45.0 %) tang sinh lanh tinh TTL kem theo xam nhap viem;
Tinh frang tang sinh lanh tinh TTL co kem theo viem TTL lam tang nong do PSA. su khac biet CO y nghTa th6ng ke vai OR = 3.7; CI: 1.5 - 8.9: p < 0.05.
185
Hpl NGHI KHOA HQC L-AN THCf VII, Hpl TigT NlgU - THAN H(?C VigT NAM (VUNA) Bang 5: Anh hir6ng cua tinh
Nhiem khuan Nu'dc tieu
C6NK Khong NK
n 46 63
trang nhilm kliuin ni?u den PSA (n = 109).
PSA (ng/ml)
£ 10 S.lutlng
26 18
%
56,5 28,6
< 10 S.iuanq
20 45
%
43,5 71,4
OR [951/001]
3,3 11,4-7,91
P
0,003
C6 46 tnrdng hgp nhilm khuSn nude tieu khi vto vi^n (chiem 42,2 %), nhiing truong h(ip niy dugc dilu trj din khi \6t nghi$m l?i hit tinh trang nhiem khuin mcri tiln hanli phau thii|t.
Tinh tr^g nhiem khuan nu6c tieu lim tang n^ng do PSA, s\r kh^c bi$t co y nghTa thing ke vdi OR = 3,3; CI: 1,4 - 7,9; p < 0,05.
Bang 6:
eat
thong tieu Co dat Khonq dat
Anh hirdng ciia tinh trang da n
40 69
thong tieu den PSA Nong do PSA (ng / ml)
> 10 S.iuanq
22 22
%
55,0 31,9
< 10 S.iuanq 1 %
18 45,0 47 1 68,1
( n = I 0 9 ) . OR [95»/oCI]
2,6 [1,1-6,3]
P 0,017 Khi vao vien cd 40 tnrdng hc^p (chilm 36,7 %) bi bi dai cjp tinh phii dat thong tilu dl &
lim nude tilu tam thdi, Tinh trang bi tieu cap tinh phai dat thdng tieu lam tang ndng do PSA, su khac biet cd y nghTa thdng ke vdi vdi OR = 2,6; CI: 1,1 - 6,3; p < 0,05.
Bang 7: Anh Nhom tuoi
<70 70 - < SO
>80
hudng tuoi ddi cua b n
38 48 23
enh nhan de n ndng dp PSA (n = 109).
Nonq do PSA (na / ml)
> 10 S.lu'anq
8 24 12
%
21,1 50,0 52,2
< 10 S.IUdng
30 24 11
%
78,9 50,0 47,8
P
0,87 Gia trj trung binh tudi ddi nhdm phlu thuat: 72,5 ± 7,4; Tudi thdp nhit: 57; Tu6i cao nhat: 90; Nhdm tudi 70 - 80 chilm ty le cao nhit (chilm 44,0 %); Tudi cua benh nhan anh hudng khong rd rang din ndng do PSA, sir khac bi?t khdng cd y nghTa thdng ke voi vcri pjrend > 0,05.
IV- BAN LUAN
4.1. Xac djnh nong dp PSA
Theo nghien cim cua Trin Vilt Ti?p, nong dq PSA huylt thanh d nhOng b?nh nhan tang sinh lanh tinh TTL cd chi djnh phau thujt cao hon mirc binh thudng li kha phd biln (61%) [3]. Theo mot s6 nghien cim trong nude vi nude ngoai, nong dg PSA toan phan (tPSA) d ngudi binh thudng < 4 ng/ml;
neu tPS A > 10 ng/ml, nghi ngd ung thu TTL, cin phai dugc sinh thiit dl loai trir; nlu tPSA trong khoang 4ng/ml din < lOng/ml dirpc gpi la "viing xam" [1],
Kit qua nghien cihi trinh bay tai bang 1 cho thiy: Gia trj trung binh tPSA la 11,8 ± 15,5 ng/ml; thip nhit la 0,34 ng/ml; cao nUt la 100 ng/ml; nhdm cd ndng do tPSA tren 10 ng/ml la 43 tnrdng hgp (chilm 39,4 %). Neu
Y HOC VrfiT NAM THANG 8 - s 6 OiSiC BIET / 2013
chi dua vao n6ng do tPSA trong huy^t thanh, thi trong nghien cuu nay co toi 43 tru£mg hgp (PSA > 10 ng/ml) can phai dugc chpc sinh thiSt dk chan doan phan biet ung thu TTL.
Chiing toi kh6ng co dieu ki^n choc sinh thidt, nhung khi tham true trang khong thay dau hi§u chi diem ung thu TTL (trucmg hgp ung thu TTL, nghi ngof ung thu TTL d3 dugc Ioai khoi nghien cuu nay), do do van dugc chi dinh phSu thuat, ket qua giai phau b?nh ly phin mo TTL c3t bo cua nhung tru6ng hgp nay dSu la tang sinh lanh tinh.
N6ng do tPSA lien quan toi the tich TTL trong tang sinh lanh tinh TTL do tren sieu an) da dugc nhieu nghien cuu khang djnh, gia tri nay con de xac djnh ty trgng nong do PSA/
thg tich TTL (PSA density - PSAD). Theo Benson va Nishiya thi PSAD: 6 ngu6i binh thu&ng la < 0,15; 6 nhung trucmg hgp tang sinh lanh tinh TTL la 0,218 ± 0,085; 6 nhimg truang hgp ung thu TTL la 0,572 ± 0,363 [7].
Theo nghien cuu ciia Do Thi Khanh Hy, Ngucri Viet Nam neu PSAD cao hon 1, nen sinh thiet de chan doan phan biet vai ung thu TTLfl],
Ket qua tai bang 2 cho thay: Hau het doi tugng nghien cuu co PSAD duoi 0,57 (chiem 96,3 %); gia tn trung binh PSAD la 0,18 ± 0,15; thap nhat la 0,001 ng/ml; cao nhat la 0,90; CO 2 truang hgp PSA toan phkn Ik 100 ng/ml, nhung ty trgng PSA la 0,8 va 0,9. Nhu vEiy, neu theo khuyen cao cua Do Thi Khanh Hy, thi trong nghien ciiu nay kh6ng truong hop nao nhdt thiit phai choc sinh thiet de chdn doan phkn biet. Thuc te tat ca cac doi tugng nay deu co kSt qua giai phau benh ly ia tang sinh lanh tinh (kit qua hinh bay tai bang 4).
Tom lai, trong nghien cuu nay, hau het doi tugng nghien cuu co nong dg PSA toan phan trong huyit thanh cao ban binh thuang.
Nhung CO ty trgng PSA trong giai han cua benh ly tang sinh lanh tinh TTL.
4.2. Tim hieu anh hirdng cua m9t so yeu to den nong dg PSA
Theo Zentner PG, n6ng do PSA tang trung binh 3,5 ng/ml cho mgt gam mo ung thu TTL, tang trung binh 0,3 ng/m! cho mot gam mo tang sinh lanh tinh TTL [10]. Theo Marks L. S, nong dp PSA cung tang theo th§
tich TTL [7]. NhiJng nghien cuu nay dSu co chung mgt ket lu^n do la nong dp PSA dSu tang len theo the tich TTL. Thk tich trung binh TTL truac mo cua cac nghien cuu co xu huong mo rgng len theo thoi gian. Theo thong ke cua Vu Son, mpt so nghien cihi trong nuoc cho thay gia tri trung binh nay trong khoang 30 - 80 cm3 [2].
Ket qua nghien ciiu trinh bay tai bang 3 cho thay: Nong dp PSA tang len theo the tich TTL (sir khac biet co y nghTa thong ke voi p
< 0,001)
Nhu vay, th8 tich TTL la mgt trong nhiing ySu to anh huong toi nong dp PSA toan phdn. The tich TTL tang thi nong do PSA toan phan ciing tang.
Theo Brawar MK, Hasui Y, viem TTL tiem tang dugc phat Men qua sinh thiet tuyen ti§n liet co ve nhu khong lien quan toi nong do PSA huydt thanh. Theo Irani va cgng su, viem TTL tidm tang chi lien quan toi PSA khi viem pha hiiy cac te bao mo tuyen. Theo Nickel JC, viem TTL tilm tang khong lien quan gi voi n6ng dp PSA huyet thanh [6].
Ngugc lai co nhieu nghien cuu Iai cho thdy viem TTL tilm tang co lien quan din n6ng dp PSA huylt thanh. Viec sang Igc viem TTL tilm tang 6 nhung benh nhan co n6ng do PSA huylt thanh cao se giup lo^i bo viSc sinh thiit TTL mgt each khong cdn thiit [8]. Theo Guercio S, dilu tri bdng Levofloxacin frong vong 20 ngay cho nhung truang hgp viem
187
Hpl NGHI KHOA HOC LAU THIJ VII, Hpl TigT NlSU - THAN HQC VI$T NAM (VUNA) TTL loai IV, da lim giim ndng dg PSA han
mpt nira so vdi trudc khi dieu trj [5].
Ket qui nghien ctiu trinh biy tai bang 4 cho thay: Ndng dg tPSA d nhdm lilng sinh linh tinh TTL kem theo viem TTL cao hgn d nhdm tang sinh linh tinh TTL khdng kim theo viem TTL, sy khic bi?t cd y nghTa thong ke vdi OR = 3,7; CI: 1,5 - 8,9; p <
0,05.
Nhu vay. viem TTL la mgt trong nhihtg ylu td inh hudng tdi ndng dg PSA toin phan. Nhimg trudng hgp cd viem TTL thi ndng dg PSA toan phan s6 cao hon nhO-ng trudng hgp khdng cd viem TTL.
ICet qui nghien ciru trinh bay tai bang 5 cho thiy: Ndng do PSA d nhdm benh nhan cd nhiem khuan ni?u cao hon d nhdm benh nhan khdng cd nhiem khuin nieu, sir khac biet cd y nghTa thdng ke vdi OR = 3,3; CI:
1,4 - 7,9; p < 0,05.
Nhu vay, nhiem khuin nieu la mgt trong nhimg yeu tl inh hudng tdi ndng do PSA toan phan. Nhimg trudng hgp cd nhilm khuin nieu thi ndng do PSA toin phin se cao hon nhimg trudng hgp khdng nhiem khuin nieu.
Nghien ciin cua Do Thj KhiSnh Hy, do nong dg PSA cho 32 benh nhan trong thdi gian dang va sau dit thdng tilu din luxi nude tilu trong tnrdng hgp bi dai, thiy ndng do PSA tir 13,6 ng/ml giim tdi tren 50% dl cdn 6,0 ng/ml. Day la dilu phii luu y khi do ndng dp PSA [1].
Trong nghien cim nay, xet ngiem ndng dg PSA dugc thuc hien ngay trong 24 gid dau khi nhap vien. Kit qui nghien cim trinh biy tai bang 6 cho thiy: Ndng dg PSA d nhdm benh nhan cd dat thdng tilu cao hon d nhdm benh nhan khdng dat thdng tilu, sir khic biet cd y nghTa thdng ke vdi vdi OR = 2,6; CI: 1,1-6.3; p< 0,05.
Nhu vay, dit thdng tieu la mdt trong nhung yeu td anh hudng tdi ndng dp PSA toan phan. Nhihig trudng hgp cd dat thong tilu thi nong dg PSA toin phan se cao hon nhirng trucmg hgp khdng dit thdng tilu.
Theo Do Khinh Hy, ndng do PSA 6 ngudi binh thudng tang dan theo nhdm tu6i:
45-59 tudi li 0,89 ± 0.75 ng/ml; 60-74 la 1,68 ± 0,63 ng/ml; tir 75 tudi trd len la 2,12 i 0.79 ng/ml [I J.
Ket qui nghien ciru trinh bay tai bang 7 cho thay: Tudi ddi cua benh nhan anh hudng khdng ro ring den ndng do PSA, su khic biet khdng cd y nghTa thdng ke vdi ptrend >
0,05. Sd dl cd sir khac nhau giiia kit qui ciia nghien ciru niy vdi mdt sd nghien ciiu da neu, theo chiing tdi, dd la do each chpn mau nghien ciiu cd sir khac nhau. Cic nghien ciru tren chgn mau nghien ciiu li chgn theo tuii ddi, cdn trong nghien cuu niy chgn mau theo chi dinh diiu trj (nhdm benh nhan dugc phlu thuat).
Nhu vay, trgng nghien ciiu nay, mdi doi inh hudng khdng rd rang din ndng dp PSA toan phan.
V- KET LUAN
Nghien ciru 109 trudng hgp dugc phau thuat vdi chin dgin trudc md va kit qui giai phiu benh ly la ting sinh lanh tinh TTL tai khoa ngoai Tilt nieu benh vien Da khoa tinh Thai Binh chung tdi rut ra mdt sd kit luan sau:
1. Ve nong do PSA toan phan - Ndng do PSA toin phin trong huylt thanh cao hem mirc binh thudng. Nong do PSA cd gia trj trung binh li 11,8 ± 15,5 ng/ml; thip nhit la 0.34 ng/ml; cao nhit la 100 ng/ml. Nhdm cd ndng do PSA tren 10 ng/ml li 38.5%.
Y HOC VlfiT NAM THANG 8 - SO D A C BIET / 2013 - Hau het doi tugng nghien cuu co
PSAD duai 0,57 (chilm 96,3 % ) ; PSAD co gia tri trung binh la 0,18 ± 0,15; thap nhdt la 0,001 ng/ml; cao nhdt la 0,9.
2. Ve anh hyorng cua mgt so yeu to den n^ng do PSA toan phan
Tuoi dai cua benh nhan anh huong khong r6 rang den su thay doi nong dp PSA (su khac biet khong co y nghTa thong ke voi p>0,05).
- The tich TTL tang; Viem tuyen tien liet; Nhiem khuan nuac tieu; Tinh trang dat thong tieu la nhirng yeu to lam tang nong do PSA (su khac biet co y nghia thong ke voi p
<0,05).
TAI LIEU THAM KHAO
1. D6 Thi Khanh Hy (2003) "Nghien cuu mpt so dac diem dich te hpc cua u tuyen tien liet va danh gia vai tro ciia PSA huyet thanh trong chan doan va tien lugng benh"; Luan an Tien sy Y hpc; Ha Ngi;
2003.
2. Vu SoTi (2011) "Nghien cim dac diem dich te va ket qua phau thuat npi soi tang san lanh tinh tuyen tien liet dugc dieu tra tai thai binh"; Luan an Tien sy Y hgc; Ha Ngi; 2011.
3. Iran Van Tiep (2007) "Nghien cuu viem nhiem tiem tang tuyen tien liet tren benh nhan phau thuat npi soi u tang san lanh tinh tuyen tien Het"; Luan an Tien sy Y hpc; Ha Npi; 2007.
Babaian, R.J, Evans, R.B.Miyashita, H. and Ramirez, E.I (1991) "The distrubution of PSA in a normal population :ReIationship to gland volume and age". J.Urol. 145;381A.
Guercio S, Tcrron C, Tarabuzzi R (2004) "PSA decrease after levofloxacin therapy in patients with histological prostatitis"; Arch Ital Urol Androl, Dec 76(4): 154-158.
Nickel J.C, Downey J, Young I and Boag S (1999) "Asymtomatic inflamation and/or infection in benign prostatic hyperplasia"; British Journal of urology,84: 976-981.
Oesling J.E., Kumamoto Y., Tsukamoto T., Girman C J , Guess H.A. et al (1995)
"Serum prostate specific antigen in a community based populatinon of healthy Japanese man: lower values than for similarly aged white men"; Br J Urol 1995 Mar, 75 (3) :347-53.
Stancik I, Luftenegger W, Klipfmger M (2004) "Effect of NIH-IV prostatitis on free anf free-to-total PSA'"; Eur Urol, Dec 46(6): 760-764.
Zentner PG, Pao LK, Benson MC, et al. (1993) "Prostate specifm antigen density: a new prognostic indicator for prostate cancer"; Int J Radiat Oncol Biol Phys. 1993 Sep 1; 2 7 ( 1 ) : 4 7 - 5 8 .
