摘要
目的探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)和前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义.方法对192例患者行前列腺穿刺活检,其中PSA≥4 ng/ml者184例,PSA＜4 ng/ml且直肠指诊及经直肠B超有阳性发现者8例.对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析.结果192例患者中经前列腺穿刺诊断为前列腺癌(PCa)100例,活检阳性率52.1%,其中8例PSA＜4 ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,良性前列腺增生7例;93例PSA＞20 ng/ml者中80例为PCa,活检阳性率86.0%;91例PSA 4～20 ng/ml者中19例为PCa,活检阳性率20.9%.血清PSA 4～20 ng/ml患者,PSAD＞0.10或PSAT＞0.10时,敏感性均为100%,特异性为11.1%或4.2%,阳性预测值为22.9%或21.6%,可避免8.8%(8/91)或3.3%(3/91)阴性穿刺结果.血清PSA 4～20 ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为(13.2±4.7)和(11.4±4.6)ng/ml(P＞0.05);PSAD分别为0.36±0.18和0.19±0.09(P=0.001);PSAT分别为0.67±0.36和0.32±0.18(P=0.000).血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.613、0.810和0.833,PSAD和PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P＜0.05). 结论PSA＞20 ng/ml时应做前列腺穿刺活检;PSA 4～20 ng/ml时,PSAD和PSAT对预测患者是否行前列腺穿刺活检有较大帮助.
0.001）; PSAT values were 0.67Objective To determine the predictive value of serum prostate specific antigen （PSA）, prostate specific antigen density （PSAD） and prostate specific antigen transition zone density （PSAT） in prostate biopsy. Methods Prostate biopsy was performed in 192 subjects; among them, 184 subjects had PSA≥4ng/ml, and 8 subjects had PSA〈4ng/ml and positive findings for digital rectal examination and transrectal ultrasound, which were suspicious of cancer. The associations of PSA, PSAD and PSAT with the prostate biopsy results were analyzed. Results Prostate cancer on prostate biopsy was detected in 100 of the 192 subjects （52.1%）. Among the 8 subjects with PSA〈4ng/ml, one had prostate rhabdomyosarcoma and 7 had BPH. Among the 93 subjects with serum PSA〉20ng/ml, 80（86.0%） had prostate cancer. Among the 91 subjects with serum PSA from 4 to 20ng/ml, 19 （20.9%） had prostate cancer. The results indicated that for subjects with serum PSA 4-20 ng/ml and PSAD〉0.10 or PSAT〉0.10, the sensitivity was 100%, the specificity was 11.1% or 4.2%, and the positive predictive value was 22.9% or 21.6%, such that negative prostate biopsy of 8.8% or 3.3% was avoided. Within the range of serum PSA of 4-20ng/ml, in positive biopsy group and negative biopsy group, PSA values were （13.2±4.7） and （11.4±4.6）ng/ml, respectively （P〉0.05 ）; PSAD values were 0.36±0.18 and 0.19±0.09, respectively （P=0.001）; PSAT values were 0.67±0.36 and 0.32±0.18, respectively （P=0.000）. The area under ROC curve for PSA, PSAD and PSAT were 0.613, 0.810 and 0.833, respectively, which indicated that PSAD and PSAT were significantly better predictors than PSA （P〈0.05）. Conclusions When PSA level is more than 20ng/ml, prostate biopsy should be performed. When PSA level ranges 4-20ng/ml, PSAD and PSAT have a greater value for predicting whether prostate biopsy should be performed.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第9期622-625,共4页
Chinese Journal of Urology
