PSA和PA比值、PSAD对低水平PSA前列腺癌的诊断价值  

Diagnosis Value of the Ratio of PSA to PA and PSAD for Low Level PSA Prostate Cancer

作　　者：黄聪[1] 林文强 林腾[1] HUANG Cong;LIN Wen-qiang;LIN Teng(Department of Ultrasound,The First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]汕头大学医学院第一附属医院超声科,广东汕头515041

出　　处：《汕头大学医学院学报》2018年第4期206-210,共5页Journal of Shantou University Medical College

摘　　要：目的:比较血清前列腺特异性抗原密度(PSAD)、前列腺特异性抗原(PSA)与前列腺横切面积比值(PSA/PA比值)对低水平PSA前列腺癌的诊断价值,并探讨PSAD、PSA/PA比值预测前列腺穿刺活检的应用价值。方法:回顾性分析72例PSA介于4～20 ng/mL并行经直肠超声引导下前列腺穿刺活检的患者,经直肠超声检查测量前列腺体积(PV)及前列腺横切面积(PA),计算前列腺PSAD及PSA/PA比值,使用受试者工作特征曲线(ROC)评估血清PSA、PASD和PSA/PA比值的诊断标准、敏感性和特异性。结果:前列腺癌(PCa)组17例,良性前列腺增生(BPH)组55例。BPH组PA、PV值高于PCa组,但PSAD值和PSA/PA比值低于PCa组(均P<0.01)。PSA/PA、PSAD、PSA的ROC曲线下面积(AUC)依次为0.870、0.843和0.503。PSA/PA比值和PSA D的A UC均高于PSA (均P<0.01),PSA/PA比值与PSA D间A UC比较差异无统计学意义(P>0.05)。当PSA/PA比值、PSAD、PSA截点分别取0.57、0.21 ng·mL-1·cm-3、10 ng/mL时,PSA/PA比值及PSAD诊断前列腺癌的特异度、诊断准确率和避免穿刺率均明显高于PSA,且差异具有统计学意义(P<0.01),PSA/PA比值敏感度及诊断准确率稍高于PSAD,但两者差异无统计学意义(P>0.05)。结论:对于PSA介于4～20 ng/mL的患者,PSA/PA比值及PSAD对前列腺癌诊断价值高于PSA,PSA/PA比值诊断效能与PSAD相近,建议以PSA/PA比值为0.57或PSAD为0.21 ng·mL-1·cm-3作为低水平PSA前列腺癌的预测值,并可以该值作为是否行前列腺穿刺活检的预测值。Objective: This study aims to compare the capacity of the ratio of the prostate specific antigen to prostate maximum transverse-sectional area(PSA/PA) with the PSA density(PSA D) in diagnosing prostate cancer(PCa) when serum PSA in low abnormal levels and investigates the clinical application of the PSA/PA ratio and PSA D for predicting prostate biopsy. Methods: A total of 72 patients with PSA between 4 ~ 20 ng/mL underwent transrectal ultrasound-guided biopsy. Prostate volume(PV) and PA were measured to calculate the PSA D and PSA/PA ratio. Diagnosis criteria, sensitivity, and specificity of serum PSA, PA SD, and PSA/PA ratio were assessed using the receiver operating characteristic(ROC) curve. Results: A total of 17 PCa cases and 55 benign prostatic hyperplasia(BPH) cases were investigated. The PA and PV values of the BPH group were significantly higher than those of the PCa group(P<0.01), but the PSA D value and PSA/PA ratio were significantly lower(P<0.01). Overall, the areas under the ROC curve(A UROCs) of the three parameters were PSA/PA ratio(0.870), PSA D(0.843), and PSA(0.503) in descending order. The A UROCs of PSA/PA ratio and PSA D were significantly higher than that of PSA(P<0.01). However, no significant difference was observed between PSA/PA ratio and PSA D(P>0.05). The Specificities, diagnostic accuracy rates and avoid unnecessary biopsy rates of PSA/PA ratio and PSA D were significantly higher than those of PSA(P<0.01) when 0.57, 0.21 ng·mL-1·cm-3 and 10 ng/mL as the threshold of the PSA/PA ratio, PSA D and PSA, respectively. W hile, there was no significant difference between PSA/PA ratio and PSA D(P>0.05). Conclusions: W hen PSA between 4 ~20 ng/mL, the PSA/PA ratio and PSA D are more effective than PSA in diagnosing PCa, and there is no significant difference between the PSA/PA ratio and PSA D. The PSA/PA ratio of 0.56 or PSA D of 0.21 ng·mL-1·cm-3 could be recommended as a threshold for diagnosing PCa and determining whether a prostate biopsy should be performed when serum PSA in low leve

关 键 词：前列腺癌 前列腺横切面积 PSA/PA比值 PSA密度 经直肠超声 

分 类 号：R445.1[医药卫生—影像医学与核医学]