PSA及其相关指标对前列腺癌的诊断价值  

Predictive value of PSA and its related indicators in the diagnosis of prostate cancer

作　　者：李明[1] 周剑芳 高诚 阳东荣[1] LI Ming;ZHOU Jianfang;GAO Cheng;YANG Dongrong(Department of Urology,Affiliated Second Hospital,Soochow University,Suzhou,Jiangsu,215004,China)

机构地区：[1]苏州大学附属第二医院泌尿外科

出　　处：《临床泌尿外科杂志》2019年第12期995-998,共4页Journal of Clinical Urology

摘　　要：目的:探讨当患者前列腺MRI影像报告和数据系统(PI-RADS V2)评分为3分,且前列腺特异性抗原(PSA)位于灰区(4.0~10.0 ng/ml)时,PSA及其相关指标对前列腺癌(PCa)的诊断价值。方法:回顾性分析2015年1月~2018年5月于苏州大学附属第二医院行MRI检查PI-RADS V2评分为3分、PSA值位于灰区且经穿刺病理证实为前列腺疾病患者的临床资料。受试者工作特征(ROC)曲线分析各指标对PCa的诊断价值,并利用Logistic回归分析筛选出危险预测因子,建立危险评估模型。结果:总计55例患者,其中PCa 24例(PCa组),非PCa 31例(非PCa组)。两组前列腺特异性抗原密度(PSAD)和游离PSA/总PSA(F/T)比较差异有统计学意义(P<0.05)。PSAD诊断PCa的cut-off值为0.145 ng/ml^2,灵敏度和特异度分别为83.3%和90.3%(P<0.05);F/T诊断PCa的cut-off值为0.174,灵敏度和特异度分别为75.0%和87.1%(P<0.05);PSAD+F/T联合诊断PCa的cut-off值为0.295,灵敏度和特异度分别为91.3%和78.2%(P<0.05)。利用危险预测因子PSAD和F/T建立患癌风险评估模型:logit(p)=(-3.745798)+(-12.13921)×F/T+38.92853×PSAD。结论:对于PI-RADS V2评分为3分且PSA位于灰区的患者,PSAD、F/T单独应用及联合诊断均能有效提高对PCa诊断的灵敏度,避免漏诊。危险评估模型凭借灵敏度高、使用便捷等优点,在PCa诊断中值得进一步推广。Objective:To explore the diagnostic value of PSA and its related indicators for prostate cancer when the prostate MRI imaging report and data system(PI-RADS V2)score was 3 and PSA was located in gray area(4.0-10.0 ng/ml).Method:The clinical data of patients who underwent MRI examination from January 2015 to May 2018 in Second Affiliated Hospital of Soochow University with PI-RADS V2 score of 3 and PSA value in the gray area were retrospectively analyzed.ROC analyzed the diagnostic value of each indicator and establish a prediction model through analysis of Logistic regression.Result:A total of 55 patients were treated,There were 24 cases of PCa and 31 cases of others.PSAD cut-off value was 0.145 ng/ml^2,sensitivity and specificity were 83.3%and 90.3%(P<0.05)respectively.fPSA/tPSA(F/T)cut-off value was 0.174,sensitivity and specificity were 75.0%and 87.1%(P<0.05)respectively.PSAD+F/T combined with cut-off value was 0.295,sensitivity and specificity were 91.3%and 78.2%respectively.PSAD and F/T risk predictors were used to establish a cancer risk assessment model:logit(p)=(-3.745798)+(-12.13921)×F/T+38.92853×PSAD.Conclusion:For patients with PSA in grey area,independent application of PSAD or F/T or combination of them can improve sensitivity of PCa and reduce meaningless biopsy.Risk assessment model is worth promotion because of its high diagnostic sensitivity and easy application.

关 键 词：前列腺癌 前列腺MRI影像报告和数据系统 前列腺特异性抗原密度 游离PSA/总PSA 前列腺特异性抗原灰区风险预测模型 

分 类 号：R737.25[医药卫生—肿瘤]