MRI阴性且PSA异常男性患者前列腺穿刺阳性的风险因素分析  

Risk factors for prostate cancer in male patients with MRI-negative and PSA-abnormal findings

作　　者：鄂少龙 张旖骁[1] 吴斌[1] E Shao-long;ZHANG Yi-xiao;WU Bin(Department of Urology,Shengjing Hospital of China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院泌尿外科,辽宁沈阳110004

出　　处：《中华男科学杂志》2021年第10期886-891,共6页National Journal of Andrology

基　　金：国家自然科学基金青年项目(81902607)。

摘　　要：目的:探讨MRI阴性且PSA异常的患者行经直肠超声引导下系统性前列腺穿刺活检诊断为临床有意义前列腺癌的风险因素。方法:回顾性分析2014年1月至2017年12月在我科因MRI阴性(PI-RADS 2.0评分≤2分)且PSA异常(PSA:4~30 ng/ml)进行局麻下经直肠超声引导下系统性前列腺穿刺活检的患者335例。收集资料包括人口学资料,临床症状、合并症,既往史和前列腺的特异性抗原密度(PSAD)。结果:在335例MRI阴性且PSA异常的男性患者中临床有意义前列腺癌检出率为6.3%。多因素Logistic回归分析提示独立危险因素是患者较高的年龄和PSAD,二者ROC曲线下面积(AUC)分别为0.704 (P<0.01)、0.743 (P<0.01)。年龄和PSAD的截断值分别为71岁和0.18 ng/ml/ml。结论:高龄和升高的PSAD是临床有意义前列腺癌诊断的危险因素,当年龄>71岁或PSAD>0.18 ng/ml/ml时更推荐进行前列腺穿刺活检甚至多次、饱和穿刺,从而避免漏诊;反之可积极监测,避免不必要的有创穿刺活检。Objective: To investigate the risk factors for clinically significant PCa diagnosed by transrectal ultrasound-guided systematic prostate biopsy in patients with MRI-negative and PSA-abnormal findings. Methods: From January 2014 to December 2017, 335 male patients with MRI-negative(PI-RADS 2.0 score ≤ 2) and PSA-abnormal(4-30 ng/ml) findings underwent systematic prostate biopsy guided by transrectal ultrasound under local anesthesia in our department. We collected and analyzed the demographic data, clinical symptoms, complications, past history and PSA density(PSAD) of the patients. Results: Clinically significant PCa was diagnosed in 21(6.3%) of the 335 patients. Multivariate logistic regression analysis showed that the independent risk factors were higher age(AUC: 0.704, P < 0.01) and PSAD(AUC: 0.743, P < 0.01). The cutoff values of age and PSAD were 71 years and 0.18 ng/ml/ml, respectively. Conclusion: Higher age and PSAD are risk factors for clinically significant PCa. Prostate biopsy, even repeated or saturated puncture, is recommended for those aged >71 years old or with PSAD >0.18 ng/ml/ml so as to avoid missed diagnosis and unnecessary invasive biopsy as well.

关 键 词：临床有意义前列腺癌 直肠指诊 前列腺特异性抗原 PSAD 年龄 

分 类 号：R737.25[医药卫生—肿瘤]