前列腺小体外泄蛋白联合PSA在PSA“灰区”且PI-RADS评分3分前列腺癌诊断中的临床意义  

Clinical significance of prostatic exosomal protein and PSA in detecting prostate cancer with the PSA gray zone and PI-RADS-3 lesions

作　　者：刘伊扬 毛兴君 夏佳东[1] LIU Yi-yang;MAO Xing-jun;XIA Jia-dong(Department of Urology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;Department of Urology,Baoying People's Hospital,Yangzhou,Jiangsu 225800,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,江苏南京210029 [2]宝应县人民医院泌尿外科,江苏扬州225800

出　　处：《中华男科学杂志》2024年第7期597-603,共7页National Journal of Andrology

基　　金：国家自然科学基金面上项目(81971377)。

摘　　要：目的:探讨前列腺小体外泄蛋白(PSEP)联合前列腺特异性抗原(PSA)在PSA“灰区”且前列腺影像报告和数据系统(PI-RADS)评分3分前列腺癌诊断中的价值。方法:收集2019~2022年行前列腺多参数核磁共振检查,并且接受前列腺穿刺活检或经尿道前列腺电切/剜除术的211例PSA“灰区”(4~10μg/L)且PI-RADS评分3分患者的临床资料。术前收集尿样,采用酶ELISA检测尿PSEP浓度。分析在PSA“灰区”且PI-RADS评分3分患者中PSEP、PSA用于诊断前列腺癌的性能及差异。结果:病理确诊前列腺癌57例(阳性组);良性前列腺组织154例(阴性组)。阳性组游离前列腺特异性抗原(fPSA)、游离前列腺特异性抗原(fPSA)与总前列腺特异性抗原(tPSA)比值(f/t PSA)、尿PSEP水平均低于阴性组(P均<0.01)。在PSA“灰区”且PI-RADS评分3分的患者中,f/t PSA,PSEP均可作为独立因子用于预测前列腺癌(P均<0.01)。其中,以f/t PSA、PSEP单参数诊断前列腺癌的受试者操作特征(ROC)曲线下面积、最佳截断值、敏感度、特异度分别为0.70、0.18、84.21%、58.44%;0.78、1.45μg/L、70.18%、77.27%。利用PSEP联合f/t PSA多参数模型预测前列腺癌的ROC曲线下面积为0.82,最佳截断值为0.31,敏感度为82.46%,特异度为75.32%,其预测性能显著优于单参数f/t PSA、PSEP(P<0.01,P=0.04)。结论:对于PSA“灰区”且PI-RADS评分3分的患者,f/t PSA,PSEP均可作为独立预测前列腺癌的有效因子;PSEP联合f/t PSA多参数模型可替代传统筛查所用的单参数f/t PSA,提高诊断性能,减少非必要穿刺活检。Objective:To explore the clinical value of prostatic exosomal protein(PSEP)and PSA in the diagnosis of PCa with PSA in the gray zone(4-10μg/L)and Prostate Imaging Reporting and Data System category 3(PI-RADS-3)lesions.Methods:From 2019 to 2022,211 patients with the PSA gray zone and PI-RADS-3 lesions underwent prostate multi-parameter MRI,prostate needle biopsy or transurethral resection/enucleation of the prostate.We collected the baseline urine samples from the patients,examined the content of PSEP in the urine by ELISA and evaluated the performance of PSEP and PSA in the diagnosis of PCa.Results:Among the total number of patients,57 were confirmed with PCa(the positive group)and the other 154 with benign prostate conditions(the negative group)by biopsy pathology.The free PSA level(fPSA),free to total PSA ratio(f/tPSA)and PSEP content were dramatically lower in the positive than in the negative group(all P<0.01).Uni-and multivariate analyses showed f/tPSA and PSEP to be independent factors for predicting PCa with the PSA gray zone and PI-RADS-3 lesions,with the AUC values of 0.70 and 0.78,best cutoff values of 0.18 and 1.45μg/L,sensitivity of 84.21%and 70.18%,and specificity of 58.44%and 77.27%,respectively(P<0.01).The multivariate model with combined use of f/tPSA and PSEP(AUC:0.82,best cutoff value:0.31,sensitivity:82.46%,specificity:75.32%)outperformed either f/tPSA or PSEP alone in the diagnosis of PCa with the PSA gray zone and PI-RADS-3 lesions(P<0.01,P=0.04).Conclusion:For patients with the PSA gray zone and PI-RADS-3 lesions,f/tPSA and PSEP are significant predictors of PCa.The multivariate model of PSEP combined with f/tPSA can replace f/tPSA in the detection of PCa to improve diagnostic performance and avoid unnecessary prostate biopsy.

关 键 词：前列腺癌 前列腺小体外泄蛋白 f/t PSA 前列腺影像报告和数据系统评分3分 

分 类 号：R737.25[医药卫生—肿瘤]