前列腺移行区抗原密度诊断早期前列腺癌的价值

Value of prostate specific antigen density of transition zone in prostate cancer

目的阐明移行区前列腺特异性抗原密度(PSATZ)对早期前列腺癌(PCa)的诊断价值。方法对于血清前列腺特异性抗原(PSA)值处于灰值区的61例PCa和87例前列腺增生(BPH)患者进行经直肠超声检查,并穿刺活检。通过与血清PSA和前列腺特异性抗原密度(DPSA)比较,分析PSATZ的敏感性和特异性。结果①与血清PSA、DPSA相比,PSATZ是最佳的PCa检测指标,具有最大的约登指数、ROC曲线下面积和最高的特异性;②PSATZ的最佳临界值是0.41ng/(ml.cm3),可作为疑似PCa的穿刺活检指标。结论PSATZ法明显优于血清PSA和DPSA法。在进行早期PCa筛选时,应在经直肠超声检查的基础上,对于PSATZ大于0.41ng/(ml.cm3)的病例进行穿刺活检。

Objective To determine the effect of the prostate specific antigen density of the transition zone （PSATZ） in the detection of prostate cancer （PCa）. Methods A total of 61 PCa patients and 87 benign prostate hypertrophy （BPH） patients with intermediate serum PSA level underwent transrectal ultrasound （TRUS） guided biopsy. The ability of DPSA （density of PSA） and PSATZ to improve the power of PSA in detecting PCa was evaluated. Results ①Compared with PSA, DPSA, PSATZ had the highest Youden＇s index, the area of the receiver operating characteristic curve （AUC） and specificity. ② PSATZ was the most valuable predictor among PSA-based parameters, and at the cutoff of 0. 41 ng/（ml · cm^3） , it had both higher sensitivity and lower unnecessary biopsies done. Conclusion PSATZ is superior to PSA and DPSA, and can be used to as a predictor of PCa in intermediate PSA levels. Base on TRUS during screening, biopsies should be done for patients with PSATZ value higher than the cutoff of 0.41 ng/（ml· cm^3）.