血清PSA密度变化对前列腺癌高危人群的诊断价值

Oignostic valne of elevated prostate-specific antigen density in high risk population of prostate cancer

目的:探讨前列腺特异抗原(PSA)、前列腺特异抗原密度(PSAD)变化对前列腺癌高危人群的诊断价值。方法:对初次活检阴性的432例患者进行随访,其中79例重复穿刺活检,确诊前列腺癌27例(34.2%),消化道来源肿瘤1例,BPH25例,前列腺上皮内肿瘤(PIN)13例,慢性前列腺炎13例。对重复活检患者的PSA、PSAD等临床资料进行统计分析。结果:配对t检验显示,良性病变首末次穿刺前PSA、PSAD差异均无统计学意义,而前列腺癌末次穿刺前PSA、PSAD较首次穿刺前升高,差异有统计学意义。以PSA>4ng/ml筛选前列腺癌,其敏感性、特异性、阳性预测值分别为92.5%、17.6%、37.6%,PSA末-PSA首>0筛选前列腺癌的敏感性、特异性、阳性预测值分别为85.2%、41.2%、40.4%;而以PSAD末-PSAD首>0筛选前列腺癌的敏感性、特异性、阳性预测值分别为81.5%、54.9%、48.9%。结论:在前列腺癌高危人群中应该重复穿刺,以减少漏诊;以PSAD动态升高来指导穿刺,可以明显提高阳性率。

Objective：To estimate the value of PSA and PSAD in repeat prostate biopsies in order to improve cancer detection rates. Methods：We analyzed the outcome of repeated transrectal ultrasound （TRUS）-guided systematic prostate biopsy for patients with previous negative biopsies. Prostate cancer was detected in 27 of 79 patients （34.2%）. PSA and PSAD were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. Results：Both the PSA concentration and the PSA density at repeat biopsy in men with positive repeat biopsy was significantly greater than those at the initial biopsy. Conclusions：Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of elevated PSA or PSAD,and elevated PSAD may be used to avoid more unnecessary biopsies with an acceptable decrease in sensitivity.