经直肠三维超声检测前列腺特异性抗原相关参数诊断前列腺癌的价值

Study of prostate specific antigen relevant parameters in prostate cancer by three-dimensional transrectal ultrasonography

目的 探讨经直肠三维超声与血清前列腺特异性抗原（PSA）相关参数前列腺特异抗原密度（PSAD）、前列腺移行区抗原密度（PSAT）、游离前列腺特异抗原百分比和前列腺特异抗原密度的比值[（F/T）/PSAD]诊断前列腺癌的价值.方法 血清PSA位于4～20μg/L之间的患者78例,应用经直肠三维超声检测前列腺体积和移行区体积,分别计算出PSA相关参数PSAD、PSAT、（F/T）/PSAD.经直肠超声引导下前列腺穿刺活检,获得病理诊断.结果 前列腺癌组27例,前列腺增生组51例,PSAD、PSAT、（F/T）/PSAD在前列腺癌和前列腺增生组中的差异有统计学意义（P〈0.05）,诊断前列腺癌的ROC曲线下面积分别为 0.736、0.760、0.800.各参数诊断前列腺癌的合理截点分别为：PSAD〉0.20、PSAT〉0.33、（F/T）/PSAD〈0.8.结论 血清PSA在4～20μg/L时,PSAD、PSAT、（F/T）/PSAD对前列腺癌和前列腺增生的鉴别有重要参考价值.通过经直肠三维超声计算前列腺体积得出的参数更可靠.

Objective To investigate the utility of serum prostate specific antigen（PSA） density （PSAD）,prostate antigen transition zone density（PSAT） and the ratio of free/total PSA with PSAD [（F/T）/PSAD] in the diagnosis of prostatic carcinoma （PCa） by three-dimensional ultrasonography.Methods Seventy-eight patients （serum prostate-specific antigen between 4-20 μg/L ） were involved.The prostatic volume and its transition zone volume were measured by three-dimensional ultrasonography.Then the relative parameters of PSA [PSAD,PSAT and （F/T）/PSAD] were calculated.Pathologic types were determined by using needle biopsy of prostate.Results Among them,27 patients were suffering from PCa,while the other 51 benign prostate hypertrophy （BPH）.The difference of PSAD,PSAT and （F/T）/PSAD between PCa and BPH had arrived statistical significance （P〈0.05）.Proportions under the PCa curves were 0.736,0.760,0.800 respectively.Considering both sensitivity and specificity,a cutoff was recommanded：PSAD〉0.20,PSAT〉0.33,（F/T）/PSAD〈0.8.Conclusions When the serum PSA level is between 4 μg/L and 20 μg/L,PSAD,PSAT and （F/T）/PSAD are of significant value to differentiate PCa from benign prostatic hyperplasia patients.The data are more reliable if prostatic volume are calculated by three-dimensional transrectal ultrasonography.