FPSA／TPSA与PSAD在PSA灰区患者中前列腺癌诊断价值的比较

Comparison of the diagnostic value of FPSA/TPSA ratio and PASD for prostate cancer with PSA in diagnostic gray zone

目的:比较FPSA/TPSA、PSAD在PSA灰区中对前列腺癌的诊断价值。方法:回顾性总结2007年1月至2011年1月TPSA在4～10ng/mL之间的415例患者,测定其血清TPSA、FPSA,经直肠B超测定前列腺体积,所有患者均经前列腺穿刺活检诊断为53例前列腺癌(PCa)及362例前列腺增生(BPH)。计算FPSA/TPSA、PSAD,通过统计学方法比较FPSA/TPSA、PSAD在灰区诊断PCa的价值。结果:PCa组的FPSA/TPSA较BPH组降低(P<0.001),PCa组的PSAD较BPH组升高(P<0.001)。TPSA、FPSA/TPSA、PSAD在ROC曲线下的面积从大到小依次是PSAD>FPSA/TPSA>TPSA。当FPSA/TPSA和PSAD临界值分别为0.16和0.15时,诊断PCa的敏感性和特异性分别是81.1%和60.2%,66.0%和87.0%。结论:FPSA/TPSA、PSAD的测定能显著提高灰区PCa诊断的敏感性和特异性,且PSAD诊断价值高于FPSA/TPSA。

Objective To compare the diagnostic value of FPSA/TPSA ratio with PSAD for prostate cancer with PSA in diagnostic gray zone. Methods Prostate biopsy was performed in 415 patients whose TPSA were between 4 - 10 ng/mL （diagnostic gray zone） from Jan 2007 to Jan 2011. Among these patients, 362 with benign prostatic hyperplasia （BHP group） and 53 with prostate cancer （PCa group） were diagnosed by pathology, and the serum levels of TPSA and FPSA were examined. The volume of prostate was examined by transrectal ultrasound. FPSA/TPSA ratio and PSAD were obtained and analyzed. Results The FPSA/TPSA ratio was significantly lower and the level of PSAD was significantly higher in PCa group than those in BPH group （both P 〈 0.001 ）. The area under ROC curve of these indexes in descending order was PSAD, FPSA/TPSA radio, and TPSA. When the cutoffs of FPSA/TPSA ratio and PSAD were 0.16 and 0.15, the sensitivity and specificity of diagnosing PCa were 81.1% and 60.2%, 66.0% and 87.0%, respectively. Conclusions The FPSA/TPSA ratio and PSAD can improve the diagnosis of prostate cancer with PSA in diagnostic gray zone, and the value of PSAD was higher than FPSA/TPSA ratio for the diagnosis of prostate cancer.