Ⅲ型前列腺炎PSA及其相关形式对筛选早期前列腺癌的临床意义

Clinical Significance of Type Ⅲ Prostatitis Prostate-Specific Antigen and Its Related Forms in the Screening of Early Prostate Cancer

目的探讨总前列腺特异性抗原(tPSA)4～10 ng/ml时其相关形式截点值,用于鉴别Ⅲ型前列腺炎与前列腺癌临床意义。方法前列腺癌69例,前列腺炎110例。采用全自动免疫荧光检测系统检测两组患者tPSA、游离PSA(fPSA),采用彩色多普勒超声诊断仪测量前列腺体积(PV)、移行区体积(TZV)、外周区体积(PZV),并计算前列腺特异性抗原密度(PSAD)、前列腺移行带特异性抗原密度(TZ-PSAD)、前列腺外周带特异性抗原密度(PZ-PSAD);对两组的PSA及其相关形式进行对比分析,寻找能够起鉴别作用的截点值。结果检出血清tPSA 4～10 ng/ml共127例,其中前列腺癌27例占21.3%(27/127);tPSA>10 ng/ml 52例,前列腺癌42例占80.8%(42/52)。前列腺癌组tPSA、PV、PZV、PSAD、PZ-PSAD明显高于前列腺炎组(P<0.05);两组fPSA、TZV、TZ-PSAD比较差异无统计学意义(P>0.05)。PSAD为0.20时,诊断前列腺癌的敏感性为88.4%,特异性为63.6%;PZ-PSAD为0.40时,诊断前列腺癌的敏感性为85.5%,特异性为72.7%。结论在tPSA4～10 ng/ml区域,利用f/tPSA和TZ-PSAD鉴别前列腺癌和前列腺炎意义不大,而PSAD、PZ-PSAD鉴别诊断有重要作用。

Objective To investigate the cut-off value of related forms of total prostate-specific antigen （tPSA） whose level of 4 -10 ng/ml and its clinical significance in identification of type Ⅲ prostatitis（CP/CPPS） and prostate cancer（PCa）. Methods Sixty nine cases of PCa and 110 cases of CP/CPPS were enrolled in the study. Automatic immune fluorescence detection was adopted to detect tPSA and free PSA（fPSA） ;Color Doppler was used to measure the prostate volume （PV）, transition zone volume （TZV） and prostate peripheral zone （PZV）, and prostate-specific antigen density（PSAD）, transition zone of prostate-specific antigen density （TZ-PSAD） and peripheral zone of prostate-specific antigen density （PZ-PSAD） were counted;A comparison analysis of PSA and its related forms was performed in two groups to identify the effective cut-off value. Results There were 127 cases of serum tPSA whose level of 4 - 10 ng/ml, including 27 cases of PCa accounted for 21.3% （27/127） ;Of 52 cases of tPSA whose level 〉 10 ng/ml,42 cases of PCa accounted for 80.8% （42/52）. tPSA, PV, PZV, PSAD, PZ-PSAD of PCa group were significantly higher than those of CP/CPPS group（P 〈0.05）;There was no significant difference in fPSA,3XV,TZ-PSAD between two groups（P 〉0.05）. The diagnostic sensitivity of PCa was 88.4% with PSAD of 0.20 while the specificity was 63.6% ;The diagnostic sensitivity of PCa was 85.5% with PZ-PSAD of 0.40 while the specificity was 72.7%. Conclusion When tPSA ranges from 4 to 10 ng/ml,it is of little significance to identify PCa and CP/CPPS with f/tPSA and TZ-PSAD. PSAD and PZ-PSAD play an important role in the differential diagnosis of PCa and CP/CPPS.