血清PSA含量及前列腺PSA密度与经直肠超声引导下前列腺穿刺活检诊断前列腺癌的关系

Correlation of transrectal ultrasound guided prostate biopsy and serum oncentration of prostate specific antigen,prostate specific antigen density in diagnosis of prostatic carcinoma

目的探讨经直肠超声引导下前列腺穿刺活检术前列腺癌检出率与血清前列腺特异性抗原(PSA)及血清前列腺特异性抗原密度(PSAD)的关系。方法对134例患者行经直肠超声引导下前列腺5区13针系统穿刺活检。根据PSA水平分为PSA≤4ng/ml组(7例)、4ng/ml<PSA<15ng/ml组(48例)及PSA≥15ng/ml组(79例)。测量并计算前列腺体积(PV)及PSAD,分析前列腺癌检出率及不同PSA、PSAD水平下对前列腺癌的诊断效能。比较前列腺癌与非前列腺癌患者PSA、PV及PSAD的差异。结果前列腺癌总检出率为50.75%(68/134),前列腺患者共68例(前列腺癌组),非前列腺癌患者共66例(非前列腺啊组)。PSA≤4ng/ml、4ng/ml<PSA≤15ng/ml及PSA>15ng/ml组前列腺癌检出率分别为14.29%(1/7)、20.83%(10/48)及72.15%(57/79),差异有统计学意义(P<0.05)。PSA≥4ng/ml时前列腺癌检出率随着PSA值的增高而上升。134例患者PSAD值为(1.09±1.72)ng/(ml·cm3),以PSAD≥0.19ng/(ml·cm3)为截点诊断前列腺癌的敏感度为95.59%(65/68),特异度为51.52%(34/66),阳性预测值67.01%(65/97),阴性预测值为32.99%(32/97)。4ng/ml<PSA≤15ng/ml组中,以PSAD≥0.19ng/(ml.cm3)为截点诊断前列腺癌的敏感度为80.00%(8/10),特异度为71.05%(27/38),阳性预测值为42.11%(8/19),阴性预测值为57.89%(11/19)。前列腺癌组PSA及PSAD值均高于非前列腺癌组(P均<0.05),PV小于非前列腺癌组(P<0.05)。4ng/ml<PSA≤15ng/ml组中,前列腺癌与非前列腺癌患者PSA及PV差异均无统计学意义(P均>0.05),前列腺癌患者PSAD高于非前列腺癌患者(P<0.05)。结论血清PSA及PSAD均与前列腺穿刺活检前列腺癌检出率有关,PSA>15ng/ml应行穿刺活检,PSAD对4ng/ml<PSA≤15ng/ml的患者是否应行穿刺活检具有指导意义。

Objective To investigate the relationship between prostate specific antigen（PSA）,prostate specific antigen density（PSAD）and the detection of prostatic carcinoma with transrectal ultrasound guided prostate biopsy.Methods A total of 134 patients with prostatic carcinoma underwent transrectal ultrasound guided 13 core prostate biopsy,and were divided into 3groups according to PSA level.There were 7cases in PSA≤4ng/ml group,48 cases in 4ng/ml〈PSA〈15ng/ml group and 79 cases in PSA≥15ng/ml group.The prostate volume（PV）and PSAD were calculated.The detection rate of prostatic carcinoma and the diagnosis efficacy under different PSA and PSAD lenels were studied.And the differences of PSA,PV and PSAD between different groups were analyzed.Results The total detection rate of prostatic carcinoma was 50.75%（68/134）.Among 134 patients,there were 68 cases of detected prostatic carcinoma（prostatic carcinoma group）and 66 cases without prostatic carcinoma（non-prostatic carcinoma group）.The detection rate was 14.29%（1/7）,20.83%（10/48）and 72.15%（57/79）in PSA≤4ng/ml,4ng/mlPSA15ng/ml and PSA≥15ng/ml groups,respectively.Statistical difference of the detection rate was found among 3groups（P〈0.05）.Under the level of PSA≥4ng/ml,the detection rate of prostatic carcinoma increased with PSA.The PSAD was（1.09±1.72）ng/（ml·cm^3）.With the threshold of 0.19ng/（ml.cm^3）in PSAD,the sensitivity,specificity,positive predictive value and negative predictive value for the diagnosis of prostatic carcinoma was 95.59%（65/68）,51.52%（34/66）,67.01%（65/97）and 32.99%（32/97）,respectively.In 4ng/ml〈PSA≤15ng/ml group,the sensitivity,specificity,positive predictive value and negative predictive value was 80.00%（8/10）,71.05%（27/38）,42.11%（8/19）and 57.89%（11/19）,respectively.Compared with non-prostatic carcinoma group,the PSA and PSAD of prostatic carcinoma group were higher（both P〈0.05）,while the PV of prostatic carcinoma group was lower（P〈0.05）.In 4ng/mlPSA≤15ng/ml group,no statistical difference of PSA and PV was found between patients with or without prostatic carcinoma（both P〉0.05）,while the PSAD of patients with prostatic carcinoma was higher than that of patients without prostatic carcinoma（P〈0.05）.Conclusion The serum PSA lever and PSAD are associated with the biopsy detection rate of prostatic carcinoma.When PSA〉15ng/ml,prostate biopsy should be performed.When PSA level is between 4ng/ml and 15ng/ml,PSAD has important references for prostate biopsy selection.