PSA及前列腺体积联合磁共振波谱成像在大体积前列腺癌诊断中的价值

Serum PSA and Prostate Volme Combined with Magnetic Resonance Spectroscopy in Diagnosis of Prostate Cancer With Large-volume

目的初步探讨血清前列腺特异抗原(PSA)及前列腺体积联合磁共振波谱成像(MRS)在大体积前列腺癌(PCa)诊断的运用价值。方法回顾性分析2012年10月~2014年12月在笔者医院初次行经直肠前列腺穿刺活检且行MRI检测前列腺体积>40ml的男性患者142例,分析不同水平PSA(PSA<10ng/ml组,PSA≥10ng/ml组)及不同体积(40~80ml组,>80ml组)联合PSA穿刺活检的检出率。结果病理结果证实前列腺癌49例、非前列腺癌93例。单独运用MRS检出率56.91%。根据前列腺体积将患者分成两组:40~80ml组(96例),>80ml组(46例);40~80ml组联合MRS前列腺活检检出率由42.71%提高到65.38%,>80ml组联合MRS前列腺活检检出率由17.39%提高到33.33%;根据PSA水平将患者分为PSA<10ng/ml组(42例),PSA≥10ng/ml组(100例);PSA<10ng/ml组联合MRS前列腺穿刺活检检出率由4.76%提高到15.38%,,而PSA≥10ng/ml组联合MRS前列腺穿刺活检检出率由47%提高到65%,各组差异有统计学意义(P<0.05)。结论 MRS在大体积前列腺癌诊断中具有无创性、快速性、方便性、低风险性,其联合PSA有助于提高大体积前列腺癌诊断的准确性,减少不必要穿刺,具有较高的临床应用价值。

Objective To investigate the significance of combining magnetic resonance spectroscopy（MRS） with serum level of prostate-specific antigen （PSA） and prostate volume in the diagnosis of prostate cancer with large-volume. Methods Study population consisted of 142 patients scheduled for first prostate biopsy. All patients with volume larger than 40ml by MRI underwent prostate MRS examination before prostate biopsy. The results were contrasted with pathology obtained by prostate biopsy. Different serum levels of PSA （PSA 〈 10ng/ml group,PSA≥10ng/ml group） in the diagnosis of PCa were evaluated,then they were dirided into two groups by the levels of prostate volume （40-80ml group, 〉 80ml group）.The figures of diagnosis of PCa were compared. Results According to the pathological outcome,49 cases were identified as PCa,93 cases were non-prostate cancer.MRS had a positive biopsy rate 56.16%.40-80ml group increased from 42.71% to 65.38% with combining MRI, 〉 80ml group from 17.39% to 33.33%,and PSA 〈 10ng/ml group increased from 4.76% to 15.38% though joint MRI,PSA≥10ng/ml group from 47% to 65% All the differences of werw significant（P 〈 0.05）. Conclusion MRS is noninvasive,rapid,convenient and low risk in he diagnosis of PCa with large-volume,and the efficiency can be improved obviously combing with PSA.It can also reduce unnecessary biopsy,so it has high clinical application value.