PSA密度与PI-RADS(第二版)对各PSA区间前列腺癌的诊断价值

PSA Density and PI-RADS Version 2 in Predicting Prostate Cancer in Diverse PSA Zone

目的:探讨PSA密度(PSAD)、PI-RADS(第二版)及两者联合对不同PSA区间前列腺癌(PCa)的诊断价值及差异。方法:对2015年1月至2017年9月在我院行前列腺穿刺患者进行回顾,筛选行MRI检查且PSA≤30ng/ml的患者纳入研究,按PSA水平0~10ng/ml、10~20ng/ml及20~30ng/ml分为3个区间,再根据穿刺病理将每个区间人群分为PCa组和良性组,分别对各区间两组患者的PSAD、PIRADS(第二版)评分进行统计学分析,并使用ROC曲线对PSAD、PI-RADS(第二版)及两者联合进行分析,观察三者的诊断价值及差异。结果:三个区间的PCa组与良性组间的PSAD及PI-RADS(第二版)评分均有统计学差异;ROC分析示0~30ng/ml及0~10ng/ml区间人群的PSAD和两者联合应用之间有统计学差异。结论:血清PSA≤30ng/ml的各个区间,PSAD、PI-RADS v2评分及两者联合均能诊断PCa,而对于0~30ng/ml和0~10ng/ml区间,两者联合较PSAD效果更佳。

Purpose： To explore the value of PSA density （PSAD） and Prostate Imaging Reporting and Data System version 2 （PI-RADS v2） in diagnosis of prostate cancer （PCa） in patient with diverse PSA zone. Methods： A retrospective review was performed on a series of consecutive 211 patients who underwent prostate biopsy in our hospital between January 2015 and September 2017. Patients who underwent MRI scan and whose PSA were under 30ng/ml were recruited in this study. The study population were divided into 3 groups according to the serum PSA level. The patients with PSA 0-10ng/ml were in group A, 10-20ng/ml in group B and 20-30ng/ml in group C. Then each group was divided into two sub-groups according to the biopsy results： PCa sub-group and benign sub-group. The PSAD and PI-RADS v2 score were statistically analyzed between the two sub-groups to predict the likelihood of PCa in patient with diverse PSA zone. ROC was used to evaluate the diagnostic performance of PSAD, PI-RADS v2 score and the combination of these two parameters. Results： A total of 142 patients were recruited in this study. There were 85 patients in group A, 39 patients in group B and 18 patients in group C, respectively. Statistical analysis results showed that PSAD and PI-RADS score were with statistical significant difference between the PCa sub-group and benign sub- group in all PSA zone. By using Delong method, area under the curves of PSAD and combination of PSAD with PI- RADS v2 score were with statistical significant difference in PSA 0-30ng/ml and 0-10ng/ml zone. Conclusion： All of the PSAD, PI-RADS v2 score and the combination of two parameters showed excellent performance in predicting PCa in every PSA zone. While in the PSA zone of 0-30ng/ml and 0-10ng/ml, a combination of PSAD with PI-RADS v2 score showed better performance than PSAD alone.