tPSA灰区f/tPSA与PSAD对前列腺癌与前列腺增生伴前列腺炎的诊断价值

Diagnostic effectiveness of f/tPSA and PSAD in PSA gray zone for diagnosis of prostate cancer and prostatic hyperplasia accompanied with prostatitis

目的探讨在总前列腺特异性抗原(tPSA)灰区(tPSA为4～10 ng/ml)前列腺特异性抗原(PSA)、游离前列腺特异性抗原/总前列腺特异性抗原(f/tPSA)、前列腺特异性抗原密度(PSAD)对前列腺癌(PCa)与前列腺增生伴前列腺炎的诊断价值。方法回顾性分析2016年9月至2018年9月tPSA位于4～10 ng/ml的前列腺疾病患者96例临床资料,经病理证实PCa 26例,BPH伴前列腺炎70例,统计tPSA、游离PSA(fPSA),PSA比值(f/tPSA)、PSA密度(PSAD),分别计算f/tPSA与PSAD对PCa诊断的敏感性、特异性。结果 PCa组tPSA水平与BPH伴前列腺炎组比较,差异未见统计学意义(P>0.05)。PCa组f/tPSA水平与BPH伴前列腺炎组比较,差异有统计学意义(P<0.05),PCa组f/tPSA低于BPH伴前列腺炎组。PCa组PSAD水平与BPH伴前列腺炎组比较,差异有统计学意义(P<0.05),PCa组PSAD高于BPH伴前列腺炎组。当f/tPSA临界值取0.16时,其对PCa诊断敏感性为70.11%,特异性为57.10%;当PSAD临界值取0.15 ng/(ml·cm^3)时,其对PCa诊断敏感性为86.23%,特异性为57.84%。结论 f/tPSA和PSAD对鉴别PCa与BPH伴前列腺炎具有重要意义,PSAD对PCa诊断的敏感性、特异性均高于f/tPSA。

Objective To investigate the efficacy of PSA, f/tPSA and PSAD in the diagnosis of prostatic cancer(PCa) and benign prostatic hyperplasia(BPH) accompanied prostatitis. Methods A retrospective analysis was made of 96 patients with prostate diseases whose tPSA was located in 4-10 ng/ml from September 2016 to September 2018. Pathologically confirmed 26 patients was PCa and 70 patients was BPH complicated with prostatitis. tPSA, free PSA(fPSA), PSA ratio(f/tPSA), PSA density(PSAD) were counted. The sensitivity and specificity of f/tPSA and PSAD were calculated respectively. Results There was no significant difference between two groups in tPSA(P>0.05). The serum f/tPSA in PCa group was significantly lower than that in BPH with prostatitis group(P<0.05), and the PSAD in PCa group was significantly higher than that in BPH group(P<0.05). When the critical value of f/tPSA was 0.16, the diagnostic sensitivity was 70.11% and the specificity was 57.10%. When the critical value of PSAD was 0.15 ng/ml/cm^3, the diagnostic sensitivity was 86.23% and the specificity was 57.84%. Conclusions PSAD is more suitable for differentiating BPH and PCa than f/tPSA.