前列腺特异抗原相关变量和磁共振及其波谱分析与前列腺穿刺之间的联系

Relationship of prostate specific antigen related variables and MRI+ MRS examination with prostate biopsy

目的评价灰区前列腺特异抗原(PSA)相关变量和磁共振(MRI)检查及其波谱分析(MRS)与前列腺穿刺结果之间的联系。方法回顾性分析2014年5月至2018年9月于我院行前列腺穿刺的共1227例患者中血清总PSA处于灰区的老年患者共242例,年龄55~90岁,平均(66.1±7.7)岁;均具备穿刺指征。对其进行超声引导下经直肠前列腺穿刺,根据活检结果分为前列腺癌(PCa)组和良性前列腺增生(BPH)组,对患者tPSA、f/tPSA、PSAD、(f/t)PSA/PSAD、前列腺体积等相关数据及MRI+MRS检查结果进行统计学分析。结果灰区患者前列腺穿刺结果阳性组63例,阳性率为26.0%(63/242),其中腺癌56例,黏液腺癌3例,间质肉瘤4例;穿刺结果阴性组179例。216例穿刺前行MRI+MRS检查,其中阳性81例,阴性135例。两组灰区患者PSAD、(f/t)PSA/PSAD、前列腺体积及MRI+MRS检查,差异有统计学意义(P值分别为0.001、0.002、0.045、0.001);tPSA、(f/t)PSA差异无统计学意义(P>0.05)。结论灰区患者前列腺穿刺阳性率为26.0%,PSAD、(f/t)PSA/PSAD、前列腺体积及MRI+MRS检查都对是否进行前列腺穿刺具有很好的提示作用,可用于指导灰区前列腺穿刺。

Objective To evaluate the relationship of prostate specific antigen(PSA)related variables and MRI+ MRS examination with the results of prostate biopsy. Methods A total of 1227 patients aged(66.1±7.7)years(range, 55-90 years)undergoing prostate biopsy in our hospital from May 2014 to September 2018 were retrospectively analyzed.Two hundred forty-two patients with serum prostate-specific antigen(PSA)in "the grey zone(total PSA=4-10 μg/L)", and having indications for prostate biopsy were selected.According to the results of transrectal ultrasound-guided prostatic biopsy, patients were divided into the prostate cancer group and the benign prostate hyperplasia group.The levels of total PSA(tPSA), free PSA/tPSA ratios(f/t PSA), prostate specific antigen density(PSAD),(f/t)PSA/PSAD, prostate volume(PV)and other relevant data, as well as MRI+ MRS test findings were statistically analyzed. Results The positive cancer rate of prostate biopsy was 26.0%(63/242)in patients with total PSA in "the grey zone", including 56 cases of adenocarcinoma, 3 cases of mucinous adenocarcinoma, and 4 cases of stromal sarcoma.Negative prostate biopsy results were found in 179 cases.Two hundred sixteen patients underwent MRI+ MRS test before prostate biopsy, among which 81 were positive and 135 were negative.There were significant differences in PSAD,(f/t)PSA/PSAD, PV and MRI+ MRS test findings(P=0.001, 0.002, 0.045 and 0.001)and there was no significant difference in tPSA and free/total PSA ratios(P>0.05)between the prostate cancer group and the benign prostate hyperplasia group. Conclusions The positive cancer rate of prostate biopsy in patients with total PSA in the gray zone is 26.0%.The PSAD,(f/t)PSA/PSAD, prostate volume and MRI+ MRS examination are very useful for whether or not to perform the prostate biopsy, which can be used to guide the prostate biopsy in patients with total PSA in the "gray zone".