前列腺癌患者血清睾酮水平与前列腺穿刺活检阳性的相关性

Correlation between total serum testosterone level and positive prostate biopsy in patients with prostate cancer

目的探讨血清总睾酮水平与前列腺穿刺活检阳性之间的相关性,为临床个体化治疗方案的选择提供理论依据。方法 2015年9月至2019年3月期间在汉中市人民医院泌尿外科接受前列腺穿刺活检的患者,收集患者的年龄、血清总前列腺特异性抗原(tPSA)及性激素等相关资料,观察这些指标对前列腺穿刺活检阳性率的影响。结果在113例患者中,前列腺癌(PCa)患者检出率共89例,穿刺阳性率为78.76%。与穿刺阴性组比较,患者血清tPSA[(12.42±4.64)vs.(5.35±1.66)ng/mL,P<0.001]和催乳素水平[(8.55±2.48)vs.(6.91±1.92)ng/L,P=0.003]升高与前列腺穿刺活检阳性有关,而总睾酮激素水平下降与前列腺穿刺活检阳性有关[(12.64±3.28)vs.(16.85±3.37)nmol/L,P<0.001]。多变量分析证实tPSA[P<0.001,OR=3.383(1.924~5.342)]和血清睾酮[P=0.038,OR=1.361(1.124~1.927)]是预测前列腺穿刺活检阳性的独立预测因子。受试者工作曲线(ROC)显示tPSA水平与前列腺穿刺阳性风险呈正相关,曲线下面积(AUC)为0.989,最佳截断值为8.022,敏感度和特异度分别为87.5%和98.88%;总睾酮激素水平与前列腺穿刺阳性风险呈负相关,AUC为0.786,最佳截断值为17.85,敏感度和特异度分别为66.67%和78.65%,差异具有统计学意义(P<0.001)。结论低血清睾酮激素与前列腺穿刺检测PCa的风险有关,这些结果可能揭示了PCa与睾酮两者关系的潜在机制。

Objective To investigate the correlation between total serum testosterone level and positive prostate biopsy in order to provide a theoretical basis for the selection of individualized treatment options.Methods The clinical data of 113 patients who underwent prostate biopsy during Sep.2015 and Mar.2019 were collected,including age,body weight,serum total prostate specific antigen(tPSA),serum total testosterone,luteinizing hormone,follicle stimulating hormone and prolactin.The effects of these indicators on the positive rate of prostate biopsy were observed.Results Prostate cancer was detected in 89 patients,and the positive rate was 78.76%.Compared with the negative group,the positive group had elevated serum tPSA[(12.42±4.64)vs.(5.35±1.66)ng/mL,P<0.001]and prolactin[(8.55±2.48)vs.(6.91±1.92)ng/L,P=0.003],but decreased total testosterone level[(12.64±3.28)vs.(16.85±3.37)nmol/L,P<0.001].Multivariate analysis indicated that tPSA[P<0.001,OR=3.383(1.924-5.342)]and serum testosterone[P=0.038,OR=1.361(1.124-1.927)]were independent predictors of positive prostate biopsy.The receiver operating characteristic(ROC)curve showed that the tPSA level was positively correlated with risk of positive biopsy.The area under the curve(AUC)was 0.989,optimal cut-off value was 8.022,sensitivity was 87.5% and specificity was 98.88%.The total testosterone level was negatively correlated to risk of positive biopsy.The AUC was 0.786,optimal cut-off value was 17.85,sensitivity was 66.67% and specificity was 78.65%,with statistical differences(P<0.001).Conclusion Low serum testosterone prostate cancer and testosterone.