游离前列腺特异性抗原密度对前列腺穿刺活检结果的预测价值

Predictive value of free prostate-specific antigen density for prostate biopsy results

目的:探讨血清游离前列腺特异性抗原密度(fPSAD)预测前列腺穿刺活检结果的价值。方法:回顾性分析2017年1月—2020年1月我院行经直肠前列腺穿刺活检术患者的临床资料,收集患者一般情况和入院时血清总前列腺特异性抗原(tPSA)及游离前列腺特异性抗原(fPSA)的水平,超声或MRI测量患者前列腺三横径的大小。利用Excel软件计算出fPSA/tPSA、前列腺体积、PSAD和fPSAD,再采用IBM SPSS Statistics 22软件绘制游离PSA密度诊断前列腺癌的ROC曲线,通过曲线确定游离PSA密度诊断前列腺癌的最佳临界值,再使用卡方检验,从敏感度、特异度、约登指数、诊断符合率及Kappa值等方面比较tPSA、fPSA/tPSA、PSAD及fPSAD诊断前列腺癌的能力,评价fPSAD的水平对前列腺穿刺活检患者结果的预测价值。结果:本研究共纳入符合标准的患者394例,其中前列腺癌144例(36.5%),前列腺增生250例(63.5%)。fPSAD诊断前列腺癌的ROC曲线下面积为0.848,最佳临界值为fPSAD=0.06,此临界值的灵敏度为(75.7%)、特异度为(89.6%)、约登指数(0.653)和诊断符合率为(84.5%)。tPSA、fPSA/tPSA、PSAD及fPSAD诊断前列腺癌的Kappa值分别为0.034、0.207、0.231和0.662。当PSA≤4 ng/mL、4 ng/mL10 ng/mL时前列腺癌的发生率分别为11.8%、12.5%和47.3%,fPSAD预测前列腺活检结果的诊断符合率分别为82.4%、87.5%和83.5%。结论:当临界值为0.06时,fPSAD预测前列腺穿刺活检结果的准确性优于tPSA、fPSA/tPSA和PSAD,是前列腺癌诊断和预测穿刺结果的最佳工具。

Objective: To explore the value of serum free prostate specific antigen density(fPSAD) in predicting the results of prostate biopsy. Methods: The clinical data of patients undergoing transrectal prostate biopsy in Foshan Hospital of Traditional Chinese Medicine from January 2017 to January 2020 were retrospectively analyzed. The general information of the patients and the serum levels of total prostate-specific antigen and free prostate-specific antigen at admission were collected, and the size of the three-transverse diameter of the prostate was measured by ultrasound or MRI. Results: A total of 394 eligible cases were included in this study, including 144 cases of prostate cancer(36.5%) and 250 cases of prostatic hyperplasia(63.5%). The area under ROC curve for fPSAD diagnosis of prostate cancer was 0.848, and the optimal critical value was fPSAD=0.06, with sensitivity(75.7%), specificity(89.6%), Jorden index(0.653) and diagnostic coincidence rate(84.5%). The Kappa values of tPSA, fPSA/tPSA, PSAD and fPSAD were 0.034, 0.207, 0.231 and 0.662, respectively. When PSA ≤4 ng/mL, 4 ng/mL10 ng/mL, the incidence of prostate cancer was 11.8%, 12.5% and 47.3%, respectively, and the diagnostic coincidence rate of fPSAD predicating prostate biopsy results were 82.4%, 87.5% and 83.5%, respectively. Conclusion: When the critical value is 0.06, the accuracy of fPSAD in predicting prostate biopsy results is better than tPSA, fPSA/tPSA and PSAD, which is the best tool for diagnosing prostate cancer and predicting prostate biopsy results.