前列腺结石对PSA 4~10μg/L患者前列腺穿刺活检结果的影响

Influence of prostatic calculi on the results of prostate biopsy in patients with a PSA level of 4-10μg/L

目的:探讨前列腺结石对PSA 4~10μg/L患者前列腺穿刺活检结果的影响。方法:回顾性分析2017年1月至2019年6月317例PSA 4~10μg/L行前列腺穿刺活检的患者资料,收集其年龄、身体质量指数(BMI)、前列腺体积(PV)、TPSA、FPSA/TPSA、PSA密度(PSAD)、前列腺影像报告和数据系统第二版(PI-RADS V2)评分、前列腺结石情况、病理结果等资料。采用Logistic回归分析和受试者工作特征(ROC)曲线评估前列腺结石对PSA 4~10μg/L患者前列腺穿刺活检结果的影响。结果:多因素分析显示,年龄和PI-RADS评分是前列腺穿刺活检阳性的独立危险因素,而PV、FPSA/TPSA和结石负荷是其独立保护因素;PI-RADS评分和结石负荷、FPSA/TPSA分别是临床显著性前列腺癌检出的独立危险因素与独立保护因素;结石类型亚组分析显示,分布于外周区者活检阳性率和临床显著性癌检出率显著高于其余组;而分布于中央区和移行区者活检阳性率和临床显著性癌检出率低于外周区组和无结石组。结论:合并前列腺结石的PSA 4~10μg/L患者穿刺阳性率及临床显著性癌检出率较低,尤其是中央区和移行区前列腺结石患者,对于部分患者可减少不必要穿刺。

Objective:To investigate the influence of prostatic calculi on the results of prostate biopsy in patients with a PSA level of 4-10μg/L.Methods:We reviewed the clinical data on 317 patients with a PSA level of 4-10μg/L on prostate biopsy performed in The First Affiliated Hospital of Fujian Medical University between May 2012 and May 2019,concerning age,body mass index(BMI),prostate volume,PSA level,FPSA/TPSA ratio,PSA density(PSAD),scores on Prostate Imaging Reporting and Data System version 2(PI-RADS),prostatic calculi and pathological findings.Using logistic regression analysis and ROC curves,we evaluated the influence of prostatic calculi on the results of prostate biopsy.Results:Multivariate analysis showed that age and the PI-RADS score were independent risk factors of positive prostate biopsy,while the prostate volume,FPSA/TPSA ratio and calculus burden were independent protective factors,and that the PI-RADS score was an independent risk factor of clinically significant PCa,while calculus burden and FPSA/TPSA ratio were independent protective factors.Subgroup analysis of the prostatic calculi revealed that the rates of positive prostate biopsy and clinically significant PCa were higher in the patients with calculi in the peripheral zone than in the other groups,but lower in those with calculi in the central or transitional zone than in the peripheral zone and non-calculus groups.Conclusion:The rates of positive prostate biopsy and clinically significant PCa are low in prostatic calculus patients with a PSA level of 4-10μg/L,especially in those with calculi in the central or transitional zone.