PSA和PSAD对留置尿管前列腺癌患者的早期预测价值

Early predictive value of PSA and PSAD in prostate cancer patients with indwelling catheter

目的:探讨前列腺特异性抗原(prostate specific antigen,PSA)、前列腺特异性抗原密度(prostate specific antigen density,PSAD)、游离前列腺特异性抗原密度(fPSAD)对留置尿管前列腺癌患者的早期预测价值。方法:对2017年1月—2021年2月天津市第三中心医院泌尿外科收治的64例因急性尿潴留而留置尿管并行前列腺穿刺活检患者的临床数据资料进行回顾性分析。根据美国癌症分期联合委员会(American Joint Committee on Cancer,AJCC)前列腺癌预后分期标准,评估不同PSA水平患者的前列腺癌穿刺阳性率,并通过受试者工作特征(receiver operating characteristic,ROC)曲线计算PSAD、fPSAD的曲线下面积(area under curve,AUC),用来分析PSA、PSAD、fPSAD在此类患者行前列腺癌筛查中的诊断价值。结果:前列腺穿刺活检病理结果提示前列腺癌的穿刺阳性率为37.5%(24/64)。当PSA为4.1~10.0、10.1~20.0、20.1~50.0和>50.1 ng/mL时,穿刺阳性率分别为17.6%(3/17)、36.0%(9/25)、46.2%(6/13)和66.7%(6/9)。PSAD>0.40 ng/mL^(2)时,对穿刺(PSA≥4.1 ng/mL)前列腺癌诊断的AUC为0.77±0.06,灵敏度为66.7%,特异度为82.5%;fPSAD>0.05 ng/mL^(2)时,对前列腺癌诊断的AUC为0.65±0.08,灵敏度为58.3%,特异度为82.5%。结论:部分因尿潴留行导尿治疗后出现PSA升高的患者可不必接受前列腺穿刺活检,应特别关注PSA>50.1 ng/mL,或PSA≥4.1 ng/mL且PSAD>0.40 ng/mL^(2)的患者,这些患者确诊前列腺癌的可能性较大。

Objective To investigate the early predictive value of prostate specific antigen(PSA),prostate specific antigen density(PSAD)and free prostate specific antigen density(fPSAD)in prostate cancer patients with indwelling catheter.Methods The clinical data of 64 patients with indwelling catheter and prostate biopsy due to acute urinary retention admitted to the Department of Urology of Tianjin Third Central Hospital from January 2017 to February 2021 were retrospectively analyzed.The positive rate of prostate cancer puncture at different PSA levels were evaluated according to the prognostic staging standard of prostate cancer of the American Joint Committee on Cancer(AJCC),and the area under curve(AUC)of PSAD and fPSAD were calculated through the receiver operating characteristic(ROC)curve to analyze the diagnostic value of PSAD and fPSAD in prostate cancer screening for such patients.Results The pathological results of prostate biopsy showed that the positive rate of prostate cancer was 37.5%(24/64).When PSA was 4.1-10.0,10.1-20.0,20.1-50.0 and>50.1 ng/mL,the positive rates of puncture were 17.6%(3/17),36.0%(9/25),46.2%(6/13)and 66.7%(6/9),respectively.When the PSAD truncation point was>0.40 ng/mL^(2),the AUC for the diagnosis of puncture(PSA≥4.1 ng/mL)prostate cancer was(0.77±0.06).The sensitivity was 66.7%,and the specificity was 82.5%.When the fPSAD truncation point>0.05 ng/mL^(2),the AUC for prostate cancer diagnosis was(0.654±0.08).The sensitivity was 58.3%,and the specificity was 82.5%.Conclusion Some patients with elevated PSA after catheterization treatment for urinary retention may not have to undergo prostate biopsy.Patients with PSA>50.1 ng/mL or PSA≥4.1 ng/mL and PSAD>0.40 ng/mL^(2) should be especially concerned,for these patients are more likely to be diagnosed with prostate cancer.