联合PSAD及MRI建立PSA 4～10 ng/ml患者前列腺穿刺活检阳性风险分层

潘俊; 谢旻君; 胡萍; 吴涛; 代睿欣; 王昭辉; 王树声; 古炽明; 向松涛; 白遵光

doi:10.13201/j.issn.1001-1420.2019.04.010

联合PSAD及MRI建立PSA 4～10 ng/ml患者前列腺穿刺活检阳性风险分层

- 广州中医药大学第二附属医院广东省中医院泌尿外科(广州, 510120)
基金项目:
广东省中医药局科研项目(编号粤中医[2016]11号20162055)

广州中医药大学一流学科研究重点项目(编号广中医规划[2018]6号)

详细信息

通讯作者: 白遵光,E-mail:zunguangbai@163.com

中图分类号: R737.25

收稿日期: 2018-07-04

Risk stratification of prostate biopsy by combining PSAD and MRI among men with PSA 4-10 ng/ml

- Department of Urology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangdong Traditional Chinese Medicine Hospital, Guangzhou, 510120, China

More Information

Corresponding author: BAI Zunguang, E-mail: zunguangbai@163.com

Received Date: 04 July 2018

摘要

摘要: 目的:基于临床指标及MRI结果建立PSA 4~10 ng/ml(灰区)患者前列腺穿刺活检阳性风险分层,指导个性化穿刺决策。方法:回顾性分析2012年1月~2017年12月我院212例PSA 4~10 ng/ml的前列腺穿刺活检患者的年龄、PSA、f/t值、前列腺体积、MRI结果等临床资料。定义Gleason评分≥3+4分为有临床意义前列腺癌(csPCa)。筛选前列腺穿刺阳性预测指标并建立前列腺穿刺阳性风险分层方案。结果:212例患者前列腺穿刺活检阳性39例(18.4%),csPCa 14例(6.6%),前列腺穿刺阳性组和阴性组PSA值分别为(6.82±1.68) ng/ml和(6.82±1.73) ng/ml,f/t值分别为0.14±0.06和0.17±0.08,两组比较差异均无统计学意义(P＞0.05);年龄分别为(69.85±8.82)岁和(66.65±7.78)岁,前列腺特异性抗原密度(PSAD)分别为(0.18±0.12) ng·ml^-1·ml^-1和(0.14±0.07) ng·ml^-1·ml^-1,两组比较差异均有统计学意义(P＜0.05)。将PSAD依据＜0.08、0.08~0.15、＞0.15 ng·ml^-1·ml^-1分为PSAD分级(PSADD)1~3级,各级阳性率分别为7.7%、12.2%和28.4%,csPCa阳性率分别为0、3.1%和12.5%。PSADD预测前列腺穿刺阳性的ROC曲线下面积(AUC)与PSAD比较差异无统计学意义(0.647 vs.0.641,P=0.785)。212例患者中MRI阳性组117例,其中前列腺癌31例(26.5%),csPCa 12例(10.3%);MRI阴性组95例,其中前列腺癌8例(8.4%),csPCa 2例(2.1%),两组比较差异有统计学意义(P＜0.05)。联合MRI及PSADD将患者分为低危、中危和高危3组,PSADD 1级且MRI阴性的患者定义为低危组,PSADD 3级且MRI阳性的患者定义为高危组,其余患者定义为中危组。低危、中危和高危组的前列腺穿刺阳性率分别为0、11.7%和39.3%,csPCa阳性率分别为0、2.8%和17.9%。结论:基于PSAD及MRI的前列腺特异性抗原“灰区”患者前列腺穿刺活检阳性风险分层有助于临床制定个性化穿刺决策、减少不必要的前列腺穿刺活检。
- 前列腺特异性抗原 /
- 前列腺穿刺阳性风险分层 /
- 前列腺癌
Abstract: Objective: To establish a risk stratification based on the clinical factors and MRI result for patients with PSA 4-10 ng/ml to individualize prostate biopsy decision. Method: The clinical data of 212 patients of PSA 4-10 ng/ml who underwent prostate biopsy in our hospital from January 2012 to December 2017 were retrospectively analyzed, such as age, PSA, f/t, prostate volume and MRI results. Gleason score ≥3+4 is defined as clinically significant prostate cancer(csPCa). Predictive factors for PCa were identified to establish a risk stratification for prostate biopsy. Result: Of 212 patients 39(18.4%) were diagnosed with PCa and 14(6.6%) with csPCa. The average PSA of the biopsy positive group and the negative group were(6.82±1.68) ng/ml and(6.82±1.73) ng/ml(P＞0.05), the average f/t value were(0.14±0.06) and(0.17±0.08)(P＞0.05), the average age were(69.85±8.82) and(66.65±7.78)(P＜0.05) and the PSAD were(0.18±0.12) ng·ml^-1·ml^-1 and(0.14±0.07) ng·ml^-1·ml^-1(P＜0.05), respectively. PSAD was divided into PSAD Grade(PSADD) 1-3 according to ＜0.08, 0.08-0.15 and ＞0.15 ng·ml^-1·ml^-1. The detection rate of PCa for each grade were 7.7%, 12.2% and 28.4% respectively and the csPCa were 0, 3.1% and 12.5%. There was no significant difference for the area under the ROC curve between PSADD and PSAD(0.647 vs. 0.641, P=0.785). Of the 117 patients with positive MRI, 31(26.5%) were diagnosed with PCa and 12(10.3%) were csPCa, of 95 with negative MRI, 8(8.4%) were diagnosed with PCa and 2(2.1%) were csPCa(each P＜0.05). The patients were divided into low-risk, intermediate-risk and high-risk based on MRI and PSADD. The patients with PSADD 1 and negative MRI were defined as the low-risk group. The patients with PSADD 3 and positive MRI were defined as the high-risk group, and the others were defined as the intermediate-risk group. The detection rate of PCa were 0, 11.7% and 39.3% in low-risk, intermediate-risk and high-risk patients respectively and the csPCa detection rate were 0, 2.8% and 17.9%, respectively.Conclusion: The risk stratification based on PSAD and MRI for patients with PSA 4-10 ng/ml is helpful for the individualized decision of prostate biopsy and the reduction of unnecessary prostate biopsy.
- prostate specific antigen /
- prostate biopsy risk stratification /
- prostate cancer

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