Predictive value of free prostate-specific antigen density for prostate biopsy results
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摘要: 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/mL<PSA≤10 ng/mL及PSA>10 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。
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关键词:
- 游离前列腺特性性抗原密度 /
- 前列腺癌 /
- 诊断 /
- 预测
Abstract: 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/mL<PSA≤10 ng/mL and PSA>10 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.-
Key words:
- free prostate specific antigen density /
- prostate cancer /
- diagnosis /
- predict
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[1] Halpern JA,Oromendia C,Shoag JE,et al.Utility of Digital Rectal Examination(DRE)as an Adjunct to Prostate Specific Antigen(PSA)in the Detection of Clinically Significant Prostate Cancer[J].J Urol,2017,199(4):947-953.
[2] Cooperberg MR,Davicioni E,Crisan A,et al.Combined value of validated clinical and genomic risk stratification tools for predicting prostate cancer mortality in a high-risk prostatectomy cohort[J].Eur Urol,2015,67(2):326-333.
[3] Deruiter WK,Jeynes B,Hay J,et al.The efficacy of the percent free prostate specific antigen density in screening for prostate cancer in patients with normal digital rectal examinations and intermediate prostate specific antigen levels[J].Ann Epidemiol,2003,13(8):560.
[4] Lynn NNK,Collins GN,Alexandrou K,et al.Comparative Analysis of the Role of Prostate Specific Antigen Parameters in Clinical Practice[J].Prostate J,2010,2(4):205-210.
[5] Naya Y,Fritsche HA,Cheli CD,et al.Volume indexes of total,free,and complexed prostate-specific antigen enhance prediction of extraprostatic disease extension in men with nonpalpable prostate cancer[J].Urology,2003,62(6):1058-1062.
[6] Lin FX,Zhao L,Liu JM,et al.Free prostate specific antigen density predicts prostate cancer with high accuracy[J].Biomed Res(Aligarh),2017,28(18):7806-7809.
[7] 赖秀梅,沈宗坤,张娜.fPSA、tPSA及f/tPSA对前列腺癌患者的临床诊断效果研究[J].实用癌症杂志,2019,34(1):58-60.
[8] 潘俊,谢旻君,胡萍等.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[J].临床泌尿外科杂志,2019,34(5):289-292.
[9] 张振奇,刘桂丽,夏小彬,等.血清PHI和尿PCA3联合检测评分对PSA灰区前列腺癌诊断价值探讨[J].中华肿瘤防治杂志,2018,25(5):329-333.
[10] 刘研,徐勇,张志宏,等.血清前列腺健康指数在前列腺癌诊断中预测活检结果价值的meta分析[J].中华男科学杂志,2014,20(8):723-729.
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