Early predictive value of PSA and PSAD in prostate cancer patients with indwelling catheter
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摘要: 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/mL2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/mL2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/mL2的患者，这些患者确诊前列腺癌的可能性较大。
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关键词:
- 前列腺癌 /
- 尿潴留 /
- 前列腺特异性抗原 /
- 前列腺特异性抗原密度 /
- 游离前列腺特异性抗原密度
Abstract: 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/mL2, 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/mL2, 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/mL2 should be especially concerned, for these patients are more likely to be diagnosed with prostate cancer. -
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表 1 BPH组与PCa组患者数据比较
M(IQR) 项目 BPH组(40例) PCa组(24例) u值 P值 年龄/岁 72.78(9.00) 72.46(12.00) -0.12 0.91 检测PSA前留置导尿时间/d 7.55(5.00) 6.42(4.00) -1.38 0.17 PSA/(ng/mL) 18.32(13.35) 36.48(45.16) -2.64 0.01 fPSA/(ng/mL) 3.24(2.00) 5.44(5.00) -1.01 0.25 fPSA/tPSA 0.72(0.10) 0.13(0.08) -1.86 0.06 PV/mL 75.93(59.54) 55.97(45.54) -2.14 0.03 PSAD/(ng/mL2) 0.33(0.23) 0.82(0.97) -3.52 0.00 fPSAD/(ng/mL2) 0.06(0.03) 0.14(0.09) -2.05 0.04 
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表 2 PCa危险因素的logistic回归分析
项目 单因素分析 多因素分析 OR 95%CI P OR 95%CI P PSA 1.03 1.00~1.06 0.01 1.04 1.01~1.07 0.01 fPSA 1.83 0.58~5.73 0.30 PSAD 4.19 1.31~13.39 0.02 4.27 1.11~16.41 0.04 fPSAD 2.96 0.98~8.97 0.05 2.36 0.70~7.93 0.17
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表 3 PSA、fPSA、PSAD、fPSAD诊断PSA≥4.1 ng/mL AUR患者为PCa的ROC曲线结果
项目 AUC 灵敏度/% 特异度/% 截断值 P值 PSA 0.70±0.07 62.50 70.00 18.28 ng/mL 0.01 fPSA 0.59±0.08 42.70 87.50 3.57 ng/mL 0.25 PSAD 0.77±0.06 66.70 82.50 0.40 ng/mL2 < 0.001 fPSAD 0.65±0.08 58.30 82.50 0.05 ng/mL2 0.40 PSA+PSAD 0.75±0.06 83.30 62.50 < 0.001
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[1] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2] Latest global cancer data: Cancer burden rises to 19.3 million new cases and 10.0 million cancerdeathsin 2020[EB/OL]. (2020-12-15).
https://www.iarc.fr/faq/latest-global-cancer-data-2020/ [3] 前列腺癌筛查中国专家共识(2021年版)[J]. 中国癌症杂志, 2021, 31(5): 435-440.
[4] Hah YS, Lee JS, Rha KH, et al. Effect of Prior Local Treatment and Prostate-Specific Antigen Kinetics during Androgen-Deprivation Therapy on the Survival of Castration-Resistant Prostate Cancer[J]. Sci Rep, 2019, 9(1): 11899. doi: 10.1038/s41598-019-48424-6
[5] Huang LK, Chang YH, Shao IH, et al. Clinical Outcome of Immediate Transurethral Surgery for Benign Prostate Obstruction Patients with Acute Urinary Retention: More Radical Resection Resulted in Better Voiding Function[J]. J Clin Med, 2019, 8(9): 1278. doi: 10.3390/jcm8091278
[6] Song ZJ, Qian JK, Yang Y, et al. PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium[J]. Asian J Androl, 2021, 23(3): 300-305. doi: 10.4103/aja.aja_61_20
[7] 黄健, 王建业, 孔垂泽, 等. 2019中国泌尿外科和男科疾病诊断治疗指南[M]. 北京: 科学出版社, 2020: 85-144.
[8] Hugosson J, Roobol MJ, Månsson M, et al. A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer[J]. Eur Urol, 2019, 76(1): 43-51. doi: 10.1016/j.eururo.2019.02.009
[9] Vella M, Abrate A, Costanzo A, et al. Predictive variables of spontaneous micturition recovery after acute urinary retention in men with benign prostatic enlargement: An observational prospective study[J]. Low Urin Tract Symptoms, 2019, 11(3): 104-108. doi: 10.1111/luts.12241
[10] 廖土明, 谢克基, 王宇雄, 等. 良性前列腺增生并急性尿潴留患者血清肌酐、PSA及其膀胱功能的相关性研究[J]. 广州医药, 2016, 47(1): 64-67.
[11] Antunes AA, Barbosa JA, Reis ST, et al. Prostate biopsy in patients with long-term use of indwelling bladder catheter: what is the rationale?[J]. Urol Oncol, 2012, 30(5): 620-623. doi: 10.1016/j.urolonc.2010.07.013
[12] Benson MC, Whang IS, Pantuck A, et al. Prostate specific antigendensity: a means of distinguishing benign prostatic hypertrophy andprostate cancer[J]. J Urol, 1992, 147(3 Pt 2): 815-816.
[13] Stevens E, Truong M, Bullen JA, et al. Clinical utility of PSAD combined with PI-RADS category for the detection of clinically significant prostate cancer[J]. Urol Oncol, 2020, 38(11): 846.e9-846.e16. doi: 10.1016/j.urolonc.2020.05.024
[14] Sebastianelli A, Morselli S, Vitelli FD, et al. The role of prostate-specific antigen density in men with low-risk prostate cancer suitable for active surveillance: results of a prospective observational study[J]. Prostate Int, 2019, 7(4): 139-142. doi: 10.1016/j.prnil.2019.02.001
[15] Bruno SM, Falagario UG, d'Altilia N, et al. PSA Density Help to Identify Patients With Elevated PSA Due to Prostate Cancer Rather Than Intraprostatic Inflammation: A Prospective Single Center Study[J]. Front Oncol, 2021, 11: 693684. doi: 10.3389/fonc.2021.693684
[16] Bai X, Jiang Y, Zhang X, et al. The Value of Prostate-Specific Antigen-Related Indexes and Imaging Screening in the Diagnosis of Prostate Cancer[J]. Cancer Manag Res, 2020, 12: 6821-6826. doi: 10.2147/CMAR.S257769
[17] Nan LB, Yin XT, Gao JP. Significant Diagnostic Value of Free-Serum PSA(FPSA)/Prostate-Specific Antigen Density(PSAD)and(F/T)/PSAD for Prostate Cancer of the Chinese Population in a Single Institution[J]. Med Sci Monit, 2019, 25: 8345-8351. doi: 10.12659/MSM.916900
[18] Joshi S, Tilak M, Jadhav S. Significance of detection of free/total PSA ratio and other biochemical parameters in patients with BPH, carcinoma prostate and its clinicopathologic correlation[J]. JMMR, 2021, 7(1): 42-50.
[19] 林富祥, 黄剑华, 钟羽翔, 等. 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[J]. 临床泌尿外科杂志, 2021, 36(3): 219-222. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW202103012.htm
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