Djavan B, Remzi M, Zlotta A R, Seitz C, Wolfram R, Hruby S, Bursa B, Schulman C C, Marberger M
Department of Urology, University of Vienna, Austria.
Tech Urol. 1999 Jun;5(2):71-6.
The aim of this study was to evaluate the ability of prostate-specific antigen (PSA)-based parameters including PSA density (PSAD), PSAD of the transition zone (PSA-TZ), percent free PSA, PSA velocity, and their combination to enhance the specificity of PSA for prostate cancer detection in men with serum PSA levels between 4 and 10 ng/mL. We evaluated prospectively 559 consecutive men referred for early detection of prostate cancer who had serum PSA levels between 4 and 10 ng/mL. All men underwent prostatic ultrasonography and sextant biopsy with two additional TZ biopsies. In all cases, if first biopsies were negative an additional set of biopsies was obtained within 6 weeks. The ability of PSAD, PSA-TZ, PSA velocity, percent free PSA, and their combination to improve the detection of prostate cancer was evaluated by univariate and multivariate analysis as well as receiver operating characteristic (ROC) curves. In this prospective study of 559 patients, 217 had prostate cancer and 342 had histologically confirmed benign prostatic hyperplasia. Multivariate analysis and ROC curves showed that PSA-TZ and percent free PSA (f/t PSA) were the most powerful and highly significant predictors of prostate cancer. Areas under the ROC curve (AUC) for PSA-TZ and percent free PSA were 0.827 and 0.778, respectively (p = .01). Combination of f/t PSA with PSA-TZ (AUC = 88.1%) significantly increased AUC as compared to each of the other parameters alone as well as their combination (p = .02). The next best combinations were PSA-TZ + PSAD, PSA-TZ + PSA, and f/t PSA + PSA. PSA-TZ followed by f/t PSA and PSAD were the most powerful predictors of prostate cancer in referred patients with a serum PSA between 4 and 10 ng/mL. f/t PSA + PSA-TZ was the most effective combination. When volume-independent PSA parameters were taken into consideration, f/t PSA + PSA clearly outperformed the other options.
本研究的目的是评估基于前列腺特异性抗原（PSA）的参数，包括PSA密度（PSAD）、移行区PSAD（PSA-TZ）、游离PSA百分比、PSA速率及其组合，以提高PSA对血清PSA水平在4至10 ng/mL之间男性前列腺癌检测的特异性。我们前瞻性地评估了559名因早期前列腺癌检测而转诊、血清PSA水平在4至10 ng/mL之间的连续男性。所有男性均接受前列腺超声检查和六分区活检，并额外进行两次TZ活检。在所有病例中，如果首次活检为阴性，则在6周内进行额外的一组活检。通过单变量和多变量分析以及受试者操作特征（ROC）曲线评估PSAD、PSA-TZ、PSA速率、游离PSA百分比及其组合改善前列腺癌检测的能力。在这项对559例患者的前瞻性研究中，217例患有前列腺癌，342例经组织学证实为良性前列腺增生。多变量分析和ROC曲线显示，PSA-TZ和游离PSA百分比（f/t PSA）是前列腺癌最有力且高度显著的预测指标。PSA-TZ和游离PSA百分比的ROC曲线下面积（AUC）分别为0.827和0.778（p = 0.01）。与其他参数单独使用及其组合相比，f/t PSA与PSA-TZ的组合（AUC = 88.1%）显著提高了AUC（p = 0.02）。次优组合是PSA-TZ + PSAD、PSA-TZ + PSA以及f/t PSA + PSA。在血清PSA在4至10 ng/mL之间的转诊患者中，PSA-TZ其次是f/t PSA和PSAD是前列腺癌最有力的预测指标。f/t PSA + PSA-TZ是最有效的组合。当考虑与体积无关的PSA参数时，f/t PSA + PSA明显优于其他选项。
