Boulos M T, Rifkin M D, Ross J
Childrens' Hospital of Buffalo, Buffalo, New York, USA.
Ultrasound Q. 2001 Sep;17(3):177-80. doi: 10.1097/00013644-200109000-00006.
Prostate ultrasound has been accepted as the appropriate tool for prostate biopsy guidance to determine the presence of prostate cancer if the prostate-specific antigen (PSA) level is not normal. Prostate-specific antigen density (PSAD) has been used to determine if an increased PSA level may be because of benign enlargement of the gland or possible presence of cancer. The specific "cutoff" for PSA and PSAD to delineate which patients are at highest risk has been controversial. We attempted to assess which PSA level or PSAD level should be used. A retrospective analysis of 600 consecutive men, referred for prostate ultrasound and possible biopsy because of an abnormal DRE result or increased PSA level was undertaken. All had prostate volume determined by biplanar endorectal ultrasound. One hundred sixty-six men had cancer confirmed by biopsy. This latter group was further analyzed and was divided into PSA <4.0, PSA 4 to 10, or PSA >10.0 ng/ml. Groups were divided according to those with PSAD <0.10, <0.12, and <0.15 ng/ml. Correlation with Gleason grade of the tumor was made. Of the 166 men with cancer, 15 had PSA levels <4 ng/ml (all palpable), and 81 had PSA levels between 4.0 and 10.0 ng/ml (48 were not palpable by digital rectal examination [DRE]). There were 38 (22.8%) of 166 men with cancer who had a PSAD <0.15. Using the Gleason scoring system, 30 of 38 men had mid-grade or high-grade cancers. Twenty-one (12.6%) of 166 men with cancer had a PSAD <0.12. Of these, 17 of 21 men had mid-grade or high-grade cancers. Fifteen (9.0%) of 166 men with cancer had a PSAD <0.10. Of these, 13 of 15 had mid-grade or high-grade cancer. If the PSA level is more than 4.0 ng/ml, even if no palpable lesion is discerned by DRE, suspicion for the presence of cancer should be raised. The use of PSAD threshold of 0.15 is not inclusive enough to identify clinically important cancer, and it should not be used. Our data demonstrate that 7.9% of men with cancer had a PSAD <0.15 and mid-grade or high-grade, i.e., clinically important, cancer. Although more negative biopsy results will be obtained, we recommend the use of a lower PSAD "cutoff" than the literature has suggested. We recommend that those men with PSA levels more than 4 ng/ml and a PSAD higher than 0.10 should undergo a prostate biopsy to detect clinically important cancer.
如果前列腺特异性抗原（PSA）水平不正常，前列腺超声已被公认为是用于前列腺活检引导以确定是否存在前列腺癌的合适工具。前列腺特异性抗原密度（PSAD）已被用于确定PSA水平升高是否可能是由于腺体良性增生或可能存在癌症。用于界定哪些患者处于最高风险的PSA和PSAD的具体“临界值”一直存在争议。我们试图评估应采用何种PSA水平或PSAD水平。对600名因直肠指检（DRE）结果异常或PSA水平升高而转诊接受前列腺超声检查及可能活检的连续男性患者进行了回顾性分析。所有患者均通过双平面直肠内超声测定了前列腺体积。166名男性经活检确诊患有癌症。对后一组患者进一步分析，并根据PSA<4.0、PSA 4至10或PSA>10.0 ng/ml进行分组。根据PSAD<0.10、<0.12和<0.15 ng/ml对各组进行划分。分析了其与肿瘤Gleason分级的相关性。在166名患有癌症的男性中，15名患者的PSA水平<4 ng/ml（均可触及），81名患者的PSA水平在4.0至10.0 ng/ml之间（48名经直肠指检[DRE]不可触及）。166名患有癌症的男性中有38名（22.8%）的PSAD<0.15。采用Gleason评分系统，38名男性中有30名患有中级或高级癌症。166名患有癌症的男性中有21名（12.6%）的PSAD<0.12。其中，21名男性中有17名患有中级或高级癌症。166名患有癌症的男性中有15名（9.0%）的PSAD<0.10。其中，15名中有13名患有中级或高级癌症。如果PSA水平超过4.0 ng/ml，即使DRE未发现可触及病变，也应提高对癌症存在的怀疑。采用0.15的PSAD临界值不足以涵盖所有具有临床意义的癌症，不应使用。我们的数据表明，7.9%患有癌症的男性PSAD<0.15且患有中级或高级（即具有临床意义）癌症。尽管会获得更多阴性活检结果，但我们建议采用比文献中建议的更低的PSAD“临界值”。我们建议那些PSA水平超过4 ng/ml且PSAD高于0.10的男性应接受前列腺活检以检测具有临床意义的癌症。
