前列腺特异性抗原水平≤4.0纳克/毫升的T1c活检转诊男性中的当代前列腺癌患病率。

Contemporary prostate cancer prevalence among T1c biopsy-referred men with a prostate-specific antigen level < or = 4.0 ng per milliliter.

作者信息

Ahyai Sascha A, Graefen Markus, Steuber Thomas, Haese Alexander, Schlomm Thorsten, Walz Jochen, Köllermann Jens, Briganti Alberto, Zacharias Mario, Friedrich Martin G, Karakiewicz Pierre I, Montorsi Francesco, Huland Hartwig, Chun Felix K-H

机构信息

Department of Urology, University of Hamburg, Hamburg, Germany.

出版信息

Eur Urol. 2008 Apr;53(4):750-7. doi: 10.1016/j.eururo.2007.10.017. Epub 2007 Oct 17.

DOI:10.1016/j.eururo.2007.10.017

PMID:17964070

Abstract

OBJECTIVE

To investigate the prostate cancer (PCa) prevalence and risk factors of men with prostate-specific antigen (PSA) level< or =4.0 ng/ml and an unsuspicious digital rectal examination (DRE) in a large biopsy referral cohort.

MATERIALS AND METHODS

Between 1997 and 2005, 855 men underwent initial transrectal ultrasound (TRUS)-guided prostate biopsy at the University Hospital Hamburg-Eppendorf. Patients with any previous surgical or medical treatment were excluded from analyses. Logistic regression analyses were performed to determine risk factors of PCa at biopsy and high-grade PCa defined as biopsy Gleason sum> or =7.

RESULTS

Overall PCa detection rate was 23.1%. The majority had a biopsy Gleason sum of 6 (79.5%) and 20.5% had a biopsy Gleason sum> or =7. Total PSA (tPSA) and percentage of free PSA (%fPSA) were statistically significantly different in men with and without PCa (all p<0.001). In tPSA strata < or = 0.5, 0.6-1.0, 1.1-2.0, 2.1-3.0, and 3.1-4.0 ng/ml, PCa prevalence was 4.0%, 10.6%, 14.8%, 24.5%, and 32.1%, respectively. In logistic regression analyses addressing PCa and Gleason sum > or = 7 at biopsy, %fPSA and prostate volume represented independent and most informative risk factors.

CONCLUSION

Our data demonstrate that a substantial percentage (23.1%) of men with a PSA< or =4.0 ng/ml and an unsuspicious DRE in a biopsy referral population harbor PCa, with 20.5% being high grade. Low %fPSA and low prostate volume represent important parameters in PCa and in high grade disease detection at biopsy, respectively.

摘要

目的

在一个大型活检转诊队列中，研究前列腺特异性抗原（PSA）水平≤4.0 ng/ml且直肠指检（DRE）无异常的男性的前列腺癌（PCa）患病率及危险因素。

材料与方法

1997年至2005年间，855名男性在汉堡-埃彭多夫大学医院接受了初次经直肠超声（TRUS）引导下的前列腺活检。排除既往有任何手术或药物治疗史的患者后进行分析。采用逻辑回归分析确定活检时PCa及活检Gleason评分≥7分的高级别PCa的危险因素。

结果

总体PCa检出率为23.1%。大多数患者活检Gleason评分为6分（79.5%），20.5%的患者活检Gleason评分≥7分。总PSA（tPSA）和游离PSA百分比（%fPSA）在有PCa和无PCa的男性中差异有统计学意义（均p<0.001）。在tPSA分层为≤0.5、0.6 - 1.0、1.1 - 2.0、2.1 - 3.0和3.1 - 4.0 ng/ml时，PCa患病率分别为4.0%、10.6%、14.8%、24.5%和32.1%。在针对活检时PCa及Gleason评分≥7分的逻辑回归分析中，%fPSA和前列腺体积是独立且最具信息量的危险因素。