Zheng Xiang-Yi, Xie Li-Ping, Wang Yu-Yong, Ding Wei, Yang Kai, Shen Hua-Feng, Qin Jie, Bai Yu, Chen Zhao-Dian
Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.
J Cancer Res Clin Oncol. 2008 Nov;134(11):1207-10. doi: 10.1007/s00432-008-0400-8. Epub 2008 Apr 30.
To investigate the utility of prostate specific antigen density for detecting prostate cancer in men with serum PSA levels of 4-10 ng/mL.
Between January 2003 and November 2007, 237 men (aged 48-84 years, median 71) with total PSA levels of 4-10 ng/mL participated in a protocol for prostate cancer screening. Eligible patients were recommended for transrectal ultrasonography (TRUS)-guided prostate biopsies after measuring prostate volumes transrectally. The diagnostic value of PSA levels and the free-to-total PSA ratio (f/tPSA), PSA densities (PSAD) were compared using receiver operating characteristic analysis.
Prostate cancer was diagnosed in 44 (18.6%) of the 237 men who had biopsies. There were significant differences between the groups in the prostate volumes determined by TRUS, PSAD, PSA levels and f/tPSA, whereas there was no significant difference in patient age. The area under the curve (AUC) of PSA (0.6786) and PSAD (0.717) was similar and significantly greater than that of f/tPSA (AUC 0.329). PSAD was a significantly better indicator of prostate cancer than f/tPSA. The sensitivity and specificity of PSA density at a cutoff of 0.134 ng/mL(2) was 90 and 33.7%, respectively.
PSAD was a better predictor of prostate cancer in Chinese men with PSA levels of 4-10 ng/mL, especially those who have had prior ultrasound-determined measurements of prostate volume. Our data suggest that different PSAD cutoffs may need to be defined for Chinese.
探讨前列腺特异性抗原密度在血清前列腺特异性抗原（PSA）水平为4 - 10 ng/mL的男性中检测前列腺癌的效用。
2003年1月至2007年11月期间，237名年龄在48 - 84岁（中位年龄71岁）、总PSA水平为4 - 10 ng/mL的男性参与了前列腺癌筛查方案。在经直肠测量前列腺体积后，符合条件的患者被推荐进行经直肠超声（TRUS）引导下的前列腺活检。使用受试者工作特征分析比较PSA水平、游离PSA与总PSA比值（f/tPSA）、PSA密度（PSAD）的诊断价值。
在接受活检的237名男性中，44名（18.6%）被诊断为前列腺癌。TRUS测定的前列腺体积、PSAD、PSA水平和f/tPSA在各组之间存在显著差异，而患者年龄无显著差异。PSA（曲线下面积[AUC]为0.6786）和PSAD（AUC为0.717）的曲线下面积相似，且显著大于f/tPSA的曲线下面积（AUC为0.329）。PSAD是比f/tPSA更好的前列腺癌指标。PSA密度在临界值为0.134 ng/mL²时的敏感性和特异性分别为90%和33.7%。
对于PSA水平为4 - 10 ng/mL的中国男性，尤其是那些先前已通过超声测量前列腺体积的男性，PSAD是前列腺癌更好的预测指标。我们的数据表明，可能需要为中国人定义不同的PSAD临界值。
