Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Urology. 2011 Aug;78(2):386-91. doi: 10.1016/j.urology.2011.04.023. Epub 2011 Jun 17.
To assess the utility of the percent free prostate-specific antigen (%fPSA) for the prediction of prostate cancer in men undergoing repeat biopsy.
A retrospective review was performed of 1037 patients in an institutional review board-approved repeat prostate biopsy database. A total of 617 patients who underwent 683 biopsies had all their data available for analysis. The patients were categorized as having undergone 1 repeat biopsy or >1 repeat biopsy.
The overall cancer detection rate was 27% and 22% in men who underwent 1 and >1 repeat biopsy, respectively. The area under the receiver operating characteristic curve for the %fPSA was 0.65 for men who underwent 1 repeat biopsy. Multivariate analysis demonstrated that a positive family history, decreasing %fPSA, and presence of high-grade intraepithelial neoplasia and/or atypical small acinar proliferation predicted for cancer. The univariate odds ratio for every 5% decrease in the %fPSA was 1.5 (95% confidence interval 1.2-1.7). The performance of %fPSA was further improved in men who underwent >1 repeat biopsy, with an area under the curve of 0.72. In men who underwent >1 repeat biopsy, multivariate analysis showed that a decreasing %fPSA, >20 cores removed, and high-grade intraepithelial neoplasia predicted for cancer. The univariate odds ratio for every 5% decrease in the %fPSA was 1.8 (95% confidence interval 1.4-2.3). A %fPSA cutoff of 10% achieved 90% and 91% specificity in the 1 repeat biopsy and >1 repeat biopsy groups, respectively.
%fPSA is useful in predicting for prostate cancer in the repeat biopsy population, particularly for those who have undergone multiple repeat biopsies. A persistently low %fPSA should prompt additional investigation in these men.
评估游离前列腺特异性抗原百分比（%fPSA）在预测接受重复前列腺活检的男性前列腺癌中的作用。
对机构审查委员会批准的重复前列腺活检数据库中的 1037 名患者进行回顾性分析。共有 617 名患者接受了 683 次活检，所有数据均可用于分析。将患者分为接受 1 次重复活检或>1 次重复活检。
总的癌症检出率分别为 27%和 22%，在接受 1 次和>1 次重复活检的男性中。在接受 1 次重复活检的男性中，%fPSA 的受试者工作特征曲线下面积为 0.65。多变量分析表明，阳性家族史、%fPSA 降低、高级别上皮内瘤变和/或不典型小腺泡增生存在预测癌症。%fPSA 每降低 5%，单变量比值比为 1.5（95%置信区间 1.2-1.7）。在接受>1 次重复活检的男性中，%fPSA 的性能进一步提高，曲线下面积为 0.72。在接受>1 次重复活检的男性中，多变量分析表明，%fPSA 降低、切除>20 个核心和高级别上皮内瘤变预测癌症。%fPSA 每降低 5%，单变量比值比为 1.8（95%置信区间 1.4-2.3）。%fPSA 截断值为 10%时，在 1 次重复活检和>1 次重复活检组中，特异性分别为 90%和 91%。
%fPSA 可用于预测重复活检人群中的前列腺癌，特别是对于那些接受多次重复活检的患者。持续低 %fPSA 应促使这些男性进行进一步检查。
