移行区 PSA 密度可提高中国男性 PSA 在 4.0-10.0 和 10.1-20.0ng/ml 范围内的前列腺癌检出率。
Transition zone PSA density improves the prostate cancer detection rate both in PSA 4.0-10.0 and 10.1-20.0 ng/ml in Chinese men.
机构信息
Department of Urology, Guangzhou First Municipal People's Hospital, Guangzhou Medical College, Guangdong, China.
出版信息
Urol Oncol. 2013 Aug;31(6):744-8. doi: 10.1016/j.urolonc.2011.06.012. Epub 2011 Aug 24.
OBJECTIVES
We hypothesized the prostate-specific antigen (PSA) "grey zone" in Chinese men was higher than the traditional value (4.0-10.0 ng/ml) since incidence of prostate cancer (CaP) in Chinese men was relative low. We then assessed the efficiencies of transition zone PSA density (TZPSAD) in the diagnosis of CaP in Chinese men with a PSA of both 4.0-10.0 and 10.1-20.0 ng/ml.
MATERIALS AND METHODS
Men had a prostatic biopsy for detecting CaP from November 1999 to August 2009 were retrospectively retrieved from our computer center. Those had a document of transrectal ultrasound transition zone measurement with a PSA of 4.0-20.0 ng/ml were included. Receiver-operating characteristic (ROC) curve was used to analyze the efficiencies of PSA and TZPSAD in the diagnosis of CaP.
RESULTS
A total of 189 men were included in the study. Of these men, 78 and 111 had a PSA of 4.0-10.0 and 10.1-20.0 ng/ml, respectively. The rate of CaP in men with a PSA of 4.0-10.0 ng/ml was not statistically significantly different compared with those with a PSA of 10.1-20.0 ng/ml (20.5% vs. 21.6%, P = 0.854). The areas under the ROC curve (AUCs) in diagnosis of CaP for PSA and TZPSAD were 0.569 and 0.702 in men with a PSA of 4.0-10.0 ng/ml and 0.463 and 0.730 in men with a PSA of 10.1-20.0 ng/ml, respectively. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 4.0-10.0 ng/ml was 0.370 ng/ml/ml, the sensitivity of which equaled 68.8%, specificity 72.6%. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 10.1-20.0 ng/ml was 0.500 ng/ml/ml. Its sensitivity equaled 70.8%, specificity 70.1%.
CONCLUSIONS
Using TZPSAD can improve the efficiency of PSA in diagnosis of CaP and decreases the unnecessary prostatic biopsy in men with a PSA of both 4.0-10.0 and 10.1-20.0 ng/ml in Chinese men.
目的
我们假设中国男性的前列腺特异性抗原（PSA）“灰区”高于传统值（4.0-10.0ng/ml），因为中国男性的前列腺癌（CaP）发病率相对较低。然后，我们评估了 PSA 密度（TZPSAD）在 PSA 为 4.0-10.0 和 10.1-20.0ng/ml 的中国男性 CaP 诊断中的效率。
材料和方法
从我们的计算机中心回顾性检索了 1999 年 11 月至 2009 年 8 月间因检测 CaP 而接受前列腺活检的男性。这些男性的 PSA 为 4.0-20.0ng/ml，并且有经直肠超声（TRUS）测量的移行区（TZ）的文件。使用受试者工作特征（ROC）曲线分析 PSA 和 TZPSAD 在诊断 CaP 中的效率。
结果
共有 189 名男性纳入本研究。其中，78 名男性的 PSA 为 4.0-10.0ng/ml，111 名男性的 PSA 为 10.1-20.0ng/ml。PSA 为 4.0-10.0ng/ml 的男性 CaP 发生率与 PSA 为 10.1-20.0ng/ml 的男性无统计学差异（20.5%对 21.6%，P=0.854）。PSA 为 4.0-10.0ng/ml 的男性，PSA 和 TZPSAD 诊断 CaP 的 ROC 曲线下面积（AUC）分别为 0.569 和 0.702，PSA 为 10.1-20.0ng/ml 的男性分别为 0.463 和 0.730。PSA 为 4.0-10.0ng/ml 的男性中，预测 CaP 的 TZPSAD 最佳截断值为 0.370ng/ml/ml，其敏感性为 68.8%，特异性为 72.6%。PSA 为 10.1-20.0ng/ml 的男性中，预测 CaP 的 TZPSAD 最佳截断值为 0.500ng/ml/ml，其敏感性为 70.8%，特异性为 70.1%。
结论
在中国男性中，PSA 结合 TZPSAD 可提高 PSA 诊断 CaP 的效率，减少 PSA 为 4.0-10.0 和 10.1-20.0ng/ml 的男性不必要的前列腺活检。
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