Liu Xin, Tang Jie, Fei Xiang, Li Qiu-Yang
Zhonghua Nan Ke Xue. 2014 Mar;20(3):234-8.
To evaluate digital rectal examination (DRE) , transrectal ultrasonography (TRUS) , free/total (f-PSA/ t-PSA) prostate-specific antigen (PSA), and PSA density (PSAD) in the diagnosis of prostate cancer (PCa) in patients with PSA < or = 4.0 microg/L.
Between April 1996 and December 2012, a total of 343 subjects, aged 30 -91 years, with PSA < or =4.0 microg/L and abnormal findings on DRE or TRUS underwent prostatic biopsy. Based on the levels of PSA, the subjects were divided into four groups: 0 -1.0, 1.1 -2. 0, 2.1 -3. 0, and 3.1 -4.0 microg/L. The diagnostic values of DRE, TRUS, f-PSA/t-PSA, and PSAD were assessed in those with different PSA levels. According to the age, the subjects were again divided into five groups: C49 yr, 50 -59 yr, 60 -69 yr, 70 -79 yr, and > 80 yr. The rates of PCa detection in relation to PSA levels were estimated in different age groups.
Of the 343 subjects, 65 (19.0% ) were diagnosed with PCa, with detection rates of 16.28% (21/129) , 17. 17% (17/99), 21.82% (12/55), and 25.00% (15/60) in those with the PSA levels of 0 -1.0, 1.1 -2.0, 2.1 -3.0, and 3.1 -4.0 microg/L, respectively. There were statistically significant differences in f-PSA/t-PSA between the PCa patients and non-PCa subjects with the PSA level > 2.0 microg/L (P <0.05) , but not with the PSA level < or =2.0 microg/L (P > 0.05) , nor did PSAD show any significant difference between the PCa and non-PCa groups ([0.09+/-0. 16] versus [0. 06 +/- 0. 07] micro/L/ml, P > 0. 05). The rate of cancer detection rose -with the elevation of the PSA level, but had no statistically significant difference among different age groups (P >0.05).
PSA 2.1 -4.0 microg/L with abnormal DRE and TRUS findings should be considered as a warning signal, which requires regular follow-up and PSA detection. With f-PSA/t-PSA <0. 15 with or without abnormal DRE and TRUS findings, routine prostate biopsy should be performed. PCa diagnosis cannot be effectively established by DRE, TRUS, f-PSA/t-PSA, and PSAD in those with PSA < or = 2.0 microg/L.
评估直肠指诊（DRE）、经直肠超声检查（TRUS）、游离/总前列腺特异性抗原（f-PSA/t-PSA）以及前列腺特异性抗原密度（PSAD）在前列腺特异性抗原（PSA）≤4.0μg/L的患者中诊断前列腺癌（PCa）的价值。
1996年4月至2012年12月期间，共有343名年龄在30 - 91岁之间、PSA≤4.0μg/L且DRE或TRUS检查结果异常的受试者接受了前列腺活检。根据PSA水平，将受试者分为四组：0 - 1.0、1.1 - 2.0、2.1 - 3.0和3.1 - 4.0μg/L。评估不同PSA水平患者中DRE、TRUS、f-PSA/t-PSA和PSAD的诊断价值。根据年龄，将受试者再次分为五组：≤49岁、50 - 59岁、60 - 69岁、70 - 79岁和＞80岁。估计不同年龄组中与PSA水平相关的PCa检出率。
343名受试者中，65例（19.0%）被诊断为PCa，PSA水平为0 - 1.0、1.1 - 2.0、2.1 - 3.0和3.1 - 4.0μg/L的患者的检出率分别为16.28%（21/129）、17.17%（17/99）、21.82%（12/55）和25.00%（15/60）。PSA水平＞2.0μg/L的PCa患者与非PCa受试者之间的f-PSA/t-PSA存在统计学显著差异（P＜0.05），但PSA水平≤2.0μg/L时无差异（P＞0.05），PSAD在PCa组和非PCa组之间也无显著差异（[0.09±0.16]与[0.06±0.07]μg/L/ml，P＞0.05）。癌症检出率随PSA水平升高而上升，但不同年龄组之间无统计学显著差异（P＞0.05）。
PSA 2.1 - 4.0μg/L且DRE和TRUS检查结果异常应被视为一个警示信号，需要定期随访和PSA检测。f-PSA/t-PSA＜0.15且无论DRE和TRUS检查结果是否异常，均应进行常规前列腺活检。对于PSA≤2.0μg/L的患者，DRE、TRUS、f-PSA/t-PSA和PSAD不能有效确诊PCa。
