Chiu Peter Ka-Fung, Teoh Jeremy Yuen-Chun, Chan Samson Yun-Sang, Chu Peggy Sau-Kwan, Man Chi-Wai, Hou See-Ming, Ng Chi-Fai
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
Int Urol Nephrol. 2014 Dec;46(12):2251-4. doi: 10.1007/s11255-014-0826-7. Epub 2014 Sep 9.
To compare the performance of prostate-specific antigen (PSA) density in the diagnosis of prostate cancer in obese and non-obese Chinese men.
The results of transrectal ultrasound-guided (TRUS) prostate biopsies of Chinese men with PSA <20 ng/mL were reviewed. Parameters including age, body mass index (BMI), TRUS prostate volume, and TRUS biopsy results were recorded. The diagnostic yields of PSA density (>0.15 ng/mL as positive) in obese and non-obese men with PSA <20 ng/mL were compared. Obesity was defined as BMI ≥ 27 kg/m(2) according to WHO recommendation for Hong Kong Chinese.
TRUS biopsy, BMI, and PSA density data were available for 854 men (mean age 65.9 ± 7.3). The mean PSA values for the obese and non-obese patients were 7.9 ± 3.7 and 8.2 ± 4.1 ng/mL, respectively (p = 0.416). TRUS volumes in obese and non-obese men were 63.2 ml and 51.6 ml, respectively (t test, p < 0.001), and PSA density was significantly lower in obese men (0.145 vs. 0.188, p < 0.001). For obese men, positive PSA density was associated with four times (41.1 vs. 9.5 %, p < 0.001) the risk of prostate cancer, compared to only twice the risk (18.8 vs. 9.7 %, p = 0.001) in non-obese men. The specificity and area under the curve of PSA density were 74.2 % and 0.731, respectively, for obese men, and 51.4 % and 0.653, respectively, for non-obese men. Among patients with a diagnosis of prostate cancer, the obese patient group had a significantly higher proportion of patients with Gleason 7-10 prostate cancer than the non-obese patient group (48.9 vs. 32.7 %, Chi-square test, p = 0.035), and a trend toward a higher proportion of bilateral lobe involvement.
PSA density had better performance in obese men. Positive PSA density in obese men was associated with four times the risk of prostate cancer.
比较前列腺特异性抗原（PSA）密度在诊断肥胖和非肥胖中国男性前列腺癌中的表现。
回顾了PSA<20 ng/mL的中国男性经直肠超声引导（TRUS）前列腺活检结果。记录年龄、体重指数（BMI）、TRUS前列腺体积和TRUS活检结果等参数。比较了PSA<20 ng/mL的肥胖和非肥胖男性中PSA密度（>0.15 ng/mL为阳性）的诊断率。根据世界卫生组织针对中国香港人的建议，肥胖定义为BMI≥27 kg/m²。
854名男性（平均年龄65.9±7.3）有TRUS活检、BMI和PSA密度数据。肥胖和非肥胖患者的平均PSA值分别为7.9±3.7和8.2±4.1 ng/mL（p = 0.416）。肥胖和非肥胖男性的TRUS体积分别为63.2 ml和51.6 ml（t检验，p<0.001），肥胖男性的PSA密度显著更低（0.145对0.188，p<0.001）。对于肥胖男性，PSA密度阳性与前列腺癌风险增加四倍相关（41.1%对9.5%，p<0.001），而在非肥胖男性中仅为两倍风险（18.8%对9.7%，p = 0.001）。肥胖男性中PSA密度的特异性和曲线下面积分别为74.2%和0.731，非肥胖男性分别为51.4%和0.653。在诊断为前列腺癌的患者中，肥胖患者组中Gleason 7 - 10级前列腺癌患者的比例显著高于非肥胖患者组（48.9%对32.7%，卡方检验，p = 0.035），并且双侧叶受累比例有升高趋势。
PSA密度在肥胖男性中表现更佳。肥胖男性中PSA密度阳性与前列腺癌风险增加四倍相关。
