Sanchis-Bonet Angeles, Morales-Palacios Nelson, Barrionuevo-Gonzalez Marta, Ortega-Polledo Luis-Enrique, Ortiz-Vico Francisco-Javier, Sanchez-Chapado Manuel
Principe de Asturias University Hospital, Department of Urology, Madrid, Spain.
Cent European J Urol. 2017;70(1):30-36. doi: 10.5173/ceju.2017.881. Epub 2017 Jan 3.
To investigate prostate-specific antigen (PSA) accuracy and digital rectal examination (DRE) accuracy in detecting prostate cancer according to body mass index (BMI) in Spanish men with an indication of the first prostate biopsy.
We reviewed the clinical and histopathological data of 1,319 patients who underwent transrectal ultrasound-guided prostate needle biopsy. The patients were categorised according to the BMI as follows: <25 kg/m (normal weight); 25-29.9 kg/m (overweight); and ≥30 kg/m (obese). Receiver operator characteristic curves were used to assess PSA accuracy and DRE accuracy by calculating the area under the curve.
The obesity rate of the cohort was 14%. PSA accuracy for predicting prostate cancer in each BMI category was 0.52, 0.58 and 0.62, respectively (p = 0.01). After stratification by DRE findings, there was no difference in the performance accuracy of PSA in predicting the presence of cancer across BMI groups in abnormal DRE (p = 0.90). Serum PSA, DRE and BMI were strong predictors of prostate cancer diagnosis (odds ratio 1.07, 2.02 and 1.4, respectively; p <0.001). When the DRE was abnormal, a BMI ≥30 increased the risk of prostate cancer twice. With the addition of BMI to the model, the area under the curve of the combined PSA and DRE for diagnosing prostate cancer improved from 0.60 to 0.63.
The predictive value of PSA in predicting prostate cancer is not poorer in the obese population and the predictive value of an abnormal DRE in cancer detection is significantly modified by the patient's BMI.
在有首次前列腺活检指征的西班牙男性中，根据体重指数（BMI）研究前列腺特异性抗原（PSA）检测前列腺癌的准确性以及直肠指检（DRE）检测前列腺癌的准确性。
我们回顾了1319例接受经直肠超声引导下前列腺穿刺活检患者的临床和组织病理学数据。根据BMI将患者分为以下几类：<25kg/m（正常体重）；25 - 29.9kg/m（超重）；≥30kg/m（肥胖）。采用受试者操作特征曲线，通过计算曲线下面积来评估PSA准确性和DRE准确性。
该队列的肥胖率为14%。各BMI类别中PSA预测前列腺癌的准确性分别为0.52、0.58和0.62（p = 0.01）。根据DRE结果分层后，在DRE异常的BMI组中，PSA预测癌症存在的性能准确性无差异（p = 0.90）。血清PSA、DRE和BMI是前列腺癌诊断的强预测因素（比值比分别为1.07、2.02和1.4；p <0.001）。当DRE异常时，BMI≥30使前列腺癌风险增加两倍。在模型中加入BMI后，联合PSA和DRE诊断前列腺癌的曲线下面积从0.60提高到0.63。
PSA在肥胖人群中预测前列腺癌的价值并不差，且患者的BMI显著改变了DRE异常在癌症检测中的预测价值。
