Liang Jing, Zhao Xiao-Zhi, Shi Jing-Yan, Qiu Xue-Feng, Zhang Qing, Zhuang Jun-Long, Wang Wei, Deng Yong-Ming, Huang Hai-Feng, Zhang Cheng-Wei, Guo Hong-Qian
Department of Urology / Nanjing University Research Institute of Urology, Nanjing Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210008, China.
Zhonghua Nan Ke Xue. 2019 Sep;25(9):815-822.
To investigate the exact prevalence of PCa among males in Nanjing and search for a mode of PCa screening suitable for the specific conditions.
From January to December 2018, we collected serum samples and clinical information from 6 903 men aged ≥50 years taking physical examination in 16 community health service centers in Nanjing. We proposed multi-parametric MRI (mpMRI) for those with serum PSA ≥4 μg/L, transperineal systematic biopsy and MRI/ultrasound fusion targeted prostate biopsy for those who scored ≥3 points on the Prostate Imaging-Reporting and Data System Version 2 (PI-RADS v2), transperineal systematic biopsy only for those with a PI-RADS v2 score of <3 and serum PSA ≥10 μg/L, and follow-up examinations every 6 months for those with a PI-RADS v2 score of <3 and serum PSA <4 μg/L.
Among the 6 903 male subjects, 835 (12.1%) were found with serum PSA≥4 μg/L; 229 (77.4%) of the 296 men that received mpMRI scored ≥3 points on PI-RADS v2; and 79 (53.4%) of the 148 males that underwent prostate biopsy were diagnosed with PCa, with a total detection rate of 1.14% in all the subjects. Of the 77 patients with complete pathological data, 73 (94.8%) were found with clinically significant PCa, 30 (39.0%) with localized, 41 (53.2%) with locally advanced and 6 (7.8%) with metastatic malignancy, 6 (7.8%) in stage Ⅰ, 21 (27.3%) in stage Ⅱ, 34 (44.2%) in stage Ⅲ and 16 (20.8%) in stage Ⅳ. There were 47 (66.2%) high-risk, 18 (25.4%) moderate-risk and 6 (8.5%) low-risk cases among those with localized or locally advanced PCa.
The prevalence of PCa in Nanjing deserves considerable attention, and PCa screening is highly necessary in the high-risk population, for which the combination of serum PSA assay, mpMRI and targeted prostate biopsy may be an ideal method.
调查南京男性人群中前列腺癌（PCa）的实际患病率，并寻找适合当地情况的PCa筛查模式。
2018年1月至12月，我们收集了南京市16家社区卫生服务中心6903名年龄≥50岁男性的血清样本和临床信息。对于血清前列腺特异抗原（PSA）≥4μg/L的患者，建议进行多参数磁共振成像（mpMRI）检查；对于前列腺影像报告和数据系统第2版（PI-RADS v2）评分≥3分的患者，进行经会阴系统活检和MRI/超声融合靶向前列腺活检；对于PI-RADS v2评分<3且血清PSA≥10μg/L的患者，仅进行经会阴系统活检；对于PI-RADS v2评分<3且血清PSA<4μg/L的患者，每6个月进行一次随访检查。
在6903名男性受试者中，发现835例（12.1%）血清PSA≥4μg/L；在接受mpMRI检查的296名男性中，229例（77.4%）PI-RADS v2评分≥3分；在接受前列腺活检的148名男性中，79例（53.4%）被诊断为PCa，所有受试者的总检出率为1.14%。在77例有完整病理数据的患者中，73例（94.8%）为具有临床意义的PCa，其中局限性PCa 30例（39.0%），局部进展性PCa 41例（53.2%），转移性恶性肿瘤6例（7.8%）；Ⅰ期6例（7.8%），Ⅱ期21例（27.3%），Ⅲ期34例（44.2%），Ⅳ期16例（20.8%）。在局限性或局部进展性PCa患者中，高危病例47例（66.2%），中危病例18例（25.4%），低危病例6例（8.5%）。
南京地区PCa的患病率值得高度关注，高危人群中PCa筛查非常必要，血清PSA检测、mpMRI和靶向前列腺活检相结合可能是一种理想的筛查方法。
