血清前列腺特异抗原（PSA）水平在0至4.0 ng/ml之间的患者前列腺活检的病理特征及预测因素
Pathological characteristics and predictive factors of prostate biopsy in patients with serum PSA levels between 0 and 4.0 ng/ml.
作者信息
Su Rui, Pan Jin-Feng, Ren Da-Wei, Jiang Jun-Hui, Ma Qi
机构信息
Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China.
Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China.
出版信息
Front Oncol. 2022 Jul 28;12:957892. doi: 10.3389/fonc.2022.957892. eCollection 2022.
BACKGROUND
This study aimed to analyze the pathological characteristics and predictive factors of prostate biopsy in men with PSA levels below 4.0 ng/ml.
PATIENTS AND METHODS
We retrospectively analyzed 158 patients who underwent prostate biopsy with PSA levels below 4.0 ng/ml. Pathological results were statistically analyzed. The logistic regression analysis was used to determine the predictive factors for malignant outcomes. Subgroup analysis was performed on patients who received surgery and the postoperative pathological upgrading was counted.
RESULTS
A total of 143 patients were enrolled. The tumor detection rate was 20.3%. Among these patients, most of them (79.3%) had prostate adenocarcinoma, but rare malignant tumors also accounted for 20.7%. Logistic regression analysis indicated that the only independent predictive factor for a positive prostate biopsy was the PI-RADS score. For prostate adenocarcinoma cases, 95.7% of them were organ localized and 47.8% of cases were clinically significant. Subgroup analysis was performed on 14 patients who received surgical treatment. 28.6% of patients were upgraded to clinically significant prostate cancer, while 64.3% of patients had an upgrade in tumor stage.
CONCLUSION
Our study indicated that 20.3% of men with PSA levels between 0 and 4.0 ng/ml were diagnosed with prostate malignancies. Among these patients, most of them (79.3%) were diagnosed with prostate adenocarcinoma, and several uncommon types of malignancies were also detected in 20.7% of patients. The only risk factor for a positive biopsy in patients with a low PSA concentration was the PI-RADS score. It should be emphasized that the invasiveness of PCa patients diagnosed by biopsy may be underestimated as more than half of patients will upgrade their Gleason score or clinical stages after surgery. Thus, clinicians should pay more attention to patients with PSA levels between 0 and 4.0 ng/ml.
背景
本研究旨在分析前列腺特异性抗原（PSA）水平低于4.0 ng/ml的男性患者前列腺活检的病理特征及预测因素。
患者与方法
我们回顾性分析了158例PSA水平低于4.0 ng/ml且接受前列腺活检的患者。对病理结果进行统计学分析。采用逻辑回归分析确定恶性结果的预测因素。对接受手术的患者进行亚组分析，并统计术后病理升级情况。
结果
共纳入143例患者。肿瘤检出率为20.3%。在这些患者中，大多数（79.3%）为前列腺腺癌，但罕见恶性肿瘤也占20.7%。逻辑回归分析表明，前列腺活检阳性的唯一独立预测因素是前列腺影像报告和数据系统（PI-RADS）评分。对于前列腺腺癌病例，95.7%为器官局限性病变，47.8%为具有临床意义的病变。对14例接受手术治疗的患者进行亚组分析。28.6%的患者升级为具有临床意义的前列腺癌，而64.3%的患者肿瘤分期升级。
结论
我们的研究表明，PSA水平在0至4.0 ng/ml之间的男性中，20.3%被诊断为前列腺恶性肿瘤。在这些患者中，大多数（79.3%）被诊断为前列腺腺癌，20.7%的患者还检测到几种罕见类型的恶性肿瘤。PSA浓度低的患者活检阳性的唯一危险因素是PI-RADS评分。应强调的是，活检诊断的前列腺癌患者的侵袭性可能被低估，因为超过一半的患者术后Gleason评分或临床分期会升级。因此，临床医生应更加关注PSA水平在0至4.0 ng/ml之间的患者。
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