Ozah Ehiremhen, Agbugui Jude Orumuah
Urology Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Department of Surgery, Kings Hospitals, NHS Foundation Trust, United Kingdom.
Niger Med J. 2025 Jan 10;65(6):1124-1134. doi: 10.60787/nmj.v65i6.623. eCollection 2024 Nov-Dec.
Prostate cancer is the most common urologic malignancy in men, it is witnessing a huge burden in developing countries. Prostate-specific antigen has served as a tool in diagnosis and prognostication. To improve its sensitivity, Prostate-specific antigen density is being used to discriminate between benign and malignant conditions to avoid the incidence of unnecessary biopsy. Similarly, it is important to establish the importance of Prostate-specific antigen density in prognostication to help in treatment stratification. The aim of this study, therefore, is to assess the relationship between Prostate-specific antigen density and tumour grade using the Gleason score.
This study was a prospective cross-sectional study carried out between 2015-2016. It involved 191 consecutive patients who were either asymptomatic or symptomatic with elevated prostate-specific antigen (PSA)/abnormal digital rectal examination findings or both. They had a Prostate volume assessment and digitally guided prostate biopsy. Prostate-specific antigen density was calculated, and histopathology reports were evaluated. Data were analysed using SPSS version 20.0. Pearson correlation coefficient and test of ANOVA were used to assess the relationship between prostate-specific- antigen and Gleason score while a scatterplot was used to determine the relationship between prostate-specific antigen and prostate volume. The level of significance was set at p< 0.05.
All patients in this study were Nigerians, mean age of the study population was 68.2+ 9.4 years. The median PSA for patients with prostate cancer was 76.9ng/ml and 14.5ng/ml for patients with benign disease, the difference was statistically significant (p<0.001), and median prostate volume was 84.5mls while the median PSAD was 0.25. PSAD for Gleason score 2-4,5-7,8-10 was 0.4,0.8 and1.1 respectively which was statistically significant using a test of ANOVA (p=0.001). Pearson correlation coefficient revealed a statistically significant correlation between Prostate-specific antigen and Gleason score (r= 0.375, p=0.024). Using Fisher's exact test there was a statistically significant difference between PSAD for benign prostatic disease and carcinoma of the prostate, p<0.001.
The study revealed that Prostate-specific antigen density has a statistically significant predictive value for tumour grade using Gleason score, however no statistically significant correlation was observed between prostate-specific antigen and prostate volume in prostate cancer.
前列腺癌是男性中最常见的泌尿系统恶性肿瘤，在发展中国家正面临着巨大的负担。前列腺特异性抗原已成为诊断和预后评估的工具。为提高其敏感性，前列腺特异性抗原密度正被用于区分良性和恶性情况，以避免不必要的活检。同样，确定前列腺特异性抗原密度在预后评估中的重要性对于治疗分层也很重要。因此，本研究的目的是使用 Gleason 评分评估前列腺特异性抗原密度与肿瘤分级之间的关系。
本研究是一项于 2015 年至 2016 年期间开展的前瞻性横断面研究。研究对象为 191 例连续患者，他们要么无症状，要么有前列腺特异性抗原（PSA）升高或直肠指检异常或两者皆有的症状。他们接受了前列腺体积评估和在数字引导下的前列腺活检。计算前列腺特异性抗原密度，并评估组织病理学报告。使用 SPSS 20.0 版进行数据分析。Pearson 相关系数和方差分析用于评估前列腺特异性抗原与 Gleason 评分之间的关系，同时使用散点图确定前列腺特异性抗原与前列腺体积之间的关系。显著性水平设定为 p < 0.05。
本研究中的所有患者均为尼日利亚人，研究人群的平均年龄为 68.2 ± 9.4 岁。前列腺癌患者的 PSA 中位数为 76.9ng/ml，良性疾病患者为 14.5ng/ml，差异具有统计学意义（p < 0.001），前列腺体积中位数为 84.5ml，而 PSAD 中位数为 0.25。Gleason 评分为 2 - 4、5 - 7、8 - 10 的 PSAD 分别为 0.4、0.8 和 1.1，使用方差分析具有统计学意义（p = 0.001）。Pearson 相关系数显示前列腺特异性抗原与 Gleason 评分之间存在统计学显著相关性（r = 0.375，p = 0.024）。使用 Fisher 精确检验，良性前列腺疾病和前列腺癌的 PSAD 之间存在统计学显著差异，p < 0.001。
该研究表明，前列腺特异性抗原密度对于使用 Gleason 评分的肿瘤分级具有统计学显著的预测价值，然而在前列腺癌中未观察到前列腺特异性抗原与前列腺体积之间存在统计学显著相关性。
