Dong Qi-Fei, Liu Yi-Xun, Chen Yu-Han, Ma Yi-Fan, Zhou Tao, Fan Xue-Feng, Yu Xiang, Wang Chang-Ming, Xiao Jun
Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
Department of Urology, Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China.
Asian J Androl. 2025 Jul 1;27(4):531-536. doi: 10.4103/aja202499. Epub 2025 Jan 28.
We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen (tPSA) >10 ng ml -1 and Prostate Imaging Reporting and Data System (PI-RADS) scores between 1 and 3. Clinical data derived from 517 patients of The First Affiliated Hospital of USTC (Hefei, China) from January 2020 to December 2023 who met the screening criteria for the study were retrospectively collected. Independent predictors were identified via univariate and multivariate logistic regression analysis. The diagnostic capacity of clinical variables was evaluated using the receiver operating characteristic (ROC) curves and area under the curve (AUC). A prostate biopsy strategy was developed via risk stratification. Of the 517 patients, 17/348 (4.9%) with PI-RADS 1-2 were diagnosed with clinically significant prostate cancer (csPCa), and 27/169 (16.0%) patients with PI-RADS 3 were diagnosed with csPCa. The appropriate prostate-specific antigen density (PSAD) cut-off values were 0.45 ng ml -2 for PI-RADS 1-2 patients and 0.3 ng ml -2 for PI-RADS 3 patients. The appropriate prostate volume (PV) cut-off values were 40 ml for PI-RADS 1-2 patients and 50 ml for PI-RADS 3 patients. The prostate biopsy strategy based on PSAD and PV developed in this study can reduce unnecessary prostate biopsies in patients with tPSA >10 ng ml -1 and PI-RADS 1-3. In the study, 66.5% (344/517) patients did not need to undergo prostate biopsy, at the expense of missing only 1.7% (6/344) patients with csPCa.
我们提出了一种策略，以减少中国总前列腺特异性抗原（tPSA）>10 ng/ml且前列腺影像报告和数据系统（PI-RADS）评分为1至3分的患者中不必要的前列腺活检。回顾性收集了2020年1月至2023年12月期间中国科学技术大学附属第一医院（合肥，中国）517例符合本研究筛查标准患者的临床资料。通过单因素和多因素逻辑回归分析确定独立预测因素。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估临床变量的诊断能力。通过风险分层制定前列腺活检策略。在517例患者中，PI-RADS 1-2的患者中有17/348（4.9%）被诊断为临床显著前列腺癌（csPCa），PI-RADS 3的患者中有27/169（16.0%）被诊断为csPCa。PI-RADS 1-2患者合适的前列腺特异性抗原密度（PSAD）临界值为0.45 ng/ml²，PI-RADS 3患者为0.3 ng/ml²。PI-RADS 1-2患者合适的前列腺体积（PV）临界值为40 ml，PI-RADS 3患者为50 ml。本研究中基于PSAD和PV制定的前列腺活检策略可减少tPSA>10 ng/ml且PI-RADS 1-3患者中不必要的前列腺活检。在该研究中，66.5%（344/517）的患者无需进行前列腺活检，代价是仅漏诊1.7%（6/344）的csPCa患者。
