Caner Ediz, Serkan Akan, Neslihan Kaya, Aysenur Ihvan
Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul, Turkey.
Department of Pathology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul, Turkey.
Arch Med Sci. 2021 Oct 15;20(6):1894-1901. doi: 10.5114/aoms/131789. eCollection 2024.
This study aimed to discuss the necessity of a second prostate biopsy in patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table to be used as new criteria for a second biopsy.
The study reviewed the data of 2,845 patients who underwent transrectal ultrasonography-guided prostate biopsy in the period between January 2008 and May 2019. A total of 128 patients with ASAP were included in the study. The tPSA, fPSA, f/tPSA, and PSA-density levels before the first and second biopsies and changes in the measured levels between the values obtained before the first and the second biopsies were recorded. The ASAP Scoring System and Risk Table (ASS-RT) was evaluated before the second biopsy.
The mean age of 128 patients with ASAP was 62.9 ±7.8 years. The ASS-RT scores of prostate cancer patients were significantly higher compared to patients without prostate cancer ( = 0.001). In the ROC curve analysis of ASS-RT, the area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 ( = 0.001). The cut-off point of ASS-RT scores in diagnosing cancer was ≥ 7 with 60.8% sensitivity and 80.5% specificity.
The cut-off value of 7 determined for the ASS-RT score in this study suggests that patients with ASS-RT scores of ≥ 7 should undergo a second prostate biopsy. We think that there may be no need for a second biopsy if the ASS-RT score is < 7, especially for low-risk patients.
本研究旨在探讨非典型小腺泡增生（ASAP）患者进行二次前列腺活检的必要性，并开发一种评分系统和风险表，作为二次活检的新标准。
本研究回顾了2008年1月至2019年5月期间接受经直肠超声引导下前列腺活检的2845例患者的数据。共有128例ASAP患者纳入研究。记录首次和二次活检前的总前列腺特异性抗原（tPSA）、游离前列腺特异性抗原（fPSA）、f/tPSA和PSA密度水平，以及首次和二次活检前测量值之间的水平变化。在二次活检前评估ASAP评分系统和风险表（ASS-RT）。
128例ASAP患者的平均年龄为62.9±7.8岁。前列腺癌患者的ASS-RT评分显著高于无前列腺癌患者（P = 0.001）。在ASS-RT的ROC曲线分析中，曲线下面积为0.804，标准误为0.04。ROC曲线下面积显著高于0.5（P = 0.001）。ASS-RT评分诊断癌症的截断点为≥7，灵敏度为60.8%，特异度为80.5%。
本研究确定的ASS-RT评分截断值为7，表明ASS-RT评分≥7的患者应进行二次前列腺活检。我们认为，如果ASS-RT评分<7，特别是低风险患者，可能无需进行二次活检。
