前列腺特异性抗原和前列腺特异性抗原密度在前列腺癌检测中的前瞻性评估：种族差异

Prospective evaluation of prostate specific antigen and prostate specific antigen density in the detection of carcinoma of the prostate: ethnic variations.

作者信息

Presti J C, Hovey R, Bhargava V, Carroll P R, Shinohara K

机构信息

Department of Urology, University of California School of Medicine, San Francisco, USA.

出版信息

J Urol. 1997 Mar;157(3):907-11; discussion 911-2.

PMID:9072597

Abstract

PURPOSE

We evaluated prospectively the ethnic variations in prostate specific antigen (PSA) and prostate specific antigen density in the detection of carcinoma of the prostate.

MATERIALS AND METHODS

A total of 297 consecutive patients with an elevated serum PSA and/or abnormal digital rectal examination underwent transrectal ultrasound with lesion directed and systematic biopsy (6 if the prostatic volume was 50 cc or less and 12 if it was greater than 50 cc). Receiver operating characteristic curves, predictive values and likelihood ratios were calculated for PSA and PSA density for white and black patients. Ethnic analysis was performed for the entire group, patients with a normal digital rectal examination, and those with a normal digital rectal examination and PSA of 4 to 10 ng./ml.

RESULTS

Of the 297 patients 131 (44%) had cancer, including 48 of 97 black (50%) and 83 of 200 white (42%) patients. Median PSA, PSA density and prostate size did not differ between the positive or negative biopsy groups, or between the ethnic groups in any of the analyses. If all digital rectal examinations were considered PSA density was superior to PSA by receiver operating characteristic analysis for cancer detection in both ethnic groups when all values or PSA of 4 to 10 ng./ml. were considered. However, the significance was lost if only patients with a normal digital rectal examination were considered. In general, predictive values were greater in black patients. Likelihood ratios for a negative test result in black patients demonstrated significant changes in the post-test probability if a PSA density cutoff of 0.1 was used to determine the need for biopsy. Many unnecessary biopsies could be avoided and few cancers would be missed.

CONCLUSIONS

A PSA density cutoff of 0.1 may be warranted in determining the need for prostate biopsy in black men with a normal digital rectal examination.

摘要

目的

我们前瞻性地评估了前列腺特异性抗原（PSA）及前列腺特异性抗原密度在前列腺癌检测中的种族差异。

材料与方法

共有297例血清PSA升高和/或直肠指检异常的连续患者接受了经直肠超声检查，并进行了针对病变部位和系统的活检（如果前列腺体积为50立方厘米或更小则活检6处，如果大于50立方厘米则活检12处）。计算了白人和黑人患者PSA及PSA密度的受试者工作特征曲线、预测值和似然比。对整个组、直肠指检正常的患者以及直肠指检正常且PSA为4至10纳克/毫升的患者进行了种族分析。

结果

297例患者中，131例（44%）患有癌症，其中97例黑人患者中有48例（50%），200例白人患者中有83例（42%）。在任何分析中，活检阳性或阴性组之间以及种族组之间的PSA中位数、PSA密度和前列腺大小均无差异。如果考虑所有直肠指检结果，在所有值或PSA为4至10纳克/毫升时，通过受试者工作特征分析，PSA密度在两个种族组中检测癌症方面均优于PSA。然而，如果仅考虑直肠指检正常的患者，则这种显著性消失。总体而言，黑人患者的预测值更高。如果使用PSA密度临界值0.1来确定是否需要活检，黑人患者阴性检测结果的似然比显示出检测后概率的显著变化。可以避免许多不必要的活检，且很少会漏诊癌症。