Netto Júnior N R, De Lima M L, Lavoura Júnior N da S, Apuzzo F, De Lucena R G
Division of Urology, University of Campinas Medical Center and Urology Clinic, Hospital Beneficência Portuguesa, São Paulo, Brazil.
Arch Esp Urol. 1998 Dec;51(10):1050-3.
To determine prostate specific antigen density (PSAD) in a risk population without evidence of prostatic cancer, and to assess the long-term usefulness of PSAD as a parameter for determining the need for a prostatic biopsy in patients with a normal digital rectal examination (DRE) and transrectal ultrasound (TRUS).
The records of 582 patients referred to the clinic between February, 1992 and February, 1994 were studied retrospectively. All these patients with lower urinary tract symptoms (LUTS) were evaluated based on the following parameters: digital rectal examination, serum PSA levels, prostate volume measured using transrectal ultrasound and PSAD. Prostatic biopsy was performed on 431 patients who had a serum PSA level greater than 4.0 ng/mL. A total of 299 patients (69.3%) had PSA levels between 4.0 and 10.0 ng/mL and represented the target population. The study had two parts, in the first one cancer was diagnosed just by one biopsy and in part II, the patients with negative biopsy in part I were followed for a two-year period and required 2 or 3 biopsies for diagnosis. Of the total of patients who had a negative prostate biopsy in part I of the study, 269 were followed for a period of two years with repeated prostate biopsies.
Overall prostate cancer was detected in 22/299 (13.9%) patients, 6/105 (5.7%) with PSAD up to 0.15 and 16/194 (8.2%) with PSAD over 0.15 (p = 0.569).
PSAD is a useful indicator in decreasing the number of negative biopsies in patients with benign prostatic hyperplasia. However, in a long-term follow-up the PSAD (cutoff level 0.15) was unable to predict which patients had a positive biopsy. According to our results, 5.6% of patients with prostate cancer will be missed using the PSAD criteria.
确定无前列腺癌证据的风险人群中的前列腺特异性抗原密度（PSAD），并评估PSAD作为一项参数，对于直肠指检（DRE）和经直肠超声检查（TRUS）结果正常的患者确定是否需要进行前列腺活检的长期效用。
回顾性研究了1992年2月至1994年2月间转诊至该诊所的582例患者的记录。所有这些有下尿路症状（LUTS）的患者均根据以下参数进行评估：直肠指检、血清PSA水平、经直肠超声测量的前列腺体积以及PSAD。对431例血清PSA水平大于4.0 ng/mL的患者进行了前列腺活检。共有299例患者（69.3%）的PSA水平在4.0至10.0 ng/mL之间，构成了目标人群。该研究分为两部分，第一部分仅通过一次活检诊断癌症，第二部分中，第一部分活检结果为阴性的患者随访两年，诊断需要进行2或3次活检。在该研究第一部分前列腺活检结果为阴性的所有患者中，269例接受了为期两年的随访并重复进行前列腺活检。
在299例患者中，共检测出22例（13.9%）前列腺癌，PSAD高达0.15的患者中有6例（5.7%），PSAD超过0.15的患者中有16例（8.2%）（p = 0.569）。
PSAD是减少良性前列腺增生患者阴性活检数量的有用指标。然而，在长期随访中，PSAD（临界值0.15）无法预测哪些患者活检结果为阳性。根据我们的结果，使用PSAD标准会漏诊5.6%的前列腺癌患者。
