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目的 ROC曲线分析探讨前列腺特异性抗原密度(PSAD)、总PSA(tPSA)和游离PSA/总PSA(fPSA/tPSA)3者在PSA灰区前列腺癌(PCa)中的临床诊断价值。方法回顾性分析tPSA在4～10ng/ml之间的前列腺增生(BPH)患者75例和前列腺癌患者31例。化学发光法测定血清tPSA和fPSA,经直肠超声(TRUS)测定前列腺体积,计算fPSA/tPSA和PSAD。比较BPH组和PCa组间tPSA、PSAD和fPSA/tPSA各指标的差异,分析各指标在ROC曲线下的面积、各指标的诊断特异性及敏感性。结果PCa组与BPH组tPSA差异无统计学意义(P>0.05),PCa组fPSA/tPSA比值较BPH组降低(P<0.01),PSAD值较BPH组升高(P<0.05)。ROC曲线下的面积从大到小为fPSA/tPSA>PSAD>tPSA。在诊断敏感性相同的情况下,fPSA/tPSA比值诊断特异性高于PSAD的诊断特异性。当fPSA/tPSA临界值取0.16时,诊断前列腺癌的灵敏度和特异性为67.7%和79.7%,PSAD临界值取0.12时,其灵敏度和特异性为61.3%和62.7%。结论当tPSA在诊断灰区时,PSAD和fPSA/tPSA可以提高前列腺癌的诊断特异性和敏感性,fPSA/tPSA较PSAD有更高的诊断价值。
Objective To investigate the clinical diagnostic value of prostate specific antigen density (PSAD), total PSA (tPSA) and free PSA / total PSA (fPSA / tPSA) in PSA gray zone prostate cancer (PCa) Methods Retrospective analysis of 75 cases of benign prostatic hyperplasia (BPH) patients with tPSA between 4 ~ 10ng / ml and 31 cases of prostate cancer patients. Serum tPSA and fPSA were measured by chemiluminescence method. Prostate volume was measured by transrectal ultrasound (TRUS) and fPSA / tPSA and PSAD were calculated. The differences of tPSA, PSAD and fPSA / tPSA between BPH group and PCa group were analyzed. The area under the ROC curve, the diagnostic specificity and sensitivity of each index were analyzed. Results There was no significant difference in tPSA between PCa group and BPH group (P> 0.05). The ratio of fPSA / tPSA in PCa group was lower than that in BPH group (P <0.01) and PSAD value was higher than that in BPH group (P <0.05). The area under the ROC curve is fPSA / tPSA> PSAD> tPSA. The diagnostic specificity of the fPSA / tPSA ratio is higher than the diagnostic specificity of PSAD for the same diagnostic sensitivity. Sensitivity and specificity of 67.7% and 79.7% for the diagnosis of prostate cancer when fPSA / tPSA cutoff was 0.16, and sensitivity and specificity of 61.3% and 62.7% for PSAD cutoff of 0.12, respectively. Conclusions PSAD and fPSA / tPSA can improve the diagnostic specificity and sensitivity of prostate cancer when tPSA is used to diagnose gray matter area. FPSA / tPSA has higher diagnostic value than PSAD.