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目的:探讨不同尿液中前列腺癌基因3(PCA3)评分的截断值对可疑前列腺癌患者诊断的应用价值。方法:纳入123例因血清总前列腺特异性抗原(t-PSA)升高和(或)直肠指诊(DRE)异常住院的患者,采集前列腺按摩后的初始尿液标本,使用实时定量PCR检测尿沉渣中PSA及PCA3 mRNA的表达,测定穿刺前尿样PCA3的评分。结合穿刺的病理结果分析不同尿PCA3评分的截断值对诊断前列腺癌的敏感性和特异性(阳性预测和阴性预测)。结果:经穿刺病理结果证实前列腺癌32例,前列腺良性增生91例。当取PCA3评分截断值为35时,可避免52.7%(48例)的患者进行不必要的穿刺,8.8%(8例)的患者被漏诊(被漏诊的患者均是低危前列腺癌);当取PCA3评分截断值为50时,可避免72.5%(66例)的患者进行不必要的穿刺,但13.2%(12例)的患者被漏诊,且2例(16.7%)是中高危前列腺癌。结论:检测可疑前列腺癌患者尿液中PCA3评分可减少不必要的穿刺,且取截断值为35时可获得较高的诊断价值。
Objective: To investigate the diagnostic value of PCA3 score in different urine for the diagnosis of patients with suspected prostate cancer. Methods: A total of 123 patients with abnormal prostate cancer (T-PSA) and / or DRE were enrolled in this study. Initial urine samples were collected after prostatic massage, and urine was detected by real-time quantitative PCR The expression of PSA and PCA3 mRNA in sediment and the score of PCA3 in urine samples before puncture. Combined with the biopsy results of the different urinary PCA3 cutoff value of the diagnosis of prostate cancer sensitivity and specificity (positive predictive and negative predictive). Results: Thirty-two cases of prostate cancer and 91 cases of benign prostatic hyperplasia were confirmed by biopsy. When the cutoff value of PCA3 was 35, 52.7% (48 cases) of patients could avoid unnecessary puncture, and 8.8% (8 cases) of patients were missed (low-risk prostate cancer was missed); when A cutoff of 50 for PCA3 was used to avoid unnecessary puncture in 72.5% (66 patients), but 13.2% (12 patients) were missed and 2 (16.7%) were high-risk prostate cancer. Conclusion: PCA3 score in urine of patients with suspected prostate cancer can reduce unnecessary puncture, and take a cut-off value of 35 can get a higher diagnostic value.