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目的探讨血清睾酮(T)水平对提高前列腺癌检出率的临床意义。方法选择2007年4月-2010年4月间在卫生部北京医院及吉林大学第一医院行前列腺6-8针穿刺的患者共75例。穿刺前患者行血清睾酮、PSA检测,直肠指检、前列腺彩超或前列腺MRI检查并测量前列腺体积。病理组织学检查明确前列腺癌的诊断。统计学方法采用单因素多元方差分析及ROC曲线分析。结果前列腺癌患者的血清T水平略低于前列腺增生患者,但无显著差异(P=0.084),ROC曲线分析:血清T水平的ROC曲线下面积为0.617,(P=0.107,95%CI:0.469-0.763),T/PSA的曲线下面积为0.770,(P=0.000,95%CI:0.659-0.881),T/PSAD的曲线下面积为0.858,(P=0.000,95%CI:0.771-0.945),T×PSA-r的曲线下面积为0.800,(P=0.000,95%CI:0.693-0.908)。T/PSA<0.495时,诊断前列腺癌的敏感度为75%,特异度为71%;T/PSAD<21.7时,诊断前列腺癌的敏感度为88%,特异度为71%;T×PSA-r<0.59时,诊断前列腺癌的敏感度为79%,特异度为67%。结论血清睾酮水平对于提高前列腺癌的检出率,增加PSA、PSAD、PSA-r的敏感性及特异性有较为显著的意义,以考虑将血清睾酮水平作为常规前列腺癌筛查的指标。
Objective To investigate the clinical significance of serum testosterone (T) level in improving the detection rate of prostate cancer. Methods From April 2007 to April 2010, 75 cases of prostatic 6-8-needle puncture were performed in Beijing Hospital of Ministry of Public Health and First Hospital of Jilin University. Patients before puncture serum testosterone, PSA test, digital rectal examination, prostate ultrasonography or prostate MRI examination and measurement of prostate volume. Histopathological examination to confirm the diagnosis of prostate cancer. Statistical methods using one-way multivariate analysis of variance and ROC curve analysis. Results The serum T level of prostate cancer patients was slightly lower than that of benign prostatic hyperplasia patients (P = 0.084). The ROC curve showed that the area under the ROC curve of serum T level was 0.617 (P = 0.107, 95% CI: 0.469 -0.763), the area under the curve for T / PSA was 0.770 (P = 0.000, 95% CI: 0.659-0.881) and the area under the curve for T / PSAD was 0.858 (P = 0.000,95% CI: ), The area under the curve for T × PSA-r was 0.800 (P = 0.000, 95% CI: 0.693-0.908). For T / PSA <0.495, the sensitivity and specificity of diagnosing prostate cancer were 75% and 71% respectively. The sensitivity and specificity of T / PSAD <21.7 were 88% and 71% For r <0.59, the sensitivity of diagnosing prostate cancer was 79% and the specificity was 67%. Conclusions Serum testosterone levels have significant significance in improving the detection rate of prostate cancer, increasing the sensitivity and specificity of PSA, PSAD and PSA-r, and taking the serum testosterone level as the index of routine prostate cancer screening.