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目的:在日本某单机构中评定前列腺特异抗原指数(f/tPSA)的价值和局限性,重点在于避免无意义的前列腺组织活检。方法:631名年龄在44-93岁之间(平均年龄69.8岁)的男性,在日本新滹中心医院用能量多普勒超声波图像引导的经直肠10-点前列腺组织活检后发现其 PSA 值增加,用总体前列腺特异抗原 (tPSA)和前列腺特异抗原指数(f/tPSA)观察组织学特征。结果:在134名 tPSA 为26 ng/mL 或更高病人中,126人(94.3%)检测到前列腺癌(PCa),tPSA 为21-25 ng/mL 时的 PCa 检出率是59.4%,16-20 ng/mL 时为39.2%,11-15 ng/mL 时为30.0%,4.1-10 ng/mL 时为20.0%,小于等于4.0 ng/mL 时为7.6%。在任何一个 tPSA 值区间,PCa 组的 f/tPSA 值都明显低于非肿瘤组(平均为0.122vs.0.160,P<0.001)。接收器特性法表明,对于 tPSA 值在3.0-10 ng/mL(P<0.01)之间的病人,f/tPSA(AUC:0.664)比 tPSA(AUC:0.559)更有价值。虽然以 f/tPSA 等于0.250为分界点可能产生1.8%的 PCa 漏诊率,但是这样有可能节约9.2%不必要的组织活检。结论:对预测 PCa 发病率,f/tPSA 比单独的 tPSA 更有价值。因此,对于被称为 tPSA 灰色地带的亚洲男性来说,我们推荐在 PCa 筛查中用0.250作为 f/tPSA分界点。
OBJECTIVE: To assess the value and limitations of the prostate-specific antigen index (f / tPSA) in a single institution in Japan and to focus on avoiding meaningless prostate biopsies. METHODS: Six hundred and seventy men aged 44-93 years (mean age 69.8 years) were found to have an increased PSA value after transrectal 10-point prostate biopsy guided by energy Doppler ultrasound images at Nihon Center Hospital in Japan Histological features were observed with total prostate specific antigen (tPSA) and prostate specific antigen index (f / tPSA). RESULTS: Of the 134 patients with tPSA of 26 ng / mL or higher, prostate cancer (PCa) was detected in 126 (94.3%) patients and 59.4% (59.4%) at 21-25 ng / mL tPSA 39.2% at -20 ng / mL, 30.0% at 11-15 ng / mL, 20.0% at 4.1-10 ng / mL, and 7.6% at 4.0 ng / mL. The f / tPSA value of PCa group was significantly lower than that of non-tumor group (mean 0.122 vs.0.160, P <0.001) at any one tPSA interval. Receiver characterization demonstrated that f / tPSA (AUC: 0.664) was more valuable than tPSA (AUC: 0.559) for patients with tPSA values between 3.0 and 10 ng / mL (P <0.01) Although a PCa missed diagnosis of 1.8% may occur with a cutoff of f / tPSA equal to 0.250, this may save 9.2% of unnecessary tissue biopsies. Conclusion: f / tPSA is more valuable than tPSA alone in predicting the incidence of PCa. Therefore, for Asian men, known as the gray zone of tPSA, we recommend 0.250 for f / tPSA cutoff in PCa screening.