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目的:探讨u PCA3m RNA、t PSA、f PSA/t PSA、PSAD对PSA灰区前列腺癌的诊断价值。方法:经前列腺穿刺活检诊断为前列腺增生(BPH)111例和前列腺癌(PCa)89例,测定血清t PSA、f PSA与前列腺体积,所有病例均计算f PSA/t PSA、PSAD。用RT-PCR的方法检测PSA m RNA、PCA3 m RNA的含量,以PCA3 m RNA/PSA m RNA表示PCA3 m RNA的含量。比较两组间t PSA、f PSA/t PSA、PSAD及PCA3m RNA各指标的差异,分析各指标在ROC曲线下的面积、各指标的诊断敏感性和特异性。结果:PCa组的f PSA/t PSA较BPH组降低(P<0.01),PCa组的t PSA、PSAD及PCA3 m RNA较BPH组均升高(P<0.01)。t PSA、f PSA/t PSA、PSAD及PCA3 m RNA在ROC曲线下的面积从大到小依次是PCA3 m RNA>PSAD>f PSA/t PSA>t PSA。当PCA3 m RNA和PSAD临界值分别为0.27和0.15时,诊断PCa的敏感性和特异性分别是86.5%和77.5%,80.9%和55.9%。结论:u PCA3m RNA、f PSA/t PSA、PSAD的测定能显著提高灰区PCa诊断的敏感性和特异性,且u PCA3 m RNA诊断效能最高。
Objective: To investigate the diagnostic value of PCa3m RNA, t PSA, f PSA / t PSA and PSAD in the diagnosis of prostate cancer with PSA gray zone. METHODS: Totally 111 cases of benign prostatic hyperplasia (BPH) and 89 cases of prostate cancer (PCa) were diagnosed by prostatic biopsy. The serum levels of t PSA, f PSA, and prostate volume were measured. The f PSA / t PSA and PSAD were calculated in all cases. The contents of PSA m RNA and PCA3 m RNA were detected by RT-PCR and the content of PCA3 m RNA was expressed by PCA3 m RNA / PSA m RNA. The differences of the indexes of t PSA, f PSA / t PSA, PSAD and PCA3m RNA between the two groups were compared. The area under the ROC curve and the diagnostic sensitivity and specificity of each index were analyzed. Results: The f PSA / t PSA in PCa group was lower than that in BPH group (P <0.01). The levels of t PSA, PSAD and PCA3 mRNA in PCa group were higher than those in BPH group (P <0.01). The areas under the ROC curve of PSA, t PSA, f PSA / t PSA, PSAD and PCA3 m RNA were PCA3 m RNA> PSAD> f PSA / t PSA> t PSA in descending order. The sensitivity and specificity for diagnosing PCa were 86.5% and 77.5%, 80.9% and 55.9%, respectively, when the PCA3 m RNA and PSAD cutoff were 0.27 and 0.15, respectively. Conclusion: The detection of PCA3m RNA, f PSA / t PSA and PSAD can significantly improve the sensitivity and specificity of PCa3-PCA in diagnosis of gray matter, and uPCA3-m RNA has the highest diagnostic efficiency.