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目的探讨血清F/TPSA、PSAD、PSA-TZ在PSA>10ng/ml的大体积前列腺患者中的诊断价值,提高大前列腺体积患者的前列腺癌检出率,减少不必要的穿刺活检。方法回顾性分析郑州大学第二附属医院2004年3月—2010年3月期间243例PSA>10ng/ml、经直肠彩超检查前列腺体积>50ml、直肠指检未扪及硬结并行前列腺穿刺活检术的前列腺患者资料,年龄50～87岁,平均年龄69岁。依据前列腺穿刺结果分为BPH组及PCa组,分析比较两组间F/T、PSAD、PSA-TZ,并结合ROC曲线的AUC评价不同水平的F/T、PSAD、PSA-TZ作为前列腺癌鉴别诊断中的最佳切变值。组间比较采用t检验,数据采用SPSS13.0软件进行处理。结果 29例患者在穿刺后活检为前列腺癌,阳性率11.6%,血清总PSA均数(27.55±10.00)ng/ml;F/T值均数(0.15±0.08),PS-AD均数(0.36±0.18)ng/ml2;PSA-TZ均数(0.58±0.32)ng/ml2;前列腺增生214例,阴性率88.4%,血清总PSA均数(26.51±8.11)ng/ml;F/T均数(0.32±0.11),PSAD均数(0.18±0.06)ng/ml2;PSA-TZ均数(0.30±0.11)ng/ml2。BPH组与PCa组在F/T、PSAD、PSA-TZ差异均有显著性(P<0.05)。PSA、F/TPSA、PSAD、PSA-TZ的变化在ROC曲线下的面积AUC依次为0.537,0.614,0.785,0.865,F/T、PSAD、PSA-TZ三者皆高于PSA,差异有显著性(P<0.05)。F/T、PSAD、PSA-TZ分别在临界值0.16、0.18、0.40时,AUC面积最大,对诊断前列腺的效力最好,其敏感性依次为76.53%、67.85%、74.79%,特异性依次为为69.52%、79.63%、87.51%。结论 PSA>10ng/ml做为大体积前列腺患者前列腺穿刺指征,其前列腺癌检出率较低;血清F/TPSA、PSAD、PSA-TZ可以做为PSA>10ng/ml的大体积前列腺患者的辅助诊断指标,提高前列腺患者穿刺活检阳性率,减少不必要的穿刺活检。
Objective To investigate the diagnostic value of serum F / TPSA, PSAD and PSA-TZ in large volume prostate patients with PSA> 10ng / ml, to increase the detection rate of prostate cancer in patients with large prostate volume and to reduce unnecessary biopsy. Methods 243 cases of PSA> 10ng / ml in the Second Affiliated Hospital of Zhengzhou University from March 2004 to March 2010 were retrospectively reviewed. Prostate volume was> 50ml by transrectal color Doppler ultrasound. Prostate biopsy was performed without rectal palpation in rectal examination. Prostate patient data, aged 50 to 87 years, mean age 69 years. According to the results of prostatic puncture, the patients were divided into BPH group and PCa group. F / T, PSAD and PSA-TZ were compared between two groups, and the AUC of ROC curve was used to evaluate the different levels of F / T, PSAD and PSA-TZ as prostate cancer The best shear value in diagnosis. Comparison between groups using t test, the data using SPSS13.0 software for processing. Results Twenty-nine patients were biopsied for prostate cancer after puncture. The positive rate was 11.6%, the mean serum total PSA was (27.55 ± 10.00) ng / ml, the mean F / T value was 0.15 ± 0.08, the mean PS-AD was 0.36 ± 0.18) ng / ml2; PSA-TZ mean (0.58 ± 0.32) ng / ml2; 214 cases of benign prostatic hyperplasia, the negative rate of 88.4%, serum total PSA were (26.51 ± 8.11) ng / (0.32 ± 0.11), PSAD mean (0.18 ± 0.06) ng / ml2, and PSA-TZ mean (0.30 ± 0.11) ng / ml2 respectively. The differences of F / T, PSAD and PSA-TZ in BPH group and PCa group were significant (P <0.05). The AUCs of PSA, F / TPSA, PSAD and PSA-TZ under the ROC curve were 0.537,0.614,0.785,0.865, respectively. The F / T, PSAD and PSA-TZ were all higher than PSA (P <0.05). The AUC area of F / T, PSAD and PSA-TZ were the largest at the critical values of 0.16, 0.18 and 0.40, respectively. The sensitivity was 76.53%, 67.85% and 74.79%, respectively, and the specificity was 69.52%, 79.63%, 87.51%. Conclusion PSA> 10ng / ml could be used as an indicator of prostate biopsy in large-volume prostate patients with low detection rate of prostate cancer. Serum F / TPSA, PSAD and PSA-TZ can be used as large volume prostate patients with PSA> 10ng / ml Assisted diagnosis of indicators to improve the positive rate of prostatic biopsy and reduce unnecessary biopsy.