篇名 | Prostate-Specific Antigen Density is a More Accurate Predictor of Prostate Cancer in Patients With Prostate-Specific Antigen Levels of 4-10 ng/mL and Normal Digital Rectal Examination Findings |
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卷期 | 15:4 |
並列篇名 | 針對肛門指診正常且攝護腺特定抗原指標 在4 至10 的病患,在偵測攝護腺癌中攝護腺 特定抗原密度是較好的預測指標 |
作者 | 蔡樹衛 、 林志明 、 羅華安 、 陳紹寬 、 陳國強 、 蔡尚憲 、 謝德生 |
頁次 | 173-178 |
關鍵字 | Prostate-specific antigen density 、 prostate cancer 、 biopsy 、 prostate-specific antigen 、 護腺特定抗原密度 、 攝護腺癌 、 切片 、 護腺特定抗原 |
出刊日期 | 201712 |
DOI | 10.3966/181020932017121504001 |
目的:本研究目的針對攝護腺特定抗原(prostate-specific antigen,t PSA)為4 ~ 10 奈公克/毫公升(ng/mL)且經肛門指診檢查(Digital Rectal Examination, DRE) 正常 的攝護腺癌(prostate cancer)病患,找出較好的診斷指標。方法:我們利用回顧性評估, 從2008 年1 月至2013 年6 月,490 例患者在我們醫院接受了經直腸超聲波引導下攝 護腺穿刺(transrectal ultrasound-guided prostate biopsy)。排除肛門指診(DRE)異常 和攝護腺特定抗原(PSA)>10 奈公克/毫公升(ng/mL)的病人。最後收集了238 名男性,以此數據來做統計分析。另外使用接受者操作特性曲線(receiver operating characteristic,ROC)分析,我們評估t PSA、f/tPSA、攝護腺特定抗原密度(Prostatespecific antigen density, PSAD),來比較診斷前列腺癌的準確度。結果:238 人中的47 人(19.7%)有攝護腺癌。攝護腺特定抗原密度(PSAD)有顯著差異(平均0.306 奈 公克/毫公升平方(ng/mL2)和0.156 奈公克/毫公升平方(ng/mL2),P <0.001)。 ROC 曲線下對tPSA、f/tPSA、PSAD 分別為59.8%,36.6% 和77.4%。當PSAD 在0.16 奈公克/毫公升平方(ng/mL2)的數值,針對攝護腺癌的診斷有較高的靈敏度和特異 性(分別為72% 和61%)。ROC 曲線分析表明,PSAD 是一個更好的預測前列腺癌 相對於f/tPSA。結論:結果表明,PSAD 在護腺特定抗原為4 ~ 10 奈公克/毫公升(ng/ mL)且經肛門指診(DRE)檢查正常的病患中,有提高診斷攝護腺癌的準確率。
Purpose: This study was conducted to identify the optimal predictor of prostate cancer among several prostate-specific antigen (tPSA) derivatives in prostate biopsies of patients with PSA levels of 4–10 ng/mL and normal digital rectal examination (DRE) findings. Materials and methods: We retrospectively assessed prostate biopsy specimens of 490 patients who underwent transrectal ultrasound-guided prostate biopsy in our hospital from January 2008 to June 2013. We excluded patients with abnormal DRE findings and serum tPSA levels of >10 ng/mL. Finally, 238 men with serum tPSA levels of 4–10 ng/mL and normal DRE findings were included in the statistical analysis. We performed receiver operating characteristic (ROC) curve analysis and assessed the predictive power of tPSA, percentage of free PSA (f/tPSA), and PSA density (PSAD) for detecting prostate cancer. Results: Overall, 47 (19.7%) of the 238 prostate biopsy specimens were positive for prostate cancer. Patients with positive and negative biopsy results had significant differences in the mean PSAD (0.306 and 0.156 ng/mL2, respectively, p < 0.001). The areas under the ROC curves for tPSA, f/tPSA, and PSAD were 59.8%, 36.6%, and 77.4%, respectively. Moreover, when PSAD was considered as a predictor at an optimal cutoff value of 0.16 ng/mL2, the detection of prostate cancer was highly sensitive (72%) and specific (61%). The ROC curve analysis indicated that PSAD was a more accurate predictor of prostate cancer than was f/tPSA. Conclusion: The results suggest that PSAD improves the specificity of cancer detection in men with normal DRE findings and an intermediate PSA level.