PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/ml
PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/ml
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DOI：
10.1016/s0090-4295(99)00153-3
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发表时间：
1999-09-01
期刊：
影响因子：
2.1
通讯作者：
Marberger, M
中科院分区：
文献类型：
--
作者：
Djavan, B;Zlotta, A;Marberger, M
目标.为了提高前列腺癌（PCa）检测的特异性，减少前列腺特异性抗原（PSA）水平为2.5至4.0 ng/mL的男性不必要的活检，我们前瞻性地评估了各种基于PSA的诊断参数。本研究纳入了273名连续男性，血清PSA为2.5至4.0 ng/mL，被转诊为早期PCa检测或下尿路症状。所有男性均接受前列腺超声和六分活检，并额外进行两次移行区（TZ）活检。如果第一次活检是阴性的，则在6周时进行重复活检。测定总PSA、PSA密度（PSAD）、移行区PSA密度（PSA-TZ）、游离PSA/总PSA比值（fit PSA）、PSA流速（PSAV），计算各参数的敏感性、特异性和预测值。在273例患者中，207例经组织学证实为良性前列腺增生（BPH），66例为PCa。fit PSA和PSA-TZ是预测PCa最有效的指标，其次是PSA、PSAD和PSAV。PSA和PSA-TZ的受试者工作特征曲线下面积分别为74.9%和70.1%。PCa检测的敏感性为95%，与所有其他PSA相关参数相比，f/t PSA 41%的临界值和PSA-TZ 0.095的临界值将导致最低数量的不必要活检（fit PSA和PSA-TZ的特异性分别为29.3%和17.2%）。与标准总PSA检测相比，fit PSA和PSA-TZ显著提高了总PSA为2.5至4.0 ng/mL的转诊患者人群中PCa检测的灵敏度和特异性。(C)1999年，Elsevier Science Inc.
Objectives. To enhance the specificity of prostate cancer (PCa) detection and reduce unnecessary biopsies in men with prostate-specific antigen (PSA) levels of 2.5 to 4.0 ng/mL, we prospectively evaluated various PSA-based diagnostic parameters.Methods. This study included 273 consecutive men with serum PSA of 2.5 to 4.0 ng/mL referred for early PCa detection or lower urinary tract symptoms. All men underwent prostate ultrasound and sextant biopsy with two additional transition zone (TZ) biopsies. If the first biopsies were negative, repeated biopsies were performed at 6 weeks. Total PSA, PSA density (PSAD), PSA density of the transition zone (PSA-TZ), free/total PSA ratio (fit PSA), and PSA velocity (PSAV) were determined, and the sensitivity, specificity, and predictive values of these various parameters were calculated.Results. Of 273 patients, 207 had histologically confirmed benign prostatic hyperplasia (BPH) and 66 had PCa. fit PSA and PSA-TZ were the most powerful predictors of PCa, followed by PSA, PSAD, and PSAV. Areas under the receiver operating characteristic curves for fit PSA and PSA-TZ were 74.9% and 70.1%, respectively. With a 95% sensitivity for PCa detection, an f/t PSA cutoff of 41% and a PSA-TZ cutoff of 0.095 would result in the lowest number of unnecessary biopsies (29.3% and 17.2% specificity for fit PSA and PSA-TZ, respectively) compared with all other PSA-related parameters evaluated.Conclusions. Compared with standard total PSA assays, fit PSA and PSA-TZ significantly enhance the sensitivity and specificity of PCa detection in a referral patient population with a total PSA of 2.5 to 4.0 ng/mL. (C) 1999, Elsevier Science Inc.