PROSPECTIVE EVALUATION OF PROSTATE-SPECIFIC ANTIGEN DENSITY AND SYSTEMATIC BIOPSIES FOR EARLY DETECTION OF PROSTATIC-CARCINOMA
PROSPECTIVE EVALUATION OF PROSTATE-SPECIFIC ANTIGEN DENSITY AND SYSTEMATIC BIOPSIES FOR EARLY DETECTION OF PROSTATIC-CARCINOMA
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DOI：
10.1016/s0090-4295(94)80260-2
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发表时间：
1994-01-01
期刊：
影响因子：
2.1
通讯作者：
ELHILALI, MM
中科院分区：
文献类型：
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作者：
BAZINET, M;MESHREF, AW;ELHILALI, MM
对于血清前列腺特异性抗原（PSA）水平高于4 ng/mL（Hybritech检测）的患者是否需要进行系统性活检，尤其是在直肠指检（DRE）或经直肠超声检查（TRUS）未显示前列腺癌体征的情况下，仍存在重大争议。我们评估了565例因前列腺增生、DRE上可疑病变或血清PSA水平升高而转诊至我们的连续患者。这些患者并不代表纯粹的筛查人群。通过DRE和/或TRUS对可疑病变进行直接活检，以及对血清PSA水平高于4 ng/mL的所有患者进行系统活检，检出率为38.4%。在142例血清PSA在4.1和10 ng/mL之间，但在DRE和TRUS（DRE- TRUS-）上没有怀疑癌症的患者中，大量患者（6.2）接受了系统性活检，以检测一种癌症。应用于该人群的PSA密度（PSAD）的受试者工作特征曲线证实，活检的最佳截止点是PSAD 0.15，低于该值，23例癌症中只有2例会被遗漏，142例患者中有77例免于活检。将类似的方法应用于血清PSA水平高于10 ng/mL的DRE- TRUS-患者。血清PSA在10.1和14 ng/mL之间的癌症数量太低，无法建立PSAD临界点。在血清PSA高于14 ng/mL的患者中，活检的最佳PSAD临界点为0.3，低于该临界点，13例癌症中有2例会被遗漏，39例患者中有19例免于活检。我们的结论是，PSAD可以安全地减少系统活检的患者数量，而不会显着影响癌症检测。
Significant controversies persist in regard to the need for systematic biopsies in patients with serum prostate-specific antigen (PSA) levels above 4 ng/mL (Hybritech assay), especially if they show no signs of prostatic cancer on digital rectal examination (DRE) or transrectal ultrasonography (TRUS). We evaluated 565 consecutive patients referred to us for prostatism, suspicious lesions on DRE, or an elevated serum PSA level. These patients do not represent a purely screened population. A detection rate of 38.4 percent was achieved by performing directed biopsies of suspicious lesions on DRE and/or TRUS, and systematic biopsies of all patients with serum PSA levels above 4 ng/mL. Among 142 patients with serum PSA between 4.1 and 10 ng/mL, but without suspicion for cancer on DRE and TRUS (DRE- TRUS-), a large number of patients (6.2) were subjected to systematic biopsies to detect one cancer. A receiver-operating characteristic curve for PSA density (PSAD) applied to this population confirmed that the best cut-off point for biopsies was a PSAD of 0.15, below which only two of twenty-three cancers would have been missed, sparing biopsies in 77 of 142 patients. A similar approach was applied to DRE- TRUS- patients with serum PSA levels above 10 ng/mL. The number of cancers in those with serum PSA between 10.1 and 14 ng/mL was too low to establish a PSAD cut-off point. In patients with serum PSA above 14 ng/mL, the best PSAD cut-off point for biopsies was 0.3, below which two of thirteen cancers would have been missed, sparing biopsies in 19 of 39 patients. We conclude that PSAD can safely reduce the number of patients subjected to systematic biopsies without significantly compromising cancer detection.