Developing a follow-up strategy for patients with PSA ranging from 4 to 10 ng/ml via a new model to reduce unnecessary prostate biopsies.
Developing a follow-up strategy for patients with PSA ranging from 4 to 10 ng/ml via a new model to reduce unnecessary prostate biopsies.
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DOI：
10.1371/journal.pone.0106933
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Yin C
中科院分区：
文献类型：
--
作者：
Zhao R;Huang Y;Cheng G;Liu J;Shao P;Qin C;Hua L;Yin C
本研究的目的是根据新模型制定随访策略，以减少前列腺特异性抗原（PSA）范围为4 - 10 ng/ml的患者不必要的前列腺活检。共436例PSA范围为4 - 10 ng/ml的患者接受了经直肠超声（TRUS）引导的前列腺活检，在第一阶段进行了评价。年龄、PSA、游离PSA（fPSA）、直肠指检（DRE）结果、超声低回声肿块、超声微钙化、前列腺体积（PV）和PSA密度（PSAD）被认为是预测因素。多元逻辑回归分析，包括向后消除选择程序，以选择独立的预测因素。在对所有结果进行综合分析后，我们开发了一个新的模型来评估前列腺癌的风险和有效的随访策略。年龄、PSA、PV、fPSA、异常DRE发现率和TRUS检测到的低回声肿块率均包括在我们的模型中。与单独使用PSA相比，在我们的模型中获得了更大的受试者工作特征曲线下面积（0.782 vs. 0.566）。根据前列腺癌风险值（PCaR）对患者进行分组。在我们研究的第二阶段，建议PCaR>0.52的患者立即进行活检，而其余患者继续密切随访观察。与第一阶段相比，第二阶段PCa的检出率显著增加（33.0% vs 21.1%，p = 0.012）。 两个阶段的Gleason评分分布无显著差异（p = 0.808）。 我们根据新模型制定了一项随访策略，减少了不必要的前列腺活检，而不会延误患者的诊断和治疗。
The aim of this study was to develop a follow-up strategy based on the new model to reduce unnecessary prostate biopsies in patients with prostate specific antigen (PSA) ranging from 4 to 10 ng/ml. A total of 436 patients with PSA ranging from 4 to 10 ng/ml who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy were evaluated during the first stage. Age, PSA, free PSA (fPSA), digital rectal examination (DRE) findings, ultrasonic hypoechoic mass, ultrasonic microcalcifications, prostate volume (PV) and PSA density (PSAD) were considered as predictive factors. A multiple logistic regression analysis involving a backward elimination selection procedure was applied to select independent predictors. After a comprehensive analysis of all results, we developed a new model to assess the risk of prostate cancer and an effective follow-up strategy. Age, PSA, PV, fPSA, rate of abnormal DRE findings and rate of hypoechoic masses detected by TRUS were included in our model. A significantly greater area under the receiver-operating characteristic curve was obtained in our model when compared with using PSA alone (0.782 vs. 0.566). Patients were grouped according to the value of prostate cancer risk (PCaR). In the second stage of our study, patients with PCaR>0.52 were recommended to undergo biopsies immediately while the rest of the patients continued close follow-up observation. Compared with the first stage, the detection rate of PCa in the second stage was significantly increased (33.0% vs 21.1%, p = 0.012). There was no significant difference between the two stages in distribution of the Gleason score (p = 0.808). We developed a follow-up strategy based on the new model, which reduced unnecessary prostate biopsies without delaying patients’ diagnoses and treatments.
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