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目的探讨游离前列腺特异抗原百分比(FPSA/TPSA值)/前列腺特异抗原密度[(F/T)/PSAD值]在前列腺癌诊断中的意义。方法回顾分析204例行经直肠超声引导前列腺穿刺活检患者的诊断资料,其中前列腺癌90例、良性前列腺增生114例,分析总PSA(TPSA)、FPSA/TPSA值、PSAD、(F/T)/PSAD值等指标在判断前列腺癌的敏感性为90%时的截点及相应的特异性。结果不同血清PSA水平(<4.0,4.0~,10.1~和>20.0μg/L)的前列腺癌患者的(F/T)/PSAD值与良性前列腺增生患者比较,差异有统计学意义(P<0.05);前列腺癌患者的(F/T)/PSAD值低于良性前列腺增生患者;(F/T)/PSAD值比FPSA/TPSA值和PSAD更有助于提高诊断特异性,在敏感性为90%左右的前提下,FPSA/TPSA值的特异性为31.6%,PSAD的特异性为45.6%,(F/T)/PSAD值的特异性为64.0%;PSA水平不同,取的(F/T)/PSAD值截点也不同PSA<4.0μg/L时截点为2.5,PSA为4.0~20.0μg/L时截点为0.8;PSA>20.0μg/L时截点为0.5。结论应用(F/T)/PSAD值能够在保持较高敏感性的前提下,显著提高前列腺癌诊断的特异性。
Objective To investigate the significance of the percentage of free prostate-specific antigen (FPSA / TPSA) / prostate-specific antigen density (F / T) / PSAD in the diagnosis of prostate cancer. Methods Totally 204 cases of prostate cancer and 90 cases of benign prostatic hyperplasia were retrospectively analyzed. The total PSA (TPSA), FPSA / TPSA, PSAD, (F / T) / PSAD value and other indicators in determining the sensitivity of prostate cancer is 90% of the cut-off point and the corresponding specificity. Results (F / T) / PSAD values of prostate cancer patients with different serum PSA levels (<4.0, 4.0 ~, 10.1 ~ and> 20.0μg / L) were significantly different from those of benign prostatic hyperplasia patients ); (F / T) / PSAD in patients with prostate cancer is lower than that in patients with benign prostatic hyperplasia; (F / T) / PSAD values are more helpful to improve diagnostic specificity than FPSA / TPSA values and PSAD. The specificity of FPSA / TPSA was 31.6%, the specificity of PSAD was 45.6% and the specificity of (F / T) / PSAD was 64.0%. The level of PSA was different from that of F / T ) / PSAD also had a cut-off point of 2.5 for PSA <4.0 μg / L and 0.8 for PSA of 4.0-20.0 μg / L and a cut-off point of 0.5 for PSA> 20.0 μg / L. Conclusion The application of (F / T) / PSAD can significantly improve the diagnostic specificity of prostate cancer while keeping the high sensitivity.