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目的探讨尿液前列腺癌抗原3(PCA3)评分在前列腺超声引导穿刺患者中的诊断作用。方法于2010年1月至2012年12月,收集248例在南京医科大学附属无锡第二医院行前列腺超声引导穿刺患者前列腺按摩后尿液。应用实时定量PCR检测尿沉渣中PCA3 mRNA和PSA mRNA的表达。计算PCA3评分,通过ROC曲线评价PCA3评分在前列腺超声引导穿刺中的预测作用并与血清PSA进行比较。结果在248例患者中,穿刺阳性80例,穿刺阴性168例,前列腺超声引导穿刺阳性率为32.3%。前列腺穿刺阳性患者PCA3评分明显高于穿刺阴性患者(P<0.001)。经ROC曲线分析,血清总PSA、PCA3评分和两者合用的曲线下面积分别为0.620、0.693和0.724。PCA3评分截断值为90.2456时,其诊断敏感性为67.5%,特异性为61.9%。PCA3评分与血清总PSA诊断价值比较,差异无统计学意义(P=0.160),但两者合用优于单用血清总PSA(P=0.011)。此外,联合前列腺癌多种危险因素和PCA3评分的前列腺癌综合诊断模型可进一步提高前列腺癌预测的准确性。结论 PCA3评分在前列腺超声引导穿刺患者中有良好的预测作用,前列腺癌综合诊断模型可提高前列腺癌预测的准确性。该研究结果需全国多中心、大样本研究进一步验证。
Objective To investigate the diagnostic value of urine prostate cancer antigen 3 (PCA3) score in prostatic ultrasonography guided puncture. Methods From January 2010 to December 2012, 248 cases of prostate cancer were collected after prostatic ultrasonography guided prostate biopsy in Wuxi No.2 Hospital Affiliated to Nanjing Medical University. Real-time quantitative PCR was used to detect the expression of PCA3 mRNA and PSA mRNA in urine sediment. The PCA3 score was calculated and the predictive value of PCA3 score in prostatic ultrasound guided puncture was evaluated by ROC curve and compared with serum PSA. Results Of the 248 patients, 80 were positive for puncture and 168 were negative for puncture. The positive rate of prostatic ultrasonography was 32.3%. Prostate puncture positive PCA3 score was significantly higher than puncture negative patients (P <0.001). According to the ROC curve analysis, the area under the curve of total serum PSA, PCA3 score and the combination of the two were 0.620, 0.693 and 0.724 respectively. The PCA3 score cut-off value of 90.2456, the diagnostic sensitivity was 67.5%, the specificity was 61.9%. PCA3 score and serum total PSA diagnostic value, the difference was not statistically significant (P = 0.160), but the combination of both better than single serum total PSA (P = 0.011). In addition, prostate cancer combined with multiple risk factors and PCA3 score of prostate cancer diagnosis model can further improve the accuracy of prostate cancer prediction. Conclusion The PCA3 score has a good predictive value in the prostatic ultrasound-guided puncture. Prostate cancer comprehensive diagnostic model can improve the accuracy of the prediction of prostate cancer. The results of this study need to be further verified by a multicentre, large sample study.