建立前列腺特异性抗原灰区患者重复穿刺阳性的数学模型

目的:建立预测前列腺特异性抗原(PSA)灰区患者重复穿刺阳性的数学模型。方法:选择2004~2016年158例血清PSA位于4~10ng/ml且首次穿刺病理结果为阴性的患者行重复穿刺,记录并分析患者的年龄、前列腺体积(PV)、PSA、游离PSA(fPSA)/总PSA(tPSA)、前列腺特异性抗原速率(PSAV)、前列腺特异抗原密度(PSAD)、前列腺移行带特异性抗原密度(PSAD-TZ)、超声检查(TRUS)、直肠指检(DRE)、高级别上皮内瘤变(HGPIN)、不典型小腺泡增生(ASAP)等重复活检结果的潜在预测指标。将有统计学意义的变量行二分类Logistic回归分析和建立数学模型,该模型的预测价值通过ROC曲线下面积(AUC)来评估。结果:158例前列腺重复穿刺活检患者中,前列腺癌的检出率为25.9%(41/158),单变量分析结果中统计学上有意义的指标包括Age、PV、f/tPSA、PSAD、PSAD-TZ、DRE、TRUS、Previous HGPIN、Previous ASAP(P<0.05),对以上所有变量进行二分类Logistic回归分析并建立数学模型,预测指标ASAP、HGPIN、f/tPSA、TRUS、DRE被纳入该模型。该模型AUC为89.8%,预测价值较高。结论:该数学模型可以很好的预测PSA患者重复穿刺阳性的概率,能够帮助临床医师判断哪些PSA灰区患者更适合行超声引导下前列腺重复穿刺活检术。     

前列腺特异性抗原持续异常患者前列腺重复穿刺活检的临床分析

目的 探讨PSA持续异常患者前列腺重复穿刺活检的诊断价值及适应证. 方法选取2004年1月至2011年9月首次穿刺活检诊断为前列腺良性病变但PSA持续异常的患者90例,其中BPH、正常前列腺组织及前列腺炎症患者组(BPH组)66例,前列腺上皮内瘤变(prostatic intraepithelial neoplasia,PIN)组10例,前列腺不典型小腺泡增生(atypical small acinar proliferation,ASAP)组14例.年龄43～86岁,平均71岁.PSA 3.1～168.0μg/L,平均17.6 μg/L.直肠指检(digital rectal examination,DRE)触及结节26例.采用模板定位经会阴重复穿刺活检. 结果 本组90例根据重复穿刺活检病理结果分为良性组57例,PIN或ASAP组5例,前列腺癌(prostate cancer,PCa)组28例.其中BPH组发现PCa为14例(21.2％),PIN组发现PCa为6例(60.0％),ASAP组发现PCa为8例(57.1％),BPH组与PIN组、ASAP组比较差异均有统计学意义(P＜0.05).BPH组重复穿刺活检诊断为良性组的平均前列腺体积为(65.9±22.6)ml,DRE阳性7例,PCa组为(50.4±20.8) ml,DRE阳性5例,两组间比较差异有统计学意义(P＜0.05).PIN组和ASAP组的患者重复穿刺活检结果显示年龄、PSA值、PSAD值、前列腺体积、DRE阳性例数在重复穿刺后诊断为良性组、PIN或ASAP组和PCa组间差异均无统计学意义(P＞0.05). 结论 对PSA持续异常患者行前列腺重复穿刺活检可以提高PCa的诊断率.首次穿刺诊断为BPH的患者,前列腺体积越小及DRE结果阳性者,若PSA持续升高,应强烈建议重复穿刺活检.首次穿刺诊断为PIN或ASAP的患者,不论年龄、PSA、PSAD、前列腺体积和DRE结果如何,均应建议重复穿刺活检.     

前列腺特异性抗原≤4.0μg/L前列腺癌的诊断

目的:评价直肠指检(DRE)、经直肠超声(TRUS)、游离前列腺特异性抗原/总前列腺特异性抗原(fPSA/t-PSA)、前列腺特异性抗原密度(PSAD)对前列腺特异性抗原(PSA)≤4.0μg/L PCa的诊断价值。方法:回顾性分析1996年4月至2012年12月解放军总医院超声科PSA≤4.0μg/L的前列腺穿刺患者共343例,年龄30~91岁。将患者按PSA含量0.0~1.0μg/L、1.1~2.0μg/L、2.1~3.0μg/L、3.1~4.0μg/L分为4组,评价DRE、TRUS、f-PSA/t-PSA、PSAD在不同PSA水平下PCa患者中的诊断价值,同时按年龄分为5组:≤49岁、50~59岁、60~69岁、70~79岁、≥80岁,评价不同PSA水平下不同年龄患者PCa的检出率。结果:343例患者中,共检出PCa 65例,检出率19.0%。PSA含量0.0~1.0μg/L、1.1~2.0μg/L、2.1~3.0μg/L、3.1~4.0μg/L时PCa的检出率分别为16.28%(21/129)、17.17%(17/99)、21.82%(12/55)、25.00%(15/60)。PSA≤2.0μg/L时,f-PSA/t-PSA比值在PCa和非PCa患者中没有明显差异(P0.05),而PSA2.0μg/L时有明显差异(P0.05)。而PSAD值在PCa组与非PCa组中分别为(0.09±0.16)μg/L/ml、(0.06±0.07)μg/L/ml,没有明显差异(P0.05)。随着PSA含量的升高,PCa的检出率相应升高,各年龄段的检出率没有明显差异(P0.05)。结论:当PSA含量在2.1~4.0μg/L时,若DRE/TRUS异常,则应引起重视,定期随访,监测PSA变化;若f-PSA/t-PSA≤0.15,伴或不伴DRE/TRUS异常,均应该行前列腺穿刺活检,以明确诊断。而对于PSA在0.0~2.0μg/L时,DRE、TRUS、f-PSA/t-PSA比值和PSAD均不能有效诊断PCa。     

良性前列腺增生合并慢性前列腺炎的临床特点分析

目的:探讨良性前列腺增生(BPH)合并慢性前列腺炎(CP)患者的临床特点。方法:将行经尿道前列腺电切术(transurethral resection of the prostate,TURP),术后病理诊断证实为BPH的患者120例,按是否合并CP分为单纯BPH组(简称单纯组,75例)和BPH合并CP组(简称合并组,45例)。结合术前经直肠超声检查及f-PSA、t-PSA、f-PSA/t-PSA检测结果,并根据公式计算出前列腺总体积(TPV)、PSA密度(PSAD),进行统计和分析。结果:单纯组患者,随着年龄或前列腺体积的增加,f-PSA及t-PSA均呈上升趋势,差异有统计学意义(P<0.05),但f-PSA/t-PSA值及PSAD差异无统计学意义(P>0.05)。合并组患者,随着年龄的增加,f-PSA及t-PSA各组间比较差异有统计学意义(P<0.05),随着前列腺体积的增加,f-PSA及t-PSA各组间比较差异有统计学意义(P<0.05),均呈上升趋势,但f-PSA/t-PSA值及PSAD各组间比较差异无统计学意义(P>0.05)。合并组患者较单纯组患者的f-PSA、t-PSA及PSAD有所上升,差异有统计学意义(P<0.05),但f-PSA/t-PSA值变化不大,差异无统计学意义(P>0.05)。通过对各项指标做ROC工作曲线分析发现,f-PSA、t-PSA、PSAD 3项指标的曲线下面积分别为0.644、0.628、0.624,均介于0.5至0.7之间。结论:BPH患者常合并CP,临床中f-PSA、t-PSA升高,同时伴PSAD升高的BPH患者,应考虑合并前列腺炎的可能性大,上述3个指标作为诊断BPH伴CP的依据有一定的意义,但并不是十分可靠。     

以前列腺特异抗原水平分组筛查与前列腺穿刺阳性率的关系

目的探讨不同血清前列腺特异抗原(PSA)水平前列腺癌检出情况以及直肠指诊(DRE)、经直肠超声检查(TRUS)、PSA密度(PSAD)等指标对筛查前列腺穿刺活检病例的意义。方法回顾性分析在1996年4月至2002年12月间行TRUS引导前列腺6点系统穿刺活检的634例患者的诊断资料,对各PSA组(≤4.0,4.1~,10.1~和>20.0μg/L组)中前列腺癌的检出率,以及PSA、DRE、TRUS、PSAD等对前列腺癌的预测作用进行t检验、χ2检验和多因素Logistic回归分析。结果PSA≤4.0,4.1~,10.1~和>20.0μg/L各组的前列腺癌检出率分别为11.6%(17/146),26.8%(38/142),39.8%(68/171)和68.6%(120/175)。PSA的敏感性最高(93.0%),特异性低(33.0%);DRE、TRUS等诊断效率较低。随血清PSA水平升高,前列腺癌检出率以及DRE、TRUS的阳性预测值逐渐升高;在PSA4.1~20.0μg/L者中,PSAD对前列腺癌有较大的预测价值(OR=687.09±646.96,P=0.000)。以PSAD≥0.13μg.L-1.cm-3为截点筛查前列腺穿刺病例,可在不明显降低敏感性的基础上,减少阴性穿刺。结论各PSA组国人与欧美等国前列腺癌检出率有较大差别;DRE、TRUS的筛查作用与血清PSA水平有关;按PSA水平分组筛查穿刺病例,可提高前列腺穿刺的阳性率。     

血清PSA密度变化对前列腺癌高危人群的诊断价值

目的:探讨前列腺特异抗原(PSA)、前列腺特异抗原密度(PSAD)变化对前列腺癌高危人群的诊断价值。方法:对初次活检阴性的432例患者进行随访,其中79例重复穿刺活检,确诊前列腺癌27例(34.2%),消化道来源肿瘤1例,BPH25例,前列腺上皮内肿瘤(PIN)13例,慢性前列腺炎13例。对重复活检患者的PSA、PSAD等临床资料进行统计分析。结果:配对t检验显示,良性病变首末次穿刺前PSA、PSAD差异均无统计学意义,而前列腺癌末次穿刺前PSA、PSAD较首次穿刺前升高,差异有统计学意义。以PSA>4ng/ml筛选前列腺癌,其敏感性、特异性、阳性预测值分别为92.5%、17.6%、37.6%,PSA末-PSA首>0筛选前列腺癌的敏感性、特异性、阳性预测值分别为85.2%、41.2%、40.4%;而以PSAD末-PSAD首>0筛选前列腺癌的敏感性、特异性、阳性预测值分别为81.5%、54.9%、48.9%。结论:在前列腺癌高危人群中应该重复穿刺,以减少漏诊;以PSAD动态升高来指导穿刺,可以明显提高阳性率。     

前列腺特异性抗原升高的组织病理学基础

目的 探讨前列腺特异性抗原(PSA)与前列腺结节增生、Ⅳ型前列腺炎及前列腺癌之间的关系,探讨PSA升高的病理学基础.方法 有完整临床病理资料的前列腺疾病504例患者,均无前列腺癌和穿刺活检史,均行PSA、全身骨扫描、MRI和前列腺穿刺活检.直肠B超引导下以18G自动穿刺活检枪行双侧叶6-13点法前列腺穿刺活检.对患者穿刺的病理标本按前列腺结节增生、前列腺癌以及Ⅳ型前列腺炎病理诊断标准进行评价.结果 504例患者经病理证实前列腺癌185例(37%),Ⅳ型前列腺炎109例(21%),前列腺增生210例(42%).3组总PSA(t-PSA)分别为27.6(0.4～7116)、10.6(0.2～168)和9.2(0.3～60)ng/ml,3组间比较差异有统计学意义(P＜0.01);f-PSA分别为3.5(0.1～3356)、1.7(0.1～42)和1.5(0.06～15.8)ng/ml,3组间比较差异有统计学意义(P＜0.001);f/t-PSA分别为0.14(0＜0.94)、0.17(0.04～0.91)和0.16(0.02～0.75).3组间比较差异有统计学意义(P=0.019);3组间年龄、B超、直肠指诊结果比较差异无统计学意义(P＞0.05).前列腺癌分级与f-PSA(r=0.33,P＜0.001)、t-PSA(r=0.27,P＜0.001),f/t-PSA(r=0.22,P=0.003)具有显著相关性;多元线性回归分析发现前列腺癌分级与f-PSA(t=-2.34,P=0.02),t-PSA(t=2.77,P=0.006),f/t-PSA(t=3.97,P＜0.001)具有显著相关性.前列腺癌临床分期间f-PSA和t-PSA差异有统计学意义(P＜0.001).210例前列腺增生患者若按腺体增生为主和间质增生为主2类比较,t-PSA和f-PSA差异均有统计学意义(P＜0.05).多元线性回归分析发现t-PSA足前列腺增生病理结节类型最相关的指标,t-PSA≥2.5 ng/ml,确定腺体增生为主型前列腺增生的敏感性为96%,特异性为20%(P＜0.05).Ⅳ型前列腺炎109例和前列腺增生210例,2组间比较f-PSA,t-PSA,f/t-PSA差异有统计学意义(P＜0.05).通过ROC曲线确定前列腺癌敏感指标的界值:f-PSA≥0.85 ng/ml,t-PSA≥4 ng/ml和f/t-PSA≤0.16(P＜0.05).结论 血清PSA升高的病理基础为任何破坏前列腺上皮血屏障的病变;任何形成前列腺上皮增生,分泌更多PSA的病变;其中以破坏前列腺上皮血屏障最重要.     

建立一种简易评分系统预测前列腺穿刺活检前列腺癌阳性率

目的:分析经直肠前列腺穿刺活检前列腺癌阳性率的预测因素。方法:总结2006年1月至2014年4月进行经直肠超声引导下前列腺穿刺活检患者的资料,包括年龄(age)、体质指数(BMI)、症状(syptoms)、直肠指检(DRE)、血清总PSA(t PSA)、游离PSA(f PSA)、游离PSA与总PSA比值(f/t PSA)、前列腺体积(PV)、PSA密度(PSAD)。通过单因素方差分析和多因素回归模型,筛选与活检阳性率相关的危险因素。在此基础上构建一个评分系统作为在活检前预测前列腺癌阳性率的工具,并通过受试者工作特征(ROC)曲线计算假阳性率,以检测评分系统的敏感性。结果:在385例经直肠超声引导下穿刺活检患者中,共139例患者被诊断为前列腺癌,阳性率36.1%。单因素分析显示,在活检阳性组和阴性组之间,年龄(P<0.01)、DRE(P<0.01)、t PSA(P<0.01)、f PSA(P<0.01)、f/t PSA(P<0.01)、PV(P<0.01)和PSAD(P<0.01)在前列腺癌患者中比例均高于活检阴性人群。将单因素回归有意义的因素纳入多因素逐步Logistic分析,结果显示,年龄、t PSA、f/t PSA、PV和PSAD是经直肠反复前列腺活检阳性的独立影响因素,其比值比(ORs)及其相应的95%可信区间(95%CIs)分别为1.07(1.05~1.16)、1.05(1.02~1.15)、0.97(0.86~0.99)、0.98(0.87~0.96)和1.79(1.48~2.06)。根据其OR值,设定年龄>71岁(中位数)、t PSA>14.1μg/L(中位数)、f/t PSA<14.07(中位数)、PV<42.8 ml(中位数)、PSAD>0.31μg/L/ml(中位数)分别各计1分,总分为5分。将385例患者的资料通过评分系统计算前列腺癌的检出率,发现评分为0、1、2、3、4、5分的患者前列腺癌的检出率分别为7.69%、8.98%、15.19%、39.39%、54.55%和72.15%。ROC曲线提示曲线下面积为0.82(95%CI:0.80~0.84,P<0.01)。另外,评分3~5分的患者比0~2分的患者前列腺癌的检出率高50%以上(64%vs 11%,P<0.01)。结论:该评分系统可以帮助泌尿科医师确定需要行前列腺活检的患者。     

影响灰区PSA区间前列腺穿刺活检结果的多因素研究

目的:探讨灰区PSA(4~10μg/L)区间影响前列腺穿刺活检结果的因素。方法:回顾性分析2013年6月~2016年7月446例灰区PSA患者,应用12+X的方法进行超声引导下前列腺穿刺活检术。同时收集患者年龄、BMI、f/t比值、前列腺体积、PSAD、尿常规结果、DRE、超声造影以及MRI资料,运用SPSS 22.0进行统计分析。结果:总体穿刺阳性率为25.34%(113/446);单因素回归分析显示:年龄(P=0.000)、tPSA(P=0.012)、f/t比值(P=0.000)、PSAD(P=0.000)、超声造影(P=0.000)以及MRI(P=0.000)与前列腺穿刺阳性率显著相关(P0.05);Logistic多因素回归分析显示:年龄(P=0.000)、BMI(P=0.038)、f/t比值(P=0.010)、PSAD(P=0.000)、DRE(P=0.023)、超声造影(P=0.000)以及MRI(P=0.046)与前列腺穿刺阳性率显著相关(P0.05);ROC面积前三位为PSAD,年龄和超声造影。结论:在灰区PSA前列腺穿刺活检中,年龄、PSAD、超声造影等是较好的预测因子。     

联合指标对前列腺癌活检阳性结果预测的价值分析

目的 探索多指标联合对前列腺癌初次穿刺活检阳性诊断的预测价值。方法 选取本院首次进行前列腺穿刺术的患者345例为观察对象,根据前列腺初次穿刺活检结果,将其分别纳入阳性组及阴性组,分别对每组的年龄、tPSA、β-二微球蛋白等实验室指标及影像学检查等进行单因素及多因素分析,并建立ROC曲线分析各指标独立及联合预测前列腺癌穿刺活检阳性结果。结果 多因素回归分析显示前列腺癌家族史（P=0.031）、tPSA（P=0.003）、β-二微球蛋白（P=0.008）、直肠指检（P=0.001）、PSAD（P=0.036）及TRUS(P=0.046)是前列腺癌初次穿刺活检阳性的独立影响因素。预测前列腺癌首次穿刺活检阳性结果的指标中,直肠指检的敏感性和特异性分别为79.10%和48.34%;TRUS分别为94.02%和70.62%;tPSA分别为84.2%和56.3%;β-二微球蛋白分别为79.6%和62.9%;PSAD分别为91.0%和41.2%。tPSA与PSAD联合预测的准确性最高（AUC=0.975）。结论 直肠指检、TRUS、血清tPSA、β-二微球蛋白及PSAD可作为前列腺癌初次穿刺活检阳性的预测指标,tPSA联合PSAD可明显提高预测的准确性。     

A nomogram based on age,prostate-specific antigen level,prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) status, % free PSA and transrectal ultrasound (TRUS) findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% (223/535). The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.     

Combining free and total prostate specific antigen assays from different manufacturers: the pitfalls

OBJECTIVES: We investigated the impact of interchanging free prostate specific antigen (f-PSA) concentrations from 10 different assays over a reference total PSA (t-PSA) on predicting prostate histology with free-to-total PSA ratios (f/t-PSA). METHODS: Archival sera from 80 t-PSA- and age-matched pairs of histologically confirmed prostate cancer (PCA) and benign prostatic hyperplasia (BPH) patients with t-PSA levels between 2 and 25 microg/l were investigated. Serum aliquots were analyzed for t- and f-PSA using a reference method (Access, Beckmann-Coulter Hybritech) and 10 commercially available f-PSA assays. Passing Bablok and linear regression were performed to investigate the interassay agreement between f-PSA assays. To compare diagnostic performance, ROC curves for PCA detection were calculated for the 10 f/t-PSA combinations using the reference t-PSA as denominator. Sensitivities, specificities and f/t-PSA cut-offs were calculated for varying points of the ROC curve. RESULTS: Despite good correlation of all 10 f-PSA assays with the reference method 4 showed significantly lower mean f-PSA levels. For f/t-PSA as a predictor of prostate histology, areas under the ROC curve (AUC) varied between 0.65 and 0.71 and, if compared to the reference method (AUC=0.70), were significantly lower in three cases. Ensuring 80% specificity, sensitivities ranged between 34% and 54% (reference method: 53%) and f/t-PSA cutpoints differed considerably depending on the f-PSA assay used (range: 0.15-0.24; reference: 0.15). Similar variations were noted at 95% specificity and 80% and 95% sensitivity. CONCLUSIONS: Arbitrary combinations of f- and t-PSA assays should not be used to calculate f/t-PSA ratios unless adequate studies have validated the diagnostic performance and cut-offs of that particular assay choice.     

History of malignancy is a predictor of prostate cancer detection: Incorporation into a pre‐biopsy nomogram

Objectives: To examine whether history of malignancy adds any significant information to the prediction of positive prostate biopsy in referred men with moderately elevated prostate‐specific antigen (PSA) and to develop a predicting nomogram that does not require extra examinations other than PSA. Methods: A total of 1767 consecutive Japanese men with PSA less than 10 ng/mL who underwent prostate biopsy were included in the study cohort. Age, digital rectal examination (DRE), PSA, body mass index, family history of prostate cancer and number of previous malignancies other than the prostate were evaluated in regard to their association with prostate cancer. A logistic regression‐based nomogram for predicting prostate cancer was developed and externally validated. Results: Of the 1767 men, 269 had a history of malignancy with a total of 312 primary sites. Univariate and multivariate analyses revealed that DRE, PSA, age, family history and number of previous malignancies are independent and significant predictors of positive biopsy result. External validation revealed that the predicting accuracy of a nomogram incorporating these five variables is significantly higher than those of PSA or PSA and DRE. Using the nomogram, 8% of unnecessary biopsies would be saved at 95% sensitivity. Conclusions: We demonstrated for the first time that history of malignancy is a potent predictor of prostate cancer in men with moderately elevated PSA even if the established risk factors are adjusted. The nomogram can be a useful tool in decision‐making of prostate biopsy. In daily practice, history of malignancy should be rigorously taken from these men before a decision is made regarding prostate biopsy.     

Community‐based prostate cancer screening in Japan: Predicting factors for positive repeat biopsy

Objectives: To assess possible predictors in determining criteria for repeat biopsy in a prostate cancer screening population. Methods: A total of 50 207 men over 55 years‐of‐age have participated in a prostate cancer screening program in Otokuni, Kyoto, Japan for 12 years. Transperineal systematic biopsy was carried out in case of positive digital rectal examination (DRE) or positive transrectal ultrasonography (TRUS) or a prostate‐specific antigen (PSA) value greater than 10.0 ng/mL. For those with a PSA level from 4.1 to 10.0 ng/mL, and negative DRE and TRUS findings, biopsy was indicated only when PSA density (PSAD) was greater than 0.15. The same indication was applied for the repeat biopsy. Results: A repeat biopsy after an interval of more than 2 years was carried out in 140 patients and was positive in 50 (36%) patients. The PSA value at the diagnosis of cancer declined from the initial value in six (12%) patients. On multivariate logistic regression analysis, PSA velocity (PSAV) as well as PSAD and DRE findings at latest screening were independent predictors for positive repeat‐biopsy outcome. The odds ratio (95% confidence intervals) of PSAV >0.48, latest PSAD >0.33 and positive latest DRE were 4.17 (1.05–18.5), 4.15 (1.31–14.0), and 3.62 (1.06–13.2), respectively. A combination of three variables defined as positive if any of these were positive, reduced 31% of unnecessary biopsies while missing 8% of low volume, low grade cancers. Conclusions: A combination of latest PSAD, PSAV and positive DRE at latest screening might help to reduce unnecessary repeat biopsies in high‐risk patients with an initial negative biopsy.     

Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy

BACKGROUND: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. METHODS: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. RESULTS: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. CONCLUSION: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS.     

预测中国男性前列腺癌切片检查阳性率的视距诺模图：基于台湾地区的研究

最近有许多前列腺癌检测的视距诺模图被开发出来。然而,中国男性前列腺癌的发病率较低,这些针对于其他人群所开发的视距诺模图可能无法直接应用于中国男性身上。因此,我们根据临床与实验室数据,开发了一个预测中国男性前列腺切片检查阳性率的模型。我们收集893位转诊来做初步前列腺切片检查的中国男性病人资料,利用其中697位的资料来开发新的视距诺模图,然后再用其他196位来做外部验证。我们分析了年龄、前列腺体积、总前列腺特异性抗原、前列腺特异性抗原密度、直肠指检以及经直肠超声波回声结果。统计使用罗吉斯回归分析来估算胜算比、95％置信区间以及P值。切片检查阳性率的独立预测因子包括年龄、前列腺体积、总前列腺特异性抗原升高、异常直肠指检以及经直肠超声波高回声或低回声。我们使用这些独立预测因子开发了一个预测切片检查阳性几率的视距诺模图。此视距诺模图的接收操作特征曲线下面积为88．8％,高于单独以总前列腺特异性抗原的预测力（接收操作特征曲线下面积为74．7％）。我们将此视距诺模图做外部验证,发现预测概率为0．827,准确率为78．1％。结合临床和实验室数据所开发出的视距诺模图,比起用其他个别因子,大大提高了预测前列腺癌的准确率。     

Potential predictive factors of positive prostate biopsy in the Japanese population

Introduction There are numerous arguments for the predictive factors of positive prostate biopsies, differing according to race and region. This study aimed to determine predictive factors for a positive prostate biopsy in East Asian, especially Japanese men, using clinical, laboratory, and transrectal ultrasound (TRUS) findings. Methods Data were collected from 466 men who underwent a prostate biopsy for suspected prostate cancer. Variables analyzed including age, digital rectal examination (DRE) findings, prostate-specific antigen (PSA) level, PSA density, prostate volume, and TRUS findings. Logistic regression analysis and the Mann–Whitney U test were used for this study. Results Logistic regression analysis showed that significant predictors for a positive prostate biopsy for all patients were positive DRE results, prostate volume, and hypoechoic lesions on TRUS. Especially in the patients with PSA levels <10 ng/ml, the significant predictor for positive biopsy was prostate volume. The Mann–Whitney U test showed that significant predictors for a positive prostate biopsy in all patients were PSA density >0.15, positive DRE results, and prostate volume <25 cm³. Especially in patients with PSA levels <10 ng/ml, significant predictors for a positive prostate biopsy were prostate volume <25 cm³ and PSA density >0.15. Additionally, even if the data were confined to those patients with seven or more core biopsies, all the predictive factors shown in all patients were significant predictors in this category. Conclusion This study investigated potential predictors for positive prostate biopsy and demonstrated that prostate volume was an independent predictive factor for positive prostate biopsy in patients with PSA levels <10 ng/ml. In the future, we may be able to use our findings to create a nomogram for predicting positive prostate biopsy in Japanese men.     

前列腺特异性抗原相关指标检测对于前列腺癌与良性前列腺增生鉴别诊断的意义

目的 探讨前列腺特异性抗原相关指标检测在前列腺癌(PCa)与良性前列腺增生(BPH)鉴别诊断中的作用.方法 对5家医院107例PCa患者和319例BPH患者的血清总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)、结合前列腺特异性抗原(c-PSA)、f-PSA/t-PSA和c-PSA/t-PSA的差异进行分析比较.结果 PCa和BPH患者中,血清t-PSA处于4～20 μw,/L区间者分别达到68.2%和32.9%.血清t-PSA、f-PSA和c-PSA以及f-PSA/t-PSA和c-PSA/t-PSA在PCa组和BPH组之间差异均有统计学意义(P<0.05).只有f-PSA/t-PSA和c-PSA/t-PSA在PCa和BPH组内各年龄组之间差异无统计学意义(P>0.05),结果相对稳定.血清t-PSA在4-20μg/L区间时,以f-PSA/t-PSA<0.16作为诊断PCa的指标,诊断PCa的敏感度、特异度、阳性预测值和阴性预测值分别是89.0%、78.0%、60.7%和94.6%,以c-PSA/t-PSA>0.84作为诊断PCa的指标时,分别是91.8%、81.3%、66.3%和96.1%.结论 PCa和BPH患者血清t-PSA在4～20μg/L区间存在较大重叠.在此区间,f-PSA/t-PSA<0.16和c-PSA/t-PSA>0.84可作为诊断PCa较为理想的标准.     

Development and internal validation of a nomogram predicting extracapsular extension in radical prostatectomy specimens

Objectives: To present a nomogram predicting the side‐specific probability of extracapsular extension (ECE) in radical prostatectomy (RP) specimens. Methods: Three hundred and fifty‐four patients with T1c‐T3a prostate cancer undergoing RP were included in the analysis. A receiver operating characteristic (ROC) analysis was carried out to evaluate the predictive values of each clinical and pathological factor, separately and in combination. Based on logistic regression analysis, a nomogram predicting the side‐specific probability of ECE was developed. Results: Overall, 146 (40%) of 354 patients and 165 (23%) of 708 lobes had ECE pathologically. The areas under the ROC curve (AUC) of the standard features, such as serum PSA, clinical stage and biopsy Gleason sum on each side, in predicting side‐specific probability of ECE were 0.624, 0.627, and 0.747, respectively. When these three features were combined, AUC increased to 0.773 which was not significantly different from 0.791 of maximum percent of cancer alone (P = 0.613) and significantly enhanced by including maximum percent of cancer on each side, 0.799 (P = 0.022). The resulting nomogram was internally validated and had excellent calibration. Conclusions: The accuracy in predicting ECE is increased by combining standard clinical factors (clinical stage, serum PSA, highest Gleason score) and biopsy features, such as maximum percent of cancer in the cores. The developed nomogram is helpful when deciding whether or not neurovascular bundles can be preserved.