FPSA/TPSA、PSAD联合多参数磁共振成像PI-RADS评分在诊断PSA灰区前列腺癌中的作用

目的探讨游离前列腺特异性抗原(PSA)与总PSA的比值(FPSA/TPSA)、PSA密度(PSAD)联合多参数磁共振成像(mp-MRI)PI-RADS(前列腺影像数据与报告系统)评分在PSA灰区前列腺癌(PCa)中的诊断价值。方法选取2016年5月至2018年8月在本院就诊的PSA灰区、经前列腺穿刺活检确诊为前列腺癌或良性前列腺增生(BPH)的患者117例,统计上述患者FPSA、TPSA、多参数磁共振PI-RADS评分数据,计算FPSA/TPSA、PSAD,比较两组患者各项指标的差异,并使用受试者工作曲线(ROC)分析FPSA/TPSA、PSAD及多参数磁共振PI-RADS评分对PSA灰区前列腺癌的诊断价值。结果两组患者的年龄、FPSA、TPSA、FPSA/TPSA差异均无统计学意义(P>0.05);但两组患者PSAD、多参数磁共振PI-RADS评分差异有统计学意义(P<0.01);受试者工作曲线(ROC)分析结果显示FPSA/TPSA、PSAD联合PI-RADS评分检测对PCa及BPH患者曲线下面积AUC=0.771(P<0.01)。结论对于PSA在灰区的患者,PSAD、PI-RADS评分对诊断前列腺癌有显著价值。FPSA/TPSA、PSAD联合多参数磁共振成像PI-RADS评分在诊断PSA灰区前列腺癌方面有重要应用价值。     

外周血和组织炎性细胞在鉴别PSA4～10ng/ml的前列腺癌和前列腺增生中的临床意义

目的:评价外周血和前列腺组织炎性细胞在鉴别前列腺特异性抗原(PSA)4～10 ng/ml的前列腺癌(PCa)和良性前列腺增生(BPH)中的临床意义。方法:回顾性分析我院2013年10月～2018年10月PSA水平4～10 ng/ml的PCa和BPH患者共45例,其中PCa组患者20例,BPH组患者25例。PCa组患者行前列腺癌根治术后病理确诊,BPH组患者行耻骨上经膀胱前列腺摘除术或经尿道前列腺电切术(TURP)后病理确诊。所有患者在行前列腺穿刺活检术前检测血常规,记录患者外周血中WBC、中性粒细胞、淋巴细胞和单核细胞计数,分析外周血淋巴细胞与单核细胞比率(LMR)、中性粒细胞与单核细胞比率(NMR)和中性粒细胞与淋巴细胞比率(NLR)等。同时收集患者术后病理石蜡切片,采用免疫组织化学(IHC)染色法检测前列腺组织中炎性细胞表达情况。结果:PCa组和BPH组患者外周血白细胞、中性粒细胞和淋巴细胞计数等指标比较差异无统计学意义。PCa组单核细胞计数明显低于BPH组,差异有统计学意义(P0.05)。两组LMR、NMR和NLR值比较差异无统计学意义。两组淋巴细胞和中性粒细胞表达比较差异无统计学意义,但BPH组单核细胞标志物CD14表达高于PCa组,差异有统计学意义(P0.05)。结论:检测外周血和组织中单核细胞计数有助于诊断PSA浓度4～10 ng/ml的PCa患者。     

尿液蛋白激酶Y甲基化联合前列腺影像数据与报告系统评分在前列腺癌早期诊断中的价值

目的探讨尿液蛋白激酶Y(PRKY)基因甲基化联合前列腺影像数据与报告系统(PI-RADS)评分在前列腺癌(PCa)中的诊断价值。方法收集2018年10月至2019年10月在苏州大学附属第二医院住院的51例可疑PCa患者的尿液, 提取DNA后通过焦磷酸测序法检测PRKY基因启动子区甲基化水平, 同时根据前列腺穿刺活检病理结果将患者分为PCa组和良性前列腺增生(BPH)组。采用Mann-Whitney检验分析两组患者年龄、前列腺特异性抗原(PSA)等临床指标的差异, 运用χ2检验分析两组患者尿液中的PRKY基因启动子甲基化状态。建立PRKY甲基化和PI-RADS评分的受试者工作特征曲线(ROC), 计算曲线下面积(AUC), 分析PRKY甲基化在PCa中的诊断价值, 并联合磁共振PI-RADS评分进行联合诊断。结果 PCa和BPH患者尿液中PRKY甲基化阳性率分别为79.17%(19/24)和25.93%(7/27), 差异有统计学意义(χ2=3.516, P<0.01)。ROC分析得出PRKY甲基化对于诊断PCa的曲线下面积(AUC)为0.813, PRKY甲基化联合PI-RADS...     

PSADR、DPC及TSRP在PI-RADS评分3分前列腺穿刺患者中的应用价值何民心1,2,种铁2,马继霞2,王红2,刘芳2,李明睿1,2,薛力

目的 研究前列腺特异性抗原(PSA)周下降速率(PSADR)、前列腺塌陷程度(DPC)及前列腺组织信号比(TSRP)与前列腺影像报告和数据系统(PI-RADS)评分相结合在前列腺癌(PCa)与前列腺炎性疾病鉴别诊断中的价值。方法 回顾性分析74例PSA10ng/mL的前列腺穿刺患者的临床资料,根据病理结果分为PCa组与前列腺炎性疾病组。以最新PI-RADS V2.1评分为基础,采用双参数MRI(bp MRI)评分方案对研究对象的MRI图像进行评分。选出PI-RADS评分为3分的患者,收集其PSADR、DPC及TSRP协助诊断。最后,将诊断结果与最终的病理结果相对比,寻求PSADR、DPC及TSRP与PI-RADS评分相结合在PCa与前列腺炎性疾病鉴别诊断中的价值。结果 在所有患者中,PI-RADS评分为3分者共有25例,其中11例为PCa,14例为前列腺炎性疾病。对于PI-RADS评分为3分的患者,当结合PSADR、DPC及TSRP时,PCa的诊断敏感性为81.82%,诊断特异性为92.86%。结论 PSADR、DPC和TSRP相结合可被用于PI-RADS评分3分患者前列腺穿刺前的炎性疾病与癌的鉴别,减少不必要的前列腺穿刺。     

PI-RADS v2为3分时运用PSAMR诊断前列腺癌的价值

目的 探讨根据第2版前列腺影像报告与数据系统v2（PI-RADS v2）为3分时运用前列腺特异抗原质量比（PSAMR）诊断前列腺癌的效能。方法 回顾性分析攀枝花学院附属医院2016年1月至2020年8月收治的81例PI-RADS v2为3分患者的临床资料，所有患者行多参数磁共振成像（MRI）检查，均在B超引导下穿刺活检。以病理诊断结果为诊断标准，将患者分为前列腺癌组（19例）和非前列腺癌组（62例）。比较两组年龄、前列腺体积、前列腺特异抗原（PSA）、PSA密度（PSAD）、PSA质量（PSAM）及PSA质量比（PSAMR）之间的差异，运用受试者工作特征（ROC）曲线评价各指标在PI-RADS v2为3分前列腺癌中的诊断效能。结果 单因素分析结果显示，前列腺癌组的年龄、PSA、PSAD、PSAM、PSAMR、前列腺体积与非前列腺癌组比较，差异均有统计学意义（均P<0.05，表2）。多因素logistic回归分析结果显示，PSAD、PSAM及PSAMR与前列腺癌诊断有相关性（均P<0.05）。SMAR诊断PI-RADS v2为3分前列腺癌的ROC曲线下面积及特异度均高于其他三项指标。结论 PSAMR在诊断PI-RADS v2为3分的前列腺癌患者中具有较高的效能，临床工作中判断为PI-RADS v2为3分的前列腺疾病患者可以借助PSAMR得出更为准确的诊断。     

单核细胞表面人类白细胞抗原DR表达水平与慢性阻塞性肺疾病急性期感染的相关性研究

目的探讨人外周血单核细胞表面人类白细胞抗原DR(HLA-DR)表达水平与慢性阻塞性肺疾病(COPD)急性期感染的相关性。方法选取天津市南开医院慢性阻塞性肺疾病急性加重(AECOPD)患者和体检健康者共37例, 根据临床症状及感染指标分为对照组(15例)、急性期组(临床治疗干预前, 22例)和稳定期组(临床干预后, 16例)。采集患者外周静脉血, 用流式细胞仪分析CD14+单核细胞HLA-DR的表达水平, 并与患者C反应蛋白(CRP)、白细胞计数、中性粒细胞百分比、中性粒细胞计数、CD3+ T细胞百分比、CD3+CD4+ T细胞百分比、CD3+CD8+ T细胞百分比和CD4+/CD8+等进行相关性分析。结果与对照组比较, 急性期组患者外周静脉血CD14+单核细胞HLA-DR的表达水平降低(P<0.05)。与急性期组比较, 稳定期组患者外周静脉血CD14+单核细胞HLA-DR的表达水平升高(P<0.05), CRP的水平降低(P<0.05), 白细胞计数、中性粒细胞百分比、中性粒细胞计数下降(均P<0.05), CD3+CD4+ T细胞百分比、CD4+/CD8+增加...     

外周血中血小板计数与前列腺体积相关性研究

目的:探讨外周血中炎症细胞计数与前列腺体积的关系,以期阐明良性前列腺增生(BPH)的机制。方法:严格遵守入组和排除标准募集了本中心自2015~2019年104例病理明确诊断为BPH的患者。分别采用一元和多元线性回归模型分析外周血中性粒细胞计数,血小板计数,中性淋巴比(NLR),血小板白细胞比值(PWR)及淋巴细胞单核细胞比值(LMR)等炎症指标与前列腺体积的相关性。结果:外周血中血小板计数(r=0.401,P<0.001),PWR(r=0.343,P<0.001)均与前列腺体积明显正相关,并与血清PSA水平正相关但与国际前列腺症状评分(IPSS)不相关;系统性炎症指标如NLR,LMR等与前列腺体积没有明确的相关性。结论:BPH人群里外周血中血小板计数是前列腺体积的重要预测因素,血小板可能在BPH的发生发展中扮演重要作用。     

PI-RADS评分3分患者诊断有临床意义前列腺癌的预测因素分析

目的:探索前列腺影像报告和数据系统(PI-RADS)评分为3分的患者诊断有临床意义前列腺癌(CsPCa)的预测因素。方法:回顾性分析2019年1月至2020年12月南京医科大学第一附属医院133例PI-RADS评分3分行前列腺穿刺患者的临床资料。年龄66(60~72)岁,前列腺特异性抗原(PSA) 8.22(5.95~...     

PI-RADS评分5分前列腺活检良性病变患者的临床和磁共振影像特点

目的探讨前列腺影像报告和数据系统(PI-RADS)评分5分前列腺活检良性病变患者的临床和磁共振影像特点。方法回顾性分析2019年5月至2021年7月于南京医科大学第一附属医院行磁共振超声靶向联合系统活检的289例PI-RADS评分5分患者的临床资料。中位年龄72(66, 77)岁。中位体质量指数(BMI)24.4(22.3, 27.1)kg/m2。中位前列腺体积(PV)37.39(29.39, 48.86)ml。中位前列腺特异性抗原(PSA) 22.24(10.91, 62.69)ng/ml。中位PSAD 0.53(0.30, 1.52)ng/ml2。根据活检病理结果将患者分为良性病变组和前列腺癌组, 比较两组的PSA、PSAD、PV、磁共振检查的表观扩散系数(ADC)值, 分析良性病变组的磁共振影像和临床特点。结果本研究289例, 良性病变组11例(3.8%), 前列腺癌组278例(96.2%)。良性病变组中位年龄69(66, 79)岁, 中位BMI 22.0(21.0, 25.5)kg/m2;直肠指检异常5例;吸烟7例、饮酒4例;中位PV 62.90(38.48, 71.96)ml...     

基于多参数磁共振建立前列腺穿刺活检预测模型

目的 拟建立包含常用临床指标及磁共振参数的前列腺癌穿刺活检预测模型。方法回顾性分析2018年1月至2021年2月于香港大学深圳医院行超声引导下前列腺穿刺活检患者的临床资料。对年龄、前列腺体积、直肠指检结果、经直肠前列腺超声结果(TRUS)、fPSA/tPSA、第二版前列腺影像报告和数据系统(PI-RADs v2)评分、动态对比增强、表观弥散系数(ADC)等临床及核磁共振指标进行单因素及多因素分析,并建立前列腺穿刺活检预测模型,计算其ROC曲线下面积诊断效能。结果 单因素分析显示年龄、前列腺体积、直肠指检结果、前列腺超声结果、ADC、动态对比增强及PI-RADS v2评分差异具有统计学意义(P0.05),tPSA水平差异无统计学意义(P=0.1)。多因素分析显示fPSA/tPSA、经直肠超声结果、ADC及PI-RADS v2评分为独立危险因素。利用上述指标建立前列腺穿刺活检预测模型为P=1/1+exp[11.1–3.49×(fPSA/tPSA)–2.02×TRUS–1.59×ADC–1.73×PI-RADS]。结论 基于PI-RADS v2评分及ADC建立前列腺癌穿刺活检预测模型,与单独应用PSA及其他临床指标相比能够提高前列腺癌的诊断效能。     

Can the combination of biparametric magnetic resonance imaging and PSA-related indicators predict the prostate biopsy outcome?

To assess the value of biparametric magnetic resonance imaging (bpMRI) for detecting and ruling out prostate cancer in patients with elevated prostate-specific antigen (PSA). The basic information and bpMRI images of enrolled patients who took transperineal template saturate biopsy were retrospectively collected for analysis. Based on our results, we found that free/total PSA, and PI-RADS score were independent risk factors of PCa (p < .05), the PSA density, PI-RADS score were the independent risk factors of csPCa (p < .05). PI-RADS score threshold of 3 could achieve the highest Yonder index for predicting PCa, and PI-RADS score threshold of 4 could achieve the highest Yonder index for predicting csPCa. Therefore, we draw a conclusion that PI-RADSv2 score-based bpMRI could diminish the unnecessary prostate biopsies in patients with elevated PSA when combined with other PSA-related indicators.     

基于多参数磁共振成像的PI-RADS第二版评分联合f/tPSA及PSAD在前列腺癌早期筛查中的预测价值

目的 探讨基于多参数磁共振成像的PI-RADS第二版评分联合f/t PSA及PSAD在前列腺癌早期筛查中的预测价值.方法 回顾性分析2015年1月至2020年12月期间的289例疑似前列腺癌患者的临床资料,根据是否确诊前列腺癌分为前列腺癌组和非前列腺癌组,绘制患者PI-RADS第二版评分、f/tPSA及PSAD三项诊断...     

常规临床检查与PSA灰区患者前列腺癌检出率的关系

目的:探讨直肠指检(DRE)、影像学(TRUS、MRI)检查、血清游离与总前列腺特异性抗原(PSA)比值(f/t)与PSA在4～10μg/L之间患者前列腺癌检出率的关系。方法:回顾性分析365例PSA处于灰区的患者进行DRE、TRUS、MRI检查、游离PSA测定,并对这些患者行经直肠B超引导下的前列腺穿刺活检。评估其临床资料与前列腺穿刺病理结果的关系。结果:在365例患者中,穿刺病理为前列腺癌的患者共有87例(23.84%)。DRE阳性的患者共有128例,穿刺阳性40例,阳性率为31.25%,TRUS检查的患者共有257例,其中有异常回声结节的69例患者中穿刺阳性26例,阳性率为37.68%,MRI检查的患者共有191例,其中有异常信号结节的107例患者中穿刺阳性59例,阳性率为55.14%。198例患者行fPSA与tPSA比值分析,其中前列腺癌患者的平均f/t PSA明显低于穿刺阴性患者。f/t PSA受试者曲线(ROC)下的面积(0.725)高于患者PSA ROC的面积(0.542)。结论:结合临床DRE、影像学资料及f/t PSA比值可以有效提高前列腺癌检出率,从而减少不必要的穿刺给患者带来的痛苦。     

建立预测中国人前列腺重复穿刺活检阳性的数学模型

目的:建立可以预测国人经直肠超声引导下重复穿刺活检阳性的数学模型。方法:170例在首次穿刺活检诊断为前列腺良性病变的患者行重复穿刺。记录并分析患者的年龄、前列腺体积、血清PSA、游离PSA(f-PSA)/总PSA(t-PSA)、PSA上升速度、PSA密度(PSAD)、直肠指检(DRE)、首次穿刺病理结果等相关因素。将变量通过逐步回归建立回归方程,在此基础上建立重复穿刺活检阳性的危险评分数学模型。该模型的预测价值通过受试者工作曲线下面积来评估。结果:170例前列腺重复穿刺活检的患者中,前列腺癌的穿刺检出率为31.8%(54/170)。建立的数学模型影响因素包括:患者的年龄、前列腺体积、PSA、f-PSA/t-PSA、PSA上升速度、PSAD、DRE、首次穿刺结果是否为上皮内瘤变。该模型预测价值较高,曲线下面积为82.4%,大于患者PSAD、前列腺体积、PSA上升速度、f-PSA/t-PSA、DRE等单因素的66.9%、72.6%、69.6%、69.3%、58.5%。结论:该数学模型是临床多因素综合分析基础上建立的,可以很好地预测前列腺重复穿刺活检阳性的概率。     

Change in the ratio of free-to-total prostate-specific antigen during progression of advanced prostate cancer.

BACKGROUND: The ratio of free-to-total prostate-specific antigen (PSA) is different in benign prostatic hyperplasia and in the early stage of prostate cancer. The present study was undertaken to examine the ratio of free-to-total PSA in the advanced stage of this cancer and its subsequent change during course of the disease. METHODS: Free and total PSA were measured in sera collected from the following patients with benign and cancerous prostatic diseases: 47 cases of benign prostatic hypertrophy, nine in TIC with less than 10 ng/mL of total PSA, 11 in stage C, 16 in D2, 22 in remission under endocrine therapy, and 12 in relapse. In addition, PSA was measured sequentially in four other patients who were also in relapse. RESULTS: The ratio of free-to-total PSA was similar in early and advanced stages of untreated prostate cancer and was lower than that in benign prostatic hyperplasia. The ratio increased to the level of benign prostatic hyperplasia during remission from stages C and D2 under endocrine therapy. There was no correlation with the intervals from the start of the therapy to examination. Following relapse, the ratio came down gradually to the level obtained in untreated prostate cancer. CONCLUSION: The ratio of free-to-total PSA was similar in all stages of untreated prostate cancer. Response and relapse to endocrine therapy were associated with increase and decrease in ratio, respectively.     

Prospective evaluation of prostate cancer detection by prostate-specific antigen-related parameters

BACKGROUND: The diagnostic value of prostate-specific antigen (PSA) for differentiating prostate cancer from benign prostatic conditions is limited by its lack of specificity. Several PSA-related parameters have been suggested as enhancing the discriminatory power of total PSA values, but their clinical utility should be considered preliminary until established in a prospectively evaluated cohort. METHODS: In a prospective cohort study, results of ultrasound-guided biopsy and/or transurethral resection of the prostate gland were assessed in 706 consecutive Japanese men. The clinical usefulness of total PSA, free PSA, percentage of free PSA, PSA density (PSAD), PSA density for transition zone (PSADT) and gland volume for predicting prostate cancer was investigated using receiver operating characteristic (ROC) curve analysis in 16 different patient subgroups. RESULTS: Overall, 150 of the 706 patients (21.2%) had prostate carcinoma. The ROC curve analysis showed that PSAD and PSADT were more powerful predictors of prostate cancer than total PSA in most of the 16 patient subgroups tested. The improvement in performance was modest, however. No substantial difference was noted between PSAD and PSADT. Total gland volume did not significantly affect the performance of these parameters. The use of a PSAD threshold value of 0.11-10.15 ng/mL per cm3 (or a PSADT value of 0.23-0.27 ng/mL per cm3) would have avoided 24-48% (or, for PSADT, 34-40%) of unnecessary biopsies at the cost of missing 5-10% of detectable cancers in a patient subgroup with intermediate total PSA levels. The performance of free PSA and percentage of free PSA was worse than that of any other test in this study. This may be due to inappropriate handling of sera prior to measurement. CONCLUSIONS: The discriminatory potential of total PSA for predicting prostate cancer was modestly improved by the use of PSAD and PSADT. No substantial advantage of PSADT over PSAD could be demonstrated. Stringent and standardized storage conditions should always be maintained when applying free PSA-related parameters.     

Ratio of gamma-seminoprotein to prostate-specific antigen for the detection of prostate cancer: Its discrimination power could be influenced by the assay methods of PSA and/or gamma-seminoprotein

BACKGROUND: The ratio of gamma-seminoprotein (gamma-Sm) and prostate-specific antigen (PSA) has been regarded as being superior over PSA alone as a discriminator between prostate cancer and benign prostatic diseases. In previous studies, PSA and gamma-Sm were measured by the Eiken kit and the old-version or revised Chugai kit, respectively. We compared the power of gamma-Sm ratio with that of PSA alone when using Markit-M PSA assay and the revised Chugai gamma-Sm assay. METHODS: Fifty-three patients with prostate cancer having no metastasis and 116 with benign prostatic diseases were enrolled in this study. Prostate-specific antigen was measured by Markit-M kit and gamma-Sm was measured by the revised Chugai kit. The discrimination power of gamma-Sm ratio and PSA alone was evaluated with receiver operating characteristic (ROC) curves. Comparisons between prostate cancer and benign diseases were performed with Mann Whitney U-test and Fisher's exact test. RESULTS: The optimal cut-off value was set at 3.1 ng/mL for PSA and 0.935 for gamma-Sm ratio. Sensitivity, specificity and positive predictive value of PSA alone were 81.1, 81.0 and 66.2%, respectively, while those of gamma-Sm ratio were 73.6, 90.5 and 78.0%, respectively. There was no statistical significance in each value between PSA and gamma-Sm ratio. Areas under the ROC curves of PSA and gamma-Sm ratio were 0.881 and 0.866, respectively (P>0.05). CONCLUSION: Contrary to the previous reports, gamma-Sm ratio and PSA were not different in the discrimination between prostate cancer and benign prostatic diseases, which suggested that the discrimination power of gamma-Sm ratio, and presumably that of the free PSA to total PSA ratio as well, could be considerably influenced by the assay kits for serum PSA and/or gamma-Sm (free PSA) used. Therefore, the clinical significance of gamma-Sm ratio should be evaluated for each PSA assay kit.     

Immunohistochemical finding of α-1-antichymotrypsin in tissues of benign prostatic hyperplasia and prostate cancer

BACKGROUND: Ratio of free to total (F/T) prostate-specific antigen (PSA) is higher in the blood of patients with benign prostatic hyperplasia than those with prostate cancer. To clarify the difference between ratios in these two, alpha-1-antichymotrypsin, the major component of the bound PSA in the blood, was immunohistochemically examined. METHODS: Tissues were obtained surgically via a retropubic approach from patients with benign prostatic hyperplasia (nine cases) and prostate cancer (27 cases). These samples were processed in paraffin blocks, cut into 5 mm sections and stained with antibodies against alpha-1-antichymotrypsin and PSA. RESULTS: The percentage of alpha-1-antichymotrypsin-stained cells in prostate cancer was higher than that in benign prostatic hyperplasia (P<0.05). Almost all of glandular and cancer cells were stained with PSA antibody. The percentage of alpha-1-antichymotrypsin-stained cells in prostate cancer did not correlate to histologic grade, although alpha-1-antichymotrypsin-stained cells were more widely scattered in high grade tissues. No correlation was found between alpha-1-antichymotrypsin-stained cells and ratio of F/T in the blood of cancer patients. In about 20% of cancer tissues, histiocytes with positive alpha-1-antichymotrypsin staining were found in stroma but not in that of benign prostatic hyperplasia. CONCLUSIONS: Prostate cancer tissues are shown to have a richer environment of alpha-1-antichymotrypsin than those of benign prostatic hyperplasia. Some cancer tissues contained alpha-1-antichymotrypsin-stained histiocytes. These local events may correlate to a high amount of the bound form among total PSA in the blood of prostate cancer patients.