血清睾酮水平对提高前列腺癌检出率临床意义的研究

目的探讨血清睾酮（T）水平对提高前列腺癌检出率的临床意义。方法选择2007年4月-2010年4月间在卫生部北京医院及吉林大学第一医院行前列腺6-8针穿刺的患者共75例。穿刺前患者行血清睾酮、PSA检测,直肠指检、前列腺彩超或前列腺MRI检查并测量前列腺体积。病理组织学检查明确前列腺癌的诊断。统计学方法采用单因素多元方差分析及ROC曲线分析。结果前列腺癌患者的血清T水平略低于前列腺增生患者,但无显著差异（P=0.084）,ROC曲线分析：血清T水平的ROC曲线下面积为0.617,（P=0.107,95%CI：0.469-0.763）,T/PSA的曲线下面积为0.770,（P=0.000,95%CI：0.659-0.881）,T/PSAD的曲线下面积为0.858,（P=0.000,95%CI：0.771-0.945）,T×PSA-r的曲线下面积为0.800,（P=0.000,95%CI：0.693-0.908）。T/PSA〈0.495时,诊断前列腺癌的敏感度为75%,特异度为71%;T/PSAD〈21.7时,诊断前列腺癌的敏感度为88%,特异度为71%;T×PSA-r〈0.59时,诊断前列腺癌的敏感度为79%,特异度为67%。结论血清睾酮水平对于提高前列腺癌的检出率,增加PSA、PSAD、PSA-r的敏感性及特异性有较为显著的意义,以考虑将血清睾酮水平作为常规前列腺癌筛查的指标。

A clinic research of serum testosterone level to improve the detection rate of prostate cancer

Objective To investigate if the serum testosterone level could improve the detection rate of prostate cancer（PCa）.Methods a total of 75 cases who received the first time transrectal ultrasound guide 6-8 cores prostatic biopsy for prostate cancer at the first hospital of Jilin university and Beijing hospital in 2007-2010.Serum testosterone,PSA test,imaging examinations（US or MRI） and pathology examinations were performed.One-way ANOVA and ROC curve statistic analysis were used.Results Serum testosterone levels were slightly different（P=0.084）between BPH and PCa groups.ROC analysis：Area under curve（AUC） of serum testosterone was 0.617（P=0.107,95% CI：0.469-0.763）,AUC of T/PSA was 0.770（P=0.000,95% CI：0.659-0.881）,AUC of T/PSAD was 0.858（P=0.000,95% CI：0.771-0.945）,AUC of T×PSA-r was 0.800（P=0.000,95% CI：0.693-0.908）.When T/PSA0.495,sensitivity is 75%,specificity is 71%.T/PSAD21.7,sensitivity is 88%,specificity is 71%.T×PSA-r0.59,sensitivity is 79%,specificity is 67%.Conclusion The level of serum testosterone could improve the detection rate of PCa and increasing the sensitivity and specificity of PSA,PSAD,PSA-r.Serum testosterone could be a routine screening factor for PCa diagnosis.