CAJ | 학술논문

目的分析因急性尿潴留留置尿管且PSA异常升高患者前列腺穿刺活检的临床病理特征,探讨PSA和前列腺特异性抗原密度(PSAD)对这类患者的前列腺癌诊断价值. 方法对2009年1月至2011年10月收治的95例患者的临床资料进行回顾性分析,患者均因急性尿潴留而留置尿管,并因考虑前列腺癌可能而接受前列腺穿刺活检,指征包括PSA异常升高、B超检查提示前列腺低回声结节、MRI提示前列腺异常信号、直肠指检发现结节等.评估不同PSA水平下的前列腺癌发现率,并通过受试者工作特征曲线计算PSAD的曲线下面积(AUC),评估PSAD对这类患者的前列腺癌诊断价值. 结果前列腺穿刺活检阳性率为17.9％(17/95).当PSA为4.1～10.0、10.1 ～20.0、20.1 ～ 50.0和≥50.1μg/L时,穿刺阳性率分别为0(0/21)、6.1％ (2/33)、13.0％ (3/23)、66.7％(12/18).当PSA≥10.1 μg/L时,PSAD的AUC为0.935,PSAD的截断点为＞0.54 mg/L2,诊断敏感性、特异性、阳性预测值及阴性预测值分别为94.1％、84.2％、61.5％和97.9％. 结论对于发生急性尿潴留而留置尿管且PSA异常升高的患者,应当有选择地进行前列腺穿刺活检,需特别注意PSA≥10.1μg/L且PSAD＞0.54 mg/L2的患者.
목적 분석인급성뇨저류류치뇨관차PSA이상승고환자전렬선천자활검적림상병리특정,탐토PSA화전렬선특이성항원밀도(PSAD)대저류환자적전렬선암진단개치. 방법 대2009년1월지2011년10월수치적95례환자적림상자료진행회고성분석,환자균인급성뇨저류이류치뇨관,병인고필전렬선암가능이접수전렬선천자활검,지정포괄PSA이상승고、B초검사제시전렬선저회성결절、MRI제시전렬선이상신호、직장지검발현결절등.평고불동PSA수평하적전렬선암발현솔,병통과수시자공작특정곡선계산PSAD적곡선하면적(AUC),평고PSAD대저류환자적전렬선암진단개치. 결과 전렬선천자활검양성솔위17.9％(17/95).당PSA위4.1～10.0、10.1 ～20.0、20.1 ～ 50.0화≥50.1μg/L시,천자양성솔분별위0(0/21)、6.1％ (2/33)、13.0％ (3/23)、66.7％(12/18).당PSA≥10.1 μg/L시,PSAD적AUC위0.935,PSAD적절단점위＞0.54 mg/L2,진단민감성、특이성、양성예측치급음성예측치분별위94.1％、84.2％、61.5％화97.9％. 결론 대우발생급성뇨저류이류치뇨관차PSA이상승고적환자,응당유선택지진행전렬선천자활검,수특별주의PSA≥10.1μg/L차PSAD＞0.54 mg/L2적환자.
Objective To analyze the clinicopathological characteristics of patients transurethrally cathetered due to acute urinary retention (AUR) and with high prostate specific antigen (PSA),and to evaluate the value of PSA and prostate specific antigen density (PSAD) in the diagnosis of prostate cancer (PCa) in these patients.Methods Data from 95 patients who had been transurethrally cathetered due to AUR and underwent transrectally ultrasound-guided prostate biopsy were retrospectively analyzed.The indications for biopsy in this study were abnormally elevated serum levels of PSA,positive transrectal prostate ultrasound and/or magnatic resonance imaging findings,and abnormal digital rectal examination.The incidence of PCa was recorded according to total PSA levels,while receiver operating characteristic curve (ROC curve) was plotted for appraisement on the predictive value of PSAD.Results The positive biopsy rate was 17.9％ (17/95).The positive rate was 0 (0/21),6.1％ (2/33),13.0％ (3/23) and 66.7％ (12/18) for patients with PSA 4.1-10.0,10.1-20.0,20.1-50.0 and ≥50.1 μg/L,respectively.In patients with PSA≥ 10.1 μg/L,the area under ROC curve of PSAD was 0.935,and the optimal cutoff was ＞ 0.54 mg/L2,while corresponding sensitivity,specificity,positive predictive value,negative predictive value was 94.1％,84.2％,61.5％ and 97.9％,respectively.Conclusions Prostate biopsy should not be performed on all AUR patients with transurethral catheters and elevated PSA levels.Patients with PSA ≥10.1 μg/L and PSAD ＞ 0.54 mg/L2 are at higher risk of PCa diagnosis.