| Purpose：Combined with digital rectal examination (DRE) and transrectal ultrasound (TRUS),explore the value of prostate specific antigen density (PSAD) and free to total prostatespecific antigen (f/t PSA) in the diagnosis of prostate cancer (PCa) with different PSAlevels.Materials and Methods：1. A total of2,976patients were biopsied from October1996toDecember2012due to increased prostate specific antigen or digital rectal examinationand/or transrectal ultrasound highly suspected of prostate cancer in PLA General.52cases with the PSA results missing and134cases with pathological findings missingwere removed, and the patients included in this study were2790cases ultimately.2, patients were divided into four groups according to PSA levels, group A:0.0~4.0ng/ml, group B:4.1~10.0ng/ml, group C:10.1~20.0ng/ml, D group:≥20.1ng/ml. The value of PSAD, f/t PSA, DRE and TRUS in the diagnosis of PCa withdifferent PSA levels at different ages.3, Patients were divided into five age groups:≤49years old,50to59years,60to69years,70to79years,≥80years, the detection rate of PCa were evaluated in patientswith different PSA levels at different ages.Results：11150cases of PCa were detected in the total of2,790patients; the detection rate ofPCa was41.22%. The detection rates were18.95%,27.21%,33.28%and56.80%ingroup A, B, C and D respectively.2. The sensitivity of DRE for group B, C and D was31.79%,28.14%,31.34%and thespecificity was68.56%,64.66%,71.20%respectively.3. The sensitivity of TRUS for group B, C and D was23.84%,24.12%25.71%and the specificity was75.99%,63.41%and57.07%respectively.4.65cases of PCa were detected in343patients from group A and the detection rate ofPCa was19.0%. The sensitivity of DRE and TRUS in diagnosis of PCa was66.2%and69.2%, the specificity was34.2%and33.1%respectively. The sensitivity and specificityof DRE combined TRUS was49.2%and59.7%respectively.5. In group A, f/t PSA in PCa patients (0.22±0.13) was lower than the non-PCa patients(0.27±0.13)(P <0.01), while PSAD value although in PCa patients (0.09±0.16ng/ml/cc) was slightly higher than in the non-PCa patients (0.06±0.07ng/ml/cc), but therehad no statistical significance (P>0.1). In groups B, C and D, f/t PSA in PCa patientswere lower than in non-PCa patients(P<0.01), PSAD value in PCa patients were higherthan in non-PCa patients (P <0.001).5. In groups B, C and D, the percentage of patients with Gleason score≤6was43.71%,35.17%and23.13%respectively. The percentage of patients with Gleason score≥8was13.91%,15.60%and36.60%respectively.6. In group A, the percentage of patients with Gleason score≤6and≥8was29.23%and35.38%respectively.7. In group A, B, C and D, the area under the ROC curve for f/t PSA was0.613,0.635,0.681and0.651respectively; the area under the ROC curve for PSAD was0.500,0.749,0.774and0.908respectively.Conclusions：(1) Patients with PSA≤4.0ng/ml and with positive DRE and/or TRUS findings, thedetection rate of high-grade PCa was higher; while PSA≥4.1ng/ml, with the elevationof PSA, the detection rate of high-grade PCa increased, especially when PSA≥20.1ng/ml, the detection rate was significantly higher.(2) PSAD for patients with PSA≤4.0ng/ml had no use in the diagnosis of PCa, forpatients with PSA level4.1to20.0ng/ml, there was a certain diagnostic accuracy, andfor patients with PSA≥20.1ng/ml, there had a higher diagnostic accuracy. Objects: To value the usefulness of digital rectal examination(DRE)，transrectalultrasonography (TRUS), free/total (f/t) prostate-specific antigen (PSA) and PSAdensity (PSAD) for prostate cancer in the patients with PSA levels of4.0ng/ml or less.Materials and Methods: Between April1996and December2012, a total of343subjects, age30to91years old, with PSA levels of4.0ng/ml or less and abnormalfindings on DRE or TRUS were biopsied. All patients were divided into four groupsaccording to the PSA levels:0to1.0ng/ml,1.1to2.0ng/ml,2.1to3.0ng/ml, and3.1to4.0ng/ml. The cancer detection rate of DRE and TRUS, and the reliability of cancerdetection in relation to the f/t PSA ratio and PSAD were estimated. The cancer detectionrates in patients with different ages were estimated also.Results: Of the343subjects,65(19.0%) were diagnosed with prostate cancer. Thedetection rate was16.28%(21/129）,17.17%(17/99),21.82%(12/55) and25.00%(15/60)in subjects with PSA levels of0to1.0ng/ml,1.1to2.0ng/ml,2.1to3.0ng/ml and3.1to4.0ng/ml respectively. The f/t PSA ratio was significantly lower in the patients withprostate cancer and PSA levels of2.1to4.0ng/ml (P<0.05). The PSAD was(0.09±0.16)ng/ml/cc and (0.06±0.07)ng/ml/cc in cancer group and non-cancer grouprespectively, and there had no statistic significance between the two groups (P>0.1).The cancer detection rates rose as the PSA level went up, but there had no statisticsignificance among the age groups (P>0.05).Conclusions: Routine prostate biopsy should be undertaken if the f/t PSA ratio less than0.15and with/without abnormal DRE/TRUS findings. The means of DRE, TRUS, f/tPSA ratio, and PSAD can not diagnose the prostate cancer effectively in patients withPSA levels of2.0ng/ml or less. |
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