Peripheral zone PSA density:a predominant variable to improve prostate cancer detection efficiency in men with PSA higher than 4 ng ml^(-1)
作者机构：Department of UrologyJiangsu Jiangyin People's HospitalJiangyin 214400China Department of UrologyShanghai General Hospital of Nanjing Medical UniversityShanghai 200080China Department of UrologyShanghai General HospitalShanghai Jiao Tong University School of MedicineShanghai 200080China Department of UrologyKashgar Prefecture Second People's HospitalKashi 844000China
出 版 物：《Asian Journal of Andrology》 (亚洲男性学杂志（英文版）)
年 卷 期：2021年第23卷第4期
页 面：415-420页
核心收录：
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
基 金：This study was supported by the National Natural Science Foundation of China(No.81772746,No.81870516) Natural Science Foundation of Xinjiang Province(2019D01C091)
主 题：benign prostate hyperplasia detection efficiency peripheral zone prostate-specific antigen density prostate biopsy prostate-specific antigen prostatic neoplasm
摘 要：To improve the diagnostic efficiency of prostate cancer(PCa)and reduce unnecessary biopsies,we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen(PSA)density(PZ-PSAD).Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital(Shanghai,China)between January 2012 and January 2018 were retrospectively identified(n=529).Another group of patients with benign prostatic hyperplasia(n=100)were randomly preselected to obtain the PSA density of the non-PCa cohort(N-PSAD).Prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging(mpMRI)and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific *** operating characteristic(ROC)curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level,and the area under the ROC curve(AUC)of PZ-PSAD was higher than that of PSA,PSA density(PSAD),and transition zone PSA density(TZ-PSAD).PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography(TRUS)and mpMRI *** TRUS and mpMRI findings were ambiguous to predict PCa(PIRADS score≤3),PZ-PSAD could increase the positive rate of biopsy from 21.7%to 54.7%,and help 63.8%(150/235)of patients avoid unnecessary prostate *** patients whose PSA was 4.0–10.0 ng ml^(−1),10.1–20.0 ng ml^(−1),and20.0 ng ml^(−1),the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml^(−2),0.297 ng ml^(−2),and 1.180 ng ml^(−2),respectively(sensitivity90%).Compared with PSA,PSAD,and TZ-PSAD,the efficiency of PZ-PSAD for predicting PCa is the highest,leading to fewer missed diagnoses and unnecessary biopsies.
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