Značaj odnosa indeksa slobodnog i ukupnog prostata specifičnog antigena prema gustini prostata specifičnog antigena u dijagnostici karcinoma prostate u "sivoj zoni"

Abstract

Ispitivali smo znaĉajnost, odnos slobodnog i ukupnog PSA (F/T) prema PSA gustini (F/T)/PSAD u sivoj zoni, PSA 4-10 ng/ml za rano otkrivanje karcinoma prostate. Materijal i metode: Istraţivanje je rađeno na Urološkoj klinici Kliniĉkog centra Srbije i Medicinskog fakulteta Univerziteta u Beogradu u periodu od 2007. godine do 2015. godine. Kriterijum za odabir 150 bolesnika bio je serumski PSA između 4,0-10,0 ng/ml. Svim bolesnicima određivan je serumski PSA, slobodni PSA (F PSA), odnos slobodnog i ukupnog PSA (F/T PSA) i PSA gustina (PSAD), korišćen je Abbott test. Volumen prostate meren je transrektalnim ultrazvukom (TRUS), svima je rađena TRUS sextant biopsija prostate. Rezultati rada: Od 150 ispitivanih bolesnika, kod 91 (60,7%) bolesnika je patohistološki verifikovana benigna prostatiĉna hiperplazija (BPH), a 59 (39,3%) bolesnika imalo je patohistološki verifikovan kracinom prostate (CaP). (F/T)/PSAD je pokazao statistiĉki znaĉajno niţe vrednosti kod bolesnika sa CaP (0,75), nego kod BPH (1,42) (p<0,01). F/T statistiĉki niţi kod CaP (0,15) nego kod BPH (0,21) (p<0,01) i PSAD statistiĉki znaĉajno viši kod CaP (0,21) nego kod BPH (0,17) (p<0,01). Cutoff za (F/T)/PSAD 0,85, daje senzitivnost 68,6% i specifiĉnost 66 %, a površina ispod krive (AUC) 0,725, cutoff za F/T 0,145 daje senzitivnost 70,3%, specifiĉnost: 60,3% i AUC: 0,671 i cutoff za PSAD: 0,185 daje senzitivnost: 65,0%, specifiĉnost: 65,1% i AUC: 0,683. Poređenjem površina ispod krive (AUC) vidi se da najbolje vrednosti pokazuje odnos (F/T)/PSAD. Zakljuĉak: Bolesnicima sa PSA od 4-10 ng/ml moţe se predloţiti cutoff za (F/T)/PSAD 1,40, koji će smanjiti broj nepotrebnih biopsija za 25% Bolesnicima koji imaju niske vrednosti (F/T)/PSAD, F/T i visoke vrednosti PSAD, predlaţe se biopsija prostate zbog visokog rizika za karcinom prostate.

We have examined usefulness of the free to total PSA (F/T) against PSA density (F/T)/PSAD) in the gray zone, PSA 4-10 ng/ml for the early cancer detection. Material and methods : The examination took place at the Urology Clinics of Clinical Centre of Serbia and University of Belegrade School of Medicine in the period from 2007. to 2015. The criteria for the selection of 150 patients was the serum PSA between 4.0 – 10.0 ng/ml. All the patients were determined with serum PSA, free PSA (F PSA), free to total PSA ratio (F/T PSA) and PSA density (PSAD) by the Abbott test. Prostate volume was measured by transrectal ultrasound (TRUS) procedure and all of them had undergone TRUS sextant prostate biopsy. Results : Of 150 examined patients, 91 (60,7%) were histopathologically verified with the benign prostatic hyperplasia (BPH), and another 59 (39,3%) were with histopathologically verified prostate cancer (CaP). (F/T)/PSAD showed statistically significant lower values at the patients with CaP (0,75) then those with BPH (1,42) (p<0,01). F/T is statistically lower with CaP (0,15) than with BPH (0,21) (p<0,01) and the PSAD is significantly higher with CaP(0,21) than with BPH(0,17) (p<0,01). Cutoff for (F/T)/PSAD of 0,85 gives 68,6% sensitivity and 66,0% specificity and area under the curve (AUC) is 0,725, cutoff for F/T of 0,145 gives 70,3% sensitivity and 60,3% specificity and AUC 0,671 and PSAD 0,185 cutoff gives 65,0% sensitivity and 65,1% specificity and AUC 0,683. By area under the curve (AUC) comparison it can be seen that the best values are with (F/T)/PSAD ratio. Conclusion Patients with PSA 4-10 ng/ml can be recommended cutoff for (F/T)/PSAD 1,40, which and reduces number of unnecessary biopsies for 25%. Patients with low (F/T)/PSAD, F/T values, and high PSAD are prostate biopsy recommended because of prostate cancer high risk.