| Objective:At present,clinical diagnosis of prostate cancer(PCa)mainly relies on prostate biopsy,and prostate biopsy is a invasive method.The positive rate in suspected PCa cases is only 30% to 50%.How to more accurately screen suspected cases and avoid unnecessary biopsy is still a clinically unsolved problem.This study was designed to review and analyze the diagnostic results of patients undergoing prostate biopsy in our hospital and to use the receiver operating characteristic curve(ROC curve)to compare total prostate specific antigen(tPSA),free prostate specific antigen(fPSA),and free Clinical Diagnosis of Prostate Specific Antigen/Total Prostate Specific Antigen(fPSA/tPSA),Serum Cystatin in Total Serum Prostate Specific Antigen(t PSA)Levels,and Prostate Cancer in t PSA Diagnostic Grey Areas(tPSA 4 to 10 ng/m L)The value,therefore,can help clinically improve the accuracy of PCa diagnosis and avoid over-puncture biopsy.Methods: Retrospective analysis of clinical data of 838 patients undergoing transrectal ultrasound-guided 12-needle prostate biopsy between December 2012 and January 2017 in our hospital.Including patient age,pathological diagnosis,tPSA,fPSA/tPSA,serum cystatin and other clinical data.Analysis of tPSA,fPSA,fPSA/tPSA,and serum cystatin predicted prostate cancer sensitivity and diagnostic specificity under the ROC curve.Results: There were 482 cases(58%,482/838)of benign prostatic hyperplasia(BPH),aged 43-87 years old with an average of 67.7 ± 7.6 years old,and the largest number of people aged 65-70 years old(25.8%)in the age group,including 70 years old patients The largest proportion(6.6%);in patients with BPH tPSA in the proportion of 10-50ng/mL most(67.0%);tPSA> 100ng/mL the lowest proportion of patients(2.1%).There were 356 cases(42.0%,356/838)of PCa patients aged 49-89 years with an average of69.3 ± 7.9 years old,and the largest number of people aged 70-75 years(25.1%),of whom 75 years were the largest(6.1%).In patients with PCa,the proportion of tPSA>100 ng/mL was the highest(40.4%),and the proportion of patients with tPSA 4–10 ng/mL was the least(5.9%).The area under the ROC curve of the overall tPSA level:the ROC area of tPSA(0.84)was the largest,the ROC area of fPSA was the second(0.79),and the serum cystatin area(0.54)was the smallest.When the tPSA level was between 4 and 10 ng/mL,serum cystatin(0.66)was the largest in the area under the ROC curve,and fPSA/tPSA(0.47)was the smallest.The sensitivity of the diagnosis was 65%and the specificity was 75% when the serum cystatin threshold value was set at 1.05mg/L in the grey PSA region of tPSA;the sensitivity of the diagnostic value of the fPSA/tPSA threshold value at 0.13 in the gray PSA region of tPSA was 80%,specificity is 27%.The sensitivity of the fPSA/tPSA threshold at 0.17 was 55% and the specificity was 50%.Conclusions: 1)In this study,prostate biopsy patients had more pathological diagnoses of BPH(58%);2)tPSA and fPSA had better diagnostic sensitivity and specificity;diagnosis of fPSA/tPSA and serum cystatin Sensitivity and specificity are relatively poor.3)When tPSA was between 4 and 10 ng/mL,serum cystatin had better diagnostic sensitivity and specificity than tPSA,fPSA,and fPSA/tPSA;3)When serum tPSA was in the gray zone,serum cystatin was selected.At a sensitivity of 1.05 mg/L,prostate cancer has a sensitivity of 65%,a specificity of 75%,and a good sensitivity and specificity.Therefore,when the serum cystatin level is ≥ 1.05 mg/L,the relevant history and examination are combined.Prone to be diagnosed as prostate cancer,consider biopsy of prostate;When serum cystatin is <1.05 mg/L,follow-up review is recommended;4)Sensitivity of prostate cancer is diagnosed when fPSA/tPSA threshold is set at 0.17.It is55% with a specificity of 50%.Its sensitivity and specificity are relatively good. |
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