Objective To investigate the diagnostic value of a new parameter-(F/T)/PSAD for prostate cancer in Chinese men with serum total prostatic-specific antigen (tPSA) between 4.0-10.0 μg/L by receiver operating characteristics (ROC) curves and general Loglinear model.Methods a series of 513 men (162 with prostate cancer,and 351 free of cancer) with total PSA levels of 4.0-10.0 μg/L participated in a protocol for prostate cancer screening.All patients were examined total PSA,free PSA,and prostate volume before submitted to TRUS guided multiple prostate biopsies.ROC curves of PSAD,F/T,and (F/T)/PSAD were constructed.And the corresponding specificity and cutoff of a relative high sensitivity were calculated and compared by general loglinear analysis.Results The mean value of PSAD,F/T and (F/T)/PSAD in patients with prostate cancer were significantly different from individuals free of cancer (Z=-11.59,Z=8.91 and Z=-11.93,all P＜0.01).Analysis of ROC curves showed that the AUC for (F/T)/PSAD is significant higher than F/T(0.827 vs 0.744,Z=2.86,P＜0.01).When sensitivity was fixed at a relative high level of 90.1％,(F/T)/PSAD would show a superior specificity than PSAD and F/T (65.0％ vs 51.3％ and 49.9％,both P＜0.01) by general loglinear model.Conclusions In our research,(F/T)/PSAD was an excellent parameter derived from PSA,which could improve the accuracy for diagnosis of prostate cancer without additional medical spending.When high sensitivity is demanded,(F/T)/PSAD would show a higher diagnostic efficacy for PCA over PSAD and F/T in Chinese men with PSA levels of 4.0-10.0 μg/L,which maybe useful to avoid unnecessary biopsies.The lower (F/T)/PSAD value a patient possessed,the higher PCA risk who would confound.%目的 应用受试者工作特征曲线(ROC)及广义对数线性模型探讨(F/T)/PSAD对血清总PSA(tPSA)4.0～10.0 μg/L的前列腺癌患者的诊断价值. 方法 回顾性分析2000年3月至2008年10月513例PSA4.0～10.0 μg/L、接受经直肠超声引导前列腺穿刺活检患者的临床资料,其中前列腺癌162例、良性病变351例.记录血清tPSA、游离PSA (fPSA)和前列腺体积,分别计算PSA密度(PSAD)、fPSA百分比(F/T)和(F/T)/PSAD,构建PSAD、F/T和(F/T)/PSAD的ROC曲线,计算曲线下面积(AUC),应用广义对数线性模型比较相同高敏感性时(F/T)/PSAD与PSAD和F/T的特异性差异. 结果 前列腺癌组的PSAD为(0.34±0.21)μg/L2,高于良性病变组的(0.16±0.12)μg/L2(Z=一11.59,P＜0.01)；F/T为0.10±0.08,低于良性病变组的0.22±0.17(Z=-8.91,P＜0.01); (F/T)/PSAD为(0.44±0.59) L2/μg,低于良性病变组的(2.03±2.26) L2/μg(Z=-11.93,P＜0.01).ROC曲线分析结果显示(F/T)/PSAD的AUC为0.827,显著高于F/T的0.744(Z=2.86,P＜0.01),与PSAD的0.819相近(Z=0.29,P=0.39)；保持相同的高敏感性(90.1％),广义对数线性模型分析显示(F/T)/PSAD的特异性为65.0％,高于PSAD的51.3％和F/T的49.9％,差异有统计学意义(P＜0.01). 结论 (F/T)/PSAD能够在不增加额外医疗费用的前提下进一步提高PSA 4.0～10.0 μg/L的前列腺癌患者的诊断准确性,并且在高敏感性时具有比PSAD和F/T更高的特异性,(F/T)/PSAD水平越低,患者发生前列腺癌的可能性越大.
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