经直肠前列腺超声造影与血清PSA检测在前列腺癌诊断中的价值

摘要

目的 探讨经直肠前列腺超声造影(CETRUS)与血清前列腺特异性抗原(PSA)检测在前列腺癌诊断中的价值.方法 回顾性分析经前列腺穿刺活检确诊的1 12例前列腺癌和86例良性前列腺增生患者的临床资料,比较两组患者血清PSA指标[包括游离前列腺特异性抗原(f-PSA)、总前列腺特异性抗原(T-PSA)、游离前列腺特异抗原/前列腺特异抗原比值(f/T-PSA)、前列腺特异性抗原密度(PSAD)]及CETRUS检查结果[包括前列腺体积、时间-强度曲线(TlC)、峰值强度(PK)、达峰时间(TP)、斜率(Sharpness)],并以病理检查结果为金标准,采用ROC曲线分析PSAD对前列腺癌的诊断价值.结果 前列腺癌与良性前列腺增生患者年龄、前列腺体积、f-PSA、T-PSA、f/T-PSA比较差异均无统计学意义(均P＞0.05),而PSAD比较差异有统计学意义(P＜0.05).PSAD为0.31时诊断前列腺癌的灵敏度和特异度最好.前列腺癌与良性前列腺增生患者CETRUS检查PK比较差异无统计学意义(P＞0.05),而TP、SharpnessⅢAUC比较差异均有统计学意义(均P＜0.05).结论 CETRUS检查与PSAD可为前列腺癌早期诊断提供有效信息.CETRUS检查具有快进快退、快速达峰、加速时间短等血流灌注特点,可用于指导穿刺活检策略,提高穿刺活检阳性率.%Objective To assess the value of contrast-enhanced transrectal ultrasonography (CETRUS) and serum prostate special antigen (PSA) in diagnosis of prostate cancer.Methods One hundred and ninety eight patients with prostate carcinoma confirmed by pathological examination were enrolled in the study.The free prostate specific antigen (f-PSA),total prostate specific antigen (T-PSA),f-PSA to T-PSA ratio (f/T-PSA),PSA density (PSAD) were measured.All patients underwent CETRUS and ultrasound-guided "12+X" biopsy.The time-intensity curves (TIC) was developed;and peak enhancement (PK),time to peak (TP),sharpness and area under the enhancement curve (AUC) were obtained.With pathological examination as gold standard the diagnostic value of CETRUS and PSA was analyzed.Results PSAD in prostate cancer group was higher than that in benign prostate hyperplasia group.CETRUS showed the "rapidly in and out",fast to peak,short acceleration time as characteristic features for prostate cancer.Conclusion CETRUS and PSAD have high diagnostic value for prostate cancer.