摘要:
目的 通过分析BMI与PSA处于4~10 ng/mL的前列腺癌病理诊断的关系,提高PSA处于诊断灰区的前列腺癌高危人群的早期诊断率.方法 2012年8月至2016年7月南方医科大学南方医院泌尿外科收治的250例PSA在4~10 ng/mL之间,并接受经直肠超声引导下前列腺穿刺活检的患者,分别以年龄、BMI及Gleason评分做为亚组分层依据,分析BMI与前列腺穿刺病理结果及Gleason评分的关系.结果 所有分组病例活检结果确认为前列腺癌者共计24例,其中高BMI组10例,低BMI组14例.高BMI组中,高Gleason评分9例,比率为90%,与低BMI组相比(高Gleason评分5例,35.7%),存在统计学差异(90% vs.35.7%,P=0.003).其中老龄组亚组分析显示:高BMI组前列腺癌检出率为14.3%(9/63),低BMI组前列腺癌检出率5.0%(5/100),P=0.039;高BMI组病理活检阳性率31.7%(20/63),低BMI组病理活检阳性率14%(14/100),P=0.007.结论 临床工作中在对可疑人群评估前列腺穿刺活检时,除考虑t-PSA、f-PSA/t-PSA和PSAD外,还应考虑年龄和BMI,尤其是老龄肥胖患者.%Objective To explore the relationship between body mass index (BMI) and prostatic specific antigen (PSA) in the diagnosis of prostatic cancer.Methods During Aug.2012 and July 2016,250 patients received transrectal ultrasonograhy (TRUS) guided prostate biopsy.The total PSA all ranged from 4 to10 ng/mL.The patients were divided into subgroups according to age,BMI and Gleason score,to investigate the relationship between BMI and prostate pathological feathers.Results Of the 250 cases,24 were confirmed as prostate cancer,10 were classified into the high BMI group,and 14 into the low BMI group.In the high BMI group,9 cases (90%) had high Gleason score,while 5 cases (35.7%) had high Gleason score in the low BMI group (P =0.003).In the elder age group (≥65 y),the detection rate of prostate cancer was 14.3 % (9/63) in the high BMI group,and 5.0 % (5/100) in the low BMI group (P =0.039);the positive rate of biopsy was 31.7 % (20/63) in the high BMI group,and 14% (14/100) in the low BMI group (P=0.007).Conclusion BMI can affect prostate cancer diagnosis and Gleason score.In clinical practice,we should evaluate the age,total PSA (tPSA),free/total PSA (f/t PSA),prostatic specific antigen density (PSAD),and BMI,especially in elder patients with high BMI.