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目的 分析因急性尿潴留留置尿管且PSA异常升高患者前列腺穿刺活检的临床病理特征,探讨PSA和前列腺特异性抗原密度(PSAD)对这类患者的前列腺癌诊断价值. 方法 对2009年1月至2011年10月收治的95例患者的临床资料进行回顾性分析,患者均因急性尿潴留而留置尿管,并因考虑前列腺癌可能而接受前列腺穿刺活检,指征包括PSA异常升高、B超检查提示前列腺低回声结节、MRI提示前列腺异常信号、直肠指检发现结节等.评估不同PSA水平下的前列腺癌发现率,并通过受试者工作特征曲线计算PSAD的曲线下面积(AUC),评估PSAD对这类患者的前列腺癌诊断价值. 结果 前列腺穿刺活检阳性率为17.9％(17/95).当PSA为4.1～10.0、10.1 ～20.0、20.1 ～ 50.0和≥50.1μg/L时,穿刺阳性率分别为0(0/21)、6.1％ (2/33)、13.0％ (3/23)、66.7％(12/18).当PSA≥10.1 μg/L时,PSAD的AUC为0.935,PSAD的截断点为＞0.54 mg/L2,诊断敏感性、特异性、阳性预测值及阴性预测值分别为94.1％、84.2％、61.5％和97.9％. 结论 对于发生急性尿潴留而留置尿管且PSA异常升高的患者,应当有选择地进行前列腺穿刺活检,需特别注意PSA≥10.1μg/L且PSAD＞0.54 mg/L2的患者.

Objective To analyze the clinicopathological characteristics of patients transurethrally cathetered due to acute urinary retention (AUR) and with high prostate specific antigen (PSA),and to evaluate the value of PSA and prostate specific antigen density (PSAD) in the diagnosis of prostate cancer (PCa) in these patients.Methods Data from 95 patients who had been transurethrally cathetered due to AUR and underwent transrectally ultrasound-guided prostate biopsy were retrospectively analyzed.The indications for biopsy in this study were abnormally elevated serum levels of PSA,positive transrectal prostate ultrasound and/or magnatic resonance imaging findings,and abnormal digital rectal examination.The incidence of PCa was recorded according to total PSA levels,while receiver operating characteristic curve (ROC curve) was plotted for appraisement on the predictive value of PSAD.Results The positive biopsy rate was 17.9％ (17/95).The positive rate was 0 (0/21),6.1％ (2/33),13.0％ (3/23) and 66.7％ (12/18) for patients with PSA 4.1-10.0,10.1-20.0,20.1-50.0 and ≥50.1 μg/L,respectively.In patients with PSA≥ 10.1 μg/L,the area under ROC curve of PSAD was 0.935,and the optimal cutoff was ＞ 0.54 mg/L2,while corresponding sensitivity,specificity,positive predictive value,negative predictive value was 94.1％,84.2％,61.5％ and 97.9％,respectively.Conclusions Prostate biopsy should not be performed on all AUR patients with transurethral catheters and elevated PSA levels.Patients with PSA ≥10.1 μg/L and PSAD ＞ 0.54 mg/L2 are at higher risk of PCa diagnosis.