目的 比较血清游离PSA比值(FPSA/TPSA)、前列腺移行区特异性抗原密度(PSATZ)、游离前列腺特异抗原百分比与前列腺特异抗原密度比值[(F/T)/PSAD]诊断PSA灰值区前列腺癌的价值.方法 分析2007年1月至2010年10月期间在南昌大学第一附属医院泌尿外科就诊或住院,血清PSA位于4～10 ng·mL-1的患者,其中前列腺癌(PCa组)患者20例,对照组前列腺增生(BPH组)患者42例.时间分辨免疫荧光分析法测定血清总前列腺特异抗原(TPSA)、游离PSA,经直肠超声(TURS)测量前列腺体积和移行区体积,分别计算出FPSA/TPSA、PSATZ和(F/T)/PSAD并进行分析判断.结果 PCa组和BPH组血清总前列腺特异抗原(TPSA)分别为(6.670±1.780)、(5.937±1.411)ng·mL-1,差异无统计学意义(P>0.05);FPSA/TPSA为0.122±0.058、0.185±0.078,差异有统计学意义(P<0.01);PSATZ为(0.592±0.255)、(0.285±0.184)ng·mL-1·cc-1,差异有统计学意义(P<0.01);(F/T)/PSAD为0.437±0.449、1.822±1.527,差异有统计学意义(P<0.01).ROC曲线下面积AUC自大至小依次为(F/T)/PSAD、PSATZ、FPSA/TPSA、TPSA.结论 当血清PSA位于4～10 ng·mL-1时,FPSA/TPSA、PSATZ及(F/T)/PSAD可辅助提高PCa的诊断符合率.其中PSATZ、(F/T)/PSAD 较FPSA/TPSA有更高的诊断价值.%Objective To evaluate the diagnostic values of free/total (F/T) prostate-specific antigen (PSA) ratio (FPSA/TPSA) , PSA transition zone density (PSATZ) and (F/T)/PSA Density [(F/T)/PSAD] in prostate cancer in patients with gray zone PSA. Methods A retro-spective analysis was performed in 62 patients with serum PSA 4 to 10 ng · mL-1 (20 prostate cancer patients and 42 benign prostatic hyperplasia patients) who were treated in the department of urinary surgery of the first affiliated hospital of Nanchang university between January 2007 and October 2010. Concentrations of TPSA and FPSA were detected by time-resolved fluoroimmuno-assay. Prostate volume and transition zone volume were measured by transrectal ultrasound. Then FPSA/TPSA,PSATZ and (F/T)/PSAD were calculated with the formula. Results There were no obvious differences in TPSA between prostate cancer group and benign prostatic hyperplasia group [(6. 670 ± 1. 780)ng ·mL-1vs (5. 937 ± 1. 411) ng · mL-1 ,P>0. 05]. However, differences in FPSA/TPSA,PSATZ and (F/T)/PSAD were significantly different between the two groups [(0. 122 ± 0. 058) ,(0. 592 ± 0. 255)ng-1· mL-1 · cc-1 and (0. 437 ±0. 449) vs (0. 185 ± 0. 078) , (0.285 ± 0. 184)ng-1 · mL-1· cc-1and (1. 822 ± 1. 527) , respectively; P<0. 01]. The descending order of the values of the area under ROC curve was (F/T)/PSAD, PSATZ, FPSA/TPSA ratio and TPSA. Conclusion FPSA/TPSA, PSATZ and (F/T)/PSAD, especially PSATZ and (F/ T)/PSAD,offer an improvement in the diagnosis of prostate cancer in patients with serum PSA 4 to 10 ng · mL -1.
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