Objective: To explore the decision-making value of clinical data in prostate imaging reporting and data system version 2 (PI-RADS V2) 3 lesions, and to compare the diagnostic value of related data for prostate cancer (PCa) and clinically PCa(csPCa). Methods: From March 2016 to October 2018,a subset of 121 men with 121 PI-RADS 3 index lesions were retrospectively analyzed. There were 31 PCa lesions and 14 csPCa lesions, aged from 46 to 91 years with a mean age of (71±9) years. The clinical data of the age, prostate specific antigen (PSA), free PSA (fPSA), f/tPSA, PSA density (PSAD) and prostate volume (PV) were compared between PCa group and non-PCa group, csPCa group and non-csPCa group using univariate analysis, respectively.The receiver operating characteristic (ROC) curve was used to evaluate the efficiency of statistically data in detecting PCa and csPCa in men with PI-RADS 3 index lesions. Results: The differences of PSA, f/tPSA and PSAD were all statistically significant (Z=-2.004, -2.527, -2.623, all P<0.05) between PCa group and non-PCa group, and they were all also statistically significant(Z=-2.415, -2.158, -2.870, all P<0.05) between csPCa group and non-csPCa group. Both PSAD had the best diagnostic efficiency, the ROC curve of detecting PCa and csPCa was 0.658 and 0.736, respectively. If used PSAD>0.20 μg·L(-1)·ml(-1) as the biopsy threshold, the sensitivity, specificity, positive predictive value and negative predictive value of csPCa were 78.6%, 58.9%, 20.0%, 95.4%, and 54.5% (66/121) of the enrolled men can avoid biopsy, resulting only 3 cases of csPCa missed. Conclusion: PSA, f/tPSA, PSAD, especially PSAD can improve the detection efficiency of PCa,especially csPCa in PI-RADS 3 lesions, assisting clinical decision-making.
目的： 探讨临床相关指标在第2版前列腺影像报告与数据系统（PI-RADS V2）3分病灶临床穿刺活检决策中的价值，比较上述观察指标对前列腺癌（PCa）和临床显著性前列腺癌（csPCa）的诊断效能。 方法： 回顾性分析2016年3月至2018年10月苏州大学附属第二医院121例前列腺主病灶PI-RADS V2评分为3分患者的病例资料，PCa 31例，csPCa 14例，患者年龄46~91（71±9）岁。比较年龄、前列腺特异性抗原（PSA）、游离前列腺特异性抗原（fPSA）、前列腺特异性抗原游离与总量比值（f/tPSA）、前列腺特异性抗原密度（PSAD）以及前列腺体积（PV）在PCa组和非PCa组间以及csPCa组和非csPCa组间的差异，运用受试者工作特性（ROC）曲线比较差异有统计学意义的指标对PI-RADS 3分患者的PCa及csPCa的诊断价值。 结果： 患者的PSA、f/tPSA、PSAD值在PCa组和非PCa组间（Z=-2.004、-2.527、-2.623，均P<0.05）以及csPCa组和非csPCa组间（Z=-2.415、-2.158、-2.870，均P<0.05）差异均有统计学意义，且均以PSAD诊断效能最高，其检出PCa和csPCa的ROC曲线下面积分别为0.658和0.736。若以PSAD>0.20 μg·L(－1)·ml(－1)作为穿刺参考阈值，诊断csPCa的敏感度、特异度、阳性预测值、阴性预测值分别为78.6%、58.9%、20.0%、95.4%，有54.5%（66/121）的病例可避免穿刺，3例csPCa漏诊。 结论： PSA、f/tPSA、PSAD，尤其是PSAD可提高PI-RADS 3分病灶中PCa，尤其是csPCa的检出效能，对临床决策制定具有重要参考价值。.
Keywords: Diagnosis; Prostate imaging reporting and data system; Prostatic neoplasms.