探討最佳iPSA臨界值以預測攝護腺癌是否合併骨轉移
鄭百諭、李宏耕、洪順發、吳維哲、曾一修、邱斌、蔡宗佑、張效駿、楊清華、鍾旭東
亞東紀念醫院 外科部 泌尿科
The optimal iPSA cutoff value to predict prostate cancer with bone metastasis
Pai-Yu Cheng, Hung-Keng Li, Shun-Fa Hung, Wei-Che Wu, Yi-Shiou Tseng, Bin Chiu, Chung-You Tsai, Hsiao-Chun Chang, Ching-Hwa Yang, Shiu-Dong Chung
Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
Purpose: Serum PSA level was widely used in prostate cancer, from diagnosis, treatment to followup. High initial PSA (iPSA) level may raise the suspension for locally advanced or metastatic disease, and image study such as MRI and bone scan may be arranged subsequently after tissue proof from biopsy. However, waiting those images was time consuming in certain countries, and patients may not be treated properly. Hereby, we invested the iPSA level and the final clinical stage, in order to find the optimal iPSA cutoff value for prostate cancer with bone metastasis.
Materials & Methods: From Jan 2015 to Dec 2018, 234 patients with prostate cancer proof by TRUS biopsy was retrospectively reviewed. Clinical stage was reported either by CT and MRI image. Patients who didn’t received bone scan was excluded from our study, and total 220 patients were analyzed finally. The patient’s age, iPSA, Gleason score, clinical stage and metastatic status was recorded. The ROC curve correlated to iPSA and bone metastasis was analyzed by SPSS version 19, and cutoff value was calculated by Youden index.
Results: The patient demographics was below, the average age was 69.7 years old, with iPSA < 50 in most patients(Table-1). Bone metastasis was found in 66 patients. All patients with M1c prostate cancer were found to have simultaneous bone metastasis. The ROC curve for iPSA to prostate cancer with bone metastasis is significant then population area, and area under ROC curve was 0.922(95%CI: 0.881-0.964)(Fig-1). The Youden index was 0.699, and the corresponding iPSA value was 45.915 ng/mL, with sensitivity 0.894 and specificity 0.805.
Conclusion: The level of iPSA was correlated to probability of bone metastasis in prostate cancer, and the optimal cutoff value was 45.9 ng/mL. Early treatment for metastatic disease can be considered before further image was performed.
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Table -1 Patient demographics
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Item
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Value
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Age (years)
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69.7 (49-89)
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iPSA (ng/mL)
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<10
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59
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10-20
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40
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20-50
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36
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50-100
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12
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100-200
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17
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200-500
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21
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>500
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35
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Gleason score
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≤3+3
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42
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3+4
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52
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4+3
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35
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4+4, 3+5, 5+3
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20
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4+5, 5+4, 5+5
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67
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Clinical stage
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T1a-2a
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34
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T2b-c
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58
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T3-4
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34
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N1
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21
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M1a
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5
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M1b
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46
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M1c
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7
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Fig-1 ROC curve for iPSA level and incidence of prostate cancer with bone metastasis
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