以前列腺剜除術的術後前列腺指數最低值來預測潛在的前列腺癌
鄭詠庭，陳忠信，洪健華，呂育全，張奕凱，劉詩彬，黃昭淵，蒲永孝
國立台灣大學附設醫院 泌尿部
The nadir level of serum prostate specific antigen after encucleation of the prostate predicted the risk of latent prostate cancer
Yung-Ting Cheng, Chung-Hsin Chen, Jian-Hua Hong, Yu-Chuang Lu, Yi-Kai Chang, Shih Ping Liu, Chao-Yuan Huang, Yeong-Shiau Pu
Department of Urology, National Taiwan University Hospital
Abstract
Purpose
Enucleation of the prostate is effective for patients with lower urinary symptoms. Serum prostate specific antigen (PSA) decreased accordingly with the proportion of resected prostate. However, latent prostate cancer was diagnosed incidentally at the time or after the enucleation of the prostate. We aimed to evaluate the predictive role of PSA nadir level in the diagnosis of latent prostate cancer.
Materials and Methods
A total of 76 patients who underwent bipolar or laser enucleation of the prostate were enrolled between November 2014 to August 2017. Patients who were diagnosed as prostate cancer before the operation were excluded.
Results
Median follow-up duration was 10 months (range:1-32 months). 8% of patients (n=6) were diagnosed as prostate cancer incidentally, while another two patients with benign pathology were diagnosed as prostate cancer afterwards. There was no difference in patient characteristics between cancer and non-cancer groups. In patients with benign pathology result, PSA nadir <1.5 ng/ml after enucleation had a highest area under the curve 0.98 (95% CI: 0.94-1.00, p value =0.023) of the receiver operating characteristic curve predicting the diagnosis of latent prostate cancer. The cut of value had the highest sensitivity 100% and specificity 93.6%.
Conclusions
The nadir level of PSA after the enucleation of prostate had the best predictive value of latent prostate cancer when PSA less than 1.5 ng/ml. Either incomplete resection or latent prostate cancer should be considered if PSA nadir failed to achieve the cut off value.