目的 ·探讨前列腺特异抗原（ prostate-specific antigen，PSA）灰区（ 4～ 10 ng/mL）患者前列腺体积、游离 PSA/总 PSA（f-PSA/t-PSA）、PSA密度（ PSA density，PSAD）、彩色多普勒超声及经直肠超声造影（ contrast-enhanced transrectal ultrasonography, CETRUS）对前列腺癌诊断的价值。方法 ·回顾性分析 2015年 1月—2018年 7月在上海市浦东新区公利医院就诊怀疑为前列腺癌的 119例 PSA灰区患者的首次前列腺穿刺活检结果。所有患者均采用超声引导下经会阴部的（ 8+n）针穿刺方案。根据穿刺结果，分析具有不同前列腺体积、 f-PSA/t-PSA比值、 PSAD、彩色血流信号及 CETRUS结果的患者中前列腺癌的检出率。结果 ·所有患者中前列腺癌的检出率为 56.3%（67/119），良性前列腺增生占 43.7%（52/119）。f-PSA/t-PSA比值≤ 0.15组的前列腺癌检出率高于 f-PSA/ t-PSA比值 > 0.15组（73.6% vs 42.4%，P0.001）；PSAD>0.2 μg/L组的前列腺癌检出率高于 PSAD ≤ 0.2 μg/L组（69.8% vs 48.7%， P0.026）；CETRUS阳性组的前列腺癌检出率高于 CETRUS阴性组（72.4% vs 41.0%，P0.001）。结论 ·在 PSA灰区（4～ 10 ng/mL）患者中，f-PSA/t-PSA、PSAD及 CETRUS结果对前列腺癌的诊断具有重要的临床意义。

Objective · To investigate the value of prostate volume, free prostate-specific antigen (f-PSA)/ total PSA (t-PSA) ratio, PSA density (PSAD), colour Doppler ultrasound and contrast-enhanced transrectal ultrasonography (CETRUS) in patients with PSA level of 4–10 ng/mL. Methods · Retrospective analysis were performed in 119 patients with serum prostate-specific antigen level of 4–10 ng/mL who suspected prostate cancer in Pudong Gongli Hospital Jan 2015 to Jul 2018. All patients received TRUS-guided rectal (8+n)-core method biopsy. According to the result of puncture, the prostate cancer detection rate in patients with different prostate volumes, f-PSA/t-PSA ratios, PSADs, colour Doppler blood flow signals and CETRUS examination results. Results · The detection rate of prostate cancer in biopsies was 56.3% (67/119). The incidence of benign prostatic hyperplasia was 43.7% (52/119). The detection rate of prostate cancer in patients with f-PSA/t-PSA ratio ≤0.15 was higher than that with f-PSA/t-PSA ratio>0.15 (73.6% vs 42.4%, P0.001). The detection rate of prostate cancer in the patients with PSAD>0.2 μg/L was higher than PSAD ≤0.2 μg/L（69.8% vs 48.7%, P0.026). The detection rate of prostate cancer in the patients with positive CETRUS results was higher than that with negative CETRUS results (72.4% vs 41.0%，P0.001). Conclusion · The f-PSA/t-PSA ratio, PSAD and CETRUS examination results have important clinical significance for diagnosis of prostate cancer in patients with serum PSA level of 4–10 ng/mL.