前列腺穿刺患者前列腺癌检出率及其与 PSA、年龄的相关性

目的：探讨前列腺穿刺患者前列腺癌检出率情况,并分析其与前列腺特异性抗原（prostate specific an-tigen,PSA）、年龄的相关性。方法：回顾性收集2009年1月至2015年12月自贡市第一人民医院收治的年龄≥50岁且符合前列腺穿刺活检指征患者232例,对患者行 PSA 检测、直肠指诊（digital rectal examination,DRE）和经腹前列腺超声、MRI 检查,计算前列腺癌的检出率,分析前列腺癌检出率与年龄、PSA 水平的相关关系。结果：本组232例穿刺活检患者中,病理诊断为前列腺癌74例,阳性检出率为31．9％（74／232）。74例患者中,高分化癌16例（21.6％）、中分化癌24例（32．4％）、低分化癌34例（45．9％）。PSA 值＜4μg／L、4．1～10μg／L、10．1～20μg／L、＞20μg／L 4组患者前列腺癌检出率分别为9．1％、13．0％、16．2％、52．3％,随着 PSA 值的增加,前列腺癌检出率增长明显,呈明显的上升趋势（P ＜0．001）。随着年龄增高,PSA 值也越大,差异有统计学意义（Z ＝－3．328,P ＜0.001）;年龄＜60岁、60～69岁、70～79岁、≥80岁4个年龄组前列腺癌的检出率分别为11．1％、23．6％、40．0％、46.7％,随着年龄的增长,前列腺癌的检出率增长明显（P ＝0．011）。前列腺穿刺患者前列腺癌检出率与血清 PSA值呈正相关（r ＝0．376,P ＜0．001）,前列腺癌检出率与年龄亦呈正相关（r ＝0．288,P ＝0．019）。结论：随着年龄的增加、血清 PSA 值增高,前列腺穿刺患者前列腺癌的检出率也相应增高。     

前列腺肿物检查方法的临床评价

目的评价血清前列腺特异性膜抗原（PSA）和各项物理检查对指导前列腺活检的意义。方法结合血清PSA、直肠指诊（DRE）、直肠B超（TRUS）及磁共振成像（MRI）检查,对148例可疑前列腺病变患者,经直肠B超引导下行前列腺穿刺活检。结果前列腺活检阳性率为43.9%（65/148）。DRE和PSA对前列腺癌的诊断有意义(P＜0.05),其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE（P<0.01）,但前述三者之间对前列腺癌的诊断差异无显著性（P=0.46,P＝0.16,P＝0.52）。MRI的敏感性高于DRE和TRUS（P=0.05,P=0.01）,TRUS的特异性高于PSA或MRI（P=0.02,P=0.001）。结论前列腺活检是诊断前列腺癌的重要手段,其初步筛选以DRE加PSA为主,同时结合TRUS及MRI,可提高筛选的敏感性和特异性,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。     

PSA、FPSA检测和骨显像对前列腺癌骨转移的诊断价值

目的：探讨联合应用前列腺特异性抗原（PSA）、游离PSA（FPSA）检测和全身骨显像诊断前列腺癌骨转移的意义。方法：回顾性分析70例经临床确诊的前列腺癌患者，全部行血清PSA、FPSA测定，并作全身骨显像。结果：PSA〈4ng／ml在14例病人中，发生骨转移者7例，诊断阳性率为50％；PSA4ng／ml～20ng／ml共7例，发生骨转移者6例、诊断阳性率为87％；PSA〉20ng／ml组49例，发生骨转移45例，阳性率为92％。结论：PSA、FPSA检测结合全身骨显像，可尽早、全面地发现前列腺癌患者全身骨转移。     

TPSA、F／T及PSAD在前列腺癌诊断中的意义

目的探讨血清中总前列腺特异性抗原（TPSA）、血清游离PSA（FPSA）与TPSA比值（F／T）及PSA密度（PSAD）在前列腺癌诊断中的意义。方法对50例健康体检男性、467例良性前列腺增生症（BPH）及116例前列腺癌患者TPSA、F／T及PSAD值的差异进行分析、比较。结果血清TPSA值前列腺癌组（53．26±33．10）高于BPH组（8．12±9．70）及对照组（1．51±1．17）;PSAD值前列腺癌组[（1．59±1．46）ng·ml^-1·cm^-3]高于BPH组[（0．14±0．17）ng·ml^-1·cm^-3]及对照组[（0．08±O．07）ng·ml^-1·cm^-3];而F／T值前列腺癌组（0．22±0．16）低于BPH组（0．27±0．15）及对照组（0．36±0．14）,差异均有统计学意义（P值均〈0．01）。PSA处于4～10ng／ml时,前列腺癌组F／T（0．18±0．13）显著低于BPH组（0．27±0．14）（P〈0．05）;前列腺癌组PSAD[（0．21±0．07）ng·ml^-1·cm^-3]显著高于BPH组[（0．11±0．06）ng·ml^-1·cm^-3]（P〈0．001）。取F／T值0．16、PSAD值0．15ng·ml^-1·cm^-3为临界值时,F／T、PSAD值灵敏度、特异度及阳性预测值分别为81．6％、78．2％、96．1％和53．8％、76．9％、97．9％,诊断效率最高。结论F／T、PSAD是诊断前列腺癌的良好指标,当PSA为4-10ng／ml诊断灰区时,F／T与PSAD对诊断前列腺癌有较好的价值。     

前列腺癌并发上尿路积水的诊断和治疗(附32例报告)

目的：探讨前列腺癌并发上尿路积水的诊断和治疗方法。方法：回顾性分析32例前列腺癌并发上尿路积水患者诊断、治疗方法及疗效。结果：32例患者中行IVU5例、经直肠B超32例、CT23例、MRI 15例。32例均行全雄激素阻断治疗，血液透析4例．上尿路分流术11例。32例患者中28例治疗前血清PSA值平均47、73ng／ml（6．00～120．00），治疗后血清PSA值平均14．17ng／ml（0～38．40），平均下降33、56ng／ml（3．40～111、40）。B超示肾积水改善19例，未有明显变化10例，积水加重3例。经治疗后3个月，除1例死亡外，14例受损肾功能均有不同程度的改善。结论：B超是诊断前列腺癌并发上尿路积水的主要方法。内分泌治疗在前列腺癌并发上尿路积水的临床处理中占有重要的地位。     

263例前列腺癌患者诊断治疗现状

目的：探讨263例前列腺癌患者就诊情况及诊断治疗现状方法：将我院近22年来263例前列腺癌患者的临床资料按年份1983～1992年．1993～1998年和1999～2004年分为3组，从就诊情况、诊断和治疗方面进行分析：结果：1999年～2004年6年间共收治180例，总例数是1983年～1992年的3．67倍，是1993年～1999年的5．29倍。近年来老龄化更加明显（x^2=5．957，P=0．015）。前列腺特异抗原检测应用前后，患者的临床分期（x^2=1．146，P=0．564）和肿瘤分级构成比（x^2=6．696，P=0．153）无统计学差异。直肠指诊（DRE）、前列腺特异性抗原（PSA）和经直肠前列腺B超（TRUS）在前列腺癌的诊断中已占主导地位。根治性手术逐渐增多，采用内分泌治疗的患者仍占多数。结论：前列腺癌临床发病率有增高趋势，临床应用PSA检测后，患者年龄、临床分期和肿瘤分级没有明显下降。内分泌治疗仍占重要地位。     

89Sr联合内分泌治疗前列腺癌多发骨转移的临床研究

[目的]探讨^89Sr（^89锶）联合内分泌治疗前列腺癌多发骨转移的疗效。[方法]52例确诊前列腺癌多发骨转移患者,手术去势后随机分为两组：单纯内分泌治疗组20例。口服抗雄激素内分泌治疗;其余32例采用^89Sr联合内分泌治疗。治疗后3个月随访,观察两组镇痛效果、骨转移病灶数目、前列腺特异性抗原（PSA）变化。[结果]20例内分泌治疗患者,15例疼痛缓解,止痛率为75％,骨转移病灶和PSA不同程度下降,PSA下降55．35±18．23ng／ml;32例患者行^89Sr联合内分泌治疗,30例疼痛缓解,止痛率为93．8％,骨转移病灶和PSA明显下降,PSA下降68．77±20．35ng／ml。较单纯内分泌治疗,联合治疗镇痛效果、骨转移病灶数目减少及PSA降低均有显著性意义（P〈0．05）。[结论]对前列腺癌多发骨转移患者,采用^89Sr联合内分泌治疗,可明显提高止痛疗效,减少骨转移病灶数目、缩小病灶范围及降低血清PSA浓度,疗效优于单纯内分泌治疗。     

抗前列腺癌多肽APP216的体外活性

目的：探讨抗前列腺癌多肽APP216对体外培养的前列腺癌细胞的杀伤作用，为抗前列腺癌新药的研究奠定基础。方法：利用MTT实验、细胞凋亡染色及流式细胞仪，检测包含有BH3、K237、DG2结构域和能被PSA特异性水解的短肽序列的多肽药物APP216对分泌PSA的前列腺癌细胞系LNCaP、22RV1及不分泌PSA的前列腺癌细胞系PC3m、DU145的杀伤作用。结果：APP216（270 μg／mL）处理48h后，前列腺癌细胞系LNCaP、22RV。的细胞生存率分别为22％和34％，72h后为10％和8％；前列腺癌细胞系PC3m、DU145的细胞生存率分别为90％和95％，72h后为87％和92％。APP216作用后，分泌PSA的前列腺癌细胞胞核呈致密浓染，或呈碎块状，有凋亡小体出现；不分泌PSA的PC3m细胞则未发现改变。APP216（270 μg／ml）处理48h后，分泌PSA的LNCaP细胞凋亡率为36．26％，不分泌PSA的PC3m细胞凋亡率仅为1．63％。结论：APP216多肽对分泌PSA的前列腺癌细胞有杀伤作用，可诱导肿瘤细胞发生凋亡；而对于不分泌PSA的前列腺癌细胞则效果不佳。证实了该多肽可被PSA特异性酶切；同时，BH3结构域可通过HIV-TAT的转导作用转入细胞内诱导凋亡。     

PSA、PSAD测定对前列腺癌诊断的价值

目的：探讨血清前列腺特异抗原（PSA）和前列腺特异性抗原密度（PSAD）作为前列腺癌（PC）诊断指标的价值。方法：采用放射免疫分析方法测定50例前列腺增生（BPH）患者36例前列腺癌（PC）患者的血清PSA水平，B超测定前列腺体积，计算单位体积的PSA值（PSAD），结果：PSA界限值定为4μg/L时，其诊断PC敏感度为94％，特异度为36％，准确度为60％，PSA界限值为10μg/L时，敏感度为89％，特异率为62％，准确度为73％，PSAD测定诊断PC敏感度为89％，特异度为90％，准确度为90％，结论：对于前列腺癌的诊断，PSAD值测定较PSA值测定的准确度高。     

前列腺癌肿瘤相关抗原表达的意义

应用PSA（pc）、PSA（McAb）、PAP和CEA对25例前列腺癌进行免疫组织化学检测，同时检测正常前列腺4例，增生前列腺8例。结果表明PSA和PAP为敏感的前列腺上皮标记，PSA（pc）更敏感。PSA表达与前列腺癌的分化程度相关．PAP却无根。关，CEA多在分化好的前列腺癌中表达。对以上几种抗原在前列腺癌中表达的意义进行了讨论．以其为前列腺癌的临床病理诊断提供可靠的诊断依据。     

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.     

Transrectal Ultrasonically-Guided Core Biopsies In The Assessment Of Local Cure Of Prostatic Cancer After Radical External Beam Radiotherapy

Fifty-five patients were included in an extended follow-up after radical radiation therapy (RRT) for localized prostatic cancer (T1-3, Nx, MO). Local cure was assessed by a combination of digital rectal examination (DRE), transrectal ultrasound (TRUS) and systematic 'mapping' with TRUS-guided core biopsies (TGCB). After a mean follow-up of 6.8 years, 33% (18/55) of the patients were locally free of tumour, while in 67% (37/55) of cases residual cancer was demonstrated in the biopsies. Endocrine treatment did not influence the local cure rate, nor did the T stage of tumour grade at diagnosis or the cumulative radiation effect (CRE) values within the range of the present study. The sensitivity of DRE and TRUS was low; 37% and 20% respectively, while the specificity of the DRE and TRUS methods was 83% and 94% respectively. The conclusion of the study is that residual tumour was found in the high proportion of biopsied patients nearly 7 years after RRT and that multiple, TRUS-guided core biopsies are mandatory in the assessment of local cure in patients irradiated for prostatic cancer; both DRE and TRUS on their own are less reliable.     

老年人前列腺癌的早期诊断(附45例分析)

目的指出临床早期诊断对老年前列腺癌(PC)的病理分期及愈后有重要意义。方法分析了5年来我院收治的经病理确诊的45例老年前列腺癌的临床特点。结果较准确的早期诊断方法为直肠指检(DRE)、血清前列腺特异抗原(PSA)、经直肠前列腺B超(TRUS)、经直肠前列腺活检,阳性率分别为83%、82%、76%、73%。结论老年人应定期体检,前列腺癌的筛选应以PSA为基础,结合肛诊、TRUS及经直肠前列腺活检进行。     

前列腺癌的诊断(附56例报告)

目的为提高前列腺癌的早期诊断水平.方法通过对1983年1月2000年12月收治的56例前列腺癌的临床症状、直肠指检、B超、CT、MRI及PSA检查进行分析和探讨.结果临床症状中排尿不畅47例(83.9%),血尿9例(16.1%),尿潴留6例(10.7%),腰骶部疼痛6例,体检PSA升高6例,明显消瘦4例(7.1%),贫血4例,腹部包块1例(1.8%);直肠指检56例,阳性率91.1%;B超检查45例,异常回声改变33例(73.3%);CT检查10例,阳性率70%;MRI检查25例,阳性率76%;PSA检查36例,30例高于正常值(83.3%).结论直肠指检、影象学检查、PSA测定及穿刺活检是诊断前列腺癌的重要依据.     

Prostate Cancer Screening in a Healthy Population Cohort in Eastern Nepal: an Explanatory Trial Study

Background: Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer,and it ranks among the top ten specific causes of death in males. Objective: To explore the situation of prostatecancer in a healthy population cohort in Eastern Nepal. Materials and Methods: This study was conducted inthe Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in thestudy and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal.Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessmentof serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormalPSA/DRE findings. Results: A total of 1,521 males more than 50 years of age were assessed and screened aftermeeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ≤4.0 ng/ml. AbnormalPSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were bothabnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals weresubjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%)and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% anda positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostatewas 100% and the positive predictive value for serum PSA was 19.0% Conclusions: The overall cancer detectionrate in this study was 0.73% and those detected were locally advanced. Larger community-based studies arehighly warranted specially among high-risk groups.     

Model of screening for prostatic cancer among patients with prostate specific antigen concentration of 4-10 ng/ml in blood

Screening based on the measurement of prostate specific antigen (PSA) in the blood is the basic method for early detection of prostatic cancer. However the specificity of this method even in combination with the digital rectal examination (DRE) or with PSA derivatives remains disputable in cases when PSA concentrations in the blood vary between 4 and 10 ng/ml. We evaluated the efficiency of different diagnostic methods in order to create an effective diagnostic method in patients with PSA concentrations of 4-10 ng/ml. The study was carried out in 176 patients divided into 2 groups. Group 1 consisted of 120 patients. The efficiency of DRE, PSA density, PSA transition zone density (PSAT), free to total PSA ratio, and repeated PSA (measured after antibiotic therapy in patients with prostatic inflammations) were assessed. Diagnostic methods with the highest predictive values were identified. Positive predictive values of PSAT (cut-point 0.25 ng/ml/cc), nodule and induration (revealed by DRE) were estimated as 100, 100, and 75%, respectively. Negative predictive value of repeated PSA measurement (after antibiotic therapy) was 100% with the threshold value of 4 ng/ml. Using these diagnostic methods, a model of prostatic cancer screening was created. Group 2 consisted of 56 cases. A screening model representing a combination of the above diagnostic methods with the highest predictive value was clinically tried in this group. The sensitivity of the model was 80%, specificity 94%, positive predictive value 89%, and negative predictive value 89%. Use of this model makes biopsies unnecessary in 64% cases, with the risk of undetected cancer cases no higher than 20%. Hence, the screening model based on the use of diagnostic methods with the highest predictive value effectively detects prostatic cancer among patients with PSA concentrations of 4-10 ng/ml.     

前列腺癌的诊断(附65例分析)

报告６５例经病理确诊的前列腺癌，讨论了其早期诊断的方法及其临床价值。方法经直肠指诊，经直肠超声，经腹会阴超声，前列腺特异性抗原，酸性磷酸酶诊断前列腺癌。结果以上几种诊断阳性率分别为８５％、７５％、６２％、８０％和３５％。结论ＤＲＥ，ＴＲＵＳ，ＰＳＡ及经直肠穿刺检是目前筛选及早期诊断ＰＣ的重要方法。     

The utility of digital rectal examination after radical radiotherapy for prostate cancer

AimsThe aim of the current study was to determine the utility of routine digital rectal examination (DRE) after radical radiotherapy for prostate cancer.Materials and methodsBetween 1990 and 1999, 899 patients with clinically localised prostatic adenocarcinoma (T1-4, N0/Nx, M0/Mx) underwent neoadjuvant androgen deprivation and radical radiotherapy at the Royal Marsden Hospital. Patients were followed with serum prostate-specific antigen (PSA) test and DRE carried out at 6-monthly intervals for the first 2 years, and then annually.ResultsAt a median follow-up of 5 years, 39 out of 899 cases (4.3%) had local recurrence detected on DRE. DRE failed to detect any local recurrences in the absence of a rising PSA. The lowest serum PSA concentration at the time of clinically detectable local recurrence was 1.7 ng/ml.ConclusionsThese findings question the standard model of follow-up after radiotherapy for prostate cancer, and suggest that alternatives, such as telephone clinics, should be considered.     

Is sextant biopsy a valid method in diagnosis of prostatic cancer?

We evaluated effectiveness of a laterally directed sextant biopsy on large prostates and analysed the results of this biopsy technique in a group of men with obstructive voiding symptoms and suspected prostatic cancer (PC). Biopsy was performed in 386 men because of elevated PSA and/or abnormality in digital rectal examinations (DRE). The mean prostate volume was 79.6 +/- 39.1 cm3, and in 72.3% of the cases the volume of the prostate was > or = 50 cm3. PC was diagnosed in 107 of 386 cases (27.7%). In groups of patients with < 50 cm3 (small), 50 to 79 cm3 (medium) and > or = 80 cm3 (large) prostate volume and normal DRE, PC was detected in 27.5, 19.4 and 9.5% of cases, respectively (p < 0.018). PC detection rate was statistically insignificant (SI) in the same groups of patients with abnormal findings at DRE, 49.2, 54.2 and 51.9%, respectively (SI). Repeat sextant biopsy revealed PC in 14.5% patients. After TURP prostatic cancer was found in 7.7% patients who had undergone biopsy two times before. Thus, our results show that laterally directed sextant biopsy is an effective method of PC detection among suspected patients (PSA > 4 ng/ml) with large volume prostates and abnormal findings at DRE. An extensive biopsy protocol should be considered as a more appropriate method for markedly enlarged prostates with normal DRE findings but also for repeat biopsies.     

Utility of Digital Rectal Examination,Serum Prostate Specific Antigen,and Transrectal Ultrasound in the Detection of Prostate Cancer: A Developing Country Perspective

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen(tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men withlower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serumtPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue wereobtained from different areas of the peripheral prostate and examined histopathologically for the nature of thepathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changeswith or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) ofpatients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCahad abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA>20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: Theincidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can befurther improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.