血清PSA含量及前列腺PSA密度与经直肠超声引导下前列腺穿刺活检诊断前列腺癌的关系

目的探讨经直肠超声引导下前列腺穿刺活检术前列腺癌检出率与血清前列腺特异性抗原(PSA)及血清前列腺特异性抗原密度(PSAD)的关系。方法对134例患者行经直肠超声引导下前列腺5区13针系统穿刺活检。根据PSA水平分为PSA≤4ng/ml组(7例)、4ng/mlPSA15ng/ml组(48例)及PSA≥15ng/ml组(79例)。测量并计算前列腺体积(PV)及PSAD,分析前列腺癌检出率及不同PSA、PSAD水平下对前列腺癌的诊断效能。比较前列腺癌与非前列腺癌患者PSA、PV及PSAD的差异。结果前列腺癌总检出率为50.75%(68/134),前列腺患者共68例(前列腺癌组),非前列腺癌患者共66例(非前列腺啊组)。PSA≤4ng/ml、4ng/mlPSA≤15ng/ml及PSA15ng/ml组前列腺癌检出率分别为14.29%(1/7)、20.83%(10/48)及72.15%(57/79),差异有统计学意义(P0.05)。PSA≥4ng/ml时前列腺癌检出率随着PSA值的增高而上升。134例患者PSAD值为(1.09±1.72)ng/(ml·cm3),以PSAD≥0.19ng/(ml·cm3)为截点诊断前列腺癌的敏感度为95.59%(65/68),特异度为51.52%(34/66),阳性预测值67.01%(65/97),阴性预测值为32.99%(32/97)。4ng/mlPSA≤15ng/ml组中,以PSAD≥0.19ng/(ml.cm3)为截点诊断前列腺癌的敏感度为80.00%(8/10),特异度为71.05%(27/38),阳性预测值为42.11%(8/19),阴性预测值为57.89%(11/19)。前列腺癌组PSA及PSAD值均高于非前列腺癌组(P均0.05),PV小于非前列腺癌组(P0.05)。4ng/mlPSA≤15ng/ml组中,前列腺癌与非前列腺癌患者PSA及PV差异均无统计学意义(P均0.05),前列腺癌患者PSAD高于非前列腺癌患者(P0.05)。结论血清PSA及PSAD均与前列腺穿刺活检前列腺癌检出率有关,PSA15ng/ml应行穿刺活检,PSAD对4ng/mlPSA≤15ng/ml的患者是否应行穿刺活检具有指导意义。     

PSA、PSAD和PSAT在前列腺穿刺活检中的价值

目的 研究血清前列腺特异性抗原(PSA)及其密度(PSAD)和移行带密度(PSAT)在前列腺穿刺活检中的价值.方法 选取本院2014年5月至2015年5月收治的150例患者进行前列腺穿刺活检,分析并比较PSA、PSAD、PSAT在前列腺穿刺活检中的差异及其在确诊疾病方面的价值.结果 在前列腺穿刺活检的150例中发现PSA＜4 ng/mL有8例,4 ng/mL≤PSA≤20 ng/mL有66例,PSA ＞20 ng/mL有76例.其中在PSA＜4 ng/mL的8例中,活检结果良性前列腺增生6例,前列腺小细胞癌1例,前列腺横纹肌肉瘤1例.在4 ng/mL≤PSA≤20 ng/mL的66例中,活检结果诊断为前列腺癌增生患者54例,活检阳性率为81.8％,PSA平均值为(13.98±1.51) ng/mL,PSAD平均值为(0.32±0.18);PSAT平均值为(0.35±0.18);活检前列腺癌12例,活检阳性率为19.2％,PSA平均值为(14.29±1.48) ng/mL,PSAD平均值为(0.42±0.15),PSAT平均值为(0.82±0.15);将其分为良性前列腺增生组和前列腺癌组,两组差异具有统计学意义(P＜0.05).当PSAD ＞0.13或PSAT＞ 0.15时,前列腺癌的敏感性分别为92.86％和96.94％.在PSA＞ 20 ng/mL的76例中,前列腺癌有68例,活检阳性率89.47％.结论 在4 ng/mL≤PSA≤20 ng/mL时,PSAD和PSAT对前列腺增生和前列腺癌的鉴别诊断具有重要意义,其中又以PSAT更为准确;PSA＞ 20ng/mL时,应高度怀疑前列腺癌,及时确诊治疗.     

联合PSAD及MRI建立PSA4～10ng/ml患者前列腺穿刺活检阳性风险分层

目的:基于临床指标及MRI结果建立PSA 4～10 ng/ml(灰区)患者前列腺穿刺活检阳性风险分层,指导个性化穿刺决策。方法:回顾性分析2012年1月～2017年12月我院212例PSA 4～10 ng/ml的前列腺穿刺活检患者的年龄、PSA、f/t值、前列腺体积、MRI结果等临床资料。定义Gleason评分≥3+4分为有临床意义前列腺癌(csPCa)。筛选前列腺穿刺阳性预测指标并建立前列腺穿刺阳性风险分层方案。结果:212例患者前列腺穿刺活检阳性39例(18.4%),csPCa 14例(6.6%),前列腺穿刺阳性组和阴性组PSA值分别为(6.82±1.68) ng/ml和(6.82±1.73) ng/ml,f/t值分别为0.14±0.06和0.17±0.08,两组比较差异均无统计学意义(P0.05);年龄分别为(69.85±8.82)岁和(66.65±7.78)岁,前列腺特异性抗原密度(PSAD)分别为(0.18±0.12) ng·ml~(-1)·ml~(-1)和(0.14±0.07) ng·ml~(-1)·ml~(-1),两组比较差异均有统计学意义(P0.05)。将PSAD依据0.08、0.08～0.15、0.15 ng·ml~(-1)·ml~(-1)分为PSAD分级(PSADD)1～3级,各级阳性率分别为7.7%、12.2%和28.4%,csPCa阳性率分别为0、3.1%和12.5%。PSADD预测前列腺穿刺阳性的ROC曲线下面积(AUC)与PSAD比较差异无统计学意义(0.647 vs.0.641,P=0.785)。212例患者中MRI阳性组117例,其中前列腺癌31例(26.5%),csPCa 12例(10.3%);MRI阴性组95例,其中前列腺癌8例(8.4%),csPCa 2例(2.1%),两组比较差异有统计学意义(P0.05)。联合MRI及PSADD将患者分为低危、中危和高危3组,PSADD 1级且MRI阴性的患者定义为低危组,PSADD 3级且MRI阳性的患者定义为高危组,其余患者定义为中危组。低危、中危和高危组的前列腺穿刺阳性率分别为0、11.7%和39.3%,csPCa阳性率分别为0、2.8%和17.9%。结论:基于PSAD及MRI的前列腺特异性抗原"灰区"患者前列腺穿刺活检阳性风险分层有助于临床制定个性化穿刺决策、减少不必要的前列腺穿刺活检。     

PSA密度在PSA 2.5～10.0 ng/mL和10.1～20.0 ng/mL患者前列腺癌诊断价值的多中心研究

目的探讨前列腺特异性抗原密度(PSAD)在前列腺特异性抗原(PSA)值位于2.5~10 ng/m L和10.1~20.0 ng/m L患者前列腺癌诊断的效能。方法回顾性分析广州地区两家医院中PSA在2.5~20.0 ng/m L之间,行经直肠前列腺体积测量并行前列腺穿刺的461名患者临床资料,入选者分为PSA 2.5~10.0 ng/m L和PSA10.1~20.0 ng/m L两组,通过受试者工作特征曲线(ROC)分析法评价PSAD与PSA在预测前列腺癌的诊断效力。结果 PSA 2.5~10.0 ng/m L和PSA 10.1~20.0 ng/ml两组的曲线下面积比较,PSAD均高于PSA。在PSA 2.5~10.0 ng/m L组,PSAD预测前列腺癌的最佳临界点为0.15 ng·m L~(-1)·m L~(-1),敏感性和特异性分别为64.4%和64.6%;在PSA10.1~20.0 ng/m L组,PSAD预测前列腺癌的最佳临界点为0.33 ng·m L~(-1)·m L~(-1),敏感性和特异性分别为60.3%和82.7%。结论对于PSA2.5~10.0 ng/m L和10.1~20.0 ng/m L的中国男性,PSAD是一种更优的前列腺癌预测指标。     

血清PSA、PSAD和PSAT在前列腺穿刺活检中的意义

目的探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)和前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义。方法对192例患者行前列腺穿刺活检,其中PSA≥4ng/ml者184例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者8例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果192例患者中经前列腺穿刺诊断为前列腺癌(PCa)100例,活检阳性率52.1%,其中8例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,良性前列腺增生7例;93例PSA>20ng/ml者中80例为PCa,活检阳性率86.0%;91例PSA4~20ng/ml者中19例为PCa,活检阳性率20.9%。血清PSA4~20ng/ml患者,PSAD>0.10或PSAT>0.10时,敏感性均为100%,特异性为11.1%或4.2%,阳性预测值为22.9%或21.6%,可避免8.8%(8/91)或3.3%(3/91)阴性穿刺结果。血清PSA4~20ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为(13.2±4.7)和(11.4±4.6)ng/ml(P>0.05);PSAD分别为0.36±0.18和0.19±0.09(P=0.001);PSAT分别为0.67±0.36和0.32±0.18(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.613、0.810和0.833,PSAD和PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P<0.05)。结论PSA>20ng/ml时应做前列腺穿刺活检;PSA4~20ng/ml时,PSAD和PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

福州市PSA异常的老年男性前列腺疾病跟踪调查与分析

目的 了解老年男性前列腺疾病的发病情况探讨前列腺特异性抗原(PSA)在前列腺癌诊断中的价值.方法 对1234名老年男性进行前列腺指检(DRE)和PSA测定,然后对其中PSA＞4.0ng/mL者进行了随访复查,检查项目包括PSA和经亢肠前列腺超声,并建议行前列腺穿刺活检.结果 1234例调查者中,PSA＞4.0ng/ml者146例,其中126例得到随访,并接受了经亢肠超卢引导F"10点法"前列腺穿刺活检,其中101例前列腺增生患者中,PSA为(8.4±14.2)ng/ml,而25例前列腺癌患者中,PSA明显增高,为(29.3±17.5)ng/ml,两组相比筹异有统计学意义(P＜0.05);101例前列腺增生患者中,所测PV值为(32.61±16.19)ml,而25例前列腺癌患者所测PV值为(36.13±12.73)ml,两者相比差异无明显统计学意义(P＞0.05).比较不同PSA浓度与前列腺癌发牛率的关系,PSA＞10ng/ml时其前列腺癌的发生率显著高于4ng/ml＜PSA＜10nglml组.前列腺癌组PSA值显著高于前列腺增生组,两组前列腺体积相比差异无统计学意义.结论 PSA是诊断前列腺癌的重要瘤标,前列腺"10点法"穿刺活检是诊断前列腺癌的有效方法.对PSA＞4.0ng/ml的患者应密切随访复查,并建议行经直肠前列腺穿刺活检.对PSA高于10ng/ml时应高度警惕前列腺癌的发生.     

前列腺癌体积的临床预测及其意义

目的　研究以术前前列腺活检资料来推断前列腺癌体积及病理的价值。方法　以 3 3例因前列腺癌而行根治术的患者作为研究对象 ,将术前PSA、PSAD及前列腺 8点活检的结果与前列腺癌体积及病理进行相关分析研究。结果　 (1)前列腺癌体积与术前PSA、PSAD及前列腺活检的结果呈显著正相关 ,而与年龄、术前前列腺体积以及摘除标本的体积无明显相关关系 ;(2 )前列腺活检中阳性点数联合PSA与前列腺癌体积的回归模型预测前列腺癌体积最好 ;(3 )前列腺活检中阳性点数≤ 3点组的癌体积及精囊浸润率低于阳性点数≥ 4点组 ,两者有显著性差异。结论　前列腺 8点活检中阳性点数是预测前列腺癌体积及病理的一个重要参考指标 ,尤其是联合检测PSA ,更增加其预测前列腺癌体积的准确性     

PSAD预测前列腺癌根治术前后G1eason评分变化的临床应用价值

目的：探讨前列腺根治术前血清前列腺特异性抗原密度（PSAD）预测术后Gleason评分变化的应用价值。方法：对133例行前列腺癌根治术的患者资料进行回顾,将前列腺癌根治术前术后Gleason评分变化与患者年龄、术前Gleason评分、前列腺特异性抗原（PSA）、前列腺体积和PSAD的相关性进行分析,并进一步分析术前Gleason评分≤6患者中评分升高和Gleason评分≥7患者中评分下降与上述因素的关系。结果：133例患者中经直肠超声（TRUS）引导下前列腺穿刺活检Gleason评分与前列腺癌根治术后Gleason评分保持一致52例（39．1％）,评分下降13例（9．8％）,评分升高68例（51．1％）。PSAD（P=0．002）与Gleason评分升高明显相关,未发现Gleasbn评分≥7患者中评分下降与前列腺特异性抗原（PSA）、前列腺体积和PSAD有相关性。进一步应用受试者工作特征（receiver operating characteristic,ROC）曲线分析得出：TRUS穿刺活检Gleason评分≤6患者PSAD〉0．2435预示根治术后Gleason评分升高可能性较大。结论：TRUS引导下前列腺穿刺活检Gleason评分较低且PSAD较高的前列腺癌患者提示有可能实际Gleason评分升高,进而影响治疗选择和预后。     

血清PSA密度变化对前列腺癌高危人群的诊断价值

目的:探讨前列腺特异抗原(PSA)、前列腺特异抗原密度(PSAD)变化对前列腺癌高危人群的诊断价值。方法:对初次活检阴性的432例患者进行随访,其中79例重复穿刺活检,确诊前列腺癌27例(34.2%),消化道来源肿瘤1例,BPH25例,前列腺上皮内肿瘤(PIN)13例,慢性前列腺炎13例。对重复活检患者的PSA、PSAD等临床资料进行统计分析。结果:配对t检验显示,良性病变首末次穿刺前PSA、PSAD差异均无统计学意义,而前列腺癌末次穿刺前PSA、PSAD较首次穿刺前升高,差异有统计学意义。以PSA>4ng/ml筛选前列腺癌,其敏感性、特异性、阳性预测值分别为92.5%、17.6%、37.6%,PSA末-PSA首>0筛选前列腺癌的敏感性、特异性、阳性预测值分别为85.2%、41.2%、40.4%;而以PSAD末-PSAD首>0筛选前列腺癌的敏感性、特异性、阳性预测值分别为81.5%、54.9%、48.9%。结论:在前列腺癌高危人群中应该重复穿刺,以减少漏诊;以PSAD动态升高来指导穿刺,可以明显提高阳性率。     

PSA、PSAD和PSAT对前列腺癌诊断的比较

目的　比较前列腺移行带特异性抗原密度（PSAT）与前列腺特异性抗原（PSA）及前列腺特异性抗原密度（PSAD）在前列腺癌诊断中的意义。方法　对78例PSA4～20ng/ml的患者行前列腺穿刺活检后比较PSA、PSAD和PSAT指标。结果　78例中,病理诊断为前列腺癌(PCa)32例,良性前列腺增生(BPH)46例,二者PSA平均值分别为(14.32±1.46)ng/ml、(13.89±1.52)ng/ml,二者相比差别无显著性意义(P>0.05);PSAD平均值分别为0.43±0.14、0.36±0.17,二者相比差别有显著性意义(P<0.05);PSAT平均值分别为0.75±0.19、0.31±0.06,二者相比差别有非常显著性意义(P<0.01)。结论　PSAD和PSAT对预测PSA<20ng/ml的患者是否患前列腺癌有较大帮助,特别是PSAT更为准确。     

超声引导下前列腺12针系统穿刺活检增加前列腺癌检出率的研究

目的:探讨不同年龄及前列腺特异性抗原(PSA)分组对12针穿刺活检前列腺癌检出率及肿瘤特征的影响。方法:临床表现怀疑前列腺癌患者210例,按照患者的年龄分为≤59岁组、60～69岁组、70～79岁组、≥80岁组,按照PSA水平分为0～4μg/L组、4.1～10μg/L组、10.1～20μg/L组、20.1～50μg/L组、>50μg/L组,记录患者临床资料及活检结果。提出不同的穿刺方案并计算其检出率。结果:210例怀疑为前列腺癌患者,检出前列腺癌91例,总的前列腺癌检出率为43.3%,随着年龄的增长,PSA水平的提高,检出率逐渐提高。年龄的增长、PSA水平的提高与体积较大、分级较高的肿瘤密切相关。外周带穿刺与旁正中矢状尖部穿刺有较高的前列腺癌检出率。当患者年龄<60岁,PSA水平<20μg/L时,12针穿刺活检为较佳方案。结论:12针穿刺活检可以弥补6针穿刺活检的缺陷,随着患者年龄的增长,PSA水平的提高,肿瘤的体积增大、病理分级较差。传统6针穿刺法与12针相比,受患者年龄、PSA水平的影响较大。     

前列腺特异性抗原≤4.0μg/L前列腺癌的诊断

目的:评价直肠指检(DRE)、经直肠超声(TRUS)、游离前列腺特异性抗原/总前列腺特异性抗原(fPSA/t-PSA)、前列腺特异性抗原密度(PSAD)对前列腺特异性抗原(PSA)≤4.0μg/L PCa的诊断价值。方法:回顾性分析1996年4月至2012年12月解放军总医院超声科PSA≤4.0μg/L的前列腺穿刺患者共343例,年龄30~91岁。将患者按PSA含量0.0~1.0μg/L、1.1~2.0μg/L、2.1~3.0μg/L、3.1~4.0μg/L分为4组,评价DRE、TRUS、f-PSA/t-PSA、PSAD在不同PSA水平下PCa患者中的诊断价值,同时按年龄分为5组:≤49岁、50~59岁、60~69岁、70~79岁、≥80岁,评价不同PSA水平下不同年龄患者PCa的检出率。结果:343例患者中,共检出PCa 65例,检出率19.0%。PSA含量0.0~1.0μg/L、1.1~2.0μg/L、2.1~3.0μg/L、3.1~4.0μg/L时PCa的检出率分别为16.28%(21/129)、17.17%(17/99)、21.82%(12/55)、25.00%(15/60)。PSA≤2.0μg/L时,f-PSA/t-PSA比值在PCa和非PCa患者中没有明显差异(P0.05),而PSA2.0μg/L时有明显差异(P0.05)。而PSAD值在PCa组与非PCa组中分别为(0.09±0.16)μg/L/ml、(0.06±0.07)μg/L/ml,没有明显差异(P0.05)。随着PSA含量的升高,PCa的检出率相应升高,各年龄段的检出率没有明显差异(P0.05)。结论:当PSA含量在2.1~4.0μg/L时,若DRE/TRUS异常,则应引起重视,定期随访,监测PSA变化;若f-PSA/t-PSA≤0.15,伴或不伴DRE/TRUS异常,均应该行前列腺穿刺活检,以明确诊断。而对于PSA在0.0~2.0μg/L时,DRE、TRUS、f-PSA/t-PSA比值和PSAD均不能有效诊断PCa。     

Value of prostate volume measurement using transabdominal ultrasonography for the improvement of prostate-specific antigen-based cancer detection

PURPOSE: To examine value of prostate-speci fi c antigen (PSA) adjusted by prostate volume measured using transabdominal ultrasonography in prostate cancer detection among men with elevated PSA. METHODS: 238 men aged 79 years or younger with serum PSA levels of 2.0-20.0 ng/mL and normal digital rectal examination fi ndings were studied in terms of total and free PSA, prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography and transition zone volumes with TRUS prior to transrectal 10-core biopsy. In addition to sole PSA values and the free-to-total PSA ratio, volume-adjusted PSA values, PSA densities determined by TRUS (PSAD(TRUS)), and TAUS (PSAD(TAUS)), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic (ROC) analysis. RESULTS: Prostate cancer was diagnosed in 58 (24.4%) of the 238 men who underwent prostate biopsies. Of the areas under ROC curves (AUC) of studied parameters, PSATzD (AUC 0.751) was the best and signi fi cantly superior to PSAD(TAUS) (AUC 0.664, P = 0.007). However, PSAD(TAUS) exceeded PSA (AUC 0.559, P = 0.004) and showed potential capability of a one-fourth reduction in unnecessary biopsies without spoiling sensitivity (90%). Cancer detection rate was only 4.2% in the 48 patients whose prostate volume in TAUS was > 50 mL and PSAD(TAUS) was < 0.075. CONCLUSIONS: Since PSAD(TRUS) and PSATzD were signi fi cantly superior to PSAD(TAUS), TRUS is feasible as the standard fashion to determine prostate volume in the diagnosis of prostate cancers. However, TAUS is also worthwhile as it can improve the prostate cancer detection using sole PSA, and primary use of TAUS has the potential to reduce the substantial number of unnecessary biopsy safely.     

Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection

PURPOSE: Previous studies have indicated that 6-core transrectal prostate biopsy misses a considerable number of cancers. We performed an extensive biopsy protocol of 12-core sampling using both transperineal and transrectal approaches to determine the impact on the cancer detection rate. MATERIALS AND METHODS: We prospectively evaluated 402 men who underwent 6-core transperineal and 6-core transrectal biopsies simultaneously due to abnormal digital rectal examination (DRE) and/or elevated prostate-specific antigen (PSA) levels of 4.0 ng/mL or greater. Using the transperineal approach we obtained four cores from the bilateral peripheral zone targeting the lateral and parasagittal areas and two cores from the bilateral transition zone. The following transrectal biopsy was performed traditionally. We compared cancer detection rate between the extended 12-core procedure and conventional 6-core transperineal and transrectal groups in terms of total PSA and DRE findings. RESULTS: Using the extensive combined method, prostate cancer was detected in 195 cases (48.5%) and the detection rate significantly increased 7.2% and 8.5% compared to the transperineal and transrectal groups, respectively. According to PSA levels and DRE findings, the cancer detection rate by the combined method was significantly improved in patients with PSA levels of 4-10 ng/mL and negative DRE: 10.3% and 11.6% compared to the transperineal and transrectal groups, respectively. CONCLUSIONS: The extensive 12-core method significantly improved the overall cancer detection rate and was especially efficient for men with PSA levels of 4-10 ng/mL accompanied by a negative DRE finding.     

前列腺体积与前列腺癌穿刺阳性率的相关性研究

【摘要】 目的 探讨前列腺体积与前列腺癌穿刺阳性率的相关性研究。方法 选取2014年1月至2017年7月经直肠超声引导下行前列腺穿刺活检术的患者，共145例患者。入选标准：前列腺特异性抗原（prostatic specific antigen,PSA）≥10 ng/mL，4 ng/mL≤总的前列腺特异性抗原（total prostatic specific antigen,tPSA）＜10 ng/mL且f/t≤0.16，直肠指检发现前列腺结节，或超声、MRI发现异常影像的患者；排除标准：tPSA＞100 ng/mL，或穿刺病理为非前列腺腺癌的患者。其临床资料包括年龄、tPSA、前列腺体积（prostate volume，PV）、PSA密度等。结果 前列腺体积＜25 mL（Ⅰ度）、25～55 mL（Ⅱ度）和≥55 mL（Ⅲ度）的前列腺穿刺阳性率分别为53%、33%和17%，差异比较有统计学意义（χ²=9.1653，P=0.010）。行Cochran-Armitage趋势检验方法,提示：穿刺阳性率随着前列腺体积的增大而降低，差异比较有统计学意义（Z=2.9948，P=0.003）。多因素logistic回归分析，发现PV是前列腺癌穿刺阳性率的独立危险因素，PV为Ⅰ度相对Ⅲ度的优势比为6.268（95%CI：1.802～21.805，P=0.004）；PV为Ⅱ度相比Ⅲ度的优势比为2.444（95%CI：0.962～6.205，P=0.060）。结论 对tPSA＜100 ng/ mL的患者行前列腺穿刺，前列腺体积越小则是前列腺癌相对高发的危险因素，前列腺癌的穿刺阳性率也越高。     

Direct comparison between transrectal and transperineal extended prostate biopsy for the detection of cancer

AIM: To establish whether extended transrectal (TR) and extended transperineal (TP) biopsies are equivalent in detecting prostate cancer. METHODS: Due to an elevated prostate-specific antigen (PSA) greater than 2.5 ng/mL or abnormal digital rectal examination findings, 783 men underwent a transrectal ultrasound-guided three-dimensional 26-core biopsy, a combination of TR 12-core and TP 14-core biopsies. Using recursive partitioning, the best combination of sampling sites that gave the highest cancer detection rate at a given number of biopsy cores was selected either with a TR or a TP approach. The cancer detection rate and characteristics of detected cancers were compared between the TP 14-core and the TR 12-core biopsies and between selected subset biopsy schemes. RESULTS: Prostate cancer was detected in 283 of the 783 men (36%). There was no statistical difference in cancer detection rate or in the characteristics of detected cancers between TP 14-core and TR 12-core biopsies. As far as the best combination of sampling sites was selected, there was no statistical difference in cancer detection rates or in the characteristics of detected cancers between the TP and the TR subset biopsy schemes up to 12 cores. TP and TR biopsies performed equally, regardless of a history of negative biopsy, a digital rectal examination finding, the PSA level or the prostate volume. CONCLUSIONS: We demonstrated for the first time that extended TP biopsy is as effective as its TR counterpart in detecting cancer and the characteristics of detected cancers, as far as sampling sites are selected to maximize the cancer detection rate.     

Prostate-specific antigen adjusted for the transition zone volume versus free-to-total prostate-specific antigen ratio in predicting prostate cancer

BACKGROUND: We performed this study to assess the efficacy of prostate-specific antigen adjusted for the transition zone volume (PSATZ) and free-to-total prostate-specific antigen (PSA) ratio (F/T ratio) in predicting prostate cancer in men with intermediate PSA levels of 4.1-10.0 ng/mL. METHODS: Between March 1997 and September 1998, PSATZ was obtained from 67 patients who underwent ultrasonography guided systemic sextant biopsies and had a PSA of 4.1-10.0 ng/mL. PSATZ was compared with F/T ratio via receiver operating characteristic (ROC) curves. RESULTS: Of 67 patients, 22 (32.8%) had prostate cancer and 45 (67.2%) had benign prostatic hyperplasia (BPH) on pathologic examination. Mean PSA, PSA density, F/T ratio and PSATZ were 7.96+/-2.01ng/mL, 0.28+/-0.14 ng/mL/cc, 0.10+/-0.06 and 0.70+/-0.28 ng/mL/cc in patients with prostate cancer and 6.39+/-1.68 ng/mL, 0.16+/-0.06 ng/mL/cc, 0.15+/-0.05 and 0.29+/-0.10 ng/mL/cc in patients with BPH, respectively. The ROC curve analysis demonstrated that PSATZ predicted the biopsy outcome significantly better than F/T ratio in all 67 patients (P<0.01) and in a subset of 53 men with normal digital rectal examination (P<0.01). With a cut-off value of 0.35 ng/mL/cc, PSATZ had a sensitivity of 86% and a specificity of 89% for predicting prostate cancer. CONCLUSIONS: These results suggest that PSATZ and F/T ratio may be useful in diagnosing prostate cancer with intermediate levels of PSA. Prostate-specific antigen adjusted for the transition zone volume is more accurate than F/T ratio in distinguishing benign prostatic disease from prostate cancer. But large prospective studies are required to assess the precise role of PSATZ and F/T ratio in early prostate cancer detection.     

Prostate-specific antigen cut-off point of 2.5 ng/mL and increasing the number of prostate biopsies results in the detection of curable prostate cancer even in Japanese population

AIM: There is a trend for the cut-off point of Prostate-specific antigen (PSA) to be lower and the number of biopsies to be increased for detecting prostate cancer. I divided patients who visited my institution for prostate biopsy into 3 groups based on the time of examination. The results were evaluated retrospectively. METHODS: The three groups were: group A, PSA cut-off point of 4.0 ng/mL and sextant biopsy; group B, 2.5 ng/mL and 12 core biopsies; and group C, 2.5 ng/mL and saturation biopsy. I evaluated the rates of cancer detection, localized cancer, T1c, high grade cancer, major complications, insignificant cancer and the pain scores, and compared biopsy number and cancer detection rates with PSA range. Only the patients with T1c and PSA 2.6-10.0 ng/mL were evaluated about high grade cancer and insignificant cancer rates. RESULTS: Cancer detection rates, localized cancer rates and T1c rates were significantly high in group C. There were no significant differences in the high grade cancer rates, major complication rates and the insignificant cancer rates. A comparison between biopsy number and cancer detection rates was significantly high in the saturation biopsy group with PSA 4.1-10.0 ng/mL. CONCLUSION: A PSA cut-off point of 2.5 ng/mL and increasing the number of biopsies results in the increased detection of localized prostate cancer. The insignificant cancer rate, the high grade cancer rate and the complication rate were not significantly different among the groups. I recommend a PSA cut-off point of 2.5 ng/mL and an increased number of biopsies, saturation biopsy particularly in cases with PSA 4.1- 10.0 mg/mL.