经直肠超声检查前列腺癌100例

目的评价经直肠超声（TRUS）检查前列腺癌(PCA)的临床价值。方法回顾性分析TRUS检查并经穿刺活检证实的100例PCA声像图和临床资料。结果59例声像图显示为单发癌肿,17例为弥漫性癌肿,其中35例PCA瘤体最大径线≤1.5cm。TRUS对前列腺癌的诊断率为76.0%,特异性89.4%,假阳性率10.6%,阴性预测值88.9%。前列腺特异抗原（PSA）随癌肿最大径线增加而升高(P<0.05),且低分化组PSA明显高于高分化组（P<0.05）。结论TRUS操作方便,无需特殊准备,有助于提高早期PCA的确诊率。     

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。     

血清前列腺特异性抗原联合血清肿瘤相关物质在早期前列腺癌诊断中的应用分析

目的分析血清前列腺特异性抗原(PSA)联合血清肿瘤相关物质(TAM)在早期诊断前列腺癌中的应用价值。方法选择128例前列腺癌患者为病例组,另选择128例前列腺良性病变者为对照组,检测所有患者PSA及TAM值,分析PSA联合TAM在早期诊断前列腺癌中的应用价值。结果以PSA≥4.08 ng/ml为诊断前列腺癌的临界值,PSA诊断前列腺癌的准确度、特异度以及灵敏度分别为82.8%、76.1%和88.6%,受试者工作特征(ROC)曲线下面积为0.873。以TAM≥98.36 U/ml为诊断前列腺癌的临界值,TAM诊断前列腺癌的准确度、特异度以及灵敏度分别为77.3%、78.7%和74.5%,ROC曲线下面积为0.832。实施双指标联合检测,特异度为96.6%,高于单一指标诊断特异度。病例组患者TAM和PSA水平均高于对照组,差异均有统计学意义(P﹤0.05)。结论在进行筛查以及早期诊断前列腺癌中,采用PSA及TAM联合检测法,可提升诊断特异度,令检查结果更为精准,值得进一步在临床中推广应用。     

直肠超声引导下前列腺穿刺活检148例

前列腺癌（PCA）是老年男性常见的癌症之一，已严重危及到人类的健康，在我们国家的发病率及检出率也逐年增加。临床上常把前列腺特异性抗原（PSA）检查和超声检查作为普查手段，但二者均不具特异性。直肠内超声检查结合超声引导下的前列腺穿刺活检，已使PCA的早期诊断成为可能。我院自1999年6月以来，应用经直肠内超声（TRUS）引导下前列腺穿刺活检148例，报告并分析如下。     

前列腺癌临床诊断中经直肠彩超引导下穿刺诊断的敏感度及特异度

目的探讨前列腺癌(PCA)临床诊断中经直肠彩超引导下穿刺诊断的敏感度及特异度。方法选取103例临床疑似PCA的患者为研究对象,以手术病理结果为诊断金标准,对患者分别采用经直肠彩超通过直肠壁显示前列腺诊断(A方案)、经直肠彩超引导下穿刺活检诊断(B方案)。对2种诊断的敏感度、特异度和准确度进行统计学比较,分析2种诊断方法对PCA临床的判断价值。结果手术病理结果显示,103例患者中有60例(58.25%)诊断为PCA,其余43例(41.75%)为良性疾病。经直肠彩超通过直肠壁显示前列腺诊断结果显示,患者中有51例(49.51%)诊断为PCA,其余52例(50.49%)为良性疾病,与手术病理诊断结果比较,其诊断灵敏度、特异度、准确度分别为:73.33%(44/60)、83.72%(36/43)、77.67%(80/103);经直肠彩超引导下穿刺活检结果显示,患者中有56例(54.37%)诊断为PCA,其余47例(45.63%)为良性疾病,与手术病理诊断结果比较,其诊断灵敏度、特异度、准确度分别为:90.00%(54/60)、95.37%(41/43)、92.23%(95/103)。经直肠彩超引导下穿刺诊断效能均高于单纯的经直肠彩超诊断效能,差异有统计学意义(P<0.05)。结论经直肠彩超引导下穿刺诊断PCA优于单纯的经直肠彩超诊断,具有较高的临床应用价值。     

经直肠超声引导下前列腺细针穿刺中液基薄层细胞学及免疫细胞化学诊断前列腺癌的应用价值北大核心

目的:探讨经直肠超声引导下前列腺细针穿刺细胞学中液基薄层细胞学(thinprep liquid based cytology test,TCT)及免疫细胞化学(immunocytochemistry,ICC)诊断前列腺癌的应用价值。方法:收集321例前列腺疾病患者细针穿刺物,TCT及传统涂片(conventional smear,CS)制片,其中153例有术后对照,回顾性比较不同制片方法诊断灵敏度、特异度及前列腺癌确诊率,分析漏诊及误诊原因,并结合ICC及前列腺癌分级,寻求早期诊断前列腺癌的有效方法。结果:TCT灵敏度及特异度高于CS,假阳性率及假阴性率减少,尤其是Gleason评分≤7分时明显。TCT联合ICC后,灵敏度及前列腺癌确诊率更高。结论:TCT和CS均能鉴别前列腺病变的良恶性,但TCT对于Gleason评分≤7分的前列腺癌患者有更高诊断价值,ICC辅助诊断后,其价值更高,是前列腺癌早期诊断的有效方法。     

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。     

多肿瘤标志物蛋白芯片检测在乳腺癌早期诊断中的价值

目的:研究多肿瘤标志物蛋白芯片(C12)联合检测在乳腺癌早期诊断中的价值.方法:对病理确诊的200例乳腺恶性肿瘤妇女进行12种肿瘤标志物的联合定量检测,采用100例女性健康献血员作为对照.对检查结果的漏诊率、误诊率、灵敏度和特异度等指标进行分析.结果:200例早期乳腺癌患者有106例血清肿瘤标志物为阳性,阳性率为53%;100名健康妇女有12例肿瘤标志物为阳性,假阳性率(误诊率)为12%.肿瘤标志物蛋白芯片对乳腺癌的定性诊断的灵敏度为53%,特异度为88%.结论:多肿瘤标志物蛋白芯片用于乳腺癌辅助诊断具有一定参考价值,但误诊率和漏诊率都比较高,有待进一步改善.     

经直肠超声引导前列腺穿刺活检方案的合理选择

目的 分析经直肠超声(TRUS)和前列腺特异性抗原(PSA)及其相关参数在前列腺穿刺活检中的作用,探讨个体化前列腺穿刺方案的可行性。方法 回顾性分析195例患者的首次穿刺活检资料,所有患者均采用系统8点穿刺方案,并对可疑病灶增加1~2点。依据穿刺病理结果,分析前列腺癌(PCa)检出率与TRUS、PSA及其相关参数的关系。结果 195例患者中检出PCa 98例(50.3%),其中PSA 4~10 ng/mL组45例,检出PCa 16例(35.6%),其中TRUS(+)且PSATZ≥0.35 ng/mL² 210例均证实为PCa;PSA＞10 ng/mL组150例,检出PCa 82例(54.7%)。PSA 4~10 ng/mL与PSA＞10 ng/mL两组患者PCa检出率差异有统计学意义(P＜0.05),且两组中TRUS(+)与TRUS(-)患者相较PCa检出率差异均有统计学意义(P＜0.01)。结论 依据TRUS、PSA及其相关参数制定个体化前列腺穿刺方案是可行的。     

血清PSA联合PSAD检测对前列腺癌的诊断价值

目的:探讨血清前列腺特异抗原（PSA）、前列腺特异抗原密度（PSAD）对前列腺癌的诊断价值。方法:检测经病理确诊的57例前列腺癌、125例前列腺增生患者的血清PSA。经直肠超声测定其前列腺的体积（PV）并计算PSAD。结果:前列腺癌组患者的PSA、PSAD明显高于前列腺增生组(P<0.05)。PSA值在4.1-10.0,10.1-20.0,>20.0ng/ml区间时PCa诊断率分别为8.8%,36.8%,54.4%。前列腺癌组的ROC曲线图中PSAD的AUC值（0.682）高于PSA的AUC值（0.601）,当取PSAD≥0.18ng/（ml·cm3）时,敏感性为84.5%,特异性为78.6%。比较58例重复穿刺患者的PSA、PSAD,只有PSAD差异有统计学意义(P<0.05)。结论:PSA动态监测结合PSAD是重复穿刺的重要参考指标,PSAD是PSA对前列腺癌诊断的有益补充。     

The Significance of PSA Modified Parameters （F/T）/ PSAD for Diagnosing Prostatic Cancer in the Grey Zone of 4-10 ng/ml

OBJECTIVE To investigate the diagnostic value of modified prostate specific antigen(PSA)parameters in the diagnosis of prostate cancer(PCA) when the serum PSAis in a grey zone of 4~10 ng/ml. METHODS The results of serum PSA determinations of the patients receiving a transrectal ultrasound-guided multiphase prostatic biopsy,were retrospectively analyzed.In the 88 patients with a serum PSA value of 4-10 ng/ml,the final diagnosis of PCA was made in 21,and that of benign prostate hyperplasia(BPH)in 67 patients.The percentage of the free-serum PSA([FPSA]/total-serum PSA[TPSA],F/T),PSA density(PSAD)and the sensitivity and specificity of the new PSA modified parameter(F/T)/PSAD in diagnosing PCA,within a set threshold value,was compared. RESULTS In the 88 patients with serum PSA in the grey zone of 4.0-10.0 ng/ml,there was no significant difference in comparing the TPSA between the 21 PCA patients and 67 BPH patients(P>0.05).However, there was a significant difference in the value of modified PSA parameters, such as F/T,PSAD and(F/T)/PSAD,between the PCA and the BPH groups (P<0.001).As the cut off point-value of the F/T,PSAD and(F/T)/PSAD was set at 0.16,0.15 and 0.8,the diagnostic sensitivity for PCA was 66.7%, 76.2%and 85.7%,and the specificity was 41.8%,43.3%and 68.7%,respectively.There was no significant difference in the sensitivity comparing the modified parameters for diagnosing PCA(P>0.05),whereas an overt predominance was present in the specificity of(F/T)/PSAD for PCAdiagnosis (P<0.05). CONCLUSION In the serum PSA grey zone of 4-10 ng/ml,a modified PSA parameter can improve the PCA diagnostic accuracy rate.With a considerably high sensitivity,application of the(F/T)/PSAD may effectively enhance the diagnostic specificity,which is superior to the F/T and PSAD, and can be expected to be one of the new indices derived from the PSA.     

血清嗜铬粒蛋白A在前列腺癌诊断中的辅助作用

[目的]探讨血清嗜铬粒蛋白A(CgA)在前列腺癌(Pca)诊断中的辅助作用。[方法]采用ELISA法测定30例健康志愿者(正常对照组),35例前列腺癌患者及10例前列腺增生(BPH)患者的血清中的CgA。[结果]前列腺癌患者血清CgA与正常对照组及良性前列腺增生组比较差别有显著性意义(P<0.05)。血清CgA水平随癌分期的升高而升高,D2期患者血清CgA水平明显高于正常对照组及其他分期癌患者(P<0.01和P<0.05)。CgA和前列腺特异性抗原(PSA)联合检测前列腺癌可提高诊断价值,平行试验灵敏度达83%,系列试验特异度达93%。[结论]血清CgA水平可应用于前列腺癌的诊断,尤其是对于PSA阴性或伴有远隔转移病例的诊断。     

The time-resolved fluorescence-based PCA3 test on urinary sediments after digital rectal examination; a Dutch multicenter validation of the diagnostic performance.

PURPOSE: To improve the specificity in prostate cancer diagnosis and to prevent unnecessary prostate biopsies, especially in the serum prostate-specific antigen (PSA) "gray zone" between 3 and 15 ng/mL, the implementation of prostate cancer-specific markers is urgently needed. The recently discovered prostate cancer antigen 3 (PCA3) is such a promising prostate cancer marker. In a previous single institution study, the PCA3 urine test clearly proved to be of diagnostic value. Therefore, the diagnostic performance of the PCA3 urine test was validated in a multicenter study. EXPERIMENTAL DESIGN: The first voided urine after digital rectal examination was collected from a total of 583 men with serum PSA levels between 3 and 15 ng/mL who were to undergo prostate biopsies. We determined the PCA3 score in these samples and correlated the results with the results of the prostate biopsies. RESULTS: A total of 534 men (92%) had an informative sample. The area under the receiver-operating characteristic curve, a measure of the diagnostic accuracy of a test, was 0.66 for the PCA3 urine test and 0.57 for serum PSA. The sensitivity for the PCA3 urine test was 65%, the specificity was 66% (versus 47% for serum PSA), and the negative predictive value was 80%. CONCLUSIONS: In this multicenter study, we validated the diagnostic performance of the PCA3 urine test in the largest group studied thus far using a PCA3 gene-based test. This study shows that the PCA3 urine test, when used as a reflex test, can improve the specificity in prostate cancer diagnosis and could prevent many unnecessary prostate biopsies.     

Prostate-specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of cancer.

Over a 4 1/2 year period, 1,940 asymptomatic men were entered in a prostate cancer detection program consisting of digital rectal examination (DRE), prostate-specific antigen (PSA), and transrectal prostate ultrasound (TRUS). Four hundred and sixteen biopsies were performed resulting in the diagnosis of 79 cancers; 82% had clinically organ confined tumors. A recommendation for biopsy was made in 260 (62%) based on the TRUS alone, 55 (13%) by DRE alone, 92 (22%) when the DRE and TRUS were both abnormal, and in 9 (2.2%) cases when only PSA levels were elevated. The DRE, PSA, and TRUS were abnormal in 1,261 (65%), 989 (51%), and 1,552 (80%) of the patients with cancer, respectively. Prostate cancer detection increased as the serum PSA level increased above 4 ng/ml. The positive predictive value of both DRE and TRUS were significantly influenced by an elevated PSA, (P = .042 and P less than .00005, respectively). The results of this study support the idea that, although the prostate cancer detection rate is influenced by these three modalities and the detection rate of localized disease can be improved by early detection programs, its effect on mortality rates remains undefined at this time.     

PCA3: from basic molecular science to the clinical lab

Prostate cancer is the second leading cause of cancer deaths in men in the United States. Use of the serum prostate specific antigen (PSA) test to screen men for prostate cancer since the late 1980s has improved the early detection of prostate cancer, however low specificity of the test translates to numerous false positive results and many unnecessary biopsies. New biomarkers to aid in prostate cancer diagnosis are emerging and prostate cancer gene 3 (PCA3) is one such marker. PCA3 is a noncoding RNA that is highly over-expressed in prostate cancer tissue compared to benign tissue. A non-invasive test for PCA3 was developed using whole urine collected after a digital rectal exam (DRE). Numerous clinical studies have demonstrated the utility of PCA3 for the diagnosis of prostate cancer and some studies suggest that PCA3 may also have prognostic value. The use of PCA3 in combination with serum PSA and other clinical information enhances the diagnostic accuracy of prostate cancer detection and will enable physicians to make more informed decisions with patients at risk for prostate cancer.     

PSA与AR联合检测在前列腺癌诊断及预后评价中的作用

目的 探讨PSA与AR联合检测在前列腺癌诊断及短期复发预后评价中的作用.方法 选取前列腺病变患者201例,其中前列腺癌98例、良性前列腺增生103例;另选取可比的正常对照组110例.测定雄激素受体以及各组患者血清中PSA表达水平.比较并评价诊断价值与对预后的影响.使用SPSS16用于数据分析.结果 前列腺癌组患者PSA水平(15.32±6.02)ng/ml,AR阳性率为60.20%;前列腺良性增生组103例患者,PSA水平(6.73±4.02)ng/ml,AR阳性率为74.76%;健康对照110例,平均年龄(45.88±1.98)岁,血清PSA水平(0.71±0.02)ng/ml.组间比较结果提示PSA水平和AR阳性率均以前列腺癌组的水平最高,P＜0.01.血清PSA单独用于前列腺癌诊断的真实性分析的灵敏度为87.76%(86/98),特异度为84.47%(87/103);血清AR单独用于前列腺癌诊断的真实性分析的灵敏度为80.61%(79/98),特异度为63.11%(65/103);而两个指标联合诊断的灵敏度为92.86%(91/98),特异度为89.32%(92/103).随访1年观察短期预后,在单因素Logistics回归分析结果的基础上在进行多因素Logistics回归分析,结果提示与复发存在潜在关联的因素包括PSA表达增高,其OR值为1.395(1.217~1.599),P＜0.001;AR 阳性也是复发的潜在危险因素,OR值为 1.094(1.051~1.139),P＜0.001;二者联合均表现为表达增高也会增高复发的风险,OR值最高,为1.870(1.338~2.614),P＜0.001.结论 PSA与AR联合检测在前列腺癌诊断中灵敏度和特异度均较好,且优于单独使用;同时联合两个指标对于预测近期复发也有一定的价值.     

血清PSA、FPSA/TPSA与ACP联合检测对前列腺癌诊断的意义

目的：探讨血清PSA、FPSA、FPSA/TPSA与ACP联合检测在前列腺癌诊断中的临床意义。方法：用化学发光法检测前列腺癌（PC）与良性前列腺增生（BPH）患者血清中的PSA和FPSA,计算FPSA/TPSA比值;用速率法检测前列腺疾病患者血清中的酸性磷酸酶（ACP）含量,并与正常人群进行比较。结果：PC组血清PSA、FPSA和ACP水平显著高于BPH组和对照组（P〈0.01）,BPH组又显著高于对照组（P〈0.01）;PC组FPSA/TPSA比值显著低于BPH组和对照组（P〈0.01）。结论：联合检测PSA、FPSA、FPSA/TPSA与ACP可有效地提高诊断PC的特异性和灵敏度;血清ACP检测可用于PC转移患者的诊断和术后监测。     

经直肠超声诊断前列腺癌的临床价值

[目的]探讨经直肠超声检查诊断前列腺癌的临床价值：[方法]32例血清前列腺特异性抗原升高或直肠指诊阳性的前列腺患者，经直肠超声检查引导穿刺活检。[结果]32例患者中，病理证实前列腺癌30例、移行细胞癌及黏液腺癌各1例。按声像图表现分为弥漫型、结节型及无结节型。经直肠超声检出异常结节23个，病理证实为癌性结节14个，增生结节9个。[结论]经直肠超声声像图有较高的敏感性。经直肠超声穿刺活检有助于提高前列腺癌的诊断。