经直肠超声引导前列腺穿刺活检对前列腺特异抗原小于4 ng/ml前列腺癌的诊断

目的探讨经直肠超声引导下前列腺穿刺活检对前列腺特异抗原(PSA)<4ng/ml前列腺癌诊断的临床价值。方法59例PSA<4ng/ml疑为前列腺癌的患者行经直肠超声引导下前列腺多点穿刺活检,观察前列腺内结节声像图特点,并病理分级,对照分析活检术式的检出情况。结果59例患者中经病理证实前列腺癌16例,检出率为27%,其中12例声像图显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高。结节区域定点穿刺的检出率较六点系统穿刺活检术高(P<0.05);活检阳性点数占所有活检点数比率为51.2%,病理分级中分化程度占56.25%,低分化程度占31.25%。结论结合经直肠超声声像图和前列腺多点穿刺活检可提高PSA<4ng/ml的前列腺癌检出率,对前列腺癌的早期诊断非常必要。

The diagnosis of the prostate cancer with PSA level less than 4 ng/ml by transrectal ultrasound guided biopsy

Objective To evaluate the clinical value of transrectal ultrasound guided biopsies of the prostate cancer (PCA)with serum prostate specific antigen (PSA)level less than 4 ng/ml. Methods Prostate biopsy with transrectal ultrasound guidance was applied on 59 patients with suspected PCA. The ultrasonographic features of lesions and prostate gland were observed. The positive detection core of multicore biopsy and pathology grade were also analyzed by refering to the pathology results. Results In 59 patients, 16 were proved to be cancer by pathological examination. The positive detection rate was 27%. In these 16 patients, 12 had lesions located in outer gland with more vascularity than in benign and precancerous lesion and higher detection rate than 6 cores biopsy. The percentage of positive biopsy cores was 51.2% in all biopsy cores.56.25% of the PCA was moderate differentiated, and 31.25% was poorly differentiated.Conclusion Combining TRUS features with prostate multicore biopsy technique can further increase positive detection rate of PCA with PSA level less than 4 ng/ml,which is essential for early diagnosis of PCA.