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。     

经直肠超声定位下前列腺穿刺活检术的探讨

目的探讨理想的前列腺穿刺活检方案。方法回顾性分析127例疑诊为前列腺癌患者的年龄、直肠指检（DRE）或经直肠超声（TRUS）情况、血清前列腺特异性抗原（PSA）水平、前列腺体积大小、穿刺针数等,与穿刺活检阳性率的关系。结果 127例穿刺活检结果显示：前列腺增生症（BPH）80例,前列腺癌（PCa）47例,PCa活检阳性率为37.9%;随着患者年龄的增长及PSA水平的增高,PCa检出率明显增高,差异有统计学意义（P〈0.05）,对前列腺体积不同患者,采用不同穿刺活检方案,其PCa活检阳性率不等,小体积前列腺患者,系统6针、10针、12针穿刺活检三组阳性率比较差异无统计学意义（P〉0.05）,大体积前列腺患者,12针穿刺活检阳性率明显高于系统6针的。直肠指检阳性组穿刺活检阳性率与阴性组比较有统计学意义（P〈0.05）。结论对不同的初次前列腺活检患者,应当根据患者的个体情况选择不同的穿刺活检方案。     

前列腺特异抗原正常进展型前列腺癌的临床特点分析

 目的　探讨正常水平血清前列腺特异抗原（PSA）进展型前列腺癌的临床特点。方法　回顾性分析12例血清PSA值为0～4 ng／ml并确诊为前列腺癌患者的临床资料。患者年龄60～77岁,平均67.5岁。B型超声检查发现阳性5例,后经前列腺穿刺活组织检查确诊;5例经尿道前列腺电切术,术后病理确诊;2例骨扫描异常,后经前列腺穿刺活检确诊。结果　T1期6例,T2a期3例,T3期1例,M1b 期2例;Gleason评分：2～4分2例,5～7分3例,8～10分7例。随访11例,术后3、6、9个月内分别死亡7、10、11例。结论　血清PSA水平为0～4 ng／ml进展型前列腺癌症状相对较轻,多数肿瘤细胞分化低,病情进展快,转移早,预后差。     

PSAT 在前列腺穿刺活检中的意义

目的:探讨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120例患者行前列腺穿刺活检,其中PSA≥4ng/ml者105例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者15例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果:120例患者中经前列腺穿刺诊断为前列腺癌(PCa)63例,活检阳性率52.5,其中15例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,前列腺小细胞癌2例,腺癌4例,良性前列腺增生8例;42例>20ng/ml者中32例为PCa,活检阳性率76.2;63例PSA4-20ng/ml者中24例为PCa,活检阳性率38.1;29例PSA4-10ng/ml者中10例为PCa,活检阳性率34.5。血清PSA4-20ng/ml患者,PSAD≥0.13或PSAT≥0.15时,敏感性均为100,特异性为20.5或17.9,阳性预测值为43.6或42.9,可避免12.7(8/63)或11.1(7/63)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11.18±4.49和10.05±4.29ng/ml(P=0.318);PSAD分别为0.45±0.33和0.26±0.15(P=0.003);PSAT分别为0.94±0.65和0.43±0.24(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.576、0.676和0.77,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:PSA4-20ng/ml时,PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

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。     

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。     

胰岛素生长因子-1及其结合蛋白-3在前列腺癌患者血清中的表达及其临床意义

 目的　检测前列腺癌患者血清胰岛素生长因子-1（IGF-1）及胰岛素生长因子结合蛋白-3（IGFBP-3）的水平变化,探讨其与肿瘤分级、分期的关系。方法　采用酶联免疫吸附测定法（ELISA）检测45例前列腺癌患者（前列腺癌组）血清中IGF-1、IGFBP-3和前列腺特异性抗原（PSA）水平,并以32例良性前列腺增生患者（前列腺增生组）作对照。结果　前列腺癌组血清IGF-1（179.76±55.83）ng／ml高于前列腺增生组,差异有统计学意义（t＝1.725,P＜0.05）。Ⅲ+Ⅳ期前列腺癌血清IGF-1（189.72±38.15）ng／ml高于Ⅰ+Ⅱ期,差异有统计学意义（t＝1.943,P＜0.05）。G3+G4级患者IGF-1水平（195.46±37.26）ng／ml高于G1+G2,差异有统计学意义（t＝1.824,P＜0.05）。前列腺增生组血清IGFBP-3（3608.17±1298.00）pg／ml高于前列腺癌组,差异有统计学意义（t＝1.786,P＜0.05）。Ⅰ+Ⅱ期前列腺癌血清IGFBP-3（3753.67±1582.35）pg／ml高于Ⅲ+Ⅳ期,差异有统计学意义（t＝1.894,P＜0.05）。结论　血清IGF-1、IGFBP-3与前列腺癌的临床分期、病理分级有关,其检测对前列腺癌术前病情判断、早期诊断和治疗有一定的临床意义。     

前列腺穿刺活检病理结果提示神经周围侵犯在评估前列腺癌进展风险中的价值

目的探讨前列腺穿刺活检病理结果提示神经周围侵犯在评估前列腺癌进展风险中的价值。方法选取2015年3月至2018年1月间上海市宝山区罗店医院收治的134例前列腺癌患者为研究对象,根据病理检查结果分为有神经周围侵犯(PNI)组和无PNI组,其中有PNI组54例,无PNI组80例。记录患者前列腺穿刺病理和根治病理Gleason评分,分析两组患者的肿瘤T分期、精囊侵犯率、包膜侵犯率、手术切缘阳性率、盆腔淋巴结转移率和血清PSA,对相关因素进行多因素分析。结果前列腺癌患者术前及术后临床资料比较,有无PNI前列腺患者的肿瘤分期、术后血清、前列腺穿刺病理评分、根治病理评分、精囊侵犯和包膜侵犯比较,差异均有统计学意义(均P <0. 05)。有PNI组相关因素多因素分析显示,前列腺癌患者肿瘤分期、前列腺穿刺病理评分、根治病理评分及包膜侵犯和患者有无合并PNI有关,差异均有统计学意义(均P <0. 05)。结论神经周围侵犯监测能够有效评估前列腺癌进展风险和危险程度,具有临床应用价值,值得推广应用。     

血清PSA及超声引导穿刺活检对前列腺癌病理分期预测价值研究

目的 研究血清前列腺特异性抗原(PSA)及超声引导穿刺活检对前列腺癌病理分期的预测价值.方法 选取200例经直肠超声引导前列腺穿刺活检确诊为前列腺癌的患者的临床资料进行研究.分析患者的血清PSA、穿刺活检阳性百分数及Gleason评分3个参数与前列腺癌病理分期的相关性;同时对比性分析以上3个参数在不同病理分期前列腺癌患者中的差异情况.结果 血清PSA、穿刺活检阳性百分数及Gleason评分均与前列腺癌患者的病理分期呈正相关(P﹤0.001);D期前列腺癌患者的血清PSA水平明显高于A期、B期、C期前列腺癌患者(P﹤0.05),而A期、B期、C期前列腺癌患者的血清PSA水平两两之间比较,差异均无统计学意义(P﹥0.05);C期与D期前列腺癌患者的穿刺活检阳性百分数比较,差异无统计学意义(P﹥0.05),而其他各分期间穿刺活检阳性百分数两两比较,差异均有统计学意义(P﹤0.05);A期与C期、B期与C期、A期与D期、B期与D期前列腺癌患者的Gleason评分比较,差异均有统计学意义(P﹤0.05),而A期与B期、C期与D期前列腺癌患者的Gleason评分比较,差异无统计学意义(P﹥0.05).结论 血清PSA、穿刺活检阳性百分数及Gleason评分均可单独用于前列腺期病理分期的预测,同时该3个参数在区分前列腺癌病理分期方面也发挥一定辅助作用.     

TRUS引导下前列腺穿刺活检联合PSA水平变化在诊断前列腺癌中的价值

目的 探讨经直肠内超声(TRUS)引导下前列腺穿刺活检联合血清前列腺特异性抗原(PSA)诊断前列腺癌(PCA)的临床价值.方法 选取怀疑为PCA的患者128例,分别接受TRUS引导下前列腺穿刺活检、血清PSA检测,以最终病理学检查结果作为金标准,探讨二者联合诊断PCA的临床价值.结果 不同PSA水平下TRUS引导下前列腺穿刺活检对PCA的检出率比较,差异有统计学意义(P﹤0.001).血清PSA检测鉴别诊断PCA的灵敏度为72.97%,特异度为61.11%,漏诊率为27.03%,误诊率为38.89%;TRUS引导下前列腺穿刺活检鉴别诊断PCA的灵敏度为70.27%,特异度为61.11%,漏诊率为29.73%,误诊率为38.89%;TRUS引导下前列腺穿刺活检联合血清PSA检测鉴别诊断PCA的灵敏度为98.65%,特异度为87.04%,漏诊率为1.35%,误诊率为12.96%.结论 TRUS引导下前列腺穿刺活检联合血清PSA检测诊断PCA的临床价值高于二者单独应用.     

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.     

The role of prostate-specific antigen as part of the diagnostic triad and as a guide when to perform a biopsy.

The authors reviewed the results and relationship of prebiopsy prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasound (TRUS) in 124 consecutive patients who underwent a prostate biopsy because of abnormal results of either DRE or TRUS. Results of the three tests (PSA, DRE, and TRUS) showed abnormalities in 54%, 75%, and 84.6% of patients, respectively; biopsy results were positive for cancer in 45.2%. Cancer detection rate increased as the PSA value increased from less than or equal to 4 ng/ml (17.5%) to more than 4 ng/ml (68.7%) to more than 20 ng/ml (83.3%), and as the number of positive tests increased (6.9% for one, 32.7% for two, and 82.6% for three). The PSA assay was the most important parameter of the diagnostic triad. These results suggested that regardless of DRE and TRUS findings, PSA less than or equal to 4 ng/ml confers a low prostate cancer risk, PSA more than 4 ng/ml but less than or equal to 10 ng/ml confers an intermediate prostate cancer risk, and PSA more than 10 ng/ml confers a high prostate cancer risk. Regardless of other findings, all patients with a PSA value more than 10 ng/ml require biopsy because of the high likelihood of cancer. All patients with abnormal DRE or TRUS results still require biopsy despite a low index of suspicion of prostate cancer when the PSA value is less than or equal to 4 ng/ml.     

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.     

Is extended biopsy protocol justified in all patients with PSA ≥ 20 ng/mL？

The aim of this study was to investigate whether it was necessary to increase the number of cores at initial prostate biopsy with patients of prostate-specific antigen （PSA） ≥ 20 ng/mL and to explore an appropriate individualized transrectal ultrasonograhpy （TRUS）-guided prostate biopsy for the detection of prostate cancer in men suspicious of prostate cancer. Methods： A total of 115 patients with PSA ≥ 20 ng/mL and suspicious of prostate cancer were prospectively randomized to perform TRUS-guided biopsy. Patients were randomized to a ＂6 ＋ X＂ cores or a ＂10 ＋ X＂ cores protocol. The primary end point was cancer detection rate. Secondary end points were cancer characteristics, rate of complications and the level of pain experienced by patients during TRUS-guided prostate biopsy. Results： Preoperative variables were similar in both groups. The overall prostate cancer detection rate was 73.9%. The ＂10 ＋ X＂ cores strategy increased cancer detection rate only 9.7% in patients with PSA ≥ 20 ng/mL but 〈 50 ng/mL, while there was no difference between the two strategies for cancer detection in patients with PSA ≥ 50.1 ng/mL. The number of extended biopsy cores and pain score of extended biopsy in prostate cancer patients increased significantly （P 〈 0.001）. Conclusion： Our findings suggest that there is no significant advantage in using extended biopsy protocol in all patients with PSA≥20 ng/mL.     

超声引导下经直肠前列腺穿刺活检560例分析

目的：探讨15针经直肠超声引导下前列腺穿刺活检术诊断前列腺癌的临床价值及其安全性。方法：回顾性分析我院2010-01—10—2012—12—20560例初次行经直肠超声引导下前列腺穿刺活检术的可疑前列腺癌患者的临床资料,对穿刺结果及穿刺后并发症情况做相关分析。结果：560例穿刺患者平均年龄（67．34±9．75）岁,平均前列腺特异性抗原（prostatespecificantigen,PSA）水平为（8．41±33．45）μg／L,平均前列腺体积大小为（64．52±35．47）mL,穿刺结果为前列腺癌214例（38．2％）,前列腺增生65例（11．6％）,前列腺增生伴低级别上皮内瘤变（prostaticintraepithelialneoplasia,PIN）I128例（22．9％）,PINII～Ⅲ35例（6．3％）,良性前列腺增生（benignprostatichyperplasia,BPH）伴慢性炎症96例（17．1％）,腺泡状横纹肉瘤1例。穿刺术后119例出现肉眼血尿（21．3％）,尿频、尿急和尿痛18例（3．2％）,直肠出血3例（0．5％）,急性尿潴留15例（2．7％）,发热10例（1．8％）,无其他严重并发症。结论：经直肠超声引导下前列腺15针系统穿刺法穿刺阳性率高,并发症少,是诊断前列腺癌的安全、有效方法,值得推广。     

Transrectal ultrasound guided biopsy for detecting early prostate cancer: An Indian experience

BACKGROUND: With the advent of prostate specific antigen the number of patients undergoing prostate biopsy has dramatically increased. The sextant biopsy technique has been conventionally used for the diagnosis of prostate cancer. Recently, concern has arisen that the original sextant method may not include an adequate sample of the prostate, hence it may result in high false negative rates. We conducted a prospective study to determine whether the 5-region prostate biopsy technique significantly increases the chance of prostate cancer detection as compared to the sextant biopsy technique. AIMS: To evaluate the efficacy of TRUS guided sextant and 5-region biopsy techniques in detecting carcinoma prostate in patients with PSA between 4 and 10 ng/ml and normal digital rectal examination. METHODS AND MATERIAL: Between December 2001 and August 2003 one forty-two men, aged 49-82 years, who presented with LUTS, normal digital rectal examination (DRE) and PSA between 4 and 10 ng/ml underwent TRUS guided sextant prostate biopsy. Serum PSA was reassessed after 3 months in patients whose biopsies were negative for cancer. If PSA was still raised, the patients underwent extensive 5-region biopsy. RESULTS: Mean patient age was 64 years and median PSA was 6.9 ng/ml. TRUS guided sextant biopsy revealed adenocarcinoma prostate in 34 men (24%). Median Gleason score was 7. Seven men (4.9%) had cellular atypia and 3(2.1%) had prostatic intraepithelial neoplasia (high grade). On repeat PSA estimation after 3 months, 48 patients showed stagnant or rising trend for which they underwent TRUS guided 13-core biopsy. Five (10.4%) patients were detected to have adenocarcinoma on repeat biopsy. Biopsy negative patients are on regular follow up with yearly PSA estimation. Complications included transient mild haematuria in14 patients (9.82%) and haematospermia in 4 (2.8%). Urinary retention developed in one patient and required an indwelling catheter for 4 days. CONCLUSION: Transrectal ultrasound guided sextant biopsy has shown a false negative rate of approximately 11%. A repeat 5- region (13-core) biopsy strategy can decrease the false negative rate of conventional sextant biopsy in patients with previously negative biopsies but persistently high PSA levels, high grade PIN or cellular atypia.     

Transrectal ultrasound in detecting prostate cancer compared with serum total prostate-specific antigen levels

We carried out a retrospective study to review the efficiency of grey-scale transrectal ultrasonography (TRUS) in detecting prostate cancer compared with the data in recent published work, including alternative imaging methods of the prostate gland. Our study group consisted of 830 patients who underwent TRUS-guided biopsy of the prostate between May 2000 and June 2004. The relation between abnormal TRUS findings and serum total prostate-specific antigen (tPSA) levels was evaluated in patients with prostate cancer who were divided into three different groups according to serum tPSA levels. Group I included patients with tPSA levels of 4-9.9 ng/mL, group II included tPSA levels of 10-19.9 ng/mL and group III included patients with tPSA levels of 20 ng/mL or more. In general, TRUS detected 185 (64%) of 291 cancers with a specificity of 89%, a PPV of 76% and an accuracy of 80%. TRUS findings enabled the correct identification of 22 (56%) of the 39 cancers in group I, 28 (30%) of the 93 cancers in group II and 135 (85%) of the 159 cancers in group III. In conclusion, TRUS alone has a limited potential to identify prostate cancer, especially in patients with tPSA levels lower than 20 ng/mL. Therefore, increased numbers of systematically placed biopsy cores must be taken or alternative imaging methods are required to direct TRUS-guided biopsy for improving prostate cancer detection.     

经直肠彩超引导下穿刺诊断前列腺癌的临床分析

目的评估经直肠彩超引导下前列腺穿刺活检术在前列腺癌诊断和鉴别诊断中的价值。方法对直肠指检阳性或经直肠彩超检查怀疑有占位性病变的35例患者行经直肠彩超引导下前列腺穿刺活检。结果经直肠彩超引导下穿刺诊断前列腺癌的敏感度、特异度分别为84．2％、81．5％,与手术切检比较差异无统计学意义;前列腺癌病灶RI≥0．75者所占比例显著高于非前列腺癌结节者（P〈0．05）。结论经直肠彩超引导下前列腺穿刺活检操作简单、安全,对前列腺癌的诊断具有重要的指导意义。     

5种前列腺穿刺活检方式的对比研究

目的比较5种不同前列腺穿刺活检方式的前列腺癌检出率和并发症情况。方法收集2001年至2012年间前列腺穿刺活检的住院病例239例,分别采用经会阴6点、手指引导6点、经直肠超声引导6点、5区13针(13点)和6+4(10点)5种不同穿刺活检方式分组。比较5种前列腺穿刺活检方式的阳性率及并发症情况;同时对比按年龄、直肠指检(DRE)结果、前列腺特异性抗原(PSA)和直肠超声(TRUS)情况分组后的相关结果。结果 5种不同穿刺方式组的前列腺癌检出阳性率差异无统计学意义(χ2=6.530,P>0.05);5组血尿阳性率的差异有统计学意义(χ2=9.947,P<0.05),其中5区13针组的血尿阳性率分别高于6+4组和超声6点组(P<0.005),手指6点组血尿阳性率高于6+4组(P=0.005)。按不同年龄和PSA水平分组后,PSA>20μg/L组的前列腺癌检出阳性率高于<10μg/L和10~20μg/L组(P<0.012 5);>80岁组的前列腺癌检出阳性率也高于<70岁组(P<0.025);同时DRE阳性和TRUS可疑组的前列腺癌检出阳性率也均高于阴性组(均P<0.05)。而各分层分组并发症发生情况均无统计学差异(均P>0.05)。结论对国内临床就诊人群,初次穿刺活检者采用10点的前列腺扩充穿刺即可,部分临床局部进展或前列腺体积较小者,采用6点穿刺足够诊断需要。对未细分穿刺人群简单的统一采用12点以上的穿刺方式不应是最佳选择。