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随着临床上B超引导下前列腺穿刺活检的开展,前列腺癌的病理诊断中遇到了一些困难。本文收集解放军总医院1980年 ̄1993年间前列腺穿刺活检397例中原诊断前列腺癌的142例,重新复方,发现14例非癌。同时在前列腺增生中发现7例为癌,最后确诊为前列腺癌135例。分析误诊的因素后发现过失诊断的情况是将增生、萎缩、炎细胞、人为挤压四种因素误认为是癌,反之,诊断不足的情况是将高分化癌、导管内癌、癌间质增生、 相似文献
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随着临床上B超引导下前列腺穿刺活检的开展,前列腺癌的病理诊断中遇到了一些困难.本文收集解放军总医院1980年~1993年间前列腺穿刺活检397例中原诊断前列腺癌的142例,重新复片,发现14例非癌.同时在前列腺增生中发现7例为癌,最后确诊为前列腺癌135例.分析误诊的因素后发现过失诊断的情况是将增生、萎缩、炎细胞、人为挤压四种因素误认为是癌,反之,诊断不足的情况是将高分化癌、导管内癌、癌间质增生、未分化小细胞癌四种因素误认为非癌。上述结果对于提高前列腺活检标本中前列腺癌的诊断有一定意义. 相似文献
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目的 比较不同PSA水平患者采用6点法和12点法的前列腺活检阳性率,探讨针对不同的患者人群设计国人合理的首次前列腺穿刺点数。 方法 通过研究首次接受直肠超声引导经会阴前列腺穿刺的425例患者,在PSA的不同水平段,比较6点法和12点法的阳性率的差异,以及阳性患者穿刺活检Gleason评分与前列腺癌根治术后病理标本Gleason评分之间的差异。 结果 425例患者中6点法穿刺224例,12点法201例。PSA>20 ng/ml的患者6点法与12点法的阳性率分别为85.3%、77.5%(P>0.05);PSA10~20 ng/ml患者6点法和12点法的阳性率分别为33.8%、39.1%(P>0.05)。两者的12点法比6点法没有更高的阳性率。PSA≤10 ng/ml患者6点法和12点法的阳性率分别为24.1%、45.8%(P<0.05),12点法比6点法阳性率显著提高。结论 对于国人首次行前列腺穿刺,若PSA>20 ng/ml推荐行6点法穿刺;PSA≤10 ng/ml推荐12点法穿刺,而PSA在10~20 ng/ml则两种穿刺方法均可以选用。 相似文献
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目的:通过总结经直肠超声(TRUS)引导下经会阴途径前列腺癌(PCa)穿刺活检患者的临床表现、相关检查及病理特征,提高对PCa穿刺活检的病理诊断水平.方法:选择2014年7月至2016年12月期间于我院行TRUS引导下经会阴途径PCa穿刺活检患者101例,对这些患者的临床表现、血清PSA检查、影像学检查及病理检查进行总结.结果:PCa患者年龄多大于60岁,多伴有泌尿系统症状与直肠指检异常、血清PSA常超出上限;影像学表现为病变区域图像改变与血流信号异常;镜检特征主要表现在细胞异型、结构异型和浸润性生长,镜下特征性结构与免疫组化检查有助于PCa的诊断.结论:前列腺穿刺活检病理检查是诊断PCa的金标准,在熟练掌握其病理特征与免疫组化表达的同时,注意结合PCa临床表现与临床相关检查的特点,对提高病理诊断准确性具有重要的临床意义. 相似文献
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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. 相似文献
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分析血清PSA系列及Gleason评分在前列腺癌分期中的预测价值 总被引:1,自引:0,他引:1
目的:探讨血清前列腺特异性抗原(prostate specific antigen,PSA)系列及穿刺活检Gleason评分对前列腺癌病理分期的预测价值。方法:回顾性分析根治术后病理证实为前列腺腺癌的92例患者资料,具备术前总前列腺特异抗原(total pros-tate specific antigen,tPSA)、游离PSA(free prostate specific antigen,fPSA)、fPSA/tPSA、前列腺特异抗原密度(prostate specific antigen density,PSAD)及穿刺活检Gleason评分。比较器官局限组和包膜外侵犯组之间以上指标的差异,运用工作特征曲线(ROC曲线)比较各指标的预测价值,并通过多因素logistic回归分析筛选器官局限最主要的影响因素。结果:包膜外侵犯组PSAD、tPSA、fPSA/tPSA和穿刺活检Gleason评分值均高于器官局限组(P〈0.05);ROC曲线对器官局限性前列腺癌的单因素预测比较,仅PSAD、tPSA预测价值较好[工作特征曲线下面积(areaunder ROC,AUC)〉0.7,P〈0.05];多因素分析中仅PSAD、穿刺活检Gleason评分为器官局限最主要的影响因素(P〈0.05),AUC达0.8(P=0.000)。结论:PSAD比tPSA对病理分期显示了更好的预测价值,病理分期预测模型可考虑以PSAD替代tPSA,结合其他因素,有望提高预测准确度。 相似文献
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直肠指诊,血清PSA及经直肠穿刺活检联合诊断前列腺癌的评价(?… 总被引:2,自引:0,他引:2
前列腺癌的早期诊断对于选择有效的治疗方法至关重要。对我科1988年11月至1998年11月收治并明确诊断的49例前列腺癌的直肠指诊(DRE)、血清前列腺特异性抗原(PSA)及经直肠前列腺穿刺活检方法进行了分析 ,并探讨三种方法单独与联合对前列腺癌的诊断价值。1临床资料本组49例 ,年龄46~83岁 ,平均64.5岁。主要临床表现有:排尿困难39例 ,无痛肉眼血尿14例 ,腰痛7例 ,消瘦及恶液质4例。全部病例均行DRE检查 ,发现前列腺异常者40例(81.6%),包括前列腺质地坚硬35例(71.4%);表面不光… 相似文献
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Huilian Hou Xu Li Xingfa Chen Chunbao Wang Guanjun Zhang Honghan Wang Huilin Gong Yuan Deng Min Wang Xuebin Zhang Department of Pathology The Fist Affiliated Hospital of Medical School of Xi’an Jiaotong University Xi’an China Experimental Medicine Center China Department of Urology China 《中德临床肿瘤学杂志》2011,10(7)
Objective: The significance of isolated high-grade prostatic intraepithelial neoplasia in initial biopsy as an predic-tor for prostate cancer has been extensively research, and the true relationship remnant is no clear till now. The aim of this study is to evaluate prediction value of cancer on repeat biopsy in patients with high-grade prostatic intraepithelial neoplasia, using multivariate analysis. Methods: Thirty-eight men with a diagnosis of isolated high-grade prostatic intraepithelial neo-plasia in in... 相似文献
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Percent free prostate-specific antigen (PSA) is an accurate predictor of prostate cancer risk in men with serum PSA 2.5 ng/mL and lower 总被引:1,自引:0,他引:1
Walz J Haese A Scattoni V Steuber T Chun FK Briganti A Montorsi F Graefen M Huland H Karakiewicz PI 《Cancer》2008,113(10):2695-2703
BACKGROUND: Up to 17% of men with a prostate-specific antigen (PSA) level below the accepted prostate biopsy cutoff of 2.5 ng/mL may have prostate cancer. Because identification of these patients represents a difficult task, we assessed the ability of percent free PSA to discriminate between benign and malignant prostate biopsy outcomes in men with PSA < or =2.5 ng/mL. METHODS: Between 1999 and 2006, 543 men with a PSA < or =2.5 ng/mL were referred for initial prostate biopsy. Age, total PSA, percent free PSA, and digital rectal examination findings represented predictors of prostate cancer at biopsy in logistic regression models. The area under the receiver operating characteristics curve (AUC) quantified the discriminative ability of the predictors. The pathological characteristics of the detected cancers were assessed in individuals treated with radical prostatectomy. RESULTS: Of all, 23% had prostate cancer on biopsy, 16.5% of patients treated with radical prostatectomy had pT3 stage, and 35.6% had a pathological Gleason score of 3 + 4 or higher. The most accurate predictor of prostate cancer on biopsy was percent free PSA (0.68) versus age (0.50), total PSA (0.57), or rectal examination findings (0.58). Of patients with percent free PSA below 14%, 59% had prostate cancer. In multivariate models, percent free PSA (P < .001) and rectal examination findings (P = .001) were the only independent predictors of prostate cancer. The combined AUC of all predictors (0.69) was not significantly (P = .7) higher than that of percentage of free PSA alone (0.68). CONCLUSIONS: The risk of prostate cancer is clearly non-negligible in patients with PSA < or =2.5 ng/mL. The percent free PSA can accurately predict the prevalence of prostate cancer at prostate biopsy in these individuals. 相似文献
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Schwartz MJ Hwang DH Hung AJ Han J McClain JW Shemtov MM Te AE Sosa RE Vaughan ED Scherr DS 《Cancer》2008,112(8):1718-1725
BACKGROUND: A correlation between prostate specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were different from what they are today. We evaluated if changes in biopsy practice patterns have affected the ability of PSA to predict cancer detection on prostate biopsy in the current era. METHODS: Of 3634 prostate biopsies performed from 1993-2005, 1607 met criteria for analysis. Biopsy data were divided into 3 time-cohorts (1993-1997, 1998-2001, and 2002-2005) to assess for practice patterns shifts and correlation between PSA and biopsy results. RESULTS: Significant changes in biopsy practice patterns included an increase in biopsy cores and more frequent use of PSA 2.5-3.99 ng/mL as a biopsy indication. In men with normal DRE, a moderate correlation between PSA and positive biopsy rate did exist from 1993-1997, but was subsequently lost. On multivariate analysis, PSA was not a significant predictor of biopsy result in men with normal DRE. CONCLUSIONS: Early in the PSA era, the predictive power of PSA depended on multiple factors: high prevalence of disease, higher prevalence of high-grade disease, and low likelihood of prostate cancer diagnosis in men with low PSA. Now, beyond the culling effect of increased biopsy incidence and with shifted biopsy practice patterns, the correlation between PSA and biopsy result is lost in men with normal DRE. Diagnosing a higher proportion of tumors in men with a PSA between 2.0-4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection. 相似文献
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Lin JF Xu J Tian HY Gao X Chen QX Gu Q Xu GJ Song JD Zhao FK 《International journal of cancer. Journal international du cancer》2007,121(12):2596-2605
Although serum prostate specific antigen (PSA) is a well-established diagnostic tool for prostate cancer (PCa) detection, the definitive diagnosis of PCa is based on the information contained in prostate needle biopsy (PNBX) specimens. To define the proteomic features of PNBX specimens to identify candidate biomarkers for PCa, PNBX specimens from patients with PCa or benign prostatic hyperplasia (BPH) were subjected to comparative proteomic analysis. 2-DE revealed that 52 protein spots exhibited statistically significantly changes among PCa and BPH groups. Interesting spots were identified by MALDI-TOF-MS/MS. The 2 most notable groups of proteins identified included latent androgen receptor coregulators [FLNA(7-15) and FKBP4] and enzymes involved in mitochondrial fatty acid beta-oxidation (DCI and ECHS1). An imbalance in the expression of peroxiredoxin subtypes was noted in PCa specimens. Furthermore, different post-translationally modified isoforms of HSP27 and HSP70.1 were identified. Importantly, changes in FLNA(7-15), FKBP4, and PRDX4 expression were confirmed by immunoblot analyses. Our results suggest that a proteomics-based approach is useful for developing a more complete picture of the protein profile of PNBX specimen. The proteins identified by this approach may be useful molecular targets for PCa diagnostics and therapeutics. 相似文献
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目的探讨尿前列腺癌抗原3(PCA3)基因表达水平及与血清前列腺特异性抗原(PSA)的表达水平,及其与肿瘤分化程度的关系。方法选择81例因血清PSA表达升高和(或)直肠指诊异常行前列腺穿刺活检的患者。采用苏木精-伊红(HE)染色及免疫组化鸡尾酒染色明确病理活检结果,定量-实时逆转录聚合酶链反应(qRT-PCR)检测尿PCA3 m RNA表达水平,并分析其与肿瘤分化程度的关系。前列腺癌患者尿PCA3 mRNA和血清PSA表达水平间的相关性采用线性回归分析。结果 81例患者的前列腺活检组织中,诊断前列腺癌阳性53例,阴性28例。前列腺癌患者尿PCA3 mRNA和血清PSA表达水平,均明显高于非前列腺癌患者(P﹤0.01);前列腺癌患者尿PCA3 m RNA表达水平与血清PSA表达水平无线性相关关系(P﹥0.05)。PCA3 mRNA高表达组患者Gleason评分明显高于低表达组患者(P﹤0.01),尿PCA3高表达倾向低、中度分化(P﹤0.01)。尿PCA3 mRNA高表达组患者NME1、NME3和SPARCL1 mRNA表达水平均明显低于低水平组患者(P﹤0.01);SPOCK1和survivin m RNA表达水平均明显高于低表达组患者(P﹤0.01)。结论前列腺癌患者尿PCA3 mRNA及血清PSA表达水平明显升高,但二者间无线性关系。前列腺癌患者尿PCA3 mRNA高表达时,NME1、NME3和SPARCL1mRNA表达水平及分化程度均降低,SPOCK1和survivin mRNA表达水平升高。 相似文献
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CHENZhaohui WUJianmin 《中德临床肿瘤学杂志》2002,1(4):233-237
Objective:To study the diagnostic value of complex PSA(cPSA),the calculated free/total PSA(f/t PSA) raio and total PSA(tPSA)in the differentiation of prostate cancer from benign prostate hyperplasia.Methods:The tPSA,cPSA and fPSA were measured using the Bayer ACS-180 chemiluminescence immuno-assay.152 patients(21 with prostate cancer and 131 with benign prostate hyperplasia proven by tissue pathology)whose serum total PSA ranged from 0.2-20.0ng/ml were accessed from July 2001 to May 2002 consecutively.The correlation between tPSA and cPSA was analyzed.The re-ceiver operator characteristic curves(ROC curve)were generated by plotting the sensitivity versus specificity.Areas under the curve were calculated for each assay.Logistic regression analysis was used to evaluate the ability of the indices as independent varia-bles to predict prostate cancer.Results:In the experimental group,the areas under the ROC curve of cPSA ,tPSA and fPSA/tPSA ratio were 0.811,0.799 and 0.376 respectively.The specificity for tPSA,fPSA/tPSA ratio and cPSA were 62%,57% and 4.7%,respectively,at cotoff yield-ing 95% sensitivity.Serum cPSA concentration was determined to be the best index among the three through logistic regression analy-sis.Conclusion:The serum levels of cPSA and tPSA are better indices than f/tPSA in the differentiation of prostate cancer from benign prostate hyperplasia.At the same level of sensitivity,cPSA has a higher specificity than tPSA.Serum cPSA may be a better indicator in the prediction of prostate cancer of early stage. 相似文献
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目的:探讨前列腺癌(prostate cancer,PCa)患者表观扩散系数(apparent diffusion coefficient,ADC)与血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、白细胞介素-6(interleukin-6,IL-6)、前列腺特异性抗原(prostate specific antigen,PSA)的相关性。方法:收集2016年1月至2017年12月经临床病理证实且资料齐全的60例PCa患者,将其分成两组,经SPECT/CT全身骨显像诊断为30例骨转移患者及30例未发生全身骨转移患者。采集全部患者的肘静脉血,利用酶联免疫吸附法(ELISA法)及化学发光法测定血清VEGF、IL-6及PSA水平。结果:60例PCa患者ADC值与血清VEGF、IL-6及PSA存在负相关(r=-0.431,P=0.001<0.005;r=-0.534,P=0.000<0.005;r=-0.593,P=0.000<0.005),骨转移组血清VEGF、IL-6及PSA水平明显高于无骨转移组(P<0.05)。结论:血清VEGF、IL-6及PSA与PCa发生、进展及转移关系密切。PCa患者ADC值与血清VEGF、IL-6、PSA的相关性可以作为评估患者病情进展程度的一个指标。 相似文献