直肠超声引导下经会阴前列腺穿刺分析

目的：探讨直肠超声引导下（TRUS）经会阴前列腺穿刺活检术诊断前列腺癌的价值。方法：对491例PSA〉4ng／ml、直肠指检异常或B超发现异常回声的病例行经会阴前列腺标准六点穿刺活检术,同时对可疑回声区随机增加穿刺点,并与病理结果对照分析。结果：穿刺活检证实为前列腺癌190例,阳性率38．70％。结论：TRUS引导下经会阴前列腺穿刺准确率高,并发症少且轻,是诊断前列腺癌的重要方法。     

经直肠前列腺超声造影对前列腺癌诊断的应用价值

目的探讨经直肠前列腺超声造影对前列腺癌诊断的应用价值。方法分析我院70例临床怀疑前列腺癌患者,经直肠指检发现异常,血清前列腺特异性抗原(PSA)均持续性异常增高,PSA 4. 0μg/ml,经TRUS及MRI检查异常者,年龄52～92岁,中位年龄72岁。其中研究组30例患者,先行前列腺超声造影选择靶区,再经直肠超声引导下行12+X针(靶向区加1～2针)穿刺活检;另外对照组40例患者,直接进行经直肠超声引导下常规12针穿刺活检,对比两组患者前列腺癌穿刺活检的阳性率。根据PSA值不同将患者分为3组,分析各组靶向区的检出率。结果研究组前列腺癌结节超声造影表现为早期高增强,早消退或不规则增强。前列腺癌穿刺活检阳性率为53. 3%,明显高于对照组32. 5%(P 0. 05); PSA 4. 1～20μg/ml中靶向区的检出率为25%,PSA 20. 1～40μg/ml中靶向区的发现率为42. 9%,PSA 40μg/ml中靶向区的检出率为80%,差异有统计学意义(P 0. 05)。结论经直肠前列腺超声造影能有效提高前列腺穿刺活检阳性率及前列腺癌的诊断率。超声造影在前列腺多点穿刺中真正具有可视、安全、结果可靠、漏诊率低的优点。     

经直肠超声引导10点前列腺穿刺活检诊断前列腺癌临床分析

目的:探讨经直肠彩色多普勒超声引导10点前列腺穿刺活检诊断前列腺癌的临床价值。方法:对71例血清PSA升高和直肠指诊阳性、彩色多普勒出现局部血流增加异常者,行经直肠彩色多普勒超声引导10点前列腺穿刺活检术。结果:71例患者中确诊为前列腺癌者24例(33.8%);前列腺增生28例(39.4%);前列腺炎14例(19.7%);前列腺炎性肉芽肿4例(5.6%);前列腺结核1例。71例患者接受10点前列腺穿刺活检术,有12例(16.9%)术后出现血尿;2例出现血便;1例出现血精,未出现严重的并发症。结论:经直肠彩色多普勒超声引导10点前列腺穿刺活检术是一种安全的方法,有助于提高前列腺癌的早期诊断及前列腺疾病的鉴别诊断。     

腹腔镜探头经直肠超声引导下行经会阴前列腺穿刺活检术的初步探讨

目的探讨腹腔镜线阵探头在经直肠超声引导下行经会阴前列腺穿刺活检术中的应用价值。方法对因前列腺直肠指检发现结节、血清PSA水平高于正常值(如PSA>4μg/L)、超声或其他影像学检查发现前列腺占位病变、发现转移癌,怀疑原发灶在前列腺的72例疑似前列腺癌患者,将腹腔镜线阵探头前方涂抹较多超声耦合剂外套避孕套后放入直肠内行经直肠超声引导下经会阴前列腺穿刺活检术,分析其临床资料和声像图表现。结果 (1)本组72例均取材满意,经病理证实前列腺癌24例;前列腺增生41例;前列腺炎4例;不典型增生3例。(2)腹腔镜探头经直肠检查刺激小、易接受,可清晰显示直肠壁、前列腺(尤其外腺)及其周围组织结构的声像图。(3)腹腔镜线阵探头经直肠超声引导下的穿刺活检术可清晰显示穿刺针针尖的位置及穿刺活检的动态过程。结论在经会阴前列腺穿刺活检术中运用腹腔镜线阵探头经直肠超声引导是一种易被患者接受的、既能提高前列腺病灶、穿刺针针尖及针道超声显示的清晰度,又能有效减少穿刺活检术盲目性的方法。     

经直肠超声引导下穿刺活检在前列腺癌诊断中的临床应用价值

目的 探讨经直肠超声引导下改良6点(6+X)前列腺穿刺活检术在前列腺癌诊断中的临床应用价值.方法 对2013年7月-2015年7月在锦州医科大学附属第一医院就诊的224例临床疑似前列腺癌患者的临床资料进行回顾性分析.所有患者均进行了经直肠超声引导下改良6点前列腺穿刺活检术及手术治疗,将穿刺诊断结果与术后病理结果进行比较.结果 224例疑似前列腺癌患者中,129例经直肠超声引导下改良6点前列腺穿刺术诊断为前列腺癌,90例诊断为前列腺增生,此219例诊断结果与术后病理相符,另5例穿刺活检诊断为前列腺增生而术后病理证实为前列腺癌.穿刺活检诊断前列腺癌的敏感度、特异度、准确度分别为96.3％、100.0％、97.8％,传统的6针法前列腺穿刺术的诊断准确率为93.3％(209/224),两者比较差异有统计学意义(P＜0.05).结论 经直肠超声引导下穿刺活检对于前列腺癌的诊断是一种安全可靠的辅助诊断方法,且改良6点比传统的6针法前列腺穿刺活检术诊断前列腺癌的准确率更高.     

直肠指检和经直肠超声检查对血清前列腺特异抗原≤4ng／ml的前列腺癌的诊断价值

目的探讨直肠指检（digitalrectalexamination,DRE）和经直肠超声检查（transrectalultrasonography,TRUS）对血清前列腺特异抗原（prostatespecificantigen,PSA）≤4ng／ml的前列腺癌的诊断价值。方法对112例血清PSA≤4ng／ml而DRE或（和）TRUS异常的男性患者进行了TRUS引导的前列腺系统10针＋可疑区穿刺活检。根据血清PSA范围将病例分成0～0．9ng／ml,1．0～1．9ng／ml,2．0—2．9ng／ml和3．0～4．0ng／ml4组。结果112例病例中有14例被诊断为前列腺癌,检出率为12．5％。4组中：检出前列腺癌病例分别为0、2、5、7例。血清PSA在0—1．9ng／ml和2．0—4．0ng／ml范围：DRE异常患者中前列腺癌检出率分别为5％和21．1％（P〈0．05）;TRUS异常患者中前列腺癌检出率分别为2．4％和28．6％（P〈0．05）。在14例前列腺癌患者中有4例仅被TRUS发现,并且这4例PSA值均在2．0～4．0ng／ml范围内。结论血清PSA〈2rig／ml时,除非DRE高度异常,患前列腺癌风险低,不需行前列腺穿刺活检。血清PSA在2．0—4．0ng／ml,应行TRUS检查,以提高前列腺癌检出敏感性。     

经会阴前列腺分层饱和穿刺活检在首次前列腺穿刺活检阴性患者中的价值

目的 探讨经会阴前列腺分层饱和穿刺活检在首次前列腺穿刺活检阴性患者中的应用价值。方法84例因直肠指诊、血清前列腺特异性抗原（PSA）和前列腺MRI检查异常而接受经直肠标准12针穿刺活检且结果为良性的患者,行超声引导下经会阴前列腺分层饱和穿刺活检,计算前列腺癌的检出率。结果84例患者行经会阴前列腺分层饱和穿刺活检,诊断为前列腺癌23例（27.4%）,良性前列腺增生61例（72.6%）,其中合并高级别上皮内瘤变3例,慢性前列腺炎5例。结论经会阴前列腺分层饱和穿刺活检可以提高前列腺癌的检出率,对于初次活检阴性,但直肠指诊、前列腺MRI检查异常并且血清前列腺特异性抗原持续升高的患者,可以考虑应用此穿刺活检方法再次穿刺活检予以明确诊断,避免漏诊和延误治疗。     

经直肠超声引导穿刺活检诊断前列腺癌价值分析

目的：探讨经直肠超声引导前列腺穿刺活检（TPB）对前列腺癌（PCa）的诊断价值。方法：选择经常规临床检查拟诊可疑PCa者77例,在直肠超声引导下行TPB,与筛查PC．常用检查方法的活检阳性率进行比较,并对不同PSA值所对应的病理活检阳性率进行分析。结果：经穿刺后送病理检查,共检出Pca25例（32．5％）,良性前列腺增生（BPH）52例（67．5％）;血清PSA异常50例活检阳性率为44．oN,经腹超声（us）阳性36例为27．8％,直肠指检（DRE）阳性32例为21．9％;血清T-PSA〉10μg／L且F-PSA/-PSA〈0．25者13例,活检阳性率为53．8％。结论：经直肠超声引导TPB对PCa的诊断价值较高,但应合理选择适应证。     

经直肠超声引导下前列腺穿刺活检的临床应用价值

目的:探讨经直肠超声引导下前列腺穿刺活检的临床价值.材料和方法:146例临床疑似前列腺癌(PCA)患者在经直肠超声引导下对前列腺行"6+X"法穿刺活检.结果:经直肠超声引导下前列腺穿刺活检病理诊断PCA 45例,占30.8%,前列腺增生(BPH) 98例,占67.1%;对PCA诊断的敏感性、特异性、准确性分别为75.6%、80.6%、79.1%.结论:经直肠超声引导下前列腺穿刺活检有助于前列腺疾病的鉴别诊断,具有很高的临床价值.     

经直肠超声引导下前列腺穿刺活检诊断前列腺癌

目的:探讨经直肠彩色多普勒超声引导下前列腺穿刺活检诊断前列腺癌的价值。材料和方法:对36例临床肛门指检、前列腺特异抗原及经直肠超声三项检查之一异常者行经直肠超声检查,并行超声引导下穿刺活检。穿刺部位选择在可疑的前列腺癌结节,再结合6点穿刺法对其它部位进行穿刺。结果:19例前列腺癌,超声发现结节11例,9例位于外腺或内外腺交界处;17例前列腺增生,超声发现结节9例,7例结节位于内腺。结论:对可疑前列腺癌病例行经直肠超声引导下穿刺活检是一种快速有效的诊断技术。     

前列腺穿刺活检联合血清前列腺特异抗原在前列腺癌诊断中的意义

目的探讨经直肠前列腺穿刺活检与血清前列腺特异抗原联合检测在前列腺癌诊断中的价值。方法对61例经直肠指检阳性,和（或）总前列腺特异抗原≥10ug／L,和（或）游离前列腺特异抗原/总前列腺特异抗原〈0．25的可疑前列腺癌患者,在超声引导下经直肠前列腺多点穿刺活检。结果61例中,前列腺活检病理检查诊断为前列腺癌25例（40．98％）,良性前列腺增生36例（59．02％）。其中,游离前列腺特异抗原／总前列腺特异抗原〈0．20的患者中前列腺癌检出8例（8／13,占61．54％）。结论总前列腺特异抗原≥10ug／L,特别是游离前列腺特异抗原／总前列腺特异抗原〈0．20对前列腺癌的诊断比前列腺穿刺活检更为敏感,两者联合检测对临床诊治具有更重要的价值和意义。     

Multiple prostatic biopsies in the "gray zone" of the specific prostatic antigen

PURPOSE: Aim of our study was to identify cases of undetected prostatic cancer in patients with normal findings at digital examination and transrectal US, and prostate specific antigen (PSA) values ranging 4-10 ng/mL. MATERIAL AND METHODS: Two hundred and ninety patients were submitted to transrectal US and random bilateral prostatic biopsy; 3 samples were collected from each side of the gland using 16-Gauge thru-cut needles. Of the 290 patients who gave fully informed consent, we selected 34 whose age ranged 56 to 76 years (mean: 64). Inclusion criteria were PSA 4-10 ng/mL, PSAD cut-off 0.15, free/total PSA ratio 15-25%, and normal findings at digital examination and transrectal US. PSA velocity was calculated collecting 3 blood samples every 30 days for 2 months. RESULTS: Five of the 34 selected patients (15%) had prostatic cancer, and 2 (6%) Pin (1 Pin 1 and 1 Pin 2). As for the other 27 patients, biopsy demonstrated 4 (12%) cases of prostatitis and 23 (62%) cases of BPH. PSA values increased in all patients with positive histology, versus only 6 (22%) of those with negative histology. PSAD was 0.15 or greater in 3 of 7 prostatic cancer patients. Free/total PSA ratio never exceeded the cut-off value. Gleason score ranged 2 to 4. CONCLUSIONS: Our findings confirm that prostatic biopsy can detect tumors also in areas which appear normal at transrectal US and digital examination, and that PSA rate increases in patients with positive histology. Finally, the actual clinical role of prostatic biopsy relative to all other diagnostic imaging techniques remains to be defined.     

Likelihood of prostate cancer based on prostate-specific antigen density by MRI: retrospective analysis

OBJECTIVE: As a screening test for prostate cancer (PCA), prostate-specific antigen (PSA) may induce unnecessary prostate biopsy in patients with PSA 4.1-10.0 ng/ml. PCA detection may be delayed in patients with PSA < or =4.0 ng/ml. MRI-based PSA density of the prostate (PSAD) and of the prostatic transitional zone (PSAT) could improve differentiation of PCA and benign prostatic hyperplasia. MATERIAL AND METHODS: Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo MR images of the prostate. Serum PSA concentration was measured with an automated standardized microparticle enzyme immune assay. PSAD and PSAT were calculated in 17 patients with clinically significant PCA and 42 patients with benign prostatic hypertrophy (BPH) (66 +/- 6 versus 64 +/- 8 years, p = 0.2410, t test) who had PSA levels < or =10.0 ng/ml. RESULTS: For differentiation of BPH and PCA, PSA alone above the optimal cutoff level of 4.2 ng/ml showed an odds ratio for PCA of 6.7 (95% confidence interval [CI], 1.9-23.2). PSAD showed an odds ratio for PCA of 71.3 (95% CI, 11.8-430.9) above the optimal cutoff level of 0.07 ng/ml/cc. PSAT demonstrated an odds ratio for PCA of 320.0 (95% CI, 27.1-3781.4) above the optimal cutoff level of 0.15 ng/ml/cc. CONCLUSIONS: In patients with PSA < or =10.0 ng/ml, MRI-based PSAD and PSAT appear to improve differentiation of prostate cancer and BPH and are feasible to reduce the frequency of unnecessary prostate biopsy.     

The value of endorectal MR imaging to predict positive biopsies in clinically intermediate-risk prostate cancer patients

The aim of this study was to assess the effectiveness of endorectal MR imaging in predicting the positive biopsy results in patients with clinically intermediate risk for prostate cancer. We performed a prospective endorectal MR imaging study with 81 patients at intermediate risk to detect prostate cancer between January 1997 and December 1998. Intermediate risk was defined as: prostatic specific antigen (PSA) levels between 4 and 10 ng/ml or PSA levels in the range of 10–20 ng/ml but negative digital rectal examination (DRE) or PSA levels progressively higher (0.75 ng/ml year^–1). A transrectal sextant biopsy was performed after the endorectal MR exam, and also of the area of suspicion detected by MR imaging. The accuracies were measured, both singly for MR imaging and combined for PSA level and DRE, by calculating the area index of the receiver operating characteristics (ROC) curve. Cancer was detected in 23 patients (28 %). Overall sensitivity and specificity of endorectal MRI was 70 and 76 %, respectively. Accuracy was 71 % estimated from the area under the ROC curve for the total patient group and 84 % for the group of patients with PSA level between 10–20 ng/ml. Positive biopsy rate (PBR) was 63 % for the group with PSA 10–20 ng/ml and a positive MR imaging, and 15 % with a negative MR exam. The PBR was 43 % for the group with PSA 4–10 ng/ml and a positive MR study, and 13 % with a negative MR imaging examination. We would have avoided 63 % of negative biopsies, while missing 30 % of cancers for the total group of patients. Endorectal MR imaging was not a sufficient predictor of positive biopsies for patients clinically at intermediate risk for prostate cancer. Although we should not avoid performing systematic biopsies in patients with endorectal MR imaging negative results, as it will miss a significant number of cancers, selected patients with a PSA levels between 10–20 ng/ml or clinical-biopsy disagreement might benefit from endorectal MR imaging. Received: 8 February 2000/Revised: 7 July 2000/Accepted: 10 July 2000     

经直肠超声引导下前列腺穿刺活检的临床价值

目的：评价经直肠超声引导下前列腺穿刺活检的临床价值。材料和方法：怀疑前列腺癌并行经直肠超声引导下前列腺穿刺患者２０例。结果：组织学证实前列腺癌（ＰＣＡ）５例、前列腺增生（ＢＰＨ）１２例、前列腺内皮瘤形成（ＰＩＮ）２例和前列腺结核１例。在８例前列腺特异抗原（ＰＳＡ）＞１０μｇ／Ｌ中，ＰＣＡ２例、ＢＰＨ４例、ＰＩＮ２例；在５例ＰＣＡ中，有２例ＰＳＡ＜４μｇ／Ｌ。结论：前列腺穿刺活检是诊断ＰＣＡ的最有效方法之一，有助于前列腺疾病的鉴别诊断。经直肠超声引导下前列腺穿刺活检优于其它前列腺穿刺方法，患者无需麻醉、痛苦小、操作时间短、准确，值得在临床推广应用。     

Long-term prognostic value of dobutamine stress 99mTc-sestamibi SPECT: single-center experience with 8-year follow-up

PURPOSE: To determine the role of magnetic resonance (MR) imaging performed with a combined endorectal body phased-array coil for patients with elevated prostate-specific antigen (PSA) levels or suspicious free-to-total PSA ratios in whom prior transrectal ultrasonographically (US) guided biopsy findings were negative for prostate cancer. MATERIALS AND METHODS: Forty-four patients with PSA levels greater than 4 ng/mL or free-to-total PSA ratios lower than 15% but negative biopsy findings were examined with T1- and T2-weighted MR imaging at 1.5 T with a combined endorectal body phased-array coil. All patients underwent digital rectal examination (DRE) and transrectal US. Thirty-eight patients underwent repeat biopsy after MR imaging. The accuracy of MR imaging for detection of prostate cancer was assessed prospectively. Retrospectively, MR imaging findings were correlated with individual biopsy site findings. MR imaging and biopsy results were correlated by using a cross table to calculate sensitivity, specificity, and positive predictive value (PPV). Retrospective analysis results were evaluated with receiver operating characteristic analysis. A P value of less than.05 indicated significance (chi(2) test according to Pearson). RESULTS: At prospective analysis, MR imaging had a sensitivity of 83% and a PPV of 50% for detection of prostate cancer; these values were 33% and 67%, respectively, for DRE and 33% and 57%, respectively, for transrectal US. At retrospective site-by-site analysis, MR imaging results did not correlate significantly with individual biopsy site findings (P =.126); sensitivity was 65% and PPV was 12%. CONCLUSION: In this patient population, MR imaging has higher sensitivity for detection of prostate cancer than DRE or transrectal US.     

Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers

PURPOSE: To determine the accuracy of detecting prostate cancer by using (a) gray-scale and color Doppler transrectal ultrasonography (US), (b) serum and excess prostate-specific antigen (PSA) levels, and (c) targeted and sextant transrectal US-guided biopsy. The relationship between US-detected neovascularity and tumor biologic activity was also evaluated. MATERIALS AND METHODS: Between 1995 and 1999, 544 patients with elevated PSA levels and/or abnormal digital rectal examination underwent transrectal US-guided sextant biopsy and targeted biopsy of US abnormalities. Sensitivity, specificity, and accuracy of gray-scale US, color Doppler US, targeted biopsy, and PSA and excess PSA were calculated. RESULTS: Gray-scale US depicted 78 (41.1%) of 190 cancers, whereas color Doppler US depicted 30 (15.8%) additional cancers. Targeted biopsy was used to detect 108 (56.8%) cancers, whereas sextant biopsy was used to detect 82 (43.2%) additional cancers. Although US-visible cancers had a higher Gleason grade than did cancers discovered at sextant biopsy (P <.05), 25 of the 66 cancers identified with sextant biopsy alone were Gleason grade 6 or higher. Color Doppler US-depicted hypervascularity correlated with biologically aggressive tumors. Excess PSA was normal in 58 (30.5%) cancers, with an accuracy of 67.3%, resulting in better prediction of prostate tumors than with serum PSA level alone. CONCLUSION: Gray-scale transrectal US, even coupled with color Doppler US, is inadequate for prostate carcinoma screening; therefore, targeted biopsy should always be accompanied by complete sextant biopsy sampling.