多参数核磁引导的前列腺靶向穿刺应用进展

前列腺系统穿刺仍是穿刺的标准方法,随着多参数磁共振成像技术（mpMRI）及其评分系统的不断发展,磁共振成像技术（MRI）靶向的前列腺穿刺正在逐渐替代系统穿刺的传统地位。前列腺影像报告和数据系统（PI-RADS）是临床最常用的MRI评分系统。在前列腺特异性抗原（PSA）异常的PI-RADS阴性患者前列腺癌阴性率达90.8...     

翁沥通胶囊在前列腺特异性抗原处于灰区前列腺穿刺活检中的应用价值研究

目的 探讨翁沥通胶囊在前列腺特异性抗原处于灰区(4～10ng/mL)范围的患者前列腺穿刺活检临床决策中的应用价值.方法 回顾性分析前列腺特异性抗原处于灰区、直肠指诊无异常的患者91例,按其是否使用翁沥通胶囊进行治疗分为两组:翁沥通治疗组(使用翁沥通治疗并未立即行前列腺穿刺活检,简称治疗组,n=44)和翁沥通未治疗组(未...     

磁共振与经直肠超声认知融合引导的经直肠前列腺靶向穿刺活检614例单中心临床研究

本研究旨在探索磁共振(MRI)-经直肠超声(TRUS)认知融合引导下的,经直肠前列腺靶向穿刺活检与经直肠前列腺系统穿刺活检对前列腺癌的检出率的差异性。回顾性纳入自2016年-2018年于我院行前列腺多参数MRI检查后行前列腺穿刺活检的患者614例。对于根据PI-RADS V2评分≥3分的患者同时行MRI-TRUS认知融合靶向活检和系统活检,对PI-RADS V2评分≤2分的患者只行系统活检,比较靶向活检和系统活检在前列腺癌检出率方面的差异。结果显示认知融合靶向活检检出肿瘤342例(75.7%),系统活检检出肿瘤358例(79.2%),二者对于前列腺癌的检出率无显著差异(χ^2=1.621,P=0.203)。靶向活检穿刺针数显著低于系统穿刺活检针数,减少了(9.3±0.11)针(P <0.001)。靶向穿刺活检阳性针中肿瘤组织平均占比比系统穿刺活检多10.8%(P <0.001)。研究结果表明MRI-TRUS认知融合引导的靶向穿刺与系统穿刺对于前列腺癌都具有较高的检出率。MRI-TRUS有望减少穿刺针数,并能提供更多肿瘤组织。     

超声引导下经直肠前列腺穿刺诊断前列腺癌的价值研究

目的 研究与分析超声引导下经直肠前列腺穿刺诊断前列腺癌的价值。方法 选取2015年1月~2017年1月我院收治的疑似前列腺癌患者100例,其中经超声引导下行会阴法穿刺诊断者50例为对照组,经超声引导下行直肠前列腺12点穿刺诊断者50例为观察组。比较分析两组诊断结果以及并发症情况。结果 观察组确诊率为72.00%,高于对照组的42.00%,差异具有统计学意义（P＜0.05）。观察组并发症发生率为8.00%,低于对照组的22.00%,差异具有统计学意义（P＜0.05）。结论 超声引导下经直肠前列腺穿刺诊断前列腺癌具有较高的确诊率,且能有效减少患者各种并发症,并为临床诊断前列腺疾病提供一定依据,值得应用推广。     

前列腺特异性抗原在前列腺增生和前列腺肿瘤中的鉴别诊断价值

为评价前列腺特异性抗原（ＰＳＡ）及其密度（ＰＳＡＤ）对前列腺增生（ＢＰＨ）和肿瘤的鉴别诊断价值,采用放射免疫法对３０例前列腺癌（Ｐｃａ）和８０例ＰＢＨ患者进行了检测。结果发现：Ｐｃａ患者的平均血清ＰＳＡ含量显著高于ＢＰＨ患者,且界线以１０μｇ／Ｌ时的敏感性、特异性、准确性及诊断效率为高,分别为５０％、９１３％、８０％和４５７％;Ｐｃａ患者的ＰＳＡＤ值也明显高于ＢＰＨ者,当界线值≥０２时,其诊断的敏感性为９６７％,特异性为８５％,准确性为８８２％,诊断效率为８８２％,阴、阳性预测值也较理想。ＰＳＡ随病情进展升高,而ＰＳＡＤ则随病情进展下降,表明ＰＳＡ与临床分期成正相关而ＰＳＡＤ则成负相关,ＰＳＡＤ较ＰＳＡ对Ｐｃａ及ＰＢＨ更具有鉴别诊断意义。     

抗游离前列腺特异性抗原(f-PSA)单克隆抗体的研制与应用

前列腺特异性抗原(Prostate Specific Antigen，PSA)是目前公认的最有价值的前列腺癌肿瘤标志物。PSA在血清中存在不同的分子形式：游离前列腺特异性抗原(f-PSA)、前列腺特异性抗原与α1抗糜蛋白酶结合的结合型PSA(PSA-ACT)、前列腺特     

前列腺特异性膜抗原为靶标治疗激素难治性前列腺癌的研究进展

激素难治性前列腺癌（hormone refractory prostate cancer,HRPC）是近年来前列癌预后差的主要原因,而前列腺特异性膜抗原（prostate specific membrane antigen,PSMA）因在HRPC高特异性表达,而在其它良性病变组织如炎性病变和正常脏器组织等低水平表达或不表达而备受关注,成为HRPC靶向治疗的主要靶标,现将以PSMA为靶标的免疫治疗、基因治疗和内放射靶向治疗方面的研究和进展进行综述。     

153例经直肠前列腺穿刺活检病例临床病理及免疫组化分析

目的:对经直肠前列腺穿刺活检病例的临床资料、病理形态学及免疫组化进行分析,以提高对前列腺癌的临床及病理诊断准确率.方法:回顾性分析我院2006年1月~2011年6月间153例行前列腺穿刺活检病人的临床及病理资料,研究其血清PSA、病理形态学特点,并将其中确诊为前列腺癌患者50例与良性前列腺病变患者103例进行对比分析....     

抗血栓药物的应用与前列腺穿刺活检术的安全性

前列腺癌的发病率位于男性恶性肿瘤的第一位,前列腺穿刺活检术是目前诊断前列腺癌的金标准,关于前列腺穿刺活检术前是否须停用抗血栓药物尚无定论。总结既往研究提示,口服抗血栓药物对于前列腺穿刺活检术是相对安全的。对于心脑血管意外高风险患者,建议围手术期可以不停用抗血栓药物。     

抗血栓药物的应用与前列腺穿刺活检术的安全性

前列腺癌的发病率位于男性恶性肿瘤的第一位,前列腺穿刺活检术是目前诊断前列腺癌的金标准,关于前列腺穿刺活检术前是否须停用抗血栓药物尚无定论。总结既往研究提示,口服抗血栓药物对于前列腺穿刺活检术是相对安全的。对于心脑血管意外高风险患者,建议围手术期可以不停用抗血栓药物。     

Diagnostic effect of an improved preembedding method of prostate needle biopsy specimens

The authors compared the influence of a conventional and an optimized submitting method of prostate core needle biopsy specimens on the frequency of cancer detected and the pathologic characteristics of the adenocarcinoma bearing biopsy specimens. The patients included were part of the prostate-specific antigen (PSA) screening program of Tyrol/Austria. Of the systematic core needle biopsy specimens from 500 unselected men obtained within 1 year from the Urological Department, University of Innsbruck, the core biopsy specimens of 250 cases were submitted conventionally, floating free in formalin-filled containers, whereas the biopsy specimens of the other 250 cases were stretched and orientated between 2 meshes in tissue cassettes at the time of biopsy before formalin fixation. On 136 cases diagnosed as adenocarcinoma the number and the length of cores as well as number of the cores involved by cancer and the tumor size were morphometrically determined. The diagnosis of benign prostatic hyperplasia, isolated high-grade prostatic intraepithelial neoplasia (PIN), atypical foci suspicious for cancer, and carcinoma was made in 66%, 5.6%, 4.8%, and 23.6% after conventional submission and in 61.6%, 6.4%, 1.2%, and 30.8% of the cases after optimized preembedding respectively. In the adenocarcinoma cases the optimizedly preembedded material showed higher mean total core length (126.5 mm versus 93.9 mm; P < .0001), a higher mean total tumor length (14.1 mm versus 8.6 mm; P = .01), and more cores involved by cancer (2.9 versus 2.4; P = .01) compared with the conventionally worked-up biopsy specimens. Optimized preembedding of core needle biopsy specimens in tissue cassettes could be quickly and routinely done by the assistance of the urologists at the time of biopsy. The significant improvement of the histologic yield of optimizedly preembedded prostatic needle biopsy specimens led to a higher frequency of cancer diagnosis, a reduction of cases with atypical foci suspicious for cancer and a significantly lower number of cases with only 1 core biopsy involved by cancer.     

Technical improvement of the prostate thick-needle biopsy

The method is proposed for minimizing loss of material of needle biopsy of the prostate by means of a container during fixation. This allous (1) saving all the fragments, (2) to increase the surface of the material in the micropreparation and (3) to put into one paraffin block several columns and thus to decrease the cost of histological study.     

Predictive factors in prostate needle biopsy

Prostate cancer (PCa) is a leading cause of morbidity and mortality in men, accounting for approximately 30% of all new cases of cancer and approximately 14% of cancer deaths. Despite considerable advances achieved in the ability to detect and treat PCa, there have not been significant corresponding decreases in PCa-related morbidity and mortality. Proper examination of prostate biopsy specimens by pathologists is critical in determining the type of treatment and predicting patient outcome. The goal is to tailor the therapeutic approach to the clinical, morphological and molecular features of each patient.     

Fine needle aspiration biopsy of the prostate gland

With the worldwide acceptance of mechanically assisted, ultrasound guided thin needle biopsy of the prostate gland, prostate fine needle aspiration (FNA) has fallen out of favor with both urologists and cytopathologists. Nonetheless, given today's trend to submit from 12 to 18 core biopsies per patient, prostate FNA remains less expensive, more expedient and more economical than any other sampling method so far developed. This short overview presents prostate FNA as a sensitive, specific and reliable diagnostic modality that should not be dismissed, as an anachronism, from the diagnostic armamentarium of either the urologist or the pathologist.     

Aspiration biopsy cytology of the prostate in young adult men

The aspiration biopsy cytology of 11 prostates obtained at autopsy from men younger than 40 yr old were studied to define the cytologic criteria of benign changes in this age group. Cytologic features that differ from those of older men with benign prostatic enlargement include abundant cellularity, the presence of large and small cell groups (which would otherwise suggest dyshesion), and a predominantly columnar cell shape. These differences can be attributed to age-related changes in the prostate. A case of a prostatic nodule in a 22-yr-old that was evaluated by fine-needle aspiration biopsy is presented to illustrate the diagnostic difficulties that can arise when the interpreter is unaware of differences in cytologic patterns due to age.     

Metabolic alterations and targeted therapies in prostate cancer

Cancer cells synthesize de novo large amounts of fatty acids and cholesterol, irrespective of the circulating lipid levels and benefit from this increased lipid synthesis in terms of growth advantage, self-survival and drug resistance. Key lipogenic alterations that commonly occur in prostate cancer include over-expression of the enzyme fatty acid synthase (FASN) and deregulation of the 5-AMP-activated protein kinase (AMPK). FASN is a key metabolic enzyme that catalyses the synthesis of palmitate from the condensation of malonyl-CoA and acetyl-CoA de novo and plays a central role in energy homeostasis, by converting excess carbon intake into fatty acids for storage. AMPK functions as a central metabolic switch that governs glucose and lipid metabolism. Recent interest has focused on the potential of targeting metabolic pathways that may be altered during prostate tumorigenesis and progression. Several small molecule inhibitors of FASN have now been described or in development for therapeutic use; in addition, drugs that directly or indirectly induce AMPK activation have potential benefit in prostate cancer prevention and treatment.     

Diagnosis of adenocarcinoma in prostate needle biopsy tissue

Prostate cancer is a major public health problem throughout the developed world. For patients with clinically localised prostate cancer, the diagnosis is typically established by histopathological examination of prostate needle biopsy samples. Major and minor criteria are used to establish the diagnosis, based on the microscopic appearance of slides stained using haematoxylin and eosin. Major criteria include an infiltrative glandular growth pattern, an absence of basal cells and nuclear atypia in the form of nucleomegaly and nucleolomegaly. In difficult cases, basal cell absence may be confirmed by immunohistochemical stains for high-molecular-weight cytokeratins (marked with antibody 34betaE12) or p63, which are basal cell markers. Minor criteria include intraluminal wispy blue mucin, pink amorphous secretions, mitotic figures, intraluminal crystalloids, adjacent high-grade prostatic intraepithelial neoplasia, amphophilic cytoplasm and nuclear hyperchromasia. Another useful diagnostic marker detectable by immunohistochemistry is alpha-methylacyl coenzyme A racemase (AMACR), an enzyme selectively expressed in neoplastic glandular epithelium. Cocktails of antibodies directed against basal cell markers and AMACR are particularly useful in evaluating small foci of atypical glands, and in substantiating a diagnosis of a minimal adenocarcinoma. Reporting of adenocarcinoma in needle biopsy specimens should always include the Gleason grade and measures of tumour extent in the needle core tissue. Measures of tumour extent are (1) number of cores positive for cancer in the number of cores examined, (2) percentage of needle core tissue affected by carcinoma and (3) linear millimetres of carcinoma present.     

Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer

Over the past 25 years, our understanding of prostatic disease has evolved secondary to the increased detection, treatment and study of both benign and neoplastic prostatic lesions. The advent of aggressive prostate-specific antigen screening and standardization of extended transrectal needle biopsy protocols has resulted in significant stage migration and earlier detection of prostate cancers, a growing proportion of which are lower-volume posterior peripheral zone tumours. Consequently, an increased incidence of anterior-predominant prostate cancers has been observed. Given the histomorphological complexity of the prostate, these developments have necessitated a reconsideration of prostatic anatomy, biopsy strategies in the detection of anterior tumours and the determination and relevance of zonal origin in prostate cancer. This review will provide a contemporary update of these topics, while highlighting specific areas in which a keen understanding of prostatic histoanatomy may influence biopsy interpretation.