经直肠超声引导下"13+X"点前列腺穿刺活检61例临床分析

目的 评价经直肠超声引导下"13+X"前列腺穿刺活检诊断前列腺癌的临床应用价值.方法 回顾性分析血PSA升高和(或)直肠指检前列腺结节及前列腺MRI示外周带有异常信号的61例患者经直肠超声引导下前列腺穿刺活检的临床资料.结果 61例患者中,诊断为前列腺癌24例,阳性率为39.4%;前列腺增生29例,占47.5%;PIN 6例,占9.8%前列腺脓肿2例,占3.3%.均未出现严重并发症.结论 经直肠超声引导下前列腺"13+X"点穿刺是筛查前列腺癌的一种安全、有效检查方法,在临床早期诊断前列腺癌具有重要价值.     

317例前列腺癌诊断分析

目的　提高前列腺癌的诊断水平。　方法　回顾性分析 317例前列腺癌患者的临床资料 ,对前列腺癌的筛选诊断方法进行统计分析。　结果　 317例前列腺癌占同期泌尿外科住院患者总数的 2 .2 % ,为同期泌尿生殖系肿瘤患者的 9.8%。近 10年收治的新病例数为前 2 0年的 4 .2倍。临床应用PSA检测后确诊为前列腺癌的患者数 (2 11例 )和T1～T2 患者的比例 (6 0 .2 % )显著高于PSA检测应用前 (10 6例 ,5 0 .0 % )。单项PSA、直肠指检 (DRE)及经直肠前列腺超声 (TRUS)检查的诊断阳性率为 86 .1%～ 89.1%。而当PSA结合DRE或TRUS任何一项检查时 ,阳性率可提高至 99.0 %。相关分析显示 :血清PSA与临床分期、病理分级及肿瘤体积显著相关。　结论　近 10年前列腺癌患者的住院人数呈增高趋势。血清PSA检测对于发现早期肿瘤具有重要意义。PSA与DRE、TRUS是筛选诊断前列腺癌的主要方法 ,三者结合可提高诊断阳性率与准确率     

应用PSA对12027名老年男性进行前列腺癌集团检诊及意义分析

目的　揭示长春市老龄人群中前列腺癌的发病现状 ,探讨PSA在前列腺癌人群筛查及对临床分期预测中的意义。以长春市 12 0 2 7名 5 5岁以上男性为对象。EIA技术测定血清前列腺特异抗原 (PSA) :以PSA >4 .0ng/ml者确定为前列腺癌可疑病例 ,经直肠行超声引导下前列腺 6点活检 ,病理学诊断 ;参照国际标准进行ABCD和TNM临床分期 ,并分析血清PSA含量与临床分期的相关关系。结果　表明 :①血清PSA >4 .0ng/ml者占6 .8% (813/ 12 0 7) ,针对总体癌发现率为 0 .5 7% (6 9/ 12 0 2 7) ;②前列腺癌的ABCD和TNM分期显示未突破被膜的A、B期和T1、T2期分别为 5 8.8%和 5 9.6 % ,而发生淋巴结和远位转移的晚期前列腺癌均超过 2 0 % ;③与相关分析表明ABCD、TNM分期与PSA含量间均呈明显的正相关关系。结论　血清PSA含量不仅是前列腺癌人群筛查的金指标 ,而且 ,可预测前列腺癌的临床分期 ;证明在老龄人群中确有无症状的早、中和晚期前列腺癌患者 ,提示前列腺癌集团检诊的重要性     

累及移行带前列腺癌的诊断分析

目的分析累及移行带前列腺癌的临床特征,提高移行带前列腺癌的诊断率。方法回顾我院收治的77例前列腺癌患者,一组44例仅限于外周带;另一组33例已累及移行带。分析两组的临床表现、直肠指检、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原、经直肠前列腺超声以及前列腺穿刺活检。结果两组患者的年龄、排尿期和储尿期症状、直肠指检阳性率、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原以及病理分级没有显著性差异。移行带肿瘤存在泌尿系转移的风险。经直肠超声为移行带可疑病灶的定位提供了重要的参考,而对可疑病灶穿刺活检则能提高累及移行带前列腺癌的诊断率。结论经直肠超声行移行带可疑病灶的穿刺活检是诊断累及移行带前列腺癌的有效手段。     

103例前列腺癌的诊断分析

目的 :提高前列腺癌的诊断水平。方法 :回顾分析 10 3例前列腺癌的临床资料 ,对前列腺癌的诊断方法进行探讨。结果 :单项PSA ,直肠指检 (DRE)及经直肠前列腺超声 (TRUS)检查诊断阳性率为 65 .9%～ 90 .3 % ,而前列腺穿刺诊断阳性率 95 .1%。结论 :前列腺穿刺活检对诊断前列腺癌具有重要意义。PSA、DRE、TRUS与前列腺穿刺结合可提高诊断的阳性率与准确率。     

PAP、PSA与前列腺癌的诊断

本院从1992年7月至1996年9月收治经病理检查证实的前列腺癌52例,均行直肠指检(DRE)、B超、血清前列腺酸性磷酸酶(PAP)和前列腺特异抗原(PSA)检查,其诊断前列腺癌阳性率分别为78.8％、50.0％、61.5％、84..％。PSA阳性率明显高于其它检查(P<0.005)。若结合DRE、TRUS则诊断前列腺癌之敏感性达到96.2％。经直肠前列腺穿刺活检31例,穿刺阳性率为87.1％。PAP、PSA升高患者的比例与前列腺癌的分期、肿瘤细胞分化程仅具相关性。因此,PAP、PSA对前列腺癌的诊断、临床分期、判断预后有较大价值。     

超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

Synchronous primary carcinomas of the bladder and prostate

目的:评价台湾男性膀胱恶性肿瘤患者接受膀胱前列腺根除手术后偶发性前列腺癌的发病率。方法:248位台湾男性膀胱移行性上皮癌患者接受膀胱前列腺根除手术后,进行前列腺病理切片分析。结果:在这248位患者中,10人(4.03%)的前列腺病理切片报告其患偶发性前列腺癌,其中8位处于 T1或 T2阶段、2位分别处于 T3和 T4阶段。本研究结果显示出的偶发性前列腺癌发病率低于美国同类研究所得出的发病率。结论:尽管偶发性前列腺癌在台湾膀胱恶性肿瘤患者中的发病率低于西方国家,但我们仍然建议在台湾男性膀胱癌患者,尤其是60岁以上患者的前列腺癌筛查过程中将肛门指检及前列腺特异抗原作为必要的常规检查项目,以避免偶发性前列腺癌的发生。     

经直肠超声引导自动活检枪前列腺穿刺26O例分析

目的研究经直肠超声引导自动活检枪前列腺穿刺在诊断早期前列腺癌方面的意义.方法患者分为两组,第1组230例为经每年一次PSA筛选,PSA＞4ug/L而进行直肠指检(DRE)和经直肠超声引导自动活检枪穿刺(TRUS)加活检的澳大利亚患者;第2组30例为DRE有可疑结节而进行TRUS加活检的国内病例.结果经直肠超声引导自动活检枪前列腺穿刺所获标本取材全部优良,符合病理诊断的要求.第1组检出前列腺癌82例,其中T2a期以内80例,T2b2例,不典型增生19例;第2组检出前列腺癌8例,其中1例属T2b,已行根治性前列腺切除术,另外7例至少在T3期以上.所有患者穿刺后未发生严重并发症.结论经直肠超声引导自动活检枪前列腺穿刺是确诊早期前列腺癌的重要的方法,而且并发症少,值得推广.     

前列腺异常声像特征及位置对经直肠超声穿刺活检诊断前列腺癌的影响

目的 探讨经直肠超声检查中异常声像特征及位置对经直肠超声(TRUS)穿刺活检诊断前列腺癌的影响.方法 前列腺特异性抗原(PSA)4~20 ng/ml、发现异常声像和/或合并直肠指检异常的可疑前列腺癌患者410 例,根据声像特征分为低回声、等回声、高回声组,所有患者均行8+X 针的穿刺方法,详细记录患者临床资料及病理结果,比较两组的穿刺结果.结果 总的前列腺癌检出率为27.07%,低回声组前列腺癌穿刺阳性率(34.27%)明显高于等回声(22.77%)和高回声(13.33%)组(P<0.05),Gleason 评分在低、等回声组前列腺癌中无明显统计学差异(P>0.05).左右侧外周带单独存在低回声病例前列腺癌穿刺阳性率无明显统计差异(P>0.05),双侧外周低回声病例前列腺癌穿刺阳性率(46.97%)明显高于左侧(27.27%)与右侧(28.85%)外周带存在低回声病例(P<0.05).结论 PSA4~20 ng/ml,TRUS 存在低回声声像前列腺穿刺率阳性率明显高于TRUS 中等回声、高回声病例病例,双侧外周带存在低回声病例前列腺穿刺阳性率明显高于单侧外周带存在低回声病例.     

Diagnostic value of percent free prostate-specific antigen: retrospective analysis of a population-based screening study with emphasis on men with PSA levels less than 3.0 ng/mL

OBJECTIVES: To retrospectively investigate the use of percent free prostate-specific antigen (PSA) compared with total PSA in serum as predictor of prostate cancer in men selected randomly from the general population who underwent biopsy on the basis of abnormal findings on digital rectal examination (DRE) or transrectal ultrasound (TRUS) and/or serum PSA levels greater than 10 ng/mL. METHODS: A single intervention, population-based screening study was undertaken in 1988 and 1989. Of the 2400 men aged 55 to 70 years invited to participate, 1782 men responded and were examined with DRE, TRUS, and PSA testing (Tandem-Hybritech). In 1995, frozen serum samples from 1748 men were analyzed for percent free PSA (Prostatus, Wallac OY). Five-year follow-up data on new cancers in the screened population were obtained from the Swedish Cancer Registry (SCR). RESULTS: Of the 1748 men, 367 underwent TRUS-guided biopsies because of abnormal findings on either DRE or TRUS or serum PSA levels of greater than 10 ng/mL. This resulted in the diagnosis of 64 cases of prostate cancer (3.7%). PSA levels of 3.0 ng/mL or greater were found in 55 (86%) of 64 cancer cases and in 399 (24%) of the 1684 benign cases. Among the 1294 men with PSA less than 3.0 ng/mL, 9 prostate cancers were diagnosed (14% of all prostate cancers). All 9 patients with cancer and with PSA less than 3.0 ng/mL had a percent free PSA of 18% or less. In the group of 1109 patients with PSA less than 3.0 ng/mL and a percent free PSA greater than 18%, 159 biopsies were performed because of abnormal DRE or TRUS. However, no prostate cancer was diagnosed in this category of patients. Five years after the screening intervention, 7 more cases of prostate cancer were clinically diagnosed in the screened population according to the SCR. CONCLUSIONS: The combination of PSA levels less than 3.0 ng/mL and percent free PSA greater than 18% defines a large part of the population at a very low risk of cancer of the prostate both at the time of screening and during the following 5 years. Men in this group may be spared DRE, and longer screening intervals may be considered. However, the risk of having prostate cancer is not negligible in men with PSA less than 3.0 ng/mL and percent free PSA of 18% or less. The results of this study indicate that biopsy should be recommended to men fulfilling these criteria, although these results should be confirmed in larger prospective studies because of the limited number of patients with prostate cancer in the present series.     

PROSTATE-SPECIFIC ANTIGEN IN MASS SCREENING FOR CARCINOMA OF THE PROSTATE

Background:
Prostate-specific antigen (PSA) has various advantages over prostatic acid phosphatase (PAP) as a marker for prostate cancer, but its role in prostate cancer mass screening remains controversial. We measured serum PSA in addition to serum PAP determination and digital rectal examination (DRE) in our mass screening program to assess the usefulness of PSA for prostate cancer mass screening.
Methods:
Serum PSA and PAP measurements and DRE were performed in 1249 patients in mass screening for carcinoma of the prostate in 1989 and 1990. Thirteen cancers were diagnosed. We calculated the mean plus standard deviations (2SD) of the PSA and PAP values of men without cancer, and assessed the usefulness of PSA for prostate cancer screening by using these figures as the upper limit of normal.
Results:
The number positive for PSA, PAP and DRE were 39, 36 and 48, respectively. If our screening had been performed without DRE, three cancers would have remained undetected, and the number would have been the same if performed without PSA. If the screening had been performed without PAP, on the other hand, no cancers would have remained undetected. The sensitivities of PSA and PAP were 54% and 23%, respectively. The screening detection rate with DRE and PSA was 0.88%, and with DRE and PAP was 0.64%.
Conclusions:
Measurement of serum PSA values with adjustment of the cut-off value was considered more useful than PAP in mass screening for prostate cancer.     

The significance of early detection for prostate cancer in mass screening

PURPOSE: In Mitaka city, mass screening for prostate cancer was conducted for 3 years from 1995 to 1997. Clinical stages were compared between patients found by screening and those diagnosed at our clinic during the same time. The significance of serum-free prostate specific antigen (PSA) in mass screening for prostate cancer was examined. MATERIAL AND METHODS: A prospective clinical trial was conducted on men aged 50 years or older. The primary examination consisted of taking the international prostate symptom score, quality of life score, PSA (Tandem-R) and digital rectal examination (DRE). If PSA was greater than 4.0 ng./ml and/or if DRE suggested cancer, transrectal ultrasound-guided sextant prostate biopsies were indicated. RESULTS: Of the men screened, 23.2% (320/1375) had serum PSA greater than 4.0 ng./ml. and/or suspicious findings on DRE. Biopsy was performed in 199 of 320 (62.1%). Cancer was detected in 21 (1.5%, 21/1375). Prostate cancer was found in one case among 154 males (0.65%, 1/154) who were screened twice or more. The cancer stage found by screening was significantly earlier than that diagnosed at the outpatient clinic (Wilcoxon's rank-sum test: p = 0.0047). Receiver operating characteristics analysis showed that the optimal free PSA-to-PSA ratio was 12%. Positive predictive value increased from 18% to 50% when free PSA-to-PSA ratio was combined with PSA. CONCLUSION: 1. Cancer detection rate was 1.5% in the mass screening in Mitaka City. 2. Cancer stage found by screening was significantly earlier than that diagnosed at the outpatient clinic. 3. Free PSA determination might eliminate unnecessary biopsies in men with PSA above 4.0 ng./ml with minimal loss of cancer detection.     

Diagnostic value of serum prostate-specific antigen in hemodialysis patients

BACKGROUND: The value of serum prostate-specific antigen (PSA) screening was examined to detect prostate cancer in men receiving hemodialysis. METHODS: Forty-one male patients age 60-95 (median age, 70 years) receiving hemodialysis were investigated for PSA levels. We set the cut-off point at 4 ng/mL (the usual reference range). Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) of the prostate were performed in patients whose PSA was more than 4 ng/mL and/or who expected further examination of the prostate. When prostate cancer was suspected, biopsy of the prostate was performed. In patients with prostate cancer, magnetic resonance imaging, computed tomography and bone scintigraphy were performed to diagnose the clinical stage. RESULTS: The mean serum level of PSA was 2.10 +/- 0.49 ng/mL. In this screening study, four of 41 men required further examinations for prostate cancer. Two of four refused further examinations. The other two were diagnosed with prostate cancer. The incidence of prostate cancer was at least 5% in our hemodialysis patients. One man, whose clinical stage was T2aN0M0, was treated with radical retropubic prostatectomy. Another man, whose clinical stage was T2bN0M0, was treated with luteinizing hormone-releasing hormone analogue. CONCLUSION: In our preliminary study, prostate cancer screening with PSA was useful for the early detection of prostate cancer in hemodialysis patients. If possible, DRE and TRUS should be performed in conjunction with PSA tests.     

Early detection program for prostate cancer: results and identification of high-risk patient population.

Three hundred sixty-two men underwent transrectal ultrasound of the prostate (TRUS), digital rectal examination (DRE), and serum prostate-specific antigen (PSA) determination as part of an early detection program for prostate cancer. Thirty-seven (10%) cancers were detected. DRE had the highest sensitivity and specificity, 89 percent and 84 percent, respectively. TRUS and PSA had comparable sensitivities (84% and 81%) and specificities (82% and 82%). The positive predictive values of DRE, TRUS, and PSA determination were 39 percent, 35 percent, and 33 percent, respectively. We found a cancer detection rate of 16 percent among patients with symptoms of bladder outlet obstruction and 5 percent in patients without these symptoms. The detection rate was 36 percent for physician-referred patients and 3 percent for self-referred patients. This suggests to us that at the present time the best utilization of medical resources to increase prostate cancer detection is to educate men to have annual medical evaluations by primary-care physicians who are encouraged to incorporate risk assessment and screening DRE as part of their routine practice. Any man with either abnormal findings on examination or increased risk should be referred to a urologist for further evaluation.     

血清前列腺特异抗原测定的临床意义

以12例前列腺癌、102例前列腺良性增生(BPH)、16例直肠指检(DRE)异常、5例前列腺炎及30例正常男性为对象,用酶免法测定血清前列腺特异抗原(Prostate specific antigen,PSA)浓度,用放免法测定其中37例。前列腺癌的PSA浓度明显高于BPH(P<0.01),PSA对前列腺癌诊断的敏感性为91.7％。DRE异常者大于BPH(P<0.05),低于前列腺癌(P<0.01)。BPH高于正常对照(P<0.01)。前列腺切除术后一日的PSA高于术前(P<0.01),术后6～8日同术前无显著性差异(P>0.05)。70岁以上高于70岁以下(P<0.05)。PSA>10ng/ml时酶免检测值低于放免法(0.010.05)。单纯PSA升高并不能说明任何特异性病理过程,前列腺癌的诊断,应结合PSA系列测定值及DRE和经直肠B超(TRUS)来综合分析。     

Prevalence of undiagnosed prostate cancer in men with erectile dysfunction

OBJECTIVE: To explore the prevalence of prostate cancer in men presenting with erectile dysfunction (ED). PATIENTS AND METHODS: In a prospective study, 127 men with ED of at least 6 months duration underwent screening for prostate cancer using prostate specific antigen (PSA) and a digital rectal examination (DRE). Men with a high PSA level (> 4 ng/mL) had sextant biopsies taken under sedoanalgesia. The serum testosterone level was measured in all the men. RESULTS: Twenty-six men were aged < 50 years and all had a normal PSA level; of 101 men aged > 50 years, 20 had an abnormal PSA. The detection rate for prostate cancer using PSA and DRE was 5%, which was not significantly higher than in the general population. All the detected cancers were clinically significant (> T2a, Gleason grade > 4). Two of the five men diagnosed with prostate cancer were Afro-Caribbean. Of the 127 men, 31% had a low serum testosterone level, but there was no association between testosterone and PSA levels. CONCLUSIONS: Prostate cancer is no more common in men with ED than in the normal male population. Therefore, routine screening for prostate cancer in men with ED is not indicated.     

Digital rectal examination as a prostate cancer-screening method in a country with a low incidence of prostate cancer

The objective of this study was to evaluate the value of using digital rectal examination (DRE) for prostate cancer diagnosis in an Asian population. Patients with serum prostate-specific antigen (PSA) levels ranging from 2.5 to 19.9 ng/ml underwent transrectal ultrasonography-guided prostate biopsies. Patients were divided into two groups: the normal DRE group (n=721) and the abnormal DRE group (n=192). The cancer detection rate was higher in the abnormal DRE group (47.4%) than in the normal DRE group (23.0%) (P<0.001). However, the detection rates in these two groups were not significantly different in men 45-59 years old as well as in men with low PSA levels (2.5-3.9 ng/ml). In all subjects, the areas under the receiver operating characteristic curves for positive biopsies were 60.0% (95% confidence interval (CI), 55.7-64.3%, P<0.001). However, in the subgroup analysis, the predictive power of the DRE was not significant in men 45-59 years old. In addition, DREs of patients with low PSA levels had no discriminative ability. The pathological features of the prostate biopsies were not significantly different between the two groups in subjects 45-59 years old and in subjects with PSA levels from 2.5 to 3.9 ng/ml. Our data indicate that DREs increase the probability of cancer detection. However, our findings also raise the question, 'Are DREs really useful for cancer detection in younger men and men with low PSA levels in the Asian population?'     

Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy

BACKGROUND: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. METHODS: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. RESULTS: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. CONCLUSION: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS.     

Prostate cancer in patients with screening serum prostate specific antigen values less than 4.0 ng/dl: results from the cooperative prostate cancer tissue resource

PURPOSE: Prostate cancer can occur in patients with low screening serum prostate specific antigen (PSA) values (less than 4.0 ng/ml). It is currently unclear whether these tumors are different from prostate cancer in patients with high PSA levels (greater than 4.0 ng/ml). MATERIALS AND METHODS: From the Cooperative Prostate Cancer Tissue Resource database through March 2004, 3,416 patients with screening PSA less than 16.0 ng/ml diagnosed with prostate cancer between 1993 and 2004 were stratified in groups based on screening serum PSA. These subsets were compared for race, age at diagnosis, clinical and pathological stage, Gleason score, positive surgical margins, posttreatment recurrent disease, and vital status. RESULTS: We identified 468 (14%) patients with screening PSA less than 4.0 ng/ml, 142 (4.2%) of whom had a PSA of less than 2.0 ng/ml. This group included 40 black and 376 white patients. Men with low screening PSA treated with radical prostatectomy had smaller cancers, lower Gleason scores, lower pathological tumor (T) stage and lower PSA recurrence rates than men with high PSA levels (4 ng/ml or greater). These differences held true for men who were younger than 62 years or were white, whereas older or black men had tumor characteristics and outcomes similar to those with higher PSA levels. CONCLUSIONS: Young (younger than 62 years) or white patients with screening serum PSA less than 4.0 ng/ml had smaller, lower grade tumors and lower recurrence rates than patients with PSA 4.0 ng/ml or greater. This was not true for those older than 62 years and for black men.