经直肠与超声引导下经会阴前列腺穿刺活检的比较

目的 :比较直肠指检引导下经直肠前列腺穿刺与超声引导下经会阴前列腺穿刺两种活检方法的阳性率和安全性。方法 :对 136例PSA >4ng /ml或直肠指检异常的患者进行前列腺穿刺活检 ,其中经直肠 2 2例 ,经会阴 114例。结果 :根据不同PSA水平及直肠指检结果分组 ,两组穿刺活检阳性率差异无统计学意义。超声引导下经会阴穿刺感染及便血发生率明显低于直肠指检引导下经直肠穿刺。结论 :直肠指检引导下经直肠前列腺穿刺和超声引导下经会阴前列腺穿刺都是进行前列腺活检的有效方法 ,应根据患者直肠指检、经直肠超声表现以及PSA水平选择穿刺方法 ,而后者的安全性高于前者     

经直肠超声诊断前列腺癌的临床价值

目的探讨经直肠超声检查前列腺癌的临床价值。方法应用经直肠超声对临床拟诊53例前列腺癌患进行检查，观察前列腺内腺及外腺回声，发现形态不规则低回声区，仔细分辨与周围组织的关系，并行彩色及能量多普勒血流显像。结果经穿刺活检及手术病理证实46例为前列腺癌，7例为前列腺增生，诊断符合率为86．8％。结论经直肠超声显示前列腺癌声像图的敏感性及特征性较腹部超声明显增高，结合直肠指检(DRE)及前列腺特异性抗原(PSA)测定可提高前列腺癌的检出率。     

383例男性血清PSA测定影响因素及其临床价值分析

为研究除前列腺癌以外影响血清ＰＳＡ水平波动的因素,我们调查了３８３例健康男性成人,收集血清ＰＳＡ、ＰＡＰ、肛检前后及活检前后ＰＳＡ水平、前列腺直肠指检和Ｂ超等资料进行我元性回归分析。     

经直肠动态能量多普勒血流显像诊断早期前列腺癌临床价值的评价

目的：评估经直肠动态多普勒能量血流显像（TRDPFI）鉴别诊断早期前列腺癌的临床价值。方法：利用TRDPFI对88例患者的前列腺结节进行观察，并进行前列腺穿刺活检和／或手术，取得病理结果。检测结果与直肠指诊（DRE）、前列腺特异抗原（PSA）、经直肠B超（TRUS）相对照。结果：88例患者中26例（29．5％）为前列腺癌，62例为良性增生结节（70．5％）。运用TRDPFI良性增生结节与癌结节内的动态检出率，结节内的动脉收缩期峰值流速，均有显著差别，经卡方检验、t检验差异有显著性意义（P＜0．05），尤其癌结节内显示穿入血流率达92．31％（24／26），本组良性增生结节无一例测及穿入血流（P＜0．01）。结论：经直肠能量多谱勒血流显像能显著提高早期前列腺癌的检出率，降低假阳性和假阴性。     

超声、磁共振动态增强扫描联合PSA检测在前列腺肿瘤良恶性鉴别诊断中的应用

目的  观察经直肠超声（TRUS）、磁共振动态增强扫描（DCE-MRI）联合血清前列腺特异性抗原（PSA）检测在前列腺肿瘤良恶性鉴别诊断中的应用价值。方法  选取2019年1月~2022年10月我院收治的前列腺肿瘤患者102例,对所有入选患者行TRUS及DCE-MRI检查,以穿刺活检诊断结果为金标准,观察良恶性前列腺肿瘤患者的血清PSA水平,并比较TRUS、DCE-MRI、PSA以及三者联合诊断对前列腺肿瘤良恶性鉴别的价值。结果  102例前列腺肿瘤患者中,经穿刺活检发现38例为恶性肿瘤,64例为良性肿瘤。采用TRUS鉴别前列腺肿瘤良恶性的敏感度、特异性及准确性分别为63.16%、76.56%及71.57%,DCE-MRI检查为73.68%、78.13%及76.47%,PSA检测为89.47%、70.31%及76.47%,且经穿刺活检诊断为恶性前列腺肿瘤的患者,PSA水平及DCE-MRI检查参数值均高于良性肿瘤患者（P＜0.05）。三者联合检测的敏感度及准确性分别为97.37%、88.24%,高于单一检查方法（P＜0.05）。结论  恶性前列腺肿瘤患者与良性患者相比,其血清PSA水平更高,采用TRUS、DCE-MRI及PSA三者联合检测的方法能显著提高前列腺肿瘤良恶性鉴别的诊断效能,值得推广。     

Biopsy of the prostate guided by transrectal ultrasonography: early experience in a teaching community hospital.

Transrectal ultrasonography (TRUS) was used to guide 277 biopsies of the prostate in 182 patients. The Bard Biopty system was used. Of these 182 patients, 107 (59%) had benign changes, and 75 (41%) had malignant lesions. Of those with cancer, 40% (30/75) had negative results of digital rectal examination (DRE). The cancer detection rate by TRUS was 40.7%, and by DRE alone it was 24.2%. Use of TRUS before transurethral resection of the prostate (TURP) in 47 patients with negative findings on DRE yielded 22 cancerous lesions (47%). We advocate this method in patients with abnormalities detected on DRE or with elevated levels of prostate-specific antigen or prostatic acid phosphatase, and as preoperative screening in patients having TURP because of the potential impact of a preoperative diagnosis of cancer upon the choice of treatment.     

前列腺特异抗原＜4μg/L前列腺癌经直肠超声引导穿刺活检的临床研究

目的 评价经直肠超声(TRUS)引导下前列腺穿刺活检对前列腺特异抗原(PSA)＜4μg/L前列腺癌(PCA)诊断的临床价值,借以探讨提高PSA＜4μg/L的PCA诊断率的方法.方法 选取59例PSA＜4μg/L怀疑PCA的患者进行TRUS引导下前列腺多点穿刺活检.分析其TRUS声像图特点尤其对前列腺内结节声像特点进行总结,并比较PCA与非PCA组患者间的PSA、前列腺特异抗原密度(PSAD)、前列腺游离抗原与总前列腺抗原比值(F/T)、前列腺体积(PV),进一步分析PSAD、F/T的各阈值范围内对PCA诊断的敏感性及特异性.结果 59例受检者中经病理证实PCA 16例,检出率为27%,12例PCA患者声像图检查显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高.PCA组与非PCA组间的PSA、PSAD、F/T、PV差异均有统计学意义.将PSAD阈值设为0.09μg/L2时有较高的敏感性及特异性,F/T值设为0.20时有较高的敏感性及特异性,但不及PSAD有优势.结论 TRUS前列腺穿刺活检是确诊PSA＜4 μg/L PCA的最有效方法之一,结合TRUS声像图特点及PSA修正方法可进一步提高PCA的检出率.     

Correlations among prostatic biopsy results, transrectal ultrasound findings and PSA levels in diagnosing prostate adenocarcinoma.

OBJECTIVE: The objective of this study was to evaluate transrectal ultrasound (TRUS) findings and prostate-specific antigen (PSA) levels in relation to prostatic biopsy results and to analyze their individual and combined performances in diagnosing prostate adenocarcinoma (PAC). METHODS: Men (n=143) with PSA levels above 4 ng/ml underwent TRUS and randomized ultrasound-guided prostatic biopsy through the peripheral zone, including additional hypoechoic nodules biopsies, if they were noted on TRUS. Data related to TRUS, biopsy, and PSA level results were then correlated. RESULTS: A significant correlation between TRUS images suspicious for PAC and a biopsy-confirmed diagnosis of PAC, or between the lack of such images and a negative biopsy result, was not found. However, a significant correlation was found between positive biopsy results and PSA levels greater or equal to 10 ng/ml. The sensitivity of transrectal ultrasound in making a diagnosis of PAC was 63%, whereas its specificity was 73%. CONCLUSION: We conclude that while the separate performances of these examinations were not effective in diagnosing PAC, the integrated use of these methods was more adequate for making the diagnosis.     

Clinical efficacy of prostate cancer detection using power doppler imaging in American and Japanese men

PURPOSE: The aim of this study was to compare the detection rates of tumor vascular flow as measured by power Doppler imaging (PDI) in 2 populations and to determine whether PDI can reduce the number of unnecessary prostate biopsies in men with serum prostate-specific antigen (PSA) concentrations less than 10.1 ng/ml. METHODS: The patient populations were Japanese (group 1) and American (group 2) men with either serum PSA concentrations of 4.1-10.0 ng/ml or abnormal findings on digital rectal examination (DRE) plus PSA concentrations less than 4.1 ng/ml. We compared the overall diagnostic accuracy of DRE, gray-scale transrectal sonography (TRUS), and PDI between the 2 groups. RESULTS: In total, 275 men were studied, 154 in group 1 and 121 in group 2. Cancer was identified in 27% of men in group 1 and in 60% of group 2. Men with cancer in both groups differed significantly in age, peripheral zone volume, and mean number of positive biopsy cores. The sensitivity and specificity of PDI in group 2 were significantly inferior to those in group 1. The negative predictive value (NPV) of PDI was significantly higher for group 1 than for group 2. The NPV of PDI in group 1 was equivalent to that for the combination of DRE and TRUS, whereas the NPV for PDI in group 2 was significantly inferior to that of DRE and TRUS.CONCLUSIONS: Tumor vascularity could be detected by PDI more effectively in Japanese men with cancer than in American men with cancer. We hypothesize that this difference was a result of larger cancer volumes and smaller prostates in the Japanese men. PDI did not provide any performance advantage over DRE and TRUS in avoiding unnecessary biopsies.     

Role of transrectal ultrasonography in the prediction of prostate cancer: artificial neural network analysis.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of an artificial neural network (ANN) model with and without transrectal ultrasonographic (TRUS) data. METHODS: Six hundred eighty-four consecutive patients who had undergone TRUS-guided prostate biopsy from May 2003 to January 2005 were enrolled. We constructed 2 ANN models. One (ANN_1) incorporated patient age, digital rectal examination findings, prostate-specific antigen (PSA) level, PSA density, transitional zone volume, and PSA density in the transitional zone as input data, whereas the other (ANN_2) was constructed with the above and TRUS findings as input data. The performances of these 2 ANN models according to PSA levels (group A, 0-4 ng/mL; group B, 4-10 ng/mL; and group C, >10 ng/mL) were evaluated using receiver operating characteristic analysis. RESULTS: Of the 684 patients who underwent prostate biopsy, 214 (31.3%) were confirmed to have prostate cancer; of 137 patients with positive digital rectal examination results, 60 (43.8%) were confirmed to have prostate cancer; and of 131 patients with positive TRUS findings, 93 (71%) were confirmed to have prostate cancer. In groups A, B, and C, the AUCs for ANN_1 were 0.738, 0.753, and 0.774, respectively; the AUCs for ANN_2 were 0.859, 0.797, and 0.894. In all groups, ANN_2 showed better accuracy than ANN_1 (P < .05). CONCLUSIONS: According to receiver operating characteristic analysis, ANN with TRUS findings was found to be more accurate than ANN without. We conclude that TRUS findings should be included as an input data component in ANN models used to diagnose prostate cancer.     

Nonspecific granulomatous prostatitis

Nonspecific granulomatous prostatitis (NSGP) is a relatively uncommon type of chronic inflammation of the prostate, frequently mistaken for carcinoma on digital rectal examination, trans-rectal ultrasound (TRUS) and serum PSA test. It is presently the most frequent variety of granulomatous prostatitis observed at histological examination. The present study reviews the trans-rectal US results and serum PSA levels of 20 patients with biopsy-proven NSGP. Physical findings, laboratory data and US indicated malignancy in all cases. Sonographically (TRUS), the lesions appeared as single or multiple hypoechoic nodules, mainly localised in the peripheral zone of the gland, mimicking carcinoma. Mean serum PSA values were 13.3 ng/ml (range from 3.5 to 34 ng/ml), and only one patient had a value lower than 4 ng/ml. A sufficiently long period of follow-up (mean 19 months; range from 7 to 48 months) with TRUS and PSA was only possible in 11/20 patients. In 8/11 cases, serum PSA returned within normal range, and in 5/11 patients the US features slowly resolved, the hypoechoic nodules disappearing. Final diagnosis can only be obtained by prostatic biopsy. Several questions remain unanswered regarding the relationship between chronic prostatitis and prostatic carcinoma, natural history, the need for specific therapy and also the follow-up of this disease.     

Percent free PSA as an additional measure in a prostate cancer screen.

OBJECTIVE: To assess the ability of the ratio of free prostate specific antigen to total prostate specific antigen (% fPSA) to aid in selection of subjects who would require follow-up studies. DESIGN: Retrospective, nonrandomized analysis measuring total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) in serum from men enrolled in a community-based prostate cancer screening offered by the Cancer Outreach Program (COP), Christiana Care Health Systems (CCHS), Wilmington, DE. PARTICIPANTS Informed consent was obtained from 172 of the 231 eligible participants. Complete laboratory and follow-up data, excluding ethnic origin, was gathered from 157 participants; therefore, theoretical participation was 75% (172/231) while realized participation rate was 68% (157/231). Criteria for inclusion in this study included ambulatory men of age 40 and older with serum total PSA (tPSA) level >1.9 ng/mL and/or an enlarged or abnormal prostate by digital rectal examination (DRE). Subjects with a history of prostate cancer or prostatitis were excluded. MAIN OUTCOME MEASURES: Laboratory tests to determine tPSA and fPSA were performed on serum samples obtained from consenting participants. Percent fPSA was calculated. Results of clinical findings with respect to each participant's DRE were recorded as normal, suggestive of a benign condition, such as benign prostate hyperplasia, or suspicious for prostate cancer. When available, transurethral ultrasound (TRUS) results and biopsy results were also noted. Each participant's results were evaluated and given one of the following diagnoses: Normal prostate (N), Benign Prostate Hyperplasia (BPH), or Prostate Cancer (PCa). RESULTS: Prevalence of cancer 3/157 = 0.0191; of BPH = 0.688; of N = 0.293. Median values for tPSA for each of these groups were as follows: N, 2.9 ng/mL; BPH, 3.0 ng/mL; and PCa, 6.3 ng/mL; (p = 0.079). Median values for fPSA were as follows: N, 0.6 ng/ mL; BPH, 0.5 ng/mL; PCa, 0.5 ng/mL; (p = 0.51). Median values for % fPSA were as follows: N, 19%; BPH, 17%; and PCa, 9%; (p = 0.01). Medians were found to differ for % fPSA measurements, but not for tPSA or fPSA values. DRE screening results of 110 subjects were reported as not normal indicating either an enlarged (n = 97) or abnormal prostate gland (n = 13). Nine subjects had normal DRE results with serum tPSA level above 4.0 ng/mL. Using the combination of DRE and tPSA > 4.0 ng/mL as criteria for the recommendation of follow-up studies, 119 of the participants would have been advised to seek additional testing. CONCLUSION: Using these two routine criteria, 119 (119/157; 76%) subjects would be candidates for follow-up procedures, such as transurethral ultrasound (TRUS) and/or sextant prostate biopsy. By adding % fPSA results of < 10% fPSA to tPSA results > 4.0 mg/mL as criteria for follow-up studies, specificity can be improved threefold with sensitivity unchanged. If an abnormal DRE suggestive of malignancy was included as part of the criteria, sensitivity of the diagnostic scheme would reach 100%. Using the triple diagnostic parameters of tPSA > 4.0 ng/mL, the ratio of free prostate specific antigen to total prostate specific antigen <10%, and an abnormal prostate DRE, 16 participants would be recommended for follow-up studies (16/157; 10%). This would eliminate 103 subjects from unnecessary and expensive testing.     

血清t-PSA、f-PSA/t-PSA、DRE及TRUS对前列腺癌的诊断价值分析

目的探讨前列腺特异抗原(t-PSA)、游离PSA与总PSA比值(f-PSA/t-PSA)、直肠指诊(DRE)和直肠超声(TRUS)诊断前列腺癌(PCa)的价值。方法回顾性分析经病理诊断的31例PCa患者和34例前列腺增生(BPH)患者的血清PSA水平、f-PSA/t-PSA比值、DRE和TRUS的检测结果。结果 ROC曲线分析结果显示t-PSA和f-PSA/t-PSA对PCa的诊断敏感性分别为67.7%和77.4%,特异性分别为58.8%和73.5%,曲线下面积(AUC)分别能达到0.659和0.808。而DRE和TRUS对PCa的诊断敏感性分别为58.1%和51.6%,特异性分别为82.3%和73.5%。联合f-PSA/t-PSA与DRE或TRUS检测,对PCa的诊断敏感性分别上升到87.1%和83.9%,3项指标联合可提高诊断敏感性至90.3%。结论 f-PSA/t-PSA比t-PSA更适合用于临床PCa的诊断,联合f-PSA/t-PSA,TRUS和DRE检查可明显提高临床PCa的检出率。     

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%、84.6%,PSA阳性率明显高于其它检查(P<0.005),若结合DRE、TRUS(直肠B超),则诊断前列腺癌的敏感性达到96.2%;经直肠前列腺穿刺活检31例,其穿刺阳性率为87.1%。PAP、PSA升高患者的比例与前列腺癌的分期、肿瘤细胞分化程度具相关性。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。     

超声引导下经直肠前列腺活检的临床应用

目的 探讨经直肠超声引导下前列腺穿刺活检在诊断前列腺疾病中的临床应用。方法对36例前列腺特异性抗原（PSA）〉4ng／ml或直肠指检（DRE）有结节或经直肠超声发现有异常的患者，行经直肠超声引导6针系统活检加异常区域处1～2针活检。结果36例经直肠超声引导前列腺穿刺活检，检出良性前列腺增生20例，占55．6％，前列腺癌9例，占25％，前列腺轻度不典型增生4例，占11．1％，前列腺良性增生合并前列腺炎性改变3例，占8．3％。无严重的并发症。结论经直肠超声引导前列腺穿刺活检术有助于前列腺疾病的诊断和鉴别诊断，为临床进一步诊治提供了依据。     

Estimation of prostate cancer probability by logistic regression: free and total prostate-specific antigen, digital rectal examination, and heredity are significant variables.

BACKGROUND: Despite low specificity, serum prostate-specific antigen (PSA) is widely used in screening for prostate cancer. Specificity can be improved by measuring free and total PSA and by combining these results with clinical findings. Methods such as neural networks and logistic regression are alternatives to multistep algorithms for clinical use of the combined findings. METHODS: We compared multilayer perceptron (MLP) and logistic regression (LR) analysis for predicting prostate cancer in a screening population of 974 men, ages 55-66 years. The study sample comprised men with PSA values >3 microg/L. Explanatory variables considered were age, free and total PSA and their ratio, digital rectal examination (DRE), transrectal ultrasonography, and a family history of prostate cancer. RESULTS: When at least 90% sensitivity in the training sets was required, the mean sensitivity and specificity obtained were 87% and 41% with LR and 85% and 26% with MLP, respectively. The cancer specificity of an LR model comprising the proportion of free to total PSA, DRE, and heredity as explanatory variables was significantly better than that of total PSA and the proportion of free to total PSA (P <0.01, McNemar test). The proportion of free to total PSA, DRE, and heredity were used to prepare cancer probability curves. CONCLUSION: The probability calculated by logistic regression provides better diagnostic accuracy for prostate cancer than the presently used multistep algorithms for estimation of the need to perform biopsy.     

Prostate cancer screening.

No screening test has been proven to reduce prostate cancer mortality. DRE has been the traditional method of screening, and it is often used to detect other diseases in addition to prostate cancer. Newer modalities, such as TRUS and PSA, can identify patients with nonpalpable prostate cancer, but the use of these tests will also result in many false-positives. In addition, it is not known whether the use of these tests will reduce prostate cancer mortality, or instead cause harm to those patients screened. Given the potential for harm, and the extraordinary expense, routine screening of asymptomatic men with newer modalities should be considered experimental.     

经直肠多模态超声影像评分系统诊断前列腺癌的临床研究

目的建立前列腺癌多模态超声影像评分系统,并评价该评分系统对前列腺癌的诊断价值。 方法选取2016年5月至2017年12月在解放军总医院行超声引导下穿刺活检和（或）手术切除的86例可疑前列腺癌患者,术前对前列腺行经直肠常规超声、剪切波弹性成像、超声造影检查,分析三种模态超声影像特征,并与手术或穿刺病理进行对照。总结前列腺癌经直肠多模态超声影像特征,建立评分系统,并评价该系统对前列腺癌的诊断价值。 结果前列腺癌常规超声表现为低回声、边界不清、形态不规则、内外腺分界不清、包膜侵犯、血流信号丰富且为中心血流;剪切波弹性成像表现为非对称分布,前列腺癌病灶平均弹性模量高于良性病灶［（94.7±44.2）kPa vs（60.8±26.0）kPa］,差异有统计学意义（t=-3.578,P=0.001）;超声造影表现为快速高增强,分布不均匀（低增强区伴点状血管结构,点状、片状或结节状高增强）,内外腺分界不清,包膜或直肠壁侵犯。常规超声、超声造影、弹性成像有1项阳性即诊断为前列腺癌,其敏感度、阴性预测值和准确性分别为98.0%、96.7%和89.5%;三者均为阳性诊断为前列腺癌,其特异度和阳性预测值分别为97.3%和97.1%。 结论经直肠多模态超声影像评分系统可提高超声对前列腺癌的诊断价值。     

Real-time elastography in the detection of prostate cancer in patients with raised PSA level

The study was done to evaluate the role of real-time elastosonography (ES) in the detection of prostate cancer (PCa) in 50 consecutive patients with raised PSA level and to determine whether ES can be of use to perform a targeted biopsy. Fifty consecutive patients with raised PSA levels underwent transrectal ultrasound (TRUS) and ES examination. ES images with adequate compression and a quality factor of more than 50% were analyzed for areas of increased glandular stiffness. The ES findings were correlated with the targeted and 10-core biopsy and sensitivity, specificity calculated on per patient and per core basis. ES showed a sensitivity and specificity of 91.7% and 86.8% on per patient basis, respectively, with a false positive rate of 13%. The calculated sensitivity and specificity on per core basis of ES targeted biopsy was 72.5% and 100% compared with 100% and 81% of 10-core systematic biopsy group. The study concludes that combining ES with TRUS significantly improves the sensitivity to detect carcinoma prostate in patients with raised PSA, however, ES is unable to differentiate PCa from chronic prostatitis. The use of ES for targeted biopsy also improves the specificity over a 10-core systematic biopsy.     

经直肠超声引导前列腺穿刺活检对前列腺特异抗原小于4 ng/ml前列腺癌的诊断

目的探讨经直肠超声引导下前列腺穿刺活检对前列腺特异抗原(PSA)<4ng/ml前列腺癌诊断的临床价值。方法59例PSA<4ng/ml疑为前列腺癌的患者行经直肠超声引导下前列腺多点穿刺活检,观察前列腺内结节声像图特点,并病理分级,对照分析活检术式的检出情况。结果59例患者中经病理证实前列腺癌16例,检出率为27%,其中12例声像图显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高。结节区域定点穿刺的检出率较六点系统穿刺活检术高(P<0.05);活检阳性点数占所有活检点数比率为51.2%,病理分级中分化程度占56.25%,低分化程度占31.25%。结论结合经直肠超声声像图和前列腺多点穿刺活检可提高PSA<4ng/ml的前列腺癌检出率,对前列腺癌的早期诊断非常必要。