12+X法超声引导下经会阴前列腺穿刺活检术35例报告

目的:进一步验证12+X法超声引导下经会阴前列腺穿刺活检术的应用价值及其安全性。方法:于2012年1月~2014年4月期间对35例可疑前列腺癌患者行12+X法超声引导下经会阴前列腺穿刺活检术。结果:确诊为前列腺癌患者18例(阳性率51.4%),其中PSA10μg/L组、PSA10~20μg/L组、PSA20~100μg/L组、PSA100μg/L组穿刺阳性率分别为20%、28.6%、70%、87.5%。前列腺体积小于25ml组前列腺癌阳性率为75%;大于50ml组阳性率为42.1%。并发症包括血管迷走神经反射1例(2.86%),血尿11例(31.4%),尿潴留5例(14.3%),无直肠出血、泌尿系感染及发热等。结论:12+X法超声引导下经会阴前列腺穿刺活检术是一种安全有效、简单易行的前列腺癌确诊方法,值得在临床上使用。     

实时超声造影在经直肠前列腺穿刺活检中的应用

目的:探讨实时超声造影技术提高经直肠超声引导下前列腺穿刺活检阳性率的应用价值。方法:PSA异常升高(4~20μg/L)、直肠指检(DRE)异常或前列腺MRI异常的男性患者,经积极肠道准备后进行前列腺穿刺活检,穿刺方案为12+X针(左右侧叶前列腺尖部、中部及基底部腺体各穿刺1针+可疑结节靶向穿刺X针)。穿刺前先对前列腺进行常规超声检查,然后进行超声造影。比较超声造影前后发现前列腺结节内可疑前列腺癌结节数目差异,以及常规超声引导和实时超声造影引导下前列腺穿刺活检前列腺癌检出率的差异。结果:常规经直肠超声发现可疑结节86个,检出前列腺癌57个,阳性率为66.3%。超声造影发现异常结节118个,其中108个检测出前列腺癌,阳性率91.5%。超声造影诊断前列腺异常结节效率明显高于常规经直肠超声(P0.01)。超声造影引导下穿刺检出前列腺癌39例(42.8%),而常规经直肠超声检查仅能检出28例(30.8%),两者差异显著(P=0.033)。结论:实时超声造影可提高前列腺可疑结节的检出率,为前列腺靶向穿刺提供更精确定位。靶向穿刺可有效提高前列腺癌的检出率,有利于早期发现前列腺癌。     

直肠超声引导经会阴模版12+X针前列腺穿刺活检术临床研究

目的:评价直肠超声引导下经会阴模版12+X针前列腺穿刺活检术的临床价值和安全性。方法:2009年9月~2014年5月,对临床怀疑为前列腺癌的1 300例患者行直肠超声引导下经会阴模板前列腺穿刺活检术。1 300例患者平均年龄70.5岁,穿刺前均行血清PSA监测(不少于2次)、前列腺直肠指诊、经直肠前列腺超声及前列腺磁共振平扫加动态增强。所有患者取截石位,1%利多卡因注射液10~20ml会阴皮下及前列腺尖部局部浸润麻醉973例,骶管阻滞麻醉75例,硬膜外麻醉252例。共937例采用12+X针穿刺,363例采用常规12针穿刺。结果:所有患者均顺利完成操作,活检针数12~24针,平均14.5针;活检时间15~30 min,平均20.4min。术后发生一过性血尿201例,会阴部血肿14例,尿潴留21例,发热5例。穿刺病理结果:前列腺癌540例(41.5%),其中腺癌527例,其他类型肿瘤13例;前列腺上皮内瘤(PIN)57例(4.4%);前列腺增生及各类前列腺炎703例(54.1%)。T-PSA4μg/L、4~10μg/L、10~20μg/L及20μg/L组的穿刺阳性率分别为:13.1%、17.1%、31.9%、73.8%。TPSA 4~10μg/L组(灰区)293例患者分别以F/T PSA和PSAD分组,F/T≥0.16和0.16组的穿刺阳性率分别为12.0%、18.8%,PSAD≥0.15和0.15组的穿刺阳性率分别为9.8%、21.5%。直肠指诊异常、经直肠超声异常及前列腺MRI异常患者的穿刺阳性率分别为:24.0%、30.1%、59.2%。12+X针组穿刺阳性率为47.2%,12针组为34.5%。结论:直肠超声引导下经会阴12+X针前列腺穿刺活检术阳性率高,并发症少,是诊断前列腺癌的理想方法。     

徒手TRUS引导下经会阴前列腺活检的临床应用探讨

目的:探讨徒手"12+X"法TRUS引导下经会阴前列腺活检术诊断前列腺癌的临床应用价值。方法:2014年12月~2015年12月,对74例可疑前列腺癌患者行经直肠B超引导下18G自动穿刺活检针行双侧外周带12点法系统穿刺,其中直肠指诊(DRE)触及结节24例,超声提示异常回声14例,前列腺核磁提示异常信号30例;前列腺特异性抗原(PSA)<4ng/ml者14例,PSA 4~10ng/ml 25例,PSA>10ng/ml者35例。同时对每个可疑病灶进行1~2针靶向穿刺。回顾性分析穿刺的阳性率和并发症。结果:成功对74例患者进行徒手"12+X"法TRUS引导下经会阴前列腺活检术。年龄43~81岁,中位年龄72岁;PSA 1.9~500ng/ml,中位PSA17.8ng/ml。经病理诊断,前列腺癌23例,阳性率31.1%,穿刺阴性病例中3例TURP术后病理诊断结果为前列腺癌;2例首次穿刺阴性,6个月后重复穿刺时发现前列腺癌。低危前列腺癌(Gleason≤6分)、中危前列腺癌(Gleason=7分)和高危前列腺癌(Gleason≥8分)分别为13.1%、30.4%和56.5%。其余51例为良性前列腺增生或合并前列腺炎症。术后短暂和轻度的肉眼血尿6例(8.1%),均在1~3d后缓解,5例(6.8%)轻度发热,2例(2.7%)会阴部轻度不适。无脓毒症、急性尿潴留等严重并发症的发生。结论:徒手"12+X"法TRUS引导下经会阴前列腺活检安全可行,阳性率稳定,值得在临床上进一步推广。     

超声引导下经直肠与经会阴途径前列腺穿刺活检术的比较

目的比较超声引导下经直肠与经会阴途径前列腺穿刺活检术在前列腺癌诊断中的效果。方法我院2015年12月~2018年12月超声引导下前列腺穿刺319例,其中经直肠162例(经直肠组),经会阴157例(经会阴组),比较2种穿刺活检方法阳性率、并发症发生率。结果经直肠与经会阴途径穿刺阳性率分别为31.5%(51/162)、35.7%(56/157),差异无统计学意义(χ^2=0.765,P=0.382)。2组穿刺后血尿、尿潴留、血管迷走神经反射发生率均无统计学意义(P>0.05)。经直肠组血便发生率14.2%(23/162),明显高于经会阴组1.9%(3/157)(χ^2=16.078,P=0.000);发热发生率9.9%(16/162),明显高于经会阴组2.5%(4/157)(χ^2=7.287,P=0.007);疼痛发生率3.7%(6/162),明显低于经会阴组10.2%(16/157)(χ^2=5.226,P=0.022)。结论直肠超声引导下经直肠与经会阴前列腺穿刺均为检测前列腺癌的有效途径,2种穿刺方法的阳性率相近,经会阴途径血便、发热发生率明显低于经直肠途径,疼痛发生率明显高于经直肠途径,应根据患者具体病情选择合理的穿刺方式。     

盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术的临床应用

目的:评估盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术的临床价值和安全性。方法:2015年12月至2018年05月,对164例(PSA10μg/L 28例、PSA 10～20μg/L 56例、PSA 20.01～100μg/L 53例、PSA100μg/L 27例)可疑前列腺癌患者由同一医疗小组实施盆腔MRI辅助模板定位B超引导经会阴前列腺穿刺活检术。患者平均年龄71.2岁,穿刺前均行血清PSA检测、直肠指检以及盆腔前列腺MRI平扫检查。所有患者均接受截石位穿刺,选择静脉全身麻醉或腰麻,均采用X+12针穿刺。结果:所有患者均顺利完成活检操作,活检针数(2～4)+12针;活检时间15～28 min,平均18 min。术后一过性血尿4例,会阴阴囊皮下淤血12例,发热1例,无尿潴留病例。穿刺病理结果:前列腺腺癌95例,导管上皮癌2例;前列腺增生伴间质慢性炎症63例,前列腺不典型增生症4例。PSA 10、10～20、20.01～100、100μg/L组穿刺阳性率分别为25.00%、42.86%、73.58%、100.00%。PSA10μg/L组与PSA10～20μg/L组相比无统计学差异(P=0.086),但与PSA 20.01～100μg/L和100μg/L组相比差异具有统计学意义(P0.01)。结论:与目前常规使用的经直肠前列腺穿刺术相比,盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术并发症发生率更低,且阳性率显著增高同时穿刺方法更简单易掌握,是诊断前列腺癌的理想方法。     

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.     

经会阴B型超声引导下前列腺穿刺活检的临床价值研究

目的:探讨经会阴扇型B型超声引导下前列腺6针穿刺活检术诊断前列腺癌的临床价值。方法:对经直肠指检或经腹部B超检查发现前列腺结节、血清总前列腺特异性抗原(tPSA)在4μg/L以上或游离PSA(fPSA)/tP-SA<0.16的可疑前列腺癌104例患者,经会阴扇型B超引导下18G自动穿刺活检针行双侧叶6点法穿刺,对穿刺的阳性率和并发症及影响穿刺阳性率的因素进行分析。结果:经病理诊断,检出前列腺癌24例,检出率23%,前列腺癌分级评分中位数为7分,高分化癌(2~4分)、中分化癌(5~7分)和低分化癌(8~10分)分别为12.5%(3/24)、62.5%(15/24)和25%(6/24);其余80例为良性前列腺增生(BPH)。术后短暂和轻度的肉眼血尿5例(4.8%),均在1~3 d后缓解,4例(3.8%)发热37.2℃~38.0℃,术后会阴部轻度不适5例(4.8%)。术后无1例出现血便、血精、前列腺脓肿、高热、败血症、急性尿潴留等严重并发症。经分析发现tPSA、fPSA、fPSA/tPSA、前列腺抗原密度(PS-AD)和前列腺体积是影响前列腺穿刺阳性率的重要因素(P<0.05),经会阴穿刺优势主要反映在tPSA≥10μg/L、fP-SA≥2μg/L、fPSA/tPSA<0.16、PSAD≥0.2和前列腺体积<40 m l时提示应行会阴穿刺术。结论:经会阴扇型B型超声引导下6针前列腺穿刺活检,是一种安全准确的前列腺癌检出方法。     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

经会阴前列腺24针饱和穿刺活检与14针活检在PSA＜20μg/L患者中筛检前列腺癌的对比性研究

目的:探讨超声引导下经会阴前列腺24针饱和穿刺活检与14针穿刺活检方案对PSA<20μg/L可疑前列腺癌患者的筛检阳性率及其相关并发症。方法:选取116例可疑前列腺癌患者行经会阴超声引导下14针穿刺活检(14针组),另136例患者,行经会阴24针饱和前列腺穿刺活检(24针饱和组),比较两组前列腺癌筛检阳性率、标本阳性率及穿刺后肉眼血尿、泌尿系感染、尿潴留等并发症的发生率。结果:两组患者平均年龄、穿刺前PSA水平、平均前列腺体积等指标均无统计学差异(P>0.05)。24针饱和组及14针组前列腺癌筛检总体阳性率分别为48.53%和17.24%,存在显著性差异(P<0.001),标本阳性率分别为8.09%和2.83%(P=0.012);其中24针饱和组前列腺尖部肿瘤的检出率(11.76%)显著高于14针组(1.72%,P<0.05)。两组穿刺后尿潴留、泌尿系感染和肉眼血尿等发生率均无统计学差异(P>0.05)。结论:24针经会阴前列腺饱和穿刺活检方法显著提高PSA<20μg/L患者中前列腺癌的筛检阳性率,尤其是增加了前列腺尖部区域的肿瘤筛检阳性率,而并未增加相关并发症。     

Transrectal ultrasound-guided transperineal 14-core systematic biopsy detects apico-anterior cancer foci of T1c prostate cancer

AIM: The optimal biopsy strategy for prostate cancer detection, especially in men with isolated prostate-specific antigen (PSA) elevation, remains to be defined. We evaluated diagnostic yield and safety of transrectal ultrasound (TRUS)-guided transperineal systematic 14-core biopsy and compared the spatial distribution of cancer foci detected with this technique in men with and without abnormality on digital rectal examination (DRE). METHODS: In a prospective study, 289 men aged between 50 and 87 years (median age, 70 years) underwent TRUS-guided transperineal systematic 14-core prostate biopsy because of elevated PSA and/or abnormal DRE findings. Using the fan technique, 12 cores from the peripheral zone and two cores from the transition zone were obtained systematically. To characterize the spatial distribution of cancer positive cores, site-specific overall and unique cancer detection rates were compared between stage T1c and T2 cancers. RESULTS: Prostate cancer was detected in 105 of the 289 patients (36%). Major complications requiring prolonged hospital stay or re-hospitalization during a 4-week postbiopsy period were rare (1.4%). Sixty-seven stage T1c cancers were identified. These cancers were associated with significantly lower PSA and a smaller number of cancer positive cores when compared with stage T2 cancers (n= 38). The overall cancer detection rate was highest at the anterior peripheral zone and the posterior peripheral zone in stage T1c and stage T2 cancers, respectively. The unique cancer detection rate at the anterior peripheral zone was significantly higher in stage T1c cancers than in stage T2 cancers. Therefore, when the prostate is extensively biopsied using the transperineal approach, cancer positive cores are characteristically distributed anteriorly in stage T1c cancers and posteriorly in stage T2 cancers. CONCLUSIONS: TRUS-guided transperineal systematic 14-core biopsy showed an apico-anterior distribution of cancer foci in stage T1c prostate cancers.     

超声引导下12+x针前列腺穿刺活检单中心407例临床分析

目的:分析单中心超声引导下12+x针前列腺穿刺活检结果,比较不同穿刺途径的临床效果。方法:回顾分析2016年6月~2019年12月我院完成的407例前列腺穿刺活检的临床资料,经直肠前列腺穿刺290例(经直肠组),经会阴前列腺穿刺117例(经会阴组),均采用超声引导下12+x针法,前列腺影像学正常者行系统穿刺,影像学异常者行系统+靶向穿刺。比较两组前列腺癌(PCa)的检出率及并发症差异,分析两组按PSA、影像学分层PCa检出率的差异,比较靶向穿刺与系统穿刺癌检出率的差异,分析临床有意义前列腺癌(csPCa)的检出情况。结果:(1)PCa总检出率为44.0%(179/407),经直肠组与经会阴组PCa检出率比较差异无统计学意义[44.8%(130/290)vs.41.9%(49/117),P>0.05]。其中,PSA≤4 ng/mL、4 ng/mL20 ng/mL各水平分层中,两组PCa检出率比较差异无统计学意义(P>0.05)。两组中前列腺影像学异常者的PCa检出率均高于影像学正常者(P<0.05)。影像学异常者中,经直肠组与经会阴组PCa检出率比较差异无统计学意义(P>0.05)。(2)前列腺影像学异常者总的PCa检出率为57.5%(111/193),靶向穿刺PCa检出率为42.0%(81/193),系统穿刺为47.7%(92/193),两者比较差异无统计学意义(P>0.05),但靶向穿刺单针阳性率比系统穿刺更高(P<0.01)。同一途径下的靶向穿刺与系统穿刺PCa检出率比较差异无统计学意义(P>0.05)。两组中分别比较靶向穿刺、系统穿刺的PCa检出率,差异均无统计学意义(P>0.05)。(3)在所有患者中,经直肠途径csPCa检出率为36.9%(107/290),经会阴途径csPCa检出率为40.2%(47/117),两者比较差异无统计学意义(P>0.05)。靶向穿刺与系统穿刺在csPCa的检出率上比较差异无统计学意义。csPCa在诊断出的PCa患者中的占比,经会阴途径占比高于经直肠途径[95.9%(47/49)vs.82.3%(107/130),P<0.05]。(4)经直肠组总并发症发生率显著高于经会阴组[39.3%(114/290)vs.20.5%(24/117),P<0.01]。经直肠组发热、血便发生率比经会阴组更高,分别为[10.3%(30/290)vs.3.4%(4/117),P<0.05]、[14.1%(41/290)vs.1.7%(2/117),P<0.01],两组在血尿、下尿路症状、尿潴留、迷走反射发生率上比较差异均无统计学意义(P>0.05)。结论:超声引导下12+x针前列腺穿刺活检PCa检出率较好,影像学异常者靶向穿刺与系统穿刺PCa、csPCa检出率差异均无统计学意义,靶向穿刺单针阳性率较高。经直肠途径与经会阴途径在PCa、csPCa检出率比较差异无统计学意义,经会阴途径并发症更少。在诊断出的PCa中,经会阴途径可检出更多的csPCa。     

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.     

Ultrasound-guided transrectal extended prostate biopsy： a prospective study

AIM: To evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer. Methods: One hundred and fifty-two patients with suspected prostate cancer were included in the study. Patients were entered in the study because they presented with high levels of prostate specific antigen (PSA) (over 4 ng/mL) and/or had undergone an abnormal digital rectal examination (DRE). In addition to sextant prostate biopsy cores, four more biopsies were obtained from the lateral peripheral zone with additional cores from each suspicious area revealed by transrectal ultrasound. Sextant, lateral peripheral zone and suspicious area biopsy cores were submitted separately to the pathological department. Results: Cancer detection rates were 27.6% (42/152) and 19.7% (30/152) for the 10-core and sextant core biopsy protocols, respectively. Adding the lateral peripheral zone (PZ) to the sextant prostate biopsy showed a 28.6% (12/42) increase in the cancer detection rate in patients with positive prostate cancer (P < 0.01). The cancer detection rate in patients who presented with elevated PSA was 29.3% (34/116). When serum PSA was 4-10 ng/mL TRUS-guided biopsy detected cancer in 20.6%, while the detection rate was 32.4% and 47.0% when serum PSA was 10-20 ng/mL and above 20 ng/mL, respectively. Conclusion: The 10 systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer by 28.6% when compared with the sextant biopsy technique alone, without increase in the morbidity. We therefore recommend the 10-core biopsy protocol to be the preferred method for early detection of prostate cancer.     

经会阴前列腺穿刺484例分析

目的 分析484例直肠超声导引下经会阴前列腺穿刺病例,以提高穿刺活检的阳性率.方法 484例患者,以PSA＞4 ng/ml或肛指检查异常或B超发现异常回声为穿刺指征,行经会阴的6～8点系列加异常回声处活检.患者采取膀胱截石位,充分暴露会阴部.以1%利多卡因10 ml作浸润麻醉,至前列腺包膜.随后用自动活检枪以6针系列穿刺法对前列腺双侧外周带各2针,移行带各1针.对B超发现的可疑处另穿刺数针.其中315例使用Alokal700彩超仪和Promag2.2活检枪,另169例用ESAOTE TechrosMPS彩超仪和BardMagmun活检枪.结果 两组共484例,前列腺癌173例（35.7%）,前列腺增生262例（54.1%）,各级PIN35例（7.2%）,不典型增生12例（2.8%）,慢性肉芽肿性炎2例（0.4%）.Aloka组和ESAOTE组之间的阳性率比较无统计学上显著性差异.结论 经会阴前列腺穿刺活检是一种并发症较轻,阳性率较高的前列腺肿瘤的诊断方法,且在不同B超仪和活检枪情况下可以达到相似的阳性率.     

USEFULNESS OF DIGITAL RECTAL EXAMINATION, SERUM PROSTATE-SPECIFIC ANTIGEN, TRANSRECTAL ULTRAS ONOGRAPHY AND SYSTEMATIC PROSTATE BIOPSY FOR THE DETECTION OF ORGAN-CONFINED PROSTATE CANCER

The detection rate of organ-confined prostate cancer by digital rectal examination (DRE), serum prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) of the prostate, as well as the value of a directed, guided transrectal core biopsy for the prostate (TRUS-guided biopsy) combined with systematic biopsy, were evaluated. The subjects were 171 patients with urinary symptoms suggestive of prostatic disease excluding those with clinical stage C and D prostate cancer. Twenty-five patients (14.6%) had prostate cancer, 127 (74.2%) had benign prostate hypertrophy, four (2.3%) had prostatic intraepithelial neoplasia, eleven (6.4%) had inflammation, and four (2.3%) had normal prostate tissue. The incidence of detection of hypoechoic findings by TRUS in the patients in whom nodules were detected by DRE or who had elevated serum PSA was higher than that in patients with negative diagnostic findings. In 22 of the 25 patients with prostate cancer, the cancer was detected by recognition of a hypoechoic area on TRUS. In 10 of these 22 patients, prostate cancer was also detected by systematic biopsy in isoechoic areas. Prostate cancer was detected by systematic biopsy in three patients without hypoechoic findings. The positive predictive value for patients with abnormal findings on all three tests was 64.3%, which is significantly higher than that for patients with any other combination of findings (p < 0.05). Our results indicate that the combination of DRE, serum PSA and TRUS is useful for the detection of organ-confined prostate cancer, and that TRUS and TRUS-guided prostate biopsy combined with systematic biopsy should be performed in patients with abnormal findings for both DRE and PSA. Our results also demonstrate that systematic biopsy is useful for the detention of prostate cancer from the isoechoic area visualized by TRUS.     

经直肠超声引导下前列腺穿刺活检540例临床分析

目的评价经直肠超声引导下前列腺穿刺活检诊断前列腺癌（PCa）的临床应用价值,提高PCa的诊治水平。方法回顾性分析血PSA升高和（或）直肠指检前列腺结节及超声检查有异常的540例患者经直肠超声引导下前列腺穿刺活检的临床资料和声像图表现。其中直肠指诊异常者248例;超声显示有异常回声结节者178例,145例为低回声,占81.4％,42例在声像图上未发现异常;380例PSA〉10μg／L。结果540例活检中PCa220例,阳性率为40．7％,前列腺肉瘤4例,前列腺增生症269例,前列腺增生症并上皮内瘤（PIN）35例,前列腺炎9例,前列腺结核2例,非典型增生1例。结论经直肠超声引导下前列腺穿刺活检是诊断PCa的一种安全有效的检查方法。     

Safety of transperineal 14‐core systematic prostate biopsy in diabetic men

Objectives: To examine whether the transrectal ultrasound‐guided transperineal 14‐core prostate biopsy can be carried out safely in diabetic men and to determine adequate antimicrobial prophylaxis protocol in this setting. Methods: The present study included 539 men, 135 with concurrent diabetes mellitus (DM) and 404 without DM, who underwent transperineal extended 14‐core biopsy due to elevated prostate‐specific antigen ≥2.5 ng/mL and/or abnormal digital rectal examination. Any complication requiring prolonged hospitalization or rehospitalization during the 4‐week post‐biopsy period was considered major. All other complications were considered minor. Intensity of antimicrobial prophylaxis was prospectively reduced in a stepwise manner down to single dose of oral levofloxacin. Results: Except for DM, there was no significant difference in clinical background between the diabetic and non‐diabetic men. The procedure was completed in all revealing prostate cancer in 42% of the diabetic men and 36% of the non‐diabetic men (P = 0.23). Incidence of minor or major complications was not significantly different between the two groups. Minor complications were observed in 15.6% and 16.6% of each group, respectively, with voiding disturbance being the most common. No infectious major complication was observed regardless of the presence of DM. In the diabetic men, there was no statistical difference in incidence of biopsy‐related complications according to modality of DM treatment, HbA1c level or antimicrobial prophylaxis protocol. Conclusions: Transperineal 14‐core biopsy can be carried out without major infectious complications in diabetic men. Oral levofloxacin 300 mg once before the procedure seems to represent an effective antimicrobial prophylaxis in diabetic men without other risk of infection.     

The usefulness of power Doppler ultrasonography for diagnosing prostate cancer: histological correlation of each biopsy site

OBJECTIVE: To correlate the findings of power Doppler ultrasonography (PDUS) of the prostate with those of site-specific transrectal ultrasonography (TRUS)-guided biopsy. PATIENTS AND METHODS: The study comprised 28 patients referred to our institution for TRUS-guided prostate biopsy because of an elevated PSA level and/or abnormal digital rectal examination. PDUS findings were graded 0, 1 or 2; grades 0-1 were considered as negative and grade 2 as positive. The blood volume of each biopsy site was also determined using the mean number (MN) value that represents the average vascularity in a 5-mm square sample. PDUS values were correlated with the histological findings of 147 biopsies with 19 focal lesions. RESULTS: Grade 2 was assigned to 19 sites, grade 1 to 52 sites, and grade 0 to 76 sites. Fourteen of the 19 PDUS findings of grade 2 sites revealed carcinoma and five were grade 1. Ten of 35 TRUS-positive sites were carcinomas, three benign prostatic hyperplasia (BPH) and 22 normal. The MN value for prostatic carcinoma was 4.33, for BPH 11.7 and for normal tissue 4.7. The overall sensitivity of PDUS was 74%, the specificity 96% and the positive predictive value 74%. CONCLUSIONS: Because TRUS alone cannot detect all cancers, PDUS should be used routinely in all patients undergoing TRUS-guided biopsy, to improve the diagnostic yield of prostate cancer.