经直肠超声引导前列腺穿刺活检术（附136报告）

目的探讨经直肠超声引导前列腺穿刺活检方法及阴性患者随访策略。方法136例患者因血清tPSA〉4ng／ml或伴前列腺硬结接受穿刺活检术。根据前列腺体积或硬结情况分别选择6针、8针或10针穿刺。病理为阴性,但提示HGPIN、ASAP或PSA持续〉4ng／ml,建议3-6个月后重复穿刺活检。结果136例患者共接受1172针活检,平均8．6针。总阳性率为23．5％,其中6针、8针和10针穿刺阳性率分别为0、19．1％和34．5％（P〈0．01）。30例接受了2-3次重复活检,所有重复活检均为阴性。47例患者接受平均3．6年随访,仅1例后经TURP证实为前列腺癌,其余未发现可疑前列腺癌局部或远处转移表现。结论根据超声前列腺形态选择穿刺方案可使绝大部分前列腺癌患者初次穿刺即获得确诊。重复穿刺阳性率低,应注意选择适应症。     

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＜20 μg/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＜20 μg/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.     

超声引导下经不同针数直肠前列腺穿刺活检对前列腺癌的早期诊断效果对比

目的探讨超声引导下经直肠前列腺穿刺活检在诊断前列腺癌的价值。方法选取2013年1月至2016年12月在本院就诊的疑似前列腺癌患者62例，均超声引导下经直肠前列腺穿刺活检，分析不同穿刺法的阳性检出情况。结果本组研究62例患者，穿刺活检病理结果为前列腺癌患者25例（40.32%），其中34例接受10针法穿刺，28例接受12+1针法穿刺，两种穿刺的阳性率分别为35.29%（12/34）和46.43%（13/28），差异无统计学意义（P＞0.05）；前列腺体积≥90 mL患者10针法阳性检出率为33.33%（5/15），明显低于12+1针法的87.50%（7/8），差异比较有统计学意义（P＜0.05）；10针法和12+1针法在不同年龄、前列腺特异性抗原（PSA）及指诊情况下阳性检测率比较差异无统计学意义（P＞0.05）；10针法和12+1针法穿刺后血尿、血便、疼痛、尿潴留及感染发生比例差异比较无统计学意义（P＞0.05）。结论 应根据患者具体情况选取穿刺方法，当患者前列腺体积超过90 mL时，应采取12+1针法穿刺，有助于前列腺癌的检出，而当＜90 mL时，选取10针法穿刺较适宜。     

214例前列腺穿刺结果的前列腺癌病灶分布情况分析

目的探讨经直肠超声引导下经直肠前列腺穿刺活检结果的前列腺癌病灶分布情况。方法本组214例,其中214例前列腺特异抗原＞4．0ng/ml 203例,直肠指诊可疑前列腺癌41例；均行13针前列腺穿刺活检术。入选病例的年龄为50～90岁,平均69．8岁；PSA水平0．8～112．3ng/ml,平均18．7 ng/ml；前列腺体积12．3～182．5ml,平均61．3 ml；直肠指诊阴性者173例,阳性者41例。分析各穿刺部位的阳性率。结果5区13针法的阳性率为36．0%(77/214)。前列腺各穿刺部位的阳性率为：底部48/214(22．4%)、中部57/214(26．6%)、尖部57/214(26．6%)、外侧底部47/214(22．0%)、外侧中部61/214(28．5%)。各穿刺部位的阳性率的差异具有显著性(P＜0．001)。结论前列腺穿刺活检发现的前列腺癌病灶分布不均匀。前列腺的尖部、中部和外侧中部的穿刺阳性率较其它部位高。     

超声引导下经直肠10针前列腺穿刺活检对前列腺癌诊断的研究

目的 探讨超声引导下经直肠10针前列腺穿刺活检术诊断前列腺癌的临床应用价值。方法 回顾性分析104例经直肠10针穿刺活检的可疑前列腺癌患者。在标准6针系统穿刺法基础上改进确定A组穿刺点后,依据前列腺解剖分区,在经直肠B超显示的前列腺冠状切面的两侧外侧区域（B组）及中央区域（C组）增加4针穿刺点,施行前列腺活检,病例标本分别标注送病理学检查。结果 104例患者中42例确诊为前列腺癌,总阳性率为40.4%。其中所设置的A组穿刺位点阳性25例（占总检出阳性的59.5%）,B组位点阳性9例（21.4%）,C组位点阳性8例（19.0%）。假阴性率为4.7%,术后并发症总发生率为15.4%,未出现严重并发症。结论 超声引导下经直肠10针前列腺穿刺活检术安全、可靠,可以作为临床理想的初次前列腺穿刺活检术式之一。     

经直肠超声造影靶向前列腺穿刺活检在PSA水平为4~20 ng/ml患者中的作用

目的：探讨前列腺超声造影在经直肠前列腺靶向穿刺活检中的临床应用价值.方法选择96例血清PSA在4~20 ng/ml行前列腺穿刺活检的患者,其中50例行经直肠超声前列腺13针系统性穿刺活检;46例先行经直肠前列腺超声造影,后对超声造影异常增强区靶向穿刺加6点常规穿刺,超声造影无异常者同系统性穿刺.比较两组穿刺活检的效率.结果系统性穿刺组前列腺癌的阳性率为22.0％,造影穿刺组为41.3％,两组间对单纯移行区肿瘤的检出率有统计学差异(P＜0.05).系统穿刺组人均穿刺13.0针,单针阳性率为11％;造影穿刺组人均穿刺10.9针,单针阳性率为20％;两组单针阳性率、人均穿刺针数差异均有统计学意义(P＜0.05).超声造影异常的患者单针阳性率明显高于普通超声检查的患者(31.5％ v s 11.3％),同时人均穿刺针数低于超声引导下系统性穿刺(9.7 vs 13.0针),差异具有统计学意义(P＜0.05).系统性穿刺组前列腺癌患者总 Gleason评分为74分,人均6.7分,超声造影穿刺组则分别为133、7.0分,两组比较有统计学差异.两组无严重并发症.结论对于PSA＜20 ng/ml 的患者,超声造影对引导经直肠前列腺靶向穿刺活检具有更高的效率,可减轻患者的痛苦.     

6针法和13针法前列腺穿刺活检术诊断前列腺癌的分析比较

目的探讨5区13针法和6针法前列腺穿刺活检诊断前列腺癌的差异。方法本组214例,因前列腺特异性抗原>4.0ng/ml或直肠指诊前列腺癌阳性可疑而行13针前列腺穿刺活检术,其中前列腺特异性抗原>4.0ng/ml者203例,直肠指诊前列腺癌阳性可疑者41例。入选病例的年龄为50￣90岁,平均69.8岁;PSA水平0.8￣112.3ng/ml,平均18.7ng/ml;前列腺体积12.3￣182.5ml,平均61.3ml;直肠指诊阴性者173例,阳性者41例。结果6针法和13针法的阳性率分别为30.8(f/214)和36.0(w/214),后者的阳性率提高14.3(/77()P<0.001)。两者的差异在前列腺特异性抗原≤20ng/ml,指诊阴性,体积>40ml,前列腺特异性抗原密度≤0.30,年龄<70岁的患者中更显著。结论5区13针前列腺穿刺活检术比系统6针发现前列腺癌的阳性率更高。     

超声引导下经直肠系统性12＋1针前列腺穿刺活检术

目的探讨超声引导下经直肠系统性12＋1针前列腺穿刺活检术诊断前列腺癌的临床价值。方法回顾性分析816例经直肠前列腺系统性12＋1针穿刺活检的可疑前列腺癌患者。其中PSA＜4ng／ml、直肠指诊发现结节者66例;PSA介于4～10ng／ml、f／tPSA值异常、PSAD值异常者190例;PSA〉10ng／ml、任何f／tPSA、PSAD值者560例。结果816例患者中活检病理确诊为前列腺癌者358例,总阳性率为43．9％（358／816）。其中位于前列腺尖部阳性者235例,占确诊病例总数的65．6％（235／358）。术后发热9例（1．0％,9／816）,并发血尿49例（6．0％,49／816）。几乎所有患者皆有短时大便带血。无其他严重并发症发生。结论超声引导下经直肠系统性前列腺12＋1针穿刺活检术定位准确,创伤较小,并发症较少。可以随机增加穿刺点,利于提高前列腺癌检出率。     

经直肠超声引导自动活检枪前列腺穿刺260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＞4μg/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例属于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。     

影响二次经直肠前列腺穿刺活检阳性率的因素分析

目的 探讨在二次经直肠前列腺穿刺活检中影响阳性率的因素.方法 回顾性分析2008年1月～2014年2月本院55例首次经直肠前列腺穿刺活检阴性并行二次经直肠前列腺穿刺活检的患者临床资料,依第二次穿刺活检结果分为前列腺癌组与非前列腺癌组.比较两组前列腺特异性抗原(PSA)相关参数及首次穿刺时病理结果的差异,并分析影响第二次穿刺活检阳性率的相关因素.结果 前列腺癌组家族史、前列腺特异性抗原速率(PSAV)、前列腺特异性抗原密度(PSAD)水平与非前列腺癌组比较有显著性差异(P＜0.05);两组首次穿刺活检为高级别前列腺内皮瘤(HGPIN)、非典型小腺泡增生(ASAP)、慢性前列腺炎差异也有统计学意义(P＜0.05);家族史、PSAV、PSAD、HGPIN、ASAP、穿刺针数为影响二次前列腺穿刺活检阳性率的相关因素.结论 对首次前列腺穿刺活检阴性的患者,结合患者的家族史、首次穿刺活检的病理结果(HGPIN、ASAP)及PSAV、PSAD等参数,可提高二次穿刺活检的肿瘤阳性率,减少不必要的漏诊及不必要的重复穿刺.     

Transperineal extended biopsy improves the clinically significant prostate cancer detection rate: A comparative study of 6 and 12 biopsy cores

BACKGROUND: We evaluated the improvement in the rate of prostate cancer detection when using a 12-core transperineal biopsy protocol including transitional zone biopsy. METHODS: Between April 2003 and November 2004, 247 consecutive men underwent transperineal systemic 12-core biopsy of the prostate. Six cores were obtained at the peripheral zone, four at the transitional zone and two at the apex. We examined the cancer detection rate in each of the 12 cores, and also determined the improvement of cancer detection resulting from the extensive 12-core versus standard 6-core biopsy. RESULTS: Using the extensive 12-core biopsy, prostate cancer was detected in 98 cases (39.7%). Prostate-specific antigen (PSA), PSA density, the positive rate in digital rectal examination and transrectal ultrasound findings were significantly higher in the prostate cancer group than in the non-prostate cancer group, and prostate volume was larger in non-prostate cancer group. Every site showed almost the same positive rate, between 17.8 and 21.5%. There were 20 cases which were positive in the extended biopsy, but negative in the sextant. The detection improved significantly (20.4%). The improvement of cancer detection in extended biopsy was better in men with PSA levels of 10 ng/mL or less (28.9%), PSA density 0.3 or less (25.8%), negative digital rectal examination (23.3%), and negative transrectal ultrasound (21.6%). Of these twenty patients, no cases with insignificant tumor were detected in the six prostatectomy cases. In particular, three cases of the six were transitional-zone-only cancer. CONCLUSION: Transperineal extended 12-core biopsy including 4 transitional zone cores is a more useful procedure than transperineal 6-core biopsy. Routine transitional zone biopsy, that is different from transrectal biopsy, might be useful for detecting biologically significant cancer.     

Direct comparison between transrectal and transperineal extended prostate biopsy for the detection of cancer

AIM: To establish whether extended transrectal (TR) and extended transperineal (TP) biopsies are equivalent in detecting prostate cancer. METHODS: Due to an elevated prostate-specific antigen (PSA) greater than 2.5 ng/mL or abnormal digital rectal examination findings, 783 men underwent a transrectal ultrasound-guided three-dimensional 26-core biopsy, a combination of TR 12-core and TP 14-core biopsies. Using recursive partitioning, the best combination of sampling sites that gave the highest cancer detection rate at a given number of biopsy cores was selected either with a TR or a TP approach. The cancer detection rate and characteristics of detected cancers were compared between the TP 14-core and the TR 12-core biopsies and between selected subset biopsy schemes. RESULTS: Prostate cancer was detected in 283 of the 783 men (36%). There was no statistical difference in cancer detection rate or in the characteristics of detected cancers between TP 14-core and TR 12-core biopsies. As far as the best combination of sampling sites was selected, there was no statistical difference in cancer detection rates or in the characteristics of detected cancers between the TP and the TR subset biopsy schemes up to 12 cores. TP and TR biopsies performed equally, regardless of a history of negative biopsy, a digital rectal examination finding, the PSA level or the prostate volume. CONCLUSIONS: We demonstrated for the first time that extended TP biopsy is as effective as its TR counterpart in detecting cancer and the characteristics of detected cancers, as far as sampling sites are selected to maximize the cancer detection rate.     

Clinical, biochemical and pathological features of initial and repeat transrectal ultrasonography prostate biopsy positive patients

BACKGROUND: Using sextant biopsy, 16-41% of prostate cancers were diagnosed on repeat biopsy. The objective of the present study was to compare the differences in the clinical, biochemical and pathological features between patients with positive results on initial and repeat biopsies, with an aim to identify factors that can be used to improve the detection rate of transrectal ultrasound (TRUS) biopsy of the prostate. METHODS: Between February 2000 and April 2001, 222 patients with a mean age of 64 years (range 38-85) underwent TRUS-guided 10-core prostate biopsy for either abnormal prostate specific antigen (PSA) levels (>4 ng/mL) and/or abnormal digital rectal examination (DRE). Of this number, 165 patients underwent their first biopsy, whereas 45 and 12 patients had had one or two previous biopsies, respectively. RESULTS: Prostate cancer detection rates for the initial biopsy group (n = 165), second biopsy group (n = 45) and third biopsy group (n = 12) were 29.7, 23.0 and 41.7%, respectively. Six patients who had a negative first 10-core biopsy underwent a second 10-core biopsy and one patient (16%) was found to have cancer. Apart from total prostate volume, there were no significant statistical differences between the patient age, mean total PSA, PSA density, PSA-transition zone density, DRE and TRUS findings between the initial and repeat biopsy groups of subjects who had cancer. Those who had cancer detected only on repeat biopsies had larger prostate glands (P = 0.041). CONCLUSION: Patients who had cancer detected only on repeat biopsies had bigger prostate glands, supporting the hypothesis that TRUS sextant biopsy as a technique suffers the error of under-sampling in a bigger prostate.     

Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection

PURPOSE: Previous studies have indicated that 6-core transrectal prostate biopsy misses a considerable number of cancers. We performed an extensive biopsy protocol of 12-core sampling using both transperineal and transrectal approaches to determine the impact on the cancer detection rate. MATERIALS AND METHODS: We prospectively evaluated 402 men who underwent 6-core transperineal and 6-core transrectal biopsies simultaneously due to abnormal digital rectal examination (DRE) and/or elevated prostate-specific antigen (PSA) levels of 4.0 ng/mL or greater. Using the transperineal approach we obtained four cores from the bilateral peripheral zone targeting the lateral and parasagittal areas and two cores from the bilateral transition zone. The following transrectal biopsy was performed traditionally. We compared cancer detection rate between the extended 12-core procedure and conventional 6-core transperineal and transrectal groups in terms of total PSA and DRE findings. RESULTS: Using the extensive combined method, prostate cancer was detected in 195 cases (48.5%) and the detection rate significantly increased 7.2% and 8.5% compared to the transperineal and transrectal groups, respectively. According to PSA levels and DRE findings, the cancer detection rate by the combined method was significantly improved in patients with PSA levels of 4-10 ng/mL and negative DRE: 10.3% and 11.6% compared to the transperineal and transrectal groups, respectively. CONCLUSIONS: The extensive 12-core method significantly improved the overall cancer detection rate and was especially efficient for men with PSA levels of 4-10 ng/mL accompanied by a negative DRE finding.     

Saturation technique does not improve cancer detection as an initial prostate biopsy strategy

PURPOSE: We reported on the results of a sequential cohort study comparing office based saturation prostate biopsy to traditional 10-core sampling as an initial biopsy. MATERIALS AND METHODS: Based on improved cancer detection of office based saturation prostate biopsy repeat biopsy, we adopted the technique as an initial biopsy strategy to improve cancer detection. Two surgeons performed 24-core saturation prostate biopsies in 139 patients undergoing initial biopsy under periprostatic local anesthesia. Indication for biopsy was an increased PSA of 2.5 ng/dl or greater in all patients. Results were compared to those of 87 patients who had previously undergone 10-core initial biopsies. RESULTS: Cancer was detected in 62 of 139 patients (44.6%) who underwent saturation biopsy and in 45 of 87 patients (51.7%) who underwent 10-core biopsy (p >0.9). Breakdown by PSA level failed to show benefit to the saturation technique for any degree PSA increase. Men with PSA 2.5 to 9.9 ng/dl were found to have cancer in 53 of 122 (43.4%) saturation biopsies and 26 of 58 (44.8%) 10-core biopsies. Complications included 3 cases of prostatitis in each group. Rectal bleeding was troublesome enough to require evaluation only in 3 men in the saturation group and 1 in the 10-core group. CONCLUSIONS: Although saturation prostate biopsy improves cancer detection in men with suspicion of cancer following a negative biopsy, it does not appear to offer benefit as an initial biopsy technique. These findings suggest that further efforts at extended biopsy strategies beyond 10 to 12 cores are not appropriate as an initial biopsy strategy.     

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

The objective of this study is to evaluate the performance of urology residents at each training level in detecting prostate cancer with transrectal ultrasound-guided (TRUS) biopsy. The inclusion criteria were: (1) prostate-specific antigen (PSA) 4-10 ng/ml; and (2) 10-12 cores per biopsy session. Data from repeat biopsy sessions were excluded. Overall prostate cancer detection rate for 170 patients was 39.4%. PSA, digital rectal examination (DRE), and prostate volume were predictors of cancer detection. There were no significant differences in overall cancer detection rates, PSA, DRE, or prostate volume between resident levels. In conclusion, urology residents at all levels of training perform equally well at detecting cancer using TRUS prostate biopsy technology.     

A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection

PURPOSE: Several studies suggest that sextant transrectal ultrasound guided biopsy of the prostate provides insufficient material to detect all clinically important prostate cancer, and obtaining more biopsy cores may improve the cancer detection rate. We performed a prospective randomized trial comparing 6 to 12 prostate biopsy cores to determine the impact on the cancer detection rate. MATERIALS AND METHODS: We prospectively randomized 244 men, including 71 (29%) black men, with a mean age plus or minus standard deviation of 65 +/- 8 years to undergo biopsy with 6 or 12 peripheral zone tissue cores. In our study subjects serum total prostate specific antigen (PSA) was between 2.5 and 20 ng./ml., and/or digital rectal examination was suspicious for cancer. All men completed a self-administered pre-biopsy and 2 post-biopsy questionnaires at 2 and 4 weeks. Cancer detection rates were compared in the groups and correlated with race, biopsy history, digital rectal examination findings, total PSA, transrectal ultrasound volume and PSA density, as determined by the formula, total PSA/transrectal ultrasound volume. RESULTS: The cancer detection rate in the 6 and 12 core groups was almost identical (26% and 27%, p = 0.9). There was no significant difference in cancer detection in the 2 trial arms with respect to subject race, biopsy history, digital rectal examination findings, total PSA, transrectal ultrasound volume or PSA density. However, our study did not have the statistical power to rule out small differences. CONCLUSIONS: The overall cancer detection rate is not materially increased by 12 core, peripheral zone biopsy in men in whom prostate cancer was mainly detected by screening.     

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.     

Prevalence and Predictors of a Positive Repeat Transrectal Ultrasound Guided Needle Biopsy of the Prostate

Purpose

We determined the prevalence of and risk factors for carcinoma in patients with 1 previously negative prostate biopsy.

Materials and Methods

Transrectal ultrasound guided prostate needle biopsies were repeated in 130 men. Risk factors analyzed included age, pathological result of initial biopsy, inter-biopsy interval, prostate specific antigen (PSA), PSA density, PSA velocity, digital rectal examination, abnormal transrectal ultrasound and family history of prostate cancer.

Results

A total of 39 patients (30%) had positive biopsies for cancer. Univariate analysis revealed that PSA more than 20 ng./ml. and abnormal transrectal ultrasound were more frequent in men with positive second biopsies. Using multivariate logistic regression analysis only PSA more than 20 ng./ml. was a significant risk factor (adjusted odds ratio 4.48, 95% confidence interval 1.02 to 20.1). We determined the incidence of carcinoma in patients who represent the lowest risk group as defined by PSA less than 10 ng./ml., PSA density less than 0.15 mg./ml./cm.³, PSA velocity less than 0.75, ng./ml. per year, no prostatic intraepithelial neoplasia plus negative transrectal ultrasound, digital rectal examination and family history. Of 21 patients who fit this cohort 5 (23.8%) had carcinoma on repeat biopsy.

Conclusions

A significant false-negative rate for initial transrectal ultrasound guided prostate biopsies exists. Baseline risk in lowest risk patients is sufficiently high such that one cannot define a subset of patients for whom repeat biopsy is unnecessary. We recommend repeat biopsy in all patients who meet the criteria for a transrectal ultrasound guided biopsy and in whom the initial biopsy is negative.     

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。