多普勒超声引导前列腺穿刺活检与血清PSA检测在前列腺癌诊断中的应用价值

目的 探讨直肠多普勒超声引导前列腺穿刺活检(超声引导穿刺活检)与血清前列腺特异性抗原(PSA)检测诊断前列腺癌(PCA)的临床价值。方法 选取宝丰县人民医院2020-01—2020-12手术治疗的73例疑似PCA的患者。术前均行超声引导穿刺活检和血清PSA检测。以术后病理学检查结果为“金标准”,分析超声引导穿刺活检和血清PSA检测与术后病理诊断PCA的一致性及诊断价值。结果 超声引导穿刺活检与术后病理诊断一致性Kappa值为0.933,血清PSA检测结果与术后病理学检查结果一致性Kappa值为0.506。超声引导穿刺活检的敏感度、特异度、阴性预测值均高于血清PSA检测,差异有统计学意义(P<0.05)。结论 与血清PSA检测比较,超声引导穿刺活检诊断PCA的准确度高,具有较高的PCA诊断价值。但由于超声引导穿刺活检属于有创检查,而且有一定的并发症风险,故在PCA的筛查中仍以血清PSA检测为主。对血清PSA水平持续异常升高的患者,应常规行超声引导穿刺活检,以排除PCA。     

超声引导下前列腺12针系统穿刺活检增加前列腺癌检出率的研究

目的:探讨不同年龄及前列腺特异性抗原(PSA)分组对12针穿刺活检前列腺癌检出率及肿瘤特征的影响。方法:临床表现怀疑前列腺癌患者210例,按照患者的年龄分为≤59岁组、60～69岁组、70～79岁组、≥80岁组,按照PSA水平分为0～4μg/L组、4.1～10μg/L组、10.1～20μg/L组、20.1～50μg/L组、>50μg/L组,记录患者临床资料及活检结果。提出不同的穿刺方案并计算其检出率。结果:210例怀疑为前列腺癌患者,检出前列腺癌91例,总的前列腺癌检出率为43.3%,随着年龄的增长,PSA水平的提高,检出率逐渐提高。年龄的增长、PSA水平的提高与体积较大、分级较高的肿瘤密切相关。外周带穿刺与旁正中矢状尖部穿刺有较高的前列腺癌检出率。当患者年龄<60岁,PSA水平<20μg/L时,12针穿刺活检为较佳方案。结论:12针穿刺活检可以弥补6针穿刺活检的缺陷,随着患者年龄的增长,PSA水平的提高,肿瘤的体积增大、病理分级较差。传统6针穿刺法与12针相比,受患者年龄、PSA水平的影响较大。     

直肠超声引导下经会阴和直肠前列腺穿刺活检术诊断灰区前列腺癌的对比研究

正直肠超声引导下经会阴与经直肠前列腺穿刺活检术均是目前诊断前列腺癌的常用方法,诊断前列腺癌各有其优缺点。我院2009年1月至2015年1月行前列腺穿刺活检术共150例,对两种前列腺穿刺方法的阳性率、并发症发生率进行比较,现报告如下。1资料与方法1.1一般资料选择本院2009年1月至2015年1月就诊的前列腺特异性抗原(prostate specific anti-     

特异性抗原密度联合前列腺穿刺活检诊断前列腺癌的价值

目的 :评价前列腺移行带特异性抗原密度 (PSAT)与前列腺穿刺活检联合检测在前列腺癌 (PCa)诊断中的价值。方法 :对 4 9例血清PSA >10 μg/L患者行前列腺穿刺活检后 ,部分给予重复穿刺及手术治疗 ,综合比较PSAT。结果 :4 9例中 ,前列腺活检病理检查诊断为PCa 2 4例 (4 8.98% ) ,良性前列腺增生 (BPH) 2 5例 (5 1.0 2 % ) ,其PSAT平均值分别为 (0 .6 1± 0 .11)、(0 .38± 0 .13) μg/L ,两者相比差别有统计学意义 (P <0 .0 1) ;后者行手术治疗后病理检查诊断为PCa 6例 (2 4 % ) ,BPH 19例 (76 % ) ,其PSAT平均值分别为 (0 .4 0± 0 .11)、(0 .32± 0 .0 7) μg/L ,两者相比差别有统计学意义 (P <0 .0 5 )。结论 :PSAT对PCa ,特别是早中期PCa的诊断 ,比前列腺穿刺活检更为敏感 ,二者联合检测对临床诊治有重要的价值和意义。     

8点及12点前列腺穿刺活检诊断前列腺癌的价值比较研究

目的比较8点及12点前列腺穿刺活检诊断前列腺癌的价值,分析前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)及前列腺体积(PV)对前列腺癌检出率(PCDR)的影响。方法回顾性分析260例因PSA异常增高而接受首次直肠超声引导下前列腺穿刺活检的患者相关资料,其中132例患者接受8点穿刺,128例患者接受12点穿刺。结果依据PSA、PV、PSA与PV及PSAD,患者被进一步分组。8点及12点的总的PCDR没有显著的差异,在PV≥45mL、PSA≥10ng/mL且PV≥45mL及0.15ng/(mL·cm3)≤PSAD≤0.25ng/(mL·cm3)组中,12点的PCDR明显高于8点。结论 8点及12点前列腺穿刺总的PCDR没有显著区别(P0.05),但在PV较大同时PSA较高或者PSAD处于中等大小时(0.15~0.25)ng/(mL·cm3),12点的PCDR明显高于8点(P均0.05)。     

建立一种简易评分系统预测前列腺穿刺活检前列腺癌阳性率

目的:分析经直肠前列腺穿刺活检前列腺癌阳性率的预测因素。方法:总结2006年1月至2014年4月进行经直肠超声引导下前列腺穿刺活检患者的资料,包括年龄(age)、体质指数(BMI)、症状(syptoms)、直肠指检(DRE)、血清总PSA(t PSA)、游离PSA(f PSA)、游离PSA与总PSA比值(f/t PSA)、前列腺体积(PV)、PSA密度(PSAD)。通过单因素方差分析和多因素回归模型,筛选与活检阳性率相关的危险因素。在此基础上构建一个评分系统作为在活检前预测前列腺癌阳性率的工具,并通过受试者工作特征(ROC)曲线计算假阳性率,以检测评分系统的敏感性。结果:在385例经直肠超声引导下穿刺活检患者中,共139例患者被诊断为前列腺癌,阳性率36.1%。单因素分析显示,在活检阳性组和阴性组之间,年龄(P<0.01)、DRE(P<0.01)、t PSA(P<0.01)、f PSA(P<0.01)、f/t PSA(P<0.01)、PV(P<0.01)和PSAD(P<0.01)在前列腺癌患者中比例均高于活检阴性人群。将单因素回归有意义的因素纳入多因素逐步Logistic分析,结果显示,年龄、t PSA、f/t PSA、PV和PSAD是经直肠反复前列腺活检阳性的独立影响因素,其比值比(ORs)及其相应的95%可信区间(95%CIs)分别为1.07(1.05~1.16)、1.05(1.02~1.15)、0.97(0.86~0.99)、0.98(0.87~0.96)和1.79(1.48~2.06)。根据其OR值,设定年龄>71岁(中位数)、t PSA>14.1μg/L(中位数)、f/t PSA<14.07(中位数)、PV<42.8 ml(中位数)、PSAD>0.31μg/L/ml(中位数)分别各计1分,总分为5分。将385例患者的资料通过评分系统计算前列腺癌的检出率,发现评分为0、1、2、3、4、5分的患者前列腺癌的检出率分别为7.69%、8.98%、15.19%、39.39%、54.55%和72.15%。ROC曲线提示曲线下面积为0.82(95%CI:0.80~0.84,P<0.01)。另外,评分3~5分的患者比0~2分的患者前列腺癌的检出率高50%以上(64%vs 11%,P<0.01)。结论:该评分系统可以帮助泌尿科医师确定需要行前列腺活检的患者。     

经直肠超声引导下前列腺6点穿刺活检术诊断单纯前列腺特异抗原增高型前列腺癌

目的探讨经直肠超声引导下前列腺6点穿刺活检术诊断单纯前列腺特异性抗原(PSA)增高型前列腺癌的临床应用价值。方法回顾分析84例接受经直肠超声引导下前列腺6点穿刺活检术的患者资料。所有患者直肠指诊及常规超声检查结果均为阴性。根据血清PSA分为4组:A组24例,PSA 4~20ng/ml;B组8例,PSA 21~30ng/ml;C组32例,PSA 31~100ng/ml;D组20例,PSA100ng/ml。结果 84例患者穿刺术后均未出现并发症。49例穿刺病理诊断为前列腺癌(49/84,53.33%),其中A组检出1例(1/49,2.04%),B组检出4例(4/49,8.16%),C组检出24例(24/49,48.98%),D组检出20例(20/49,40.82%)。A、B、C、D组中前列腺穿刺活检阳性率分别为4.17%(1/24)、50.00%(4/8)、75.00%(24/32)、100%(20/20),差异有统计学意义(χ2=47.143,P0.05)。结论经直肠超声引导下前列腺6点穿刺活检术并发症少,对单纯PSA增高型前列腺癌具有较高的阳性率。     

血清PSA密度在前列腺活检中的意义

目的 探讨血清ＰＳＡ密度（ＰＳＡＤ）在前列腺活检中的意义。方法 对１７３例血清ＰＳＡ升高，有阳性直肠指诊或异常直肠Ｂ超发现者，进行了前列腺活检。对血清ＰＳＡＤ与前列腺活检的关系进行分析。结果 １７３例活检的前列腺肿瘤阳性率为５０．３％（８７／１７３），其中前列腺癌８４例，肉瘤２例，移行细胞癌１例，当血清ＰＳＡ为４～２０ｎｇ／ｍｌ，ＰＳＡＤ〈０．１５时，其敏感性和特异性分别为１００．０％和０．０％；     

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。     

A-I型前列腺穿刺器活检筛选前列腺癌的临床意义

目的验证A-I型前列腺穿刺器对临床上前列腺特异性抗原(PSA)>4ng/ml和(或)前列腺直肠指诊、B超发现结节者进行前列腺癌筛查的临床意义。方法采用A-I型前列腺穿刺器,对36例PSA>4ng/ml或有前列腺结节者,在食指引导下进行前列腺左右叶的尖、中间、尾部和触及结节处活检。结果有结节者17例中发现前列腺癌(PCA)5例(29.4%);PSA>4.0ng/ml的34例中,PCA检出15例(44.12%)。分析显示:A-I型前列腺穿刺器与B-超引导系统相比较,对血清PSA>4.0ng/ml者的PCA检出率有明显的差异(x2=5.568,　P<0.05)。结论A-I型前列腺穿刺器完全可以满足临床对筛查前列腺癌的要求,是一种操作简便、易用、费用低廉的前列腺疾病的诊断器械,值得临床推广。     

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.     

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.     

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.     

The incidence of prostate cancer in men with prostate specific antigen greater than 4.0 ng/ml: a randomized study of 6 versus 12 core transperineal prostate biopsy

PURPOSE: The prostate cancer detection rate in patients with elevated prostate specific antigen (PSA) increases with extended needle biopsy protocols. Transperineal biopsy under transrectal ultrasound guidance is rarely reported, although notable cancer diagnoses are obtained with this technique. We describe the results of 6 and 12 core transperineal biopsy. MATERIALS AND METHODS: A total of 214 patients with PSA greater than 4.0 ng/ml were prospectively randomized to undergo 6 or 12 core transperineal biopsy. Each group of 107 patients was comparable in terms of clinical characteristics. The procedure was performed on an outpatient basis using local anesthesia. Specimens were obtained with a fan technique with 2 puncture sites slightly above the rectum (1 per lobe) under transrectal ultrasound guidance. Cores were taken from all peripheral areas, including the far lateral aspect of the prostate. RESULTS: The overall cancer detection rate was 38% and 51% for 6 and 12 core biopsy, respectively. In patients with PSA between 4.1 and 10 ng/ml the cancer detection rate was 30% and 49% for 6 and 12 core biopsy, respectively. CONCLUSIONS: The 12 core transperineal prostate biopsy is superior to 6 core biopsy. The technique provides optimal prostate cancer diagnosis. About half of the patients with PSA greater than 4.0 ng/ml and a slightly lower percent with PSA between 4.1 and 10 ng/ml have prostate cancer.     

Contemporary impact of transrectal ultrasound lesions for prostate cancer detection

PURPOSE: Transrectal ultrasound (TRUS) guided systematic biopsy of the prostate is the gold standard diagnostic modality for prostate cancer. Consequently, the value of discrete hypoechoic lesions on TRUS lesions considered suspicious for cancer deserves meticulous reevaluation, specifically in the prostate specific antigen era when the majority of tumors diagnosed are nonpalpable. We studied whether the predictability of a biopsy core changes if the tissue comes from an isoechoic vs hypoechoic lesion. MATERIALS AND METHODS: Prospective data were collected on 3,912 consecutive patients referred to our medical center between 1993 and 1999 for biopsy of the prostate. A sextant technique (apex, mid gland and base) with an additional core biopsy from the transitional zone was used. If a hypoechoic lesion was identified, the biopsy was taken from the lesion. Correlation between hypoechoic lesions, isoechoic areas and cancer detection for each core was performed. RESULTS: A total of 31,296 cores were obtained from the cohort. Overall 2,642 (68%) cores had at least 1 hypoechoic lesion ultrasonographically. Cancer was detected in 675 (25.5%) and 323 (25.4%) patients with or without hypoechoic lesions (p = 0.97). The per core cancer detection was fairly uniform and averaged 9.3% and 10.4% for hypoechoic and isoechoic areas, respectively. The difference was not statistically significant (p = 0.3). Gleason scores were less than 7, 7 and greater than 7 in 46%, 34% and 20% of cases, respectively. CONCLUSIONS: Despite the higher prevalence of cancers discovered in prostates with hypoechoic areas, the hypoechoic lesion itself was not associated with increased cancer prevalence compared with biopsy cores from isoechoic areas. For impalpable tumors TRUS findings are not contributory for staging.     

Predictors of prostate cancer after initial negative systematic 12 core biopsy

PURPOSE: We determined the cancer detection rate at initial systematic 12 core (S12C) biopsy and identified features associated with cancer at repeat S12C biopsy after an initial negative S12C biopsy in patients with prostate specific antigen (PSA) parameters associated with a higher risk of prostate cancer. MATERIALS AND METHODS: Between February 1999 and June 2002, 841 patients underwent initial S12C biopsy. Of these patients 99 underwent repeat S12C biopsy after initial negative S12C because of a percent free-to-total PSA of 15.0 or less and/or a yearly PSA velocity of 0.75 ng/ml or greater. The association between parameters revealed by initial biopsy and cancer at repeat biopsy was assessed. RESULTS: Of the 99 patients 21 (21.2%) had cancer at repeat biopsy. Age (p = 0.01), PSA transitional zone density (p = 0.05), and high grade PIN at initial biopsy (p = 0.01) were associated with cancer at repeat biopsy. CONCLUSIONS: In this select group of patients with PSA parameters associated with a higher risk of prostate cancer the cancer detection rate after initially negative S12C biopsy was 21%. Patients with high grade PIN on initial biopsy, advanced age and higher PSA transition zone density are at increased risk for cancer at repeat biopsy. Larger prospective studies are required to confirm these results and construct a nomogram that determines the probability of finding prostate cancer at subsequent biopsy.