前列腺癌的诊断

回顾性分析了１８年间１５９例前列腺癌的诊断结果，其发病率近９年明显增高。发病率与年龄呈正相关。直肠指诊诊断阳性率为７２．９６％，经腹Ｂ超６９．２％，ＣＴ９０．３２％，ＡＣＰ４５．７１％，ＰＳＡ８５．９２％，穿刺活检８９．３２％。作者建议：ＤＲＥ，ＰＳＡ可作为６０岁以上男性排尿困难患者的常规检查，期望早期检出前列腺癌。     

分子标志物在前列腺癌早期诊断中的进展

较多的研究显示,血清PSA值指导前列腺癌(prostate cancer,Pca)早期诊断的优势不足,例如PSA值在4～10 ng/mL.时,Pca穿刺阴性率占70%～80%.然而,阴性的穿刺结果并不能完全排除肿瘤的存在.寻找敏感性和特异性更高的肿瘤生物标志物一直是Pca研究的热点.目前,PSA衍生物、PCA3、TMPRSS2:ETS、GSTP1、AMACR、COLPH2、EPCA和肌氨酸以及多瘤标的联合应用研究受到广泛关注.本文中我们综述了这些分子标志物的研究近况,展望了多瘤标组合在Pca早期诊断中的价值和应用前景,为Pca的早期诊断和预后监测提供参考.     

前列腺癌早期诊断的研究进展

前列腺癌(prostate cancer,Pca)是中老年男性常见恶性肿瘤之一,目前尚缺乏有效的晚期癌症治疗方法,因此早期诊断对于降低Pca死亡率至关重要.近年来,较多研究开发出多种新型诊断方法以改善对Pca诊断的准确性,同时避免过度诊疗,但其有效性及实用性尚需进一步验证.本文对目前新型生物标志物、联合成像技术及风险预...     

直肠指诊,血清PSA及经直肠穿刺活检联合诊断前列腺癌的评价（？…

前列腺癌的早期诊断对于选择有效的治疗方法至关重要。对我科１９８８年１１月至１９９８年１１月收治并明确诊断的４９例前列腺癌的直肠指诊（ＤＲＥ）、血清前列腺特异性抗原（ＰＳＡ）及经直肠前列腺穿刺活检方法进行了分析 ,并探讨三种方法单独与联合对前列腺癌的诊断价值。１临床资料本组４９例 ,年龄４６～８３岁 ,平均６４．５岁。主要临床表现有：排尿困难３９例 ,无痛肉眼血尿１４例 ,腰痛７例 ,消瘦及恶液质４例。全部病例均行ＤＲＥ检查 ,发现前列腺异常者４０例（８１．６%）,包括前列腺质地坚硬３５例（７１．４%）；表面不光…     

如何早期发现前列腺癌

不久前,美国的鲍威尔将军成功地进行了前列腺癌手术,康复后很快便回到了国务卿的岗位上,这完全得益于早期发现前列腺癌的先进理念与技术.纵观当今世界,前列腺癌是造成患者死亡最多的癌症之一,其中不乏政界要人和社会名流,例如法国前总统密特朗和伊朗宗教领袖翟梅尼,均是因此而失去了生命.     

经直肠B超诊断前列腺癌

目的：评价经直肠B超（TRUS）临床诊断前列腺癌的价值。方法：应用端扫式双平面高频（7.5MHz)探头经直肠检查56例前列腺癌并分析其声像特征。结果：病灶位于前列腺外周带43例（76.8%）、移行带8例（14.3%)、中央带5例（8.9%)。病灶直接声像学特征：45例（80.4%)低回声型,4例（7.1%)高回声型,2例（3.6%)等回声型,5例（8.9%）混合回声型。病灶间接征象包括前列腺不对称、包膜隆起或中断、精囊扩张或消失。结论：经直肠B超是前列腺癌诊断及判断分散的一种有价值的检查方法。     

青年人直肠癌40例分析

目的　分析青年人直肠癌发病特点。方法　 40例青年直肠癌病人根据年龄、病变范围、临床表现、误诊率进行分析。结果　青年人直肠癌占同期收治直肠癌的 11 5 % ,临床表现以排便频繁、排便习惯改变、便条变细为主 ,误诊率 75 %。结论　青年直肠癌误诊率高 ,预后差 ,为提高诊治水平 ,应提高对青年直肠癌的认识 ,早期诊断 ,坚持早期采集病史进行直肠指诊、乙状结肠镜检查 ,并对高发人群进行普查。     

青年人直肠癌40例分析

目的 分析青年人直肠癌发病特点。方法 40例青年直肠癌病人根据年龄、病变范围、临床表现、误诊率进行分析。结果 青年人直肠癌占同期收治直肠癌的11．5％，临床表现以排便频繁、排便习惯改变、便条变细为主，误诊率75％。结论 青年直肠癌误诊率高，预后差，为提高诊治水平，应提高对青年直肠癌的认识，早期诊断，坚持早期采集病史进行直肠指诊、乙状结肠镜检查，并对高发人群进行普查。     

PSA,PSAD,fPSA在前列腺癌诊断中的应用

目的：测定１６例前列腺癌（ＰＣａ）和３３例前列腺增生（ＢＰＨ）患者血清前列腺特异性抗原（ＰＳＡ）,前列腺特异抗原密度（ＰＳＡＤ）及游离前列腺特异抗原（ｆＰＳＡ）。方法：采用放射免疫法。结果：显示ＰＳＡＤ对ＰＣａ诊断敏感度高而特异阳性预测值低,而ＰＳＡＤ及ｆＰＳＡ／ｔＰＳＡ比值（即参数百分率）是提高ＰＣａ和ＢＰＨ鉴别诊断阳性率的一种较好指标。结论：本实验结果在实际临床应用中有重要意义。     

磁共振在前列腺癌诊断与分期中的作用

前列腺癌的治疗效果与临床分期密切相关。回顾性分析经MR检查的25例前列腺癌，结果：原发灶中T2WI图像结节性病变占88％（22／25），均为混和信号结节，其中相对低信号结节72．7％，相对高信号结节27．3％。45．5％（10／22）的结书可以判别肿瘤所属的解剖分区。与Whitmore－Jeweet标准的临床分期比较，本组MR分期的总符合率为84％（21／25），区分A／B期与C／D期的敏感性为92％。结合文献本文认为MR诊断A、B期前列腺癌缺乏特异性图像，仅可作为筛选方法之一。MR分期总的可靠性较高，对肿瘤精囊浸润的判断有一定价值，但对镜下包膜侵犯及盆腔淋巴结转移的显像MR仍有局限性。     

临床分期和磁共振成像(MRI)对前列腺癌分期的临床意义

目的：探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法：对32例局限性前列腺癌术前经直肠指诊进行临床分期及MRI分期预测前列腺癌根治术后的病理分期结果，评价诊断性实验结果。结果：直肠指诊临床分期和MRI分期预测前列腺癌的病理结果有显著相关性(P=0．002)。临床分期和MRI分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3％和80．9％；对浸润包膜及包膜外肿瘤的预测(NPV)分别为50．0％和88．9％。MRI对前列腺癌病理分期的预测更具有特异性和较高的准确性，能更好的预测前列腺癌的病理结果(P=0．023)。结论：MRI较直肠指诊能更好地预测局限于前列腺内的肿瘤，对前列腺包膜及包膜以外浸润的肿瘤能进行更准确的分期。     

Korean Prostate Cancer Patients Have Worse Disease Characteristics than their American Counterparts

Background: Although the PSA test has been used in Korea for over 20 years, the incidence of prostatecancer has risen, and the associated mortality has increased about 13-fold over the 20-year period. Also, severalinvestigators have suggested that Asians in America are more likely to present with more advanced prostate cancerthan Caucasians. We compared the characteristics of native Koreans and Americans (Caucasians and African-Americans) undergoing radical prostatectomies in Korea and the US. Materials and Methods: Study subjectscomprised patients at Korean and US hospitals from 2004 to 2012 who had undergone radical prostatectomies.We compared the characteristics of the subjects, including age, preoperative prostate-specific antigen (PSA) levels,body mass index (BMI), Gleason score, and pathological T stage. Results: In total, 1,159 males (502 Koreans, 657Americans) were included. The Korean and American patients had mean ages of 67.1±6.6 and 59.2±6.7 years,respectively. The mean preoperative PSAs were 15.4±17.9 and 6.2±4.6 ng/mL (p=0.0001) and the mean BMIswere 23.6±2.6 and 28.7±4.4 kg/m2 (p=0.0001), respectively. Pathological localized prostate cancer represented71.7% of cases for Koreans and 77.6% for Americans (p=0.07). According to age, Koreans had higher T stagesthan Americans in their 50s (p=0.021) and higher Gleason scores than Americans in all age groups. Accordingto PSA, Koreans had higher Gleason scores than Americans for PSA >10 ng/mL (p<0.05). According to prostatesize and Gleason scores, Koreans had higher PSA values than Americans (p<0.01). Conclusions: These resultsshow that Korean patients have elevated risk of malignant prostate cancers, as indicated by the significantlyhigher Gleason scores and PSAs, suggesting a need for novel prostate cancer treatment strategies in Korea.     

Diagnostic Performance of the Prostate Cancer Antigen 3 Test in Prostate Cancer: Systematic Review and Meta-analysis

PurposeTo explore the diagnostic accuracy of prostate cancer antigen 3 (PCA3) test for the diagnosis of prostate cancer in this systematic review and meta-analysis.Patients and MethodsA systematic literature search of Medline, Embase, and Cochrane Library databases up to October 2019 was performed. The sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated. The summary receiver operator characteristic graph came from individual studies. We also conducted metaregression analysis to identify the moderated factors.ResultsAcross 54 studies (17,575 patients), the pooled sensitivity, specificity, and diagnostic odds ratio of PCA3 were 0.71 (95% CI, 0.67-0.74), 0.68 (95% CI, 0.63-0.74), and 5.28 (95% CI, 4.28-6.51), respectively. The area under the summary receiver operator characteristic curve was 0.75 (95% CI, 0.71-0.79).ConclusionPooled data indicated that the PCA3 test had moderate sensitivity and specificity in the diagnosis of prostate cancer. PCA3 could be used as a noninvasive method for the diagnosis of prostate cancer.     

误诊为膀胱癌的前列腺癌12例临床分析

目的：提高对前列腺癌基底部肿瘤的正确认识,规范前列腺癌的诊断,避免前列腺基底部肿瘤误诊为膀胱肿瘤。方法：收集并回顾性分析2003年4 月～2010年4 月本院收治的12例入院前误诊为膀胱癌的前列腺癌患者的临床资料。结果：本组患者平均年龄70.5 ± 7.8 岁,PSA 平均为43.62ng/mL。12例均行直肠指诊（DRE ）发现前列腺质硬8 例,质韧4 例,Ⅱ° 肿大者7 例,Ⅲ°肿大5 例,可及结节5 例。9 例行MRI 检查其中8 例考虑为前列腺癌累及膀胱,1 例考虑为前列腺癌。12例行前列腺穿刺活检（6 针法）结果均为前列腺腺癌,Gleason评分：7～8 分。临床分期T4N1M1b 7 例,T4N0M0 5 例。结论：多方位、多角度的影像学检查,重点观察前列腺结构是否紊乱,对称性是否消失,包膜是否完整,膀胱壁连续性是否存在,并联合PSA 、DRE 等检查,必要时行前列腺穿刺活检,有助于前列腺基底部肿瘤的正确诊断,对前列腺癌与膀胱癌鉴别诊断有重要价值。     

前列腺癌的诊断(附65例分析)

报告６５例经病理确诊的前列腺癌,讨论了其早期诊断的方法及其临床价值。方法经直肠指诊,经直肠超声,经腹会阴超声,前列腺特异性抗原,酸性磷酸酶诊断前列腺癌。结果以上几种诊断阳性率分别为８５％、７５％、６２％、８０％和３５％。结论ＤＲＥ,ＴＲＵＳ,ＰＳＡ及经直肠穿刺检是目前筛选及早期诊断ＰＣ的重要方法。     

Predictive Value of the Platelet-To-Lymphocyte Ratio in Diagnosis of Prostate Cancer

Purpose: To predict prostatic carcinoma using a logistic regression model on prebiopsy peripheral bloodsamples. Materials and Methods: Data of a total of 873 patients who consulted Urology Outpatient Clinics of FatihSultan Mehmet Training and Research Hospital between February 2008 and April 2014 scheduled for prostatebiopsy were screened retrospectively. PSA levels, prostate volumes, prebiopsy whole blood cell counts, neutrophiland platelet counts, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), biopsy resultsand Gleason scores in patients who had established diagnosis of prostate cancer (PCa) were evaluated. Results:This study was performed on a total of 873 cases, with an age range 48-76 years, divided into three groups asfor biopsy results. with diagnoses of benign prostatic hyperplasia (BPH) (n=304, 34.8 %), PCa (n=265, 30.4 %)and histological prostatitis (n=304; 34.8 %). Intra- and intergroup comparative evaluations were performed.White blood cell and neutrophil counts in the histological prostatitis group were significantly higher than thoseof the BPH and PCa groups (p=0.001; p=0.004; p<0.01). A statistically significant intergroup difference wasfound for PLR (p=0.041; p<0.05) but not lymphocyte count (p>0.05). According to pairwise comparisons, PLRwere significantly higher in the PCa group relative to BPH group (p=0.018, p<0.05, respectively). Though notstatistically significant, higher PLR in cases with PCa in comparison with the prostatitis group was remarkable(p=0.067, and p>0.05, respectively). Conclusions: Meta-analyses showed that in patients with PSA levels over4 ng/ml, positive predictive value of PSA is only 25 percent. Therefore, novel markers which can both detectclinically significant prostate cancer, and also prevent unnecessary biopsies are needed. Relevant to this issuein addition to PSA density, velocity, and PCA3, various markers have been analyzed. In the present study, PLRw ere found to be the additional predictor of prostatic carcinoma.