彩超引导下6点随机法前列腺活检的应用价值

目的:探讨经直肠超声引导下对PSA增高伴直肠指检阳性和/或经直肠超声检查发现异常回声的临床可疑前列腺癌的患者6针随机改良法前列腺穿刺活检的应用价值.方法:对104例PSA>4.0ng/mL伴直肠指检阳性和/或经直肠超声检查异常回声的临床可疑前列腺癌的患者行经直肠超声引导下6针随机改良法前列腺穿刺活检.即在外腺、病变可疑处、血流丰富处顺时针方向重点取材6条组织,将活检病理结果与术后病理结果进行对照,并与经直肠超声引导下13针前列腺穿刺病理活检结果进行比较.结果:104例PSA增高的临床可疑前列腺癌的患者中,穿刺活检病理结果59例为前列腺腺癌,45例为前列腺增生.与术后病理结果对照穿刺活检阳性率100%,前列腺腺癌检出率56.7%(59/104).与13针经直肠前列腺穿刺活检阳性率39%(20/51)相比,差异有显著性意义(P<0.05).结论:本研究与传统的经直肠超声引导13针前列腺穿刺活检术相比,对PSA增高伴直肠指检阳性和,或经直肠超声检查发现异常回声的临床可疑前列腺癌的患者采用经直肠超声引导下6针随机改良法穿刺活检,在减少了穿刺针数,缩短了手术时间,减少患者痛苦和并发症发生的同时保证了标本的阳性检出率,具有一定的临床应用价值,是一种安全、有效、微创的前列腺疾病诊断方法.     

前列腺体积与穿刺活检阳性率和前列腺癌恶性程度的相关性

目的:分析我院确诊为前列腺癌患者的病例资料,探讨其中超声引导下经直肠前列腺穿刺活检病例的前列腺体积(PV)与穿刺阳性率和前列腺癌恶性程度的关系.方法:回顾性分析我院1998年至今诊断明确的前列腺癌共计419例,将其中346例行前列腺穿刺活检明确诊断的病例与同期430例行前列腺穿刺活检但未诊断前列腺癌的病例进行回顾性比较分析.结果:癌症组与非癌症组相比,高PSA病例较多(P＜0.05).两组中,前列腺体积大于60ml(16.8％ vs 36.3％)和PV小于40ml(29.5％ vs 15.3％)的病例比较,差异有统计学意义.经直肠指检或经直肠超声检查有阳性发现的病例比差异较明显(65.0％ vs21.4％).两组间PS-AD值的差异有统计学意义:4.830 7 ng/ml2(0.013 5～58.107 8 ng/ml2) vs0.503 5 ng/ml2(0.015 5 ～12.850 1 ng/ml2).癌症病人中PV大于60ml的病例与PV小于等于60ml的病例相比,不同Gleason评分的病例相比,差异有统计学意义(P＜0.05).结论:前列腺体积与前列腺穿刺活检的阳性率呈负相关,也与前列腺癌恶性程度呈负相关.6针穿刺活检法存在一定局限性.     

5种前列腺穿刺活检方式的对比研究

目的比较5种不同前列腺穿刺活检方式的前列腺癌检出率和并发症情况。方法收集2001年至2012年间前列腺穿刺活检的住院病例239例,分别采用经会阴6点、手指引导6点、经直肠超声引导6点、5区13针(13点)和6+4(10点)5种不同穿刺活检方式分组。比较5种前列腺穿刺活检方式的阳性率及并发症情况;同时对比按年龄、直肠指检(DRE)结果、前列腺特异性抗原(PSA)和直肠超声(TRUS)情况分组后的相关结果。结果 5种不同穿刺方式组的前列腺癌检出阳性率差异无统计学意义(χ2=6.530,P>0.05);5组血尿阳性率的差异有统计学意义(χ2=9.947,P<0.05),其中5区13针组的血尿阳性率分别高于6+4组和超声6点组(P<0.005),手指6点组血尿阳性率高于6+4组(P=0.005)。按不同年龄和PSA水平分组后,PSA>20μg/L组的前列腺癌检出阳性率高于<10μg/L和10~20μg/L组(P<0.012 5);>80岁组的前列腺癌检出阳性率也高于<70岁组(P<0.025);同时DRE阳性和TRUS可疑组的前列腺癌检出阳性率也均高于阴性组(均P<0.05)。而各分层分组并发症发生情况均无统计学差异(均P>0.05)。结论对国内临床就诊人群,初次穿刺活检者采用10点的前列腺扩充穿刺即可,部分临床局部进展或前列腺体积较小者,采用6点穿刺足够诊断需要。对未细分穿刺人群简单的统一采用12点以上的穿刺方式不应是最佳选择。     

前列腺肿物检查方法的临床评价

目的评价血清前列腺特异性膜抗原（PSA）和各项物理检查对指导前列腺活检的意义。方法结合血清PSA、直肠指诊（DRE）、直肠B超（TRUS）及磁共振成像（MRI）检查,对148例可疑前列腺病变患者,经直肠B超引导下行前列腺穿刺活检。结果前列腺活检阳性率为43.9%（65/148）。DRE和PSA对前列腺癌的诊断有意义(P＜0.05),其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE（P<0.01）,但前述三者之间对前列腺癌的诊断差异无显著性（P=0.46,P＝0.16,P＝0.52）。MRI的敏感性高于DRE和TRUS（P=0.05,P=0.01）,TRUS的特异性高于PSA或MRI（P=0.02,P=0.001）。结论前列腺活检是诊断前列腺癌的重要手段,其初步筛选以DRE加PSA为主,同时结合TRUS及MRI,可提高筛选的敏感性和特异性,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。     

经直肠超声引导前列腺穿刺活检术的应用价值

[目的]探讨经直肠超声引导下前列腺穿刺活检术对诊断前列腺疾病的临床应用效果.[方法]对163例临床怀疑前列腺癌患者,行经直肠超声引导前列腺穿刺活检术,并对结果进行回顾性统计分析.人选患者为前列腺特异性抗原(PSA)＞4μg/L,和(或)B超或直肠指检发现前列腺结节者.对于PSA在4～10μg/L者,结合游离PSA/总PSA比值(F/T),＜0.16者行穿刺术.前列腺穿刺活检取材方案为6～12针.[结果] 163例患者病理证实前列腺腺泡癌76例,良性前列腺增生58例,前列腺不典型增生16例,慢性前列腺炎症8例,前列腺内皮瘤形成5例.前列腺癌穿刺阳性率为46.6％.引入游离PSA/总PSA比值后,能提高PSA在4～10μg/L患者中的穿刺阳性率,但差异未达到统计学意义.术后并发症主要为血尿、大便表面带血、发热,发生率分别为45.4％、7.4％、1.8％.[结论]经直肠超声引导前列腺穿刺活检术安全有效,对前列腺癌早期诊断具有较高临床应用价值.结合PSA以及游离PSA/总PSA比值可以有效提高前列腺穿刺阳性率.     

经直肠超声引导前列腺穿刺活检方案的合理选择

目的 分析经直肠超声(TRUS)和前列腺特异性抗原(PSA)及其相关参数在前列腺穿刺活检中的作用,探讨个体化前列腺穿刺方案的可行性。方法 回顾性分析195例患者的首次穿刺活检资料,所有患者均采用系统8点穿刺方案,并对可疑病灶增加1~2点。依据穿刺病理结果,分析前列腺癌(PCa)检出率与TRUS、PSA及其相关参数的关系。结果 195例患者中检出PCa 98例(50.3%),其中PSA 4~10 ng/mL组45例,检出PCa 16例(35.6%),其中TRUS(+)且PSATZ≥0.35 ng/mL² 210例均证实为PCa;PSA＞10 ng/mL组150例,检出PCa 82例(54.7%)。PSA 4~10 ng/mL与PSA＞10 ng/mL两组患者PCa检出率差异有统计学意义(P＜0.05),且两组中TRUS(+)与TRUS(-)患者相较PCa检出率差异均有统计学意义(P＜0.01)。结论 依据TRUS、PSA及其相关参数制定个体化前列腺穿刺方案是可行的。     

PSAT 在前列腺穿刺活检中的意义

目的:探讨前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义。方法:对120例患者行前列腺穿刺活检,其中PSA≥4ng/ml者105例,PSA<4ng/ml且直肠指诊及经直肠B超有阳性发现者15例。对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析。结果:120例患者中经前列腺穿刺诊断为前列腺癌(PCa)63例,活检阳性率52.5,其中15例PSA<4ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,前列腺小细胞癌2例,腺癌4例,良性前列腺增生8例;42例>20ng/ml者中32例为PCa,活检阳性率76.2;63例PSA4-20ng/ml者中24例为PCa,活检阳性率38.1;29例PSA4-10ng/ml者中10例为PCa,活检阳性率34.5。血清PSA4-20ng/ml患者,PSAD≥0.13或PSAT≥0.15时,敏感性均为100,特异性为20.5或17.9,阳性预测值为43.6或42.9,可避免12.7(8/63)或11.1(7/63)阴性穿刺结果。血清PSA4-20ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为11.18±4.49和10.05±4.29ng/ml(P=0.318);PSAD分别为0.45±0.33和0.26±0.15(P=0.003);PSAT分别为0.94±0.65和0.43±0.24(P=0.000)。血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.576、0.676和0.77,PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P<0.05)。结论:PSA4-20ng/ml时,PSAT对预测患者是否行前列腺穿刺活检有较大帮助。     

ROC曲线分析波谱定量分析在前列腺癌中的诊断价值

目的：探讨MR波谱（magnetic resonance spectroscopy,MRS）定量分析方法在前列腺癌（prostatic carci-noma,PCa）诊断中的意义。方法：对所有疑诊PCa患者行前列腺磁共振波谱分析,酶联免疫法测定血清前列腺特异抗原（PSA）,经直肠超声测定前列腺体积,计算前列腺特异抗原密度（PSAD）,经超声引导下系统穿刺活检证实的71例良性前列腺增生患者和31例PCa患者,分别测量各个位置（胆碱＋肌酸）/枸橼酸盐[（Cho＋Cre）/Cit]的比值,并取均值。结果：前列腺穿刺阳性组的PSA、PSAD及（Cho＋Cre）/Cit的比值分别为23.73±19.06、0.62±0.42、2.33±0.66;前列腺穿刺阴性组的PSA、PSAD及（Cho＋Cre）/Cit的比值分别为8.61±4.47、0.15±0.13、0.73±0.39。阳性组的检测值均较阴性组高（P〈0.05）。PSA、PSAD及（Cho＋Cre）/Cit在ROC曲线下的面积分别为0.71、0.76、0.84。在保持93.5%的敏感性以上时,PSA、PSAD及（Cho＋Cre）/Cit的特异性是43.7%、63.4%和83.1%,（Cho＋Cre）/Cit较PSA、PSAD能更好地检出PCa。结论：MRS分析方法定量评价PCa的代谢改变,有助于PCa的早期诊断,同时结合PSA、PSAD更有助于前列腺癌诊断的特异性。     

血清PSA联合PSAD检测对前列腺癌的诊断价值

目的:探讨血清前列腺特异抗原（PSA）、前列腺特异抗原密度（PSAD）对前列腺癌的诊断价值。方法:检测经病理确诊的57例前列腺癌、125例前列腺增生患者的血清PSA。经直肠超声测定其前列腺的体积（PV）并计算PSAD。结果:前列腺癌组患者的PSA、PSAD明显高于前列腺增生组(P<0.05)。PSA值在4.1-10.0,10.1-20.0,>20.0ng/ml区间时PCa诊断率分别为8.8%,36.8%,54.4%。前列腺癌组的ROC曲线图中PSAD的AUC值（0.682）高于PSA的AUC值（0.601）,当取PSAD≥0.18ng/（ml·cm3）时,敏感性为84.5%,特异性为78.6%。比较58例重复穿刺患者的PSA、PSAD,只有PSAD差异有统计学意义(P<0.05)。结论:PSA动态监测结合PSAD是重复穿刺的重要参考指标,PSAD是PSA对前列腺癌诊断的有益补充。     

血清PSA及超声引导穿刺活检对前列腺癌病理分期预测价值研究

目的 研究血清前列腺特异性抗原(PSA)及超声引导穿刺活检对前列腺癌病理分期的预测价值.方法 选取200例经直肠超声引导前列腺穿刺活检确诊为前列腺癌的患者的临床资料进行研究.分析患者的血清PSA、穿刺活检阳性百分数及Gleason评分3个参数与前列腺癌病理分期的相关性;同时对比性分析以上3个参数在不同病理分期前列腺癌患者中的差异情况.结果 血清PSA、穿刺活检阳性百分数及Gleason评分均与前列腺癌患者的病理分期呈正相关(P﹤0.001);D期前列腺癌患者的血清PSA水平明显高于A期、B期、C期前列腺癌患者(P﹤0.05),而A期、B期、C期前列腺癌患者的血清PSA水平两两之间比较,差异均无统计学意义(P﹥0.05);C期与D期前列腺癌患者的穿刺活检阳性百分数比较,差异无统计学意义(P﹥0.05),而其他各分期间穿刺活检阳性百分数两两比较,差异均有统计学意义(P﹤0.05);A期与C期、B期与C期、A期与D期、B期与D期前列腺癌患者的Gleason评分比较,差异均有统计学意义(P﹤0.05),而A期与B期、C期与D期前列腺癌患者的Gleason评分比较,差异无统计学意义(P﹥0.05).结论 血清PSA、穿刺活检阳性百分数及Gleason评分均可单独用于前列腺期病理分期的预测,同时该3个参数在区分前列腺癌病理分期方面也发挥一定辅助作用.     

基于多参数MRI（PI-RADS）认知融合经会阴前列腺穿刺活检术与系统性穿刺诊断的有效性比较

目的:探索基于多参数核磁（MRI）和前列腺影像报告和数据系统（PI-RADS）的认知融合经会阴前列腺穿刺活检术和系统性穿刺诊断的有效性和安全性差异。方法:选取2018年01月至2021年02月我院收治的可疑前列腺癌（PCa）并行经会阴前列腺活检的患者,行多参数MRI扫描并依据PI-RADS对可疑病灶予以评分。入组患者随机分为基于多参数MRI（PI-RADS）认知融合经会阴前列腺穿刺组（试验组）和系统性穿刺组（对照组）,分析两组的穿刺阳性率、病理信息和并发症等资料;在试验组内,根据穿刺步骤分为单纯认知融合穿刺组（TB组）和单纯系统性穿刺组（SB组）,比较两种方式在病理信息方面的差异性。结果:最终入组80例患者。两组在总体PCa和无临床意义PCa诊断阳性率方面无差异性,但试验组对有临床意义前列腺的诊断阳性率高于对照组（P＜0.05）;试验组可获得更多的阳性针数占比、肿瘤组织占比及Gleason评分等信息（P均＜0.05）;在试验组内,TB组与SB组在诊断阳性率方面的差异无统计学意义（P＞0.05）,但TB组可获得更高的阳性针数占比、肿瘤组织占比及Gleason评分（P均＜0.05）。试验组与对照组在操作后并发症方面均无差异性（P均＞0.05）。结论:基于多参数MRI（PI-RADS）认知融合经会阴前列腺穿刺术相比于系统性穿刺可提高有临床意义PCa的诊断阳性率,并且可获得更高的肿瘤组织占比、Gleason评分和穿刺阳性针数,同时并不会增加穿刺并发症,有较高的临床应用价值。     

Value of Prostate Cancer Screening in a Comprehensive Community Cancer Center

Early detection of prostate cancer may help decrease cancer deaths from this disease despite the increased incidence of prostate cancer. In 1990 and 1991 we conducted one-day “screens” for prostate cancer. This analysis was undertaken to determine the value of the screening procedures for detecting prostate cancer in the community. A total of 579 men, aged 39-84 years (mean 58 years), were evaluated by digital rectal examination (DRE) by a urologist, serum prostate specific antigen (PSA) determination by monoclonal antibody assay, and completion of a detailed questionnaire. Forty-eight percent had not seen a physician in over 2 years; 17% had a 1st- or 2nd-degree relative with prostate cancer. There was a 25% “suspicious” rate including 76 (13%) men with abnormal DRE only, 48 (8%) with abnormal PSA only, and 21 (4%) with abnormal DRE and PSA. Patients with findings suspicious for cancer were recontacted by telephone at 2-month intervals for 6 months to determine outcome because subsequent diagnostic management was at the discretion of practicing physicians. By 6 months, 84% of patients with abnormal findings had seen a physician as recommended. Of the 76 with abnormal DRE only, 11 were biopsied and only one cancer was found (9%). Of 48 with an elevated PSA only, 19 were biopsied; 11 (58%) had cancer (9/9 positive transrectal ultrasound) and 8 had no cancer at biopsy (5/5 negative transrectal ultrasound). Of 21 with both tests suspicious, 11 were biopsied and 9 had cancer (82%). Thus, by 6 months after each screen there was a 3.5% overall cancer detection rate for the whole population screened, a 67% positive biopsy rate among those with an elevated PSA, a 45% positive biopsy detection rate among those with an abnormal DRE, and a 51% positive biopsy rate among all those biopsied. Eighty percent of the PSA elevations were between 4.1 and 10.0 ng/ml. This screening experience yielded several new diagnoses of prostate cancer, and the use of serum PSA levels and ultrasoundguided biopsy was associated with a high positive biopsy rate for cancer.     

经直肠B超引导个体化前列腺穿刺活检方案的探讨

背景与目的:经直肠B超(transrectal uhrasonography,TRUS)引导前列腺6针穿刺活检术(sextant)曾被认为是诊断前列腺癌的"金标准".近年来,许多报道其检出率不高,应该增加穿刺针数来提高前列腺癌的检出率,但至今仍无一种理想的方案.本研究旨在探讨一种合适的前列腺穿刺活检方案,以提高前列腺癌的初次检出率.方法:回顾性分析325例疑为前列腺癌患者初次活检的临床资料.全部采用系统12针组合穿刺方案,对可疑病灶处补充1～2针.根据穿刺结果,分析穿刺阳性率与针数、体积的关系.结果:325例患者确诊前列腺癌126例(38.8%).12针中的6、8、10针组合最高阳性率与12针穿刺组合阳性率比较,差异均有统计学意义(38.8%vs.27.7%,29.8%and 35.4%,P＜0.05).比较体积不同3个组,发现＜40 ml组8针组合与10针、12针组合无统计学差异(38.4%vs.40.4%,42.4%,P＞0.05),而40～60 ml组8针组合与10针组合(36.2%vs.26.9%,P=0.046)、＞60 ml组10针组合与12针组合差异均有显著性(37.9%vs.25.8%,P=0.049).结论:并非每位患者都需行系统12针穿刺,而应该个体化对待.建议＜40 ml的前列腺采用8针、40～60 ml的10针和＞60ml的12针组合方案,并根据B超所见增加针数(1或2针)或者进行重点穿刺.     

Optimizing prostate biopsy for repeat transrectal prostate biopsies patients

Objective:Diagnosis of patients with negative prostate biopsy and persistent suspicion of prostate cancer re-mains a serious problem. In this study, we investigated the application of optimizing prostate biopsy for patients who need repeat prostate biopsy. Methods:In this prospective, non-randomized phase-I clinical trial, the prostate cancer detection rate of initial detection scheme was compared with optimizing prostate biopsy scheme. The number of punctures of initial detection scheme was the same as that of optimizing prostate biopsy scheme. The puncture direction of optimizing prostate biopsy was a 45° angle to the sagittal plane from front, middle, and back. The two cores from each lateral lobe were horizontal y inwardly inclined 45°. Results:A total of 45 patients with initial negative biopsy for cancer were received the optimizing prostate biopsy scheme. The cancer detection rate was 17.8%(8/45), and prostate intraepithelial neoplasm (PIN) was 6.7%(3/45). The pa-tients receiving repeat transrectal prostate biopsies were pathological y diagnosed as lower Gleason grade prostate cancers. Conclusion:The cancer detection rate of repeat biopsy prostate cancer is lower than that of initial biopsy. Our study showed that the optimizing prostate biopsy is important to improve the detection rate of repeat transrectal prostate biopsies patients.     

经直肠超声弹性成像在前列腺穿刺活检中的应用价值

目的:探讨经直肠超声弹性成像引导前列腺穿刺活检的应用价值。方法:对98例疑诊为前列腺癌的患者行前列腺活检,在经直肠彩色超声扫查基础上系统活检,同时应用超声弹性成像对可疑病灶增加活检针数。结果:在54例前列腺癌患者中,仅弹性成像结节加穿的穿刺阳性18例(33.3％,18/54),仅系统穿刺法阳性14例(25.9％,14/54),两种方法均阳性22例(40.7％,22/54);采用系统穿刺法和弹性成像结节加穿法的阳性率分别为40.8%(40/98)及36.7％(36/98),两者差异无统计学意义(P=0.672)。98例患者共穿刺1132针,其中系统穿刺法980针,弹性成像共在69例患者中发现异常目标,共穿刺152针。经病理证实,阳性针数为169针,总穿刺点阳性率为14.9％(169/1132);系统穿刺点阳性率为10.9％(107/980);靶向穿刺点阳性率为40.8％(62/152),弹性成像结节加穿的阳性率显著高于系统穿刺法(P<0.0001)。结论:经直肠超声弹性成像有助于确定活检的目标,提高超声引导前列腺活检的效能。     

Negative influence of changing biopsy practice patterns on the predictive value of prostate-specific antigen for cancer detection on prostate biopsy

BACKGROUND: A correlation between prostate specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were different from what they are today. We evaluated if changes in biopsy practice patterns have affected the ability of PSA to predict cancer detection on prostate biopsy in the current era. METHODS: Of 3634 prostate biopsies performed from 1993-2005, 1607 met criteria for analysis. Biopsy data were divided into 3 time-cohorts (1993-1997, 1998-2001, and 2002-2005) to assess for practice patterns shifts and correlation between PSA and biopsy results. RESULTS: Significant changes in biopsy practice patterns included an increase in biopsy cores and more frequent use of PSA 2.5-3.99 ng/mL as a biopsy indication. In men with normal DRE, a moderate correlation between PSA and positive biopsy rate did exist from 1993-1997, but was subsequently lost. On multivariate analysis, PSA was not a significant predictor of biopsy result in men with normal DRE. CONCLUSIONS: Early in the PSA era, the predictive power of PSA depended on multiple factors: high prevalence of disease, higher prevalence of high-grade disease, and low likelihood of prostate cancer diagnosis in men with low PSA. Now, beyond the culling effect of increased biopsy incidence and with shifted biopsy practice patterns, the correlation between PSA and biopsy result is lost in men with normal DRE. Diagnosing a higher proportion of tumors in men with a PSA between 2.0-4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection.     

超微血流成像技术在前列腺癌精准靶向穿刺活检中的应用

目的 探讨超微血流成像（SMI）技术在前列腺癌精准靶向穿刺活检中的应用价值。方法 87例临床拟诊断前列腺癌患者均经过第一次系统12点穿刺术1月后选择进行第二次穿刺活检方式，其中48例采用系统12点穿刺法，39例采用SMI精准靶向定位异常区域替代局部系统穿刺法。根据第一次穿刺病理组织学结果，分析两种方式在前列腺癌穿刺活检中的异同。结果 在良恶性病变中，前列腺体积的差异无统计学意义，血清PSA水平差异有统计学意义（t=2.045, P=0.04）；SMI组穿刺恶性20例，穿刺阳性率为51.28%，总穿刺456针；对照组穿刺恶性14例，穿刺阳性率为29.17%，总穿刺576针。两组穿刺阳性率、平均穿刺针点数差异有统计学意义（χ ²=4.420, P=0.036; t=13.18, P=0.000）。SMI组中恶性病理组织为79条，患者Gleason最高评分（7.2±0.4）分；对照组中恶性病理组织为64条，患者Gleason最高评分（6.5±0.4）分。两组单次取材阳性率、Gleason最高评分差异有统计学意义（χ ²=8.232, P=0.004; t=5.940, P=0.000）。结论 SMI技术引导前列腺癌穿刺活检可提高取材的阳性率。