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。     

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。     

经直肠超声造影引导前列腺穿刺活检诊断前列腺癌

目的探讨经直肠超声造影(CETRUS)引导前列腺穿刺活检对前列腺癌的诊断价值。方法对79例可疑前列腺癌患者分别行常规经直肠超声(TRUS)、CETRUS及经直肠前列腺穿刺活检。以病理结果为标准,对比TRUS、CETRUS和TRUS联合CETRUS引导经直肠前列腺穿刺活检对前列腺癌的诊断效能。结果 79例中,病理诊断为前列腺腺癌36例,前列腺良性增生43例。35例CETRUS见异常征象,其中30例病理诊断恶性,诊断敏感度83.33%(30/36),特异性88.37%(38/43),准确率86.08%(68/79)。39例TRUS见异常征象,其中24例病理诊断为恶性病变,诊断敏感度66.67%(24/36),特异度65.12%(28/43),准确率65.82%(52/79)。TRUS联合CETRUS诊断前列腺癌30例,敏感度83.33%(30/36),特异度72.09%(31/43),准确率77.22%(61/79)。ROC曲线结果显示,TRUS、CETRUS、TRUS联合CETRUS引导前列腺穿刺活检对诊断前列腺癌的AUC分别为0.740、0.859及0.777,CETRUS的诊断效能高于TRUS及TRUS联合CETRUS(Z=2.371、2.858,P=0.018、0.004)。结论 CETRUS引导前列腺穿刺活检对前列腺癌的诊断效能较高。     

前列腺异常声像特征及位置对经直肠超声穿刺活检诊断前列腺癌的影响

目的 探讨经直肠超声检查中异常声像特征及位置对经直肠超声(TRUS)穿刺活检诊断前列腺癌的影响.方法 前列腺特异性抗原(PSA)4~20 ng/ml、发现异常声像和/或合并直肠指检异常的可疑前列腺癌患者410 例,根据声像特征分为低回声、等回声、高回声组,所有患者均行8+X 针的穿刺方法,详细记录患者临床资料及病理结果,比较两组的穿刺结果.结果 总的前列腺癌检出率为27.07%,低回声组前列腺癌穿刺阳性率(34.27%)明显高于等回声(22.77%)和高回声(13.33%)组(P<0.05),Gleason 评分在低、等回声组前列腺癌中无明显统计学差异(P>0.05).左右侧外周带单独存在低回声病例前列腺癌穿刺阳性率无明显统计差异(P>0.05),双侧外周低回声病例前列腺癌穿刺阳性率(46.97%)明显高于左侧(27.27%)与右侧(28.85%)外周带存在低回声病例(P<0.05).结论 PSA4~20 ng/ml,TRUS 存在低回声声像前列腺穿刺率阳性率明显高于TRUS 中等回声、高回声病例病例,双侧外周带存在低回声病例前列腺穿刺阳性率明显高于单侧外周带存在低回声病例.     

磁共振波谱成像联合血清PSA在前列腺癌诊断中的价值

目的初步探讨磁共振波谱成像(MRS)与血清前列腺特异抗原(PSA)在前列腺癌诊断中的应用。方法选取血清PSA异常40例男性患者行前列腺MRS并与病理结果对照。再分析MRS联合不同水平PSA(低危组4ng/mlPSA10ng/ml,高危组PSA≥10ng/ml)穿刺活检的阳性率。结果病理证实前列腺癌19例、非前列腺癌21例(良性前列腺增生,20例,前列腺炎症1例)。单独MRS前列腺穿刺活检阳性率为60%,低危组前列腺活检阳性率为31.25%,高危组前列腺活检阳性率为58.3%,MRS联合PSA低危组前列腺活检阳性率为42.8%,MRS同时联合PSA高危组活检阳性率为66.7%,各组差异有统计学意义(P0.05)。结论 MRS诊断前列腺癌具有无创和简便优点,其联合PSA有助于提高诊断的准确性。     

常规临床检查与PSA灰区患者前列腺癌检出率的关系

目的:探讨直肠指检(DRE)、影像学(TRUS、MRI)检查、血清游离与总前列腺特异性抗原(PSA)比值(f/t)与PSA在4～10μg/L之间患者前列腺癌检出率的关系。方法:回顾性分析365例PSA处于灰区的患者进行DRE、TRUS、MRI检查、游离PSA测定,并对这些患者行经直肠B超引导下的前列腺穿刺活检。评估其临床资料与前列腺穿刺病理结果的关系。结果:在365例患者中,穿刺病理为前列腺癌的患者共有87例(23.84%)。DRE阳性的患者共有128例,穿刺阳性40例,阳性率为31.25%,TRUS检查的患者共有257例,其中有异常回声结节的69例患者中穿刺阳性26例,阳性率为37.68%,MRI检查的患者共有191例,其中有异常信号结节的107例患者中穿刺阳性59例,阳性率为55.14%。198例患者行fPSA与tPSA比值分析,其中前列腺癌患者的平均f/t PSA明显低于穿刺阴性患者。f/t PSA受试者曲线(ROC)下的面积(0.725)高于患者PSA ROC的面积(0.542)。结论:结合临床DRE、影像学资料及f/t PSA比值可以有效提高前列腺癌检出率,从而减少不必要的穿刺给患者带来的痛苦。     

经直肠超声造影在前列腺靶向穿刺活检中的价值

目的 探讨经直肠超声(transrectal ultrasound,TRUS)造影(TR-CEUS)技术对前列腺癌的诊断价值.方法 对60例临床诊断可疑前列腺癌患者行TR-CEUS及前列腺穿刺活检术.观察病灶造影灌注模式,对异常增强结节进行靶向穿刺、标记送检.同时将结果与49例非造影组前期常规11点穿刺比较,观察其诊断效率.结果 60例患者中10例弥漫型前列腺癌呈快速不均匀增强,18例结节型前列腺癌中共观察35个癌结节,呈高增强结节18个、等增强结节12个、低增强结节5个.前列腺增生32例,其结节多为均匀性高增强.造影假阳性7例,假阴性3例.靶向穿刺活检诊断前列腺癌28例,诊断率(46.67%)高于11点穿刺(28.57%).结论 TR-CEUS是评价前列腺良、恶性病变的有效方法,同时可以指导靶向穿刺活检,提高穿刺准确效率及减少穿刺针数.     

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。     

前列腺系统10点穿刺活检术的临床价值

目的探讨前列腺系统10点穿刺活检术的临床价值。方法对214例直肠指诊阳性或PSA>4.0 ng/ml及B超提示有异常回声结节的病例行经直肠B超引导下前列腺穿刺活检术(采用前列腺系统10点穿刺活检术,同时对可疑回声区随机增加穿刺点)。结果共检出前列腺癌76例,占35.51%,良性前列腺增生126例,占58.88%。慢性前列腺炎13例,占6.07%。前列腺囊肿3例,占1.40%。随机增加穿刺点检出32例,占15%。术后血尿者58例,占27.10%,血便6例,占2.80%,无一例出现前列腺脓肿、高热、败血症等严重并发症。结论前列腺穿刺活检是诊断前腺癌的重要手段,经直肠B超定位下系统10点穿刺法可以提高检出率,无严重并发症。     

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。     

Evaluation of Prostate Specific Antigen Density and Transrectal Ultrasonography-Guided Biopsies in 100 Consecutive Patients with a Negative Digital Rectal Examination and Intermediate Serum Prostate Specific Antigen Levels

Background : This study was undertaken to assess the importance of prostate biopsies in patients with a negative digital rectal examination (DRE) and elevated prostate specific antigen (PSA) levels and to investigate the role of PSA density (PSAD) and hypoechoic lesions on transrectal ultrasound (TRUS) in increasing the diagnostic sensitivity and specificity for prostate cancer (PCa). Methods : One hundred patients with varied initial symptoms who had a negative DRE and a PSA level between 4 and 20ng/mL underwent TRUS-guided systematic and, if present, lesion-directed biopsies. Results : PCa was detected in 11 patients (11%). TRUS examinations revealed hypoechoic lesions in 31 patients. Lesion-directed biopsies revealed PCa in 1 3% (4/31) of patients with abnormal TRUS whereas, 7% (5/69) of patients with negative TRUS findings had PCa. Additional systematic biopsies detected PCa in 2 patients where lesion-directed biopsies were negative. None (0/19) of the lesions smaller than 0.2 ml on TRUS had PCa whereas, 33% (4/1 2) of patients with lesions greater than 0.2 ml had PCa. When the subgroup of patients with negative TRUS and PSA levels between 4 and 10ng/mL were considered, 25% (1/4) of cases with PCa would have been missed if 0.15 was used as the cut-off point for PSAD, however, this would save 61% (30/49) of unnecessary biopsies. The positive predictive value of PSA (cut-off level lOng/mL), PSAD (cut-off level 0.15), and hypoechoic lesions on TRUS were found to be 11.5%, 33%, and 13%, respectively. When hypoechoic lesions greater than 0.2 mL were taken as the positive finding, the positive predictive value and specificity rates of TRUS increased to 33% and 91 %, respectively, without any change in the sensitivity. Conclusions : In patients with a negative DRE and intermediate PSA levels, the application of PSAD would have saved 49% of study patients with BPH from a biopsy, but would have missed 27% of PCa cases. By ignoring lesions smaller than 0.2 mL on TRUS, a very high specificity of 91% was achieved with a sensitivity of 36%. Thus, further investigations aimed at defining a better mode of diagnosis of PCa are warranted.     

前列腺活检后血清T-PSA动力学指标鉴别前列腺良、恶性病变

目的:探讨前列腺活检后血清总前列腺特异性抗原(total prostate specific antigen,T-PSA)指标鉴别前列腺良、恶性病变的可能性,确定活检前后T-PSA比率的临界值。方法:对血清T-PSA异常的36例患者(平均年龄69.89岁)进行直肠超声引导下前列腺穿刺活检,活检后在第10、30、60、90min分别进行血清T-PSA测定,并描绘血清T-PSA动力图。计算各时间点活检后T-PSA比率(活检后T-PSA/活检前T-PSA)。根据患者的穿刺活检结果将其分为非前列腺癌组和前列腺癌组,并进行两组活检后T-PSA比率的比较。应用统计学方法确定活检前后T-PSA比率鉴别前列腺良、恶性病变的临界值。结果:非前列腺癌组各时间点活检后T-PSA比率明显高于前列腺癌组(P<0.05)。应用ROC曲线计算获得活检后30min和T-PSA比率为1.5时是鉴别前列腺良、恶性病变的最佳时间点和临界值,其敏感性为75%,特异性为93%。结论:前列腺活检后30min时T-PSA比率可有助于筛查前列腺癌高危人群,对于活检后T-PSA比率较低且首次活检结果阴性的患者,应进行重复活检。本结果有待进一步前瞻性研究证实。     

Prostate cancer characteristics in a multiracial community

OBJECTIVES: To investigate the hypothesis that Northern Africans differ from Caucasians with regard to their PCa characteristics, using our 1988-2006 database we retrospectively reviewed the preoperative and pathological features of consecutive patients subjected to radical prostatectomy (RP) for localized prostate cancer (PCa) and stratified according to their ethnic origin. METHODS: In 727 consecutive patients (616 Caucasians; 61 Blacks originating from Central Africa and the French West Indies; 50 Northern Africans from Morocco, Algeria, Tunisia), we preoperatively analyzed and compared age, clinical stage of the tumour, prostate-specific antigen (PSA), transrectal ultrasound prostate volume, PSA density (PSAD), biopsy Gleason score, number of positive cores (NPC), and percentage of tissue core invaded by cancer (PTIC); postoperatively, we determined the status of the capsule, seminal vesicles, and margins of the RP specimen, as well as Gleason score and prostate weight. Statistical analyses (chi-square test and ANOVA) were performed to compare the results between the three groups of patients. A multivariate analysis was carried out to test the independence of variables. RESULTS: Black patients were the youngest at the time of surgery (by 3-4 yr) and had the highest rates of final Gleason score>or=8. The Northern Africans had more favourable features than did Caucasian and Black patients: mean PTIC was 7.1% versus 14.6% and 12.5%, respectively (p=0.005), mean NPC was 26.4% versus 34.7% and 36.4%, respectively (p=0.034), rates of biopsy and final Gleason score>or=8 were significantly lower (p=0.02 and p=0.028, respectively), and there were positive margins in 26% versus 36% and 35.6%, respectively (p>0.05). CONCLUSIONS: This study showed that a French Black population is the most likely of those studied to have unfavourable PCa characteristics at the time of RP. Albeit in a limited series, we show for the first time that Northern Africans have significantly better features in this regard than Caucasians and Blacks. Although Northern Africans did not have a better pathological stage outcome, they did have a more favourable Gleason score.     

Prostate cancer detection and tumor characteristics in men with multiple biopsy sessions

PURPOSES: To address prostate cancer (PCa) detection with respect to the number of biopsy sessions performed, to identify risk factors for detection after a negative biopsy, and to analyze the clinical characteristics of the detected tumors.SCOPE: Only biopsied men (sextant) were included. A total of 1011 biopsy sessions were carried out in 770 men; 172 underwent a second prostate biopsy and 51 a third biopsy. During the first biopsy round, 111 cancers were found (14.4%), 27 in the second (15.7%), and five during the third round (9.8%), P=0.156. Only high-grade PIN or atypia were identified as independent predictors or PCa detection in subsequent biopsies (P=0.008). A nonsignificant increase of clinically localized tumors, and a decrease of metastatic and poorly differentiated cases were found when more biopsy sessions were needed for detection.CONCLUSIONS: A nonsignificant trend to lower cancer detection rates and less clinical relevance of the tumors detected can be observed when more biopsy rounds are needed for detection.     

Prostate biopsy in subjects with abnormal transrectal ultrasonography but normal digital examination findings and prostate-specific antigen levels

Aim The aim of the present study was to evaluate the value of transrectal ultrasonography (TRUS) for prostate cancer diagnosis in men with no other indication for biopsy, such as an abnormal digital rectal examination or abnormally high prostate-specific antigen (PSA) levels. Materials and methods The study cohort contained a total of 104 men aged 41–78 years (median 62.5 years) who had suspicious findings on TRUS. The median prostate volume of the patients was 33.0 ml (range 15.0–90.9) and the serum PSA ranged from 0.2 to 4.0 ng/ml (median 2.5 ng/ml). Results Of 104 men, 12 (11.5%) were diagnosed with prostate cancer on initial biopsy. The positive predictive value (PPV) was 3.7% for PSA 0.1–1.0 ng/ml, 4.8% for PSA 1.1–2.0 ng/ml, 16.7% for PSA 2.1–3.0 ng/ml and 18.4% for PSA 3.1–4.0 ng/ml. The PPV for cancer with Gleason score 7 or higher was 0.0%, 0.0%, 16.7% and 7.9%, respectively. No statistically significant differences in patient characteristics and biopsy results were found between patients who received only systemic biopsy and those who received systemic plus lesion-directed biopsies. Conclusion The results of this study do not provide a rationale to recommend the additional use of lesion-directed biopsy in patients with suspicious lesions at TRUS but with no other indication for biopsy. Furthermore, our data raise the question of whether serum PSA levels lower than 4.0 ng/ml should be considered normal in Asian men.     

前列腺癌组织中前列腺癌抗原-1的表达及临床意义

目的:探讨PCa组织中前列腺癌抗原-1(PCA-1)的表达及其临床意义。方法:采用逆转录-聚合酶链反应(RT-PCR)技术,检测45例PCa组织、30例前列腺高分级上皮样内瘤样病变组织(HG-PIN)、43例BPH组织和39例其他肿瘤组织标本中PCA-1 mRNA的表达。免疫组织化学检测不同前列腺组织中PCA-1蛋白的表达。结果:PCa与HG-PIN组织标本中PCA-1 mRNA的阳性表达率分别为80.0%(36/45)和60.0%(18/30),BPH组织及其他肿瘤组织中均未见PCA-1 mRNA的表达。PCA-1 mRNA表达与PCa的临床病理参数之间无明显相关性,差异均无统计学意义(P>0.05)。PCa与HG-PIN组织标本中PCA-1蛋白的阳性表达率分别为75.6%(34/45)和50.0%(15/30),BPH组织及其他肿瘤组织中未见PCA-1蛋白阳性表达。结论:PCA-1仅在PCa组织中表达,且与PCa的临床病理参数无关,有可能作为特异性的肿瘤标志物对PCa进行早期诊断。     

Magnetic Resonance Imaging-Ultrasound Fusion-Guided Prostate Biopsy: Review of Technology,Techniques, and Outcomes

Transrectal ultrasound (TRUS)-guided (12–14 core) systematic biopsy of the prostate is the recommended standard for patients with suspicion of prostate cancer (PCa). Advances in imaging have led to the application of magnetic resonance imaging (MRI) for the detection of PCa with subsequent development of software-based co-registration allowing for the integration of MRI with real-time TRUS during prostate biopsy. A number of fusion-guided methods and platforms are now commercially available with common elements in image and analysis and planning. Implementation of fusion-guided prostate biopsy has now been proven to improve the detection of clinically significant PCa in appropriately selected patients.     

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。     

应用经直肠实时超声弹性成像引导前列腺活检

目的探讨经直肠实时超声弹性成像(TRTE)引导前列腺活检的应用价值。方法对91例疑诊前列腺癌拟行前列腺活检的患者,在经直肠彩色超声(TRUS)扫查基础上,应用TRTE明确可疑病灶引导目标活检,同期并行系统活检。结果 TRTE检出可疑病灶42个,其中34个为癌结节,阳性率80.95%(34/42),8个为非癌结节,假阳性率19.05%(8/42),4例前列腺癌弹性图无局灶性改变,假阴性率12.50%(4/32)。目标活检共计97点,前列腺癌检出率77.78%(28/36);系统活检共计642点,前列腺癌检出率31.87%(29/91);两种活检方案比较前列腺癌检出率差异有统计学意义(P<0.01)。结论 TRTE有助于确定活检靶目标,提高超声引导前列腺活检的效能。