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。     

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。     

应用前列腺特异抗原筛查诊断前列腺癌的临床意义

目的 探讨应用前列腺特异抗原(PSA)筛查诊断前列腺癌的临床意义.方法 对年龄≥50岁的8562例男性体检者进行PSA筛查,对血清PSA≥4.0 ng/ml者建议进行经直肠前列腺系统活检,活检病理确诊为前列腺癌的患者人选筛查组,记录其临床病理特点,并与同时期临床诊治的82例前列腺癌患者(临床组)进行比较.结果 在8562例进行血清PSA筛查的男性中,有719例血清PSA水平≥4.0 ng/ml,其中295例接受经直肠前列腺系统活检,共检出前列腺癌58例,活检率和活检阳性率分别为41.0%和19.7%.虽然两组患者的年龄分布差异无统计学意义(P=0.176),但筛查组中有41.4%(24/58)的患者年龄＞75岁,明显高于临床组(25.6%,P=0.0491).筛查组中血清PSA水平≥20.0 ng/ml的患者所占的比例为44.8%,明显低于临床组(75.6%,P＜0.0001).筛查组中活检Gleason评分＜7分的患者所占的比例为60.3%,明显高于临床组(34.1%,P=0.0020).筛查组中临床分期为T1和T2期(局限期)患者所占的比例为87.9%,明显高于临床组(26.8%,P＜0.0001).筛查组中接受根治性前列腺切除术的患者所占的比例为50.0%,明显高于临床组(18.3%,P＜0.0001).在年龄≤75岁的患者中,筛查组患者诊断时的血清PSA水平、活检Gleason评分和临床分期均显著低于临床组(均P＜0.05);在年龄＞75岁的患者中,筛查组患者的临床分期也明显低于临床组(P=0.0002),但两组诊断时血清PSA水平和活检Gleason评分的差异并无统计学意义(均P＞0.05).结论 应用血清PSA在我国50岁以上男性中进行前列腺筛查是有效的.筛查出的前列腺癌患者在血清PSA水平、活检Gleason评分、临床分期以及根治性切除的机会等方面均较临床组有明显优势.     

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.     

超声引导下前列腺10点加定点穿刺活检术诊断前列腺癌

目的 探讨经直肠彩色多普勒超声引导下前列腺穿刺活组织检查在前列腺癌诊断中的应用.方法 181例疑诊前列腺癌的患者进行血清总前列腺特异性抗原(T-PSA)检测,采用10点加前列腺癌可疑灶定点穿刺活检术.结果 181例中检出前列腺癌80例(44.2%),前列腺增生63例(34.8%).前列腺炎36例(19.9%),前列腺结核1例(0.6%),前列腺平滑肌瘤1例(0.6%).T-PSA水平＞20μg/L组的前列腺癌发生率高于其他各组.随着T-PSA水平的升高,Gleason评分增加(P＜0.001).结论 超声引导下10点加定点穿刺活检术诊断前列腺癌的阳性率高,对T-PSA＞20μg/L的疑诊前列腺癌患者活检意义较大.     

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.     

PSA、FPSA检测和骨显像对前列腺癌骨转移的诊断价值

目的:探讨联合应用前列腺特异性抗原(PSA)、游离PSA(FPSA)检测和全身骨显像诊断前列腺癌骨转移的意义.方法:回顾性分析70例经临床确诊的前列腺癌患者,全部行血清PSA、FPSA测定,并作全身骨显像.结果:PSA<4ng/ml在14例病人中,发生骨转移者7例,诊断阳性率为50%;PSA 4ng/ml～20ng/ml共7例,发生骨转移者6例,诊断阳性率为87%;PSA＞20ng/ml组49例,发生骨转移45例,阳性率为92%.结论:PSA、FPSA检测结合全身骨显像,可尽早、全面地发现前列腺癌患者全身骨转移.     

以尿潴留为首发表现的前列腺癌临床分析（附43例）

目的:回顾分析以尿潴留为首发表现的前列腺癌患者的临床特点。方法:收集我院2001年7月至2014年7月以尿潴留为首发症状的前列腺癌患者43例,均经前列腺穿刺活检确诊。3例患者接受腹腔镜下腹膜外前列腺癌根治术,其余40例患者均接受经尿道前列腺电切术（transurethral resection of prostate,TURP）联合内分泌治疗［（最大限度雄激素阻断（maximal androgen blockade,MAB）］。统计其年龄分布、前列腺特异性抗原（prostate specific antigen,PSA）、直肠指检(digital rectal examination,DRE)阳性率、经直肠前列腺穿刺阳性针数、Gleason评分、骨转移、肿瘤分期、治疗后排尿恢复情况、IPSS评分及1年、3年、5年生存率。结果:43例患者的年龄中位数为69岁;直肠指检阳性率达81.4%（35/43）;PSA＞20 ng/ml者占62.8%（27/43）;经直肠前列腺穿刺（12+X针穿刺法）超过7针以上阳性的占76.7%（33/43）;Gleason评分≥7分占95.3%（41/43）;骨转移患者占76.7%（33/43）;临床分期T3b-T4期占88.4%（38/43）;治疗后6个月全部患者恢复了自主排尿,1年生存率为97.7%,3年生存率为79.1%,5年生存率为55.8%。结论:老年男性发生尿潴留应当考虑有前列腺癌的可能性,该类前列腺癌患者病程往往多为晚期且为高危患者,肿瘤压迫侵犯尿道及膀胱颈是排尿困难的主要原因,经尿道前列腺电切术联合内分泌治疗,可有效解除下尿路梗阻,控制肿瘤进展,提高患者生活质量。     

经直肠超声定位下前列腺穿刺活检术的探讨

目的探讨理想的前列腺穿刺活检方案。方法回顾性分析127例疑诊为前列腺癌患者的年龄、直肠指检（DRE）或经直肠超声（TRUS）情况、血清前列腺特异性抗原（PSA）水平、前列腺体积大小、穿刺针数等,与穿刺活检阳性率的关系。结果 127例穿刺活检结果显示：前列腺增生症（BPH）80例,前列腺癌（PCa）47例,PCa活检阳性率为37.9%;随着患者年龄的增长及PSA水平的增高,PCa检出率明显增高,差异有统计学意义（P〈0.05）,对前列腺体积不同患者,采用不同穿刺活检方案,其PCa活检阳性率不等,小体积前列腺患者,系统6针、10针、12针穿刺活检三组阳性率比较差异无统计学意义（P〉0.05）,大体积前列腺患者,12针穿刺活检阳性率明显高于系统6针的。直肠指检阳性组穿刺活检阳性率与阴性组比较有统计学意义（P〈0.05）。结论对不同的初次前列腺活检患者,应当根据患者的个体情况选择不同的穿刺活检方案。     

前列腺特异性抗原4~10μg/L患者前列腺癌检出率及与年龄和病理分级的相关性分析

目的：探讨前列腺特异性抗原(prostate specific antigen, PSA) 4~10μg/L患者前列腺癌检出率及与年龄和病理分级的相关性。方法：回顾性收集2011年1月至2017年12月仁寿县人民医院收治的213例PSA 4~10μg/L患者的相关资料,所有患者均行经直肠超声引导下前列腺穿刺活检,计算前列腺癌检出率,比较各年龄组、病理分级与检出率的相关性。结果：本组213例PSA4~10μg/L患者中,穿刺活检阳性患者50例,阳性检出率23.5%。穿刺阳性患者PSA(8.11±0.53)μg/L,穿刺阴性患者PSA(6.55±0.62)μg/L,两组比较差异有统计学意义(t=16.075, P<0.001)。<60岁、60~69岁、70~79岁、≥80岁4个年龄组穿刺活检阳性率分别为：5.88%、17.28%、28.71%、42.86%,随着年龄的增长,前列腺穿刺活检阳性检出率增长明显(χ2趋势=9.046, P=0.003)。Spearman相关分析显示,前列腺穿刺活检阳性检出率与年龄存在正相关关系(r=0.486, P<0.001)。4个年龄组穿刺活检阳性患者Gleason评分≥7分患者分别为：1例(100.0%)、5例(35.7%)、13例(44.8%)和4例(66.7%),组间比较差异无统计学意义(P>0.05);不同肿瘤分期在各年龄组差异无统计学意义(P>0.05)。结论：随着年龄的增加,PSA4~10μg/L患者中,前列腺穿刺阳性的前列腺癌患者的检出率也相应增高,年龄可以作为PSA4~10μg/L低水平患者前列腺癌筛查和诊断的重要参考指标。     

Three-dimensional computed tomography-guided monotherapeutic pararectal brachytherapy of prostate cancer with seminal vesicle invasion.

PURPOSE: To treat patients with prostate cancer and seminal vesicle invasion with monotherapeutic three dimensional computed tomography (3-DCT)-guided posterior pararectal brachytherapy. METHODS AND MATERIALS: Three hundred and sixty two patients with clinical stage T1 a,b or T2 a,b of prostate cancer were referred for 3-DCT-guided brachytherapy. Each underwent ftirther staging with 3-D CT-guided pararectal biopsy of the seminal vesicles under local anesthesia during the pre-treatment CT-planning. Forty-three patients (12%) were upstaged to T3 cNoMo disease. In the set of 43 patients, Eight had Gleason's score< or =6, 24 Gleason's score=7, and 11 patients > or =8. Initial PSA was <10 ng/ml in 14 patients, 10-20 ng/ml in 11 patients, and >20 in 18 patients. Of the 43 patients, 37 patients were treated monotherapeutically with 3-D CT-guided brachytherapy. No patients received hormone therapy after the implant. The prescribed dosage to the seminal vesicles and prostate is 120 Gy with Pd-103 seeds and 144 Gy with 1-125 seeds. RESULTS: The prescribed dosage was achieved in all 37 patient's throughout the seminal vesicles whose range of target radiation extended 5-10 mm outside the target in the adjacent fat as calculated with post-implant CT-dosimetry with Varian Brachy Vision or MMS software. Prostate Specific Antigen (PSA) outcome data were available in 34 patients treated with monotherapy and follow up ranged from 12-56 months (median, 24 months). Decreased PSA levels were stratified into six groups based on the presenting Gleason's score and initial PSA. In the first group (with Gleason's score< or =6 and initial PSA <20 ng/ml), PSA levels decreased to less than 0.5 ng/ml in all seven patients (100%) after brachytherapy. In the second group (with Gleason's=7 and initial PSA<20 ng/ml), PSA levels decreased to less than 1 ng/ml in 11 of 13 patients (85%); additionally PSA levels decreased to less than 0.5 ng/ml in ten patients (77% in this group). In the third group (with Gleason's score=7 and initial PSA> 20 ng/ml), PSA decreased to less than 0.5 ng/ml in four out of eight patients (50%). All of the patients in the fourth group (with Gleason's score> or =8 and initial PSA<20 ng/ml) decreased their PSA levels to less than 0.5 ng/ml in three of three patients. PSA decreased less than 0.5 ng/ml in two out of three patients (67% in the last group with Gleason's score> or =8 and initial PSA> 20 ng/ml). There were no patients with Gleason's score of 1-6 and greater than 20 ng/ml initial PSA. Patients, irrespective of the Gleason's score and PSA, had an overall response of decreased PSA (less than 1 ng/ml) of 79%. CONCLUSION: 3-D CT-guided brachytherapy delivers adequate dosage to the seminal vesicles. Clinical and biochemical results are encouraging in patients with low initial PSA levels regardless of their Gleason's scores, but longer-term data in a greater number of patients is necessary.     

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.     

An expanded technique of transrectal prostatic biopsy

To compare diagnostic value of transrectal prostatic biopsy in obtaining samples of tissue from different sites in patients with various levels of prostate-specific antigen (PSA) and prostate size, we made primary transrectal biopsy of the prostate in 486 patients. The patients were divided into 7 groups by the number of punctures at biopsy (from 6 to 18). Among the patients with PSA under 20 ng/ml in the number of tissue biopsy samples 18, a rise in prostatic cancer detection rate (PCDR) was 16.6%. In PSA above 20 ng/ml, a statistically significant maximal rise in PCDR occurred in the increase of biopsy number from 6 to 12 (by 9.3%). The number of local cancer forms in patients with PSA < 20 ng/ml among all the detected cases rose from 70% (biopsy from 6 sites) to 92.3% (biopsy from 18 sites). Among the patients with PSA < 20 ng/ml and the size of the prostate > 50 sm3, a significant rise of PCDR increased from 20 to 33.3% in an increase of the puncture number from 6 to 12. In the group of patients with the same PSA level and prostate > 50 cm3 PCDR improves in biopsy from 14, 16 and 18 sites (from 12.1 to 27.7%, 28.5 to 33.3%, respectively). Standard biopsy is insufficient for adequate PCDR, it is necessary to obtain samples of tissue from a large number of sites with puncture of peripheral zone of the prostate. Transrectal biopsy of the prostate according to the extended method improves PCDR, primarily, in local cancer.     

Utility of Digital Rectal Examination,Serum Prostate Specific Antigen,and Transrectal Ultrasound in the Detection of Prostate Cancer: A Developing Country Perspective

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen(tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men withlower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serumtPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue wereobtained from different areas of the peripheral prostate and examined histopathologically for the nature of thepathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changeswith or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) ofpatients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCahad abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA>20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: Theincidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can befurther improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.     

前列腺特异性抗原检测及临床应用

 本文应用ELISA法定量测定血清前列腺特异性抗原（PSA）并对检测中的影响因素进行探讨，结果表明：血清放置的时间、温度及标本采集时间、药盒厂家对PSA检测结果有影响。同时也对PSA用于前列腺癌的诊断，疗效监控及病理分型等问题进行探讨。以PSA＞5ng/ml作为前列腺癌的诊断其阳性符合率为81%，特异性为94%。PSA作为前列腺癌的诊断及疗效监控是一个重要指标，而作为前列腺癌的病理分型应注意病例差异。     

前列腺癌的早期诊断

目的：评价前列腺癌早期诊断的方法及提高对一些基本诊断方法的认识。方法：对１９９１－１９９９年诊治的７０例早期前列腺癌所应用的基本诊断技术进行分析。结果：７０例患者中,６４例（９１．４％）ＤＲＥ（直肠指诊）发现前列腺异常。６６例患者接受ＰＳＡ（前列腺特异抗原）检查,其中ＰＳＡ〉４ｎｇ／ｍｌ者５２例（７８．８％）。６６例患者接受ＴＲＵＳ（经直肠前列腺Ｂ超）检查,其中５４例（８１．８％）发现异常。若将２     

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。     

Prostate cancer diagnosis: should patients with prostate specific antigen >10 ng/mL have stratified prostate biopsy protocols?

Background: Trans-rectal ultrasound (TRUS) guided systematic prostate biopsy is a standard tool in prostate cancer (CaP) diagnosis. Extended biopsy techniques using 10-12 cores are the norm. Controversy exists on extended TRUS biopsy in men with PSA >10 ng/mL. We evaluated cancer detection rates on an individual core basis, to stratify prostate biopsy protocols based on PSA levels. Patients and methods: Over a five-year period, 1036 patients underwent TRUS guided prostate biopsy for raised serum PSA (>2.5 ng/mL). 436 patients had PSA >10 ng/mL. Patients with PSA <50 ng/mL underwent a 12-core TRUS guided prostate biopsy including six peripheral biopsies. The six peripheral biopsies were directed laterally towards the base, mid-zone and apices. Remainder were standard para-sagittal sextant biopsies. Patients were stratified into three groups (PSA 10-20 ng/mL, 20-50 ng/mL and >50 ng/mL). Results: Mean age of 436 patients with PSA >10 ng/mL was 70.3years. 270 (62%) men had cancer. Cancer detection rates for different PSA levels were 46% (10-20 ng/mL), 76% (20-50 ng/mL) and 93% (>50 ng/mL). Higher PSA levels and advanced clinical stage were associated with increased cancer detection rates. All patients with clinical T3 and T4 disease had biopsy diagnosed CaP. Conclusion: TRUS guided prostate biopsy in patients with PSA >10 ng/mL did not require 12 cores to diagnose CaP. CaP diagnosis required 8 cores in men with PSA 10-20 ng/mL. These cores were right and left peripheral basal and apical, and right and left para-sagittal basal and apical biopsy. Only 6 cores were necessary to diagnose CaP in men with PSA >20 ng/mL which were right and left peripheral basal and apical, and para-sagittal apical biopsies. We suggest limited TRUS prostate biopsy protocols for men with PSA >10 ng/mL.     

Clinicopathologic analysis of extracapsular extension in prostate cancer: should the clinical target volume be expanded posterolaterally to account for microscopic extension?

PURPOSE: We performed a complete pathologic analysis examining extracapsular extension (ECE) and microscopic spread of malignant cells beyond the prostate capsule to determine whether and when clinical target volume (CTV) expansion should be performed. METHODS AND MATERIALS: A detailed pathologic analysis was performed for 371 prostatectomy specimens. All slides from each case were reviewed by a single pathologist (N.S.G.). The ECE status and ECE distance, defined as the maximal linear radial distance of malignant cells beyond the capsule, were recorded. RESULTS: A total of 121 patients (33%) were found to have ECE (68 unilateral, 53 bilateral). Median ECE distance=2.4 mm [range: 0.05-7.0 mm]. The 90th-percentile distance = 5.0 mm. Of the 121 cases with ECE, 55% had ECE distance>or=2 mm, 19%>or=4 mm, and 6%>or=6 mm. ECE occurred primarily posterolaterally along the neurovascular bundle in all cases. Pretreatment prostrate-specific antigen (PSA), biopsy Gleason, pathologic Gleason, clinical stage, bilateral involvement, positive margins, percentage of gland involved, and maximal tumor dimension were associated with presence of ECE. Both PSA and Gleason score were associated with ECE distance. In all 371 patients, for those with either pretreatment PSA>or=10 or biopsy Gleason score>or=7, 21% had ECE>or=2 mm and 5%>or=4 mm beyond the capsule. For patients with both of these risk factors, 49% had ECE>or=2 mm and 21%>or=4 mm. CONCLUSIONS: For prostate cancer with ECE, the median linear distance of ECE was 2.4 mm and occurred primarily posterolaterally. Although only 5% of patients demonstrate ECE>4 to 5 mm beyond the capsule, this risk may exceed 20% in patients with PSA>or=10 ng/ml and biopsy Gleason score>or=7. As imaging techniques improve for prostate capsule delineation and as radiotherapy delivery techniques increase in accuracy, a posterolateral CTV expansion should be considered for patients at high risk.     

前列腺特异性抗原对中国人群前列腺癌早期检测价值的Meta分析

背景与目的：前列腺特异性抗原（prostate-specific antigen,PSA）是一种前列腺癌标志物,但关于使用PSA作为筛查标准是否合适仍存在争论。评价PSA在中国人群前列腺癌早期检测中的价值,旨在为前列腺癌筛查策略的制定提供依据。方法：对万方数据库、中国医院知识仓库（China Hospital Knowledge Database,CHKD）和PubMed数据库进行文献检索,再根据已发表文献中的参考文献追溯进行手工检索。收集2000年1月—2020年3月有关PSA对中国人群前列腺癌早期检测的文献资料。按确定的纳入标准筛选文献,对纳入的文献进行质量评价。对以PSA>4 ng/mL作为临界点检测前列腺癌的灵敏度、特异度等进行Meta分析。结果：共检索到5 722篇文献,排除重复及不符合标准的5 713篇后,纳入9篇文献。累计研究对象共6 425人,其中前列腺癌患者596例;Meta分析结果显示,以PSA>4 ng/mL作为临界点检测前列腺癌的灵敏度、特异度和集成受试者工作特征（summary receiver operating characteristic,SROC）曲线的曲线下面积（area under curve,AUC）分别为91%（95% CI：89%~93%）、41%（95% CI：27%~56%）和0.91（95% CI：0.88~0.93）。结论：中国人群中以PSA>4 ng/mL作为检测前列腺癌的界值,具有较高的灵敏度,但特异度较低,前列腺癌筛查可在PSA>4 ng/mL的基础上进一步筛选。