累及移行带前列腺癌的诊断分析

目的分析累及移行带前列腺癌的临床特征,提高移行带前列腺癌的诊断率。方法回顾我院收治的77例前列腺癌患者,一组44例仅限于外周带;另一组33例已累及移行带。分析两组的临床表现、直肠指检、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原、经直肠前列腺超声以及前列腺穿刺活检。结果两组患者的年龄、排尿期和储尿期症状、直肠指检阳性率、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原以及病理分级没有显著性差异。移行带肿瘤存在泌尿系转移的风险。经直肠超声为移行带可疑病灶的定位提供了重要的参考,而对可疑病灶穿刺活检则能提高累及移行带前列腺癌的诊断率。结论经直肠超声行移行带可疑病灶的穿刺活检是诊断累及移行带前列腺癌的有效手段。     

前列腺穿刺活检的适应证

前列腺穿刺活检是诊断前列腺癌的金标准,但穿刺活检的适应证仍有争议。本文就前列腺穿刺活检适应证的最新进展作一综述。包括直肠指检,前列腺特异性抗原水平及其相关指标以及首次活检为前列腺上皮内瘤或不典型增生等。并初步介绍肿瘤标记物PCA3基因以及人工神经网络在诊断早期前列腺癌中的作用。     

前列腺穿刺活检的适应证

前列腺穿刺活检是诊断前列腺癌的金标准,但穿刺活检的适应证仍有争议。本文就前列腺穿刺活检适应证的最新进展作一综述。包括直肠指检,前列腺特异性抗原水平及其相关指标以及首次活检为前列腺上皮内瘤或不典型增生等。并初步介绍肿瘤标记物PCA3基因以及人工神经网络在诊断早期前列腺癌中的作用。     

前列腺检查对PSA、fPSA的影响研究

PSA、fPSA是前列腺癌诊断、治疗和随访中重要的肿瘤标志物。直肠指检、前列腺穿刺活检、膀胱镜检、前列腺按摩和经直肠超声是目前临床常用的前列腺检查方法。本文就上述检查方法可能造成PSA、fPSA水平的变化 ,复习国外此领域的研究进展予以综述。     

前列腺检查对PSA、fPSA的影响研究

PSA、fPSA是前列腺癌诊断、治疗和随访中重要的肿瘤标志物。直肠指检、前列腺穿刺活检、膀胱镜检、前列腺按摩和经直肠超声是目前临床常用的前列腺检查方法,本文就上述检查方法可能造成PSA、fPSA水平的变化,复习国外此领域的研究进展了予以综述。     

103例前列腺癌的诊断分析

目的 :提高前列腺癌的诊断水平。方法 :回顾分析 10 3例前列腺癌的临床资料 ,对前列腺癌的诊断方法进行探讨。结果 :单项PSA ,直肠指检 (DRE)及经直肠前列腺超声 (TRUS)检查诊断阳性率为 65 .9%～ 90 .3 % ,而前列腺穿刺诊断阳性率 95 .1%。结论 :前列腺穿刺活检对诊断前列腺癌具有重要意义。PSA、DRE、TRUS与前列腺穿刺结合可提高诊断的阳性率与准确率。     

PSA衍生指标诊断前列腺癌的研究进展

血清前列腺特异性抗原(PSA)是目前应用最为广泛的前列腺癌生物标志物,可以有效筛选出前列腺癌高危人群,监测病情变化。但是血清总PSA(tPSA)的特异性不强,容易造成误诊。近年来,国内外研究人员开发出一系列PSA衍生指标,与tPSA以及其他诊断方法(如MRI、超声、直肠指检结果和其他肿瘤标志物)联合应用能够进一步提高前列腺癌的早期诊断准确率,并可用于评估肿瘤恶性程度、侵袭性、术后生化复发以及帮助制定前列腺穿刺活检决策等,具有广阔的研究前景。本文就PSA衍生指标诊断前列腺癌的最新研究进展进行综述。     

前列腺癌综合指数及临床意义初探

目的 寻求一种诊断前列腺癌（ＰＣａ）的更有效方法．方法 ＰＣａ７８例和前列腺增生症７３例临床资料进行分析,并根据前列腺特异抗原（ＰＳＡ）、直肠指检及年龄与ＰＣａ的相关性设计出一公式,将直肠指检所得到的前列腺大小、结节、硬度进行量化,所得数值称为“前列腺癌综合指数一公式,将直甩指检所得的前列腺大小、结节、硬度进行量化,所得数值称为“前列腺癌综合指数（ＩｐＣａ）”。结果 当ＩｐＣａ以５．８０为阈值时,     

超声引导下经直肠前列腺穿刺活检术的护理配合

直肠超声是目前诊断前列腺癌的主要方法之一,然而前列腺癌的确诊仍需要病理检查。过去对可触及的前列腺肿块在直肠指检引导下行前列腺穿刺活检术,该操作较盲目,有３０％～５０％的前列腺癌漏诊［１］。１９８９年Ｐｅｒｄｅｒｓｏｎ等［２］最先采用超声引导下经直肠前...     

经直肠超声造影诊断前列腺癌的应用进展

CEUS可反映肿瘤的血流动力学特征。目前关于经直肠CEUS技术对于诊断前列腺癌的应用价值以及靶向引导前列腺穿刺活检等方面的研究越来越多。经直肠CEUS通过综合分析CEUS增强模式以及造影参数来诊断前列腺癌,具有非常重要的临床价值。本文对经直肠CEUS技术在诊断前列腺癌中的应用进展进行综述。     

Prostate-specific antigen (PSA) value change after antibacterial therapy of prostate inflammation, as a diagnostic method for prostate cancer screening in cases of PSA value within 4-10 ng/ml and nonsuspicious results of digital rectal examination.

OBJECTIVES: Investigation of the possibilities of improving the accuracy of prostate cancer (PC) screening among patients with a PSA value of 4-10 ng/ml and nonsuspicious results of digital rectal examination (DRE), using as diagnostic method the PSA value change (PSA-VCh) after antibacterial treatment of prostate inflammation. METHODS: The study included 61 patients with PSA 4-10 ng/ml, nonsuspicious DRE and inflammation in expressed prostate secretion (EPS). All these patients underwent antibacterial therapy with the following repeated PSA determination and PSA-VCh assessment. RESULTS: Antibacterial therapy led to PSA decrease in 80% of cases. Effectiveness of PSA-VCh in PC screening was estimated. Sensitivity of PSA-VCh (with cut-off point -0.1.100%) equaled 85%, specificity 96%, positive predictive value 85% and negative predictive value 96%. CONCLUSIONS: Prostate inflammation proves to be a significant factor contributing to serum PSA elevation up to 10 ng/ml among patients with nonsuspicious DRE. Assessment of PSA-VCh after antibacterial treatment can improve PC screening accuracy in cases of PSA 4-10 ng/ml, nonsuspicious DRE and inflammation in EPS.     

Defining prostate cancer risk before prostate biopsy

Prostate cancer is the most commonly diagnosed cancer in men. At present, patients are selected for prostate biopsy on the basis of age, serum prostate specific antigen (PSA), and prostatic digital rectal examination (DRE) findings. However, due to limitations in the use of PSA and DRE, many patients undergo unnecessary prostate biopsy. A further problem arises as many patients are diagnosed and treated for indolent disease. This review of the literature highlights the strengths and weaknesses of existing methods of prebiopsy risk stratification and evaluates promising serum, urine, and radiologic prostate cancer biomarkers, which may improve risk stratification for prostate biopsy in the future.     

Transrectal contrast enhanced ultrasound for diagnosis of prostate cancer

The diagnosis of prostate cancer is based on histology. Prostate biopsies are obtained based on the triad of prostate specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound. Because prostate biopsies still have a large percentage of negative outcomes, patient selection and biopsy direction need improvement. This paper describes the recent improvements in prostate cancer imaging, especially contrast-enhanced transrectal ultrasound. A paper within the framework of the European Society for Urological Imaging (ESUI).     

Elevated prostate-specific antigen, abnormal prostate evaluation on digital rectal examination, and transrectal ultrasound and prostate biopsy

Prostate cancer screening for the early diagnosis of organ-confined, potentially curable prostate cancer has dramatically changed the practice of urology over the past 15 years. The introduction of prostate-specific antigen (PSA) testing, increased medical and public awareness for digital rectal examination (DRE), and transrectal ultrasound-assisted needle biopsy of the prostate (TRUS/PNBX) has been instrumental in these dramatic changes.     

前列腺癌的早期诊断

前列腺癌(PC)是一种极为特殊的肿瘤,早期诊断、及时治疗是提高PC患者生存率的关键。探讨国内外有关PC的早期诊断方法,重视PC的危险信号,重视危险人群的检查、直肠指诊(DRE) 、经直肠超声及前列腺特异抗原,是目前临床上筛查PC的主要方法,磁共振波谱成像( MRS)对前列腺节结的鉴别有重要意义,确诊依靠前列腺穿刺活检。     

Not all patients pursue prostate biopsy after abnormal prostate specific antigen results

In prostate cancer, digital rectal examination (DRE) and serum prostate specific antigen (PSA) are used to evaluate the risk of prostate cancer. However, in published community-based screening samples, not all patients with abnormal test results pursue biopsy. To test the existence of and quantify diagnostic dropout in clinic-based early detection samples, we conducted a prospective patterns-of-care study designed to identify variables associated with pursuit of diagnostic steps. Of 76 patients with abnormal PSA and/or DRE, only 43 (57%) pursued prostate biopsy. Prostate specific antigen, but not age or chart-based comorbidities, was predictive of further diagnostic and therapeutic steps. Among patients with abnormal test results, age and abnormal PSA and DRE, but not chart-based comorbidities, strongly correlated with physician intention to diagnose prostate cancer. The factors that cause diagnostic dropout are unknown, but based on experience with other cancers, they may relate to psychological variables in tested patients. That pursuit of diagnosis and treatment appears to occur with no association with chart-based comorbidities is worrisome given the power of comorbidities to predict mortality in prostate cancer patients. Finally, from a public health perspective, a reproducible dropout phenomenon implies that the positive predictive value of DRE and PSA testing may be seriously underestimated.     

Preventing prostate carcinoma in men with familial disposition

A family history is one of the strongest risk factors for prostate cancer (PC). We evaluated the detection rate of PC in relatives of 119 German PC families that took part in ongoing linkage analyses. Brothers of patients with sporadic prostate cancer aged < 55 years at onset were included as well. Responses were received from 120/196 (61.2%) individuals of the familial and 67/120 (55.8%) of the sporadic group. Findings (DRE, TRUS, PSA) were more often suspicious for carcinoma in the PC families. Prostate cancer was diagnosed in 6 (5.0%) and 2 (2.99%) participants of the familial and the sporadic group, respectively. These detection rates tended to be higher than that of an age-matched subgroup of an unselected population in other European screening studies. The most important risk factor for the diagnosis of PC was a low average age at onset within the family. These data imply that prostate cancer screening in the high-risk group of men with familial predisposition cannot be assessed by population-based studies and should be evaluated separately.     

Prostate cancer

Prostate cancer is the most prevalent type of solid malignant tumour among men in UK. The incidence rate each year amongst age standardized males in the UK was 98.3/100,000. Increasing age is the strongest predeterminant for the development of prostate cancer. Virtually all prostate cancers are adenocarcinomas with their differentiation graded by means of the Gleason score. Since there are often no presenting symptoms, diagnosis is usually reliant on investigations such as digital rectal examination (DRE), the serum prostate-specific antigen (PSA) level, PCA3 m-RNA levels and biopsies guided by a trans-rectal ultrasound probe. Staging consists of magnetic resonance imaging or computed tomography for locally advanced disease and/or a bone scan for detection of bony metastases. Management depends largely on the stage of the disease. For localized prostate cancer, radical prostatectomy can offer a potential cure. Side effects include erectile dysfunction and incontinence. Prostate cancer is also radio-sensitive and can be treated by external-beam radiotherapy or brachytherapy. Hormonal therapy, such as luteinizing-hormone-releasing hormone (LHRH) analogues and anti-androgens are used in locally advanced and metastatic disease. Patients may opt for prostate-specific antigen (PSA) surveillance allowing other therapeutic options to be employed if the PSA starts to rise or the tumour progresses locally. Cytotoxic chemotherapy is increasingly being used for hormone escaped/resistant prostate cancer, and other newer treatment options are in the pipeline. The survival rate for all stages of prostate cancer is now extending.     

Digital rectal examination, transrectal ultrasonography and prostate specific antigen for diagnosis of prostate cancer in clinical urological practice-detection of impalpable cancer]

OBJECTIVE: The clinical usefulness of multimodality detection for prostate cancer by digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum PSA determination (PSA) was evaluated in this retrospective study. PATIENTS AND METHODS: A total of 1344 symptomatic male patients who underwent DRE, TRUS and PSA in our outpatient clinic were studied. Prostate biopsies were performed when at least one diagnostic test was positive. RESULTS: Of 1344 patients, 436 (32.4%) had positive test results. Among 403 patients who underwent biopsy, 121 patients (30.0%) were found to have prostate cancer. The overall cancer detection rate was 9.0%. Among the 121 cancer patients, if examination had been carried out using only one or two tests, cancer would have not been detected in 22 patients (18.2%) by DRE alone, 27 patients (22.3%) by TRUS alone, 18 patients (14.9%) by PSA alone, 12 patients (9.9%) by a combination of DRE and TRUS, and 6 patients (5.0%) by a combination of DRE and PSA. Among the 121 patients with cancer, 22 (18.2%) had impalpable cancer. Impalpable cancer was more likely to be localized (77.3%) than palpable cancer (28.3%, p < 0.001) and more likely to be well or moderately differentiated (72.7%) than palpable cancer (41.4%, p = 0.008). CONCLUSION: This study confirmed the need for multimodality detection using DRE, TRUS and PSA as complementary methods in order to minimize decrease in cancer detection. In particular, impalbable cancers not detectable by DRE were detected and were revealed to be more likely to be localized and amenable to curative therapy. These results therefore underscore the importance of multimodality detection for early diagnosis of prostate cancer in urological practice.     

The utility of artificial neural networks in the prediction of prostate cancer on transrectal biopsy

ObjectiveTo determine whether the development of an artificial neural network (ANN) made up of clinical variables allows for the prediction of prostate biopsy (PB) outcome.Material And MethodsPatients (n=953) underwent PB at the Arquitecto Marcide Hospital in Ferrol (Spain), between january 2000 and june 2005. The variables studied were age, PSA, digital rectal examination (DRE) and prostate volume, data for all of which were available in 843 cases. In order to determine factors related to prostate cancer (PC) diagnosis, a logistic regression analysis and a feed–forward neural network were developed, including three hidden layer nodes and an output node, representing the probability of PC. Both models were constructed from a random sample of n=643 patients (derivation set). The predictive capacity was assessed with the remaining 200 patients (validation set), by means of ROC curves and the area under the curve (AUC).ResultsPC was detected in 500 (59.3%) cases. Adjusting for age, PSA, digital rectal examination and prostate volume, in a multivariate logistic regression model it was observed that all the variables were independent predictors of PC. The AUC were 0.693 for PSA, 0.707 for prostate volume, 0.815 for logistic regression and 0.819 for ANN. The predictive capacity of the ANN was significantly higher than that of the PSA (p=0.002) and prostate volume (p < 0,001) and similar to that of logistic regression (p=0.760).ConclusionsThe ANN shows a PC prediction capacity that is significantly higher than unimodal diagnosis methods, and similar to that of logistic regression.