Retropubic adenomectomy in patients with a high level of prostate-specific antigen after prostatic biopsy

Results of examination and treatment were analysed for 58 patients after retropubic adenomectomy performed from February 2008 to June 2010. The examination protocol included assessment of a total score of the scales IPSS and QoL, parameters of uroflowmetry, total PSA, the size of the prostate, number of prostatic biopsies in a high PSA level. The removed adenomatous tissue was examined histologically. By a PSA level, all the patients were divided into 3 groups. Group 1 - 18 patients with a preoperative PSA level above 10 ng/ml, group 2 - 23 patients with a PSA level from 4 to 10 ng/ml, group 3 - 17 control patients with PSA under 4 ng/ml. Mean age of the examinees was 67.7 +/- 7, 68.7 +/- 7.7, 67.9 +/- 8.9 years (p>0.05), respectively. A mean PSA level was 20.9 (10.3-53), 6.6 (4.1-9.9) and 2.4 (1.3-3.9) ng/ml (p<0.01), respectively. A mean size of the prostate was larger in group 1 patients than in the controls: 127.3 (82-185) cm3 versus 100.7 (81-134) cm3 (p<0.05). Median of the number of transrectal multifocal biopsies was 2 (1-7), 1 (1-2) and 0 in groupl, 2 and 3, respectively. Histological examination of the adenomatous tissue detected prostatic adenocarcinoma in 0, 1(4.3%) and 1(5.9%) patients, respectively, while chronic prostatitis at different stages was diagnosed in 6(33.3%), 7(30.3%) and 7(41.2%) patients, respectively. Thus, the above protocol of examination of patients with prostatic adenoma including measurement of a PSA level, conduction of finger rectal examination followed by prostatic biopsy (transrectal saturation procedure is preferable) provides performance of adenomectomy without a risk to miss a clinically significant prostatic cancer even in a PSA level above 10 ng/ml.     

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.     

The role of prostate-specific antigen as part of the diagnostic triad and as a guide when to perform a biopsy.

The authors reviewed the results and relationship of prebiopsy prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasound (TRUS) in 124 consecutive patients who underwent a prostate biopsy because of abnormal results of either DRE or TRUS. Results of the three tests (PSA, DRE, and TRUS) showed abnormalities in 54%, 75%, and 84.6% of patients, respectively; biopsy results were positive for cancer in 45.2%. Cancer detection rate increased as the PSA value increased from less than or equal to 4 ng/ml (17.5%) to more than 4 ng/ml (68.7%) to more than 20 ng/ml (83.3%), and as the number of positive tests increased (6.9% for one, 32.7% for two, and 82.6% for three). The PSA assay was the most important parameter of the diagnostic triad. These results suggested that regardless of DRE and TRUS findings, PSA less than or equal to 4 ng/ml confers a low prostate cancer risk, PSA more than 4 ng/ml but less than or equal to 10 ng/ml confers an intermediate prostate cancer risk, and PSA more than 10 ng/ml confers a high prostate cancer risk. Regardless of other findings, all patients with a PSA value more than 10 ng/ml require biopsy because of the high likelihood of cancer. All patients with abnormal DRE or TRUS results still require biopsy despite a low index of suspicion of prostate cancer when the PSA value is less than or equal to 4 ng/ml.     

The clinical utility of measuring total PSA, PSA density, gamma-seminoprotein and gamma-seminoprotein/total PSA in prostate cancer prediction

BACKGROUND: To evaluate whether serum total prostate-specific antigen (PSA), PSA density (serum total PSA level divided by prostate volume), gamma-seminoprotein and gamma-seminoprotein/total PSA ratio could predict prostate cancer (PCa) prior to biopsy. METHODS: A total of 316 consecutive patients who had undergone transrectal prostate biopsy and/or transurethral resection were examined. The prostate volume was determined by transrectal ultrasonography (TRUS) and the ability of the above-mentioned four variables to distinguish PCa from benign prostatic hyperplasia (BPH) was evaluated. RESULTS: PCa was detected in 61 cases. Receiver-operating characteristic (ROC) analysis revealed that both the PSA density and serum total PSA were the most useful predictors of PCa among the four variables. For the patients with a serum total PSA level of 4.1-10.0 ng/ml, PSA density was significantly more accurate than total PSA (p < 0.005). An optimum PSA density value of 0.18 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 92 and 54%, respectively. Using this PSA density cutoff, the number of biopsies could have been reduced to 57 from 63% when compared with a PSA density of 0.15. CONCLUSIONS: PSA density was significantly more accurate than other variables in predicting PCa. To avoid unnecessary biopsies, the PSA density cutoff value of 0.18 would be recommendable for determining a prostate biopsy for Japanese males with a serum total PSA level of 4.1-10.0 ng/ml.     

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.     

Rationale for using serum prostate-specific antigen (PSA) level and PSA density (PSAD) to detect prostatic malignancy in a country with low prostate cancer incidence

Prostate-specific antigen (PSA) and PSA density (PSAD) values in Indonesia had been found uniquely much higher than the normal accepted values in western countries. However, PSA more than 10 ng/ml and PSAD above 0.15 in intermediate PSA of 4-10 ng/ml are still indicative of a prostate biopsy. This condition had led to unnecessary biopsies in view of the low incidence of prostatic carcinoma in our country. Our objective is to find alternative serum PSA levels and PSAD cutoff points that enhance the specificity and sensitivity of prostate cancer detection. This retrospective cross-sectional study included 805 consecutive patients from 40 to 95 years old in Sumber Waras Hospital (SWH) and Cipto Mangunkusumo Hospital (CMH) from 1994 to 1997. All patients underwent digital rectal examination (DRE) and transrectal ultrasonography (TRUS) to measure prostate volume. After the serum PSA level was determined and PSAD was calculated, prostate biopsies were performed if the PSA level was greater than 10 ng/ml or PSAD more than 0.15 at intermediate PSA levels of 4-10 ng/ml. The ability of PSA, intermediate PSA level, and PSAD to improve the accuracy of prostate cancer detection was evaluated using univariate analysis. Among 805 patients, 240 patients had PSA level < 4 ng/ml, 230 patients had PSA level 4-10 ng/ml, and 335 had PSA level > 10 ng/ml. Of the 230 patients with intermediate PSA level, 108 had PSAD > 0.15. Thirty-five patients had histologically confirmed prostatic carcinoma, i.e., 3 of 108 patients with PSA 4-10 ng/ml and PSAD > 0.15, and 32 of 335 patients with PSA > 10 ng/ml. There were 105 and 303 unnecessary biopsies in those groups. With a PSA cutoff level of > or = 8 ng/ml, we found 100% sensitivity to prostate cancer. PSAD > or = 0.20 within a PSA level of 8-30 ng/ml gave 100% sensitivity to prostate cancer. Using these new cutoffs there would be 148 biopsies (33.4%) saved. We concluded from this study that the commonly accepted values of serum PSA level and PSAD resulted in many unnecessary biopsies in our patients. Instead, the most sensitive cutoff points to perform prostate biopsy are serum PSA level greater than 8.0 ng/ml, and PSAD of more than 0.20 at an intermediate serum PSA level of 8-30 ng/ml.     

Is extended biopsy protocol justified in all patients with PSA ≥ 20 ng/mL？

The aim of this study was to investigate whether it was necessary to increase the number of cores at initial prostate biopsy with patients of prostate-specific antigen （PSA） ≥ 20 ng/mL and to explore an appropriate individualized transrectal ultrasonograhpy （TRUS）-guided prostate biopsy for the detection of prostate cancer in men suspicious of prostate cancer. Methods： A total of 115 patients with PSA ≥ 20 ng/mL and suspicious of prostate cancer were prospectively randomized to perform TRUS-guided biopsy. Patients were randomized to a ＂6 ＋ X＂ cores or a ＂10 ＋ X＂ cores protocol. The primary end point was cancer detection rate. Secondary end points were cancer characteristics, rate of complications and the level of pain experienced by patients during TRUS-guided prostate biopsy. Results： Preoperative variables were similar in both groups. The overall prostate cancer detection rate was 73.9%. The ＂10 ＋ X＂ cores strategy increased cancer detection rate only 9.7% in patients with PSA ≥ 20 ng/mL but 〈 50 ng/mL, while there was no difference between the two strategies for cancer detection in patients with PSA ≥ 50.1 ng/mL. The number of extended biopsy cores and pain score of extended biopsy in prostate cancer patients increased significantly （P 〈 0.001）. Conclusion： Our findings suggest that there is no significant advantage in using extended biopsy protocol in all patients with PSA≥20 ng/mL.     

Benefit of primary saturational biopsy in detection of localized prostatic cancer after radical prostatectomy

We studied diagnostic potential of saturational technique of prostatic biopsy in 1018 males with suspected prostatic cancer (PC). Primary transrectal multifocal prostatic biopsy under ultrasound control was made in all the examinees including 453 procedures with use of saturational technique. The age of the patients varied from 43 to 77 years (median 60 years). A total of 159 patients with diagnosed prostatic cancer have undergone retropubic radical prostatectomy. Saturational biopsy has detected prostatic cancer in 35.1% cases. This technique was employed in hard for PC diagnosis parameters: age median 60 years, PSA 11.9 ng/ml, PSA density 0.23 ng/ml/cm3, prostatic volume 59.7 cm3. The above variant of biopsy detects the highest proportion of localized PC stages, minimal incidence of positive surgical margin, perineural and perivascular invasions, minimal score by Glison/s scale. Thus, the saturational technique of biopsy can be the method of choice in patients under 65 years of age, in a PSA level under 10 ng/ml, PSA density under 0.25 ng/ml/sm3 and prostatic volume over 60 cm3.     

The diagnostic accuracy of the age-adjusted and prostate volume-adjusted biopsy method in males with prostate specific antigen levels of 4.1-10.0 ng/mL

BACKGROUND: The authors evaluated a new age-adjusted and prostate volume-adjusted biopsy method for the detection of prostate carcinoma through the transperineal and the transrectal approaches in men with PSA levels of 4.1-10.0 ng/mL. METHODS: The value of the adjusted biopsy method was calculated by using the following four factors: 1) life expectancy in Japanese men in 1998, 2) prostate volume estimated by transrectal ultrasonography, 3) tumor doubling time (4 years), and 4) tumor volume that influenced death (20 cc). The number of biopsy sites was set at 8-20. Between August, 1999 and December, 2001, 100 men age or= 50 cc, and men with PSA density (PSAD) levels /= 50 cc), and patients with PSAD levels 相似文献   

Effects of parallel ultrasonic visualization of the prostate in sagittal and cross projections in transrectal biopsy on detectability of prostatic cancer

The results of 526 transrectal prostatic biopsies are available. Mean age of the patients was 64.6 years, mean level of PSA--10.4 ng/ml, mean size of the prostate--56 cm3. Biopsy was made in visualization of the prostate in the sagittal projection (ultrasound devices Bruel & Kjaer 1846 and Kretz Voluson 730). Application of Bruel & Kjaer Medical 2102 Hawk provides visualization of the prostate during biopsy both in sagittal and cross projection. Double visualization significantly improved detectability of prostatic cancer in patients with PSA 4-10 ng/ml. In biopsy of the top and peripheral zone there was lengthening of prostatic tissue fragments, reduced fragmentation of the columns, less frequent blank shots of the biopsy gun. The data obtained supports the importance of isolated placement and marking of prostatic tissue fragments in biopsy and allow to recommend wide clinical use of ultrasonic facilities with biplanic sensors providing online sagittal and cross visualization of the prostate.     

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.     

智能融合成像技术对中低风险前列腺特异性抗原人群的临床显著性前列腺癌诊断研究

目的:探讨核磁联合经直肠超声计算机软件融合成像引导前列腺靶向穿刺活检(software guided magnetic resonance imag?ing-ultrasound fusion targeted biopsies,MRUS-TB)在中低风险前列腺特异性抗原(prostate-specific antig...     

Editorial comments

Ninety-nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlated with digital rectal examination (DRE), serum prostate specific antigen (PSA), and biopsy results. Ninety-six cases had evaluable ultrasound studies. Thirty-two of the 99 who underwent biopsy had primary carcinoma of the prostate. Prostate volume, predicted PSA, a ratio of observed/predicted PSA, and Gleason score were examined. There was no correlation between age and prostate volume, volume and the presence of carcinoma, or PSA and Gleason score. Thirty-one point six percent of the abnormal DREs, 36.6% of the abnormal TRUSs, and 40.6% of the elevated PSAs occurred in men with prostatic carcinoma (PCa). If PSA was normal (less than or equal to 4.0 ng/ml) and either DRE or TRUS was abnormal, then the risk of carcinoma was 2.9%. If PSA was elevated, regardless of the other two tests, the risk of finding PCa was at least 38%. If all three tests were abnormal, the risk of carcinoma was 38% in our series and 68% in a meta-analysis. Many men with PSA values between 4 and 10 ng/ml have benign biopsies. However, close future follow-up with consideration of repeat biopsy should be strongly considered. © 1994 Wiley-Liss, Inc.     

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。     

不同PSA水平的国人首次前列腺穿刺活检所需穿刺针数的研究

目的 比较不同PSA水平患者采用6点法和12点法的前列腺活检阳性率,探讨针对不同的患者人群设计国人合理的首次前列腺穿刺点数。 方法 通过研究首次接受直肠超声引导经会阴前列腺穿刺的425例患者,在PSA的不同水平段,比较6点法和12点法的阳性率的差异,以及阳性患者穿刺活检Gleason评分与前列腺癌根治术后病理标本Gleason评分之间的差异。 结果 425例患者中6点法穿刺224例,12点法201例。PSA＞20 ng/ml的患者6点法与12点法的阳性率分别为85.3%、77.5%（P＞0.05）;PSA10~20 ng/ml患者6点法和12点法的阳性率分别为33.8%、39.1%（P＞0.05）。两者的12点法比6点法没有更高的阳性率。PSA≤10 ng/ml患者6点法和12点法的阳性率分别为24.1%、45.8%（P＜0.05）,12点法比6点法阳性率显著提高。结论 对于国人首次行前列腺穿刺,若PSA＞20 ng/ml推荐行6点法穿刺;PSA≤10 ng/ml推荐12点法穿刺,而PSA在10~20 ng/ml则两种穿刺方法均可以选用。     

Three-dimensional combination of transrectal and transperineal biopsies for efficient detection of stage T1c prostate cancer

Background Although an increasing number of men present with stage T1c prostate cancer, the optimal biopsy strategy for detecting stage T1c disease still remains to be defined. The aim of this study was to explore an efficient first-time biopsy scheme for detecting stage T1c and T2 prostate cancer. Methods A transrectal ultrasound-guided systematic three-dimensional 26-core (3D26) biopsy comprising 12 transrectal and 14 transperineal sampling sites was performed in 321 men with median prostate-specific antigen (PSA) level of 6.0 ng/ml in the first-time biopsy setting. By analyzing site-specific cancer detection rates, we determined the best combination of transperineal and transrectal sampling sites. Results Prostate cancer was detected in 109 of the 321 men (34%) with a major complication rate of 0.6%. 3D26 biopsy significantly improved cancer detectability by 60% relative to the conventional transrectal sextant (TR6) biopsy. Improvement was significant in 263 men with normal digital rectal examination (DRE) (85%, P = 0.0004) but not in 58 men with abnormal DRE (22%, P = 0.18). The mean Gleason score of the 41 cancers without a positive core within the TR6 sites was marginally lower than that of 68 cancers with a positive core within the TR6 sites (P = 0.04). Recursive partitioning revealed that a three-dimensional 14-core (transrectal 8-core plus transperineal 6-core) and a three-dimensional 8-core (transrectal 4-core plus transperineal 4-core) biopsies could detect more than 95% of stage T1c and T2 cancers with a minimum number of cores, respectively. Conclusion We propose a three-dimensional 14-core and a three-dimensional 8-core biopsy as efficient first-time biopsy schemes to detect stage T1c and T2 prostate cancer, respectively.     

Preoperative prediction of extracapsular tumor extension at radical retropubic prostatectomy in Taiwanese patients with T1c prostate cancer

BACKGROUND: To find a predictor for extracapsular tumor extension at radical retropubic prostatectomy (RRP) in Taiwanese patients with stage T1c prostate cancer (PC), preoperative transrectal sonoguiding prostate biopsy outcomes and clinicopathological data obtained from these patients were reviewed. METHODS: Fifty-five consecutive men who underwent radical retropubic prostatectomy for stage T1c PC were included. Preoperative sextant needle biopsies of the prostate were performed and whole-mount prostatectomy specimens were processed. The pathological end point was tumor capsular perforation extending entirely through the prostate capsule. Preoperative prostate-specific antigen (PSA), free-to-total PSA ratio, prostate volume, PSA density, Gleason score, number of positive biopsy cores, percentage cancer of sextant biopsies, percentage cancer of one lobe and percentage cancer of one core were analyzed for their ability to predict extracapsular tumor extension at RRP. RESULTS: Eighteen of the 55 specimens showed evidence of tumor capsular perforation. Those with extracapsular tumor extension (ECE) had higher PSA than organ-confined disease (OCD) (18.4 vs 8.3 ng/ml, P < 0.01). The ECE had a higher PSA density than OCD (0.556 vs 0.226, P < 0.01). The percentage of cancer in biopsies, percentage cancer of one lobe and percentage cancer of one core were all higher in ECE than OCD (P < 0.05). The ECE had a higher biopsy Gleason score than OCD (5.6 vs 4.5, P < 0.01). CONCLUSIONS: The four strongest predictors for extracapsular tumor extension of patients with T1c PC were PSA density >or=0.35, biopsy Gleason score >or=6, >or=20% cancer in biopsies and PSA >or=10 ng/ml.     

经直肠超声阴性前列腺癌患者的临床病理特征分析

目的 探讨穿刺病理证实为前列腺癌而经直肠超声（TRUS）检查阴性患者的临床病理特征。方法 选择2015年1月至2017年1月TRUS引导下经会阴途径前列腺穿刺后病理诊断为前列腺癌患者73例,根据TRUS图像特征分为TRUS阴性组31例与TRUS阳性组42例,比较两组患者的临床病理特征。结果TRUS阳性组血清PSA水平为（71.27±9.71）ng／ml,高于TRUS阴性组的（41.62±6.43）ng／ml,差异有统计学意义（P<0.05）,而两组的年龄、主要区域与次要区域的Gleason评分、微血管计数、癌组织长度占穿刺组织长度比例（最典型一针）、临床分期、无明显自觉症状例数、血管淋巴管侵犯例数、神经侵犯例数及浸润周围组织例数的差异均无统计学意义（P＞0.05）。结论TRUS阴性前列腺癌患者较TRUS阳性患者,除血清PSA水平明显较低外,临床特征、病理特征和侵袭性并无明显区别。对伴血清PSA水平或（和）临床症状异常而TRUS阴性者,仍需积极行前列腺系统穿刺病理检查,以免贻误临床治疗。     

经直肠实时组织弹性成像对前列腺癌的诊断价值

目的 探讨经直肠实时组织弹性成像(transrectal real-time tissue elastography,TRTE)对前列腺癌的诊断价值.方法 选取疑诊为前列腺癌患者62例,所有患者检测血清前列腺特异性抗原(PSA)、直肠超声检查以及经直肠实时组织弹性成像检查,并在超声引导下进行前列腺穿刺活检.评定前列腺弹性评分,并与病理结果和临床分期对比.结果 62例患者中病理活检确诊为前列腺癌52例,前列腺良性肿瘤10例,TRTE诊断前列腺癌的敏感度、特异度以及准确度分别为80.8％、50.0％和75.8％,其阳性预测值和阴性预测值分别为89.4％和33.3％.实时组织弹性成像结果显示,前列腺良性病变以Ⅰ级和Ⅱ级为主,恶性病变则主要以Ⅲ～V级为主,良恶性肿瘤弹性成像分级结果差异具统计学意义(P＜0.05).结论 经直肠实时组织弹性成像诊断前列腺癌具较好的敏感度、特异度以及准确度,对前列腺癌的诊断具重要的临床意义.