经会阴前列腺24针饱和穿刺活检与14针活检在PSA＜20μg/L患者中筛检前列腺癌的对比性研究

目的:探讨超声引导下经会阴前列腺24针饱和穿刺活检与14针穿刺活检方案对PSA<20μg/L可疑前列腺癌患者的筛检阳性率及其相关并发症。方法:选取116例可疑前列腺癌患者行经会阴超声引导下14针穿刺活检(14针组),另136例患者,行经会阴24针饱和前列腺穿刺活检(24针饱和组),比较两组前列腺癌筛检阳性率、标本阳性率及穿刺后肉眼血尿、泌尿系感染、尿潴留等并发症的发生率。结果:两组患者平均年龄、穿刺前PSA水平、平均前列腺体积等指标均无统计学差异(P>0.05)。24针饱和组及14针组前列腺癌筛检总体阳性率分别为48.53%和17.24%,存在显著性差异(P<0.001),标本阳性率分别为8.09%和2.83%(P=0.012);其中24针饱和组前列腺尖部肿瘤的检出率(11.76%)显著高于14针组(1.72%,P<0.05)。两组穿刺后尿潴留、泌尿系感染和肉眼血尿等发生率均无统计学差异(P>0.05)。结论:24针经会阴前列腺饱和穿刺活检方法显著提高PSA<20μg/L患者中前列腺癌的筛检阳性率,尤其是增加了前列腺尖部区域的肿瘤筛检阳性率,而并未增加相关并发症。

Ultrasound-guided transperineal 24-core saturation prostate biopsy is superior to the 14-core scheme in detecting prostate cancer in patients with PSA < 20 microg/L

Objective: To compare the detection rates of prostate cancer(PCa) and complications of the transrectal ultrasonography(TRUS)-guided 24-core saturation scheme versus 14-core scheme for transperineal prostate biopsy in patients with total PSA < 20 μg/L.Methods: We performed TRUS-guided 24-core saturation transperineal biopsy for 136 patients suspected of PCa(24-core group) and 14-core biopsy for another 116(14-core group).We compared the PCa detection rates and post-biopsy complications,such as gross hematuria,urinary system infection,and acute urinary retention between the two groups.Results: The baseline characteristics of the two groups were comparable with regard to the mean age,prostate volume and PSA level(P > 0.05).The positive rates of PCa detection were 48.53%(66/136) in the 24-core group and 17.24%(20/116) in the 14-core group(P < 0.001),and the positive rates of samples were 8.09% and 2.83%,respectively(P = 0.012).The detection rate of PCa in the apex zone was significantly higher in the former(11.76%) than in the latter(1.72%)(P < 0.05).There were no statistically significant differences in such post-biopsy complications as gross hematuria,urinary system infection,and acute urinary retention between the two groups(P > 0.05).Conclusion: TRUS-guided 24-core saturation transperineal biopsy of the prostate is superior to the 14-core scheme for its higher detection rate of PCa,particularly PCa in the apex zone,and lower incidence of complications in patients with PSA < 20 μg/L.