血清PSA筛选结合经直肠B超引导穿刺活检诊断前列腺癌

目的探讨经直肠B超（TRUS）引导穿刺活检在诊断前列腺癌中的临床价值。方法通过血清前列腺特异性抗原（PSA）的测定和筛选，对64例有排尿症状，血清PSA≥4ng／ml男性患者行TRUS定位前列腺10针穿刺活检。结果穿刺活检确诊前列腺癌28例（43．75%），良性前列腺增生36例（56．25％）。与术后病检结果对比，有3例术前穿刺活检为良性前列腺增生，术后病检确诊为前列腺癌，穿刺活检诊断前列腺癌的敏感度为90．32％（28／31），漏诊患者血清PSA4．5～9．2ng／ml。穿刺后不良反应有一过性血尿2例、肛门或会阴部痛5例，均自行缓解消失。结论TRUS定位前列腺穿刺活检具有准确、安全等优点，并发症少，简单易行，是确诊前列腺癌的有效方法之一，穿刺中除重视可疑区外，等回声区亦不能忽视，多点多部位的穿刺能降低漏诊。同时结合血清PSA测定，不但能提高早期诊断率，而且有助于前列腺癌患者的随访。

Screening of serum PSA combined tissue biopsy under transrectal ultrasound guidance in the diagnosis of prostate cancer

Objective To evaluate the clinical value of transrectal ultrasound guided biopsy of the prostate cancer. Methods The serum PSA level were determined in the patients who had suffered from LUTs,and 10 cores prostate biopsy under transrectal untrasound guidance was executed on 64 patients,whose serum PSA level more than 4 ng/ml. Results Of all the 64 patients,28 pa tients were proved to be prostate cancer by pathological examination. The positive detection rate was 43.75%.36 patients were proved to be BPH（56. 25%）. 3 patients were proved to be prostate cancer after TURP who were diagnosed to be BPH by prostate biopsy under transrectal ultrasound guid ance. The sensitivity of puncture biopsy for the diagnosis of prostat cancer was 93. 32%（28/31）. Those patients serum PSA were 4.5-9.2 ng/ml. The adverse effect were insignificant. 2 patients suf fered temporary hematuria and 5 patients suffered pain of cavitas pelvis. All these symptoms can re leased by themselves. Conclusions We concluded that transrectal ultrasound guided 10 cores prostate biopsy could increase the cancer detection rate significantly. It is easy, safe and efficacious. We should focus on the suspected regions, but we also could not ignore the iso-echoic regions. Conbined with the serum PSA level,multi-core and multi-site biopsies could reduce the rate of missed diagno sis,increase the early detection rate and benefit to the following up.