常规临床检查与PSA灰区患者前列腺癌检出率的关系

目的:探讨直肠指检(DRE)、影像学(TRUS、MRI)检查、血清游离与总前列腺特异性抗原(PSA)比值(f/t)与PSA在4～10μg/L之间患者前列腺癌检出率的关系。方法:回顾性分析365例PSA处于灰区的患者进行DRE、TRUS、MRI检查、游离PSA测定,并对这些患者行经直肠B超引导下的前列腺穿刺活检。评估其临床资料与前列腺穿刺病理结果的关系。结果:在365例患者中,穿刺病理为前列腺癌的患者共有87例(23.84%)。DRE阳性的患者共有128例,穿刺阳性40例,阳性率为31.25%,TRUS检查的患者共有257例,其中有异常回声结节的69例患者中穿刺阳性26例,阳性率为37.68%,MRI检查的患者共有191例,其中有异常信号结节的107例患者中穿刺阳性59例,阳性率为55.14%。198例患者行fPSA与tPSA比值分析,其中前列腺癌患者的平均f/t PSA明显低于穿刺阴性患者。f/t PSA受试者曲线(ROC)下的面积(0.725)高于患者PSA ROC的面积(0.542)。结论:结合临床DRE、影像学资料及f/t PSA比值可以有效提高前列腺癌检出率,从而减少不必要的穿刺给患者带来的痛苦。

Relationship of the positive rate of TRUS guided prostatic biopsies with routine diagnostic findings in detecting prostate cancer

Objective: To study the relationship of the positive rate of transrectal ultrasound(TRUS) guided prostatic biopsies in detecting prostate cancer with the findings of digital rectal examination(DRE),prostate imaging and measurement of the f/t PSA ratio.Methods: We retrospectively analyzed the clinical findings of 365 patients with PSA of 4-10 μg/L who had received DRE,prostate imaging and measurement of the f/t PSA ratio.We performed TRUS guided prostatic biopsies and then analyzed the relationship between the biopsy results and previous findings.Results: Of the 365 patients,87(23.84%) were found with prostate cancer by pathological biopsy,and 40 cases of prostate cancer(31.25%) detected in 128 patients with positive findings in DRE,26 cases of prostate cancer(37.68%) confirmed in 69 patients with positive findings in TRUS,and 59 cases of prostate cancer(55.14%) revealed in 107 patients with positive findings in MRI.The f/t PSA ratio was significantly lower in the malignant than in the benign cases(P<0.01),and the area of f/t PSA ROC(0.725) was significantly higher than that of PSA ROC(0.542).Conclusion: DRE,prostate imaging and measurement of the f/t PSA ratio can improve the positive rate of prostate cancer detection,and therefore reduce unnecessary prostatic biopsies.