经直肠超声引导下前列腺穿刺活检临床分析

目的探讨经直肠超声引导下前列腺穿刺活检阳性率的临床影响因素。方法回顾性分析1996至2009年解放军总医院行经直肠超声引导下前列腺穿刺活检的2 364例患者的临床资料。结果 （1）1996至2009年解放军总医院经直肠超声引导下前列腺穿刺活检阳性率逐年升高。（2）年龄≥80岁的患者前列腺癌检出率高达46.73%（143/306）;年龄〈50岁的患者前列腺癌检出率较低,仅为16.22%（12/74）。（3）前列腺特异性抗原（PSA）浓度≤4、4~、10~、20~、50~、〉100μg/L的患者前列腺癌检出率分别为16.12%（49/304）、26.01%（129/496）、33.80%（195/577）、47.15%（174/369）、78.23%（97/124）、95.06%（154/162）。随着患者PSA浓度的上升,前列腺癌检出率逐渐增高。（4）前列腺体积≤20 ml的患者前列腺癌检出率为37.14%（55/147）;前列腺体积为20~30 ml的患者前列腺癌检出率为48.06%（173/360）;前列腺体积为30~40 ml的患者前列腺癌检出率最高,为50.84%（181/356）;而后随着患者前列腺体积的增大,前列腺癌检出率逐渐降低。（5）前列腺癌患者（n=285）游离PSA/总PSA（f/t PSA）低于非前列腺癌患者（n=431）（0.14±0.11 vs 0.19±0.11）,而PSA密度（PSAD）高于非前列腺癌患者（0.70±0.68 vs 0.25±0.32）,且差异均有统计学意义（t=3.969、7.219,均P〈0.05）。结论经直肠超声引导下前列腺穿刺活检阳性率可受多种因素如年龄、PSA浓度、前列腺体积、f/t-PSA与PSAD的影响,联合检测对前列腺癌的临床诊断有重要的价值和意义。

Clinical assessment of transrectal ultrasound guided biopsies of the prostate in 2 364 patients

Objective To explore the clinical factors infl uencing the positive rate of transrectal ultrasound guided prostate biopsy.Methods Data were collected from 2 364 men who underwent prostate biopsy for suspected prostate cancer during the period of 1996-2009,variables analyzed including age,prostate specifi c antigen（PSA） level,prostate volume,free PSA/total PSA（f/t PSA）,and PSA density（PSAD）.Results（1） The positive rate of transrectal ultrasound guided prostate biopsy increased from 1996 to 2009 in General Hospital of People′s Liberation Army.（2） The detection rate of prostate cancer was 46.73%（143/306） in patients ≥ 80 years;The detection rate of prostate cancer was low,only 16.22%（12/74） in patients〈50 years.（3） The detection rate of prostate cancer is 16.12%（49/304）,26.01%（129/496）,33.80%（195/577）,47.15%（174/369）,78.23%（97/124）,95.06%（154/162） with the concentration of PSA level ≤ 4,4-,10-,20-,50-,100〉 μg/L.The detection rate of prostate cancer increased gradually with the rising of PSA level in patients.（4） The detection rate of prostate cancer was 37.14%（55/147） in patients with the prostate volume ≤ 20 ml;The detection rate of prostate cancer was 48.06%（173/360） in patients with the prostate volume ranging from 20 to 30 ml;The detection rate of prostate cancer was the highest（50.84%,181/356） in patients with the prostate volume ranging from 30 to 40 ml;as the volume of prostate increased,the detection rate of prostate cancer decreased gradually.（5） The f/t PSA of patients with prostate cancer（n=285） was lower than patients without prostate cancer（n=431）（0.14±0.11 vs 0.19±0.11）,and PSAD of patients with prostate cancer was higher than patients without prostate cancer（0.70±0.68 vs 0.25±0.32）,The results showed signifi cant difference（t=3.969,7.219,both P 〈0.05）.Conclusion Transrectal ultrasound guided prostate biopsy under positive rate can be affected by many factors such as age,prostate volume,PS