社区中老年人群前列腺疾病筛查的价值

目的探讨联合应用经直肠超声(TRUS)、前列腺特异性抗原(PSA)和直肠指检(DRE)方法筛查前列腺癌的意义。方法 2010年1月—2012年3月,对来社区卫生中心就诊的325例45～80岁男性,联合应用TRUS、PSA及DRE方法,观察前列腺疾病的分布情况;三者均为阳性作为前列腺癌高风险者行前列腺穿刺活检。结果 325例中,前列腺增生、前列腺结石、前列腺囊肿及前列腺癌分别为256例(78.77%)、33例(10.16%)、31例(9.53%)和5例(1.54%)。前列腺增生和前列腺结石在不同年龄分布差异具有统计学意义(P<0.05);与临床前列腺癌组比较,本组B期以下早期癌占80%,临床组B期以下早期癌只占26.47%,且多为偶发癌;转移癌的诊断率筛查组低于临床组,临床组低分化癌的比率高于筛查组(P均<0.05)。结论社区中老年男性体检中,进行以TRUS、PSA及DRE为主的筛查,是早期发现前列腺癌的最佳途径,对临床早期诊疗具有重要的指导意义。

Significance of prostatic screening for the middle-aged and aged in the communities

Objective To discuss the significance of combined use of transrectal uhrasonography(TRUS),prostate special antigen(PSA) and digital rectal examination(DRE) in diagnosing prostatic cancer. Methods From January 2010 to January 2012,325 cases aged 45 to 80 years old who came to the community health centers to seek medical service were selected.We used the TRUS,PSA and DRE to observe the distribution of prostatic disorders in patients.Patients with 'positive in all three tests' as the high risk patients underwent transrectal prostatic biopsy. Results Among the 325 cases,there are 256 cases(78.77%) of prostatoplasia,33 cases(10.16%) of prostatolith,31 cases(9.53%) of cyst of prostate and 5 cases(1.54%) of prostatic cancer.The distribution of patients with prostatoplasia and prostatolith in different age groups is of statistical significance(P<0.05);compared with clinical prostatic cancer,early cancer below stage B in this screening group accounting for 80%,while in clinical group only takes up 26.47 % and most of them are incidental carcinoma;the diagnosis rate of metastatic carcinoma in screening group is lower than that of clinical group;the rate of poorly differentiated cancer in clinical group is higher than that of screening group,and the difference is also of statistical significance(P<0.05). Conclusion Screening with TRUS,PSA and DRE for the middle-aged and aged men in the communities is the best way to diagnose prostatic cancer in the early stage,and has important guiding significance for early clinical treatment.