6针法和13针法前列腺穿刺活检术诊断前列腺癌的分析比较

A retrospective analysis comparing 6 versus 13 prostate biopsy cores:impaction on cancer detection

目的探讨5区13针法和6针法前列腺穿刺活检诊断前列腺癌的差异。方法本组214例,因前列腺特异性抗原>4.0ng/ml或直肠指诊前列腺癌阳性可疑而行13针前列腺穿刺活检术,其中前列腺特异性抗原>4.0ng/ml者203例,直肠指诊前列腺癌阳性可疑者41例。入选病例的年龄为50￣90岁,平均69.8岁;PSA水平0.8￣112.3ng/ml,平均18.7ng/ml;前列腺体积12.3￣182.5ml,平均61.3ml;直肠指诊阴性者173例,阳性者41例。结果6针法和13针法的阳性率分别为30.8(%66/214)和36.0(%77/214),后者的阳性率提高14.3(%11/77()P<0.001)。两者的差异在前列腺特异性抗原≤20ng/ml,指诊阴性,体积>40ml,前列腺特异性抗原密度≤0.30,年龄<70岁的患者中更显著。结论5区13针前列腺穿刺活检术比系统6针发现前列腺癌的阳性率更高。

Objective To compare 6 to 13 prostate biopsy cores for determining the impact on the prostate cancer detection rate. Methods 214 consecutive men with suspected prostate cancer were included in the study. Indications for transrectal ultrasound guided prostate biopsy were： abnormal digital rectal examination（DRE） and/or a total prostate specific antigen （PSA） over 4.0ng/ml. In these candidates age was between 50 years and 90 years, mean 69.8 years; PSA was between 0.8 ng/ml and 112.3ng/ml, mean 18.7 ng/ml; and the prostate volume was between 12.3ml and 182.5ml, mean 61.3ml. DRE was negative in 173 cases and positive in 41 cases. In addition to sextant biopsies, samples of 13-core biopsy protocol were taken also from the far lateral and mid regions of the gland. Pathological findings of thel 3-core biopsy protocol were compared to those of the sextant regions and correlated with total PSA, DRE findings, prostate volume, PSA density and age. Results Prostate cancers were detected in 77 of 214 （36%） patients. Of the 77 patients with prostate cancer I l （14.3%） had carcinomas only in the additional regions （P〈0.001）. The difference of cancer detection rate was significantly associated with the parients with PSA ≤ 20 ng/ml, normal DRE findings, prostate volume〉40ml, PSA density ≤ 0.30 and age under 70 years. Conclusion The present study suggests that compared with 6-core biopsy regimen, the 13-core technique of prostate biopsy significantly increased the diagnostic yield of prostate biopsy in finding carcinoma of the prostate.