建立经会阴前列腺穿刺活组织检查的个体化方案(1044例资料总结)

Individualized regimen for transperineal prostate biopsy: an experience with 1044 cases

目的建立经会阴前列腺穿刺活组织检查的个体化方案。方法回顾性分析2000年1月-2010年12月复旦大学附属华东医院泌尿外科前列腺穿刺活组织检查的资料。2009年起采用个体化方案穿刺，即依据直肠指诊（DRE），经直肠超声（TRus）和磁共振弥散成像（MRD）检查示可疑结节，血清总前列腺特异性抗原（PSA）值，PSA修正值[包括年龄特异性PSA、游离PSA与总PSA比值（≤0．2或〉0．16）、PSA密度（≤或〉0．15ng·mL^-1·mL^-1）、PSA速度（≤或〉O．75ng·mL^-1·年^-1）]、外周带厚度（≤或〉0．5cm）来制定经会阴前列腺穿刺的个体化穿刺针数和部位。初步比较个体化穿刺方案与前期方案对前列腺癌总体检出率及对PsA≤20Mg／L患者前列腺癌的检出率。结果2000年1月-2010年12月共进行前列腺穿刺1641例，前列腺癌检出率为52．1％（855／1641）。2005年1月起采用TRUS引导下经会阴前列腺穿刺共1044例，前列腺癌检出率为52．0％（543／1044）。2009年1月-2010年12月采用个体化前列腺穿刺方案，前列腺癌检出率（60．7％）、PSA≤20btg／L的早期前列腺癌检出率（44．1％）均高于之前3个时期（P值均〈0．05）。结论依据血清总PSA值及DRE、MRD或TRUS图像下有无可疑灶，结合PSA修正值及前列腺周围带厚度，制定的可疑灶重点穿刺加系统6～14针个体化穿刺方案是可行的。

Objective To establish an individualized regimen for transperineal prostate biopsy. Methods The techenology of prostate biopsy in our unit have evolved from finger guided, transrectal ultrasound （TRUS） guided,and magnetic resonance diffusion weighted imaging （MRD） and TRUS jointly guided transperineal prostate biopsy. The clinical data of 1,044 patients with suspected prostate cancer, who underwent transperineal prostate biopsy in our hospital between Jan. 2005 and Dec. 2010, were retrospectively analyzed. We began to use individualized prostate biopsy protocol in 2009, in which we determined the biopsy cores and position of transperineal prostate biopsy according to the following factors; digital rectal examination（DRE）, TRUS, magnetic resonance diffusion weighted imaging, MRD, total prostate specific antigen （PSA）, adjusted PSA, age-specific PSA, F/T （≤0.2 or 〉0.16）, PSA density（≤ α 〉0. 15 ng·mL^-1·mL^-1）, PSA speed（≤ α 〉0.75·mL^-1·year^-1 ）, thickness of prostate peripheral zone （≤ α 〉0.5 cm）. We also compared the total detective rates of Pca between the individualized puncture regimen and traditional regimen and the rates in patients with PSA≤20 μg/L. Results The detective rate of Pca in 1,641 cases receiving prostate biopsy during Jan. 2000 to Dec. 2010 was 52.1%. Among them 1,044 patients received TRUS-guided transperineal prostate biopsy from Jan. 2005, with the detective rate for Pca being 52.0% （543/1,044）. A further modified individualized regimen for transperineal prostate biopsy was used during Jan. 2009 to Dec. 2010, which achieved a POa detective rate of 60.7 % and an early POa detective rate of 44.1% in patients with PSA≤20μg/L; the rates were significantly higher than those of the 3 above-mentioned periods （P〈0.05）. Conclusions The individualized regimen with emphasized-puncture for suspected lesions plus systemic 8- 14 cores puncture is a feasible regimen, which is based on total PSA, DRE, MRD and existence of suspected lesions on imaging findings, adjusted PSA value and thickness of prostate peripheral zone.