6点与12点前列腺穿刺活组织检查诊断前列腺癌的回顾性比较分析

Comparison of 6 o'clock and 12 o'clock position prostate biopsy cores for detection of prostate cancer: a retrospective analysis

目的探讨6点与12点前列腺穿刺活组织检查诊断前列腺癌的差异。方法选择因血清总前列腺特异性抗原（PSA）〉4ng／mL、直肠指诊或前列腺B超检查提示前列腺癌可疑的患者300例，分别接受6点或12点前列腺穿刺活组织检查。患者年龄42～87岁，平均年龄为（68．4±2．1）岁。PSA水平为（20．7±1．7）ng／mL（0．9～128．3ng／mL），其中PSA〈4ng／mL13例，≥4且〈10ng／mL30例，≥10且≤20ng／mL158例，〉20ng／mL99例。前列腺体积13．4～178．5mL，平均体积为（63．4±3．5）mL。前列腺B超检查显示阴性211例，阳性89例；直肠指诊阴性207例，阳性93例。结果6点与12点前列腺穿刺活组织检查的阳性率分别为32．9％（50／152）和41．2％（61／148）。对于PsA≤20ng／mL、前列腺体积≥50mL、B超检查阴性的患者，12点穿刺活组织检查的阳性率显著高于6点法。在12点穿刺活组织检查阳性的病例中，有18例在传统6点穿刺未检测到癌组织，而在添加的6点中检测到。结论12点前列腺穿刺活组织检查比6点穿刺检出前列腺癌的阳性率更高，两种方法穿刺后并发症发生率的差异无统计学意义。

Objective To compare the outcomes of 6 o＇clock and 12 o＇clock position prostate biopsy cores for detecting prostate cancer. Methods A total of 300 patients with suspected prostate cancer （with abnormal digital rectal examination[DRE], abnormal prostate ultrasound or/and prostate specific antigen [PSA]〉 4.0 ng/mL） were included in the present study. They received transrectal ultrasound-guided 6 o＇clock or 12 o＇clock position prostate biopsies. The patients were aged 42- 87 years old, with a mean of （68.4±2.1 ） years. They had a PSA range of 0.9- 128.3 ng/mL and a mean of （20.7±1.7） ng/mL, with PSA〈4 ng/mL in 13 cases,4-10 ng/mL in 30 cases, 10-20 ng/mL 158 cases, and 〉20 ng/mL in 199 cases. The prostate volume was 13.4- 178.5 mL, with a mean of （63.4±3.5） mL. Prostate ultrasound results were negative in 211 cases and positive in 89 cases. DRE was negative in 207 cases and positive in 93 cases. Results The positive detection rate of 6 and 12 o＇clock positions were 32.9% （50/152） and 41.2% （61/148）, respectively. Eighteen cases who were positive in 12 o＇clock position biopsy were negative in the traditional 6 o＇clock position biopsy, but were positive in the additional 6 o＇clock cores. Conclusion Compared with 6 o＇clock core biopsy,the 12 o＇clock core one can yield a higher positive rate, which is especially true when PSA≤20 ng/mL and when volume of prostate ≥50 mL. The incidences and duration of complications are similar between the 6 and 12 o＇ clock position biopsies.