前列腺肿物检查方法的临床评价

Evaluation of methods of detection for prostate neoplasm

目的 评价血清前列腺特异性膜抗原 (PSA)和各项物理检查对指导前列腺活检的意义。 方法 结合血清PSA、直肠指诊 (DRE)、直肠B超 (TRUS)及磁共振成像 (MRI)检查 ,对 148例可疑前列腺病变患者 ,经直肠B超引导下行前列腺穿刺活检。 结果 前列腺活检阳性率为 43 9%(6 5 / 148)。DRE和PSA对前列腺癌的诊断有意义 (P <0 0 5 ) ,其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE(P <0 0 1) ,但前述三者之间对前列腺癌的诊断差异无显著性 (P =0 46 ,P =0 16 ,P =0 5 2 )。MRI的敏感性高于DRE和TRUS(P =0 0 5 ,P =0 0 1) ,TRUS的特异性高于PSA或MRI(P =0 0 2 ,P =0 0 0 1)。 结论 前列腺活检是诊断前列腺癌的重要手段 ,其初步筛选以DRE加PSA为主 ,同时结合TRUS及MRI,可提高筛选的敏感性和特异性 ,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。

Objective To evaluate the significance of serum prostate specific antigen (PSA), digital rectal examination (DRE), transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) as guide to perform prostate needle biopsy. Methods One hundred forty-eight patients suspicious of prostate neoplasm were undergone transrectal ultrasound-guided prostate needle biopsy. The pathologic diagnosis was analyzed in association with the results of PSA, DRE, TRUS and MRI in various combinations. Results The positive rate of biopsy was 43.9%. While abnormal DRE or PSA contributed in the detection of prostate cancer, serum PSA became more reliable when combined with DRE, TRUS or MRI, but the contribution of each of the three diagnostic procedures was not significantly different. The sensitivity of MRI was higher than that of DRE or TRUS, whereas TRUS was more specific than PSA or MRI. Conclusion[WT5”BZ] RE and PSA can be used for preliminary screening of prostate cancer. When combined with TRUS and MRI, the positive rate of diagnosis is increased. So is the specificity of the diagnosis which helps avoid unnecessary needle biopsy.