基层医院基于医共体模式下前列腺癌筛查模式的初步探索

Preliminary exploration of prostate cancer screening mode based on the medical community model in primaryhospitals

目的探讨适合基层医院的医共体模式下前列腺癌筛查模式。方法将2021年4月至2022年4月宁波市鄞州区第二医院医共体下属9所分院共16007名≥50岁体检男性居民纳人研究。年龄(68.91±7.62)岁,其中50~59岁1628例(10.17%),60~69岁7119例(44.47%),70~79岁5940例(37.11%),≥80岁1320例(8.25%)。在常规体检项目中加入血清总前列腺特异性抗原(tPSA)检测,在医共体模式下将tPSA≥4ng/ml的患者转人医共体总院行多参数磁共振(mpMRI)检查,根据前列腺影像报告和数据系统(PI-RADS)对可疑病灶评分,对PI-RADS评分≥3分和PIRADS<3分但tPSA≥10ng/ml患者行超声引导下经会阴前列腺融合穿刺;对tPSA<10ng/ml且PIRADS<3分患者每6个月复查tPSA;对tPSA<4ng/ml患者每12个月复查tPSA。结果本研究16007例研究对象中,2007例(12.54%)tPSA≥4ng/ml。其中634例(31.59%)通过医共体转诊至总院复诊。结合tPSA与mpMRI检查结果,271例行超声引导下经会阴前列腺穿刺活检,确诊前列腺癌162例,穿刺阳性率59.78%。总体前列腺癌检出率为1.01%。162例的国际泌尿病理协会(ISUP)分级为1级5例(3.08%)2~3级95例(58.64%)、4~5级62例(38.27%);局限期、局部进展期、转移期前列腺癌分别为102例(62.96%)、39例(24.07%)、21例(12.96%)。50~59岁、60~69岁、70~79岁、≥80岁组的tPSA分别为(1.13±1.44)、(1.77±3.45)、(3.27±17.58)、(4.26±11.48)ng/ml,差异有统计学意义(P<0.01);穿刺阳性例数分别为1例(0.06%)、56例(0.79%)、81例(1.36%)、24例(1.82%),差异有统计学意义(P<0.01);ISUP分级4~5级患者例数分别为0例17例(30.35%),29例(35.80%),16例(66.67%),差异有统计学意义(P<0.01)。结论基于医共体模式,根据基层医院的tPSA筛查结果,将可疑患者转诊至中心医院行mp-MRI检查,并通过超声引导下经会阴前列腺融合穿刺筛查前列腺癌的模式是可行且有效的。

Objective To explore the suitable prostate cancer screening mode under the medical community for primary hospitals.MethodsFrom April 2021 to April 2022,a total of 16007 male population≥50 years from 9 branches of the medical community of the second hospital of Yinzhou participated in this study.They were divided into four groups according to age with group 1 of 50-59 years old,group 2 of 60-69 years old,group 3 of 70-79 years old,and group 4 of 80 years old and above.Serum tPSA was added to the routine physical examination,and the screening positive patients were referred to the referral hospital for further diagnosis and treatment under the mode of medical community.We proposed multi-parametric MRI(mpMRI)for those with serum PSA≥4 ng/ml and suspicious lesions should be scored according to PI-RADS V2.The ultrasound-guided transperineal targeted prostate biopsy was performed for those with PI-RADS≥3 and those with PI-RADS<3 but tPSA≥1O ng/ml.The tPSA follow-up examinations were performed every 6 months for tPSA<10 ng/ml and PI-RADS<3 points and once a year for tPSA<4 ng/ml.Results Among the 16007 male population≥50 years,2007(12.54%)were found serum PSA≥4 ng/ml,and 634(31.59%)were referred to the referral hospital through the medical community system.Combining tPSA and mpMRI,271 patients underwent ultrasoundguided transperineal targeted prostate biopsy.Among them,162 were finally diagnosed with PCa,with a biopsy positive rate of 59.78%.The detection rate of PCa in all the subjects was 1.01%.According to the pathological grade,5(3.08%)were in ISUP group 1,95(58.64%)in ISUP group 2-3,and 62(38.27%)in ISUP group 4-5.There were 102(62.96%),39(24.07%)and 21(12.96%)with localized,locally advanced or metastatic PCa,respectively.The levels of tPSA in the four groups were(1.13±1.44)ng/ml,(1.77±3.45)ng/ml,(3.27±17.58)ng/ml,and(4.26±11.48)ng/ml,respectively,with statistically significant dfferences(P<0.01).The positive number of biopsy in each group was 1 case(0.06%),56 cases(0.79%),81 cases(1.36%)and 24 cases(1.82%)respectively,with statistically significant differences(P<0.01).The number of ISUP 4-5 grades in each group was 0,17(30.35%),29(35.80%),and 16(66.67%)respectively,with statistically significant differences(P<0.01).Conclusions Based on the medical community system,according to the tPSA screening results of the primary hospitals,it is feasible and effective to refer suspicious patients to the referral hospitals for mpMRI examination,and screen prostate cancer by ultrasound-guided transperineal prostate fusion biopsy.