Serial biopsy results in prostate cancer screening study
Serial biopsy results in prostate cancer screening study
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DOI：
10.1016/s0022-5347(05)64999-3
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发表时间：
2002-06-01
影响因子：
6.6
通讯作者：
Catalona, WJ
中科院分区：
文献类型：
--
作者：
Roehl, KA;Antenor, JAV;Catalona, WJ
目的：我们评估了前列腺特异性抗原 (PSA) 水平升高和/或直肠指检可疑且初次活检未发现癌症的男性的前列腺活检结果。 材料和方法：总共 2,526 名 40 岁或以上的志愿者接受了 1 次或多次前列腺活检，其血清 PSA 浓度大于 4.0 ng./ml。 （1995 年 5 月之前）或大于 2.5 ng./ml。 （1995年5月以后），或直肠指检怀疑有癌症。我们根据直肠指检结果和升高的 PSA 水平评估了对活检建议的依从性以及癌症检出率。结果：在接受多达 10 次活检程序的男性中，第 1 至 6 次活检程序的连续癌症检出率分别为 29%、17%、14%、11%、9% 和 7%。使用大于 4.0 的组之间未观察到连续活检的癌症检出率存在显着差异。纳克/毫升且大于2.5纳克/毫升。隔断。与初次筛查中检测到的癌症相比，通过系列筛查检测到的局限于器官的癌症有更多趋势（78% vs 69%，p = 0.05）。此外，使用大于 2.5 ng./ml 的浓度可检测到更多癌症。截止值是器官限制（80% 与 66%，p = 0.004）。只有大约 1% 的癌症符合已发布的临床上无意义肿瘤的标准。结论：在这项筛查研究中检测到的前列腺癌中，有近四分之一在初始活检中漏掉了。在检测到的 962 例前列腺癌中，77% 通过 1 次活检检出，91% 通过 2 次活检检出，97% 通过 3 次活检检出，99% 通过 4 次活检检出。连续活检可检测更多局限于器官的癌症，而不会过度检测临床上不重要的肿瘤。未来的研究需要确定最初获得更多活检核心是否可以提供更早的前列腺癌检测并避免不必要的重复活检。
Purpose: We evaluated prostate biopsy results in men with elevated prostate specific antigen (PSA) levels and/or suspicious digital rectal examination whose initial biopsies did not reveal cancer.Materials and Methods: A total of 2,526 volunteers 40 years old or older underwent 1 or more prostate biopsies for serum PSA concentrations greater than 4.0 ng./ml. (before May 1995) or greater than 2.5 ng./ml. (after May 1995), or digital rectal examination suspicious of cancer. We evaluated compliance with the biopsy recommendation and the cancer detection rate with regard to digital rectal examination results and increasing PSA levels.Results: Of the men who underwent up to 10 biopsy procedures the serial cancer detection rates were 29%, 17%, 14%, 11%, 9% and 7%, respectively, on biopsy procedures 1 through 6. No significant difference in the yield of cancer on serial biopsies was observed between the groups using the greater than 4.0 ng./ml. and greater than 2.5 ng./ml. cutoff. There was a trend for more cancers detected through serial screening to be organ confined compared with those detected on initial screening (78% versus 69%, p = 0.05). Also, more cancers detected using the greater than 2.5 ng./ml. cutoff were organ confined (80% versus 66%, p = 0.004). Only approximately 1% of the cancers fulfilled the published criteria for clinically insignificant tumors.Conclusions: Nearly a quarter of prostate cancers detected in this screening study were missed by the initial biopsy. Of the 962 prostate cancers detected 77% were detected with 1, 91% with 2, 97% with 3 and 99% with 4 biopsy procedures. Serial biopsies detect more organ confined cancers without over detecting clinically unimportant tumors. Future studies are needed to determine whether obtaining more biopsy cores initially would provide earlier prostate cancer detection and avoid unnecessary repeat biopsies.