Clinicopathological features of prostate cancer detected by transrectal ultrasonography-guided systematic six-sextant biopsy.
Clinicopathological features of prostate cancer detected by transrectal ultrasonography-guided systematic six-sextant biopsy.
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DOI：
10.1111/j.1442-2042.1997.tb00288.x
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发表时间：
1997-09-01
期刊：
影响因子：
--
通讯作者：
Yamanaka, H
中科院分区：
文献类型：
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作者：
Ito, K;Ichinose, Y;Yamanaka, H
背景：本研究的目的是比较前列腺特异性抗原(PSA)、直肠指诊(DRE)和经直肠超声(TRUS)三种检查方法对经TRUS引导的系统六分法活检证实的前列腺癌的诊断效果，并探讨阳性核心数与几个临床病理参数的关系。方法：1992-1994年间，297名男性(其中155人来自大规模筛查项目，142人为门诊患者)，平均年龄71岁，接受了PSA测定、DRE、TRUS和系统六分法活检，和/或附加的定向活检。结果：在93名男性中发现前列腺癌。PSA检测的敏感性(85%)明显高于DRE或TRUS。DRE或TRUS异常、PSA水平升高的患者，以及T3-T4类型或中到低分化腺癌的患者有更多的阳性活检核心(P<；0.05)。此外，阳性活检核心数和肿瘤分级与骨转移显著相关(P<；0.01)。在经直肠超声发现的209个低回声区域中，42%为癌变，427个等回声区域中，12%为癌变。PSA<10 ng/m L者，活检中心低回声阳性率为86%，而PSA<10 ng/m l或<4 ng/m L阳性细胞率较低(9%)；PSA<10 ng/m l或<4 ng/m L者，阴性细胞率较高(98%)，而PSA<10 ng/m l者阴性细胞率较低(67%)。结论：血清PSA检测前列腺癌优于DRE或TRUS。骨转移百分率随阳性活检芯数的增加而增加，低回声区的阳性活检百分率与PSA水平呈正相关。
BACKGROUND: The objectives of this study were to compare the efficacy of 3 modalities (prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasonography (TRUS)) in detecting prostate cancer which was pathologically confirmed by TRUS-guided systematic six-sextant biopsy, and to investigate the relationship between the number of positive cores and several clinicopathological parameters.METHODS: Between 1992 and 1994, 297 males (155 from a mass screening program and 142 identified as outpatients) with a mean age of 71 years, underwent examinations including PSA determination, DRE, TRUS and systematic six-sextant biopsy, and/or additional directed biopsy.RESULTS: Prostate cancer was detected in 93 men. The sensitivity level of the PSA assay was significantly higher (85%) than that of either DRE or TRUS. Patients with an abnormal DRE or TRUS, elevated PSA levels, and those in the T3-T4 category or with moderate to poorly-differentiated adenocarcinomas had more positive biopsy cores (P < 0.05). Also, the relationships of both the number of positive biopsy cores and tumor grade to bone metastasis were significant (P < 0.01). Of 209 hypoechoic areas identified by transrectal ultrasonography, 42% were cancerous, and of 427 isoechoic areas, 12% were cancerous. The percentage of positive biopsy cores with hypoechoic areas was 86% in the subjects with a PSA > 10 ng/mL, but low (9%) in subjects with a PSA < or = 4 ng/mL, and the percentage of negative biopsy cores with a normal TRUS was high (98%) in subjects with a PSA of < or = 4 ng/mL, but lower (67%) in subjects with a PSA > 10 ng/mL.CONCLUSION: The serum PSA assay was more useful than either DRE or TRUS in detecting prostate cancer. The percentage of bone metastasis increased concomitant with the number of positive biopsy cores, and the positive biopsy rate of hypoechoic areas positively correlated with the PSA level.