SERIAL PROSTATIC BIOPSIES IN MEN WITH PERSISTENTLY ELEVATED SERUM PROSTATE-SPECIFIC ANTIGEN VALUES
SERIAL PROSTATIC BIOPSIES IN MEN WITH PERSISTENTLY ELEVATED SERUM PROSTATE-SPECIFIC ANTIGEN VALUES
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DOI：
10.1016/s0022-5347(17)35304-1
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发表时间：
1994-06-01
影响因子：
6.6
通讯作者：
SMITH, DS
中科院分区：
文献类型：
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作者：
KEETCH, DW;CATALONA, WJ;SMITH, DS
本研究的目的是确定初次活检结果未显示癌症或异型性证据的男性是否需要重复前列腺活检。我们评估了 1,136 名男性，他们在一项基于前列腺特异性抗原 (PSA) 的纵向前列腺癌筛查研究中接受了 1 次或多次前列腺活检，如果血清 PSA 水平大于 4.0 ng./ml，则需要进行活检。 （Hybritech 检测）以及直肠检查或超声检查结果异常或可疑癌症。在接受前列腺活检的 1,136 名男性中，有 391 名 (34%) 在初次活检时患有前列腺癌。在 427 名初次活检结果为阴性的男性中，血清 PSA 水平持续高于 4.0 ng./ml。直肠或超声检查结果异常，82 名 (19%) 在第 2 次活检中患有癌症。在 203 名持续异常的男性中，16 名 (8%) 在第 3 次活检中患有癌症，91 名 (7%) 中的 6 名在第 4 次或之后的活检中患有癌症。因此，96%的癌症是通过活检1或2检出的。与未检出癌症的男性相比，检出癌症的男性的中位初始PSA水平、随访PSA水平和PSA的年变化率显着更高（分别为每年6.4纳克/毫升、5.4纳克/毫升、7.4纳克/毫升和6.6纳克/毫升、1.1纳克/毫升和0.7纳克/毫升）。与通过初次筛查检测到的肿瘤相比，通过连续筛查检测到的病理性器官局限性肿瘤的比例较高（73% vs 62%，p = 0.07）。我们的结论是，初次前列腺活检阴性后血清 PSA 值持续升高的男性应常规进行至少 1 次重复活检，以充分排除可检测到的前列腺癌的存在。
The objective of this study was to determine the need for repeat prostatic biopsies in men whose initial biopsy results revealed no evidence of cancer or atypia. We evaluated 1,136 men who underwent 1 or more prostatic biopsies in a longitudinal prostate specific antigen (PSA) based prostate cancer screening study that called for biopsy if the serum PSA level was greater than 4.0 ng./ml. (Hybritech assay) and findings on rectal examination or ultrasonography were abnormal or suspicious for cancer. Of the 1,136 men who underwent prostatic biopsy 391 (34%) had prostate cancer on the initial biopsy. Of 427 men who had negative initial biopsy results, a persistent serum PSA level of greater than 4.0 ng./ml. and abnormal rectal or ultrasound examination findings 82 (19%) had cancer on biopsy 2. Of 203 men with persistent abnormalities 16 (8%) had cancer on biopsy 3 and 6 of 91 (7%) had cancer on biopsy 4 or later. Thus, 96% of the cancers were detected through either biopsy 1 or 2. The median initial PSA level, followup PSA levels and the yearly rate of change in PSA were significantly greater in men whose cancer was detected compared with those of men whose cancer was not detected (6.4 versus 5.4 ng./ml., 7.4 versus 6.6 ng./ml. and 1.1 versus 0.7 ng./ml, per year, respectively). There was a trend for a higher percentage of tumors detected through serial screening to be pathologically organ confined compared with those detected through initial screening (73% versus 62%, p = 0.07). We conclude that men with a persistently elevated serum PSA value after an initial negative prostatic biopsy should routinely undergo at least 1 repeat biopsy to exclude adequately the presence of detectable prostate cancer.