Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies
Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies
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DOI：
10.1016/s0022-5347(05)67994-3
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发表时间：
2000-01-01
影响因子：
6.6
通讯作者：
Amling, CL
中科院分区：
文献类型：
--
作者：
Borboroglu, PG;Comer, SW;Amling, CL
目的：标准六分仪前列腺活检可能低估了临床表现可疑的局限性前列腺癌患者的癌症。我们描述了我们的经验，广泛的经直肠超声引导前列腺活检的男性在以前的六分仪活检是阴性的。材料和方法：1997年11月至1999年3月，57名47至72岁的男性（平均年龄61.4岁）在我院接受了经直肠超声引导下广泛的前列腺穿刺活检。根据前列腺大小，平均获得22.5个核（范围15至31）。从6个矢状区进行活检，包括远侧和中期过渡区。每位患者既往至少接受过1次经直肠超声引导的良性六分仪活检（平均2.1次，范围1至4次）。重复活检的指征是89%的病例前列腺特异性抗原（PSA）持续升高，63%的病例PSA速度增加，39%的病例可疑的游离总PSA， 32%的病例以前有可疑的活检发现。分析临床因素（PSA、PSA速度、游离总PSA和既往可疑活检）预测活检阳性的能力，并对根治性前列腺切除术患者的肿瘤参数进行病理评估。结果：57例男性中有17例（30%）被确诊为腺癌，活检显示Gleason评分为6至8（平均6,4）。在17例确诊为癌症的患者中，有7例（41%）只有1例活检芯阳性。在先前六分仪活检显示高度前列腺上皮内瘤变或非典型小腺泡增生的15例患者中，广泛活检显示癌7例（47%）。虽然癌症患者的血清PSA较高，而游离总PSA较低，但活检阳性的唯一有统计学意义的预测指标是PSA速度(p
Purpose: Standard sextant prostate biopsy may underestimate cancer in men in whom clinical findings are suspicious for localized prostate cancer. We describe our experience with extensive transrectal ultrasound guided prostate biopsy in men in whom previous sextant biopsy was negative.Materials and Methods: Between November 1997 and March 1999, 57 men 47 to 72 years old (mean age 61.4) underwent extensive transrectal ultrasound guided biopsy of the prostate using intravenous sedation at our institution. An average of 22.5 cores (range 15 to 31) were obtained depending on prostate size. Biopsies were obtained from each of 6 sagittal regions, including samples from the far lateral and mid transitional zones. Each patient had undergone at least 1 previous benign transrectal ultrasound guided sextant biopsy (mean 2.1, range 1 to 4). Indications for repeat biopsy were persistently elevated prostate specific antigen (PSA) in 89% of the cases, increased PSA velocity in 63%, suspicious free-to-total PSA in 39% and a previous suspicious biopsy finding in 32%. Clinical factors (PSA, PSA velocity, free-to-total PSA and previous suspicious biopsy) were analyzed for the ability to predict positive biopsy, and tumor parameters were assessed pathologically in patients undergoing radical prostatectomy.Results: Adenocarcinoma was identified in 17 of the 57 men (30%), Biopsy revealed a Gleason score of 6 to 8 (mean 6,4). In 7 of the 17 patients (41%) in whom cancer was identified only 1 biopsy core was positive. Of the 15 patients in whom previous sextant biopsy had demonstrated high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation extensive biopsy revealed cancer in 7 (47%). Although serum PSA was higher and free-to-total PSA was lower in those with cancer, the only statistically significant predictor of positive biopsy was PSA velocity (p