Transurethral biopsy of the prostate for persistently elevated or increasing prostate specific antigen following multiple negative transrectal biopsies.
Transurethral biopsy of the prostate for persistently elevated or increasing prostate specific antigen following multiple negative transrectal biopsies.
复制标题
经尿道前列腺活检，以检测多次经直肠活检阴性后前列腺特异性抗原持续升高或增加。
作者：
E. Rovner;F. Schanne;S. Malkowicz;A. Wein
目的
前列腺特异性抗原（PSA）水平持续升高的患者在经直肠或手动引导前列腺穿刺活检病理阴性后的治疗尚不清楚。我们回顾性评价了经尿道前列腺活检作为诊断这些患者前列腺癌的一项连续性研究。
材料和方法
从1993年1月至1996年2月，71名患者接受了经尿道活检，并重复前列腺穿刺活检，以检查PSA持续升高（> 4 ng./ml）。ml.）之前的活检结果为阴性所有患者既往均至少接受过1次超声引导下的六分前列腺穿刺活检（平均1.85，范围1 - 7），有或无手动引导活检。前列腺穿刺活检阴性后，这些患者随后接受了至少4象限经尿道前列腺窝取样，然后重复进行六分前列腺穿刺活检。一部分患者在经尿道活检时使用经直肠超声引导的前列腺穿刺活检对前列腺前部组织或移行区进行取样。
结果
在71例PSA升高的患者中（平均16.2 ng/ml），ml.，范围4.2 - 171）17例（24%）在重复前列腺穿刺活检中患有前列腺癌。经尿道活检标本上有前列腺癌的2例患者在重复前列腺穿刺活检标本上也有前列腺癌。在经尿道活检标本中，共有68例患者有良性前列腺组织，1例有高度前列腺上皮内瘤变。在19例初次前列腺穿刺活检时有高度前列腺上皮内瘤变的患者中，经尿道活检标本未发现前列腺癌或前列腺上皮内瘤变。在这些高级别前列腺上皮内瘤变患者中，重复前列腺穿刺活检发现6例前列腺癌和4例高级别前列腺上皮内瘤变。
结论
在前列腺穿刺活检阴性后血清PSA持续升高或升高的患者中，经尿道活检不是诊断前列腺癌的有用辅助手段。在这些高危人群中，经尿道前列腺活检对前列腺穿刺活检的诊断价值很小或没有增加，即使是在那些高度前列腺上皮内瘤变的患者中。
PURPOSE
Treatment of the patient with persistently elevated prostate specific antigen (PSA) levels after pathologically negative transrectal or manually directed prostate needle biopsy is unclear. We retrospectively evaluated the use of transurethral biopsy of the prostate as an adjunctive study for the diagnosis of prostate cancer in these patients.
MATERIALS AND METHODS
From January 1993 through February 1996, 71 patients underwent transurethral biopsy in conjunction with repeat prostatic needle biopsy for a persistently elevated PSA (greater than 4 ng./ml.) after previously negative needle biopsy. All patients had at least 1 previous ultrasound guided sextant prostatic needle biopsy (mean 1.85, range 1 to 7) with or without manually directed biopsies. Following negative prostatic needle biopsy these patients subsequently underwent a minimum of a 4-quadrant transurethral sampling of the prostatic fossa followed by repeat sextant prostatic needle biopsy. A subset of patients underwent sampling of the anterior prostatic tissue or transition zone using transrectal ultrasound guided prostatic needle biopsy at transurethral biopsy.
RESULTS
Of the 71 patients with elevated PSA (mean 16.2 ng./ml., range 4.2 to 171) 17 (24%) had prostate cancer on the repeat prostatic needle biopsy. Both patients who had prostate cancer on the transurethral biopsy specimens also had prostate cancer on the repeat prostatic needle biopsy specimens. A total of 68 patients had benign prostatic tissue and 1 had high grade prostatic intraepithelial neoplasia on transurethral biopsy specimens. Of 19 patients with high grade prostatic intraepithelial neoplasia on the initial prostatic needle biopsy, transurethral biopsy specimens revealed no prostate cancer or prostatic intraepithelial neoplasia. Repeat prostatic needle biopsy in these patients with high grade prostatic intraepithelial neoplasia revealed prostate cancer in 6 and high grade prostatic intraepithelial neoplasia in 4.
CONCLUSIONS
In patients with persistently elevated or increasing serum PSA after a previously negative prostatic needle biopsy, transurethral biopsy is not a useful adjunct in diagnosing prostate cancer. In this high risk group of patients transurethral biopsy adds little or no diagnostic value to prostatic needle biopsy even in those with high grade prostatic intraepithelial neoplasia.
影响因子：
6.6
作者：
KEETCH, DW;CATALONA, WJ;SMITH, DS
通讯作者：
SMITH, DS