【摘要】 目的:探讨前列腺体积对不同前列腺穿刺方案诊断前列腺癌的影响。方法:选取北京大学第一医院行前列腺穿刺活检的323例男性患者,其中前列腺特异抗原(prostatic specific antigen,PSA)>4.0μg/L305例,直肠指诊可疑前列腺癌52例,均行在直肠超声引导下经直肠13针前列腺穿刺活检术(穿刺位点包括尖部、中部、底部、外侧中部、外侧底部、中间底部、中间中部、中间尖部)。入选病例的年龄为49～90岁,平均69岁;PSA水平0.6～142.5μg/L,平均20.8μg/L;前列腺体积12.3～255.5mL,平均60.4mL。入选病例依前列腺体积分为2组(<50mL,≥50mL),将13针法穿刺位点进行不同的组合,形成各种6针、8针、10针穿刺方案,统计分析各种方案发现前列腺癌的阳性率和敏感性,将能发现前列癌的例数是13针法发现前列腺癌总例数的95%以上的穿刺方案认为是理想的组合。结果:13针法的穿刺总阳性率为37.2%(120/323),与前列腺体积<50mL的病例相比,体积≥50mL的病例的13针法穿刺阳性率从51.0%(73/143)降为26.1%(47/180)。当前列腺体积<50mL时,包含前列腺尖部、中部、底部、外侧中部和包含尖部、中部、外侧中部、外侧底部的8针穿刺位点组合方案的敏感性分别为98.6%和97.3%;当前列腺体积≥50mL时,包含前列腺尖部、中部、底部、外侧中部、外侧底部的10针法的敏感性为97.6%,以上组合的阳性率与13针法发现前列腺癌的阳性率相比,差异无统计学意义(均P>0.5)。结论:对于初次前列腺活检的病例,当前列腺体积<50mL时,可以采用包含尖部、中部、底部、外侧中部或尖部、中部、外侧中部、外侧底部的8针法,而当前列腺体积≥50mL时,包含尖部、中部、底部、外侧中部、外侧底部的10针法是较为合理的选择。更多还原

【Abstract】 Objective:To assess impact of different prostate biopsy strategies according to prostate vo-lume on tumor detection.Methods:A total of 323 consecutive men with suspected prostate cancer were included in the study.Indications for transrectal ultrasound guided prostate biopsy were:abnormal digital rectal examination(DRE,52 cases) and/or a total prostate specific antigen(PSA) over 4.0 μg/L(305 cases).In the subjects,their ages were between 49 years and 90 years,the mean:69 years;PSAs were between 0.6 μg/L and 142.5 μg/L,the mean:20.8 μg/L;and the prostate volumes were between 12.3 mL and 255.5 mL,the mean:60.4 mL.Transrectal ultrasound guided prostate biopsy of 13 core scheme was conducted in each patient.The cancer detection rate for each biopsy core was calculated.The sensitivities of different combinations of biopsy cores were compared with a 13 core biopsy protocol and the prostate volumes were divided into two groups(<50 mL and≥50 mL).The optimum number of biopsy cores was determined in patients with different prostate volumes.Results:Of the 323 patients 120(37.2%) were positive for prostate cancer.Compared to the patients with a prostate volume<50 mL,cancer detection rates of 13 core biopsy protocol in the patients with a prostate volume≥50 mL decreased significanfly(51.0% vs 26.1%).In patients with a prostate volume smaller than 50 mL,the 8 core biopsy protocol consisting of the apex,mid gland,base,lateral mid gland or of the apex,mid gland,lateral mid gland,lateral base of the prostate revealed the results similar to those of the 13 core biopsy protocol(sensitivities:98.6% and 97.3%,both P>0.05).In the larger prostate volume group,10 core biopsy protocol that included cores at the apex,mid gland,base,lateral mid gland and lateral base detected 97.6% of cancers(P>0.05).Conclusion:Patients with larger prostates have lower cancer detection rates.For patients with prostate volume smaller than 50 mL,8-core biopsy protocol consisting of the apex,mid gland,base,lateral mid gland or of the apex,mid gland,lateral mid gland,lateral base of the prostate can be used since it reveals results similar to those of 13-core biopsy protocol.10-core biopsy protocol that includes cores at the apex,mid gland,base,lateral mid gland and lateral base can be used for patients with prostate volumes larger than 50 mL.更多还原