Parravicini Michele, Del Boca Carlo
Divisione di Urologia, Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy.
Arch Ital Urol Androl. 2003 Jun;75(2):99-101.
Is it convenient to do the prostate biopsy for the patients with PSA between 3 and 3.9 ng/ml?
From January 1998 to April 2001 we did 421 transrectal prostate biopsies echoconducted, 84 of which (20%) done on patients with a PSA between 3 and 3.9 ng/ml. 84.34 (40%) of them had a rectal exploration or a transrectal prostate echography suspected, apart from the value of PSA free/PSA total relation and 50 (60%) had a PSA free/PSA total relation below 0.15, even though they did not have a rectal exploration or a suspect TR transrectal prostate echography.
Of the 84 patients, with PSA between 3 and 3.9 ng/ml, who had undergone a prostate biopsy, 15 (16.6%) were positive for prostate adenocarcinoma. Of 34 patients who, besides having a PSA between 3 and 3.9 ng/ml, had a rectal exploration or a suspect transrectal prostate echography, 7 (20.5%) were positive for prostate tumour, 4 of which (57.14%) had a Gleason score greater than 7 and 3 (12.86%) a Gleason less than 7. Of the 50 patients who had a PSA free/PSA total relation less than 0.15 and did not have a rectal exploration or a suspect transrectal prostate echography, 8 (16%) were positive for prostate adenocarcinoma, 7 of which (87.5%) had a Gleason score greater than 7 and 1 (12.5%) a Gleason score less than 7. Observing that, during the period considered, we obtained 173 overall diagnoses of prostate tumour, we can note that 15 diagnoses (8.66%) had in the whole a PSA between 3 and 3.9 ng/ml, 7 of which (4.04%) had a rectal exploration and a suspect TR prostate echography and 8 (4.62%) had a PSA free/PSA total relation inferior to 0.15. During the period considered, the overall diagnoses of prostate tumour with Gleason greater than 7 were 60 (35%); according to the data of this research, 10 (16%) had a PSA between 3 and 3.9%. Of these 10.7 patients (11%) had a pathological PSA free/PSA total relation and 3 patients (5%) had a pathological rectal exploration or a suspect echography. Instead, the overall diagnosis of prostate tumour with Gleason less than 7 were 113 (65%), 5 (4.4%) had a PSA between 3 and 3.9 ng/ml, 4 of which (3.5%) had a suspect rectal exploration and 1 (0.8%) had a pathological PSA free/PSA total relation.
Doing biopsy on patients with PSA between 3 and 3.9 ng/ml and with rectal exploration and suspect TR prostate echography does not permit a remarkable increase in diagnosis of prostate tumour (4.4%). Doing prostate biopsy on patients with PSA between 3 and 3.9 ng/ml and pathological PSA free/PSA total relation, allows a more considerable increase in diagnosis of prostate tumour with Gleason score greater than 7 even if it does not permit a remarkable increase in positive diagnosis (4.62%).
对于前列腺特异性抗原（PSA）在3至3.9 ng/ml之间的患者，进行前列腺活检是否方便？
1998年1月至2001年4月，我们进行了421例经直肠超声引导下的前列腺活检，其中84例（20%）是对PSA在3至3.9 ng/ml之间的患者进行的。其中84例中的34例（40%）除了游离PSA/总PSA比值外，还进行了直肠探查或经直肠前列腺超声检查怀疑有病变，50例（60%）游离PSA/总PSA比值低于0.15，尽管他们没有进行直肠探查或经直肠前列腺超声检查怀疑有病变。
在84例PSA在3至3.9 ng/ml之间且接受了前列腺活检的患者中，15例（16.6%）前列腺腺癌呈阳性。在34例除PSA在3至3.9 ng/ml之间外还进行了直肠探查或经直肠前列腺超声检查怀疑有病变的患者中，7例（20.5%）前列腺肿瘤呈阳性，其中4例（57.14%）Gleason评分大于7，3例（12.86%）Gleason评分小于7。在50例游离PSA/总PSA比值小于0.15且没有进行直肠探查或经直肠前列腺超声检查怀疑有病变 的患者中，8例（16%）前列腺腺癌呈阳性，其中7例（87.5%）Gleason评分大于7，1例（12.5%）Gleason评分小于7。观察到在研究期间，我们共获得173例前列腺肿瘤诊断，我们可以注意到，在整个过程中，15例诊断（8.66%）的PSA在3至3.9 ng/ml之间，其中7例（4.04%）进行了直肠探查和经直肠前列腺超声检查怀疑有病变，8例（4.62%）游离PSA/总PSA比值低于0.15。在研究期间，Gleason评分大于7的前列腺肿瘤总体诊断为60例（35%）；根据本研究数据，10例（16%）的PSA在3至3.9%之间。在这10例中，7例（11%）游离PSA/总PSA比值呈病理性，3例（5%）进行了病理性直肠探查或超声检查怀疑有病变。相反，Gleason评分小于7的前列腺肿瘤总体诊断为113例（65%），5例（4.4%）的PSA在3至3.9 ng/ml之间，其中4例（3.5%）进行了直肠探查怀疑有病变，1例（0.8%）游离PSA/总PSA比值呈病理性。
对PSA在3至3.9 ng/ml之间且进行了直肠探查和经直肠前列腺超声检查怀疑有病变 的患者进行活检，前列腺肿瘤诊断率没有显著提高（4.4%）。对PSA在3至3.9 ng/ml之间且游离PSA/总PSA比值呈病理性的患者进行前列腺活检，即使阳性诊断没有显著提高（4.62%），但Gleason评分大于7的前列腺肿瘤诊断率有更显著提高。
