Nam Robert K, Toi Ants, Trachtenberg John, Jewett Michael A S, Klotz Laurence, Fleshner Neil, Bagnell P Scott, Sweet Joan, Sugar Linda, Narod Steven A
Division of Urology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada.
BJU Int. 2004 Dec;94(9):1239-44. doi: 10.1111/j.1464-410X.2004.05150.x.
To determine the practice pattern of repeat prostate biopsies to detect prostate cancer, as there is growing evidence to support the recommendation that a repeat prostate biopsy should be taken after an initially negative prostate biopsy, the rate of cancer detection then being approximately 30%.
We examined the practice patterns of taking a repeat prostate biopsy after an initial negative biopsy and the predictors for cancer at repeat biopsy among 1536 patients who had an initial prostate biopsy because of an elevated prostate-specific antigen (PSA) level (>4.0 ng/mL) or abnormal digital rectal examination.
Of the 1536 men, 712 (46.4%) had cancer detected on the first biopsy; of the remaining 824 with no cancer detected, 268 (32.5%) had a repeat biopsy within a year, and 68 of these (25.4%) had cancer detected. Of the cancers detected at repeat biopsy, 31% were high-grade. Men with abnormal histology (prostatic intraepithelial neoplasia or atypia) had an odds ratio of 3.2 (P < 0.001) for having a repeat biopsy. For men with normal initial prostate histology, those with an initial PSA of 10.0-20.0 and >20.0 ng/mL had an odds ratio of 3.6 and 4.5 (both P < 0.001), respectively, for a repeat prostate biopsy, compared with patients with a PSA of <10.0 ng/mL. However, the PSA level was not predictive of prostate cancer at repeat biopsy, but age and prostate volume were.
A third of patients had a repeat biopsy after a negative biopsy. The most important factors influencing whether a patient was to have a repeat biopsy were initial biopsy histology and PSA level. However, the latter was not an important factor for predicting prostate cancer at repeat biopsy.
鉴于越来越多的证据支持在初次前列腺活检结果为阴性后进行重复活检以检测前列腺癌这一建议（此时癌症检出率约为30%），确定重复前列腺活检检测前列腺癌的实践模式。
我们研究了1536例因前列腺特异性抗原（PSA）水平升高（>4.0 ng/mL）或直肠指检异常而进行初次前列腺活检的患者在初次活检结果为阴性后进行重复活检的实践模式以及重复活检时癌症的预测因素。
在这1536名男性中，712例（46.4%）在首次活检时检测出癌症；其余824例未检测出癌症的患者中，268例（32.5%）在一年内进行了重复活检，其中68例（25.4%）检测出癌症。在重复活检时检测出的癌症中，31%为高级别。组织学异常（前列腺上皮内瘤变或异型增生）的男性进行重复活检的比值比为3.2（P < 0.001）。对于初次前列腺组织学正常的男性，初次PSA为10.0 - 20.0 ng/mL和>20.0 ng/mL的患者进行重复前列腺活检的比值比分别为3.6和4.5（均P < 0.001），而PSA <10.0 ng/mL的患者作为对照。然而，PSA水平并不能预测重复活检时是否患有前列腺癌，但年龄和前列腺体积可以。
三分之一的患者在初次活检结果为阴性后进行了重复活检。影响患者是否进行重复活检的最重要因素是初次活检的组织学结果和PSA水平。然而，后者并非预测重复活检时前列腺癌的重要因素。
