对于血清前列腺特异性抗原>10 ng/ml且先前外周带活检阴性的良性前列腺增生患者，移行区活检是否有价值？

Is transition zone biopsy valuable in benign prostatic hyperplasia patients with serum prostate-specific antigen >10 ng/ml and prior negative peripheral zone biopsy?

作者信息

Abdel-Khalek Mohamed, Sheir Khaled Z, El-Baz Mahmoud, Ibrahiem El-Houssieny

机构信息

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

出版信息

Scand J Urol Nephrol. 2005;39(1):49-55. doi: 10.1080/00365590410002555.

DOI:10.1080/00365590410002555

PMID:15764271

Abstract

OBJECTIVES

To evaluate the importance of transition zone (TZ) biopsy in benign prostatic hyperplasia (BPH) patients with serum prostate-specific antigen (PSA) >10 ng/ml and prior negative peripheral zone (PZ) biopsy and to estimate the sensitivity of TZ biopsy.

MATERIAL AND METHODS

A total of 273 BPH patients with PSA >10 ng/ml and prior negative PZ biopsy underwent an extended biopsy protocol. In patients with a TZ volume <25 cm(3), four TZ biopsies were taken (two cores per side from the apex and base). In patients with a TZ volume > or =25 cm(3) (n=183), six TZ biopsies were taken (three cores per side from the apex, middle and base). Overall, 215 patients were subjected to either transurethral resection of the prostate (n=162) or open enucleation of the adenoma (n=53).

RESULTS

The extended biopsy revealed prostate cancers in 21.2% of cases (58/273). The zonal distribution of the positive cores was as follow: PZ cancers only in 67.2% of cases (39/58), TZ cancers only in 13.8% (8/58) and PZ+TZ cancers in 19% (11/58). Overall, 73.6% (14/19) and 36.8% (7/19) of TZ cancers were detected at the apex and middle of the TZ, respectively, while no TZ cancers at all were detected at the base (p=0.00015). The incidence of carcinoma on definitive pathology was 5.6% (12/215). Consequently, TZ biopsy detected only 61.3% (19/31) of TZ cancers. The incidence of pure TZ cancers was 7.3%. On the chi(2) test, patient age, serum PSA, transrectal ultrasonography findings and PSA density did not correlate significantly with the detection rate of TZ cancer. Prostate volume (p=0.023), TZ volume (p=0.027) and PSA/TZ density (p=0.007) were predictive of TZ cancers.

CONCLUSIONS

Although TZ biopsy was the sole site of cancer in only 2.9% of cases (8/273), it improved the cancer detection rate by 14% in this selected group of patients. The majority (74%) of TZ cancers were detected at the apex site. TZ biopsy has a low sensitivity (61%).

摘要

目的

评估在血清前列腺特异性抗原（PSA）>10 ng/ml且先前外周带（PZ）活检为阴性的良性前列腺增生（BPH）患者中，移行区（TZ）活检的重要性，并估计TZ活检的敏感性。

材料与方法

共有273例PSA>10 ng/ml且先前PZ活检为阴性的BPH患者接受了扩展活检方案。对于TZ体积<25 cm³的患者，取4次TZ活检（从尖部和底部每侧取2个芯）。对于TZ体积≥25 cm³的患者（n = 183），取6次TZ活检（从尖部、中部和底部每侧取3个芯）。总体而言，215例患者接受了经尿道前列腺切除术（n = 162）或腺瘤开放性剜除术（n = 53）。

结果

扩展活检在21.2%的病例（58/273）中发现前列腺癌。阳性芯的区域分布如下：仅PZ癌占67.2%（39/58），仅TZ癌占13.8%（8/58），PZ + TZ癌占19%（11/58）。总体而言（14/19）和36.8%（7/19）的TZ癌分别在TZ尖部和中部被检测到，而在底部未检测到TZ癌（p = 0.00015）。最终病理检查中癌的发生率为5.6%（12/215）。因此，TZ活检仅检测到61.3%（19/31）的TZ癌。纯TZ癌的发生率为7.3%。在卡方检验中，患者年龄、血清PSA、经直肠超声检查结果和PSA密度与TZ癌的检出率无显著相关性。前列腺体积（p = 0.023）、TZ体积（p = 0.027）和PSA/TZ密度（p = 0.007）可预测TZ癌。