Gupta N P, Ansari M S, Dass S C
Department of Urology, All India Institute Of Medical Sciences, New Delhi-110029, India.
Indian J Cancer. 2005 Jul-Sep;42(3):151-4. doi: 10.4103/0019-509x.17060.
With the advent of prostate specific antigen the number of patients undergoing prostate biopsy has dramatically increased. The sextant biopsy technique has been conventionally used for the diagnosis of prostate cancer. Recently, concern has arisen that the original sextant method may not include an adequate sample of the prostate, hence it may result in high false negative rates. We conducted a prospective study to determine whether the 5-region prostate biopsy technique significantly increases the chance of prostate cancer detection as compared to the sextant biopsy technique.
To evaluate the efficacy of TRUS guided sextant and 5-region biopsy techniques in detecting carcinoma prostate in patients with PSA between 4 and 10 ng/ml and normal digital rectal examination.
Between December 2001 and August 2003 one forty-two men, aged 49-82 years, who presented with LUTS, normal digital rectal examination (DRE) and PSA between 4 and 10 ng/ml underwent TRUS guided sextant prostate biopsy. Serum PSA was reassessed after 3 months in patients whose biopsies were negative for cancer. If PSA was still raised, the patients underwent extensive 5-region biopsy.
Mean patient age was 64 years and median PSA was 6.9 ng/ml. TRUS guided sextant biopsy revealed adenocarcinoma prostate in 34 men (24%). Median Gleason score was 7. Seven men (4.9%) had cellular atypia and 3(2.1%) had prostatic intraepithelial neoplasia (high grade). On repeat PSA estimation after 3 months, 48 patients showed stagnant or rising trend for which they underwent TRUS guided 13-core biopsy. Five (10.4%) patients were detected to have adenocarcinoma on repeat biopsy. Biopsy negative patients are on regular follow up with yearly PSA estimation. Complications included transient mild haematuria in14 patients (9.82%) and haematospermia in 4 (2.8%). Urinary retention developed in one patient and required an indwelling catheter for 4 days.
Transrectal ultrasound guided sextant biopsy has shown a false negative rate of approximately 11%. A repeat 5- region (13-core) biopsy strategy can decrease the false negative rate of conventional sextant biopsy in patients with previously negative biopsies but persistently high PSA levels, high grade PIN or cellular atypia.
随着前列腺特异性抗原的出现，接受前列腺活检的患者数量急剧增加。传统上采用六分区活检技术诊断前列腺癌。最近，有人担心原来的六分区方法可能无法获取足够的前列腺样本，因此可能导致高假阴性率。我们进行了一项前瞻性研究，以确定与六分区活检技术相比，五区域前列腺活检技术是否能显著增加前列腺癌的检出机会。
评估超声引导下六分区和五区域活检技术在检测前列腺特异性抗原（PSA）在4至10 ng/ml且直肠指检正常的患者前列腺癌中的疗效。
2001年12月至2003年8月期间，142名年龄在49 - 82岁、出现下尿路症状（LUTS）、直肠指检（DRE）正常且PSA在4至10 ng/ml的男性接受了超声引导下的六分区前列腺活检。活检结果为癌症阴性的患者在3个月后重新评估血清PSA。如果PSA仍然升高，这些患者接受广泛的五区域活检。
患者平均年龄为64岁，PSA中位数为6.9 ng/ml。超声引导下的六分区活检在34名男性（24%）中发现前列腺腺癌。Gleason评分中位数为7。7名男性（4.9%）有细胞异型性，3名（2.1%）有前列腺上皮内瘤变（高级别）。在3个月后重复进行PSA评估时，48名患者显示PSA停滞或上升趋势，为此他们接受了超声引导下的13针活检。5名（10.4%）患者在重复活检时被检测出患有腺癌。活检阴性的患者定期进行随访，每年评估PSA。并发症包括14名患者（9.82%）出现短暂轻度血尿和4名患者（2.8%）出现血精。1名患者发生尿潴留，需要留置导尿管4天。
经直肠超声引导下的六分区活检显示假阴性率约为11%。对于先前活检阴性但PSA水平持续升高、高级别前列腺上皮内瘤变（PIN）或细胞异型性的患者，重复进行五区域（13针）活检策略可以降低传统六分区活检的假阴性率。
