Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Prostate Int. 2014 Mar;2(1):26-30. doi: 10.12954/PI.13037. Epub 2014 Mar 30.
To evaluate whether the risk of prostate cancer was different according to the pattern of fluctuation in prostate-specific antigen (PSA) levels in patients undergoing repeat transrectal ultrasound-guided prostate biopsy (TRUS-Bx).
From March 2003 to December 2012, 492 patients underwent repeat TRUS-Bx. The patients were stratified into 3 groups based on the PSA fluctuation pattern: group 1 (continuous elevation of PSA, n=169), group 2 (PSA fluctuation with PSA velocity [PSAV]≥1.0 ng/mL/yr, n=123), and group 3 (PSA fluctuation with PSAV<1.0 ng/mL/yr, n=200).
Prostate cancer was detected in 112 of 492 patients (22.8%) in the repeat biopsy set. According to the PSA fluctuation pattern, prostate cancer detection rates at repeat TRUS-Bx were 29.6% (50/169) for patients with continuously increasing PSA, 30.1% (37/123) for PSA fluctuation with PSAV ≥1.0 ng/mL/yr, and 12.5% (25/200) for PSA fluctuation with PSAV <1.0 ng/mL/yr. Multivariate analysis showed that PSA fluctuation pattern and high grade prostatic intraepithelial neoplasia at initial TRUS-Bx were the predictive parameters for positive repeat biopsies. Among the 96 patients (85.7%) who underwent radical prostatectomy, no significant differences in pathologic outcomes were found according to the PSA fluctuation pattern.
The current study shows that the risk of prostate cancer at repeat TRUS-Bx was higher in men with a fluctuating PSA level and PSAV≥1.0 ng/mL/yr than in those with a fluctuating PSA level and PSAV<1.0 ng/mL/yr.
评估在接受重复经直肠超声引导前列腺活检（TRUS-Bx）的患者中，前列腺特异性抗原（PSA）水平波动模式是否会导致前列腺癌风险不同。
2003 年 3 月至 2012 年 12 月，492 例患者接受重复 TRUS-Bx。根据 PSA 波动模式将患者分为 3 组：组 1（PSA 持续升高，n=169），组 2（PSA 波动且 PSA 速度[PSAV]≥1.0ng/mL/yr，n=123），组 3（PSA 波动且 PSAV<1.0ng/mL/yr，n=200）。
在重复活检组中，492 例患者中有 112 例（22.8%）检测到前列腺癌。根据 PSA 波动模式，重复 TRUS-Bx 时前列腺癌检出率为：PSA 持续升高患者为 29.6%（50/169），PSA 波动且 PSAV≥1.0ng/mL/yr 患者为 30.1%（37/123），PSA 波动且 PSAV<1.0ng/mL/yr 患者为 12.5%（25/200）。多因素分析显示，PSA 波动模式和初始 TRUS-Bx 中的高级前列腺上皮内瘤变是阳性重复活检的预测参数。在 96 例（85.7%）接受根治性前列腺切除术的患者中，根据 PSA 波动模式，病理结果无显著差异。
本研究表明，与 PSA 波动且 PSAV<1.0ng/mL/yr 的患者相比，PSA 波动且 PSAV≥1.0ng/mL/yr 的患者重复 TRUS-Bx 时前列腺癌的风险更高。
