Lee F, Torp-Pedersen S T, Siders D B
Department of Radiology, St. Joseph Mercy Hospital, Ann Arbor, Michigan.
CA Cancer J Clin. 1989 Nov-Dec;39(6):337-60. doi: 10.3322/canjclin.39.6.337.
Transrectal ultrasound allows tissue characterization of normal and abnormal internal anatomy of the prostate and therefore provides valuable information for the study of prostate cancer. In an early-detection program setting, the hypoechoic lesion proved to be twice as sensitive as a palpable abnormality in predicting the presence of cancer; for every two cancers detected by transrectal ultrasound, one was detected by digital rectal examination. When the presence of a hypoechoic lesion was the criterion for biopsy in a clinical setting, 41 percent proved to be cancer. Sixty-eight percent of these cancers were palpable; thus, for every four cancers detected by transrectal ultrasound, three were detected by digital rectal examination. Hence, in our diagnostic settings, transrectal ultrasound is more sensitive than digital rectal examination. Because transrectal ultrasound can measure tumor size and offer information regarding tumor spread, we recommend that transrectal ultrasound-guided biopsy be performed first on all palpable lesions. Up to 50 percent of negative biopsies guided by palpation have subsequently proved to be cancer with transrectal ultrasound-guided biopsy. If transrectal ultrasound-guided biopsy of a palpable lesion does not reveal cancer, however, a biopsy guided by palpation should be performed. Strategic transrectal ultrasound-guided biopsy for staging should be performed to obtain tissue from areas where microscopic extracapsular tumor extension is likely to be present. Based on presently available evidence, broader implementation and evaluation of transrectal ultrasound, a tool to be complemented by digital rectal examination and prostate-specific antigen, is advocated for the early detection of prostate cancer. It is hoped that the use of transrectal ultrasound will lead to increased survival, with good quality of life, in a cost-effective manner, for men at increasing risk from prostate cancer in the aging national population.
经直肠超声可对前列腺的正常和异常内部解剖结构进行组织特征分析，因此为前列腺癌的研究提供了有价值的信息。在早期检测项目中，低回声病变在预测癌症存在方面的敏感性是可触及异常的两倍；经直肠超声检测出的每两例癌症中，有一例是通过直肠指检发现的。在临床环境中，以低回声病变的存在作为活检标准时，41%的病变被证实为癌症。这些癌症中有68%是可触及的；因此，经直肠超声检测出的每四例癌症中，有三例是通过直肠指检发现的。因此，在我们的诊断环境中，经直肠超声比直肠指检更敏感。由于经直肠超声可以测量肿瘤大小并提供有关肿瘤扩散的信息，我们建议首先对所有可触及的病变进行经直肠超声引导下的活检。高达50%的触诊引导下的阴性活检随后经经直肠超声引导下活检被证实为癌症。然而，如果经直肠超声引导下对可触及病变的活检未发现癌症，则应进行触诊引导下的活检。应进行经直肠超声引导下的分期策略性活检，以从可能存在微小包膜外肿瘤扩展的区域获取组织。基于目前可得的证据，提倡更广泛地应用和评估经直肠超声，这是一种可由直肠指检和前列腺特异性抗原辅助的工具，用于前列腺癌的早期检测。希望经直肠超声的使用能够以具有成本效益的方式，提高老年男性人群中前列腺癌风险增加者的生存率，并使其生活质量良好。
