Park Dong Jin, Kim Ki Ho, Kwon Tae Gwon, Kim Chun Ii, Park Cheol Hee, Park Jae Shin, Kim Duck Youn, Kim Jae Soo, Moon Ki Hak, Lee Kyung Seop
Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
Department of Urology, Kyungpook National University, Daegu, Korea.
Korean J Urol. 2014 Nov;55(11):718-24. doi: 10.4111/kju.2014.55.11.718. Epub 2014 Nov 10.
The aim of this study was to investigate clinicopathologic differences between prostate cancer (PCa) detected at initial and repeat transrectal ultrasound-guided prostate biopsy in a large Korean cohort.
From 2000 through 2012, a total of 7,001 patients underwent transrectal ultrasound-guided prostate biopsy at 6 centers in Daegu and Gyeongbuk provinces. Of these 7,001 patients, the initial biopsy was positive for PCa in 2,118 patients. Repeat biopsy was performed in 374 of the 4,883 patients with an initial negative finding and a persistently elevated prostate-specific antigen (PSA) level, nodules or asymmetry by digital rectal examination (DRE), high-grade prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Numbers of biopsy cores varied from 6 to 12 according to center and biopsy date.
Cancer was diagnosed in 2,118 of the 7,001 patients (30.3%) at initial biopsy and in 86 of the 374 patients (23.0%) at repeat biopsy. The repeat biopsy rate was 5.3%. Mean PSA values were 68.7±289.5 ng/mL at initial biopsy and 18.0±55.4 ng/mL at repeat biopsy (p<0.001). The mean number of cancer-positive cores per biopsy was 5.5±3.5 for initial biopsy and 3.0±2.9 for repeat biopsy (p<0.001). Mean Gleason score was 7.5±1.4 at initial biopsy and 6.6±1.3 at repeat biopsy (p<0.001). For detected cancers, the low-stage rate was higher for repeat biopsy than for initial biopsy (p=0.001).
Cancers detected at repeat biopsy tend to have lower Gleason scores and stages than cancers detected at initial biopsy. The present study shows that repeat biopsy is needed in patients with a persistently high PSA or abnormal DRE findings.
本研究旨在调查韩国一个大型队列中初次经直肠超声引导下前列腺穿刺活检和重复穿刺活检时检测到的前列腺癌（PCa）的临床病理差异。
2000年至2012年，大邱和庆北地区6个中心共有7001例患者接受了经直肠超声引导下前列腺穿刺活检。在这7001例患者中，2118例初次活检时前列腺癌呈阳性。4883例初次检查结果为阴性但前列腺特异性抗原（PSA）水平持续升高、经直肠指检（DRE）发现结节或不对称、高级别前列腺上皮内瘤变或非典型小腺泡增生的患者中，有374例进行了重复活检。根据中心和活检日期不同，活检针数从6针到12针不等。
7001例患者中，2118例（30.3%）初次活检时诊断为癌症，374例患者中有86例（23.0%）在重复活检时诊断为癌症。重复活检率为5.3%。初次活检时平均PSA值为68.7±289.5 ng/mL，重复活检时为18.0±55.4 ng/mL（p<0.001）。每次活检癌症阳性针数的平均值，初次活检时为5.5±3.5针，重复活检时为3.0±...
