Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2017 Jul;80(7):413-418. doi: 10.1016/j.jcma.2016.07.007. Epub 2017 May 18.
Prostate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate-specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA-triggered transrectal ultrasonography-guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital.
We reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008-December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow-up were reviewed and analyzed according to the Epstein criteria.
A total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40-50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy.
From our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age.
前列腺癌（PCa）在 50 岁以下的男性中并不常见。然而，在亚洲，由于对前列腺癌的认识增加，血清前列腺特异性抗原（PSA）浓度在更年轻时被更频繁地检测。我们研究的目的是探讨 PSA 触发经直肠超声引导前列腺（TRUSP）活检的疗效和并发症。我们回顾性分析了台北荣民总医院 PSA 浓度升高的年轻男性（<50 岁）的 TRUSP 活检病例。
我们回顾了 2008 年 1 月至 2013 年 12 月期间在台北荣民总医院接受 12 核 TRUSP 活检的年龄<50 岁、PSA 浓度升高（>4.0ng/ml）的患者。回顾了患者的年龄、家族史、直肠指检（DRE）结果、PSA 浓度、游离/总 PSA 比值、总前列腺体积、PSA 密度、下尿路症状以及术后并发症。根据 Epstein 标准回顾和分析 TRUSP 活检的病理结果和临床随访结果。
共纳入 77 例患者，分为 2 组：1）年轻组，20 例，年龄<40 岁；2）年长组，57 例，年龄 40-50 岁。PCa 的总检出率为 11.69%（9/77），所有 PCa 病例均诊断于年长组（组检出率：15.8%）。两组间下尿路症状（LUTS）严重程度有显著差异。根据 Epstein 标准，所有 PCa 患者均为临床显著。2 例患者（2.60%）TRUSP 活检后发热。
从我们的患者队列中可以看出，即使 PSA 升高，对<40 岁接受 TRUSP 活检的患者也没有明显获益。然而，40-50 岁男性检出的 PCa 均为临床显著。总体而言，我们的结果支持目前的主要实践指南，即建议 40 岁时进行初始 PSA 检查。
