Alotaibi Khalid M
Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Urol Ann. 2019 Apr-Jun;11(2):135-138. doi: 10.4103/UA.UA_151_18.
The aim of the study is to correlate between the value of digital rectal examination (DRE), serum prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) as predictors for diagnosing prostate cancer in patients with voiding symptoms.
A total of 1610 male patients seen over a period of 10 years in a single institution had prostate-related voiding problems. Routine studies including DRE and serum PSA were done to all patients. TRUS and TRUS biopsy were performed for patients with suspected prostatic cancer based on abnormal DRE findings and/or serum PSA levels.
TRUS biopsy revealed prostate cancer in 206 out of 1610 patients with prostate-related voiding problems (13%), 40% had abnormal PSA and 28% had abnormal DRE. Combined abnormal PSA and DRE revealed cancer in 63% of patients. This percentage increased to 90% when TRUS was also abnormal, but dropped to 54% when TRUS was normal.
DRE together with serum PSA and TRUS have the highest predictable values for diagnosis of prostate cancer among patients with voiding symptoms. In the absence of abnormal TRUS, PSA and DRE together are more predictable than either alone. Serum PSA alone is more predictable than DRE. Random prostate biopsies should be performed in the presence of high serum PSA, and/or abnormal findings by DRE in male patients with urinary symptoms suggestive of the prostate disease.
本研究旨在探讨直肠指检（DRE）、血清前列腺特异性抗原（PSA）及经直肠超声（TRUS）在诊断有排尿症状患者前列腺癌时的预测价值及其相关性。
在一家机构10年间共诊治了1610例有前列腺相关排尿问题的男性患者。对所有患者均进行了包括DRE和血清PSA在内的常规检查。对于根据DRE检查结果异常和/或血清PSA水平怀疑患有前列腺癌的患者，进行TRUS及TRUS引导下活检。
在1610例有前列腺相关排尿问题的患者中，TRUS引导下活检发现206例患有前列腺癌（13%），40%的患者PSA异常，28%的患者DRE异常。PSA和DRE均异常的患者中63%患有前列腺癌。当TRUS也异常时，这一比例增至90%，但当TRUS正常时，该比例降至54%。
对于有排尿症状的患者，DRE联合血清PSA及TRUS对前列腺癌的诊断具有最高的预测价值。在TRUS无异常时，PSA和DRE联合应用比单独应用更具预测性。单独血清PSA比DRE更具预测性。对于有提示前列腺疾病排尿症状的男性患者，若血清PSA升高和/或DRE检查结果异常，应进行随机前列腺活检。
