Keetch D W, Catalona W J, Smith D S
Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, Missouri.
J Urol. 1994 Jun;151(6):1571-4. doi: 10.1016/s0022-5347(17)35304-1.
The objective of this study was to determine the need for repeat prostatic biopsies in men whose initial biopsy results revealed no evidence of cancer or atypia. We evaluated 1,136 men who underwent 1 or more prostatic biopsies in a longitudinal prostate specific antigen (PSA) based prostate cancer screening study that called for biopsy if the serum PSA level was greater than 4.0 ng./ml. (Hybritech assay) and findings on rectal examination or ultrasonography were abnormal or suspicious for cancer. Of the 1,136 men who underwent prostatic biopsy 391 (34%) had prostate cancer on the initial biopsy. Of 427 men who had negative initial biopsy results, a persistent serum PSA level of greater than 4.0 ng./ml. and abnormal rectal or ultrasound examination findings 82 (19%) had cancer on biopsy 2. Of 203 men with persistent abnormalities 16 (8%) had cancer on biopsy 3 and 6 of 91 (7%) had cancer on biopsy 4 or later. Thus, 96% of the cancers were detected through either biopsy 1 or 2. The median initial PSA level, followup PSA levels and the yearly rate of change in PSA were significantly greater in men whose cancer was detected compared with those of men whose cancer was not detected (6.4 versus 5.4 ng./ml., 7.4 versus 6.6 ng./ml. and 1.1 versus 0.7 ng./ml. per year, respectively). There was a trend for a higher percentage of tumors detected through serial screening to be pathologically organ confined with those detected through initial screening (73% versus 62%, p = 0.07). We conclude that men with a persistently elevated serum PSA value after an initial negative prostatic biopsy should routinely undergo at least 1 repeat biopsy to exclude adequately the presence of detectable prostate cancer.
本研究的目的是确定初始活检结果未显示癌症或异型性证据的男性是否需要重复进行前列腺活检。我们评估了1136名男性，这些男性在一项基于前列腺特异性抗原（PSA）的纵向前列腺癌筛查研究中接受了1次或更多次前列腺活检。该研究要求，如果血清PSA水平大于4.0 ng/ml（Hybritech检测法），且直肠指检或超声检查结果异常或怀疑有癌症，则需进行活检。在接受前列腺活检的1136名男性中，391名（34%）在初次活检时患有前列腺癌。在初次活检结果为阴性的427名男性中，血清PSA水平持续高于4.0 ng/ml，且直肠或超声检查结果异常，其中82名（19%）在第二次活检时患有癌症。在203名持续存在异常的男性中，16名（8%）在第三次活检时患有癌症，91名中的6名（7%）在第四次或以后的活检时患有癌症。因此，96%的癌症是通过第一次或第二次活检检测到的。与未检测到癌症的男性相比，检测到癌症的男性的初始PSA水平中位数、随访PSA水平以及PSA的年变化率显著更高（分别为6.4 ng/ml对5.4 ng/ml、7.4 ng/ml对6.6 ng/ml以及每年1.1 ng/ml对0.7 ng/ml）。通过系列筛查检测到的肿瘤在病理上局限于器官内的比例有高于通过初始筛查检测到的肿瘤的趋势（73%对62%，p = 0.07）。我们得出结论，初次前列腺活检结果为阴性后血清PSA值持续升高的男性应常规至少进行1次重复活检，以充分排除可检测到的前列腺癌的存在。
