Flanigan Robert C, Catalona William J, Richie Jerome P, Ahmann Frederick R, Hudson M'liss A, Scardino Peter T, DeKernion Jean B, Ratliff Timothy L, Kavoussi Louis R, Dalkin Bruce L, Waters W Bedford, MacFarlane Michael T, Southwick Paula C
Department of Urology, Loyola University Medical Center, Maywood, Illinois 60153.
J Urol. 1994 Nov;152(5 Pt 1):1506-9. doi: 10.1016/s0022-5347(17)32457-6.
Not all prostate cancers are sonographically hypoechoic or palpable on digital rectal examination, and suspicious areas on transrectal prostatic ultrasonography or digital rectal examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and digital rectal examination. If the PSA level was elevated (greater than 4.0 ng./ml., Hybritech Tandem assay) or digital rectal examination was suspicious quadrant biopsies were performed. Biopsy specimens were labeled separately, and histological findings were correlated by quadrant with the findings on ultrasonography and digital rectal examination. Of the 6,630 subjects enrolled into the study 16% were biopsied. Of 1,002 quadrants that were suspicious on digital rectal examination 110 (11%) had cancer, while 308 of 418 quadrants containing cancer (74%) were not suspicious on digital rectal examination. Of 855 quadrants that were sonographically suspicious 153 (18%) had cancer, while 282 of 435 quadrants containing cancer (65%) were not sonographically suspicious. Of 225 patients with cancer 137 (61%) would have been missed if only the exact site of the palpable induration had been biopsied. Of 251 patients with cancer 131 (52%) would have been missed if only the exact site of the hypoechoic lesion had been biopsied. We conclude that digital rectal examination and transrectal ultrasonography have limited accuracy in identifying and localizing prostate cancer. Our study emphasizes the importance of obtaining systematic biopsies if the PSA level is elevated, even in the absence of digital rectal examination or ultrasound anomalies.
并非所有前列腺癌在超声检查中都表现为低回声，也并非所有前列腺癌在直肠指检时都可触及，经直肠前列腺超声检查或直肠指检发现的可疑区域往往并非癌症。我们展示了一项多中心前列腺癌筛查研究的象限活检结果，该研究中对男性进行了前列腺特异性抗原（PSA）检测和直肠指检。如果PSA水平升高（大于4.0 ng/ml，Hybritech Tandem检测法）或直肠指检可疑，则进行象限活检。活检标本单独标记，组织学结果按象限与超声检查和直肠指检结果相关联。在纳入该研究的6630名受试者中，16%接受了活检。在直肠指检可疑的1002个象限中，110个（11%）有癌症，而在418个包含癌症的象限中，308个（74%）在直肠指检时并无可疑表现。在超声检查可疑的855个象限中，153个（18%）有癌症，而在435个包含癌症的象限中，282个（65%）在超声检查时并无可疑表现。在225例癌症患者中，如果仅对可触及硬结的确切部位进行活检，137例（61%）将会漏诊。在251例癌症患者中，如果仅对低回声病变的确切部位进行活检，131例（52%）将会漏诊。我们得出结论，直肠指检和经直肠超声检查在识别和定位前列腺癌方面准确性有限。我们的研究强调，如果PSA水平升高，即使没有直肠指检或超声异常，进行系统性活检也很重要。
