[直肠指检、前列腺特异性抗原及经直肠超声检查在前列腺癌诊断中的应用]

[The digital rectal exam, prostate-specific antigen and transrectal echography in the diagnosis of prostatic cancer].

作者信息

Martínez de Hurtado J, Chéchile Toniolo G, Villavicencio Mavrich H

机构信息

Servicio de Urología, Fundación Puigvert, Barcelona, España.

出版信息

Arch Esp Urol. 1995 Apr;48(3):247-59.

PMID:7538749

Abstract

OBJECTIVES

This study analyzes the three available clinical methods in the diagnosis of prostate cancer (PC): digital rectal examination (DRE), serum prostate specific antigen (PSA) and transrectal ultrasound (TRUS), and attempts to establish the best system in the early detection of PC.

METHODS

The findings of DRE, serum PSA and TRUS of the prostate in patients in which a TRUS-guided prostate biopsy was performed initially, and prostate surgery afterwards (TURP in 72%, radical retropubic prostatectomy in 20% and simple prostatectomy in 8%), are retrospectively analyzed.

RESULTS

PC was eventually found in 50 patients (56%). Seventy-eight patients had an abnormal DRE, 44 of which had a final diagnosis of PC (sensitivity = 94%, specificity = 20.5%). Serum PSA levels were available in 60 cases before diagnosis. Levels > 4 ng/ml were found in 32 of 38 cases with PC (sensitivity = 84%, specificity = 31%). The TRUS finding with the highest positive predictive value (PPV) for PC was diffuse prostate heterogeneity (77.8%). When a hypoechoic nodule was seen in the prostate peripheral zone, PC was found in 53.7%. Different combinations of the three methods are analyzed, trying to increase the diagnostic capabilities of each isolated test. Transrectal ultrasound-guided prostate biopsy detected 44 (88%) of the 50 cases with PC, its negative predictive value being 86.7%. Prostate tissue valid for histologic diagnosis was obtained in 97% of the cases, and the predictive value of the true tumor grade was 84.1%. The general complication rate attained 3.4%, none being of the septic type.

CONCLUSIONS

When parallel testing was examined (one or more tests being abnormal), the most efficient combination in the early detection of PC was when DRE was suspicious or serum PSA > 4 ng/ml (sensitivity = 95%, PPV = 62%). When at least two diagnostic tests were abnormal (serial testing), the most efficient combination to confirm the presence of this tumor was an abnormal TRUS and a serum PSA > 10 ng/ml (specificity = 86%, PPV = 88%).

摘要

目的

本研究分析了前列腺癌（PC）诊断中现有的三种临床方法：直肠指检（DRE）、血清前列腺特异性抗原（PSA）和经直肠超声检查（TRUS），并试图建立早期检测PC的最佳系统。

方法

回顾性分析最初进行TRUS引导下前列腺穿刺活检、随后进行前列腺手术（72%为经尿道前列腺电切术，20%为耻骨后根治性前列腺切除术，8%为单纯前列腺切除术）患者的DRE、血清PSA和前列腺TRUS检查结果。

结果

最终在50例患者（56%）中发现PC。78例患者DRE异常，其中44例最终诊断为PC（敏感性=94%，特异性=20.5%）。诊断前60例患者有血清PSA水平数据。38例PC患者中有32例PSA水平>4 ng/ml（敏感性=84%，特异性=31%）。对PC阳性预测值（PPV）最高的TRUS表现为前列腺弥漫性异质性（77.8%）。当在前列腺外周带发现低回声结节时，53.7%的患者发现PC。分析了这三种方法的不同组合，试图提高每种单独检查的诊断能力。经直肠超声引导下前列腺穿刺活检在50例PC患者中检测出44例（88%），其阴性预测值为86.7%。97%的病例获得了可用于组织学诊断的前列腺组织，真实肿瘤分级的预测值为84.1%。总并发症发生率为3.4%，无感染性并发症。