Babaian R J, Dinney C P, Ramirez E I, Evans R B
Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston.
Urology. 1993 May;41(5):421-5. doi: 10.1016/0090-4295(93)90500-a.
The incidence of clinically organ-confined prostate cancer has markedly improved in programs designed to detect this disease by utilizing a combination of diagnostic modalities including digital rectal examination (DRE), transrectal ultrasonography (TRUS), and prostate-specific antigen (PSA). Biopsies were performed on 436 men who had abnormal findings on DRE, TRUS, or PSA. Overall, 39 percent of these men had histologic confirmation of prostate cancer. TRUS diagnosed more cancer (94%) than either DRE (80%) or PSA (89%), while the combination of TRUS and PSA diagnosed a similar number of cancers as the combination of DRE and PSA (100% vs 98%). The positive predictive value (PPV) of DRE and PSA combination was significantly better than that of TRUS and PSA (p = 0.01), but was not different from that of a combination of all three tests. DRE and PSA would have missed 4 cancers, but would have cost approximately 140 percent less than any program employing TRUS. Consequently, we recommend that the combination of DRE and PSA be used in primary early detection for prostate cancer and that TRUS be performed only when either or both DRE and PSA results are abnormal.
通过运用包括直肠指检（DRE）、经直肠超声检查（TRUS）和前列腺特异性抗原（PSA）在内的多种诊断方法来检测临床器官局限性前列腺癌的项目中，其发病率已显著改善。对436名在DRE、TRUS或PSA检查中有异常发现的男性进行了活检。总体而言，这些男性中有39%经组织学确诊为前列腺癌。TRUS诊断出的癌症（94%）比DRE（80%）或PSA（89%）更多，而TRUS和PSA联合诊断出的癌症数量与DRE和PSA联合诊断出的相似（100%对98%）。DRE和PSA联合的阳性预测值（PPV）显著优于TRUS和PSA联合的阳性预测值（p = 0.01），但与三项检查联合的阳性预测值没有差异。DRE和PSA会漏诊4例癌症，但成本比任何采用TRUS的方案低约140%。因此，我们建议在前列腺癌的早期初步检测中使用DRE和PSA联合检查，仅在DRE和PSA结果一项或两项异常时才进行TRUS检查。
