Spencer J A, Alexander A A, Gomella L, Matteucci T, Goldberg B B
Division of Diagnostic Ultrasound, Thomas Jefferson University Hospital, Philadelphia, Pa.
Radiology. 1993 Nov;189(2):389-93. doi: 10.1148/radiology.189.2.7692464.
To determine guidelines for biopsy in men with normal prostate-specific antigen (PSA) levels and suspected prostate cancer.
The clinical-sonographic features of 91 lesions of reduced echogenicity in 83 men with normal PSA levels who underwent transrectal ultrasound-guided biopsy were analyzed.
Sixteen men (19%) had cancer, two with bilateral foci, and four had prostatic intraepithelial neoplasia (PIN). Fourteen of 47 discrete hypoechoic lesions yielded cancer or PIN versus only five of 44 ill-defined vaguely hypoechoic lesions (P = .03). Fifteen of 18 malignant lesions exceeded 1 cm in longest dimension. In 47 men, sonographic and digital rectal examination (DRE) findings corresponded; 17 (36%) had cancer or PIN. By contrast, of 36 patients with differing sonographic and DRE findings, only three (8%) had malignancy at biopsy (P < .01).
Predictors of malignancy at sonography of the peripheral prostate gland in men with normal PSA levels include (a) lesion size, (b) degree and focality of hypoechogenicity, and (c) correspondence with the site of DRE abnormality.
确定前列腺特异性抗原（PSA）水平正常且疑似前列腺癌的男性患者的活检指南。
分析了83例PSA水平正常且接受经直肠超声引导活检的男性患者中91个低回声病变的临床超声特征。
16例男性（19%）患有癌症，2例为双侧病灶，4例患有前列腺上皮内瘤变（PIN）。47个离散低回声病变中有14个检出癌症或PIN，而44个边界不清的模糊低回声病变中只有5个检出（P = 0.03）。18个恶性病变中15个最长径超过1 cm。47例患者的超声和直肠指检（DRE）结果相符；其中17例（36%）患有癌症或PIN。相比之下，36例超声和DRE结果不同的患者中，活检时只有3例（8%）患有恶性肿瘤（P < 0.01）。
PSA水平正常的男性外周前列腺超声检查中恶性肿瘤的预测因素包括：（a）病变大小；（b）低回声程度和局灶性；（c）与DRE异常部位的对应关系。
