Roehrborn C G, Pickens G J, Sanders J S
Division of Urology, University of Texas Southwestern Medical Center at Dallas, Texas, USA.
Urology. 1996 Mar;47(3):347-52. doi: 10.1016/s0090-4295(99)80451-8.
To determine the diagnostic yield of secondary and tertiary transrectal ultrasound (TRUS)-guided biopsies of the prostate in men suspected of having carcinoma of the prostate because of an elevated serum prostate-specific antigen (PSA) level or an abnormal digital rectal examination (DRE).
The pathology database at the Dallas Veterans Affairs Medical Center was retrospectively searched for patients who had undergone at least two TRUS-guided biopsies of the prostate within a 6-month time span. Pertinent demographic data, serum PSA, outcomes of the two (or more) biopsies stratified in six distinct histopathologic diagnoses, and Gleason grade if carcinoma of the prostate was identified, were entered into a database and analyzed.
A total of 123 men had at least two TRUS-guided biopsies, of which 22 had three biopsies. Mean age of this group was 68.5 +/- 0.51 (SE), and mean PSA was 11.5 +/- 1.07 (SE). Of 123 patients, 28 had a positive second biopsy following a negative first biopsy, for a positive biopsy rate of 23%. Only 2 of 22 patients who underwent a third biopsy were found to have carcinoma of the prostate, for a positive biopsy rate of 9%. The positive biopsy rate for the second biopsy was 19% (3 of 16) if the PSA was 4.0 ng/mL or less, 15% (10 of 66) if the PSA was between 4 and 10.0 ng/mL independent of the DRE findings, and 37% (15 of 41) if the PSA was 10.0 ng/mL or higher. Benign prostatic hyperplasia (59 of 123 [48%]) and atypia (38 of 123 [31%]) were the most common histopathologic diagnoses on the first biopsy, and the positive re-biopsy rates were similar for these two groups (25% versus 21 %).
An overall positive biopsy rate of 23% in our retrospective series of 123 men with a mean PSA of 11.5 ng/mL warrants the performance of a second biopsy independent of the histopathologic diagnosis made on the first (negative) biopsy, if the outcome of such biopsy would have therapeutic consequences for the patient. This policy should not be restricted to men with a PSA above the cutoff level of 4.0 ng/mL alone. Patients with atypia should be pursued aggressively, as even on a third biopsy the positive biopsy rate was 29%.
确定因血清前列腺特异性抗原（PSA）水平升高或直肠指检（DRE）异常而怀疑患有前列腺癌的男性患者，经直肠超声（TRUS）引导下进行二次及三次前列腺穿刺活检的诊断率。
回顾性检索达拉斯退伍军人事务医疗中心的病理数据库，查找在6个月时间内至少接受过两次TRUS引导下前列腺穿刺活检的患者。将相关人口统计学数据、血清PSA、两次（或更多次）活检结果（按六种不同的组织病理学诊断分层）以及如果确诊为前列腺癌则记录Gleason分级，录入数据库并进行分析。
共有123名男性至少接受过两次TRUS引导下的活检，其中22人接受了三次活检。该组患者的平均年龄为68.5±0.51（标准误），平均PSA为11.5±1.07（标准误）。在123例患者中，28例在首次活检为阴性后第二次活检呈阳性，阳性活检率为23%。在接受第三次活检的22例患者中，仅2例被发现患有前列腺癌，阳性活检率为9%。如果PSA为4.0 ng/mL或更低，第二次活检的阳性活检率为19%（16例中的3例）；如果PSA在4至10.0 ng/mL之间（与DRE结果无关），阳性活检率为15%（66例中的10例）；如果PSA为10.0 ng/mL或更高，阳性活检率为37%（41例中的15例）。良性前列腺增生（123例中的59例[48%]）和异型增生（123例中的38例[31%]）是首次活检中最常见的组织病理学诊断，这两组的再次活检阳性率相似（分别为25%和21%）。
在我们对123名平均PSA为11.5 ng/mL的男性进行的回顾性系列研究中，总体阳性活检率为23%，这表明如果二次活检结果对患者有治疗意义，无论首次（阴性）活检的组织病理学诊断如何，都有必要进行二次活检。这一策略不应仅局限于PSA高于4.0 ng/mL临界值的男性。对于异型增生患者应积极追踪，因为即使在第三次活检时阳性活检率仍为29%。
