Eskew L A, Bare R L, McCullough D L
Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA.
J Urol. 1997 Jan;157(1):199-202; discussion 202-3.
The number of patients undergoing prostate biopsy has dramatically increased due to prostate specific antigen screening. The low specificity of this screening tool requires prostate biopsy for diagnosis of prostate cancer. The sextant biopsy technique has been used widely with success in diagnosing carcinoma of the prostate. However, concern has arisen that the original sextant method may not include an adequate sampling of the prostate. For many years we have used a method of prostate biopsy that, in addition to sextant biopsies, takes additional biopsies in a systematic fashion, which we call the 5 region prostate biopsy. We conducted a prospective study to determine if our 5 region prostate biopsy technique significantly increases the chances of finding carcinoma of the prostate compared to the sextant biopsy technique.
A total of 119 patients underwent transrectal ultrasound guided needle biopsy of the prostate. In addition to sextant biopsies, cores were taken from the far lateral and mid regions of the gland. Pathological findings of the additional regions were compared to those of the sextant regions.
Of the 48 patients with prostate cancer 17 (35%) had carcinomas only in the additional regions, which would have remained undetected had the sextant biopsy technique been used alone (p < 0.05). Of these additional cancers 83% had Gleason scores of 6 or more.
We introduce the 5 region technique of prostate biopsy as a means of significantly increasing the diagnostic yield of prostate biopsy in finding carcinoma of the prostate. We have found this technique to be safe, efficacious and superior to the sextant method of biopsy in identifying prostate cancer at an early but significant stage. The greatest use of the 5 region biopsy technique is in patients who have prostate specific antigen levels between 4 and 10 ng./ml.
由于前列腺特异性抗原筛查，接受前列腺活检的患者数量急剧增加。这种筛查工具的低特异性需要通过前列腺活检来诊断前列腺癌。六分区活检技术已被广泛应用于前列腺癌的诊断并取得成功。然而，有人担心最初的六分区方法可能无法对前列腺进行充分采样。多年来，我们一直采用一种前列腺活检方法，除了六分区活检外，还以系统的方式进行额外的活检，我们称之为五区域前列腺活检。我们进行了一项前瞻性研究，以确定与六分区活检技术相比，我们的五区域前列腺活检技术是否能显著增加发现前列腺癌的几率。
共有119例患者接受了经直肠超声引导下的前列腺穿刺活检。除了六分区活检外，还从腺体的远外侧和中间区域取材。将额外区域的病理结果与六分区区域的结果进行比较。
在48例前列腺癌患者中，有17例（35%）仅在额外区域发现癌，如果仅使用六分区活检技术，这些癌将无法被检测到（p < 0.05）。在这些额外的癌症中，83%的Gleason评分为6分或更高。
我们引入五区域前列腺活检技术，作为一种显著提高前列腺活检在发现前列腺癌方面诊断率的方法。我们发现这种技术是安全、有效的，并且在早期但重要阶段识别前列腺癌方面优于六分区活检方法。五区域活检技术的最大用途是应用于前列腺特异性抗原水平在4至10 ng/ml之间的患者。
