Clark T W, Goldenberg L, Cooperberg P L, Wong A D, Singer J
Department of Radiology, University of British Columbia, Vancouver.
Can Assoc Radiol J. 1997 Aug;48(4):252-8.
To determine which of several variables--age, serum level of prostate-specific antigen (PSA), findings of transrectal ultrasonography (TRUS) and findings of digital rectal examination (DRE)--are the best predictors of positive prostate biopsy results.
An urban, university-affiliated tertiary care hospital.
a cohort of 1330 consecutive men referred to the diagnostic imaging department for TRUS and TRUS-guided prostate biopsy. Each patient was referred after examination by a urologist because of clinical suspicion of prostate cancer.
All of the men had undergone prior determination of serum level of PSA. Repeat DRE was performed at the time of imaging. The variables age, PSA level, TRUS findings and DRE findings were tested aline and in combination as predictors of positive biopsy results by means of logistic regression analysis. A summary of percentage risk for positive biopsy results was constructed for each combination of statistically significant variables, stratified for age.
Cancer was detected in 541 men (40.7%). A strong correlation was observed between serum PSA level and the likelihood of positive biopsy result (p < 0.001). Of 402 men with normal age-specific PSA, 109 (27.1%) had positive biopsy results. Of 403 men with PSA of 10 ng/mL or more, 233 (57.8%) had cancer. The level of serum PSA was also related to the number of prostate sextants harbouring cancer (p < 0.001). TRUS findings at the time of biopsy were a strong predictor of cancer of the PSA level was abnormal (p < 0.001). DRE results alone did not correlate with positive biopsy results, regardless of age, PSA level of TRUS findings.
Men in whom there is a clinical concern for prostate cancer should undergo prostate biopsy if there is any elevation of age-specific PSA, particularly if the findings of TRUS are also abnormal. Because DRE alone was not predictive of biopsy outcome, algorithms for prostate cancer detection that rely on abnormal DRE results to identify men who should undergo biopsy will miss a significant number of cancers.
确定多个变量（年龄、前列腺特异性抗原[PSA]血清水平、经直肠超声检查[TRUS]结果和直肠指检[DRE]结果）中哪些是前列腺活检阳性结果的最佳预测指标。
一所城市的、与大学相关的三级护理医院。
连续1330名因临床怀疑前列腺癌而被转诊至诊断影像科进行TRUS及TRUS引导下前列腺活检的男性患者。每位患者经泌尿科医生检查后因临床怀疑前列腺癌而被转诊。
所有男性患者之前均已测定血清PSA水平。在进行影像检查时重复进行DRE。通过逻辑回归分析，对年龄、PSA水平、TRUS结果和DRE结果这些变量单独及联合作为活检阳性结果的预测指标进行测试。针对具有统计学意义的变量的每种组合构建活检阳性结果的百分比风险总结，并按年龄分层。
541名男性（40.7%）检测出癌症。血清PSA水平与活检阳性结果的可能性之间存在强相关性（p<0.001）。在402名年龄特异性PSA正常的男性中，109名（27.1%）活检结果为阳性。在403名PSA为10 ng/mL及以上的男性中，233名（57.8%）患有癌症。血清PSA水平还与患癌前列腺叶的数量相关（p<0.001）。活检时的TRUS结果是PSA水平异常时癌症的强预测指标（p<0.001）。无论年龄、PSA水平或TRUS结果如何，单独的DRE结果与活检阳性结果均无相关性。
临床上怀疑患有前列腺癌的男性，如果年龄特异性PSA有任何升高，特别是TRUS结果也异常时，应进行前列腺活检。由于单独的DRE不能预测活检结果，依赖异常DRE结果来确定应接受活检男性的前列腺癌检测算法会遗漏大量癌症病例。
