经直肠超声引导下系统六分区活检检测出的前列腺癌的临床病理特征

Clinicopathological features of prostate cancer detected by transrectal ultrasonography-guided systematic six-sextant biopsy.

作者信息

Ito K, Ichinose Y, Kubota Y, Imai K, Yamanaka H

机构信息

Department of Urology, Gunma University School of Medicine, Maebashi, Japan.

出版信息

Int J Urol. 1997 Sep;4(5):474-9. doi: 10.1111/j.1442-2042.1997.tb00288.x.

DOI:10.1111/j.1442-2042.1997.tb00288.x

PMID:9354949

Abstract

BACKGROUND

The objectives of this study were to compare the efficacy of 3 modalities (prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasonography (TRUS)) in detecting prostate cancer which was pathologically confirmed by TRUS-guided systematic six-sextant biopsy, and to investigate the relationship between the number of positive cores and several clinicopathological parameters.

METHODS

Between 1992 and 1994, 297 males (155 from a mass screening program and 142 identified as outpatients) with a mean age of 71 years, underwent examinations including PSA determination, DRE, TRUS and systematic six-sextant biopsy, and/or additional directed biopsy.

RESULTS

Prostate cancer was detected in 93 men. The sensitivity level of the PSA assay was significantly higher (85%) than that of either DRE or TRUS. Patients with an abnormal DRE or TRUS, elevated PSA levels, and those in the T3-T4 category or with moderate to poorly-differentiated adenocarcinomas had more positive biopsy cores (P < 0.05). Also, the relationships of both the number of positive biopsy cores and tumor grade to bone metastasis were significant (P < 0.01). Of 209 hypoechoic areas identified by transrectal ultrasonography, 42% were cancerous, and of 427 isoechoic areas, 12% were cancerous. The percentage of positive biopsy cores with hypoechoic areas was 86% in the subjects with a PSA > 10 ng/mL, but low (9%) in subjects with a PSA < or = 4 ng/mL, and the percentage of negative biopsy cores with a normal TRUS was high (98%) in subjects with a PSA of < or = 4 ng/mL, but lower (67%) in subjects with a PSA > 10 ng/mL.

CONCLUSION

The serum PSA assay was more useful than either DRE or TRUS in detecting prostate cancer. The percentage of bone metastasis increased concomitant with the number of positive biopsy cores, and the positive biopsy rate of hypoechoic areas positively correlated with the PSA level.

摘要

背景

本研究的目的是比较三种检查方法（前列腺特异性抗原（PSA）检测、直肠指检（DRE）和经直肠超声检查（TRUS））在检测经TRUS引导的系统六分区活检病理确诊的前列腺癌方面的疗效，并研究阳性活检芯数量与若干临床病理参数之间的关系。

方法

1992年至1994年间，297名男性（155名来自大规模筛查项目，142名被确定为门诊患者），平均年龄71岁，接受了包括PSA测定、DRE、TRUS和系统六分区活检及/或额外定向活检在内的检查。

结果

93名男性被检测出患有前列腺癌。PSA检测的灵敏度水平显著高于DRE或TRUS（85%）。直肠指检或TRUS异常、PSA水平升高以及处于T3 - T4期或患有中至低分化腺癌的患者有更多的阳性活检芯（P < 0.05）。此外，阳性活检芯数量和肿瘤分级与骨转移的关系均具有显著性（P < 0.01）。经直肠超声检查发现的209个低回声区中，42%为癌性，427个等回声区中，12%为癌性。PSA > 10 ng/mL的受试者中，低回声区阳性活检芯的比例为86%，而PSA≤4 ng/mL的受试者中该比例较低（9%）；PSA≤4 ng/mL的受试者中，TRUS正常的阴性活检芯比例较高（98%），而PSA > 10 ng/mL的受试者中该比例较低（67%）。