Speranza I, Bianco V, Banci M, Muià R, Gianni W, Bacciu O, Vecchione A, Marchei P
Dipartimento di Medicina Sperimentale e Patologia, Università degli Studi di Roma La Sapienza, Roma.
Minerva Med. 1998 Jul-Aug;89(7-8):267-75.
The aim of this study was to evaluate the advantages and limits of the various examinations, namely rectal exploration, suprapubic and transrectal scan and PSA, used in the diagnosis and follow-up of prostatic carcinoma.
The study was carried out in 21 cases of histologically confirmed prostatic carcinoma in patients aged between 57 and 82 years old (mean age: 69.5) referred to the authors' attention between January 1990 and August 1993.
With regard to the diagnosis, rectal exploration showed a sensitivity of 80.9%, suprapubic scan 95.2%, transrectal scan and PSA 100%. During the follow-up, patients were divided into operated (9) and non-operated (12) groups. Of the 9 patients undergoing radical prostatectomy, 5 showed residual locoregional disease; of the other 4 who had undergone a complete removal of the gland, one subsequently reported local recidivation. In those patients with residual disease, rectal exploration showed a postoperative sensitivity of 20%, nil sensitivity in the case of local recidivation and 100% specificity in successfully operated patients. Suprapubic scan showed a sensitivity of 60% in patients with residual disease, nil sensitivity in the case of local recidivation and 100% specificity in successfully operated patients. Transrectal scan and PSA revealed 100% sensitivity and specificity in all cases. These patients who were not operated owing to the presence of metastases at the time of diagnosis were divided into those who responded to hormone and chemotherapy (3 total responses, 6 partial responses) and patients who did not respond to this type of treatment (3 non-responders). In the cases of total response, all the tests used obtained 100% specificity. Serum levels of PSA were higher than the threshold value owing to the persistence of metastases. In the cases of partial response to treatment, rectal exploration revealed 50% sensitivity, suprapubic scan 83%, and transrectal scan and PSA 100%. Sensitivity to the four methods used was 100% in all non-responders.
From the results obtained it can be affirmed that the diagnosis of prostate pathology should start with rectal exploration and in the event that this method suggests the probable benignity of the lesion, the diagnostic process should conclude with a suprapubic scan. If rectal examination or suprapubic scan reveal a suspected malignancy, it is essential to perform a transrectal scan or PSA assay which has a high level of sensitivity and specificity for values over 10 ng/ml. During follow-up the only tests which show a high level of sensitivity are transrectal scan and PSA, whereas suprapubic scan and rectal exploration are not reliable in view of the high percentage of false negatives observed. The follow-up of those patients who were not operated and responded totally or partially to treatment must be carried out exclusively using transrectal scan and PSA assay. Suprapubic scan enables the evolution of the neoplasia to be followed over time in those patients who did not respond to treatment.
本研究旨在评估直肠指诊、耻骨上及经直肠超声检查以及前列腺特异抗原（PSA）检测在前列腺癌诊断及随访中的优势与局限性。
本研究纳入了1990年1月至1993年8月间收治的21例经组织学确诊的前列腺癌患者，年龄在57至82岁之间（平均年龄：69.5岁）。
在诊断方面，直肠指诊的敏感性为80.9%，耻骨上超声检查为95.2%，经直肠超声检查及PSA检测为100%。随访期间，患者被分为手术组（9例）和非手术组（12例）。9例行根治性前列腺切除术的患者中，5例存在局部残留病灶；另外4例腺体完全切除的患者中，1例随后出现局部复发。在残留病灶患者中，直肠指诊术后敏感性为20%，局部复发时敏感性为零，手术成功患者的特异性为100%。耻骨上超声检查在残留病灶患者中的敏感性为60%，局部复发时敏感性为零，手术成功患者的特异性为100%。经直肠超声检查及PSA检测在所有病例中的敏感性和特异性均为100%。这些因诊断时存在转移而未接受手术的患者被分为对激素及化疗有反应者（3例完全缓解，6例部分缓解）和对该类治疗无反应者（3例无反应）。在完全缓解的病例中，所有检测方法的特异性均为100%。由于转移灶持续存在，PSA血清水平高于阈值。在部分缓解的病例中，直肠指诊的敏感性为50%，耻骨上超声检查为83%，经直肠超声检查及PSA检测为100%。所有无反应者对所采用的四种方法的敏感性均为100%。
从所得结果可以肯定，前列腺疾病的诊断应从直肠指诊开始，如果该方法提示病变可能为良性，则诊断过程应以耻骨上超声检查结束。如果直肠检查或耻骨上超声检查发现可疑恶性病变，则必须进行经直肠超声检查或PSA检测，对于PSA值超过10 ng/ml的情况，其具有较高的敏感性和特异性。在随访期间，唯一具有高敏感性的检测方法是经直肠超声检查及PSA检测，而鉴于观察到的高假阴性率，耻骨上超声检查和直肠指诊并不可靠。对于未接受手术且对治疗完全或部分有反应的患者，必须仅使用经直肠超声检查和PSA检测进行随访。耻骨上超声检查可用于观察未对治疗产生反应的患者肿瘤的进展情况。
