摘要
目的探讨直肠指检(digital rectal examination,DRE)和经直肠超声检查(transrectal ultrasonography,TRUS)对血清前列腺特异抗原(prostate specific antigen,PSA)≤4 ng/ml的前列腺癌的诊断价值。方法对112例血清PSA≤4 ng/ml而DRE或(和)TRUS异常的男性患者进行了TRUS引导的前列腺系统10针+可疑区穿刺活检。根据血清PSA范围将病例分成0～0.9 ng/ml,1.0～1.9 ng/ml,2.0～2.9 ng/ml和3.0～4.0 ng/ml 4组。结果 112例病例中有14例被诊断为前列腺癌,检出率为12.5%。4组中:检出前列腺癌病例分别为0、2、5、7例。血清PSA在0～1.9 ng/ml和2.0～4.0ng/ml范围:DRE异常患者中前列腺癌检出率分别为5%和21.1%(P<0.05);TRUS异常患者中前列腺癌检出率分别为2.4%和28.6%(P<0.05)。在14例前列腺癌患者中有4例仅被TRUS发现,并且这4例PSA值均在2.0～4.0 ng/ml范围内。结论血清PSA<2 ng/ml时,除非DRE高度异常,患前列腺癌风险低,不需行前列腺穿刺活检。血清PSA在2.0～4.0 ng/ml,应行TRUS检查,以提高前列腺癌检出敏感性。
Objective To investigate the value of digital rectal examination （DRE） and transrectal uhrasonography （TRUS） for prostate cancer diagnosis in subjects with prostate specific antigen （PSA） levels of 4.0 ng/ml or less. Methods 112 subjects with PSA levels of 4.0 ng/ml or less and abnormal findings on DRE or TRUS underwent prostate biopsy. The subjects were divided into four groups according to PSA levels ： 0 to 0.9 ng/ml, 1.0 to 1.9 ng/ml, 2.0 to 2.9 ng/ml, and 3.0 to 4.0 ng/ml. The reliability of DRE and TRUS and clinicopathologic features of prostate cancer were investigated in these four groups. Results Of the 112 subjects, 14 （ 12.5% ） were diagnosed as having prostate cancer. There was 0, 2, 5, and 7 patients in subjects of the four groups, respectively. The detection rate of abnormal findings on DRE and TRUS in subjects with PSA levels of 0 to 1.9 ng/ml and 2.0 to 4.0ng/ml was 5% vs 21.1% （ P 〈 0.05 ） and 2.4% vs 28.6% （ P 〈 0.05 ）, respectively. Adding TRUS to DRE in the screening program of subjects with PSA levels of 2.0 to 4.0 ng/ml increased the detection rate of prostate cancer to 40% （4 of 10）. Conclusions Routine prostate biop- sy should not be undertaken except for highly suspicious DRE findings in subjects with PSA levels less than 2.0 ng/ml. The additional use of TRUS in subjects with PSA levels of 2.0 to 4.0 ng/ml would improve the sensitivity of prostate cancer detection. The diagnostic algorithm proposed in the present study is useful as a screening method for prostate cancer in subjects with PSA levels of 4.0 ng/ml or less.
出处
《武警医学》
CAS
2011年第10期876-878,共3页
Medical Journal of the Chinese People's Armed Police Force
关键词
前列腺肿瘤
前列腺特异抗原
直肠指检
经直肠超声
prostate neoplasms
prostate specific antigen
digital rectal examination
transrectal ultrasonography
