摘要
目的探讨PSA≥30μg／L而初次行模板引导下经会阴前列腺饱和穿刺活检阴性患者的临床特点及转归。方法回顾性分析2003年12月至2010年12月收治的PSA≥30μg／L且经直肠超声（transrectalultrasound，TRUS）引导下经会阴模板前列腺饱和穿刺活检阴性患者44例的临床资料。年龄51～80岁，平均68岁。PSA30～128μg／L，中位数为40μg／L。前列腺体积30～190m1，中位数为73ml。分为TURP组15例、慢性前列腺炎组5例、重复活检组18例，其他组6例。随访观察其PSA变化及最终诊断。44例均行模板引导下经会阴前列腺11区饱和穿刺活检阴性，每区活检1～4针，共11～44针，平均28．7针。结果随访12～91个月，平均49个月。TURP组术后病理诊断均为BPH，其中2例冈TURP术后PSA仍〉10μg／L再次活检阴性。慢性前列腺炎组，行3～4周的抗生素治疗后PSA为1．5～10．6μg/L，1例PSA〉10μg/L者再次行经会阴活榆诊断仍为前列腺炎。重复活枪组随访期间PSA兀明显下降，行2～4次活检，其中6例诊断为前列腺癌。其他组，随访期间PSA逐渐下降，未再次行活检。结论对于高PSA值而初次前列腺穿刺活检阴性患者应分析其病因、去除叮能引起PSA升高的原因，密切随访观察PSA值的变化。在尽鼍避免前列腺癌漏诊的同时，也应避免不必要的穿刺。
Objective To report outcomes of patients with PSA ≥30 μg/L with initial negative transperineal template-guided saturation biopsy （TTSB）. Methods From 2003 to 2010, a total of 1824 patients underwent transperineal saturation biopsies with the prostate template at the Peking Union Medical College Hospital. 44 of them had initial negative biopsy with PSA ≥ 30 μg/L were reviewed in this study. The mean age was 68 years old （range, 51 to 80）. The mean biopsy cores were 28.7 （range, 11 to 44）. The median PSA level was 40μg/L （range, 30 to 128） , and the median prostate volume was 73 ml （range, 30 to 190）. They were divided into four groups： TURP group, chronic prostatitis group, repeat biopsy group and miscellaneous group. Results Patients were followed up for a mean of 49 months （range, 12 to 91 ）. All patients of TURP group （15 cases） were identified as prostatic hyperplasia by postoperative pathology. 2 of them had a second TTSB for PSA 〉 10 μg/L after TURP, which were negative. 5 patients of chronic pros- tariffs group had a declining PSA level after antibiotic therapy for 3 to 4 weeks. One patient took a second biopsy, which was identified as prostatitis. All patients of repeat biopsy group （18 cases） showed no significant decrease in PSA level during follow-up and undertook biopsies 2 to 4 times, 6 of which were proved to be prostate cancer. All patients of the miscellaneous group （6 cases） had a declining PSA and didnl take a second biopsy. Conclusions Close follow-up and regular PSA testing for patients who had a high PSA level with initial negative biopsy would be help to avoid both false negative of prostate cancer and unnecessary biopsy.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第7期504-507,共4页
Chinese Journal of Urology
基金
中央保健专项基金科研课题（B2009B091）
关键词
前列腺特异性抗原
活检
经会阴
Prostate specific antigen
Biopsy
Transperineal
