CAJ | 학술논문

目的探讨根据PSA水平制定个体化前列腺穿刺活检方案的临床应用价值,以提高前列腺癌(PCa)的初次检出率.方法回顾性分析438例PSA≥4.0ng/mL疑为PCa患者初次经直肠前列腺活检的临床资料.穿刺方法为“10 +X”和“6+X”穿刺法.分析各组PSA情况及DRE、f/T-PSA、PSAD、前列腺体积与穿刺针数、穿刺阳性率等相关性.结果“6+X”针法和“10 +X”针法共438例,在T-PSA 0 ～ 20ng/mL之间患者中,PCa 112例,其中“6+X”针法检测阳性率11.76％,“10+X”针法检测阳性率22.91％,有显著性差异(P ＜0.005),表明T-PSA(0 ～ 20ng/mL)之间时,对于PCa的检测率,“10+X”针法明显优于“6+X”针法.在T-PSA 20.1～50ng/mL之间患者中,PCa 59例,其中“6+X”针法检测阳性率47.46％,“10+X”针法检测阳性率52.54％,差异无统计学意义(P＞0.25),表明T-PSA 20.1～50ng/mL之间时,“10 +X”针法与“6+X”针法相比,并不能显著性提高PCa检测率.在T-PSA≥50.1ng/mL患者中,PCa 56例,其中“6+X”针法检测出28例,占阳性率50.00％,“10+X”针法检测出28例,占阳性率50.00％,两者差异无统计学意义,由此可见,当T-PSA≥20.1 ng/mL,“10+X”针法比“6+X”针法增加的PCa检出率逐渐下降.结论推荐,当T-PSA≤20 ng/mL,采用“10+X”穿刺法；T-PSA≥20.1 ng/mL,采用“6+X”穿刺法.
목적 탐토근거PSA수평제정개체화전렬선천자활검방안적림상응용개치,이제고전렬선암(PCa)적초차검출솔.방법회고성분석438례PSA≥4.0ng/mL의위PCa환자초차경직장전렬선활검적림상자료.천자방법위“10 +X”화“6+X”천자법.분석각조PSA정황급DRE、f/T-PSA、PSAD、전렬선체적여천자침수、천자양성솔등상관성.결과“6+X”침법화“10 +X”침법공438례,재T-PSA 0 ～ 20ng/mL지간환자중,PCa 112례,기중“6+X”침법검측양성솔11.76％,“10+X”침법검측양성솔22.91％,유현저성차이(P ＜0.005),표명T-PSA(0 ～ 20ng/mL)지간시,대우PCa적검측솔,“10+X”침법명현우우“6+X”침법.재T-PSA 20.1～50ng/mL지간환자중,PCa 59례,기중“6+X”침법검측양성솔47.46％,“10+X”침법검측양성솔52.54％,차이무통계학의의(P＞0.25),표명T-PSA 20.1～50ng/mL지간시,“10 +X”침법여“6+X”침법상비,병불능현저성제고PCa검측솔.재T-PSA≥50.1ng/mL환자중,PCa 56례,기중“6+X”침법검측출28례,점양성솔50.00％,“10+X”침법검측출28례,점양성솔50.00％,량자차이무통계학의의,유차가견,당T-PSA≥20.1 ng/mL,“10+X”침법비“6+X”침법증가적PCa검출솔축점하강.결론추천,당T-PSA≤20 ng/mL,채용“10+X”천자법；T-PSA≥20.1 ng/mL,채용“6+X”천자법.
Objectives To explore an appropriate individualized Transrectal Ultrasonograhpy (TRUS)-guided prostate biopsy for the detection of prostate cancer by PSA levels and improve the PCa detection rate.Methods Clinical data of 438 consecutive men with the PSA≥4.0ng/ml with suspected PCa were analyzed.In the study,The methods of the Transrectal Ultrasound (TRUS)-guided prostate biopsy were"10 + X"and"6 + X".The relationship between the PSA relative parameters,including DRE,f/T-PSA,PSAD as well as the size of the prostate volume and the biopsy core number and the positive PCa rate were calculated and analyzed.Results The methods of the Transrectal Ultrasound (TRUS)-guided prostate biopsy with" 10 + X"and"6 + X"in individual systemic biopsies of all patients were succeed.In the patients of T-PSA between 0 and 20ng/ml,there pathology results were 112 cases of PCa,the positive rate of"6 + X" and" 10 + X" werel 1.76％ and 22.91％,respectively.The increase of" 10 + X" in cancer detection was 48.65％ (36/74) and big significant differences(P ＜0.005).So,the method of" 10 + X"was better than"6 + X"when the T-PSA≤20ng/ml.When the levels of T-PSA between 20.1 and 50ng/ml,there pathology results were 59 cases of PCa,28 patients for"6 + X"and 31 for" 10 + X",the positive rate were 47.46％ and 52.54％,respectively.The increase of" 10 + X"in cancer detection was only 9.68％ and were no significant differences between the two groups (P ＞ 0.25).So,the method of" 10 + X" has no advantage in increasing of cancer detection than"6 + X"when the T-PSA ≤20ng/ml.When the levels of T-PSA ≥50.1 ng/ml,the positive rate were similar,were all 50.00％ and no significant differences.Ii will be seen from that the positive rate of" 10 + X" than"6 + X" were falling in the levels of T-PSA ≥20.1 ng/ml.Conclusions According to the levels of PSA,we recommend the method of" 10 + X" when the T -PSA≤20 ng/ml and"6 + X"when the≥20.1 ng/ml.