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目的:探讨前列腺体积对不同前列腺穿刺方案诊断前列腺癌的影响。方法:选取北京大学第一医院行前列腺穿刺活检的323例男性患者,其中前列腺特异抗原(prostatic specific antigen,PSA)>4.0μg/L305例,直肠指诊可疑前列腺癌52例,均行在直肠超声引导下经直肠13针前列腺穿刺活检术(穿刺位点包括尖部、中部、底部、外侧中部、外侧底部、中间底部、中间中部、中间尖部)。入选病例的年龄为49～90岁,平均69岁;PSA水平0.6～142.5μg/L,平均20.8μg/L;前列腺体积12.3～255.5mL,平均60.4mL。入选病例依前列腺体积分为2组(<50mL,≥50mL),将13针法穿刺位点进行不同的组合,形成各种6针、8针、10针穿刺方案,统计分析各种方案发现前列腺癌的阳性率和敏感性,将能发现前列癌的例数是13针法发现前列腺癌总例数的95%以上的穿刺方案认为是理想的组合。结果:13针法的穿刺总阳性率为37.2%(120/323),与前列腺体积<50mL的病例相比,体积≥50mL的病例的13针法穿刺阳性率从51.0%(73/143)降为26.1%(47/180)。当前列腺体积<50mL时,包含前列腺尖部、中部、底部、外侧中部和包含尖部、中部、外侧中部、外侧底部的8针穿刺位点组合方案的敏感性分别为98.6%和97.3%;当前列腺体积≥50mL时,包含前列腺尖部、中部、底部、外侧中部、外侧底部的10针法的敏感性为97.6%,以上组合的阳性率与13针法发现前列腺癌的阳性率相比,差异无统计学意义(均P>0.5)。结论:对于初次前列腺活检的病例,当前列腺体积<50mL时,可以采用包含尖部、中部、底部、外侧中部或尖部、中部、外侧中部、外侧底部的8针法,而当前列腺体积≥50mL时,包含尖部、中部、底部、外侧中部、外侧底部的10针法是较为合理的选择。
Objective: To investigate the effect of prostate volume on the diagnosis of prostate cancer by different prostatic puncture protocols. Methods: A total of 323 male patients undergoing prostatic biopsy from Peking University First Hospital were enrolled in this study. Among them, prostatic specific antigen (PSA)> 4.0 μg / L was used in 305 cases and suspicious prostate cancer was diagnosed in rectum. Guided transrectal 13-pin prostate biopsy (puncture site including tip, middle, bottom, lateral middle, lateral bottom, middle bottom, middle middle, middle apex). The age of selected cases was 49 to 90 years old, with an average of 69 years. The PSA level was 0.6 ~ 142.5μg / L with an average of 20.8μg / L. The volume of prostate was 12.3 ~ 255.5mL with an average of 60.4mL. The selected cases were divided into two groups (<50mL, ≥50mL) according to the volume of the prostate. Different combinations of the 13-gauge puncture sites were formed to form various 6-needle, 8-needle and 10-needle punctures. The positive rate and sensitivity of the cancer, and the number of prostate cancers that can be found, is considered to be the ideal combination of the puncture regimens of 95% or more of the total number of prostate cancer detected by the 13-gauge method. Results: The total positive rate of puncture of the 13-needle method was 37.2% (120/323). The positive rate of 13-needle puncture in the volume≥50mL was 51.0% (73/143) lower than that of the prostate volume <50mL 26.1% (47/180). When the volume of the prostate was less than 50 mL, the sensitivities of the 8-needle puncture site combination solution including the prostatic apex, middle, bottom, mid-lateral and the apical, middle, lateral mid and lateral bases were 98.6% and 97.3% Prostate volume ≥ 50mL, including prostate apex, central, bottom, lateral medial and lateral bottom of the 10-pin method of sensitivity was 97.6%, the positive rate of the above combination and 13-pin method found that the positive rate of prostate cancer, the difference No statistical significance (all P> 0.5). CONCLUSIONS: For primary prostate biopsy, an 8-gauge procedure that includes apical, medial, basal, lateral medial or apical, medial, medial lateral, mid-lateral, and medial basal may be used when the prostate volume is <50 mL and when the prostate volume is ≥50 mL , Including the tip, middle, bottom, outer middle, outer bottom 10-pin method is a more reasonable choice.