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目的:探讨前列腺特异性抗原(PSA)异常且首次经直肠前列腺穿刺活检阴性患者的临床特点与转归,评价系统13点穿刺法的临床价值。方法:回顾性分析2010年12月至2013年12月收治的PSA异常且首次经直肠前列腺13点穿刺活检阴性患者204例的临床资料。观察其PSA变化并随访诊疗过程。结果:随访26-42个月,最终确诊前列腺癌(Pca)20例。根据初次活检病理结果分组比较,前列腺上皮内瘤(PIN)组与非PIN组、PIN伴慢性前列腺炎(CP)组与PIN组的Pca确诊率有统计学差异(P<0.05)。以最终是否确诊为Pca分组比较,三种影像技术(TRUS,CT及MRI)的诊断异常率、直肠指检(DRE)异常率及总PSA(TPSA)、PSA密度(PSAD)有统计学差异(P<0.05),95%的Pca患者集中于游离/总PSA(F/T)<0.25范围内。系统13点穿刺法首次检出率为31%,重复穿刺阳性率为18.6%,首次穿刺假阴性率约为7%。结论:对于PSA异常而首次穿刺诊断为阴性的患者,需谨慎排除引起PSA升高的非癌因素。应重视PIN及CP作为独立危险因素对Pca发病的影响,同时需结合影像学表现及PSAD、F/T值判断是否行重复穿刺。系统13点穿刺法假阳性率较低,检出率理想,适于初次活检。
Objective: To investigate the clinical features and prognosis of patients with abnormal prostate-specific antigen (PSA) and the first negative transrectal prostate biopsy, and to evaluate the clinical value of the system 13-point puncture. Methods: The clinical data of 204 patients with abnormal PSA and the first negative transrectal prostatic 13-point needle biopsy from December 2010 to December 2013 were retrospectively analyzed. Observe the change of PSA and follow up the course of treatment. Results: Followed up for 26-42 months, finally diagnosed prostate cancer (Pca) in 20 cases. According to the results of primary biopsy, the diagnosis rate of Pca between PIN group and non-PIN group, PIN with chronic prostatitis (CP) group and PIN group was statistically different (P <0.05). The diagnostic abnormalities, the abnormal rate of DRE and the total PSA (TPSA) and PSA density (PSAD) of the three imaging techniques (TRUS, CT and MRI) were statistically different from those of the Pca group P <0.05), 95% of Pca patients concentrated in the free / total PSA (F / T) <0.25 range. The 13-point puncture method for the first time detected the rate of 31%, the repeat puncture positive rate was 18.6%, the first puncture false negative rate was about 7%. CONCLUSIONS: Patients diagnosed negative for the first time with PSA abnormalities need to be carefully excluded from the non-cancerous factors responsible for the elevated PSA. Should pay attention to the PIN and CP as independent risk factors on the incidence of Pca, combined with imaging findings and PSAD, F / T value to determine whether the line repeat puncture. System 13-point puncture method false positive rate is low, the detection rate is ideal for the first biopsy.