Objective To estimate the diagnostic significance and indication of repeated prostate biopsy in patients with persistently abnormal serum PSA.Methods From Jan 2004 to Sep 2011,90 patients with persistently abnormal serum PSA levels underwent transperineal ultrasound guided template prostate biopsy.They were diagnosed as benign lesions (BPH 66/90,PIN 10/90,ASAP 14/90)by previous first biopsies.The ages were 43 to 86 years old (mean age 71),and their PSA levels were fluctuated in a range of 3.1 to 168.0 μg/L (mean 17.6 μg/L),26 patients were abnormal in digital rectal examination (DRE).Results According to the repeated biopsies,it was divided into three groups including benign group (57/90),PIN or ASAP group (5/90) and PCa group (28/90).21.2％ patients were confirmed as PCa (14/66) in BPH group,while 60％ (6/10) patients in PIN group and 57.1％ (8/14) patients in ASAP group were confirmed as PCa.There were significant differences in BPH group compared with PIN or ASAP group (P＜0.05).The mean prostate volume (PV) was (65.9±22.6) ml in benign group and (50.4±20.8) mlin PCa group,while abnormal DRE were foundin 7/41 in benign group and 5/9 in PCa group.There was significant differences in PV and DRE between the two groups (P＜0.05).There were no significant differences in age,PSA,PSAD,PV or DRE between PIN and ASAP group (P＞0.05).Conclusions Repeated biopsy can improve the diagnosis of PCa in patients with persistently abnormal serum PSA.Smaller PV or abnormal DRE in the patients who were diagnosed as BPH by previous first biopsies may strongly need repeated biopsies,while in the patients who were diagnosed as PIN/ASAP by previous first biopsies,repeated biopsies were required despite any age,PSA,PSAD,PV or DRE.%目的 探讨PSA持续异常患者前列腺重复穿刺活检的诊断价值及适应证. 方法选取2004年1月至2011年9月首次穿刺活检诊断为前列腺良性病变但PSA持续异常的患者90例,其中BPH、正常前列腺组织及前列腺炎症患者组(BPH组)66例,前列腺上皮内瘤变(prostatic intraepithelial neoplasia,PIN)组10例,前列腺不典型小腺泡增生(atypical small acinar proliferation,ASAP)组14例.年龄43～86岁,平均71岁.PSA 3.1～168.0μg/L,平均17.6 μg/L.直肠指检(digital rectal examination,DRE)触及结节26例.采用模板定位经会阴重复穿刺活检. 结果 本组90例根据重复穿刺活检病理结果分为良性组57例,PIN或ASAP组5例,前列腺癌(prostate cancer,PCa)组28例.其中BPH组发现PCa为14例(21.2％),PIN组发现PCa为6例(60.0％),ASAP组发现PCa为8例(57.1％),BPH组与PIN组、ASAP组比较差异均有统计学意义(P＜0.05).BPH组重复穿刺活检诊断为良性组的平均前列腺体积为(65.9±22.6)ml,DRE阳性7例,PCa组为(50.4±20.8) ml,DRE阳性5例,两组间比较差异有统计学意义(P＜0.05).PIN组和ASAP组的患者重复穿刺活检结果显示年龄、PSA值、PSAD值、前列腺体积、DRE阳性例数在重复穿刺后诊断为良性组、PIN或ASAP组和PCa组间差异均无统计学意义(P＞0.05). 结论 对PSA持续异常患者行前列腺重复穿刺活检可以提高PCa的诊断率.首次穿刺诊断为BPH的患者,前列腺体积越小及DRE结果阳性者,若PSA持续升高,应强烈建议重复穿刺活检.首次穿刺诊断为PIN或ASAP的患者,不论年龄、PSA、PSAD、前列腺体积和DRE结果如何,均应建议重复穿刺活检.
展开▼
