直肠指检和经直肠超声检查对血清前列腺特异抗原≤4ng/ml的前列腺癌的诊断价值

摘要

Objective To investigate the value of digital rectal examination (DRE) and transrectal ultrasonography (TRUS) for prostate cancer diagnosis in subjects with prostate specific antigen (PSA) levels of 4.0 ng/ml or less. Methods 112 subjects with PSA levels of 4.0 ng/ml or less and abnormal findings on DRE or TRUS underwent prostate biopsy. The subjects were divided into four groups according to PSA levels: 0 to 0.9 ng/ml, 1.0 to 1.9 ng/ml, 2.0 to 2.9 ng/ml, and 3.0 to 4.0 ng/ml. The reliability of DRE and TRUS and clinicopathologic features of prostate cancer were investigated in these four groups. Results Of the 112 subjects, 14 ( 12.5% ) were diagnosed as having prostate cancer. There was 0, 2, 5, and 7 patients in subjects of the four groups, respectively. The detection rate of abnormal findings on DRE and TRUS in subjects with PSA levels of 0 to 1.9 ng/ml and 2.0 to 4. Ong/ml was 5% vs 21.1 % ( P <0.05) and 2.4% vs 28.6% (P <0.05) , respectively. Adding TRUS to DRE in the screening program of subjects with PSA levels of 2.0 to 4.0 ng/ml increased the detection rate of prostate cancer to 40% (4 of 10). Conclusions Routine prostate biopsy should not be undertaken except for highly suspicious DRE findings in subjects with PSA levels less than 2.0 ng/ml. The additional use of TRUS in subjects with PSA levels of 2.0 to 4.0 ng/ml would improve the sensitivity of prostate cancer detection. The diagnostic algorithm proposed in the present study is useful as a screening method for prostate cancer in subjects with PSA levels of 4.0 ng/ml or less.%目的 探讨直肠指检(digital rectal examination,DRE)和经直肠超声检查(transrectal ultrasonography,TRUS)对血清前列腺特异抗原(prostate specific antigen,PSA)≤4 rg/ml的前列腺癌的诊断价值.方法 对112例血清PSA≤4 ng/ml而DRE或(和)TRUS异常的男性患者进行了TRUS引导的前列腺系统10针+可疑区穿刺活检.根据血清PSA范围将病例分成0～0.9 ng/ml,1.0～1.9 ng/ml,2.0～2.9 ng/ml和3.0 ～4.0 ng/ml4组.结果 112例病例中有14例被诊断为前列腺癌,检出率为12.5％.4组中:检出前列腺癌病例分别为0、2、5、7例.血清PSA在0～ 1.9 ng/ml和2.0 ～4.0 ng/ml范围:DRE异常患者中前列腺癌检出率分别为5％和21.1％(P＜0.05)；TRUS异常患者中前列腺癌检出率分别为2.4％和28.6％(P＜0.05).在14例前列腺癌患者中有4例仅被TRUS发现,并且这4例PSA值均在2.0～4.0 ng/ml范围内.结论 血清PSA＜2 ng/ml时,除非DRE高度异常,患前列腺癌风险低,不需行前列腺穿刺活检.血清PSA在2.0 ～4.0 ng/ml,应行TRUS检查,以提高前列腺癌检出敏感性.