| Objective:To evaluate the clinical application of transrectal ultrasound guided systematic13-Core prostatic biopsy,factors that affect biopsy results were analyzed andcomplications were summarized.Materials and Methods:323patients with suspected prostate cancer from January2010to December2013were enrolled and were examined by TRUS guided13-core Prostate biopsyin Guangzhou First People’s Hospital.The clinical data were collected,includingthe complications of prostate biopsy and age、PSA、TURS、MRI、ECT and soon.The323cases were divided into four groups by less than60years old、60～69years old、70～79years old and Over80years old, them were also dividedinto six groups according to the level of PSA <4ng/ml、4～10ng/ml、10～20ng/ml、20～50ng/ml、50～100ng/ml and>100ng/ml，the positive rates、 positive ratesof total number of needles、Gleason score、clinical stage between different groupsand other clinical data，such as the impact of PSA and its related indicators、TURS、MRI on screening for prostate cancer were recorded.Results:1.The overall positive biopsy rate was50.9%,which stage Ⅲ and Ⅳaccounted for46.4%; 2.Compared with the group of non-PCa, the group of PCa were older andhad higher PSA levels (P<0.05);The biopsy positive rate and the positive ratesof total number of needles were rising increased with age (P<0.05);With elevatedlevels of PSA, biopsy positive rate、the positive rates of total number of needlesand the proportion of high-level PCa were rising (P <0.05);when the level of PSAover100ng/ml, the positive biopsy rate was98.2%(55/56), and the positiverate of total number of needles was87.4%, the ratio of Gleason score>6pointswas87.3%；3.The sensitivity of PSA>4ng/ml、PSA>10ng/ml、PSA>20ng/ml and TRUSon screening PCa are98.8%、84.3%、60.8%、58.4%, while the specificity were7.0%、49.0%、79.6%、70.7%and accuracy were54.2%、67.2%、70.0%、64.4%,respectively；4.MRI screening for prostate cancer with a sensitivity of91.7%and a specificityof26.2%, patients showed PCa in MRI were divided into two groups of confinedto the prostate capsule and breakthrough the prostate capsule,the positive biopsyrate were62.7%(52/83)、100%(48/48)，while the proportions of PCa with Gleasonscore>6points were38.5%(20/52)、89.6%(43/48) respectively,both of them hadsignificant differences (p<0.01), and the positive rates of total number of needleswere84.5%、52.5%(p<0.05);5.When PSA between4～10ng/ml、10～20ng/ml, the volume of prostateand PSAD in the two groups had a statistically significant difference (P<0.05);The AUCs of the PSAD were larger than the AUCs of PSA in each group,when PSA between4～10ng/ml,it ranging from0.651to0.756(P<0.05),when PSA between10～20ng/ml,it ranging from0.594to0.765(P<0.05),PSAD>0.20and PSAD>0.25as standard clinical puncture have higher Youdenindex, respectively;6.In this group,14patients (4.3%) had fever after the puncture,7patients withfever>38.5℃,4cases occurred massive hemorrhage, two cases of rectal bleedingwith shock performance, one case with severe vasovagal reaction, no deaths. Conclusion:1.Age and PSA are risk factors for prostate cancer;2.PSA>4ng/ml as a screening indicator of PCa has high sensitivity and lowspecificity;PSA>10ng/ml as a standard puncture indicator still has high negativebiopsy rate;The sensitivity and specificity of TRUS in the diagnosis of PCa is nothigh，MRI has a high sensitivity in the diagnosis of PCa，but with low specificity;3.When PSA>100ng/ml, MRI shows a advanced PCa,patients have a highrisk of suffering from PCa and high levels of PCa,at the same time it is consideredto reduce the number of biopsy needles for diagnosis;4.When the level of PSA is between4～10ng/ml and10～20ng/ml,PSA-D>0.20、PSAD>0.25as standard clinical puncture for each group can improvethe specificity and accuracy of biopsy. |
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