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目的 评价血清前列腺特异性膜抗原 (PSA)和各项物理检查对指导前列腺活检的意义。 方法 结合血清PSA、直肠指诊 (DRE)、直肠B超 (TRUS)及磁共振成像 (MRI)检查 ,对 148例可疑前列腺病变患者 ,经直肠B超引导下行前列腺穿刺活检。 结果 前列腺活检阳性率为 43 9%(6 5 / 148)。DRE和PSA对前列腺癌的诊断有意义 (P <0 0 5 ) ,其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE(P <0 0 1) ,但前述三者之间对前列腺癌的诊断差异无显著性 (P =0 46 ,P =0 16 ,P =0 5 2 )。MRI的敏感性高于DRE和TRUS(P =0 0 5 ,P =0 0 1) ,TRUS的特异性高于PSA或MRI(P =0 0 2 ,P =0 0 0 1)。 结论 前列腺活检是诊断前列腺癌的重要手段 ,其初步筛选以DRE加PSA为主 ,同时结合TRUS及MRI,可提高筛选的敏感性和特异性 ,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。
Objective To evaluate the significance of serum prostate-specific membrane antigen (PSA) and various physical tests for guiding prostate biopsy. Methods Combined with serum PSA, digital rectal examination (DRE), rectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) examination, 148 patients with suspected prostate lesions underwent transrectal ultrasonography guided prostate biopsy. Results The positive rate of prostate biopsy was 43 9% (6 5 / 148). DRE and PSA were significant in the diagnosis of prostate cancer (P <0 05). Among them, PSA plus DRE, TRUS and MRI were significantly higher than those of PSA or DRE (P <0 01), but the above three There was no significant difference in the diagnosis of prostate cancer between the two groups (P =0 46, P =0 16 and P =0 52). The sensitivity of MRI was higher than that of DRE and TRUS (P =0 05, P =0 01). The specificity of TRUS was higher than that of PSA or MRI (P =0 02, P =0 01). Conclusions Prostate biopsy is an important means for diagnosing prostate cancer. The primary screening is DRE plus PSA. Combined with TRUS and MRI, the sensitivity and specificity of screening can be improved and unnecessary biopsy can be avoided. DRE or PSA plus TRUS or MRI can increase the positive rate of prostate biopsy in prostate biopsy screening.