從接受攝護腺切片病人的攝護腺特異抗原、肛門指診以及經直腸超音波研究前列腺切片之適應性

鄭皓碩

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從接受攝護腺切片病人的攝護腺特異抗原、肛門指診以及經直腸超音波研究前列腺切片之適應性

Evaluation the contribution of PSA, DRE and TRUS in prostate biopsy

鄭皓碩 , Masters　　Advisor：黃俊雄　　

繁體中文

攝護腺特異抗原；肛門指診；經直腸超音波；攝護腺切片； DRE ； PSA ； prostate biopsy ； TRUS

Abstract │ Reference (65) │ Times Cited (2) │ Altmetrics

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Prostate cancer has become the 7th most common malignancy in Taiwan in 2002. In American, regular prostate specific antigen (PSA) and digital rectal examination (DRE) yearly are recommended for prostate cancer screening. Because of different incidence and risks in different population, vary viewpoints to biopsy among the clinician and race. A total of 300 patients over 7-year period had prostate biopsy, whom received DRE, transrectal ultrasound (TRUS), and PSA tests, respectively. We collected our results and compared positive predictive value in PSA, DRE and TRUS separately for preventing unnecessary biopsy and delay in diagnosis. Then we also combined PSA, DRE and TRUS to evaluate the positive predictive value.
The mean age of the biopsy population is 71 years old. The mean PSA level is 9.8ng/ml. Total 263 patients had abnormal PSA level, 137 patients had abnormal DRE and 133 patients had abnormal TRUS findings. Fifty-two patients were diagnosed as prostate cancer in 1st biopsy, 5 patients in 2nd biopsy and 2 patients of prostate cancer were diagnosed after TURP. The distribution of pathologic grade and clinical stage is 44 patients grade ≦6, 5 patients grade 7 and 10 patients≧8; 20 patients T1cN0M0, 30 T2N0M0 and 9 T3N0M0. The positive predictive value in biopsy patients is 12% of PSA between 4~10ng/ml, 45% in PSA> 10ng/ml, 17% of abnormal DRE examinations, and 11% of abnormal TRUS findings. The positive predictive value increased mostly in the combination of abnormal DRE examinations with PSA between 4~10ng/ml. But the positive predictive value did not increase in combination of abnormal DRE or TRUS examinations with PSA >10ng/ml. The miss of prostate cancer occurred least in the combinations of PSA between 4~10ng/ml and abnormal DRE examinations. 
In the population of 2nd biopsy, the clinical distribution of prostate cancer in patients was same as 1st biopsy population. Abnormal PSA levels combined abnormal DRE examinations produce the highest positive predictive value. By doing so, miss of prostate cancer will not occur and the biopsy numbers can be reduced.
The most correlation of clinical symptoms is bone pain. The symptoms occupy larger fraction in prostate cancer than no cancer populations. The cause may be due to easy bone metastasis by prostate caner.

Reference ( 65 ) 〈TOP〉

行政院衛生署統計資料：Department of Health, Executive Yuan, Taiwan, R.O.C. Cancer registry annual report for Taiwan area, 2002.
Shimizu H, Ross RK, Bernstein L, Yatani R, Henderson BE, Mack TM: Cancers of the prostate and breast among Japanese and white immigrants in Los Angeles Country. Br J Cancer 1991; 63: 963-969.
Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, Petros JA, Andriole GL. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991; 324: 1156-1161.
Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessella RL, Lange PH. Screening for prostatic carcinoma with prostate-specific antigen. J Urol 1992; 147: 841-845.
Labrie F, Dupont A, Suburu R, Cusan L, Tremblay M, Gomez JL, Emond J. Serum prostate-specific antigen as a pre-screening test for prostate cancer. J Urol 1992; 147: 846-852.

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