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.
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