Preliminary study on the clinical method of prostate biopsy for patients after Miles surgery
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摘要: 目的：探讨体外超声定位下经会阴前列腺穿刺在Miles术后患者的临床应用价值。方法：收集2014年8月~2018年8月我院Miles术后怀疑前列腺癌患者14例。年龄62~82岁，平均（72.6±6.0）岁；PSA 7.8~32.6μg/L，平均（16.8±8.6）μg/L。入组条件：低位直肠癌Miles术后，PSA>10μg/L，PSA 4~10μg/L但游离PSA（fPSA）/总PSA（tPSA）可疑或前列腺特异性抗原密度（PSAD）值可疑者，影像学检查（腹部超声、CT、MRI）提示异常者。结果：本组行前列腺穿刺12~29针，平均（14.8±2.6）针，穿刺阳性率为35.7%（5/14），Gleason评分5~9分，平均（7.0±1.6）分。此外，另有1例前列腺占位穿刺病理提示直肠癌转移。穿刺阳性者前列腺体积30~48 ml，平均（38.6±4.6）ml；穿刺阴性者前列腺体积50~78 ml，平均（63.8±7.6） ml；两组前列腺体积比较差异有统计学意义（P<0.05）。穿刺阳性率与患者年龄、穿刺针数、PSA值无相关性（P>0.05）。穿刺后1周血尿发生率为42.9%（6/14），尿潴留发生率为14.3%（2/14），血精及会阴血肿发生率为0（0/14），并且无严重感染并发症发生。结论：针对Miles术后患者行体外超声定位经会阴前列腺穿刺方法临床应用是安全且有效的，但仍需大样本验证。Abstract: Objective: To explore the clinical application value of extracorporeal ultrasonography for transperineal prostate biopsy in patients after Miles surgery. Method: Fourteen cases of suspected prostate cancer after Miles surgery at our hospital from August 2014 to August 2018 were collected. Their age ranged from 62 to 82 years old, with an average age of(72.6±6.0) years old. Their PSA value was 7.8-32.6 μg/L, averaging(16.8±8.6) μg/L. Inclusion criteria were Miles surgery due to lower rectal cancer, PSA>10 μg/L, PSA 4-10 μg/L but fPSA/tPSA or PSAD suspected, abnormal imaging examinations such as abdomen ultrasound, CT and MRI. Result: In this group 12-29 needles were performed, with an average of(14.8±2.6) needles, and the positive rate of biopsy was 5/14. The mean Gleason score was 7(range, 5-9). In addition, another case of prostate biopsy showed metastasis of rectal cancer. Mean prostate volume in the positive and negative biopsy groups were(38.6±4.6) ml and(63.8±7.6) ml. And there is statistically significant difference between the two groups(P<0.05). There was no correlation between the rate of positive biopsy and patients' age, number of biopsy needles or PSA value(P>0.05). The incidence of hematuria was 42.9%(6/14), urinary retention was 14.3%(2/14), hematospermia and perineal hematoma was 0(0/14), and there were not serious infectious complications.Conclusion: The clinical application of this method is safe and effective, but it still needs to be verified by large samples.
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Key words:
- prostate biopsy /
- prostate cancer /
- lower rectal cancer /
- Miles surgery
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