目的：探讨PSA水平、PSA密度（PSAD）、前列腺体积对B超引导下的前列腺外侧方活检阳性率的影响。方法2005年1月至2010年1月，671例PSA在4~20ng/mL之间的患者接受了B超引导下的前列腺系统穿刺活检（大于或等于10点前列腺穿刺活检）。均资料齐全患者纳入本研究。以系统性6针前列腺穿刺活结果与系统性10针前列腺穿刺活检结果比较。所有入组患者根据PSA水平、PSAD、前列腺体积进行进一步划分。计量资料采用t 检验，计数资料采用McNemar检验和Fisher’s 精确概率法进行统计，采用SPSS19统计学软件包进行统计分析。结果系统10针穿刺和系统6针穿刺总穿刺阳性率分别为22.8%和20.0%。与6针穿刺活检相比较，10针穿刺活检可额外发现19例前列腺癌（19/153，12.4%）（P＜0.05）。PSA水平在4~20ng/mL之间且前列腺体积小于等于40mL时，10针和6针穿刺阳性率分别为28.0%和23.8%，10针穿刺活检可额外发现15例前列腺癌（15/98，15.3%）（P ＜0.05）。PSA水平在4~20ng/mL之间且PSAD大于0.15时，10针和6针穿刺阳性率分别为28.3%和14.5%，10针穿刺活检可额外发现17例前列腺癌（17/129，13.3%）（P ＜0.05）。PSA水平在4~10ng/mL之间时，10针和6针穿刺阳性率分别为19.4%和16.1%，10针穿刺活检可额外发现16例前列腺癌（16/94，17.0%）（P＜0.05）。PSA水平在4~10ng/mL之间且前列腺体积小于等于40mL时，10针和6针穿刺阳性率分别为24.2%和19.2%，10针穿刺活检可额外发现14例前列腺癌（14/68，20.6%）（P＜0.05）。PSA水平在4~10ng/mL之间且PSAD大于0.15时，10针和6针穿刺阳性率分别为24.1%和19.3%，10针穿刺活检可额外发现14例前列腺癌（14/70，20.0%）（P＜0.05）。PSA水平在10~20ng/mL之间时，10针和6针穿刺阳性率分别为31.6%和29.9%，10针穿刺活检可额外发现3例前列腺癌（3/59，5.1%）（P＞0.05）。PSA水平在10~20ng/mL之间且前列腺体积≤40mL时，10针和6针穿刺阳性率分别为41.7%和40.3%，10针穿刺活检可额外发现1例前列腺癌（1/30，3.4%）（P＞0.05）。PSA水平在10~20ng/mL之间且PSAD大于0.15时，10针和6针穿刺阳性率分别为40.0%和34.1%，10针穿刺活检可额外发现3例前列腺癌（3/59，5.1%）（P＞0.05）。结论10针前列腺穿刺活检阳性率明显高于6针穿刺。B超引导下的前列腺外侧方活检可额外发现6针穿刺漏诊的前列腺癌。PSA水平、PSAD、前列腺体积是影响B超引导下前列腺外侧方活检的因素。%Objective To investigate influence factors for efficiency of 10-core and sextant systematic transrectal ultrasound guided (TRUS) prostate biopsy in the diagnosis of prostate cancer. Methods Clinica data of 671 patients who underwent systemic transrectal ultrasound guided (TRUS) prostate biopsy under local anesthesia by using the 10 core scheme between Janary 2005 and Janary 2013 was retrospectively analyzed. The detection rates of prostate cancer using 10-core and sextant biopsy were compared. Group A (10-cores) consisted of 671 men. Group B (6-cores) included the same group of people but only the result of sextant biopsy. Men were stratified according to biopsy protocol and PSA levels. The McNemar and Fisher's exact test were used for statistical analysis. Results The overall prostate cancer detection rates were 22.8% and 20.0% using 10-core and sextant scheme, respectively. An overall 12.4% (19/153) increasing in prostate cancer detection rate was observed in 10-core technique group. When prostate volume was below 40ml and PSA level was between 4ng/ml to 20ng/ml,prostate cancer detection rates were 28.0% and 13.8% using 10-core and sextant scheme, respectively. An overall 15.2% (15/98) increasing in prostate cancer detection rate was observed in 10-core technique group. When PSAD was over 0.15 and PSA level was between 4ng/ml to 20ng/ml,prostate cancer detection rates were 28.3% and 14.5% using 10-core and sextant scheme, respectively. An overall 13.3% (17/128) increasing in prostate cancer detection rate was observed in 10-core technique group. When PSA level was between 4ng/ml to 10ng/ml,the detection rates were 19.4% and 16.1%, extra 16 cases of prostate cancer were detected by 10-core technique. When prostate volume was below 40ml and PSA level was between 4ng/ml to 10ng/ml,prostate cancer detection rates were 24.2% and 19.2% using 10-core and sextant scheme, respectively. An overall 20.6% (14/68) increasing in prostate cancer detection rate was observed in 10-core technique group. When PSAD was over 0.15 and PSA level was between 4ng/ml to 10ng/ml,prostate cancer detection rates were 24.1% and 19.3% using 10-core and sextant scheme, respectively. An overall 20% (14/70) increasing in prostate cancer detection rate was observed in 10-core technique group. When PSA level was between 10ng/ml to 20 ng/ml,prostate cancer detection rates were 31.6% and 29.9% respectively, 3 cases were undetected using 6-core technique but detected using 10-core technique. When prostate volume was below 40ml and PSA level was between 10ng/ml to 20ng/ml,prostate cancer detection rates were 41.7%and 40.3% using 10-core and sextant scheme, respectively. An overall 3.4% (1/30) increasing in prostate cancer detection rate was observed in 10-core technique group. When PSAD was over 0.15 and PSA level was between 10ng/ml to 20ng/ml, prostate cancer detection rates were 40.0% and 34.1% using 10-core and sextant scheme, respectively. An overall 5.1% (3/59) increasing in prostate cancer detection rate was observed in 10-core technique group. Conclusion Cancer detection rate using 10-core scheme was higher than that using sextant biopsy . 10-core scheme showed best efficiency in cancer detection rate. PSA level, PSAD and prostate volume might influence the efficiency of prostate biopsy guided by systematic transrectal ultrasound.
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