苏州地区经直肠超声引导下前列腺重复穿刺活检资料研究与分析
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摘要
目的评价和研究经直肠超声引导下前列腺重复穿刺活检在苏州地区临床应用的现状和价值。
方法回顾性分析2009年1月~2012年12月，苏州地区三家大型综合性三级医院（苏大附一院、苏大附二院、上海交通大学医学院附属苏州九龙医院），因前列腺特异性抗原（prostate-specific antigen，PSA）、直肠指检（digital rectal examination，DRE）和经直肠超声检查（transrectal ultrasound，TRUS）三者至少一项异常，怀疑前列腺癌（prostate cancer，PCa）行经直肠超声引导下前列腺穿刺活检939例。剔除部分资料不完整病例，分为3组：1组：（初次穿刺组）病例779例（年龄45~91岁，平均69.4岁）；2组：（重复穿刺组）病例30例（年龄54~90岁，平均67岁）；3组（初次穿刺病理阴性即刻行经尿道前列腺电切术（transurethral resection of theprostate，TURP）或经尿道前列腺汽化电切术（transurethral electrovaprization resectionof thr prostate，TUVP）手术（简称即刻TUR）病例151例（年龄53~87岁，平均69.6岁）。分别计算并比较1、2、3组的PCa阳性检出率，2组的重复穿刺率，3组的即刻TUR手术率（3组占1组的比例）。计算并比较1组内不同PSA区间亚组PCa阳性检出率、不同病理诊断亚组PSA水平变化。计算1组PSA与PCa阳性检出率间的受试者工作特征曲线（receiver operating characteristic curve，ROC曲线），并计算曲线下面积（area under the curve，AUC）、PSA最佳诊断界值。
结果：1、1组779例，PCa阳性检出率28.4%（221/779）；2组30例，PCa阳性检出率40%（12/30），重复穿刺率5.38%（30/558）；3组151例，PCa阳性检出率0.66%(1/151)，即刻TUR手术率27.1%(151/558)。
2、2组重复穿刺率明显低于3组即刻TUR手术率，三个组的PCa阳性检出率相比，2组最高，3组最低。
3、1组不同PSA亚组间PCa阳性检出率总体随PSA上升呈正相关，PSA>20ng/ml后，PCa阳性检出率明显上升。1组不同病理诊断亚组间比较，PCa组PSA水平显著高于其他各亚组。
4、计算得1组ROC曲线下面积AUC为0.767，PSA最佳诊断界值为22.785ng/ml。
结论1、苏州地区目前前列腺重复穿刺活检率偏低，而重复穿刺活检阳性检出率偏高，并且初次穿刺病理结果阴性后即刻TUR比例过高。因此，有必要进一步重视和加强前列腺重复穿刺活检工作，以提高总体PCa检出率，减少漏诊率。
2、对于PSA>22.785ng/ml的患者，若初次穿刺活检阴性，不建议即刻行TUR术，而应按照指南要求行重复穿刺活检。
3、对于PSA位于4~22.785ng/ml区间的患者，若初次穿刺活检阴性，建议可先针对良性前列腺增生症（benign prostate hyperplasia，BPH）和（或）慢性前列腺炎（chronic prostatitis，CP）等疾病用5α还原酶抑制剂（5α-reductase inhibitors，5ARIs）等药物治疗，然后根据指南要求决定是否行重复穿刺活检。
OBJECTIVE
To evaluate and investigate the clinical data and value of the transrectal ultrasoundguided repeat needle biopsy of the prostate in Suzhou area.
METHODS
From Jan2009to Dec2012,939patients underwent prostate biopsy at three largegeneral hospitals in Suzhou area (the First Affiliated Hospital of Soochow University, theSecond Affiliated Hospital of Soochow University and the Suzhou Kowoon HospitalShanghai Jiaotong University, Medical School) were investigated. All biopsies wereperformed according to the Chinese guideline: at least one of these three abnormal factorsof PSA, DRE, and TURS. After removed some disqualification cases, the data was dividedinto3groups. Group1: initial biopsy,779patients, age from45to91years old, averageage was69.4years old. Group2: repeat biopsy,30patients, age from54to90years old,average age was67years old. Group3: with immediately TUR after the initial negativebiopsy,151patients, age between53to87years old, average age was69.6years old.
We analyzed the data of PCa positive rate among the3groups, and analyzed the rateof the repeat prostate biopsy of the group2and the rate of immediately TUR after theinitial negative biopsy of the group3. Compare them with each other. We divided thegroup1into5subgroups according to the different PSA levels and divided group1intoanother5subgroups according to the different pathological results. Then analyzed the PCapositive rates and the PSA levels of the subgroups.
We calculated the ROC curve of the PSA levels and the PCa positive rate in the group1. Then obtained the AUC and the best diagnosis inflection point of PSA of the group1.
RESULTS
1. In group1, the PCa positive rate was28.4%(221/779). In group2, the PCa positiverate was40%(12/30), and the repeat biopsy rate was5.38%(30/558). In group3, the PCapositive rate was0.66%(1/151), and the rate of immediately TUR after initial negativebiopsy was27.1%(151/558).
2. The repeat biopsy cases were rather lower compare to the initial biopay cases and atthe same time, the immediately TUR rate was significantly higher than that of the repeatbiopsy rate. Among the3groups, the positive rate of the group2was the highest, the oneof the group3was the lowest.
3. In subgroups of different PSA levels, the PCa positive rate rose with the rising ofthe PSA of all. In cases which PSA above20ng/ml, PCa positive rate was significantlyhigher than those of below20ng/ml. In subgroups of different pathological results, the PSAof the PCa subgroup was significantly high.
4. AUC in group1was0.767, so that we calculated the best diagnosis inflection pointof PSA was22.785ng/ml.
CONCLUSIONS
1. The repeat prostate biopsy rate in Suzhou area was quiet low, but the PCa positiverate of the repeat biopsy was relative high, at the same time the rate of mediately TURafter initial negative biopsy was too high, which indicated that it is necessary to pay moreattention to the work of the repeat prostate biopsy. We should do more repeat prostatebiopsy according to the guideline to rise the positive rate of PCa.
2. In negative results patients who received immediately TUR, whenPSA>22.785ng/ml, immediately TUR perhaps is not a good choice, repeat biopsy shouldbe seriously considered according to the guideline.
3.In negative results patients which PSA between4~22.785ng/ml, treat CP withproper medicine and/or use5ARIs to treat the BPH is highly recommended after the initialnegative biopsy for3to6months, then decide weather or not to do the repeat prostatebiopsy according to the guideline.
方法回顾性分析2009年1月~2012年12月，苏州地区三家大型综合性三级医院（苏大附一院、苏大附二院、上海交通大学医学院附属苏州九龙医院），因前列腺特异性抗原（prostate-specific antigen，PSA）、直肠指检（digital rectal examination，DRE）和经直肠超声检查（transrectal ultrasound，TRUS）三者至少一项异常，怀疑前列腺癌（prostate cancer，PCa）行经直肠超声引导下前列腺穿刺活检939例。剔除部分资料不完整病例，分为3组：1组：（初次穿刺组）病例779例（年龄45~91岁，平均69.4岁）；2组：（重复穿刺组）病例30例（年龄54~90岁，平均67岁）；3组（初次穿刺病理阴性即刻行经尿道前列腺电切术（transurethral resection of theprostate，TURP）或经尿道前列腺汽化电切术（transurethral electrovaprization resectionof thr prostate，TUVP）手术（简称即刻TUR）病例151例（年龄53~87岁，平均69.6岁）。分别计算并比较1、2、3组的PCa阳性检出率，2组的重复穿刺率，3组的即刻TUR手术率（3组占1组的比例）。计算并比较1组内不同PSA区间亚组PCa阳性检出率、不同病理诊断亚组PSA水平变化。计算1组PSA与PCa阳性检出率间的受试者工作特征曲线（receiver operating characteristic curve，ROC曲线），并计算曲线下面积（area under the curve，AUC）、PSA最佳诊断界值。
结果：1、1组779例，PCa阳性检出率28.4%（221/779）；2组30例，PCa阳性检出率40%（12/30），重复穿刺率5.38%（30/558）；3组151例，PCa阳性检出率0.66%(1/151)，即刻TUR手术率27.1%(151/558)。
2、2组重复穿刺率明显低于3组即刻TUR手术率，三个组的PCa阳性检出率相比，2组最高，3组最低。
3、1组不同PSA亚组间PCa阳性检出率总体随PSA上升呈正相关，PSA>20ng/ml后，PCa阳性检出率明显上升。1组不同病理诊断亚组间比较，PCa组PSA水平显著高于其他各亚组。
4、计算得1组ROC曲线下面积AUC为0.767，PSA最佳诊断界值为22.785ng/ml。
结论1、苏州地区目前前列腺重复穿刺活检率偏低，而重复穿刺活检阳性检出率偏高，并且初次穿刺病理结果阴性后即刻TUR比例过高。因此，有必要进一步重视和加强前列腺重复穿刺活检工作，以提高总体PCa检出率，减少漏诊率。
2、对于PSA>22.785ng/ml的患者，若初次穿刺活检阴性，不建议即刻行TUR术，而应按照指南要求行重复穿刺活检。
3、对于PSA位于4~22.785ng/ml区间的患者，若初次穿刺活检阴性，建议可先针对良性前列腺增生症（benign prostate hyperplasia，BPH）和（或）慢性前列腺炎（chronic prostatitis，CP）等疾病用5α还原酶抑制剂（5α-reductase inhibitors，5ARIs）等药物治疗，然后根据指南要求决定是否行重复穿刺活检。
OBJECTIVE
To evaluate and investigate the clinical data and value of the transrectal ultrasoundguided repeat needle biopsy of the prostate in Suzhou area.
METHODS
From Jan2009to Dec2012,939patients underwent prostate biopsy at three largegeneral hospitals in Suzhou area (the First Affiliated Hospital of Soochow University, theSecond Affiliated Hospital of Soochow University and the Suzhou Kowoon HospitalShanghai Jiaotong University, Medical School) were investigated. All biopsies wereperformed according to the Chinese guideline: at least one of these three abnormal factorsof PSA, DRE, and TURS. After removed some disqualification cases, the data was dividedinto3groups. Group1: initial biopsy,779patients, age from45to91years old, averageage was69.4years old. Group2: repeat biopsy,30patients, age from54to90years old,average age was67years old. Group3: with immediately TUR after the initial negativebiopsy,151patients, age between53to87years old, average age was69.6years old.
We analyzed the data of PCa positive rate among the3groups, and analyzed the rateof the repeat prostate biopsy of the group2and the rate of immediately TUR after theinitial negative biopsy of the group3. Compare them with each other. We divided thegroup1into5subgroups according to the different PSA levels and divided group1intoanother5subgroups according to the different pathological results. Then analyzed the PCapositive rates and the PSA levels of the subgroups.
We calculated the ROC curve of the PSA levels and the PCa positive rate in the group1. Then obtained the AUC and the best diagnosis inflection point of PSA of the group1.
RESULTS
1. In group1, the PCa positive rate was28.4%(221/779). In group2, the PCa positiverate was40%(12/30), and the repeat biopsy rate was5.38%(30/558). In group3, the PCapositive rate was0.66%(1/151), and the rate of immediately TUR after initial negativebiopsy was27.1%(151/558).
2. The repeat biopsy cases were rather lower compare to the initial biopay cases and atthe same time, the immediately TUR rate was significantly higher than that of the repeatbiopsy rate. Among the3groups, the positive rate of the group2was the highest, the oneof the group3was the lowest.
3. In subgroups of different PSA levels, the PCa positive rate rose with the rising ofthe PSA of all. In cases which PSA above20ng/ml, PCa positive rate was significantlyhigher than those of below20ng/ml. In subgroups of different pathological results, the PSAof the PCa subgroup was significantly high.
4. AUC in group1was0.767, so that we calculated the best diagnosis inflection pointof PSA was22.785ng/ml.
CONCLUSIONS
1. The repeat prostate biopsy rate in Suzhou area was quiet low, but the PCa positiverate of the repeat biopsy was relative high, at the same time the rate of mediately TURafter initial negative biopsy was too high, which indicated that it is necessary to pay moreattention to the work of the repeat prostate biopsy. We should do more repeat prostatebiopsy according to the guideline to rise the positive rate of PCa.
2. In negative results patients who received immediately TUR, whenPSA>22.785ng/ml, immediately TUR perhaps is not a good choice, repeat biopsy shouldbe seriously considered according to the guideline.
3.In negative results patients which PSA between4~22.785ng/ml, treat CP withproper medicine and/or use5ARIs to treat the BPH is highly recommended after the initialnegative biopsy for3to6months, then decide weather or not to do the repeat prostatebiopsy according to the guideline.
引文
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11Eskicorapci SY, Guliyev F, Akdogan B, et al. Individualization of the biopsy protocolaccording to the prostate gland volume for prostate cancer detection. J Urol,2005,173(5):1536-1540.
12山刚志，金杰，郭应禄.不同前列腺穿刺活检方案检出PCa的比较.中华泌尿外科杂志,2006,27(1):40-42.
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1Crawford ED. Epidemiology of prostate cancer.[J]. Urology,2003,62(6Suppl1):3-12.
2Quinn M, Badd P. Patterns and trends in prostate cancer incidence, survival, revalence,an mortality. Part I: international comparisons [J]. BJU Int,2002,90:162-173.
3Crawford ED. Epidemiology of prostste cancer. Urology,2003,62(6Suppl1):3-12
4吴阶平.吴阶平泌尿外科学.第1版，山东科学技术出版社，2004，1059-1091.
5Geenle RT,Hill-Harmon MB,Muray T,Thur M,Cancer statistics,2001,51:15.
6Z. W. Liu, Y. B. Xiang, W. Zhang, C. X. Shao, W. Ding, et al, Cancer prevalence inshanghai after2000, Cancer23(2003)532-534.
7D. W. Ye, Epidemiology of PCa and prevalence tendency in China, Chin. J. Surg.44(2006)362-364.
8Astraldi A. Diagnosis of cancer of the prostate: biopsy by rectal route. Uorl Cutan Rev,1937,41:421-427.
9Watanabe H, Kato H, Kato T, et al. Diagnostic application of the ultrasonotomographyfor the prostate [J]. J Urol,1968,5(4):273-279.
10Ragde H, Aldape HC, Bagley CM Jr. Ultrasound-guided prostate biopsy: Biopsy gunsuperior to aspiration [J]. Urology,1988,32(6):503-506.
11Hodge KK, McNeal JE, Stamey TA. Ultrasound guided transrectal core biopsies of thepalpably abnormal prostate [J]. J Urol,1989,142(1):66-70.
12Walz J, Graefen M, Chun FK, et al. High incidence of prostate cancer detected bysaturation biopsy after previous negative biopsy series [J]. Eur Urol2006,50(3):498-505.
13Hodge KK, Mcneal JE, Terris MK, et al. Random systematic versus directedultrasound guided transrectal core biopsies of the prostate. J Urol,1989,142(1):71-74.
14Ornstein DK, Kang J. How to improve prostate biopsy detection of prostate cancer.Curr Urol Rep,2001,2(3):218-223.
15Eskicorapci SY, Guliyev F, Akdogan B, et al. Individualization of the biopsy protocolaccording to the prostate gland volume for prostate cancer detection. J Urol,2005,173(5):1536-1540.
16山刚志，金杰，郭应禄.不同前列腺穿刺活检方案检出PCa的比较.中华泌尿外科杂志,2006,27(1):40-42.
17Babaian RJ, Toi A, Kamoi K, et al. A comparative analysis of sextant and an extended11-core multisite directed biopsy strategy. J Urol,2000,163(1):152-157.
18Damiano R, Oliva A, Cantiello F, et al. Questionnaire based evaluation of prostatebiopsy complication comparing different bioptic schemes. J Urol,2003,75(1):40-45.
19Taille A, Antipgon P, Salomon L, et al. Prospective evaluation of a21-sample needlebiopsy procedure designed to improve the prostate cancer diction rate. J Urol,2003,61(6):1181-1186.
20Pepe P, Aragona F. Saturation prostate needle biopsy and prostate cancer detection atinitial and repeat evaluation. J Urol,2007,70(6):1131-1135.
21Simardi LH, Tobias-Machado M, Kappaz GT, et al. Influence of asymptomatichistologic prostatitis on serum prostate-specific antigen: A prospective study. Urology,2004,64(6):1098-1101.
22Kandirali E, Boran C, SERIN e, et al. Association of extent and aggressiveness ofinflammation with serum PSA level and PSA density in asymptomatic patients.Urology,2007,70(40:743-747.
23Schaeffer AJ, Wu SC, Tenenberg AM, et al. Treatment of chronic bacterial prostatitiswith levofloxacin an ciprofloxacin lowers serum prostate specific antigen. J Urol,2005,174(1):161-164.
24Ugurlu O, Yaris M, Oztekin CV, et al. Impacts of antibiotic and anti-inflammatorytherapies on serum prostate-specific antigen levels in the presence of prostaticinflammation: A prospective randomized controlled trial. Urol Int,2010,84(2):185-190.
25Serretta V, Catanese A, Daricelo G, et al. PSA reduction (after antibiotics) permitis toavoid or postpone prostate biopsy in selected patients. Prostate Cancer Prostatic Dis,2008,11(2):148-152.
26Dirim A, Tekin MI, Koyluoglu E, et al. Do changes in a hgh serum prostate-specificantigen level and the free/total prostate-specific antigen ratio after antibiotic treatmentrule out biopsy and the suspicion of cancer? Urol Int,2009,82(3):266-269.
27Shtricker A, Shefi S, Ringle A, et al. PSA levels of4.0-10ng/ml and negative digitalrectal examination. Antibiotic therapy versus immediate prostate biopsy. Int Braz JUrol,2009,35(5):551-558.
28Stopiglia RM, Ferreira U, Silva MM Jr, et al. Prostate specific antigen decrease andprostate cancer diagnosis: Antibiotic versus placebo prosective randomized clinicaltrial. J Urol,2010,183(3):940-944.
29贺大林，张林琳.PCa的诊断和治疗[J].临床外科杂志,2008,16(2):91-93.
30Applewhite JC, Matlaga BR, McCullough DL. Results of the5region prostate biopsymethod: the repeat biopsy population [J]. J Urol,2002,168(2):500-503.
31Campos-fernandes J L, Bastien L, Nicolaiew N, et al. Prostate cancer detection rate inpatients with repeated extended21-sample needle biopsy.[J]. Eur Urol,2009,55(3):600-606.
32Djavan B, Ravery V, Zlotta a, et al. Prospective evaluation of prostate cancer detectedon biopsies1,2,3and4: when should we stop? J Urol,2001,166(5):1679-1683.
33Epstein J I, Herawim M. Prostate needle biopsies containing prostatic intraepithelialneoplasia or atypical foci suspicious for carcinoma: implications for patirnt care.[J]. JUrol,2006,175(3Pt1):820-834.
34Naya Y, Ayala AG, Tamboli P，et al. Can the number of cores with high-grade prostateintraepithelial neoplasia predict cancer in men who undergo repeat biopsy? Urology.
2004Mar;63(3):503-8.
35Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part I:screening, diagnosis, and treatment of clinically localisde disease.[J]. Eur Urol,2011,59(1):61-71.
36Koca O, Caliskan S, Ozturk M I. Significance of atypical small ainar proliferation andhigh-grade prostatic intraepithelial neoplasia in prostate biopsy.[J], Korean J Urol,2011,52(11):736-740.
37Campodonico F, Casarico A, G avazzi L, et al. Cancer detection with TRUS-guided10-core biopsy of the prostate. An institutional assessment at the first, repeated andsurgical specimen biopsy [J]. Arch I tal Urol Androl,2006,78(2):39-43.
38Vincenzo Scattoni, et al. The Optimal Rebiopsy Protatic Scheme Depends on PatientClinicl Characteristics: Results of a Recursive Partitioning Analysis Based on a24-Core Systematic Scheme. European Urology60(2011)834-841.
39许宁，等.超声引导下经直肠前列腺饱和穿刺在首次活检阴性人群中的价值.中国介入影像与治疗学，2012，9（9）：648-651.
40Bott S R, Young M P, Kellett M J, et al. Anterior prostate cancer: is it more difficult todiagnose?[J]. BJU Int,2002,89(9):886-889.
41Marberger M et al. BJU intl.2001doi:10.1111/j.1464-410X.2011.x.
42Antonio Finelli et al. Impact of5α-Reductase Inhibitors on Men Followed by AcetiveSurveillance for Prostate Cancer. European Urology59(2011)509-514.
43Pim J. van Leeuwen, et al. Prostate Cancer Detection and Dutasteride: Utility andLimitations of Prostate-Specific Antigen in Men with Previous Negative Biopsies.European Urology59(2011)183-190.
44Ian M. Thompson, et al. Protate Cancer Detection: A View of the Future. EuropeanUrology,59(2011)191-193.
45Ian M. Thompson, et al. Journal of the National Cancer Institue.2006;98:1128-33.
46Steven A. Kaplan, et al. Prostate Biopsy in Response to a Change in Nadir ProststeSpeccific Antigen of0.4ng/ml after Treatment with5α-Reductase Inhibitors MarkedleEnhances the Detection Rate of Prostate Cancer. Journal of Urology.2012;188:757-761.
47A Gupta, MJ Roobol, CJ Savage, et al. A four-kallikrein panel for the prediction ofrepeat prostate biopsy: data from the European Randomized Study of Prostate CancerScreening in Rotterdam, Netherlands. British Jouranl of Cancer,(2010)103,708-714.
48李秋洋，等.建立预测中国人前列腺重复穿刺活检阳性的数学模型.中华男科学杂志,2012，18（4）：302-305.
49Rochester MA, Pashayan N, Matthwes F, et al, Development and validation of riskscore for predicting positive repeat prostate biopsy in patients with a previous negativebiopsy in a UK population. BMC Urol,2009,9:7.
50Aubin S M, Reid J, Sarno M J, et al. PCA3molecular urine test for predicting repeatprostate biopsy outcome in populations at risk: validation in the placebo arm of thedutasteride REDUCE trial [J], J Urol,2010,184(5):1947-1952.
51Kirby R, Fitzpatrick J M. optimising repeat prostate biopsy decisions and procedures.[J], BJU Int,2012,109(12):1750-1754.
52Barbera M, Pepe P, Paola Q, et al. PCA3score accuracy in diagnosing prostate cancerat repeat biopsy: our experience in177patients. Arch Ital Urol Androl.2012Dec;84(4):227-9.
2Quinn M, Badd P. Patterns and trends in prostate cancer incidence, survival, revalence,an mortality. Part I: international comparisons [J]. BJU Int,2002,90:162-173.
3Crawford ED. Epidemiology of prostste cancer. Urology,2003,62(6Suppl1):3-12.
4吴阶平.吴阶平泌尿外科学.第1版，山东科学技术出版社，2004，1059-1091.
5Geenle RT,Hill-Harmon MB,Muray T,Thur M,Cancer statistics,2001,51:15.
6Z. W. Liu, Y. B. Xiang, W. Zhang, C. X. Shao, W. Ding, et al, Cancer prevalence inshanghai after2000, Cancer23(2003)532-534.
7D. W. Ye, Epidemiology of PCa and prevalence tendency in China, Chin. J. Surg.44(2006)362-364.
8吴阶平主编.泌尿外科学.山东科学技术出版社,2005年4月第一版,P1076-1078.
9Hodge KK, McNeal JE, Stamey TA. Ultrasound guided transrectal core biopsies of thepalpably abnormal prostate [J]. J Urol,1989,142(1):66-70.
10Ornstein DK, Kang J. How to improve prostate biopsy detection of prostate cancer.Curr Urol Rep,2001,2(3):218-223.
11Eskicorapci SY, Guliyev F, Akdogan B, et al. Individualization of the biopsy protocolaccording to the prostate gland volume for prostate cancer detection. J Urol,2005,173(5):1536-1540.
12山刚志，金杰，郭应禄.不同前列腺穿刺活检方案检出PCa的比较.中华泌尿外科杂志,2006,27(1):40-42.
13Babaian RJ, Toi A, Kamoi K, et al. A comparative analysis of sextant and an extended11-core multisite directed biopsy strategy. J Urol,2000,163(1):152-157.
14Damiano R, Oliva A, Cantiello F, et al. Questionnaire based evaluation of prostatebiopsy complication comparing different bioptic schemes. J Urol,2003,75(1):40-45.
15Taille A, Antipgon P, Salomon L, et al. Prospective evaluation of a21-sample needlebiopsy procedure designed to improve the prostate cancer diction rate. J Urol,2003,61(6):1181-1186.
16Pepe P, Aragona F. Saturation prostate needle biopsy and prostate cancer detection atinitial and repeat evaluation. J Urol,2007,70(6):1131-1135.Babaian RJ, Toi a, kamoi K,te al. A comparative analysis of sextant and an extended11-cores multisite directedbiopsy strategy. J Urol,2000,163(1):152-157.
17Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part I:screening, diagnosis, and treatment of clinically localisde disease.[J]. Eur Urol,2011,59(1):61-71.
18Koca O, Caliskan S, Ozturk M I. Significance of atypical small ainar proliferation andhigh-grade prostatic intraepithelial neoplasia in prostate biopsy.[J], Korean J Urol,2011,52(11):736-740.
19那彦群，叶章群，孙光.2011版中国泌尿外科疾病诊断治疗指南，人民卫生出版社，2011：51.
20Campos-Fernandes J L, Bastien L, Nicolaiew N, et al. Prostate cancer detection rate inpatients with repeated extended21-sample needle biopsy.[J]. Eur Urol,2009,55(3):600-606.
21Ploussard G, Nicolaiew N, Marchand C, Risk of repeat biopsy and prostate cancerdetection after an initial extended negative biopsy: longitudinal follow-up from aprospective trial. BJU Int.2013Mar4.
22Djavan B, Ravery V, Zlotta a, et al. Prospective evaluation of prostate cancer detectedon biopsies1,2,3and4: when should we stop? J Urol,2001,166(5):1679-1683.
23Naya Y, Ayala AG, Tamboli P，et al. Can the number of cores with high-grade prostateintraepithelial neoplasia predict cancer in men who undergo repeat biopsy? Urology.
2004Mar;63(3):503-8.
24Epstein J I, Hirawi M. Prostate needle biopsies containing prosthetic intraepithelialneoplasia or atypical foci suspicious for carcinoma: implications for patient care [J]. JUrol,2006,175(3Pt1):820-834.
25Campodonico F, Casarico A, G avazzi L, et al. Cancer detection with TRUS-guided10-core biopsy of the prostate. An institutional assessment at the first, repeated andsurgical specimen biopsy [J]. Arch I tal Urol Androl,2006,78(2):39-43.
26Vincenzo Scattoni, et al. The Optimal Rebiopsy Protatic Scheme Depends on PatientClinicl Characteristics: Results of a Recursive Partitioning Analysis Based on a24-Core Systematic Scheme. European Urology60(2011)834-841.
27许宁，等.超声引导下经直肠前列腺饱和穿刺在首次活检阴性人群中的价值.中国介入影像与治疗学，2012，9（9）：648-651.
28Stewart CS, Leibovich BC, Weaver AL, et al. Prostate cancer diagnosis using asaturation needle biopsy technique after previous negative sextant biopsies. J Urol,2001,166(1):86-91.
29Bott S R, Young M P, Kellett M J, et al. Anterior prostate cancer: is it more difficult todiagnose?[J]. BJU Int,2002,89(9):886-889.
30Barbera M, Pepe P, Paola Q, et al. PCA3score accuracy in diagnosing prostate cancerat repeat biopsy: our experience in177patients. Arch Ital Urol Androl.2012Dec;84(4):227-9.
31Aubin S M, Reid J, Sarno M J, et al. PCA3molecular urine test for predicting repeatprostate biopsy outcome in populations at risk: validation in the placebo arm of thedutasteride REDUCE trial [J], J Urol,2010,184(5):1947-1952.
32Kirby R, Fitzpatrick J M. optimising repeat prostate biopsy decisions and procedures.[J], BJU Int,2012,109(12):1750-1754.
33Hodge KK, McNeal JE, Stamey TA. Ultrasound guided transrectal core biopsies of thepalpably abnormal prostate [J]. J Urol,1989,142(1):66-70.
34Roobol MJ, Kranse R, de Koning HJ, et al. Prostate-specific antigen velocity at lowprostate-specific antigen levels as screening tool for prostate cancer: results of secondscreening round of ERSPC(ROTTERDAM). Uroligy,2004,63:309-313.
35Kobayashi T, Nishizawa K, Ogura K, et al. Detection of prostate cancer in men withprostate-specific antigen levels of2.0to4.0ng/ml equivalent to that in men with4.1to10.0ng/ml in a Japanese population. Urology,2004,63:727-731.
36Yu HJ, Chie WC, Hsieh CH, et al. Clinical efficacy of prostate specific antigen testingin patients with prostatic disease. J Formos Med Assoc,1996,95:782-788.
37Simardi LH, Tobias-Machado M, Kappaz GT, et al. Influence of asymptomatichistologic prostatitis on serum prostate-specific antigen: A prospective study. Urology,2004,64(6):1098-1101.
38Kandirali E, Boran C, SERIN e, et al. Association of extent and aggressiveness ofinflammation with serum PSA level and PSA density in asymptomatic patients.Urology,2007,70(40:743-747.
39Irani J, Levillain P, Geujon JM, et al. Inflammation in benign prostatic hyperplasia;correlation with prostate specific antigen value. J Urol,1997;157(4):1301-1303.
40Schaeffer AJ, Wu SC, Tenenberg AM, et al. Treatment of chronic bacterial prostatitiswith levofloxacin an ciprofloxacin lowers serum prostate specific antigen. J Urol,2005,174(1):161-164.
41Ugurlu O, Yaris M, Oztekin CV, et al. Impacts of antibiotic and anti-inflammatorytherapies on serum prostate-specific antigen levels in the presence of prostaticinflammation: A prospective randomized controlled trial. Urol Int,2010,84(2):185-190.
42Serretta V, Catanese A, Daricelo G, et al. PSA reduction (after antibiotics) permitis toavoid or postpone prostate biopsy in selected patients. Prostate Cancer Prostatic Dis,2008,11(2):148-152.
43Dirim A, Tekin MI, Koyluoglu E, et al. Do changes in a hgh serum prostate-specificantigen level and the free/total prostate-specific antigen ratio after antibiotic treatmentrule out biopsy and the suspicion of cancer? Urol Int,2009,82(3):266-269.
44Hochberg D A, Armenakas N A, Fracchia J A, Relationshp of prostate specific antigenpeostate volume in patients with biopsy proven benign peostatic hyperplasia [J].Prostate,2000,45(4):315-319.
45Marberger M et al. BJU intl.2001doi:10.1111/j.1464-410X.2011.x.
46Antonio Finelli et al. Impact of5α-Reductase Inhibitors on Men Followed by AcetiveSurveillance for Prostate Cancer. European Urology59(2011)509-514.
47Pim J. van Leeuwen, et al. Prostate Cancer Detection and Dutasteride: Utility andLimitations of Prostate-Specific Antigen in Men with Previous Negative Biopsies.European Urology59(2011)183-190.
48Ian M. Thompson, et al. Protate Cancer Detection: A View of the Future. EuropeanUrology,59(2011)191-193.
49Ian M. Thompson, et al. Journal of the National Cancer Institue.2006;98:1128-33.
50Steven A. Kaplan, et al. Prostate Biopsy in Response to a Change in Nadir ProststeSpeccific Antigen of0.4ng/ml after Treatment with5α-Reductase Inhibitors MarkedleEnhances the Detection Rate of Prostate Cancer. Journal of Urology.2012;188:757-761.
1Crawford ED. Epidemiology of prostate cancer.[J]. Urology,2003,62(6Suppl1):3-12.
2Quinn M, Badd P. Patterns and trends in prostate cancer incidence, survival, revalence,an mortality. Part I: international comparisons [J]. BJU Int,2002,90:162-173.
3Crawford ED. Epidemiology of prostste cancer. Urology,2003,62(6Suppl1):3-12
4吴阶平.吴阶平泌尿外科学.第1版，山东科学技术出版社，2004，1059-1091.
5Geenle RT,Hill-Harmon MB,Muray T,Thur M,Cancer statistics,2001,51:15.
6Z. W. Liu, Y. B. Xiang, W. Zhang, C. X. Shao, W. Ding, et al, Cancer prevalence inshanghai after2000, Cancer23(2003)532-534.
7D. W. Ye, Epidemiology of PCa and prevalence tendency in China, Chin. J. Surg.44(2006)362-364.
8Astraldi A. Diagnosis of cancer of the prostate: biopsy by rectal route. Uorl Cutan Rev,1937,41:421-427.
9Watanabe H, Kato H, Kato T, et al. Diagnostic application of the ultrasonotomographyfor the prostate [J]. J Urol,1968,5(4):273-279.
10Ragde H, Aldape HC, Bagley CM Jr. Ultrasound-guided prostate biopsy: Biopsy gunsuperior to aspiration [J]. Urology,1988,32(6):503-506.
11Hodge KK, McNeal JE, Stamey TA. Ultrasound guided transrectal core biopsies of thepalpably abnormal prostate [J]. J Urol,1989,142(1):66-70.
12Walz J, Graefen M, Chun FK, et al. High incidence of prostate cancer detected bysaturation biopsy after previous negative biopsy series [J]. Eur Urol2006,50(3):498-505.
13Hodge KK, Mcneal JE, Terris MK, et al. Random systematic versus directedultrasound guided transrectal core biopsies of the prostate. J Urol,1989,142(1):71-74.
14Ornstein DK, Kang J. How to improve prostate biopsy detection of prostate cancer.Curr Urol Rep,2001,2(3):218-223.
15Eskicorapci SY, Guliyev F, Akdogan B, et al. Individualization of the biopsy protocolaccording to the prostate gland volume for prostate cancer detection. J Urol,2005,173(5):1536-1540.
16山刚志，金杰，郭应禄.不同前列腺穿刺活检方案检出PCa的比较.中华泌尿外科杂志,2006,27(1):40-42.
17Babaian RJ, Toi A, Kamoi K, et al. A comparative analysis of sextant and an extended11-core multisite directed biopsy strategy. J Urol,2000,163(1):152-157.
18Damiano R, Oliva A, Cantiello F, et al. Questionnaire based evaluation of prostatebiopsy complication comparing different bioptic schemes. J Urol,2003,75(1):40-45.
19Taille A, Antipgon P, Salomon L, et al. Prospective evaluation of a21-sample needlebiopsy procedure designed to improve the prostate cancer diction rate. J Urol,2003,61(6):1181-1186.
20Pepe P, Aragona F. Saturation prostate needle biopsy and prostate cancer detection atinitial and repeat evaluation. J Urol,2007,70(6):1131-1135.
21Simardi LH, Tobias-Machado M, Kappaz GT, et al. Influence of asymptomatichistologic prostatitis on serum prostate-specific antigen: A prospective study. Urology,2004,64(6):1098-1101.
22Kandirali E, Boran C, SERIN e, et al. Association of extent and aggressiveness ofinflammation with serum PSA level and PSA density in asymptomatic patients.Urology,2007,70(40:743-747.
23Schaeffer AJ, Wu SC, Tenenberg AM, et al. Treatment of chronic bacterial prostatitiswith levofloxacin an ciprofloxacin lowers serum prostate specific antigen. J Urol,2005,174(1):161-164.
24Ugurlu O, Yaris M, Oztekin CV, et al. Impacts of antibiotic and anti-inflammatorytherapies on serum prostate-specific antigen levels in the presence of prostaticinflammation: A prospective randomized controlled trial. Urol Int,2010,84(2):185-190.
25Serretta V, Catanese A, Daricelo G, et al. PSA reduction (after antibiotics) permitis toavoid or postpone prostate biopsy in selected patients. Prostate Cancer Prostatic Dis,2008,11(2):148-152.
26Dirim A, Tekin MI, Koyluoglu E, et al. Do changes in a hgh serum prostate-specificantigen level and the free/total prostate-specific antigen ratio after antibiotic treatmentrule out biopsy and the suspicion of cancer? Urol Int,2009,82(3):266-269.
27Shtricker A, Shefi S, Ringle A, et al. PSA levels of4.0-10ng/ml and negative digitalrectal examination. Antibiotic therapy versus immediate prostate biopsy. Int Braz JUrol,2009,35(5):551-558.
28Stopiglia RM, Ferreira U, Silva MM Jr, et al. Prostate specific antigen decrease andprostate cancer diagnosis: Antibiotic versus placebo prosective randomized clinicaltrial. J Urol,2010,183(3):940-944.
29贺大林，张林琳.PCa的诊断和治疗[J].临床外科杂志,2008,16(2):91-93.
30Applewhite JC, Matlaga BR, McCullough DL. Results of the5region prostate biopsymethod: the repeat biopsy population [J]. J Urol,2002,168(2):500-503.
31Campos-fernandes J L, Bastien L, Nicolaiew N, et al. Prostate cancer detection rate inpatients with repeated extended21-sample needle biopsy.[J]. Eur Urol,2009,55(3):600-606.
32Djavan B, Ravery V, Zlotta a, et al. Prospective evaluation of prostate cancer detectedon biopsies1,2,3and4: when should we stop? J Urol,2001,166(5):1679-1683.
33Epstein J I, Herawim M. Prostate needle biopsies containing prostatic intraepithelialneoplasia or atypical foci suspicious for carcinoma: implications for patirnt care.[J]. JUrol,2006,175(3Pt1):820-834.
34Naya Y, Ayala AG, Tamboli P，et al. Can the number of cores with high-grade prostateintraepithelial neoplasia predict cancer in men who undergo repeat biopsy? Urology.
2004Mar;63(3):503-8.
35Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part I:screening, diagnosis, and treatment of clinically localisde disease.[J]. Eur Urol,2011,59(1):61-71.
36Koca O, Caliskan S, Ozturk M I. Significance of atypical small ainar proliferation andhigh-grade prostatic intraepithelial neoplasia in prostate biopsy.[J], Korean J Urol,2011,52(11):736-740.
37Campodonico F, Casarico A, G avazzi L, et al. Cancer detection with TRUS-guided10-core biopsy of the prostate. An institutional assessment at the first, repeated andsurgical specimen biopsy [J]. Arch I tal Urol Androl,2006,78(2):39-43.
38Vincenzo Scattoni, et al. The Optimal Rebiopsy Protatic Scheme Depends on PatientClinicl Characteristics: Results of a Recursive Partitioning Analysis Based on a24-Core Systematic Scheme. European Urology60(2011)834-841.
39许宁，等.超声引导下经直肠前列腺饱和穿刺在首次活检阴性人群中的价值.中国介入影像与治疗学，2012，9（9）：648-651.
40Bott S R, Young M P, Kellett M J, et al. Anterior prostate cancer: is it more difficult todiagnose?[J]. BJU Int,2002,89(9):886-889.
41Marberger M et al. BJU intl.2001doi:10.1111/j.1464-410X.2011.x.
42Antonio Finelli et al. Impact of5α-Reductase Inhibitors on Men Followed by AcetiveSurveillance for Prostate Cancer. European Urology59(2011)509-514.
43Pim J. van Leeuwen, et al. Prostate Cancer Detection and Dutasteride: Utility andLimitations of Prostate-Specific Antigen in Men with Previous Negative Biopsies.European Urology59(2011)183-190.
44Ian M. Thompson, et al. Protate Cancer Detection: A View of the Future. EuropeanUrology,59(2011)191-193.
45Ian M. Thompson, et al. Journal of the National Cancer Institue.2006;98:1128-33.
46Steven A. Kaplan, et al. Prostate Biopsy in Response to a Change in Nadir ProststeSpeccific Antigen of0.4ng/ml after Treatment with5α-Reductase Inhibitors MarkedleEnhances the Detection Rate of Prostate Cancer. Journal of Urology.2012;188:757-761.
47A Gupta, MJ Roobol, CJ Savage, et al. A four-kallikrein panel for the prediction ofrepeat prostate biopsy: data from the European Randomized Study of Prostate CancerScreening in Rotterdam, Netherlands. British Jouranl of Cancer,(2010)103,708-714.
48李秋洋，等.建立预测中国人前列腺重复穿刺活检阳性的数学模型.中华男科学杂志,2012，18（4）：302-305.
49Rochester MA, Pashayan N, Matthwes F, et al, Development and validation of riskscore for predicting positive repeat prostate biopsy in patients with a previous negativebiopsy in a UK population. BMC Urol,2009,9:7.
50Aubin S M, Reid J, Sarno M J, et al. PCA3molecular urine test for predicting repeatprostate biopsy outcome in populations at risk: validation in the placebo arm of thedutasteride REDUCE trial [J], J Urol,2010,184(5):1947-1952.
51Kirby R, Fitzpatrick J M. optimising repeat prostate biopsy decisions and procedures.[J], BJU Int,2012,109(12):1750-1754.
52Barbera M, Pepe P, Paola Q, et al. PCA3score accuracy in diagnosing prostate cancerat repeat biopsy: our experience in177patients. Arch Ital Urol Androl.2012Dec;84(4):227-9.