老年男性前列腺特异抗原水平与直肠超声引导无痛前列腺穿刺结果的相关性分析

目的探讨老年男性前列腺特异抗原（PSA）水平与经直肠超声引导无痛前列腺穿刺结果和临床指标的相关性。方法选取106例2008年9月至2010年8月我院门诊及住院老年男性患者，其PSA增高（〉4n/ml），平均年龄（68±7）岁，进行静脉麻醉下经直肠超声引导无痛前列腺12针系统首次穿刺。将PSA水平分为低危组（4ng／ml〈PSA〈10ng／ml，55例）、中危组（10ng／ml〈PSA〈20ng／ml，27例）和高危组（PSA〉20ng／ml，24例）。记录穿刺时间、视觉模拟疼痛评分（VAS）、PSA密度（PSAD）、前列腺体积（PV）、穿刺病理结果、麻醉不良事件。结果平均穿刺时间（5．9±2．0）min，98例（92％）穿刺后无疼痛（VAS=0），无一例发生麻醉不良事件。共穿刺1272针，病理阳性164针，包括36例前列腺癌（Pca）、4例非典型增生、4例腺瘤样改变。低危、中危和高危纽中Pca检出率分别为10．9％、33．3％和87．5％，良性前列腺增生（BPH）捡出率分别为81．8％、59．2％和4．2％，差异均有统计学意义（P〈0．05）。低危组BPH患者PV（48±11）cm^3]和年龄（65±7）岁]均显著低于中危组（87±14）cm^2和（73±5）岁]。低危、中危和高危组中Pca的PSAD显著增力口，分别为（0．18±0．05）ng／（ml·cm^3）、（0．21±0．04）ng／（ml·cm^3）和（0．49±0．04）ng／（ml·cm^3），P〈0．05。低危和中危组中Pca的PSAD均显著高于BPH，但PV显著小于BPH。结论静脉麻醉直肠超声引导无痛前列腺穿刺对于PSA增高的老年男性患者具有无痛准确安全的优点。PSA水平分组与病理穿刺结果密切相关，PSAD是重要预测指标。

Relation of the prostate specific antigen level with the outcome of analgesic transrectal ultrasoundguided prostate biopsy by intravenous anesthesia in the older men

Objective To investigate the relation of the prostate specific antigen （PSA） level with the outcome of analgesic transrectal ultrasound - guided prostate biopsy （ATUGPB） by intravenous anesthesia and clinical parameters in the older men with evaluated PSA. Methods The AUGPB with twelve cores by intravenous anesthesia were completed in 106 patients from September 2008 to August 2010 induding our outpatient and inpatient mean age （68± 7） years ] with evaluated PSA （ 〉 4 ng/ml）. According to the PSA level, the patients were divided into low - risk group（4 ng/ml 〈 PSA 〈 10 ng/ml, 55 cases）, moderate -risk group（ 10 ng/ml 〈 PSA 〈 20 ng/ml, 27 cases） and high -risk group（ PSA 〉 20 ng/ml,24 cases）. The parameters were recorded including biopsy time, visual analog pain scale score （VAS） , prostate volume（PV） , PSA density （PSAD） , pathological outcome, anesthetic adverse events and complications. Results The mean biopsy time was（5.9 ± 2.0）rain, ninety eight cases（92% ） had no pain （VAS = 0）and no case occurred anesthetic adverse event. There were total 164 positive cores in 1272 cores, of which 36 cases were prostate cancer（Pca）, 4 cases were prostate atypical hyperplasia and 4 cases were prostate intraepithelial neoplasia. The detection rate of Pca from low - risk group to high - risk group were respectively 10.9% , 33. 3% and 87.5% , and that of benign prostatic hyperplasia （BPH） were 81.8%, 59.2% and 4.2%, the difference of them was significant （ P 〈 0.05 ）. The PV and mean age （48±11 ）cm3 and （65± 7） years] of the cases with BPH in low -risk group were signifieantly lower than those in moderate - risk group （87± 14） cm3 and （73 ± 5） years]. Moreover, the PSAD was significantly increasing in the cases with Pca from low - risk group to high - risk group （0.18 ± 0.05 ）ng/（ ml · cm3 ）, （0.21±0.04） ng/（ml· cm3） and（0.49±0.04） ng/（ml·cm3）]. Furthermore, the PSAD of the cases with Pca was significantly higher than that of the cases with BPH, however, PV was significantly lower than that of the cases with BPH from both low - risk group and moderate - risk group. Conthat it is painless, accurate and safe for ATUGPB by intravenous anesthesia in the older men with evaluated PSA. The PSA level is well relation with pathological outcome and PSAD could serve as an effetive predictive parameter.