藉由經直腸超音波導引下系統性切片探討攝護腺腫瘤分布
吳冠諭，蔡育賢，鄭鴻琳，歐建慧，楊文宏，蔡宗欣
國立成功大學醫學院附設醫院泌尿部
Prostate cancer distribution in patients diagnosed by transrectal systemic random biopsy
Kuan-Yu Wu, Yuh-Shyan Tsai, Hong-Lin Cheng, Chien-Hui Ou, Wen-Horng Yang, Tzong-Shin Tzai
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Purpose
Prostate cancer is one of the most commonly diagnosed cancers in men. The diagnosis is established by histopathologic examination of extended transrectal ultrasound (TRUS) biopsy. However, little research has been done with regard to anatomic distribution of prostate cancer. Therefore, the aim of this study is to investigate the anatomic distribution of prostate cancer in patients diagnosed by TRUS guided 10-core systemic random biopsy. In addition, our study was also attempt to establish a predictive nomogram to predict the pathological stage in patients with prostate cancer via anatomic distribution of prostate cancer.
Materials and Methods
From September 2005 to July 2014, 545 men received TRUS-guided 10-core systemic random biopsy at our hospital because of serum prostate specific antigen (PSA) over 4.0 ng/ml and/or abnormal digital rectal examination. All of them received PSA, digital rectal examination (DRE), PSA density, and transitional zone index (TZ index). Each core was reported separately, including malignancy or benignity, Gleason score, and the proportion of malignancy. If patient be treated with radical prostatectomy, the association between anatomic distribution of prostate cancer and pathological stage were analyzed.
Results
Among 545 patients, 152 men (27.9%) were diagnosed with prostate cancer, including 64 of 370 (17.3%) men with normal DRE and 88 of 175 (50.3%) men with abnormal DRE. Prostate cancer in men with abnormal DRE exhibited significantly older age (71.0 vs. 67.9, p=0.008), higher serum PSA (25.5 vs. 15.7, p=0.003), higher PSA density (0.71 vs. 0.41, p=0.002), higher percent of cores positive (p =0.022), and higher Gleason score (p =0.0006) than men with normal DRE. The most detection site of prostate cancer in men with abnormal DRE was left basal parasagittal (59.1%), following by left mid-lateral (55.7%). The most detection site of prostate cancer in men with normal DRE was left middle lateral (46.8%), following by left apex (45.3%), and left mid-parasagittal (42.2%).
Conclusions
In our study, men with abnormal DRE has higher malignancy rate than men with normal DRE but elevated PSA (50% vs. 16%). Prostate cancer in men with normal DRE exhibited younger age, lower serum PSA, lower PSA density, less positive cores, and less Gleason score than men with abnormal DRE. Contrastively, no significant difference was observed between prostate size and TZ index. The cancer foci detected by biopsies of the prostate are equally distributed even subgroup analysis depending on location of positive cores or prostate size. TRUS guided systemic random biopsy might help clinicians to predict pathological stage and determine the treatment policy.