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題名 | Detection of Prostatic Cancer Using Digital Rectal Examination, Prostate-Specific Antigen and Transrectal Ultrasonography=以肛門指診、血清攝護腺特異性抗原與經直腸攝護腺超音波偵測攝護腺癌 |
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作者 | 蔡宗欣; 林信男; 葉雨青; 周楠樺; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 29:2 民85.03-04 |
頁次 | 頁97-101 |
分類號 | 416.27 |
關鍵詞 | 肛門指診; 血清攝護腺特異性抗原; 直腸攝護腺; 超音波; 攝護腺癌; Prostate cancer; Prostate-specific antigen; Transrectal ultrasonography; |
語文 | 英文(English) |
中文摘要 | 本篇是針對253位男性有膀恍下尿路阻塞或精血症狀的病人所作之研 究。首先抽血作血清攝護腺特異性抗原(PSA),在未知其PSA之結果前隨即進行攝 護腺肛診(DRE)及經直腸超音波檢查(TRUS),如發現DRE或Z和TRUS不正常時, 在徵得病人同意下立即以超音波定位導引行對攝護腺懷疑之部位行活體切片供 病理檢查,如DRE或Z和TRUS無不正常,但PSA值偏高,則施以腺體兩側隨意採 樣切片。分析結果發現單獨以DRE不正常為依據時攝護腺癌之偵測率可由I2.5提 昇至33.9;在所有253位病人中有I36位其TRUS發現有hypoechoic病灶,其中70人有 接受切片檢查,發現祇有I6人(22.9)經病理切片證實為攝護腺癌;如單獨以PSA值為 依據時,其值在<4、4~10和>10 ng/ml時,攝護腺癌之偵測率分別為10.5、4.5和51.3。 但如果同時DRE不正常與高PSA值時偵測率可由33.3(PSA<4 ng/ml)提昇至 62.5(PSA>10 ng/ml),唯PSA介於4與10ng/ml時因我們本研究中人數太少且接受切 片檢查比率較低,所以偵測率偏低。因此基於本研究之結果,我們認為合併DRE、 PSA與TRUS可有效地提高攝護腺癌之偵測率,但建議對於PSA值介於4與10 ng/ml 而DRE與TRUS均正常者,需定期肛診檢查與多次採血追蹤PSA,並於適當時機重 覆切片檢查,如此才不致耽誤攝護腺癌之診斷。 |
英文摘要 | Two hundred and fifty-three patients with symptoms and signs of bladderoutlet obstruction or hematospermia were enrolled into this study. Afterobtaining blood samples for prostate-specific antigen (PSA) determination,digital rectal examination (DRE) and transrectal ultrasonography (TRUS)were used to evaluate the nature of either palpable nodule and/or hard consistency found on their prostate glands. Sono-guided core needle biopsieswere performed on 59 (86.8) of the 68 DRE-abnormal along with 40 (21.6)of 185 DRE-normal patients who had had abnormal TRUS findings and/orelevated PSA. The detection rate of prostatic cancer (PC) from DREabnormal and DRE-normal prostates were 33.9 and 12.5, respectively. Inthis study, hypoechoic lesions were found in 136 patients (53.8). Overall,16 (22.9) out of the 70 biopsied patients were positive for PC, a rate whichincreased to 46.4 if the PSA were greater than 10 ng/ml. Overall, the detection rate of PC for patients with PSA value < 4, 4-10 and > 10 ng/ml were10.5, 4.5 and 51.3, respectively. The combination of a high level ofserum PSA (>10 ng/ml) along with an abnormal DRE increased the PCdetection rate from 33.3 to 62.5. This experience revealed that the PCdetection rate among patients with moderate elevation of PSA value (4-10ng/ml) remains unexpectedly low compared to most other worldwide andsimilar studies. These results indicated that a PSA greater than 10 ng/mlrepresents an important indicator, especially when associated with abnormal DRE and/or sonographically hypoechoic lesions. |
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