Investigate And Analyze The Data Of Transrectal Ultrasound Guided Repeat Needle Biopsy Of The Prostate In Suzhou Area

OBJECTIVETo evaluate and investigate the clinical data and value of the transrectal ultrasoundguided repeat needle biopsy of the prostate in Suzhou area.METHODSFrom 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.RESULTS1. 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.CONCLUSIONS1. 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.