Diagnosis Of Prostate Cancer By Digital Rectal Examination,Serum Prostate Specific Antigen,Transrectal Ultrasonography And 6+X-core Prostate Biopsy

Objective To investigate the value of diagnosing prostate cancer (PCa) by digital rectal examination(DRE),serum prostate specific antigen(PSA),transrectal ultrasound(TRUS) alone and abnormalities in both or three.And to investigate the value of diagnosing PCa by transrectal ultrasound guided transperineal 6+X-core prostate biopsy of 6-core in different serum PSA levels.Methods Retrospective analysis was conducted on 106 patients of ultrasound-guided transperineal 6+X-core prostate biopsy.To observe diagnostic sensitivity and specificity of PCa in 106 patients by DRE,serum PSA,TRUS alone and abnormalities in both or three.According to the PSA level,106 patients was divided into five groups(A.PSA≤ 4ng/ml,B.4ng/ml< PSA≤ 20ng/ml,C.20ng/ml< PSA≤40ng/m,1D.40ng/ml< PSA≤ 100ng/ml,E.PSA>100ng/ml). To analysis the relationship of diagnosing PCa between 6+X-core and X-core in different serum PSA levels.In the 6+X-core prostate biopsy of B, C,Dgroups,two subgroups (including B1 and B2,C1 and C2,D1 and D2)were divided by the age of 75 years to analyze the relationship of PCa detection rate between the two subgroups respectively.Results PCa was detected in 51 patients by the 6+X-core prostate biopsy.In 70 patients with abnormal DRE,35 patients were diagnosed with PCa.In 103 patients with PSA> 4ng/ml,51 patients were diagnosed with PCa. In 61 patients with abnormal TRUS,40 patients were diagnosed with PCa.The sensitivity and specificity for detecting PCa were 68.6% and 36.4% for an abnormal DRE,100% and 0.5%for an abnormal PSA> 4n/ml,78.4% and 61.8%for an abnormal TRUS.Combining abnormal TRUS with PSA >4ng/ml in 58 patients,40 patients were diagnosed with PCa,18 patients were misdiagnosised and 11 patients had missed diagnosis. Among 31 patients with abnormal TRUS and abnormal DRE,28 patients were diagnosed with PCa,3 patients were misdiagnosised and 23 patients had missed diagnosis.Among 67 patients with abnormal TRUS and abnormal DRE,35patients were diagnosed with PCa,32 patients were misdiagnosised,16 patients had missed diagnosis.Among 28 patients with abnormal DRE and abnormal TRUS and PSA>4ng/ml,all patients were diagnosed with PCa,23 patients had missed diagnosis.Therefore,Combining TRUS with serum PSA would be of great significince to improve the detection rate of PCa and reduce the rate of missed diagnosis.PCa was detected in0%,30.2%,44.8%,66.7%,100% by the method of 6+X-core biopsy and PCa was detected in0%,25.6%,34.5%,61.1%,100% by the method of X-core biopsy in different serum PSA levels.There was no significant difference of PCa detection rate in each groups between the method of 6+X-core and X-core(P>0.05).Both of the two methods indicated the positive rate of prostate biopsy increased gradually with the level of PSA increased.No significant difference of PCa detection rate was found between the group B1 and B2 and between the group C1 and C2(P>0.05),while significant difference between the group D1 and D2 (P<0.05).Conclusion DRE,serum PSA and TRUS abnormalities in both or three were better than alone to improve the detection rate of PCa.The diagnosis of PCa was 100%,when the three methods were abnormal.Combining TRUS with serum PSA diagnosis of PCa prsented high detection rate and low missed diagnosis rate.The level of PSA and the age can provide a reference for prostate biopsy.Combining with PSA level,the 6+X-core prostate biopsy can improve the detection rate of PCa.