Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 2
Transrektal prostat iğne biyopsisi sonrasında prostat kanseri saptanmayan ve saptanan hastaların verilerinin analizi: Retrospektif bir çalışma
- Sayfa
- 148–154
- DOI
- —
Özet
Transrektal prostat biyopsisi sonuçlarına göre, prostat kanseri saptanmayan ve saptanan olguların verilerinin retrospektif olarak analizi. Eylül 2000-Aralık 2002 tarihleri arasında transrektal prostat iğne biyopsisi yapılan 349 hasta çalışmaya alınmıştır. Hastalar histopatolojik inceleme sonuçlarına göre; iyi huylu prostat hastalığı ve prostat kanseri saptanan olarak iki gruba ayrılmıştır.Her iki grubun verileri karşılaştırılmıştır. Histopatolojik inceleme sonucunda, 281 (%80.5) olgu prostat kanseri değildi, 68 (%19.5) hasta prostat kanseriydi. Serum total prostat spesifik antijen (PSA) yüksekliğinin (>4 ng/ml) ve normal olmayan parmak ile rektal inceleme (PRİ) bulgularının pozitif öngörü değerleri sırasıyla %19.2 ve %42.1 olarak bulunmuştur. Prostat kanseri grubunda; PSA dansitesi anlamlı olarak yüksek, serum serbest PSA’nın total PSA’ya oranı düşük çıkmış (p=0.001, p=0.006) ve %60.2 oranında normal olmayan transrektal ultrasonografi görüntü bulguları saptanmıştır. Ülkemizde serum total PSA değeri tek başına iyi ve kötü huylu prostat hastalıklarının ayrımında yeterli değildir. Çünkü bizim hastalarımız, batılı toplumlara göre daha yüksek serum total PSA değerine sahiptir. Biyopsi öncesinde bu durum akılda tutulmalıdır. Diğer PSA parametreleri ve tanı yöntemleri ayırıcı tanı için kullanılabilir. Bu nedenle başlangıç döneminde, serum serbest PSA’nın total PSA’ya oranı, PSA dansitesi, transrektal ultrasonografi ve PRİ, serum total PSA değeri ile beraber değerlendirilmelidir.
Abstract
Introduction: Except for skin cancer, prostate cancer is the most common type of cancer and the second leasing of death due to cancer among men in western population. Searching for prostate cancer in men lacking symptoms or signs of prostate cancer constitutes screening. The evaluation of men with clinical signs or symptoms of genitourinary disease, that results in the diagnosis of prostate cancer detection. Serum total prostate specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound needle biopsy have made routinely recommended for detecting prostate cancer. Transrectal prostate needle biopsy usually performed in patients with abnormal DRE and/or serum total PSA level. According to the transrectal prostate needle biopsy results, we can retrospective analysis the data between the cases with and without prostate cancer. Materials and Methods: Between September 2000 and December 2002, transrectal prostate needle biopsy was performed in 349 patients with abnormal DRE and/or >4ng/ml serum total PSA level were involved in the study. All prostate samples were taken eight cores. The patients with active urinary tract infection, bladder cancer, urethral catheterisation, if they had taken finasteride previous one year and were taking anticoagulan drugs were excluded from the study. According to the histop'athologlcal examination, the patients were divided into two groups as without and with prostate cancer. Their data were compared. Results: At the end of the histopathological examination, 281 (80.5%) cases had no prostate cancer and 68 (19.5%) cases had prostate cancer. No significant difference was found between the serum total PSA level the two groups (p=0.084). Serum total PSA level was higher 4 ng/ml in 272 patients (96.7%) who had not prostate cancer. In prostate cancer group, abnormal DRE was detected in 48 of the patients (70.5 %) Prostate volume was lower, mean age was higher in the prostate cancer group than the other group. In prostate cancer group, 18 patients' (26.4%) Gleason scores were between 0 and 4, 30 (44.1%) patients' (44.1%) Gleason scores were between 5 and 7, 20 patients' (29.5%) Gleason scores were between 8 and 10. Positive predictive values for high serum total PSA level (>4 ng/ml) and abnormal DRE were 19.2% and 42.1% respectively. In patients with normal DRE findings in the serum total PSA level <4 ng/ml, 4-10 ng/ml and >10 ng/ml, prostate cancer detection rates were 0%, 10.2% and 5.4% respectively In our study, prostate cancer detection rate is disappointly low in patients with normal and disease-suggestive DRE findings, in the serum PSA>4 ng/ml. In the prostate cancer group; serum PSA density was significantly higher, serum free/total PSA ratio was significantly lower (p=0.001,p=0.006) and 60.2% of the patients had abnormal transrectal ultrasound echo pattern. Conclusion: In our country, only serum total PSA measurement is an inadequate differential method between benign and malign prostate diseases. Because, our patients have high serum total PSA level than western population. Ethnic characteristics and other factors such as prostatic inflammation, recurrence urinary tract infections, prostatic enfarct and prostatic inflammation may have an important role in this condition. Hence it should be kept in mind before the biopsy. Other PSA parameters and diagnostic tools can be use for differential diagnosis between benign and malign prostatic disease. For the reason, at the initial period, serum free/total PSA ratio, PSA density, transrectal ultrasonography and DRE should be assessed with serum total PSA level.