Prostate biopsy results and clinicopathological characteristics of the 55 years or younger patients

目的 了解55岁以下行前列腺穿刺活检患者的临床病理特征,为青年前列腺穿刺活检患者提供诊疗决策.方法 回顾性分析北京大学第一医院泌尿外科自2011年1月至2013年11月间行前列腺穿刺活检年龄≤55岁的患者,收集患者的前列腺特异抗原(PSA)、直肠指诊、超声、磁共振等临床信息,以及穿刺病理结果确定是否存在前列腺腺癌或高级别前列腺腺癌(Gleason评分≥7分).结果 共82例患者顺利完成穿刺,中位年龄51岁,中位PSA 8.62 μg/L.其中71例(86.6％)穿刺前行前列腺磁共振检查,25例阳性(35.2％),28例阴性(39.4％),18例可疑(25.4％).穿刺活检病理确诊前列腺腺癌共26例(31.7％),其中23例(28.0％)为高级别前列腺腺癌.较高的PSA值、阳性的超声检查结果以及阳性的磁共振检查结果为病理诊断前列腺癌或高级别前列腺癌的危险因素.其中对于PSA值在4～10μg/L之间的患者,穿刺阳性率为15.0％,超声及磁共振检查对于穿刺结果有提示意义.结论 PSA升高或存在前列腺结节的青年(≤55岁)患者前列腺穿刺阳性率为31.7％,PSA处于灰区(4～ 10 μg/L)穿刺阳性率为15％.不可忽视该年龄段人群罹患前列腺癌的风险.PSA值、超声检查和磁共振检查为穿刺阳性的危险因素.Objective To explore the clinical features,biopsy results and risk factors of patients underwent prostate biopsy with age ≤ 55,and to help make the proper treatment strategies of this cohort of patients.Methods The data of patients with age ≤55 underwent prostate biopsy between Jan 2011 and Nov 2013 was retrospectively reviewed.Clinical factors including prostate-specific antigen,digital rectal examination,ultrasonography and magnetic resonance imaging were recorded.Biopsy positive results were defined as the presence of prostate cancer and high-grade prostate cancer (Gleason score ≥ 7).Results There were all together 82 patients in this cohort,with the median age of 51 years old and median prostate-specific antigen of 8.62 μg/L Among them 71 patients (86.6％) underwent pre-biopsy magnetic resonance imaging test,with 25 positive (35.2％),18 suspicious (25.4％) and 28 negative results (39.4％).Pathology confirmed prostate cancer in 26 patients (31.7％),including 23 (28.0％) high-grade prostate cancer.Higher prostate-specific antigen,positive ultrasonography and positive magnetic resonance imaging were risk factors for prostate cancer and high-grade prostate cancer.For patients with prostate-specific antigen between 4 and 10 μg/L,15.0％ were diagnosed with prostate cancer,and positive ultrasound and magnetic resonance imaging were predictive for biopsy results.Conclusions The positive rate of prostate biopsy in men younger than 55 years old is 31.7％,and the risk for prostate cancer of this cohort of patients shouldn't be neglected.Prostate-specific antigen value,ultrasonography and magnetic resonance imaging could help predict biopsy results.北京市科学技术委员会首都临床特色应用研究; 吴阶平医学基金(320.6750.12273)Beijing Municipal Science and Technology Commission Capital Clinical Research Project; Wu Jieping Medical Fund中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)403218-32219