摘要目的：分析前列腺活检技术变化对阳性率的影响，探讨活检阳性患者的流行病学变化，尤其PSA应用后对前列腺癌诊断及危险度分级的影响。方法回顾性分析本中心1999年3月至2015年3月3762例前列腺活检患者的临床资料。年龄22～93岁，平均69岁。所有患者均接受经直肠前列腺活检。分析PSA各区间的活检阳性率和并发症，比较手指引导下6针、8针活检法与经直肠超声（ TRUS）引导下12＋1针活检法的阳性率，总结历年活检阳性患者的PSA、年龄及Gleason评分变化趋势。结果本中心共行前列腺活检3762例，总体阳性率为39．3％。手指引导下6针活检1006例，阳性率为31．0％；8针活检398例，阳性率为36．2％；TRUS引导下12＋1针活检2258例，阳性率43．9％，高于手指引导（43．9％ vs．32．4％，P＜0．001）。总前列腺特异抗原（tPSA）异常组（PSA＞4 ng／ml）的阳性率低于直肠指检（DRE）异常组（37．8％ vs．57．6％，P＜0．001），tPSA异常组的Gleason评分均值也低于DRE异常组（6．88 vs．7．14，P＜0．001）。前列腺外周6针的阳性率高于内侧6针（37．5％vs．31．4％，P＜0．001），第13针的阳性率高于前12针平均阳性率（70．7％ vs．56．6％，P＜0．001）。术后发生轻微肉眼血尿或镜下血尿1312例（34．9％），肉眼血尿56例（1．5％），直肠出血72例（1．9％），发热63例（1．7％），肝肾功能衰竭及死亡各1例（0．03％，0．03％）。自1999年始，前列腺活检的阳性率逐渐上升。随着tPSA的升高，阳性患者的Gleason评分逐渐升高。近10年低危患者比例从6．5％逐渐上升到15．7％。2009年后因tPSA升高就诊行前列腺活检的患者较2009年以前显著增加（46．7％vs．34．1％， P＜0．001）。因tPSA升高就诊行前列腺活检患者的阳性率较以下尿路症状（LUTS）为主诉的患者无明显差异（45．2％ vs．43．2％，P＝0．362），但其阳性患者的Gleason评分均值低于LUTS组（6．76 vs．7．25，P＜0．001）。结论 TRUS引导下经直肠12＋1针活检方案阳性率显著高于手指引导下6针及8针活检。随着PSA的应用，前列腺活检的阳性率逐渐增高，阳性者的年龄呈下降趋势；年龄越大，前列腺活检的阳性率越高；直肠指检阳性患者，活检的Gleason评分偏高；外周区的活检有利于前列腺癌的检出；tPSA水平越高，前列腺活检的Gleason评分越高。 TRUS引导的前列腺12＋1针活检检出的低危患者有增加趋势，但多数仍为有临床意义的前列腺癌。

abstractsObjective To assess the improvement of prostate cancer detection rate ( PCDR) with the advance of prostate biopsy technologies and analyse the changing epidemiology of patients with positive prostate biopsy, especially the PCDR and classficaton of risk.Methods From March 1999 to March 2015, a total of 3 762 patients were recruited to the department of urology, the first affiliated hospital of Nanjing medical university.All patients underwent a systematic 6-, 8-or 13-core biopsy, guided by finger or TRUS. The PCDR of different prostate specific antigen ( PSA) interval was analyzed.The PCDR of 6-or 8-core biopsy guided by finger and 13-core biopsy guided by TRUS were compared.The trends of PSA level, age and Gleason score in the patients with positive biopsy were summarized.Results A total of 3 762 patients underwent prostate biopsies and PCa were detected in 1479 patients (39.3%).Finger-guided 6-core biopsy&nbsp;was performed on 1 106 patients, and PCa were detected in 343 cases ( 31.0%) .Finger-guided 8-core biopsy was performed on 398 patients, and PCa were diagnosed in 144 cases (36.2%).Since 2009, 2 258 patients underwent TRUS-guided 13-core biopsy, and 992 ( 43.9%) were diagnosed as PCa, higher than that of finger-guided biopsies ( 43.9% vs.32.4%, P<0.001 ) .The PCDR ( 37.8% vs.57.6%, P<0.001) and mean Gleason score (6.88 vs.7.14, P<0.001) of patients with abnormal PSA level (>4 ng/ml) were lower than that of positive in digital rectal examination.The PCDR of 6 needles biopsy was higher in prostate peripheral zone than that of prostate medial zone (37.5% vs.31.4%, P<0.001) and further analysis indicated that the PCDR of extra 13th biopsy of the area with abnormal TRUS or MRI findings was higher than the mean positive rate of the other 12 biopsies.Regarding adverse effects, 34.9%(1312/3762) reported slight gross hematuria or microscopic haematuria, 56 ( 1.5%) developed gross hematuria, 72 (1.9%) occurred rectal bleeding, 63(1.7%) needed short-term hospitalization due to fever, one patient suffered hepatorenal function failure and one patient died after biopsy.Since 1999, the PSDR rise gradually. With the increase of tPSA level, Gleason score increased in biopsy positive patients.The percentage of low risk PCa patients increased from 6.5% to 15.7% gradually in last decade, while the percentage of intermediate or high risk PCa patients is still over 80%.Since 2009, the percentage of patients who underwent prostate biopsies because of evaluated PSA level was higher than before ( 46.7% vs.34.1%, P<0.001).The PCDR of patients with an evaluated tPSA level showed no difference compared with the patients presented lower urinary tract symptoms ( LUTS ) ( 45.2% vs.43.2%, P =0.362 ) , while their mean Gleason score in positive patients was lower than that of LUTS group(6.76 vs.7.25,P<0.001). Conclusions The PCDR of TRUS-guided 13-core transrectal prostate biopsy was significantly higher than that of finger-guided 6-or 8-core biopsy.Due to the application of PSA test, the PCDR increased gradually and the mean age of positive patients decreased.The higher the age, the higher the PCDR.Gleason score was higher when patients with positive DRE, compared to an evaluated tPSA level.Biopsies of prostate peripheral zone is helpful to improve the PCDR.The higher the tPSA level, the higher the Gleason score. With the application of PSA test, TRUS-guided 13-core prostate biopsy detected more low risk PCa, and most of PCa were still clinical significant.