직장수지검사 음성이면서 혈청 전립선특이항원이 4-10ng/㎖인 환자에서 전립선 생검의 의의
The Effectiveness of Prostate Biopsy in Patients with Negative Digital Rectal Examination and Serum Prostate Specific Antigen Concentration between 4 and 10ng/㎖
민영기, 이명수, 송주흥,
소속 상세정보
민영기 ( )
원광대학교 의과대학 비뇨기과학교실
이명수 ( )
원광대학교 의과대학 비뇨기과학교실
송주흥 ( )
원광대학교 의과대학 비뇨기과학교실
KMID : 0358319990400070853
Abstract
결론
DRE 음성이면서 혈청 PSA치 회색 범위로 증가한 환자에서 전립선암의 발견율을 조사한
결과 37%(국내 문헌 고찰 증례 포함 시 43%)로 서구에서의 30%에 비해 현저히 낮았다. 따
라서 서구에서와 같이 이런 모든 환자에서 비용이 많이 들고 침습적인 전립선 생검을 시행
하는 것은 시간, 경제적인 측면에서 비효율적인 것으로 판단된다.
혈청 PSA치가 PSA>10ng/㎖일 때는 서구의 혈청 PSA치 회색 범위와 비슷한 전립선암
발견율을 보이므로 서구와 같이 적극적인 전립선 생검이 필요할 것으로 생각되고 아울러 왜
이러한 결과가 나왔는지에 대한 원인 조사도 이뤄져야 할 것으로 생각된다.
Purpose: Most urologists, to our knowledge, recommend prostatic biopsy if serum
prostate specific antigen(PSA) concentrations are between 4 and 10 ng/㎖(gray zone),
even in the abscence of abnormal digital rectal examination (DRE). But the detection of
prostate cancer has not been frequent in patients with negative DRE and gray zone of
serum PSA. So, we investigated the detection rate of prostate cancer to evaluate the
effectiveness of biopsy, and provide the clinical data which is needed to make an
appropriate guideline for management in those patients in korea.
Materials and Methods: We retrospectively reviewed 58 patients with negative DRE
and serum PSA greater than 4ng/㎖, in whom transrectal systemic biopsy was done
between January 1, 1996 and July 31, 1998. Additionally we analysed 38 patients with
negative DRE and serum PSA more than 4ng/㎖ in a Korean literature. We calculated
the detection rate of prostate cancer in patients with gray zone of serum PSA and
serum PSA greater than 10ng/㎖, respectively.
Results: Prostate cancer was detected in 5 patients out of the 58 patients (8.6%),
including 1 patient(3.7%) out of 27 patients with gray zone of serum PSA and 4(12.9%)
out of 31 patients with serum PSA greater than 10ng/㎖. Prostate cancer was detected
in 4 patients out of the 38 patients in the literature(10.5%), including 1 patient(5.0%) out
of 20 patients with gray zone of serum and 3 patients(16.7%) out of 18 patients with
serum PSA greater than 10ng/㎖. Combining the results of our current study with that
of other Korean literature, total number of patients was 96, and 9(9.4%) of them proved
to harbor prostate cancer, including 2 patients(4.3%) out of 47 patients with gray zone
of serum PSA and 7 patients(14.3%) out of 49 patients with serum PSA greater than
1.0ng/㎖.
Conclusions: The detection rate of prostate cancer in Korean with negative DRE and
gray zone of serum PSA is significantly lower than that in North American. Therefore
it may not be effective to perform biopsy in all of those patients in Korea. Needed are
Korean criteria of prostatic biopsy to detect prostate carcinoma in those patients, which
can be acceptable in Korean.
키워드
Prostate cancer; ORE; PSA; Biopsy; Gray zone;
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