Objective: To summarize the experience in ultrasound guided transrectal prostate biopsy and analyze the influencing factors of the biopsy results.
Methods: 687 patients with prostate specific antigen (PSA) > 4 microg, tubercles in prostate detected by digital rectal examination and/or prostate abnormality detected by magnetic resonance imaging, aged (70 +/- 8), underwent ultrasound guided transrectal 6 - 12 core prostate biopsy 1996 - 2007. Since 2006 the criteria for biopsy included PSA of 4 - 10 microg/ml, free PSA/total PSA ratio (F/T ratio) <or= 0.16, and PSA density > 0.15.
Results: 269 of the 687 cases, with the mean age of (72 +/- 8), were diagnosed as with prostate cancer. 294 and 121 of the 687 patients (42.8% and 17.6% respectively) accepted prostate biopsy because of elevated PSA or abnormality of DRE. The number of patients accepting prostate biopsy increased yearly (10 cases in 1996 to 98 cases in 2007). The positive biopsy rate was 39.8%, with the highest rate of 60.0% in 1999 and lowest rate of 30.4% in 2005. The highest number of prostate cancer diagnosed was the highest (42 cases) in 2007 and the lowest (4 cases) in 1996. PSA level was positively co-related with positive biopsy rate. The application of F/T ratio improved the positive biopsy rate in the patient with the PSA of 4 - 10 microg/ml. The incidence rates of the main complications hematuria, bloody stool, and fever were 46.3%, 8.7%, and 1.9% respectively.
Conclusion: Elevated PSA has become the most common reason for prostate biopsy. The combination with PSA, F/T ratio, and increased biopsy core number improve the positive biopsy rate. The ultrasound guided transrectal prostate biopsy is efficient and safe in the diagnosis of prostate cancer.