Rabets John C, Jones J Stephen, Patel Amit, Zippe Craig D
Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2004 Jul;172(1):94-7. doi: 10.1097/01.ju.0000132134.10470.75.
Patients at increased risk for prostate cancer with previously negative biopsies pose a diagnostic challenge. We have previously demonstrated that extensive saturation biopsy can be performed in an office setting. We now report the diagnostic yield of office saturation biopsy in patients at increased risk for prostate cancer and at least 1 negative prior biopsy.
We performed saturation prostate biopsy with local anesthesia in the office in 116 patients with at least 1 prior negative biopsy and with certain risk factors, namely persistently elevated prostate specific antigen, abnormal digital rectal examination, or prior atypia or PIN on prior biopsy.
A total of 34 cancers were detected for an overall diagnostic yield of 29%. A 64% detection rate was noted when a patient had undergone a single prior sextant biopsy. Subgroup analysis revealed a cancer detection rate of 41% when only prior sextant biopsies were performed, and a 24% detection rate when 10 or more cores were taken on prior biopsy. The detection rate was 33% when only 1 prior biopsy was taken and it was 24% when 2 or more prior biopsies were performed.
Saturation biopsy can be performed safely and effectively in the office with a significant diagnostic yield even in patients with previous extended biopsy schemes. We believe that it should be the next diagnostic step after an initial negative biopsy in patients in whom the diagnosis of prostate cancer is strongly suspected.
前列腺癌风险增加但既往活检结果为阴性的患者面临诊断挑战。我们之前已证明可在门诊环境中进行广泛的饱和活检。我们现在报告门诊饱和活检在前列腺癌风险增加且既往至少有1次活检为阴性的患者中的诊断率。
我们在门诊对116例既往至少有1次活检为阴性且具有某些风险因素的患者进行了局部麻醉下的饱和前列腺活检，这些风险因素包括前列腺特异性抗原持续升高、直肠指检异常或既往活检有非典型增生或前列腺上皮内瘤变。
共检测到34例癌症，总体诊断率为29%。当患者既往仅进行过1次六分区活检时，检测率为64%。亚组分析显示，仅既往进行过六分区活检时，癌症检测率为41%；既往活检取10个或更多组织芯时，检测率为24%。仅进行过1次既往活检时，检测率为33%；进行过2次或更多次既往活检时，检测率为24%。
即使在既往采用过广泛活检方案的患者中，饱和活检也可在门诊安全有效地进行，且诊断率显著。我们认为，对于强烈怀疑前列腺癌但初次活检为阴性的患者，饱和活检应是下一步的诊断措施。
