Philip Joe, Hanchanale Vishwanath, Foster Christopher S, Javlé Pradip
Department of Urology, Leighton Hospital, Crewe, UK.
BJU Int. 2006 Sep;98(3):559-62. doi: 10.1111/j.1464-410X.2006.06325.x.
To assess cancer-detection rates in repeat 12-core biopsy protocols, as extended multicore prostate biopsy protocols have become standard when investigating men with a raised prostate-specific antigen (PSA) level, but repeat prostate biopsy protocols are still developing.
During a 4.5-year period, 241 of 590 patients with persistently high age-specific PSA levels of 2.6-10 ng/mL and an initial benign biopsy were invited for repeat transrectal ultrasonography-guided 12-core prostatic biopsy. The protocol for repeat biopsy was identical to the first biopsy, and included a periprostatic nerve block. The first six biopsies were obtained from the periphery of the gland directed more laterally at the base, mid-zone and apices. The remainder were parasagittal sextant biopsies. Pathological findings were analysed on an individual core basis.
The mean age of the 241 men was 63.4 years; cancer was diagnosed in 40 (16.6%) on repeat biopsy. Men with cancer were older and had a higher median PSA level. The median Gleason score was 6, with a median of two cores positive for cancer. Maximum cancer detection rates were from peripheral apices (37.5%), basal biopsies had the lowest detection rates (23.8% and 16.3%), and parasagittal biopsies missed 35% of detected cancers. Patients with cancer also had significantly lower prostate volumes and higher PSA densities (both P < 0.001).
A low cancer yield from both peripheral basal and parasagittal basal specimens on repeat biopsy indicates adequate sampling at initial biopsy. The maximum cancer yield in the peripheral mid-zones and apical zones suggests the necessity for concentrated sampling of these zones in repeat biopsy protocols.
评估重复12针活检方案中的癌症检出率，因为在对前列腺特异性抗原（PSA）水平升高的男性进行检查时，扩展的多针前列腺活检方案已成为标准，但重复前列腺活检方案仍在发展中。
在4.5年期间，邀请了590例年龄特异性PSA水平持续高于2.6 - 10 ng/mL且初次活检为良性的患者中的241例进行重复经直肠超声引导下的12针前列腺活检。重复活检方案与首次活检相同，包括前列腺周围神经阻滞。前六针活检取自腺体周边，在基底部、中区和尖部更偏向外侧。其余为矢状旁六分区活检。对每个活检针芯的病理结果进行分析。
241名男性的平均年龄为63.4岁；重复活检诊断出40例（16.6%）患有癌症。患有癌症的男性年龄更大，PSA中位数水平更高。Gleason评分中位数为6分，癌症阳性针芯中位数为两根。癌症检出率最高的是周边尖部（37.5%），基底部活检的检出率最低（23.8%和16.3%），矢状旁活检漏诊了35%的已检出癌症。患有癌症的患者前列腺体积也显著更小，PSA密度更高（均P < 0.001）。
重复活检时周边基底部和矢状旁基底部标本的癌症检出率低，表明初次活检时采样充分。周边中区和尖部的癌症检出率最高，提示在重复活检方案中对这些区域进行集中采样的必要性。
