Pepe Pietro, Aragona Francesco
Urology Unit, Cannizzaro Hospital, Catania, Italy.
Urology. 2007 Dec;70(6):1131-5. doi: 10.1016/j.urology.2007.07.068.
To evaluate the incidence of prostate cancer (PCa) in patients who underwent a saturation prostate biopsy (SPBx) as primary biopsy or in case of rebiopsy.
We assessed 189 patients (median age 60.3 years) submitted to a transrectal ultrasound-guided SPBx (range, 24 to 37 cores; median, 29). In 98 men the SPBx was performed as the primary procedure, in 75 as the second, and in 16 as the third biopsy set. Indications for biopsy were: abnormal DRE; total prostate specific antigen (PSA) (tPSA) greater than 10 ng/mL; tPSA equal to 4 to 10, 2.6 to 3.9, less than or equal to 2.5 ng/mL; and percent free PSA (%-fPSA) 25% or less, 20% or less, and 15% or less, respectively. The PCa detection using an SPBx as initial biopsy was compared retrospectively with that found in 256 and 116 patients who underwent 12- and 18-core biopsy, respectively, according to the same protocol. The results obtained in 75 patients submitted to an SPBx as the second biopsy set were compared retrospectively with those found in 73 men who underwent an 18-core re-biopsy.
The PCa detection rate with SPBx as primary biopsy was 46.9%, greater than the 12-core biopsy (39.8%; P = 0.3) but lower than the 18-core biopsy (49%; P = 0.6). In the case of second and third biopsy, the incidence of PCa when using an SPBx compared with 18-core biopsy was 22% versus 10.9% (P = 0.003) and 6.2% versus 0%, respectively. The incidence of neoplastic microfoci was 34.7% at first and 45.5% at second biopsy set. In all patients who underwent a radical prostatectomy with a bioptic diagnosis of neoplastic microfocus, the pTNM revealed a clinically significant cancer (tumor volume greater than 0.5 mL or Gleason score of 6 or higher).
As primary biopsy, SPBx does not increase the PCa detection rate compared with an 18-core scheme; in the case of rebiopsy, the SPBx is a recommended method as the PCa detection rate is doubled compared with 12- or 18-core biopsy sets.
评估接受饱和前列腺穿刺活检（SPBx）作为初次活检或再次活检的患者中前列腺癌（PCa）的发生率。
我们评估了189例患者（中位年龄60.3岁），他们接受了经直肠超声引导下的SPBx（穿刺针数范围为24至37针；中位针数为29针）。98例男性患者中，SPBx作为初次操作进行；75例作为第二次操作；16例作为第三次活检。活检指征包括：直肠指检异常；总前列腺特异性抗原（tPSA）大于10 ng/mL；tPSA等于4至10 ng/mL、2.6至3.9 ng/mL、小于或等于2.5 ng/mL；游离PSA百分比（%-fPSA）分别为25%或更低、20%或更低、15%或更低。将以SPBx作为初次活检的PCa检出率与分别按照相同方案接受12针和18针活检的256例和116例患者的检出率进行回顾性比较。将75例接受SPBx作为第二次活检的患者的结果与73例接受18针再次活检的男性患者的结果进行回顾性比较。
以SPBx作为初次活检时，PCa检出率为46.9%，高于12针活检（39.8%；P = 0.3）但低于18针活检（49%；P = 0.6）。在第二次和第三次活检的情况下，与18针活检相比，使用SPBx时PCa的发生率分别为22%对10.9%（P = 0.003）和6.2%对0%。初次活检时肿瘤微灶的发生率为34.7%，第二次活检时为45.5%。在所有经活检诊断为肿瘤微灶并接受根治性前列腺切除术的患者中，pTNM显示为临床显著癌（肿瘤体积大于0.5 mL或Gleason评分6分或更高）。
作为初次活检，与18针方案相比，SPBx并未提高PCa检出率；在再次活检的情况下，SPBx是一种推荐方法，因为与12针或18针活检相比，其PCa检出率提高了一倍。
