Ching Christina B, Moussa Ayman S, Li Jianbo, Lane Brian R, Zippe Craig, Jones J Stephen
Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2009 May;181(5):2077-82; discussion 2082-3. doi: 10.1016/j.juro.2009.01.035. Epub 2009 Mar 14.
We compared prostate cancer detection rates for the 2 most commonly used transrectal ultrasound prostate biopsy probes, end fire and side fire, to determine whether the probe configuration affects detection rates.
We evaluated 2,674 patients who underwent initial prostate biopsy between 2000 and 2008 with respect to prostate specific antigen, biopsy technique and pathological findings. Patients were divided into 1,124 in whom biopsies were performed with an end fire probe and 1,550 in whom biopsies were performed with a side fire probe.
There was a significant difference in the overall cancer detection rate in the end vs side fire arms (45.8% vs 38.5%, p <0.001). In the subsets of patients with prostate specific antigen greater than 4 to 10 ng/ml or less and greater than 10 ng/ml a significant difference persisted (46.4% vs 38.9% and 61.7% vs 49.1%, p <0.004 and <0.015, respectively). There was also a significant difference in detection rates between probes in those who underwent 8 to 19 biopsy cores (p <0.009). Biopsies of greater than 20 cores failed to attain statistical significance (p >0.105). We also found that prostate volume, patient age, prostate specific antigen and hypoechoic findings were independent variables for predicting cancer detection on multivariate analysis (p <0.001).
The type of probe significantly affects the overall prostate cancer detection rate, particularly in patients with prostate specific antigen greater than 4 ng/ml and/or nonsaturation (8 to 19 cores) prostate biopsy. This may be because the end fire probe allows better mechanical sampling of the lateral and apical regions of the peripheral zone, where cancer is most likely to reside. We set the stage for a randomized, controlled trial to confirm our observations.
我们比较了两种最常用的经直肠超声前列腺活检探头（端射探头和侧射探头）的前列腺癌检出率，以确定探头配置是否会影响检出率。
我们评估了2000年至2008年间接受初次前列腺活检的2674例患者的前列腺特异性抗原、活检技术和病理结果。患者被分为两组，其中1124例使用端射探头进行活检，1550例使用侧射探头进行活检。
端射探头组与侧射探头组的总体癌症检出率存在显著差异（45.8%对38.5%，p<0.001）。在前列腺特异性抗原大于4至10 ng/ml或更低以及大于10 ng/ml的患者亚组中，显著差异仍然存在（46.4%对38.9%以及61.7%对49.1%，p分别<0.004和<0.015）。在接受8至19个活检核心的患者中，探头之间的检出率也存在显著差异（p<0.009）。超过20个核心的活检未达到统计学意义（p>0.105）。我们还发现，在多变量分析中，前列腺体积、患者年龄、前列腺特异性抗原和低回声表现是预测癌症检出的独立变量（p<0.001）。
探头类型显著影响总体前列腺癌检出率，特别是在前列腺特异性抗原大于4 ng/ml和/或非饱和（8至19个核心）前列腺活检的患者中。这可能是因为端射探头能够更好地对外周区的外侧和尖部区域进行机械采样，而癌症最有可能位于这些区域。我们为进行一项随机对照试验奠定了基础，以证实我们的观察结果。
