Ploussard Guillaume, Dubosq Francis, Boublil Véronique, Allory Yves, de la Taille Alexandre, Vordos Dimitri, Hoznek Andras, Abbou Claude-Clément, Salomon Laurent
Institut National en Santé et Recherche Médicale U955 EQ7, Department of Urology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.
J Urol. 2009 Oct;182(4):1342-9. doi: 10.1016/j.juro.2009.06.050. Epub 2009 Aug 14.
We determined the diagnostic role of an extensive biopsy protocol associated with transurethral prostate resection in patients with persistently increased or increasing prostate specific antigen without evidence of prostate cancer after 2 or more extended negative sets of biopsies.
A new set of 21-core biopsies was done in 113 patients under general anesthesia in association with transurethral prostate resection. Demographics, clinical and biological data, operative parameters, pathological results and followup were recorded prospectively.
Extended biopsies provided an 18.6% detection rate and detected 77.8% of prostate cancers. Transurethral prostate resection significantly increased the detection rate by 28.5% for an overall 23.9% prostate cancer detection rate (p = 0.035). Most prostate cancer detected on chips and/or biopsy was clinically significant and 30% were scored as Gleason 7 or greater. Of prostatectomy specimens 19% showed pT3a-pT4 cancer with a median Gleason score of 7. In patients with no cancer mean prostate specific antigen 1 year after transurethral prostate resection was 4.5 ng/ml (range 0.3 to 16.3), which remained stable during followup. A third of these patients underwent repeat biopsy with a 16.7% prostate cancer detection rate.
About a fourth of patients with at least 2 extended negative sets of prostate biopsies remain at risk for prostate cancer and most tumors missed on initial procedures are clinically significant. Repeat biopsy using general anesthesia detects three-fourths of these prostate cancers. However, the diagnostic yield of transurethral prostate resection appears significant and may provide additional data of clinical importance in select, informed patients.
我们确定了一种广泛活检方案联合经尿道前列腺切除术在前列腺特异性抗原持续升高或升高，且经过2次或更多次扩展阴性活检仍无前列腺癌证据的患者中的诊断作用。
对113例患者在全身麻醉下进行经尿道前列腺切除术时，同时进行一组新的21针活检。前瞻性记录人口统计学、临床和生物学数据、手术参数、病理结果及随访情况。
扩展活检的检出率为18.6%，检出了77.8%的前列腺癌。经尿道前列腺切除术使检出率显著提高了28.5%，总体前列腺癌检出率达到23.9%（p = 0.035）。芯片活检和/或穿刺活检检出的大多数前列腺癌具有临床意义，30%的患者评分为Gleason 7分或更高。前列腺切除标本中19%显示为pT3a - pT4期癌，Gleason评分中位数为7分。在无癌患者中，经尿道前列腺切除术后1年的平均前列腺特异性抗原为4.5 ng/ml（范围0.3至16.3），随访期间保持稳定。其中三分之一的患者接受了重复活检，前列腺癌检出率为16.7%。
约四分之一至少有2次扩展阴性前列腺活检的患者仍有患前列腺癌的风险，大多数在初次检查时漏诊的肿瘤具有临床意义。使用全身麻醉进行重复活检可检出这些前列腺癌中的四分之三。然而，经尿道前列腺切除术的诊断价值似乎很显著，可能为部分明智的患者提供具有临床重要性的额外数据。
