Department of Radiation Oncology, University of Washington, Seattle, WA, USA.
Prostate Cancer Prostatic Dis. 2010 Mar;13(1):71-7. doi: 10.1038/pcan.2009.42. Epub 2009 Sep 29.
Transrectal ultrasound (TRUS) biopsy can miss 20-30% of clinically significant cancers. We evaluate an alternative approach-transperineal template-guided mapping biopsy (TTMB) in the initial and repeat biopsy setting. From January 2005 through September 2008, 373 consecutive men underwent TTMB (294 men with > or =1 prior negative biopsy and 79 men as the initial biopsy). The location of each positive biopsy core, number of positive cores, and percent involvement of each core was recorded. Cancer detection rate for the initial biopsy was 75.9%. For men with 1, 2, and > or =3 prior negative biopsies detection rates were 55.5%, 41.7%, and 34.4%, respectively. In all, 55.5% of the cancers identified were Gleason > or =7. The majority of the cancers were multifocal. There was no significant change in the number of positive cores or Gleason score as the number of prior biopsies increased. The anterior and apical aspects of the prostate were among the most common cancer locations. TTMB provides a high rate of cancer detection as initial and repeat biopsy. TTMB was particularly effective at diagnosing anterior and apical cancer. TTMB may have particular application for men considering active surveillance, with prior negative TRUS biopsies, and those considering subtotal gland or other minimally invasive treatments.
经直肠超声（TRUS）活检可能会错过 20-30%的具有临床意义的癌症。我们评估了一种替代方法——经会阴模板引导的图谱活检（TTMB）在初始和重复活检中的应用。从 2005 年 1 月至 2008 年 9 月，373 例连续男性患者接受了 TTMB（294 例患者有>1 次阴性活检，79 例患者为初始活检）。记录了每个阳性活检核心的位置、阳性核心的数量以及每个核心的参与程度。初始活检的癌症检出率为 75.9%。对于有 1、2 和>1 次阴性活检的患者，检出率分别为 55.5%、41.7%和 34.4%。所有检出的癌症中，Gleason>7 的比例为 55.5%。大多数癌症是多灶性的。随着活检次数的增加，阳性核心的数量或 Gleason 评分没有明显变化。前列腺的前侧和顶端是最常见的癌症部位。TTMB 作为初始和重复活检，提供了较高的癌症检出率。TTMB 在诊断前侧和顶端癌症方面尤其有效。TTMB 可能特别适用于考虑主动监测、有先前阴性 TRUS 活检、考虑部分前列腺切除或其他微创治疗的男性。
