University Vita-Salute/San Raffaele Hospital, Milan, Italy.
Urology. 2011 Apr;77(4):921-5. doi: 10.1016/j.urology.2010.08.048. Epub 2010 Dec 4.
To test the hypothesis that there is no significant difference in the rate of prostate cancer (PCa) detection rate between the transrectal and transperineal approach in men undergoing a saturation (24-core) prostate rebiopsy.
We evaluated 472 consecutive men who underwent a 24-core prostate rebiopsy at 2 tertiary referral centers. Of these, 70% (332) underwent a transrectal biopsy, and 30% (140) underwent a transperineal biopsy. Propensity score was used to match 280 patients with homogeneous characteristics; those represented the final study cohort. Univariable and multivariable logistic regression analyses were used to address the relationship between biopsy approach and PCa detection rate. Covariates consisted of age at biopsy, prostate-specific antigen, total prostate volume, digital rectal examination findings, histologic findings on previous biopsy, and the number of previous negative biopsy sets.
Overall, PCa detection rate was 28.6%. There was no statistically significant difference in PCa detection rate between the transrectal and transperineal approach (31.4% vs 25.7%, respectively; P = .3). The type of approach was not an independent predictor of PCa detection rate at multivariable analyses (odds ratio = 0.61, P = .1).
Transrectal and transperineal prostate saturation biopsies have a similar PCa detection rate in men undergoing a saturation rebiopsy. Both approaches can be offered to men undergoing a prostate rebiopsy without undermining the rate of PCa detection.
验证在接受饱和（24 核）前列腺再活检的男性中，经直肠和经会阴途径的前列腺癌（PCa）检出率没有显著差异的假设。
我们评估了在 2 个三级转诊中心接受 24 核前列腺再活检的 472 例连续男性患者。其中，70%（332 例）接受经直肠活检，30%（140 例）接受经会阴活检。采用倾向评分匹配具有同质特征的 280 例患者；这些患者代表最终的研究队列。采用单变量和多变量逻辑回归分析来探讨活检方法与 PCa 检出率之间的关系。协变量包括活检时的年龄、前列腺特异性抗原、前列腺总体积、直肠指检结果、既往活检的组织学结果以及之前阴性活检套数。
总体而言，PCa 检出率为 28.6%。经直肠和经会阴途径的 PCa 检出率之间没有统计学上的显著差异（分别为 31.4%和 25.7%；P =.3）。在多变量分析中，方法类型不是 PCa 检出率的独立预测因素（比值比=0.61，P =.1）。
在接受饱和前列腺再活检的男性中，经直肠和经会阴前列腺饱和活检的 PCa 检出率相似。两种方法都可以提供给接受前列腺再活检的男性，而不会降低 PCa 的检出率。
