Division of Urology, University of Colorado Denver, Aurora, Colorado, USA.
J Urol. 2011 Jul;186(1):80-5. doi: 10.1016/j.juro.2011.03.005. Epub 2011 May 14.
We determined the impact of a grid based, transperineal 3-dimensional mapping biopsy on decision making for primary management of early stage prostate cancer.
We prospectively performed 3-dimensional mapping biopsy on 180 consecutive men who presented to our clinic between 2006 and 2009 with early stage, organ confined prostate cancer based on transrectal ultrasound guided 10 to 12-core biopsy, and on 35 with prior negative transrectal ultrasound biopsies.
At presentation median patient age was 60.5 years (range 43 to 77), median prostate specific antigen was 4.8 ng/ml (range 0.5 to 72.4) and median prostate volume was 35 cc (range 9 to 95). The median number of cores acquired by transrectal ultrasound and 3-dimensional mapping biopsy was 12 and 56, and the median number of positive cores was 1 and 2, respectively. We documented Gleason score upgrade in 49 of 180 cases (27.2%) and up-stage in 82 (45.6%). The incidence of urinary retention catheter requirement of greater than 48 hours was 3.2% and the incidence of transient orthostatic hypotension was 5%. No urinary tract infections were documented. A total of 38 men received radical extirpative therapy, 11 radiation and 45 cryotherapy while 60 enrolled in a targeted focal therapy study, 44 entered active surveillance and 5 underwent other focal investigational treatments. Post-mapping data on 12 men were not available for analysis.
Three-dimensional mapping biopsy revealed that a significant portion of men initially diagnosed with apparently low risk disease harbored clinically significant cancers requiring more aggressive therapy. The technique also enabled a number of men with low risk disease to elect surveillance or another less morbid option.
我们旨在确定基于网格的经会阴三维定位活检对早期局限性前列腺癌初始管理决策的影响。
我们前瞻性地对 180 例于 2006 年至 2009 年间因经直肠超声引导下 10-12 针核心穿刺活检诊断为早期局限性前列腺癌而就诊于我科的患者（根据前列腺特异性抗原水平和直肠指诊结果）进行了三维定位穿刺活检，其中 35 例患者之前经直肠超声引导下穿刺活检结果为阴性。
患者的中位年龄为 60.5 岁（范围 43-77 岁），中位前列腺特异性抗原水平为 4.8ng/ml（范围 0.5-72.4ng/ml），中位前列腺体积为 35cc（范围 9-95cc）。经直肠超声和三维定位活检的中位穿刺针数分别为 12 针和 56 针，阳性针数分别为 1 针和 2 针。我们发现 180 例患者中有 49 例（27.2%）出现 Gleason 评分升级，82 例（45.6%）出现临床分期升级。需要留置导尿管>48 小时的发生率为 3.2%，一过性体位性低血压的发生率为 5%。无泌尿道感染的发生。38 例患者接受了根治性切除术，11 例患者接受了放疗，45 例患者接受了冷冻治疗，60 例患者入组了靶向局限性治疗研究，44 例患者入组了主动监测，5 例患者接受了其他局限性研究性治疗。由于缺少 12 例患者的定位后数据，我们无法对其进行分析。
三维定位活检显示，一部分最初诊断为低危局限性前列腺癌的患者实际上存在具有临床意义的癌症，需要更积极的治疗。该技术还使一部分低危局限性前列腺癌患者可以选择监测或其他较少导致身体不适的治疗方案。
