Glickman Urological and Kidney Institute and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2011 Sep;186(3):850-4. doi: 10.1016/j.juro.2011.04.069. Epub 2011 Jul 23.
Multiple studies have shown significant prostate cancer detection for repeat biopsy. However, the best approach regarding core number and location remains controversial. Transrectal saturation biopsy is believed to increase cancer detection but to our knowledge no studies comparing it to 12 to 14-core extended biopsy have been published. We compared saturation and extended repeat biopsy protocols after initially negative biopsy.
A total of 1,056 men underwent prostate biopsy after initially negative biopsy. The extended biopsy group included 393 men with 12 to 14-core repeat biopsy. The saturation biopsy group included 663 men with 20 to 24-core repeat biopsy. We analyzed demographics and prostate cancer between the 2 groups. We compared prostate cancer detection in patients with previous atypical small acinar proliferation and/or high grade prostatic intraepithelial neoplasia as well as the risk of detecting clinically insignificant tumors.
Prostate cancer was detected in 315 of the 1,056 patients (29.8%). Saturation biopsy detected almost a third more cancers (32.7% vs 24.9%, p=0.0075). In patients with a benign initial biopsy saturation biopsy achieved significantly greater prostate cancer detection (33.3% vs 25.6%, p=0.027). For previous atypical small acinar proliferation and/or high grade prostatic intraepithelial neoplasia there was a trend toward higher prostate cancer detection rate in the saturation group but it did not attain statistical significance (31.2% vs 23.3%, p=0.13). Of 315 positive biopsies 119 (37.8%) revealed clinically insignificant cancer (40.1% vs 32.6%, p=0.2).
Compared to extended biopsy, office based saturation biopsy significantly increases cancer detection on repeat biopsy. The potential for increased detection of clinically insignificant cancer should be weighed against missing significant cases.
多项研究表明，重复活检可显著提高前列腺癌的检出率。然而，关于核心数量和位置的最佳方法仍存在争议。人们认为经直肠饱和活检可以提高癌症检出率，但据我们所知，尚未有研究将其与 12 至 14 芯扩展活检进行比较。我们比较了初次活检阴性后饱和和扩展重复活检方案。
共有 1056 名男性在初次活检阴性后接受了前列腺活检。扩展活检组包括 393 名接受 12 至 14 芯重复活检的男性。饱和活检组包括 663 名接受 20 至 24 芯重复活检的男性。我们分析了两组患者的人口统计学特征和前列腺癌。我们比较了既往存在非典型小腺泡增生和/或高级别前列腺上皮内瘤变的患者以及检测到临床无意义肿瘤的风险之间的前列腺癌检出率。
1056 名患者中有 315 名（29.8%）检出前列腺癌。饱和活检组检出的癌症几乎多了三分之一（32.7%比 24.9%，p=0.0075）。在初次活检为良性的患者中，饱和活检组显著提高了前列腺癌的检出率（33.3%比 25.6%，p=0.027）。对于既往存在非典型小腺泡增生和/或高级别前列腺上皮内瘤变的患者，饱和组的前列腺癌检出率呈上升趋势，但未达到统计学意义（31.2%比 23.3%，p=0.13）。在 315 例阳性活检中，119 例（37.8%）为临床无意义的癌症（40.1%比 32.6%，p=0.2）。
与扩展活检相比，基于诊室的饱和活检显著提高了重复活检的癌症检出率。应权衡增加检出临床无意义癌症的可能性与错过显著病例的风险。
