Giulianelli Roberto, Brunori Stefano, Gentile Barbara Cristina, Vincenti Giorgio, Nardoni Stefano, Pisanti Francesco, Shestani Teuta, Mavilla Luca, Albanesi Luca, Attisani Francesco, Mirabile Gabriella, Schettini Manlio
Division of Urology, Villa Tiberia Clinic, Rome, Italy.
Arch Ital Urol Androl. 2011 Sep;83(3):154-9.
Aim of this study was to evaluate if saturation biopsy (SB) technique increases the cancer detection rate in patients with PSA < 10 ng/ml, after a first negative biopsy.
From January 2004 to January 2006, 780 patients underwent prostate ultrasound guided transrectal (UGT) core biopsy: 186 (23.8%) presented prostate cancer (PCa) while 594 pts (76.2%), were disease free. For 1 year all the patients with no evidence of cancer were observed according to a follow-up schedule including PSA every 3 months and DRE every 6 months. During this period 140 patients showed an increase of PSA (< 10 ng/ml) or a low PSA free/total. This group underwent a second prostate UGT core biopsy with SB technique. In all the patients we evaluated PCa detection rates (DR) according to the PSA range. We also checked peri/post-operative complication rate (total post-operative hospitalization time, haemoglobin loss, catheterisation rate, pain rate, QOL).
Of the 140 patients 50 (35.7%) had PCa showing a Gleason score (GS) of 4 or 5 in 26%, 6 or 7 in 75% and 8 to 10 in 9% respectively. Sectors apical biopsies carried out in the anterior horn of peripheral zone tissue presented over 70% (35 patients) of cancer detection rate. Rectal bleeding was the major common complication. Cancer was clinically significant in 47 patients (94%) but 34 (68%) presented an organ confined disease after radical surgery.
SB technique increases of 35.7% the cancer detection rate (DR) in patients with PSA < 10 ng/ml, after a first negative biopsy, showing a higher positivity (70% PCaDR) if the SB included the anterior horn of peripheral zone tissue. No significantly pain and side effects were observed.
本研究的目的是评估在首次活检为阴性后，饱和活检（SB）技术是否能提高前列腺特异性抗原（PSA）<10 ng/ml患者的癌症检出率。
2004年1月至2006年1月，780例患者接受了前列腺超声引导下经直肠（UGT）穿刺活检：186例（23.8%）患有前列腺癌（PCa），而594例（76.2%）无疾病。对所有无癌症证据的患者进行为期1年的观察，随访计划包括每3个月检测一次PSA，每6个月进行一次直肠指检（DRE）。在此期间，140例患者PSA升高（<10 ng/ml）或游离/总PSA水平较低。该组患者采用SB技术进行了第二次前列腺UGT穿刺活检。我们根据PSA范围评估了所有患者的PCa检出率（DR）。我们还检查了围手术期/术后并发症发生率（术后总住院时间、血红蛋白丢失、导尿率、疼痛率、生活质量）。
140例患者中，50例（35.7%）患有PCa，Gleason评分（GS）为4或5的占26%，6或7的占75%，8至10的占9%。在外周带组织前角进行的尖部活检癌症检出率超过70%（35例患者）。直肠出血是主要的常见并发症。47例（94%）患者的癌症具有临床意义，但34例（68%）患者在根治性手术后表现为器官局限性疾病。
SB技术使首次活检为阴性后PSA<10 ng/ml患者的癌症检出率（DR）提高了35.7%；如果SB包括外周带组织前角，则阳性率更高（70%的PCaDR）。未观察到明显疼痛和副作用。
