Department of Urology, Wirral University Teaching Hospital, Wirral, UK.
BJU Int. 2013 Jun;111(8):E365-73. doi: 10.1111/bju.12134.
To determine the incidence of prostate cancer (PCa), and pathological grade and location of PCa, using a modified transperineal template-guided saturation biopsy (TTSB). To compare the acute urinary retention (AUR) rate found using modified TTSB with that of published reports.
A total of 270 consecutive patients with persistent clinical suspicion of PCa, despite a median (range) of 2 (1-6) sets of negative transrectal ultrasonography-guided biopsies, were enrolled and prospectively studied. All underwent modified TTSB avoiding the peri-urethral area at the base of the prostate under general anaesthesia. Statistical analysis was performed using binary logistic regression to determine the prebiopsy predictors of PCa and AUR.
The median (range) patient age was 64 (43-85) years, with a median (range) prostate-specific antigen (PSA) of 10 (1-114) ng/mL and median (range) prostate volume of 45 (17-106) mL. A mean (range) of 28 (16-43) cores were taken at modified TTSB. Prostate cancer was diagnosed in 54.8% (Gleason scores 6 in 27.7%, 7 in 43.2%, 8-10 in 29.1% of patients). The anterior third only was involved in 21%, the middle third in 6.8% and the posterior third in 8.7% of positive cases, although in 75% of positive cases there was some anterior involvement. Comparing uniquely anterior tumours with the 15.5% found uniquely in either the middle or posterior thirds, there was no significant difference between number of positive cores (2 vs 1, P = 0.091), maximum percentage core involvement (30 vs 17.5%, P = 0.315) and maximum tumour length (3.5 vs 2 mm, P = 0.092). Fourteen patients (5.2%) developed AUR. On multivariate analysis, PSA density (PSAD) and pre-TTSB PSA predicted PCa diagnosis, whilst prostate volume, prebiopsy PSA and PSAD predicted AUR.
Modified TTSB has a high cancer yield, especially in the anterior region, in patients with previously negative histology but onward suspicion of PCa. The modified TTSB technique provides a low risk of AUR without compromising cancer yield.
使用改良经会阴模板引导的饱和活检（TTSB）确定前列腺癌（PCa）的发生率以及 PCa 的病理分级和位置。将改良 TTSB 后发生急性尿潴留（AUR）的发生率与已发表的报告进行比较。
共纳入 270 例持续存在临床前列腺癌可疑症状的连续患者，尽管已经进行了中位数（范围）为 2 次（1-6 次）经直肠超声引导下活检，但均为阴性。所有患者均在全身麻醉下接受改良 TTSB，避免前列腺底部的尿道周围区域。使用二元逻辑回归分析确定 PCa 和 AUR 的术前预测因素。
中位（范围）患者年龄为 64（43-85）岁，中位（范围）前列腺特异性抗原（PSA）为 10（1-114）ng/mL，中位（范围）前列腺体积为 45（17-106）mL。改良 TTSB 取平均（范围）28（16-43）个芯。54.8%（Gleason 评分 6 分占 27.7%，7 分占 43.2%，8-10 分占 29.1%）的患者诊断为前列腺癌。前三分只占 21%，中三分占 6.8%，后三分占 8.7%的阳性病例，尽管 75%的阳性病例有一些前部分涉及。与仅在前三分之一处发现的 15.5%的独特肿瘤相比，阳性核心数量（2 对 1，P=0.091）、核心受累最大百分比（30 对 17.5%，P=0.315）和最大肿瘤长度（3.5 对 2mm，P=0.092）没有显著差异。14 例（5.2%）患者发生 AUR。多变量分析显示，PSA 密度（PSAD）和 TTSB 前 PSA 预测 PCa 诊断，而前列腺体积、TTSB 前 PSA 和 PSAD 预测 AUR。
改良 TTSB 在先前组织学阴性但仍怀疑患有前列腺癌的患者中具有较高的癌症检出率，特别是在前区。改良 TTSB 技术可降低发生 AUR 的风险，同时不会降低癌症检出率。
