Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol. 2014 Jun;65(6):1178-83. doi: 10.1016/j.eururo.2013.05.047. Epub 2013 Jun 4.
Using transrectal saturation prostate biopsy (SPBx) as an initial strategy remains a controversial topic.
To compare SPBx with extended prostate biopsy (EPBx) as an initial biopsy template in a large sequential cohort study.
DESIGN, SETTING, AND PARTICIPANTS: We reviewed 438 men with initial SPBx and 3338 men who underwent initial EPBx between January 2002 and October 2011.
Office-based SPBx under periprostatic local anesthesia.
The yield of SPBx was compared with EPBx. Multivariable logistic regression models addressed cancer detection (CD) and cancer characteristics.
Overall CD was 51.6% and 42.6% in men who underwent initial SPBx and EPBx, respectively. Multivariate analysis confirmed that SPBx was an independent predictor factor correlated with the CD (odds ratio [OR]: 1.66; 95% confidence interval [CI], 1.30-1.92). Stratified by prostate-specific antigen (PSA) values, CD was higher in SPBx compared with EPBx, 47.1% versus 32.8% (OR: 2.00; 95% CI, 1.19-3.38) in patients with a PSA <4 ng/ml and 50.9% versus 42.9% in patients with a PSA from 4 ng/ml to 9.9 ng/ml (OR: 1.62; 95% CI, 1.20-2.20). By contrast, SPBx did not increase CD in men with a PSA >10 ng/ml (60.0% vs 61%; OR: 1.42; 95% CI, 0.70-2.89). There was no significant difference in the detection of insignificant cancer (p = 0.223) or low-risk cancer (p = 0.077) between the two biopsy schemes. The limitation of our study is its retrospective nature and inhomogeneity.
Compared with EPBx, SPBx significantly increases CD as an initial biopsy strategy in men with a PSA <10 ng/ml without a significant increase in the detection of insignificant cancer. These findings suggest that SPBx may merit further investigation as an initial biopsy strategy in men with a PSA <10 ng/ml in hopes of avoiding repeat biopsy for missed malignancy during the initial biopsy.
经直肠前列腺饱和活检（SPBx）作为初始策略仍存在争议。
在一项大型连续队列研究中，比较 SPBx 与扩展前列腺活检（EPBx）作为初始活检方案。
设计、地点和参与者：我们回顾了 2002 年 1 月至 2011 年 10 月期间接受初始 SPBx 的 438 名男性和接受初始 EPBx 的 3338 名男性。
在前列腺周围局部麻醉下进行办公室内 SPBx。
比较 SPBx 与 EPBx 的活检产量。多变量逻辑回归模型解决了癌症检出（CD）和癌症特征问题。
初始 SPBx 和 EPBx 组的总体 CD 分别为 51.6%和 42.6%。多因素分析证实 SPBx 是与 CD 相关的独立预测因素（优势比[OR]：1.66；95%置信区间[CI]，1.30-1.92）。按前列腺特异性抗原（PSA）值分层，PSA<4ng/ml 时 SPBx 的 CD 高于 EPBx，分别为 47.1%和 32.8%（OR：2.00；95%CI，1.19-3.38），PSA 为 4ng/ml 至 9.9ng/ml 时为 50.9%和 42.9%（OR：1.62；95%CI，1.20-2.20）。相比之下，PSA>10ng/ml 时 SPBx 并未增加 CD（60.0% vs 61%；OR：1.42；95%CI，0.70-2.89）。两种活检方案在检出非显著性癌症（p=0.223）或低危癌症（p=0.077）方面无显著差异。本研究的局限性在于其回顾性和异质性。
与 EPBx 相比，SPBx 作为 PSA<10ng/ml 男性的初始活检策略，可显著提高 CD 检出率，且不会增加非显著性癌症的检出率。这些发现表明，SPBx 可能值得进一步研究，作为 PSA<10ng/ml 男性的初始活检策略，以避免在初始活检中漏诊恶性肿瘤而需要再次活检。
