Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France; GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie-Université Paris 06, Paris, France.
J Urol. 2015 Sep;194(3):669-73. doi: 10.1016/j.juro.2015.03.025. Epub 2015 Mar 14.
We assessed the accuracy of magnetic resonance imaging/transrectal ultrasound fusion biopsies to diagnose prostate cancer according to gland size.
A prospective study was performed in 232 men with a first round biopsy, multiparametric magnetic resonance imaging with a lesion, a Likert score of 2 or greater and prostate specific antigen less than 10 ng/ml. All men underwent a standard 12-core protocol plus a protocol of 2 or 3 targeted cores. Significant prostate cancer was defined as at least 1 core with a Gleason score of 7 (3 + 4) or 6 with a greater than 4 mm maximal cancer core length.
Mean ± SD patient age was 64 ± 6.4 years, mean prostate specific antigen was 6.65 ± 1.8 ng/ml and mean prostate volume was 40 ± 24.3 ml. The overall detection rate of clinically significant prostate cancer was 44%. The detection rate of clinically significant prostate cancer by magnetic resonance imaging-transrectal ultrasound fusion guided biopsy was 77% for prostate glands less than 30 cm(3), and 61%, 47% and 34% for glands 30 to less than 38.5, 38.5 to less than 55 and 55 to 160 cm(3), respectively (p = 0.001). Differences in prostate cancer detection rates between the standard and targeted protocols were not significant for patients with a prostate volume of 40 cm(3) or less (p = 0.8). Conversely 12 patients with a prostate volume greater than 40 cm(3) had clinically significant prostate cancer using the targeted but not the standard protocol and in 3 prostate cancer was detected by the standard but not the targeted protocol (p = 0.04).
Magnetic resonance imaging-transrectal ultrasound fusion biopsies increased the yield of first round prostate biopsies in patients with a prostate volume greater than 40 cm(3).
我们根据腺体大小评估磁共振成像/经直肠超声融合活检诊断前列腺癌的准确性。
对 232 名首次行前列腺穿刺活检、多参数磁共振成像发现病灶、Likert 评分 2 分或以上且前列腺特异性抗原（PSA）<10ng/ml 的男性进行前瞻性研究。所有男性均行标准 12 针穿刺活检加 2 针或 3 针靶向穿刺。有意义的前列腺癌定义为至少 1 针前列腺穿刺活检的 Gleason 评分为 7（3+4）或 6 分且最大癌灶长度>4mm。
患者平均年龄为 64±6.4 岁，平均 PSA 为 6.65±1.8ng/ml，平均前列腺体积为 40±24.3ml。临床显著前列腺癌的总检出率为 44%。前列腺体积<30cm3 时，磁共振成像-经直肠超声融合引导活检诊断临床显著前列腺癌的检出率为 77%，前列腺体积 3038.5cm3、38.555cm3、55~160cm3 时，检出率分别为 61%、47%和 34%（p=0.001）。对于前列腺体积<40cm3 的患者，标准和靶向穿刺活检的前列腺癌检出率差异无统计学意义（p=0.8）。相反，前列腺体积>40cm3 的 12 例患者采用靶向穿刺活检可检出临床显著前列腺癌，而采用标准穿刺活检时仅 3 例检出（p=0.04）。
对于前列腺体积>40cm3 的患者，磁共振成像-经直肠超声融合活检可提高首次前列腺穿刺活检的检出率。
