Ekin Rahmi Gokhan, Zorlu Ferruh, Akarken Ilker, Yildirim Zubeyde, Tarhan Huseyin, Koc Gokhan, Kucuk Ulku, Bayol Umit
Tepecik Teaching and Research Hospital, Urology.
Departments of Urology, Tepecik Teaching and Research Hospital, Izmir, Turkey.
Urol J. 2015 Apr 29;12(2):2084-9.
To examine the effect of routine sampling anterior apical cores in the initial prostate biopsy among patients that 14-cores of prostate biopsy (PB) planned.
Five-hundred twenty-eight patients with increased prostate-specific antigen (PSA) levels and/or abnormal digital rectal examination underwent transrectal ultrasound and initial PB between November 2012 and October 2013. We performed routine 12-cores extended PB, plus 2 anterior apex samples that were taken from the junction of urethra and apex of the prostate. Site-specific and unique cancer detection rate, tumor characteristics, the presence of clinically insignificant prostate cancer (PCa) (clinical stage ≤ T1, serum PSA level of < 10 ng/mL, biopsy Gleason score ≤ 6, number of positive biopsy cores ≤ 3 and no core with > 50% involvement) and biopsy-related pain were evaluated.
PCa was detected in 147 of 451 patients (32.6%). The lateral base of the prostate was the most affected area with 128 of 451 patients (28.3%), followed by unique cancer detection, with 17 of 40 patients (43.5%). Anterior apex (n = 6) was in third place after the lateral apex (n = 8). The patients diagnosed by anterior apex cores were all clinically insignificant PCa. The cancer diagnosis rate would be 31% if 12-cores biopsy was used, but the rate was found to be 32.6% in 14-cores biopsy (P = .016). Average biopsy pain, right anterior apex biopsy pain, and left anterior apex biopsy pain were found to register at 0.61, 1.06 and 1.08 points in the visual analog scale pain score, respectively. When right and left anterior apex biopsy pain is compared to average biopsy pain, the pain level was found to be statistically significantly higher in the biopsies of right and left anterior apex (P = .040 and P = .042, respectively).
The gold standard for the diagnosis of PCa is at least 8 cores PB. According to our results, although most PCa diagnosis is carried out with 14-cores PB, it should not be forgotten that these patients might have clinically insignificant PCa.
在计划进行14针前列腺穿刺活检（PB）的患者中，研究初始前列腺穿刺时常规采集前列腺尖部前侧组织样本的效果。
2012年11月至2013年10月期间，528例前列腺特异性抗原（PSA）水平升高和/或直肠指检异常的患者接受了经直肠超声检查和初始PB。我们进行了常规的12针扩展PB，并从尿道与前列腺尖部的交界处采集了2份前列腺尖部前侧样本。评估了特定部位和独特癌症的检出率、肿瘤特征、临床意义不显著的前列腺癌（PCa）（临床分期≤T1，血清PSA水平<10 ng/mL，穿刺活检Gleason评分≤6，阳性穿刺活检针数≤3且无针数累及>50%）的存在情况以及与穿刺活检相关的疼痛。
451例患者中有147例（32.6%）检测出PCa。前列腺外侧基部是受影响最严重的区域，451例患者中有128例（28.3%），其次是独特癌症的检出，40例患者中有17例（43.5%）。前列腺尖部前侧（n = 6）排在外侧尖部（n = 8）之后位列第三。通过前列腺尖部前侧组织样本确诊的患者均为临床意义不显著的PCa。如果采用12针穿刺活检，癌症诊断率为31%，但在14针穿刺活检中该率为32.6%（P = 0.016）。在视觉模拟量表疼痛评分中，平均穿刺活检疼痛、右侧前列腺尖部前侧穿刺活检疼痛和左侧前列腺尖部前侧穿刺活检疼痛分别为0.61、1.06和1.08分。当将右侧和左侧前列腺尖部前侧穿刺活检疼痛与平均穿刺活检疼痛进行比较时，发现右侧和左侧前列腺尖部前侧穿刺活检的疼痛程度在统计学上显著更高（分别为P = 0.040和P = 0.042）。
PCa诊断的金标准是至少8针PB。根据我们的结果，虽然大多数PCa诊断是通过14针PB进行的，但不应忘记这些患者可能患有临床意义不显著的PCa。
