Mustafa Mahmoud Othman, Pisters Louis
Department of Urology, An-najah National University, Nablus, Palestine.
Department of Urology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA.
Turk J Urol. 2015 Mar;41(1):32-8. doi: 10.5152/tud.2015.91249.
Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist.
自从首次报道经直肠超声引导下六分区活检的有效性以来，为提高前列腺癌（PCa）的检出率，在活检针数总数及活检定位方面出现了许多改进。2010年美国国立综合癌症网络早期PCa检测指南将12针活检方案列为标准方案。然而，这种扩展活检方案仍无法检测出20%可通过根治性前列腺切除术详细病理评估检测到的高级别PCa；因此，需要进行饱和活检。先前活检结果为阴性后仍怀疑存在PCa是进行饱和活检的有效指征。当饱和活检方案与扩展活检方案联合使用时，发病率或无意义PCa检出率并无显著增加。随着PCa检出率的提高，PCa的精确肿瘤定位是饱和活检的另一个重要考量因素。初始治疗失败后理想的活检针数以及饱和活检的诊断价值是一些需要解决的问题。初步报告显示，磁共振成像可提高PCa检出率，使患者免于不必要的活检，并减少对大量活检针数的需求；然而，多种局限性仍然存在。
