Nafie Shady, Wanis Michael, Khan Masood
Department of Urology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom.
Urol J. 2017 Mar 16;14(2):3008-3012.
We have previously demonstrated that transperineal template prostate biopsy (TPTPB) has a significantly higher cancer detection rate compared to transrectal ultrasound guided (TRUS) biopsy in biopsy naive men with a PSA < 20 ng/mL. We, therefore, performed a prospective study to determine whether TPTPB is still superior to TRUS biopsy in the detection of prostate cancer in men with persistently elevated PSA after one previous negative set of TRUS biopsies.
42 patients with a background of one previous negative set of TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling digital rectal examination (DRE) underwent simultaneous standard 12-core TRUS biopsy and 36-core TPTPB under general anaesthesia. We determined the prostate cancer detection rate between the two diagnostic modalities.
Mean age was 65 years (range: 50-75), mean prostate volume was 59 cc (range: 21-152), mean PSA is 8.3 ng/L (range: 4.4-19), mean time difference between the study and the previous TRUS biopsy was 33 months (range: 1-150) with mean PSA velocity of 0.7 ng/mL/year (range: 0-8). Out of the 42 patients, 22 (52%) had benign pathology. Of the 20 patients (48%) diagnosed with prostate cancer, 4 (10%) had positive results in both TRUS biopsy and TPTPB, 1 (2%) had positive result in TRUS biopsy with negative TPTPB, while 15 (36%) had negative TRUS biopsy with positive TPTPB. Hence, TRUS biopsy detected cancer in 5/42 (12%) patients versus (19/42) 45% detected by TPTPB (P < 0.01). 13/19 (68%) of cancers detected by TPTPB had Gleason score ≥7. A total of 82/141 (58%) of positive cores was found in the anterior zone. One patient (2%) experienced urosepsis, 2 (5%) temporary urinary retention, 14 (34%) mild haematuria and 13 (32%) haematospermia.
TPTPB still shows a significantly higher prostate cancer detection rate compared to TRUS biopsy (12% versus 45%, P < 0.01) in men with a previous set of negative TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling prostate on DRE.
我们之前已经证明，对于前列腺特异性抗原（PSA）<20 ng/mL且初次接受活检的男性，经会阴模板引导下前列腺穿刺活检（TPTPB）的癌症检出率显著高于经直肠超声引导（TRUS）下穿刺活检。因此，我们进行了一项前瞻性研究，以确定在之前一组TRUS活检结果为阴性但PSA持续升高的男性中，TPTPB在前列腺癌检测方面是否仍优于TRUS活检。
42例患者曾有一组TRUS活检结果为阴性，PSA持续升高（但<20 ng/mL）且直肠指检（DRE）前列腺质地正常，在全身麻醉下同时接受标准的12针TRUS活检和36针TPTPB。我们确定了两种诊断方式的前列腺癌检出率。
平均年龄为65岁（范围：50 - 75岁），平均前列腺体积为59立方厘米（范围：21 - 152立方厘米），平均PSA为8.3 ng/L（范围：4.4 - 19 ng/L），本次研究与上次TRUS活检之间的平均时间间隔为33个月（范围：1 - 150个月），平均PSA速率为0.7 ng/mL/年（范围：0 - 8 ng/mL/年）。42例患者中，22例（52%）病理结果为良性。在20例（48%）诊断为前列腺癌的患者中，4例（10%）TRUS活检和TPTPB结果均为阳性，1例（2%）TRUS活检阳性而TPTPB阴性，15例（36%）TRUS活检阴性而TPTPB阳性。因此，TRUS活检在5/42（12%）的患者中检测到癌症，而TPTPB在19/42（45%）的患者中检测到癌症（P<0.01）。TPTPB检测到的癌症中，13/19（68%）的Gleason评分≥7分。在前区共发现82/141（58%）个阳性穿刺针芯。1例患者（2%）发生尿脓毒症，2例（5%）出现暂时性尿潴留，14例（34%）有轻度血尿，13例（32%）有血精。
对于之前TRUS活检结果为阴性、PSA持续升高（但<20 ng/mL）且DRE检查前列腺质地正常的男性，TPTPB的前列腺癌检出率仍显著高于TRUS活检（12%对45%，P<0.01）。
