Tan Teck Wei, Png Keng Siang, Lee Chau Hung, Yuwono Arianto, Yeow Yuyi, Chong Kian Tai, Lee Yee Mun, Tan Cher Heng, Tan Yung Khan
1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore .
2 Department of Diagnostic Radiology, Tan Tock Seng Hospital , Singapore, Singapore .
J Endourol. 2017 Nov;31(11):1111-1116. doi: 10.1089/end.2017.0485. Epub 2017 Sep 15.
To test the hypothesis that targeted biopsy has a higher detection rate for clinically significant prostate cancer (csPCa) than systematic biopsy. We defined csPCa as any Gleason sum ≥7 cancer. In patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, to determine if factors, such as prostate-specific antigen density (PSAD) and prostate health index (PHI), can predict csPCa and help select patients for biopsy.
We report the first series of targeted biopsies in Southeast Asian men, with comparison against systematic biopsy. Consecutive patients were registered into a prospective institutional review board-approved database in our institution. We reviewed patients who underwent biopsy from May 2016 to June 2017. Inclusion criteria for our study were patients with at least one PI-RADS ≥3, and who underwent both targeted and systematic biopsies in the same sitting.
There were 115 patients in the study, of whom 74 (64.3%) had a previous negative systematic biopsy. Targeted biopsies detected significantly less Gleason 6 cancers than systematic biopsies (p < 0.01), and demonstrated significantly higher sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for the detection of csPCa. For patients with PI-RADS 3 lesions, PHI and PSAD were found to be the best predictors for csPCa. PSAD <0.10 ng/mL/mL had an NPV of 93% and sensitivity of 92%, while allowing 20% of patients to avoid biopsy. PHI cutoff of <27 would allow 34% of patients to avoid biopsy, with both sensitivity and NPV of 100%.
Targeted prostate biopsies were found to be significantly superior to systematic biopsies for the detection of csPCa, while detecting less Gleason 6 cancer. Usage of PSAD and PHI cutoff levels in patients with PI-RADS 3 lesions may enable a number of patients to avoid unnecessary biopsy.
验证靶向活检对临床显著前列腺癌（csPCa）的检出率高于系统活检的假说。我们将csPCa定义为任何Gleason评分总和≥7的癌症。对于前列腺影像报告和数据系统（PI-RADS）3类病变的患者，确定诸如前列腺特异性抗原密度（PSAD）和前列腺健康指数（PHI）等因素是否能够预测csPCa并帮助选择活检患者。
我们报告了东南亚男性的首批靶向活检系列，并与系统活检进行比较。连续的患者被纳入我们机构一项经前瞻性机构审查委员会批准的数据库。我们回顾了2016年5月至2017年6月期间接受活检的患者。本研究的纳入标准为至少有一个PI-RADS≥3且在同一次检查中同时接受靶向和系统活检的患者。
本研究中有115例患者，其中74例（占64.3%）之前系统活检结果为阴性。靶向活检检测到的Gleason 6级癌症明显少于系统活检（p < 0.01），并且在检测csPCa方面显示出显著更高的敏感性、特异性、阳性预测值和阴性预测值（NPV）。对于PI-RADS 3类病变的患者，发现PHI和PSAD是csPCa的最佳预测指标。PSAD < 0.10 ng/mL/mL的NPV为93%，敏感性为92%，同时可使20%的患者避免活检。PHI临界值< 27可使34%的患者避免活检，敏感性和NPV均为100%。
发现靶向前列腺活检在检测csPCa方面明显优于系统活检，同时检测到的Gleason 6级癌症更少。在PI-RADS 3类病变的患者中使用PSAD和PHI临界值水平可能使一些患者避免不必要活检。
