Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
World J Urol. 2018 Apr;36(4):623-628. doi: 10.1007/s00345-018-2178-x. Epub 2018 Jan 13.
To assess whether real-time elastography-targeted biopsy (RTE-bx) is superior to the standard systematic transrectal ultrasound (TRUS)-guided biopsy in predicting subsequent prostate cancer (PCa) rates in patients with initially negative biopsy and to specifically reveal differences in the occurrence of high-grade (Gleason ≥ 4 + 3) PCa by comparing both biopsy methods.
Overall, 630 patients had an initially negative prostate biopsy between 2007 and 2015, either RTE targeted (n = 213) or systematically (n = 417). Follow-up data, ascertained by a questionnaire, of patients receiving RTE-bx were compared to data of patients receiving systematic biopsy (sbx) using Mann-Whitney-U test and Chi-square test. We performed logistic regression analyses to assess any association with PCa or high-grade PCa occurrence.
In total, 258 (41%) patients were diagnosed with PCa at repeat biopsy whereof 54 (8.6%) harboured high-grade PCa. PCa occurred in 95 (44.6%) patients with initially negative RTE-bx and in 163 (39.1%) patients with initially negative sbx (p = 0.003). 24 (11.3%) patients receiving RTE-bx and 30 (7.2%) patients receiving sbx were diagnosed with high-grade PCa (p = 0.095). Logistic regression analyses showed that patients with the initial RTE-bx vs. those with the initial sbx neither resulted in a significant higher risk for PCa occurrence (OR 1.35 [CI 0.87-2.1]; p = 0.2) nor for high-grade PCa occurrence (OR 1.52 [CI 0.66-3.35]; p = 0.3).
We found no statistically significant association of prior biopsy method to subsequent PCa or high-grade PCa occurrence. Referring to our analyses, RTE is not superior to sbx in predicting subsequent PCa rates and, therefore, not eligible to decide on repeat biopsy.
评估实时超声弹性成像靶向活检（RTE-bx）是否优于标准系统经直肠超声（TRUS）引导活检，以预测初次活检阴性患者的后续前列腺癌（PCa）发生率，并通过比较两种活检方法来具体揭示高级别（Gleason≥4+3）PCa 的发生差异。
2007 年至 2015 年间，共有 630 例患者初次活检结果为阴性，分别接受 RTE 靶向（n=213）或系统（n=417）活检。通过问卷调查获得接受 RTE-bx 治疗的患者的随访数据，并与接受系统活检（sbx）的患者的数据进行比较，使用 Mann-Whitney-U 检验和卡方检验。我们进行了逻辑回归分析，以评估与 PCa 或高级别 PCa 发生的任何关联。
共有 258 例（41%）患者在重复活检中被诊断为 PCa，其中 54 例（8.6%）为高级别 PCa。在初次 RTE-bx 阴性的 95 例（44.6%）患者和初次 sbx 阴性的 163 例（39.1%）患者中发生了 PCa（p=0.003）。接受 RTE-bx 的 24 例（11.3%）患者和接受 sbx 的 30 例（7.2%）患者被诊断为高级别 PCa（p=0.095）。逻辑回归分析显示，与初次 sbx 相比，初次 RTE-bx 患者的 PCa 发生率（OR 1.35[CI 0.87-2.1]；p=0.2）和高级别 PCa 发生率（OR 1.52[CI 0.66-3.35]；p=0.3）均无显著差异。
我们没有发现先前活检方法与后续 PCa 或高级别 PCa 发生之间存在统计学显著关联。根据我们的分析，RTE 并不能在预测后续 PCa 发生率方面优于 sbx，因此不适合决定重复活检。
