Division of Urology, Department of Surgery, Taichung Arm Force General Hospital, Taichung, Taiwan, ROC; Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC.
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2018 Dec;81(12):1044-1051. doi: 10.1016/j.jcma.2018.06.003. Epub 2018 Aug 9.
Although prostate biopsy is an accepted option for cancer detection, there is little data regarding the clinical outcome of 18-core transrectal ultrasound (TRUS)-guided biopsy. This retrospective study compared cancer detection rates and biopsy complications between 12- and 18-core TRUS biopsy in Asian patients with prostate-specific antigen (PSA) levels between 4.0 and 20.0 ng/mL.
In total, 1120 consecutive patients with PSA levels between 4.0 and 20.0 ng/mL were divided into the 12-core (552 patients) and 18-core TRUS biopsy (568 patients) groups. The clinical outcomes of the 12- and 18-core TRUS-biopsy groups were compared. Clinical outcomes were evaluated by comparing the prostate cancer detection rates and post-biopsy complication rates.
There were no significant group differences in the PSA levels, but the mean age was significantly older in the 12-core biopsy group than in the 18-core biopsy group (mean age, 67.0 vs. 64.0 years, respectively; p = 0.001). The abnormal digital rectal examination rate was higher in the 12-core biopsy group than in the 18-core biopsy group (39.9% vs. 24.5%, respectively; p < 0.001). The prostate cancer detection rate was significantly higher in the 18-core group than in the 12-core group [adjusted odds ratio: 2.75, 95% confidence interval = 2.04-3.01; p < 0.001], especially in patients with age ≥ 50 years, PSA < 10 and cancer clinical stage cT1. (p < 0.001). Moreover, in patients with prostate volumes >30 mL or PSA densities <0.2, the prostate cancer detection rate was significantly higher in the 18-core group than in the 12-core group. There were no differences in the complication rates (e.g., urinary retention, hematuria, urinary tract infection, and urosepsis).
In Asian patients with serum PSA levels between 4.0 and 20.0 ng/mL, 18-core biopsy was associated with superior clinical outcomes to those of 12-core biopsy for detecting prostate cancer.
虽然前列腺活检是一种公认的癌症检测方法，但关于血清前列腺特异性抗原（PSA）水平在 4.0 至 20.0ng/mL 之间的亚洲患者中，18 针经直肠超声（TRUS）引导活检的临床结果的数据却很少。本回顾性研究比较了 PSA 水平在 4.0 至 20.0ng/mL 之间的患者中，12 针和 18 针 TRUS 活检的癌症检出率和活检并发症。
共纳入 1120 例 PSA 水平在 4.0 至 20.0ng/mL 之间的连续患者，分为 12 针（552 例）和 18 针 TRUS 活检（568 例）组。比较两组的临床结果。通过比较前列腺癌检出率和活检后并发症发生率来评估临床结果。
两组 PSA 水平无显著差异，但 12 针活检组的平均年龄明显大于 18 针活检组（平均年龄分别为 67.0 岁和 64.0 岁；p=0.001）。12 针活检组异常直肠指诊率高于 18 针活检组（分别为 39.9%和 24.5%；p<0.001）。18 针活检组的前列腺癌检出率明显高于 12 针活检组[调整后的优势比：2.75，95%置信区间为 2.04-3.01；p<0.001]，尤其是年龄≥50 岁、PSA<10 且癌症临床分期 cT1 的患者（p<0.001）。此外，在前列腺体积>30ml 或 PSA 密度<0.2 的患者中，18 针活检组的前列腺癌检出率明显高于 12 针活检组。两组的并发症发生率（如尿潴留、血尿、尿路感染和脓毒症）无差异。
在 PSA 水平在 4.0 至 20.0ng/mL 之间的亚洲患者中，18 针活检在检测前列腺癌方面的临床结果优于 12 针活检。
