Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.
World J Urol. 2019 Feb;37(2):277-287. doi: 10.1007/s00345-018-02622-5. Epub 2019 Jan 4.
To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP).
We performed a literature search of peer-reviewed English language articles using PubMed and the words "prostate" AND "biopsy". Web search was implemented by manual search.
Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx-TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues.
The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.
回顾当前前列腺活检争议相关的证据。具体探讨的问题有：（1）mpMRI 靶向（TgBx）与系统（SBx）联合活检；（2）认知与基于软件的靶向活检；（3）经直肠或经会阴途径（TP）。
我们使用 PubMed 检索了同行评议的英文文献，并使用了“前列腺”和“活检”这两个词进行搜索。网络搜索通过手动搜索实现。
前列腺 mpMRI 正在彻底改变前列腺癌（PCa）的诊断方式，与单独 SBx 相比，TgBx 提高了临床显著（cs）PCa 的检出率。SBx-TgBx 的联合应用具有不同的效果，但在非专家中心，应将两者结合起来，以克服学习曲线的局限性。在专家中心是否应保留 SBx，取决于泌尿科医生和患者愿意接受的遗漏癌症的比率；这对诊断非显著癌症也有影响。尽管一些研究表明认知性 TgBx 不劣于其他方法，但基于软件的 TgBx 可能更精确，并且可能适用于可触及的大病灶。TP 活检可在门诊环境中进行。避免直肠和几乎所有前列腺区域的可触及性是吸引人的特点。然而，这需要与当地环境和资源情况相平衡。正在进行的试验将为尚未解决的问题提供答案。
前列腺活检策略应根据当地专业知识、需求和资源可用性进行定制。靶向活检提高了 cs 和非显著癌症诊断的比值，尽管可能会遗漏一些 csPCa。基于软件的 TgBx 可能更精确，特别是对于新用户而言，尽管在所有情况下增加的成本可能都不合理。TPBx 具有进行 TgBx 和避免感染的理想特性，尽管这需要资源支持。
