Western University , London , Ontario , Canada.
Division of Urology, North York General Hospital , Toronto , Ontario , Canada.
J Urol. 2019 Jun;201(6):1121-1126. doi: 10.1097/JU.0000000000000156.
We report our experience with transperineal prostate biopsy as well as the cancer diagnosis rate, complications and patient tolerability in 1,287 consecutive patients at risk for prostate cancer.
Beginning in October 2016 transperineal prostate biopsy was performed using local anesthesia in all patients undergoing prostate biopsy. Data on prebiopsy characteristics and results, including the cancer detection rate, complications and patient tolerability scores, were collected retrospectively from patient records.
The cancer detection rate of transperineal prostate biopsy was 49.8% (641 of 1,287 patients). Clinically significant prostate cancer was detected in 385 patients and 62 (9.7%) had exclusively anterior zone pathology findings. Urinary retention developed in 20 patients (1.6%) following transperineal prostate biopsy, requiring temporary catheterization. In 4 patients (0.3%) lower urinary tract symptoms were suggestive of infection but only 1 had a positive urine culture. The only hospital admission was for a patient with persistent hypotension after biopsy. Patients tolerated transperineal prostate biopsy reasonably well and generally reported only mild levels of discomfort on a pain visual analogue scale. Infiltration of the anesthesia was rated more painful than the biopsy.
Transperineal prostate biopsy with the patient under local anesthesia is a feasible alternative to transrectal biopsy in the detection of prostate cancer. Transperineal prostate biopsy has an acceptable cancer detection rate with additional detection of anterior zone cancers. It is a safer alternative in patients due to the low risk of complications, in particular urosepsis, and it is well tolerated. Transperineal prostate biopsy using local anesthesia could be considered a standard modality for the initial diagnosis of prostate cancer.
我们报告了在 1287 例有前列腺癌风险的连续患者中，经会阴前列腺活检的经验以及癌症诊断率、并发症和患者耐受性。
从 2016 年 10 月开始，所有接受前列腺活检的患者均在局部麻醉下进行经会阴前列腺活检。从患者记录中回顾性收集了活检前特征和结果的数据，包括癌症检出率、并发症和患者耐受性评分。
经会阴前列腺活检的癌症检出率为 49.8%（1287 例患者中有 641 例）。在 385 例患者中发现了临床显著的前列腺癌，62 例（9.7%）仅存在前区病理表现。经会阴前列腺活检后 20 例（1.6%）发生尿潴留，需要临时导尿。4 例（0.3%）下尿路症状提示感染，但仅有 1 例尿液培养阳性。唯一的住院病例是一名活检后持续低血压的患者。患者经会阴前列腺活检耐受性良好，通常仅报告轻度疼痛视觉模拟评分。麻醉浸润比活检更痛。
在检测前列腺癌方面，局部麻醉下经会阴前列腺活检是经直肠活检的可行替代方法。经会阴前列腺活检具有可接受的癌症检出率，并额外检出前区癌症。由于并发症风险较低，特别是尿脓毒症，因此对患者更安全，并且耐受性良好。局部麻醉下的经会阴前列腺活检可被视为前列腺癌初始诊断的标准方法。
