Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
Department of Urology, West China Hospital, Sichuan University, West China School of Medicine, Chengdu 610041, China.
Asian J Androl. 2019 Nov-Dec;21(6):612-617. doi: 10.4103/aja.aja_16_19.
This study compared the diagnostic efficacy of transrectal ultrasound (TRUS)-guided prostate biopsy (TRBx) and transperineal prostate biopsy (TPBx) in patients with suspected prostate cancer (PCa). We enrolled 2962 men who underwent transrectal (n = 1216) or transperineal (n = 1746) systematic 12-core prostate biopsy. Clinical data including age, prostate-specific antigen (PSA) level, and prostate volume (PV) were recorded. To minimize confounding, we performed propensity score-matching analysis. We measured and compared PCa detection rates between TRBx and TPBx, which were stratified by clinical characteristics and Gleason scores. The effects of clinical characteristics on PCa detection rate were assessed by logistic regression. For all patients, TPBx detected a higher proportion of clinically significant PCa (P < 0.001). Logistic regression analyses illustrated that PV had a smaller impact on PCa detection rate of TPBx compared with TRBx. Propensity score-matching analysis showed that the detection rates in TRBx were higher than those in TPBx for patients aged >- 80 years (80.4% vs 56.5%, P = 0.004) and with PSA level 20.1-100.0 ng ml (80.8% vs 69.1%, P = 0.040). In conclusion, TPBx was associated with a higher detection rate of clinically significant PCa than TRBx was; however, because of the high detection rate at certain ages and PSA levels, biopsy approaches should be optimized according to patents' clinical characteristics.
这项研究比较了经直肠超声（TRUS）引导下前列腺活检（TRBx）和经会阴前列腺活检（TPBx）在疑似前列腺癌（PCa）患者中的诊断效果。我们纳入了 2962 名接受经直肠（n=1216）或经会阴（n=1746）系统 12 核前列腺活检的男性。记录了包括年龄、前列腺特异性抗原（PSA）水平和前列腺体积（PV）在内的临床数据。为了最大程度地减少混杂因素，我们进行了倾向评分匹配分析。我们根据临床特征和 Gleason 评分，测量并比较了 TRBx 和 TPBx 的 PCa 检出率。通过逻辑回归评估了临床特征对 PCa 检出率的影响。对于所有患者，TPBx 检测到更高比例的临床显著 PCa（P<0.001）。逻辑回归分析表明，与 TRBx 相比，PV 对 TPBx 的 PCa 检出率的影响较小。倾向评分匹配分析显示，对于年龄>80 岁（80.4%比 56.5%，P=0.004）和 PSA 水平为 20.1-100.0ng/ml（80.8%比 69.1%，P=0.040）的患者，TRBx 的检出率高于 TPBx。总之，TPBx 与更高的临床显著 PCa 检出率相关，但是由于某些年龄和 PSA 水平的高检出率，应根据患者的临床特征优化活检方法。
