Xing Nian-Zeng, Wang Ming-Shuai, Fu Qiang, Yang Fei-Ya, Li Chang-Ling, Li Ya-Jian, Han Su-Jun, Xiao Ze-Jun, Ping Hao
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
World J Clin Cases. 2019 Jun 26;7(12):1403-1409. doi: 10.12998/wjcc.v7.i12.1403.
Routinely, after receiving prostate specific antigen (PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy.
To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.
From June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive Ga-PSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients.
All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year, the mean body mass index was 24.7 ± 1.6 kg/m, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 mL, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively.
The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.
通常情况下，在接受前列腺特异性抗原（PSA）检测和直肠指检后，疑似前列腺癌的患者需要接受前列腺活检。然而，超声引导下前列腺活检检测前列腺癌的能力有限。如今，多种诊断方法以及更敏感的诊断方法，如多参数前列腺磁共振成像（mpMRI）和前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA PET/CT）已可应用于临床。此外，腹腔镜/机器人辅助前列腺切除术也是治疗良性前列腺增生的一种安全有效的手术方式。所以或许是时候重新考虑在根治性前列腺切除术前行前列腺活检的必要性了。
探讨在新成像技术和微创技术时代，不进行前列腺活检而行根治性前列腺切除术的可行性。
2014年6月至2018年11月，参与本研究的三家三级医疗中心对11例未进行前列腺活检的患者实施了腹腔镜根治性前列腺切除术。所有患者均接受了前列腺磁共振成像检查且疑似前列腺癌，其中6例患者Ga-PSMA PET/CT结果呈阳性。所有患者均接受了腹腔镜根治性前列腺切除术及盆腔淋巴结清扫术。
所有手术均成功完成。患者平均年龄为69±7.7岁，平均体重指数为24.7±1.6kg/m²，血清PSA范围为4.3至>1000ng/mL，平均前列腺体积为40.9±18.3mL。平均手术时间为96±23.3分钟，平均估计失血量为90±90.9mL，导尿管留置时间中位数为14天。最终病理证实，除1例良性前列腺增生外，所有标本均为前列腺癌。术后90天内未发生重大并发症。
在新成像技术和微创技术时代，应重新考虑前列腺切除术前强制进行前列腺活检的现行做法。在无恶性肿瘤证据的情况下也可进行根治性前列腺切除术。肯定需要大样本随机对照试验来证实这一新概念的可行性。
