He Bi-Ming, Chen Rui, Shi Zhen-Kai, Xiao Guang-An, Li Hu-Sheng, Lin Heng-Zhi, Ji Jin, Peng Hong-Xiang, Wang Yan, Sun Ying-Hao, Wang Hai-Feng
Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China.
Front Oncol. 2019 Aug 9;9:758. doi: 10.3389/fonc.2019.00758. eCollection 2019.
The present study aimed to investigate the diagnostic efficacy and the regional location of prostate cancer (PCa) as well as the accuracy of assessment between trans-perineal template-guided mapping biopsy (TTMB) and freehand trans-perineal biopsy (FTPB) for men with PSA < 20 ng/ml. Thus, we evaluated 623 consecutive patients with PSA < 20 ng/ml who had prostate biopsies in our institute between July 2017 and September 2018. Patients were divided into two groups based on different biopsy methods: 217 (34.83%) patients with TTMB and 406 (65.17%) with FTPB. Thirty six patients with TTMB and 80 with FTPB had continued undergone radical prostatectomy after a cancer diagnosis. Then the Gleason score of the biopsy and the post-radical prostatectomy specimens in each patient were compared. Overall, the PCa detection rate was 34.35%. There was no significant difference in PCa detection rate between TTMB and FTPB (35.48 vs. 33.74%, respectively; = 0.663). Besides, the detection rate of significant PCa (Gleason score ≥ 7) in TTMB was 29.03% while FTPB was 23.89% ( = 0.162). The detection rate at the apex of the prostate was higher than the detection rate at the base of the prostate (9.80 vs. 5.79%; < 0.01) when performing the TTMB. The FTPB would miss 10% of the positive diagnosis and almost half of the lesions. The upgraded of Gleason score from biopsy to post-radical prostatectomy was 16.67% with the TTMB and 36.25% with the FTPB ( = 0.034). The TTMB had a similar cancer detection rate, but a higher lesion detection rate and more accuracy in assess the actual Gleason score when comparing to FTPB for men with PSA < 20 ng/ml. By performing a 20-core TTMB, the cancer detection rate at the apex of the prostate was higher than the base.
本研究旨在调查前列腺癌（PCa）的诊断效能、区域定位，以及经会阴模板引导穿刺活检（TTMB）和徒手经会阴穿刺活检（FTPB）对PSA<20 ng/ml男性患者的评估准确性。因此，我们评估了2017年7月至2018年9月期间在我院进行前列腺活检的623例连续PSA<20 ng/ml的患者。根据不同的活检方法将患者分为两组：217例（34.83%）接受TTMB的患者和406例（65.17%）接受FTPB的患者。36例接受TTMB的患者和80例接受FTPB的患者在癌症诊断后继续接受了根治性前列腺切除术。然后比较了每位患者活检标本和根治性前列腺切除术后标本的Gleason评分。总体而言，PCa检出率为34.35%。TTMB和FTPB之间的PCa检出率无显著差异（分别为35.48%和33.74%；P = 0.663）。此外，TTMB中显著PCa（Gleason评分≥7）的检出率为29.03%，而FTPB为23.89%（P = 0.162）。进行TTMB时，前列腺尖部的检出率高于前列腺底部的检出率（9.80%对5.79%；P<0.01）。FTPB会漏诊10%的阳性诊断病例，且几乎漏诊一半的病变。从活检到根治性前列腺切除术后Gleason评分升级的比例，TTMB为16.67%，FTPB为36.25%（P = 0.034）。对于PSA<20 ng/ml的男性患者，与FTPB相比，TTMB具有相似的癌症检出率，但病变检出率更高，且在评估实际Gleason评分方面更准确。通过进行20针的TTMB，前列腺尖部的癌症检出率高于底部。
