Gil-Sousa Diogo, Oliveira-Reis Daniel, Tavares Catarina, Teves Frederico, Osório Luís, Gomes Manuel, Soares José, Fraga Avelino
Department of Urology. Hospital de Santo António. C.H.P. Porto. Portugal.
Department of Radiology. Hospital de Santo António. C.H.P. Porto. Portugal.
Arch Esp Urol. 2019 Sep;72(7):677-689.
Prostate Cancer (PC) is the most common malignancy in men, and a diagnosis can only be confirmed following a prostate biopsy (PB). 10-12 cores ultrasound-guided PB is currently the state of the art in the primary diagnosis of PC, presenting clear advantages in terms of detection rate of clinically significant PC, pathology concordance, and both positive and negative predictive value, when compared with the former classical sextant biopsy. Persistent clinical suspicion of PC despite previous negative PB is a challenging topic, with several serum and urinary markers, as well as imaging techniques, aiming to help in the optimal management of these patients.Currently, the most accepted and used methods in clinical practice to reduce the number of unnecessary PBs in this subset of patients are Prostate Cancer Antigen 3 (PCA3) and multiparametric MRI (mpMRI). These methods have shown to improve the diagnostic accuracy of prostatic rebiopsy, but there still aren't clear guidelines defining the optimal strategy in this setting. New biomarkers have been proposed in recent years with the aim of increasing specificity and distinguishing aggressive from non-aggressive PC, highlighting the emerging role of the Prostate Health Index (PHI) and the Four Kallikrein (4k) score. The aim of this review is to demonstrate the evolution to the actual standard 10-12 core ultrasound-guided PB, the indications and controversies concerning repeated PB and to explore the data regarding the potential role of the leading methods affecting the decision to rebiopse - PCA3 and mpMRI -, as well as new PC biomarkers used in the clinical practice (PHI and 4K score).
前列腺癌（PC）是男性中最常见的恶性肿瘤，只有在进行前列腺活检（PB）后才能确诊。目前，10 - 12针超声引导下的PB是PC初诊的先进技术，与以前的经典六分区活检相比，在临床显著性PC的检出率、病理一致性以及阳性和阴性预测值方面具有明显优势。尽管之前PB结果为阴性，但临床上对PC仍持续怀疑是一个具有挑战性的问题，有多种血清和尿液标志物以及成像技术旨在帮助优化这些患者的管理。目前，临床实践中最被接受和使用的减少这类患者不必要PB数量的方法是前列腺癌抗原3（PCA3）和多参数MRI（mpMRI）。这些方法已显示可提高前列腺再次活检的诊断准确性，但在这种情况下仍没有明确的指南来定义最佳策略。近年来提出了新的生物标志物，旨在提高特异性并区分侵袭性和非侵袭性PC，突出了前列腺健康指数（PHI）和四激肽释放酶（4k）评分的新作用。本综述的目的是展示向实际标准的10 - 12针超声引导下PB的演变、关于重复PB的适应证和争议，并探讨有关影响再次活检决策的主要方法——PCA3和mpMRI——以及临床实践中使用的新PC生物标志物（PHI和4K评分）的潜在作用的数据。
