Department of Urology, Singapore General Hospital, Singapore, Singapore.
Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
BJU Int. 2020 Nov;126(5):568-576. doi: 10.1111/bju.15118. Epub 2020 Sep 14.
To compare the detection rates of prostate cancer between systematic biopsy and targeted biopsy using a stereotactic robot-assisted transperineal prostate platform.
We identified consecutive patients with suspicious lesion(s) on multiparametric magnetic resonance imaging (mpMRI), who underwent both systematic and MRI-transrectal ultrasonography (US) fusion targeted biopsy using our proprietary transperineal robot-assisted prostate biopsy platform between January 2015 and January 2019 at our institution, for retrospective analysis. Comparative analysis was performed between systematic and targeted biopsy using McNemar's test, and the cohort was further stratified by prior biopsy status and Prostate Imaging Reporting and Data System (PI-RADS) v2.0 score. International Society of Urological Pathology (ISUP) grade group (GG) ≥2 cancers (previously known as Gleason grade ≥7) were considered to be clinically significant.
A total of 500 patients were included in our final analysis, of whom 67 (13%) were patients with low-risk cancer on active surveillance. Of the 433 patients without prior diagnosis of cancer, 288 (67%) were biopsy-naïve. A total of 248 (57%) were diagnosed with prostate cancer, with 199 (46%) having clinically significant prostate cancer (ISUP GG ≥2). There were no statistically significant differences in the overall prostate cancer and clinically significant prostate cancer detection rate between systematic and targeted biopsy (51% vs 49% and 40% vs 38% respectively; P = 0.306 and P = 0.609). Of the 248 prostate cancers detected, 75% (187/248) were detected on both systematic and targeted biopsy, 14% (35/248) were detected on systematic biopsy alone and 11% (26/248) were detected on targeted biopsy alone. Of the 199 clinically significant cancers detected, 69% (138/199) were detected on both systematic and targeted biopsy, 17% (33/199) on systematic biopsy alone and 14% (28/199) on targeted biopsy alone. There were no statistically significant differences in the detection rate between systematic and targeted biopsy for both overall and clinically significant prostate cancer, even when the cohort was stratified by prior biopsy status and PI-RADS score. Targeted biopsy has greater sampling efficiency compared to systematic biopsy for both overall and clinically significant prostate cancer (23.2% vs 9.8%, P < 0.001 and 14.8% vs 5.6%, P < 0.001).
Using our robot-assisted transperineal prostate platform, combined MRI-US targeted biopsy with concurrent systematic prostate systematic biopsy probably represents the optimal method for the detection of clinically significant prostate cancer.
比较使用立体定向机器人辅助经会阴前列腺平台的系统活检和靶向活检对前列腺癌的检出率。
我们回顾性分析了 2015 年 1 月至 2019 年 1 月期间，在我院使用我们专有的经会阴机器人辅助前列腺活检平台对疑似病变（s）进行多参数磁共振成像（mpMRI）检查的连续患者。对系统活检和靶向活检进行了 McNemar 检验的比较分析，并根据既往活检史和前列腺影像报告和数据系统（PI-RADS）v2.0 评分对队列进行了进一步分层。国际泌尿病理学会（ISUP）分级组（GG）≥2 级（以前称为 Gleason 分级≥7）癌症被认为具有临床意义。
我们的最终分析共纳入 500 例患者，其中 67 例（13%）为主动监测的低危癌症患者。在 433 例无既往癌症诊断的患者中，288 例（67%）为首次活检。共诊断出 248 例前列腺癌，其中 199 例（46%）为具有临床意义的前列腺癌（ISUP GG≥2）。系统活检和靶向活检的总体前列腺癌和具有临床意义的前列腺癌检出率无统计学差异（分别为 51%比 49%和 40%比 38%；P=0.306 和 P=0.609）。在检测到的 248 例前列腺癌中，75%（187/248）在系统活检和靶向活检中均有检出，14%（35/248）仅在系统活检中检出，11%（26/248）仅在靶向活检中检出。在检测到的 199 例具有临床意义的癌症中，69%（138/199）在系统活检和靶向活检中均有检出，17%（33/199）仅在系统活检中检出，14%（28/199）仅在靶向活检中检出。即使根据既往活检史和 PI-RADS 评分对队列进行分层，系统活检和靶向活检在检测总体和具有临床意义的前列腺癌方面的检出率也无统计学差异。靶向活检在检测总体和具有临床意义的前列腺癌方面的采样效率均高于系统活检（23.2%比 9.8%，P<0.001 和 14.8%比 5.6%，P<0.001）。
使用我们的机器人辅助经会阴前列腺平台，联合 MRI-US 靶向活检和同期系统前列腺系统活检可能是检测具有临床意义的前列腺癌的最佳方法。
