Department of Urology, Oslo University Hospital(,) Oslo. Norway; University of Oslo(,) Oslo. Norway.
Department of Urology Vivantes Am Urban, Berlin, Germany.
Urol Oncol. 2021 Jul;39(7):432.e1-432.e7. doi: 10.1016/j.urolonc.2020.11.009. Epub 2020 Nov 27.
Transperineal Prostate biopsies (TPBx) are usually performed under general anesthesia without image fusion. This study aimed to evaluate prostate cancer (Pca) detection rates (CDR), pain, and adverse events using a novel, free-hand TPBx technique, based on elastic fusion of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) under local anesthesia.
This multicenter retrospective study included all consecutive patients scheduled for a TPBx. All had clinical suspicion of Pca, active surveillance scheduled for a re-biopsy, or suspicion of local recurrence after previous treatment. Bi-parametric or multiparametric MRI was performed in all patients and classified as positive in the case of Prostate Imaging-Reporting and Data System (PIRADS) suspicion ≥3. At least 1 targeted TPBx was realized from each PIRADS ≥3 index lesion. Six to 12 systematic random TPBx were done in patients with negative MRI. All biopsies were performed under local anesthesia in an outpatient clinic with MRI-TRUS fusion and the 3D navigation system Trinity Perine (Koelis, France). Any- and clinically significant Pca (csPca) (ISUP gr. ≥2) was recorded. Biopsy-related pain and adverse events were reported according to a visual analogue score of 0-10.
In total, 377 patients were included for analyses. The mean age was 67 years (95% Confidence Interval: 66-68) and the median prostate-specific antigen was 7.2 ng/ml (interquartile range [IQR] 4.8-11.0). MRI was negative in 6% and positive in 94%. The median MRI prostate volume was 43 ml (IQR 31-60) and the median MRI index tumor volume was 0.9 ml (IQR 0.5-2.1). The median number of TPBx was 4 (IQR 3-4). The overall detection of any- and csPca was 64% and 52%, respectively. The overall CDR according to PIRADS 3, 4, and 5 was 30%, 70%, and 94%, respectively. In patients with negative MRI, any- and csPca was detected in 23% and 9%, respectively. The median visual analogue score score was 2 (IQR 1-3, range 0-7). Two patients (0.5%) developed postbiopsy infection, of which one developed urosepsis. Treatment requiring haematuria or urinary retention did not occur.
Free-hand MRI/TRUS fusion-guided and systematic random TPBx in LA is a feasible, safe, and well-tolerated technique for diagnosing Pca.
经会阴前列腺活检（TPBx）通常在全身麻醉下进行，而不进行图像融合。本研究旨在评估一种新的、徒手 TPBx 技术的前列腺癌（Pca）检出率（CDR）、疼痛和不良事件，该技术基于局部麻醉下磁共振成像（MRI）和经直肠超声（TRUS）的弹性融合。
这是一项多中心回顾性研究，纳入了所有计划进行 TPBx 的连续患者。所有患者均有 Pca 的临床可疑症状、主动监测计划进行再次活检、或怀疑既往治疗后局部复发。所有患者均进行双参数或多参数 MRI 检查，前列腺影像报告和数据系统（PIRADS）可疑度≥3 时诊断为阳性。从每个 PIRADS≥3 指数病变中至少进行一次靶向 TPBx。MRI 阴性的患者进行 6-12 次系统随机 TPBx。所有活检均在门诊进行，采用 MRI-TRUS 融合和 Trinity Perine（Koelis，法国）3D 导航系统进行。记录任何有意义的和临床显著的前列腺癌（csPca）（国际泌尿病理学会分级≥2）。根据视觉模拟评分（0-10）报告活检相关疼痛和不良事件。
共纳入 377 例患者进行分析。平均年龄为 67 岁（95%置信区间：66-68），中位前列腺特异性抗原为 7.2ng/ml（四分位距[IQR]：4.8-11.0）。MRI 阴性率为 6%，阳性率为 94%。MRI 前列腺体积中位数为 43ml（IQR：31-60），MRI 指数肿瘤体积中位数为 0.9ml（IQR：0.5-2.1）。TPBx 中位数为 4 次（IQR：3-4）。总检出任何有意义的和 csPca 的比例分别为 64%和 52%。根据 PIRADS 3、4 和 5，总的检出率分别为 30%、70%和 94%。MRI 阴性的患者中，任何有意义的和 csPca 的检出率分别为 23%和 9%。中位数视觉模拟评分（VAS）为 2（IQR：1-3，范围：0-7）。2 名患者（0.5%）发生活检后感染，其中 1 例发生脓毒症。未发生血尿或尿潴留需要治疗的情况。
LA 下自由手 MRI/TRUS 融合引导和系统随机 TPBx 是一种可行、安全且耐受良好的诊断 Pca 技术。
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