Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany.
Department of Urology, Oslo University Hospital, Oslo, Norway.
World J Urol. 2021 Oct;39(10):3861-3866. doi: 10.1007/s00345-021-03699-1. Epub 2021 Apr 18.
The aim of this study was to assess the post biopsy infection rate, feasibility and prostate cancer (PCa) detection rate (CDR) by performing transperineal MRI-TRUS fusion biopsy of the prostate (TPBx) under local anesthesia (LA) without antibiotic prophylaxis (AP).
We prospectively screened 766 men with suspicious lesions on mpMRI, an elevated PSA level or a suspect digital examination undergoing MRI-TRUS-TPBx in LA, from May 2019 to July 2020. Patients with the need for antibiotic prophylaxis or without a PI-RADS target lesion were excluded from final analyses. We reported CDR, perioperative pain (0-10) and postoperative complications. PCa with an ISUP grade ≥ 2 was classified as clinically significant PCa (csPCa).
We included 621 patients with a median age of 68 years (IQR 62-74), a PSA of 6.43 ng/mL (IQR 4.72-9.91) and a prostate volume of 45 cc (IQR 32-64). In median, 4 targeted (TB) (IQR 3-4) and 6 (IQR 5-7) systematic biopsies (SB) detected in combination overall 416 (67%) PCa and 324 (52%) csPCa. Overall CDR of TB for PI-RADS 3, 4 and 5 was 26%, 65% and 84%, respectively. Patients reported a median perioperative pain level of 2 (IQR 1-3). Four patients (0.6%) developed a post biopsy infection, one experienced urosepsis.
Our results demonstrate that transperineal MRI-TRUS fusion-guided prostate biopsy under LA without AP is feasible, safe and well tolerated.
本研究旨在评估在局部麻醉（LA）下不进行抗生素预防（AP），经会阴 MRI-TRUS 融合前列腺活检（TPBx）的活检后感染率、可行性和前列腺癌（PCa）检出率（CDR）。
我们前瞻性筛选了 2019 年 5 月至 2020 年 7 月期间因 MRI 可疑病变、PSA 水平升高或可疑数字检查而接受 MRI-TRUS-TPBx 的 766 名男性患者。最终分析排除了需要抗生素预防或没有 PI-RADS 靶病变的患者。我们报告了 CDR、围手术期疼痛（0-10 分）和术后并发症。ISUP 分级≥2 的 PCa 被归类为临床显著 PCa（csPCa）。
我们纳入了 621 名中位年龄为 68 岁（IQR 62-74）、PSA 为 6.43ng/mL（IQR 4.72-9.91）和前列腺体积为 45cc（IQR 32-64）的患者。中位数 4 个靶向（TB）（IQR 3-4）和 6 个（IQR 5-7）系统活检（SB）联合检测出 416 例（67%）PCa 和 324 例（52%）csPCa。TB 的 PI-RADS 3、4 和 5 的总体 CDR 分别为 26%、65%和 84%。患者报告的中位围手术期疼痛水平为 2 分（IQR 1-3）。4 名患者（0.6%）发生活检后感染，1 名患者发生尿脓毒症。
我们的结果表明，LA 下经会阴 MRI-TRUS 融合引导的前列腺活检在不进行 AP 的情况下是可行的、安全的且可耐受。
