Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Urol. 2021 Oct;206(4):894-902. doi: 10.1097/JU.0000000000001902. Epub 2021 Jun 8.
The freehand (FH) technique of transperineal prostate biopsy using commercialized needle access systems facilitates a reduction in anesthesia requirements from general to local or local/sedation. We sought to compare the efficacy and complication rates of the FH method with those of the standard grid-based (GB) method.
The GB method was performed from 2014 to 2018, and the updated FH technique was performed from 2018 to 2020, yielding comparative cohorts of 174 and 304, respectively.
The FH and GB techniques demonstrated equivalent yields of ≥Gleason grade group (GGG)-2 prostate cancer (PCa). The FH group had a significantly higher mean number of cores with ≥GGG-2 PCa involvement (p=0.011) but a significantly lower mean number of biopsy samples (p <0.01). The urinary retention rate of the GB group (10%) was significantly higher than that of the FH group (1%; p <0.01). The rates of ≥GGG-2 PCa involvement in the anterior (GB, 31%) and anteromedial (FH, 22%) sectors were higher than those in other sectors (range, 0%-9%). For multiparametric magnetic resonance imaging, the rate of ≥GGG-2 PCa detection in the anteromedial prostate (23%) was nearly half that in other locations (range, 38%-55%).
Compared with GB transperineal biopsy, FH transperineal biopsy demonstrates an equivalent cancer yield with no risk of sepsis, a significantly reduced risk of urinary retention, and reduced anesthesia needs. The higher number of cores with ≥GGG-2 PCa involvement in the FH group suggests that FH transperineal biopsy can sample the prostate better than GB-transperineal biopsy can.
使用商业化的针道系统进行经会阴前列腺自由手（FH）活检可减少从全身麻醉到局部麻醉或局部/镇静的麻醉需求。我们旨在比较 FH 方法与标准网格（GB）方法的疗效和并发症发生率。
GB 方法于 2014 年至 2018 年进行，更新后的 FH 技术于 2018 年至 2020 年进行，分别得到了 174 例和 304 例的比较队列。
FH 和 GB 技术在≥Gleason 分级组（GGG）-2 前列腺癌（PCa）的阳性率方面相当。FH 组具有更高的≥GGG-2 PCa 累及核心的平均数量（p=0.011），但活检样本的平均数量明显较少（p<0.01）。GB 组的尿潴留率（10%）显著高于 FH 组（1%）（p<0.01）。GB 组前（GB，31%）和前内侧（FH，22%）区的≥GGG-2 PCa 累及率高于其他区（范围，0%-9%）。对于多参数磁共振成像，前内侧前列腺（FH，23%）的≥GGG-2 PCa 检出率接近其他部位（范围，38%-55%）的一半。
与 GB 经会阴活检相比，FH 经会阴活检具有相同的癌症阳性率，没有脓毒症风险，尿潴留风险显著降低，麻醉需求降低。FH 组中更多的≥GGG-2 PCa 累及核心提示 FH 经会阴活检比 GB 经会阴活检能更好地采样前列腺。
