Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Int Urol Nephrol. 2021 Dec;53(12):2445-2452. doi: 10.1007/s11255-021-03007-1. Epub 2021 Oct 8.
Accurate assessment of Gleason grade is essential to guiding prostate cancer management. Not all healthcare systems have universal access to prostate MRI. We investigated whether transperineal (TP) prostate biopsies provide more accurate Gleason grading than transrectal (TR) biopsies in MRI-naïve patients.
Consecutive patients undergoing TP and TR systematic prostate needle biopsies from 2011 to 2018 were analysed. Patients who underwent radical prostatectomy (RP) within 180 days of biopsies were included. Patients undergoing MRI prior to biopsies were excluded. Pathological concordance, incidence of Gleason upgrading, and correlation coefficients among biopsies and RP Gleason grade were compared. A sub-analysis for concordance in anterior prostate tumours was conducted.
262 patients were included (112 TP; 150 TR), the median age was 63 years, and median time from biopsy to RP was 68 days. Concordance with RP histology for TP was 65% compared to 49% for TR (p = 0.011). Biopsy technique predicted RP concordance independent of the number of cores. Gleason upgrading occurred following 24% of TP versus 33% of TR biopsies. In anterior and apical tumours, upgrading occurred in 19% of TP biopsies and 38% of TR biopsies (p = 0.027).
This study suggests TP approach to prostate biopsies result in improved histological grade accuracy in men whom MRI is not available, even after controlling for number of cores. TP approach also resulted in less upgrading for lesions in the anterior and apical prostate compared to TR.
准确评估 Gleason 分级对于指导前列腺癌的管理至关重要。并非所有医疗体系都能普遍获得前列腺 MRI。我们研究了在 MRI 检查为阴性的患者中，经会阴（TP）前列腺活检与经直肠（TR）活检相比，是否能提供更准确的 Gleason 分级。
分析了 2011 年至 2018 年期间连续接受 TP 和 TR 系统前列腺穿刺活检的患者。将在活检后 180 天内行根治性前列腺切除术（RP）的患者纳入研究。排除在活检前进行 MRI 检查的患者。比较了活检与 RP Gleason 分级之间的病理一致性、Gleason 升级发生率以及活检之间的相关系数。还进行了前位前列腺肿瘤一致性的亚分析。
共纳入 262 例患者（112 例 TP；150 例 TR），中位年龄为 63 岁，活检至 RP 的中位时间为 68 天。与 TR 活检相比，TP 活检与 RP 组织学的一致性为 65%，而 TR 活检为 49%（p=0.011）。活检技术可独立于活检针数预测 RP 一致性。24%的 TP 活检出现 Gleason 升级，而 33%的 TR 活检出现 Gleason 升级。在前位和尖位肿瘤中，TP 活检的升级发生率为 19%，TR 活检的升级发生率为 38%（p=0.027）。
本研究表明，对于无法进行 MRI 检查的男性，TP 前列腺活检方法可提高组织学分级的准确性，即使控制活检针数也是如此。与 TR 相比，TP 方法在前位和尖位前列腺病变中导致升级的情况更少。
