Demirtaş Türev, Gur Ahmet, Golbasi Abdullah, Sönmez Gökhan, Tombul Şevket T, Demirtaş Abdullah
History of Medicine and Ethics, Erciyes University, Kayseri, TUR.
Urology, Kayseri City Hospital, Kayseri, TUR.
Cureus. 2021 Oct 24;13(10):e19002. doi: 10.7759/cureus.19002. eCollection 2021 Oct.
Objective Fusion prostate biopsy (FPB) has become a popular technique in biopsy-naïve patients, though not accepted as a standard approach (yet). In this study, we aimed to present the clinical outcomes of biopsy-naïve patients who underwent FPB. Material and methods The study included 400 biopsy-naïve patients aged 45-75 years who had a prostate-specific antigen (PSA) level of 2-10 ng/ml and were detected with a Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion on multiparametric prostate magnetic resonance imaging (mpMRI)-guided FPB. A combined biopsy (CB) was performed in each patient, in which 2-4 cores were obtained for suspicious lesions by targeted biopsy (TB) and then 12-core standard prostate biopsy (SPB) was conducted in the same session. Cancer detection rates, clinically significant prostate cancer (csPCa) detection rates, histological upgrading rates, and false negative rates were determined. Results The 400 patients had a mean age of 62.01±7.00 years and a mean PSA value of 6.84±1.87 ng/ml. Overall PCa detection rate was 50% (200/400). The csPCa detection rates for TB, SPB, and CB were 25.0%, 31.8%, and 44.0%, respectively (p<0.001). In PIRADS 3, 4, and 5 lesions, CB had a csPCa detection rate of 29.2%, 54%, and 64.8%, respectively (p<0.001). The ratio of false negativity was significantly higher for TB compared to SPB (43.2% vs. 27.8%, p=0.003), whereas no significant difference was found between these two techniques with regard to upgrading rates although TB had a higher rate (19.6% vs. 13.7%, p=0.144). Conclusion FPB, a combined approach involving TB and SPB, was revealed as the most successful technique in biopsy-naïve patients with PSA<10 ng/ml due to its high cancer detection rates and low false negative rates.
目的 融合前列腺穿刺活检（FPB）在未经穿刺活检的患者中已成为一种常用技术，尽管尚未被接受为标准方法。在本研究中，我们旨在呈现接受FPB的未经穿刺活检患者的临床结果。
材料与方法 本研究纳入了400例年龄在45至75岁之间、前列腺特异性抗原（PSA）水平为2至10 ng/ml且在多参数前列腺磁共振成像（mpMRI）引导下的FPB中检测到前列腺影像报告和数据系统（PIRADS）≥3级病变的未经穿刺活检患者。对每位患者进行联合活检（CB），通过靶向活检（TB）获取2至4个针对可疑病变的组织芯，然后在同一次检查中进行12芯标准前列腺穿刺活检（SPB）。确定癌症检出率、临床显著前列腺癌（csPCa）检出率、组织学升级率和假阴性率。
结果 400例患者的平均年龄为62.01±7.00岁，平均PSA值为6.84±1.87 ng/ml。总体前列腺癌检出率为50%（200/400）。TB、SPB和CB的csPCa检出率分别为25.0%、31.8%和44.0%（p<0.001）。在PIRADS 3、4和5级病变中，CB的csPCa检出率分别为29.2%、54%和64.8%（p<0.001）。与SPB相比，TB的假阴性率显著更高（43.2%对27.8%，p=0.003），尽管TB的升级率更高（19.6%对13.7%，p=0.144），但这两种技术在升级率方面未发现显著差异。
结论 FPB是一种结合了TB和SPB的方法，由于其高癌症检出率和低假阴性率，在PSA<10 ng/ml的未经穿刺活检患者中被证明是最成功的技术。
