Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Int Urol Nephrol. 2023 May;55(5):1133-1137. doi: 10.1007/s11255-023-03531-2. Epub 2023 Mar 14.
To assess the efficacy of 2-core prostate biopsy in advanced prostate cancer patients. This included a retrospective analysis of 12-core prostate biopsies and a prospective validation that a reduced number of cores are sufficient for histopathological diagnosis.
The first phase analyzed retrospective data from 12-core prostate biopsies between January 2013 and 2018. In the second phase, from January 2018 to January 2022, in a prospective setting, patients with PSA > 75 ng/dl underwent bone scans first. Those with positive bone scans underwent a 2-core biopsy. Cancer detection rate and complications were analyzed to validate the findings of the first phase.
In the retrospective analysis, the number of positive cores in metastatic disease was 12 in 93 (73.8%), 11 in 14 (11.1%), and 10 in 7 (5.6%) patients. Using probability analysis, 94% of patients with metastasis could be detected with a single core and 97.8% with a 2-core biopsy. In the prospective analysis, 52 patients with PSA > 75 were enrolled. 3/52 (5.7%) patients had a negative bone scan. 49 were assigned for 2-core biopsy, out of which 48 (97.9%) had a positive result. One patient underwent a repeat 12-core biopsy. The prospective cohort's complications (p = 0.003) and pain score (p = 0.03) were lower compared to patients who underwent standard 12-core biopsies during phase one of the study period.
A 2-core biopsy is adequate in almost all patients with metastatic prostate cancer with PSA > 75, and this avoids excess complications and morbidity associated with a systematic 12-core prostate biopsy.
评估在晚期前列腺癌患者中进行 2 芯前列腺活检的疗效。这包括对 12 芯前列腺活检的回顾性分析和前瞻性验证，即减少芯数足以进行组织病理学诊断。
第一阶段分析了 2013 年 1 月至 2018 年期间 12 芯前列腺活检的回顾性数据。在第二阶段，从 2018 年 1 月至 2022 年 1 月，在前瞻性研究中，PSA>75ng/dl 的患者首先进行骨扫描。骨扫描阳性的患者进行 2 芯活检。分析癌症检出率和并发症，以验证第一阶段的结果。
在回顾性分析中，转移性疾病的阳性核心数在 93 例（73.8%）中为 12 个，在 14 例（11.1%）中为 11 个，在 7 例（5.6%）中为 10 个。使用概率分析，94%的转移性患者可以通过单个核心检测到，97.8%的患者可以通过 2 芯活检检测到。在前瞻性分析中，纳入了 52 例 PSA>75 的患者。52 例患者中有 3 例（5.7%）骨扫描阴性。49 例患者进行了 2 芯活检，其中 48 例（97.9%）结果阳性。1 例患者进行了重复 12 芯活检。与研究期间第一阶段接受标准 12 芯活检的患者相比，前瞻性队列的并发症（p=0.003）和疼痛评分（p=0.03）较低。
在 PSA>75 的几乎所有转移性前列腺癌患者中，2 芯活检足够，这可以避免与系统 12 芯前列腺活检相关的过度并发症和发病率。
