Department of Urology, OLVG, Amsterdam, The Netherlands.
Department of Radiology, OLVG, Amsterdam, The Netherlands.
BJU Int. 2023 Oct;132(4):397-403. doi: 10.1111/bju.16041. Epub 2023 May 24.
To describe the prostate cancer (PCa) detection rate, including clinically significant prostate cancer (csPCa), in a large cohort of patients who underwent transperineal ultrasonography-guided systematic prostate biopsy (TPB-US) using a probe-mounted transperineal access system, with magnetic resonance imaging (MRI) cognitive fusion in case of a Prostate Imaging-Reporting and Data System grade 3-5 lesion, under local anaesthesia in an outpatient setting. Additionally, to compare the incidence of procedure-related complications with a cohort of patients undergoing transrectal ultrasonography-guided (TRB-US) and transrectal MRI-guided biopsies (TRB-MRI).
This was an observational cohort study in men who underwent TPB-US prostate biopsy in a large teaching hospital. For each participant, prostate-specific antigen level, clinical tumour stage, prostate volume, MRI parameters, number of (targeted) prostate biopsies, biopsy International Society of Uropathology (ISUP) grade and procedure-related complications were assessed. csPCa was defined as ISUP grade ≥2. Antibiotic prophylaxis was only given in those with an increased risk of urinary tract infection.
A total of 1288 TPB-US procedures were evaluated. The overall detection rate for PCa in biopsy-naive patients was 73%, and for csPCa it was 63%. The incidence of hospitalization was 1% in TPB-US (13/1288), compared to 4% in TRB-US (8/214) and 3% in TRB-MRI (7/219; P = 0.002).
Contemporary combined systematic and target TPB-US with MRI cognitive fusion is easy to perform in an outpatient setting, with a high detection rate of csPCa and a low incidence of procedure-related complications.
描述在局部麻醉下，于门诊环境中，使用经会阴入路的前列腺超声引导系统对患者行经会阴超声引导系统前列腺穿刺活检（TPB-US），对前列腺影像报告和数据系统（PI-RADS）分级 3-5 病变行磁共振成像（MRI）认知融合，并对疑似前列腺癌（PCa）患者进行筛查的过程中，PCa 的检出率，包括临床显著 PCa（csPCa）。同时，将该方法的检出率与经直肠超声引导（TRB-US）和经直肠 MRI 引导（TRB-MRI）活检的患者进行比较。
这是一项在一家大型教学医院进行的经会阴超声引导系统前列腺穿刺活检患者的观察性队列研究。对每位患者的前列腺特异性抗原（PSA）水平、临床肿瘤分期、前列腺体积、MRI 参数、前列腺活检针数、活检国际泌尿病理学会（ISUP）分级和与操作相关的并发症进行评估。csPCa 的定义为 ISUP 分级≥2。仅对有尿路感染风险增加的患者使用抗生素预防。
共评估了 1288 例 TPB-US 操作。活检初筛阴性患者的 PCa 总体检出率为 73%，csPCa 为 63%。TPB-US 的住院率为 1%（13/1288），TRB-US 为 4%（8/214），TRB-MRI 为 3%（7/219），差异具有统计学意义（P = 0.002）。
当代联合使用经会阴超声引导系统和 MRI 认知融合的系统和靶向性 TPB-US ，易于在门诊环境下进行，csPCa 的检出率高，与操作相关的并发症发生率低。
