Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
University Clinical Hospital No. 2, Department of Radiology, Sechenov University, Moscow, Russia.
J Endourol. 2023 Aug;37(8):940-947. doi: 10.1089/end.2022.0780. Epub 2023 Jun 27.
The aim of this research was to compare the clinically significant prostate cancer (csPCa) detection rate (International Society of Urological Pathology [ISUP] ≥2) for the four biopsy methods: transrectal ultrasound-guided biopsy (TRUS-GB), cognitive transrectal biopsy (COG-TB), fusion transperineal biopsy (FUS-TB), and transperineal template mapping biopsy (TPMB). The inclusion criteria were as follows: prostate-specific antigen (PSA) >2 ng/mL, and/or positive digital rectal examination (DRE), and/or suspicious lesion on transrectal ultrasound (TRUS) and Prostate Imaging Reporting and Data System (Pi-RADS) v2.1 ≥ 3 score. In total, 102 patients were enrolled in the study. Biopsies were performed by two urologists. In a single procedure, the first urologist performed a FUS-TB and TPMB followed by second urologist who performed TRUS-GB and COG-TB. All specimens were obtained within a single procedure. The csPCa detection rate and overall cancer detection rate (CDR) per patient were comparable among the respective biopsy methods ( > 0.05). Compared with other biopsy methods, a lower clinically insignificant prostate cancer (cisPCa) was detected using COG-TB ( = 0.004). The positive cores percentage ratio ( < 0.001) as well as positive cores containing csPCa percentage ratio ( < 0.001) significantly increased for the targeted biopsy methods. The median maximum cancer core length (MCCL; = 0.52) as well the median for the MCCL of csPCa ( = 0.47) did not differ significantly among the respective biopsy methods. Concordance of the Gleason scores between biopsy and postprostatectomy pathology did not differ significantly among biopsy methods ( = 0.87). For TRUS-GB, FUS-TB, and TPMB, the common predictive factors for csPCa were positive DRE, suspicious lesion on ultrasound and Pi-RADS 5. As for COG-TB, the only predictor was Pi-RADS 5. The targeted methods did not show an increase in detection of csPCa and overall CDR over systematic ones in patients with Pi-RADS ≥3. A lower cisPCa was detected using COG-TB in comparison with the other methods. The sampling efficiency increased for the targeted biopsy methods, which used only a proportion of positive cores and cores containing csPCa. There was no statistical difference in histology concordance among the biopsies. One common predictive factor of increased csPCa detection for all biopsy methods was Pi-RADS 5.
本研究旨在比较四种活检方法（经直肠超声引导活检（TRUS-GB）、认知经直肠活检（COG-TB）、融合经会阴活检（FUS-TB）和经会阴模板映射活检（TPMB））的临床显著前列腺癌（csPCa）检出率（国际泌尿病理学会[ISUP]≥2）。纳入标准为前列腺特异性抗原（PSA）>2ng/mL，且/或经直肠指检（DRE）阳性，且/或经直肠超声（TRUS）和前列腺影像报告和数据系统（Pi-RADS）v2.1≥3分可疑病变。共有 102 名患者入组研究。由两名泌尿科医生进行活检。在单一程序中，第一泌尿科医生进行 FUS-TB 和 TPMB，然后由第二泌尿科医生进行 TRUS-GB 和 COG-TB。所有标本均在单一程序中获得。各活检方法的 csPCa 检出率和总癌症检出率（CDR）无显著差异（>0.05）。与其他活检方法相比，COG-TB 检出的临床意义不显著的前列腺癌（cisPCa）较低（=0.004）。靶向活检方法的阳性核心百分比比值（<0.001）以及包含 csPCa 的阳性核心百分比比值（<0.001）均显著增加。各活检方法的最大癌症核心长度中位数（MCCL；=0.52）和 csPCa 的 MCCL 中位数（=0.47）无显著差异。活检和前列腺切除术后病理的 Gleason 评分一致性在各活检方法之间无显著差异（=0.87）。对于 TRUS-GB、FUS-TB 和 TPMB，csPCa 的共同预测因素是 DRE 阳性、超声可疑病变和 Pi-RADS 5。对于 COG-TB，唯一的预测因素是 Pi-RADS 5。对于 Pi-RADS≥3 的患者，靶向方法并未显示出比系统方法在检测 csPCa 和总 CDR 方面有更高的优势。与其他方法相比，COG-TB 检出的 cisPCa 较低。靶向活检方法仅使用部分阳性核心和包含 csPCa 的核心，提高了采样效率。各活检方法的组织学一致性无统计学差异。所有活检方法中，增加 csPCa 检测的一个共同预测因素是 Pi-RADS 5。
