Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TW, Taiwan.
Diagn Pathol. 2023 Sep 11;18(1):101. doi: 10.1186/s13000-023-01386-w.
Extraprostatic extension (EPE) of prostate cancer (PCa) on transrectal (TR) needle core biopsy (Bx) is a rare histopathological finding that can help in clinical decision-making. The detection efficiency of the transperineal (TP) approach is yet to be explored.
We retrospectively reviewed 2848 PCa cases using concomitant systemic template biopsy (SBx) and multiparametric magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy (TBx) using the TR (n = 1917) or TP (n = 931) approach at our institution between January 2015 and July 2022. We assessed and compared clinical, MRI, and biopsy characteristics using different approaches (TP and TR) and methods (SBx and TBx).
In total, 40 EPE cases were identified (40/2848, 1.4%). TP showed a significantly higher EPE detection rate compared to TR in SBx (TR:0.7% vs. TP:1.6%; p = 0.028) and TBx (TR:0.5% vs. TP:1.2%; p = 0.033), as well as the combined methods (2.1% vs. 1.1%, p = 0.019). A significantly higher incidence of EPEs was found at non-base sites in TP than in TR (76.7% vs. 50%, p = 0.038). SBx showed a higher EPE detection rate than TBx; however, the difference was not statistically significant. TP showed higher prostate-specific antigen density (0.35 vs. 0.17, p = 0.005), higher frequency of GG4-5 in the cores with EPE (65.0% vs. 50.0%, p = 0.020), and more PCa-positive SBx cores (10 vs. 8, p = 0.023) compared to the TR.
TP may improve EPE detection compared with TR and should be applied to patients with adverse pre-biopsy features.
经直肠（TR）针芯活检（Bx）中前列腺癌（PCa）的前列腺外延伸（EPE）是一种罕见的组织病理学发现，有助于临床决策。经会阴（TP）方法的检测效率尚未得到探索。
我们回顾性分析了 2015 年 1 月至 2022 年 7 月期间，我院使用 TR（n=1917）或 TP（n=931）方法同时进行全身模板活检（SBx）和多参数磁共振成像（MRI）-超声融合靶向活检（TBx）的 2848 例 PCa 病例。我们使用不同的方法（TP 和 TR）和方法（SBx 和 TBx）评估和比较了临床、MRI 和活检特征。
共发现 40 例 EPE 病例（40/2848，1.4%）。TP 在 SBx（TR：0.7%比 TP：1.6%；p=0.028）和 TBx（TR：0.5%比 TP：1.2%；p=0.033）以及联合方法（2.1%比 1.1%，p=0.019）中检测到 EPE 的阳性率明显高于 TR。在 TP 中，非基底部的 EPE 发生率明显高于 TR（76.7%比 50%，p=0.038）。SBx 检测到的 EPE 阳性率高于 TBx，但差异无统计学意义。TP 显示出更高的前列腺特异性抗原密度（0.35 比 0.17，p=0.005）、EPE 核中 GG4-5 更高的频率（65.0%比 50.0%，p=0.020）和更多的 PCa 阳性 SBx 核（10 比 8，p=0.023）与 TR 相比。
与 TR 相比，TP 可能提高 EPE 检测率，应应用于有不良术前特征的患者。
