The Graduate School, Chinese PLA General Hospital, Beijing 100853, China.
Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Asian J Androl. 2024 Jul 1;26(4):377-381. doi: 10.4103/aja20241. Epub 2024 Apr 16.
Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate (CDR) in patients with gray-zone prostate-specific antigen (PSA) is limited. We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone. Two hundred and twenty-two patients who underwent transrectal prostate biopsy (TRB) and 216 patients who underwent transperineal prostate biopsy (TPB) between June 2016 and September 2022 were reviewed in this study. In addition, 110 patients who received additional targeted biopsies following the systematic TPB were identified. Clinical parameters, including age, PSA derivative, prostate volume (PV), and needle core count, were recorded. The data were fitted via propensity score matching (PSM), adjusting for potential confounders. TPB outperformed TRB in terms of the CDR (49.6% vs 28.3%, P = 0.001). The clinically significant prostate cancer (csPCa) detection rate was not significantly different between TPB and TRB (78.6% vs 68.8%, P = 0.306). In stratified analysis, TPB outperformed TRB in CDR when the age of patients was 65-75 years (59.0% vs 22.0%, P < 0.001), when PV was 25.00-50.00 ml (63.2% vs 28.3%, P < 0.001), and when needle core count was no more than 12 (58.5% vs 31.5%, P = 0.005). The CDR ( P = 0.712) and detection rate of csPCa ( P = 0.993) did not significantly differ among the systematic, targeted, and combined biopsies. TPB outperformed TRB in CDR for patients with gray-zone PSA. Moreover, performing target biopsy after systematic TPB provided no additional benefits in CDR.
关于不同前列腺活检方法对灰区前列腺特异性抗原（PSA）水平升高患者前列腺癌检出率（CDR）的影响，目前知之甚少。我们进行这项研究旨在比较接受不同活检方法且 PSA 水平处于灰区升高的患者之间的 CDR。回顾性分析了 2016 年 6 月至 2022 年 9 月期间接受经直肠前列腺活检（TRB）的 222 例患者和经会阴前列腺活检（TPB）的 216 例患者的临床资料。此外，还确定了 110 例在系统 TPB 后接受额外靶向活检的患者。记录了年龄、PSA 衍生值、前列腺体积（PV）和针芯数量等临床参数。通过倾向评分匹配（PSM）对数据进行拟合，以调整潜在混杂因素。TPB 在 CDR 方面优于 TRB（49.6% vs 28.3%，P = 0.001）。TPB 和 TRB 的临床显著前列腺癌（csPCa）检出率无显著差异（78.6% vs 68.8%，P = 0.306）。在分层分析中，当患者年龄为 65-75 岁（59.0% vs 22.0%，P < 0.001）、PV 为 25.00-50.00ml（63.2% vs 28.3%，P < 0.001）和针芯数量不超过 12 个（58.5% vs 31.5%，P = 0.005）时，TPB 在 CDR 方面优于 TRB。系统、靶向和联合活检的 CDR（P = 0.712）和 csPCa 检出率（P = 0.993）无显著差异。TPB 在 CDR 方面优于 TRB 用于灰区 PSA 水平升高的患者。此外，在系统 TPB 后进行靶向活检在 CDR 方面没有带来额外的益处。
