Mian Badar M, Feustel Paul J, Aziz Asef, Kaufman Ronald P, Bernstein Adrien, Fisher Hugh A G
Department of Urology, Albany Medical Center, Albany, New York.
Department of Research Administration, Albany Medical Center, Albany, New York.
J Urol. 2024 Jul;212(1):21-31. doi: 10.1097/JU.0000000000003979. Epub 2024 May 3.
The comparative effectiveness of transrectal and transperineal prostate biopsy in detecting clinically significant prostate cancer is not well understood. We conducted a randomized clinical trial to determine whether transperineal biopsy improves the detection of clinically significant prostate cancer.
Of the 840 men randomized, 93% were White, 44% had a previous biopsy, with a median age of 66 years and median PSA density of 0.14. Of these, 384 underwent transrectal and 398 underwent transperineal prostate biopsy. Prebiopsy prostate MRI was performed in 96% of men. Grade Group ≥ 2 prostate cancer was classified as clinically significant. Odds ratios were calculated using logistic regression to evaluate the effect of biopsy procedures on cancer detection rates.
The detection rates of clinically significant prostate cancer were 47.1% and 43.2% (odds ratio 1.17; 95% CI, 0.88-1.55) for transrectal and transperineal biopsy, respectively. Age, PSA density, clinical stage and Prostate Imaging Reporting and Data System score were associated with the diagnosis of clinically significant cancer, whereas history of previous biopsy, anterior tumors, and biopsy procedure (transrectal or transperineal) were not. Clinically significant cancer detection rates in biopsy-naïve men undergoing MRI-targeted transrectal or transperineal biopsy were 59% and 62%, respectively. The overall cancer detection rates following transrectal and transperineal biopsy were 72.1% and 70.4%, respectively.
There was no significant difference noted in the detection of clinically significant prostate cancer following transrectal or transperineal prostate biopsy. Urologists may utilize either biopsy procedure that best suits their patients' needs and practice setting.
经直肠和经会阴前列腺穿刺活检在检测临床显著前列腺癌方面的相对有效性尚未得到充分了解。我们进行了一项随机临床试验，以确定经会阴穿刺活检是否能提高临床显著前列腺癌的检测率。
在840名随机分组的男性中，93%为白人，44%曾接受过穿刺活检，中位年龄为66岁，中位前列腺特异抗原（PSA）密度为0.14。其中，384人接受经直肠前列腺穿刺活检，398人接受经会阴前列腺穿刺活检。96%的男性在穿刺活检前进行了前列腺磁共振成像（MRI）检查。2级及以上前列腺癌被分类为临床显著前列腺癌。使用逻辑回归计算优势比，以评估穿刺活检程序对癌症检测率的影响。
经直肠和经会阴穿刺活检的临床显著前列腺癌检测率分别为47.1%和43.2%（优势比1.17；95%置信区间，0.88 - 1.55）。年龄、PSA密度、临床分期以及前列腺影像报告和数据系统评分与临床显著癌症的诊断相关，而既往穿刺活检史、前部肿瘤和穿刺活检程序（经直肠或经会阴）则无关。接受MRI引导的经直肠或经会阴穿刺活检的初诊男性中，临床显著癌症检测率分别为59%和62%。经直肠和经会阴穿刺活检后的总体癌症检测率分别为72.1%和70.4%。
经直肠或经会阴前列腺穿刺活检后在临床显著前列腺癌检测方面未发现显著差异。泌尿外科医生可根据最适合患者需求和实际情况的穿刺活检程序进行选择。
