Windisch Olivier, Valerio Massimo, Yee Chi-Hang, Gontero Paolo, Bakir Baris, Kastner Christof, Ahmed Hashim U, De Nunzio Cosimo, de la Rosette Jean
Division of Urology, Geneva University Hospitals, Geneva, Switzerland.
Faculty of Medicine, Geneva University, Geneva, Switzerland.
Prostate Cancer Prostatic Dis. 2024 Sep 4. doi: 10.1038/s41391-024-00884-2.
Since its initial description the prostate biopsy technique for detection of prostate cancer (PCA) has constantly evolved. Multiparametric magnetic resonance imaging (mpMRI) has been proven to have a sensitivity exceeding 90% to detect the index lesion. This narrative review discusses the evidence around several biopsy strategies, especially in the context of patients that might be eligible for focal therapy.
A non-systematic literature research was performed on February 15th 2024 using the Medical Literature Analysis and Retrieval System Online (Medline), Web of Science and Google Scholar.
The transrectal (TR) route is associated with an increased postoperative sepsis rate, even with adequate antibiotic prophylaxis. The transperineal (TP) route is now recommended by international guidelines, firstly for its decreased rate of urosepsis. Recent evidence shows a non-inferiority of TP compared to TR route, and even a higher detection rate of clinically significant PCA (csPCA) in the anterior and apical region, that are usually difficult to target using the TR route. Several targeting techniques (cognitive, software-fusion or in-bore) enhance our ability to provide an accurate risk assessment of prostate cancer aggressiveness and burden, while reducing the number of cores and reducing the number of clinically insignificant prostate cancer (ciPCA). While MRI-TB have proven their role, the role of systematic biopsies (SB) is still important because it detects 5-16% of csPCA that would have been missed by MRI-TB alone. The strategies of SB depend mainly on the route used (TR vs. TP) and the number of cores to be collected (10-12 cores vs. saturation biopsies vs. trans-perineal template mapping-biopsies or Ginsburg Protocol vs. regional biopsies).
Several biopsy strategies have been described and should be known when assessing patients for focal therapy. Because MRI systematically under evaluates the lesion size, systematic biopsies, and especially perilesional biopsies, can help to increase sensitivity at the cost of an increased number of cores.
自首次描述以来，用于检测前列腺癌（PCA）的前列腺活检技术一直在不断发展。多参数磁共振成像（mpMRI）已被证明在检测索引病灶方面具有超过90%的灵敏度。本叙述性综述讨论了几种活检策略的相关证据，特别是在可能适合局部治疗的患者背景下。
于2024年2月15日使用医学文献分析与检索系统在线数据库（Medline）、科学网和谷歌学术进行了非系统性文献研究。
经直肠（TR）途径与术后脓毒症发生率增加相关，即使进行了充分的抗生素预防。国际指南现在推荐经会阴（TP）途径，首先是因为其尿脓毒症发生率较低。最近的证据表明，与TR途径相比，TP途径并不逊色，甚至在通常难以通过TR途径靶向的前部和尖部区域，临床上有意义的PCA（csPCA）检测率更高。几种靶向技术（认知、软件融合或腔内）提高了我们对前列腺癌侵袭性和负担进行准确风险评估的能力，同时减少了活检样本数量，并减少了临床上无意义的前列腺癌（ciPCA）数量。虽然磁共振成像引导下活检（MRI-TB）已证明其作用，但系统性活检（SB）的作用仍然很重要，因为它能检测出仅靠MRI-TB会遗漏的5%-16%的csPCA。SB的策略主要取决于所使用的途径（TR与TP）以及要采集的活检样本数量（10-12个样本与饱和活检与经会阴模板映射活检或金斯堡方案与区域活检）。
在评估适合局部治疗的患者时，已描述了几种活检策略，应该了解这些策略。由于磁共振成像系统地低估了病变大小，系统性活检，尤其是病灶周围活检，可以以增加活检样本数量为代价提高灵敏度。
