Optimal approach for prostate cancer detection as initial biopsy: Prospective randomized study comparing transperineal versus transrectal systematic 12-core biopsy
Optimal approach for prostate cancer detection as initial biopsy: Prospective randomized study comparing transperineal versus transrectal systematic 12-core biopsy
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DOI：
10.1016/j.urology.2007.09.029
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发表时间：
2008-02-01
期刊：
影响因子：
2.1
通讯作者：
Nagai, Atsushi
中科院分区：
文献类型：
--
作者：
Hara, Ryoei;Jo, Yoshimasa;Nagai, Atsushi
目的经会阴和经直肠前列腺活检均可用于前列腺癌的诊断。然而，哪种方法更好仍是个未知数。方法2003年5月至2005年10月，对246例前列腺特异性抗原水平在4.0~20.0 ng/m L之间的前列腺特异性抗原水平分别为126例和120例的患者进行了会阴和经直肠12核前列腺活检的前瞻性随机对照研究。所有手术均采用切开取石位，会阴入路和直肠入路分别在腰麻(0.5%布比卡因)或尾部阻滞(0%利多卡因)下进行。结果经会阴入路癌检出53例(42.1%)，经直肠入路癌检出58例(48.3%)(P=0.323)。经会阴活检和经直肠活检的癌核率分别为13.7%(207/1512)和14.4%(208/1440)(P=0.566)。除头痛可能与腰麻有关外，两组并发症发生率无显著差异。结论两种术式在肿瘤发现率、癌核率及并发症方面无明显差异。我们认为，作为初始前列腺活检的首选方法是经直肠途径，它不需要脊柱麻醉或其他繁琐的过程。
OBJECTIVES Transperineal and transrectal prostate biopsy are both used for prostate cancer detection. However, which approach is superior remains unknown. In this study, we performed a prospective randomized study to compare the efficacy of transperineal versus transrectal 12-core initial prostate biopsy.METHODS From May 2003 to October 2005, a prospective randomized study of transperineal versus transrectal 12-core biopsy (126 and 120 patients, respectively) was conducted in 246 patients with a prostate-specific antigen level of 4.0 to 20.0 ng/mL. All procedures were performed with the patient in the lithotomy position, with the transperineal and transrectal approach performed with spinal anesthesia (0.5% bupivacaine) or a caudal block 0% lidocaine), respectively. With both approaches, eight biopsy specimens were obtained systematically from the peripheral zone, including the apex, and four from the transition zone.RESULTS The cancer detection rate was 42.1% (53 of 126 patients) with the transperineal approach and 48.3% (58 of 120 patients) with the transrectal approach (P = 0.323). For all patients undergoing transperineal and transrectal biopsy, the cancer core rate (cancer core number/biopsy core number) was 13.7% (207 of 1512 cores) and 14.4% (208 of 1440 cores), respectively (P = 0.566). Apart from headache, presumably related to the spinal anesthesia, no significant differences were found in the complications between the two groups.CONCLUSIONS No significant differences were found in the cancer detection rate, cancer core rate, or complications between the two approaches. We believe that the preferred approach as an initial prostate biopsy is the transrectal approach, which does not require spinal anesthesia or another burdensome process.