Office Based Transrectal Saturation Biopsy Improves Prostate Cancer Detection Compared to Extended Biopsy in the Repeat Biopsy Population
Office Based Transrectal Saturation Biopsy Improves Prostate Cancer Detection Compared to Extended Biopsy in the Repeat Biopsy Population
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DOI：
10.1016/j.juro.2011.04.069
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发表时间：
2011-09-01
影响因子：
6.6
通讯作者：
Jones, J. Stephen
中科院分区：
文献类型：
--
作者：
Zaytoun, Osama M.;Moussa, Ayman S.;Jones, J. Stephen
目的：多项研究表明重复活检可显着检测前列腺癌。然而，关于核心数量和位置的最佳方法仍然存在争议。经直肠饱和活检被认为可以提高癌症检出率，但据我们所知，尚未发表将其与 12 至 14 芯扩展活检进行比较的研究。我们比较了最初阴性活检后的饱和和延长重复活检方案。材料和方法：总共 1,056 名男性在最初阴性活检后接受了前列腺活检。扩展活检组包括 393 名男性，进行了 12 至 14 芯重复活检。饱和活检组包括 663 名男性，进行了 20 至 24 芯重复活检。我们分析了两组之间的人口统计学和前列腺癌。我们比较了既往患有非典型小腺泡增殖和/或高级别前列腺上皮内瘤变的患者的前列腺癌检出情况，以及检出临床上不显着肿瘤的风险。结果：1,056 名患者中有 315 名检出前列腺癌 (29.8%)。饱和活检检测到的癌症几乎增加了三分之一（32.7% vs 24.9%，p = 0.0075）。在初次活检为良性的患者中，饱和活检的前列腺癌检出率显着提高（33.3% vs 25.6%，p = 0.027）。对于既往非典型小腺泡增殖和/或高级别前列腺上皮内瘤变，饱和组中前列腺癌检出率有较高的趋势，但未达到统计学显着性（31.2% vs 23.3%，p = 0.13）。在 315 例阳性活检中，119 例 (37.8%) 发现临床上不显着的癌症（40.1% vs 32.6%，p = 0.2）。结论：与扩展活检相比，基于办公室的饱和活检显着增加了重复活检时的癌症检出率。应权衡增加临床上不重要癌症检出率的潜力与漏掉重要病例的可能性。
Purpose: Multiple studies have shown significant prostate cancer detection for repeat biopsy. However, the best approach regarding core number and location remains controversial. Transrectal saturation biopsy is believed to increase cancer detection but to our knowledge no studies comparing it to 12 to 14-core extended biopsy have been published. We compared saturation and extended repeat biopsy protocols after initially negative biopsy.Materials and Methods: A total of 1,056 men underwent prostate biopsy after initially negative biopsy. The extended biopsy group included 393 men with 12 to 14-core repeat biopsy. The saturation biopsy group included 663 men with 20 to 24-core repeat biopsy. We analyzed demographics and prostate cancer between the 2 groups. We compared prostate cancer detection in patients with previous atypical small acinar proliferation and/or high grade prostatic intraepithelial neoplasia as well as the risk of detecting clinically insignificant tumors.Results: Prostate cancer was detected in 315 of the 1,056 patients (29.8%). Saturation biopsy detected almost a third more cancers (32.7% vs 24.9%, p = 0.0075). In patients with a benign initial biopsy saturation biopsy achieved significantly greater prostate cancer detection (33.3% vs 25.6%, p = 0.027). For previous atypical small acinar proliferation and/or high grade prostatic intraepithelial neoplasia there was a trend toward higher prostate cancer detection rate in the saturation group but it did not attain statistical significance (31.2% vs 23.3%, p = 0.13). Of 315 positive biopsies 119 (37.8%) revealed clinically insignificant cancer (40.1% vs 32.6%, p = 0.2).Conclusions: Compared to extended biopsy, office based saturation biopsy significantly increases cancer detection on repeat biopsy. The potential for increased detection of clinically insignificant cancer should be weighed against missing significant cases.