Developments in optimizing transperineal prostate biopsy.
Developments in optimizing transperineal prostate biopsy.
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DOI：
10.1097/mou.0000000000000947
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发表时间：
2022-01-01
影响因子：
2.5
通讯作者：
Basourakos SP
中科院分区：
文献类型：
--
作者：
Cheng E;Davuluri M;Lewicki PJ;Hu JC;Basourakos SP
前列腺活检是一种非常常见的办公室程序，导致美国男性最常见的实体器官恶性肿瘤的诊断。虽然经直肠（TR）前列腺活检技术仍然是金标准，但对经会阴（TP）方法的兴趣越来越大，因为它提供了一种清洁的经皮方法，可显著降低感染风险。在这篇综述中，我们讨论了TP前列腺活检的新进展，这些进展可能会优化临床实践中进行活检的方式。与TR活检类似，TP方法也允许进行系统性和MRI靶向活检芯。因为TP活检避免了直肠细菌移位到前列腺或血流中，与TR活检相反，根据专业指南放弃围手术期抗生素是可行的。这可能会减弱可能与加强预防相关的抗菌素耐药性。此外，虽然TP活检传统上可以在全身麻醉下使用模板网格进行，但也可以在局部麻醉或镇静下徒手进行。避免预防性抗生素和全身麻醉以及减少全国规模的TP活检的感染/住院可能会节省大量的医疗费用。TP活检结合系统和MRI靶向芯，提供了几个优于传统TR活检的优势。在局部麻醉下，不使用围手术期抗生素的TP活检正在成为前列腺癌诊断和监测的一种有前途的方法。
Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal (TR) technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal (TP) approach, because it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in TP prostate biopsy that may optimize the way biopsies are performed in clinical practice. Similarly, to TR biopsy, the TP approach also allows for the performance of systematic and MRI-targeted biopsy cores. Because TP biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to TR biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, while TP biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for TP biopsy scaled nationally will likely result in significant healthcare savings. TP biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional TR biopsy. TP biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.