How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer?
How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer?
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DOI：
10.5489/cuaj.11224
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发表时间：
2013-05-01
影响因子：
1.9
通讯作者：
Balbay, Derya
中科院分区：
文献类型：
--
作者：
Serefoglu, Ege Can;Altinova, Serkan;Balbay, Derya
简介：前列腺活检存在假阴性风险，且尚未针对 12 芯前列腺活检评估此风险。我们计算了12核前列腺活检的假阴性率，并确定可能影响检出率的患者特征。方法：我们纳入了2005年12月至2008年4月期间经直肠超声引导12核前列腺活检确诊的90名前列腺癌患者（平均年龄64岁，范围：49-77岁）。所有患者均接受根治性耻骨后前列腺切除术，并对离体手术标本重复12核前列腺活检程序。比较术前和术后前列腺活检的结果。我们分析了患者年龄、前列腺重量、血清前列腺特异性抗原 (PSA) 水平、游离/总 PSA 比率、PSA 密度和格里森评分对检出率的影响。结果：术后使用相同的标测重复离体活检，在 67.8% 的患者中检出前列腺癌。我们发现 PSA 水平、PSA 密度和活检格里森评分有所增加；患者年龄、前列腺重量和游离/总 PSA 比率的下降产生了更高的检出率。除左侧岩心外，所有岩心均表现出轻度至中度或中度内部一致性。最终标本病理学结果显示，术前体内活检 Gleason 评分保持不变、下降和上升的比例分别为 43.3%、8.9% 和 47.8%。结论：12 芯活检对患者（均为前列腺癌）的前列腺癌检出率相当低。实际上，尽管患者患有前列腺癌，但重复活检仍可能呈阴性。如果在年轻患者、PSA水平、PSA密度和格里森评分较高的患者以及前列腺较小、游离/总PSA比率较低的患者中重复进行12芯活检，检出率会更高。
Introduction: Prostate biopsies incur the risk of being false-negative and this risk has not yet been evaluated for 12-core prostate biopsy. We calculated the false-negative rate of 12-core prostate biopsy and determined the patient characteristics which might affect detection rate.Methods: We included 90 prostate cancer patients (mean age of 64, range: 49-77) diagnosed with transrectal ultrasound guided 12-core prostate biopsy between December 2005 and April 2008. All patients underwent radical retropubic prostatectomy and the 12-core prostate biopsy procedure was repeated on surgical specimen ex-vivo. Results of preoperative and postoperative prostate biopsies were compared. We analyzed the influence of patient age, prostate weight, serum prostate-specific antigen (PSA) level, free/total PSA ratio, PSA density and Gleason score on detection rate.Results: In 67.8% of patients, prostate cancer was detected with repeated ex-vivo biopsies using the same mapping postoperatively. We found an increase in PSA level, PSA density and biopsy Gleason score; patient age, decreases in prostate weight and free/total PSA ratio yielded higher detection rates. All cores, except the left-lateral cores, showed mild-moderate or moderate internal consistency. Preoperative in-vivo biopsy Gleason scores remained the same, decreased and increased in 43.3%, 8.9% and 47.8% of patients, respectively, on final specimen pathology.Conclusions: The detection rate of prostate cancer with 12-core biopsy in patients (all of whom had prostate cancer) was considerably low. Effectively, repeat biopsies can still be negative despite the patient's reality of having prostate cancer. The detection rate is higher if 12-core biopsies are repeated in younger patients, patients with high PSA levels, PSA density and Gleason scores, in addition in patients with smaller prostates, lower free/total PSA ratios.