磁振超音波融和導引攝護腺切片及系統性切片在攝護腺癌診斷之比較

潘柏勳¹、范玉華^1,2,3、林子平^1,2,3、程威銘^2,4、王信凱^2,5、沈書慧^2,5、劉顯慈^2,5、陳威任^1,2,3、

黃子豪^1,2,3、魏子鈞^1,2,3、黃奕燊^1,2,3、林志杰^1,2,3、黃逸修^1,2,3、鍾孝仁^1,2,3、黃志賢^1,2,3

¹台北榮民總醫院 泌尿部；²陽明大學醫學院泌尿學科；³書田泌尿學研究中心；

⁴臺北市立聯合醫院 忠孝分院 泌尿科；⁵台北榮民總醫院 放射線部

MRI-TRUS fusion-targeted prostate biopsy alone compared with systematic biopsy in detecting significant prostate cancer

Po-Hsun Pan¹, Yu-Hua Fan ^1,2,3, Tzu-Ping Lin ^1,2,3, Wei-Ming Cheng^2,4, Hsin-Kai Wang^2,5,

Shu-Huei Shen^2,5, Hsian-Tzu Liu^2,5, Wei-Ren Chen^1,2,3, Tzu-Hao Huang^1,2,3, Tzu-Chun Wei^1,2,3,

I-Shen Huang^1,2,3, Chih-Chieh Lin^1,2,3, Eric Y.H. Huang^1,2,3, Hsiao-Jen Chung^1,2,3, William J.S. Huang^1,2,3

¹Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

²Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

³Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan;

⁴Division of Urology, Department of Surgery, Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan

⁵Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

 

Purpose: Multiparametric MRI (mpMRI) of prostate provides a reliable tool for prostate cancer detection by interpreting according to the PI-RADS v2 grading system. MRI-TRUS fusion-targeted prostate biopsy for the suspicious lesion plus systematic standard 12-core biopsy was proved to increase the detection of clinically significant prostate cancer (csPca) and reduce the rate of insignificant prostate cancer. However, the suggestion for MRI-TRUS fusion biopsy is to combine targeted lesion biopsy with standard systematic biopsy simultaneously. We aimed to compare the targeted biopsy alone with systematic biopsy.

 

Materials and Methods: We retrospectively enrolled patients with at least one PI-RADS ≥ 3 lesions on mpMRI and with PSA greater than 4 ng/ml and/or had a positive digital rectal examination finding who underwent MRI-TRUS fusion-targeted prostate biopsy from March 2017 through July 2019. Patients were enrolled in spite of having previous negative biopsy or not. All patients received targeted lesion biopsy and systematic standard 12-core biopsy. Each targeted prostate lesion on MRI was cognitively biopsy for two to three cores. Basic analyses of demographic data were calculated. McNemar test was performed for significant prostate cancer detected by targeted biopsy or systematic biopsy respectively.

 

Results: 164 patients were enrolled in this study with 223 targeted lesions were biopsied. Median age of this cohort is 67. 46 patients (28.0 %) had previous negative biopsy history. Prostate cancer was detected in 57.3% (94/164) and csPCa in 41.5% (68/164) of all patients. Clinically significant prostate cancer detected by targeted biopsy was 79 (35.4%). On the other hand, 53 (23.8%) csPca was diagnosed by systematic biopsy. Besides, 13% of biopsies were found to have csPca by targeted biopsy with a negative result of systematic biopsy. By contrast, only 1.3% of biopsies detected csPca by systematic biopsy but without positive targeted biopsy finding. The difference was statically significant (p value < 0.001). 

 

Conclusions: MRI-TRUS fusion-targeted prostate biopsy improves the accuracy of prostate cancer detection that reduced unnecessary prostate biopsy and overtreatment. Even targeted biopsy alone have better results than systematic biopsy. However, it still cannot replace the role of systematic biopsy owing to few clinically significant prostate cancer were found only in systematic biopsy.