经会阴前列腺24针饱和穿刺活检与14针活检在PSA＜20μg/L患者中筛检前列腺癌的对比性研究

目的:探讨超声引导下经会阴前列腺24针饱和穿刺活检与14针穿刺活检方案对PSA＜20 μg/L可疑前列腺癌患者的筛检阳性率及其相关并发症.方法:选取116例可疑前列腺癌患者行经会阴超声引导下14针穿刺活检(14针组),另136例患者,行经会阴24针饱和前列腺穿刺活检(24针饱和组),比较两组前列腺癌筛检阳性率、标本阳性率及穿刺后肉眼血尿、泌尿系感染、尿潴留等并发症的发生率.结果:两组患者平均年龄、穿刺前PSA水平、平均前列腺体积等指标均无统计学差异(P＞0.05).24针饱和组及14针组前列腺癌筛检总体阳性率分别为48.53％和17.24％,存在显著性差异(P＜0.001),标本阳性率分别为8.09％和2.83％ (P =0.012);其中24针饱和组前列腺尖部肿瘤的检出率(11.76％)显著高于14针组(1.72％,P＜0.05).两组穿刺后尿潴留、泌尿系感染和肉眼血尿等发生率均无统计学差异(P＞0.05).结论:24针经会阴前列腺饱和穿刺活检方法显著提高PSA＜20 μg/L患者中前列腺癌的筛检阳性率,尤其是增加了前列腺尖部区域的肿瘤筛检阳性率,而并未增加相关并发症.     

9+X法直肠超声引导下经会阴前列腺穿刺活检420例分析

目的:探讨9+X法经直肠超声引导下经会阴前列腺穿刺活检术诊断前列腺癌的临床价值及安全性。方法:回顾性分析2004年1月至2008年12月行9+X法经直肠超声引导下经会阴前列腺穿刺活检术的可疑前列腺癌患者420例临床资料。结果:穿刺确诊前列腺癌160例(阳性率38.1%)。PSA<4μg/L、4～10μg/L、>10μg/L、直肠指检(DRE)异常、经直肠或经腹部超声检查有异常者阳性率分别为7.4%、17.8%、65.4%、25.0%、22.2%。穿刺术后79例出现血尿(18.8%),急性尿潴留13例(3.1%),发热9例(2.1%),无其他严重并发症。结论:9+X法经直肠超声引导下经会阴前列腺穿刺阳性率高,并发症少,是诊断前列腺癌的理想方法。     

徒手TRUS引导下经会阴前列腺活检的临床应用探讨

目的:探讨徒手"12+X"法TRUS引导下经会阴前列腺活检术诊断前列腺癌的临床应用价值。方法:2014年12月~2015年12月,对74例可疑前列腺癌患者行经直肠B超引导下18G自动穿刺活检针行双侧外周带12点法系统穿刺,其中直肠指诊(DRE)触及结节24例,超声提示异常回声14例,前列腺核磁提示异常信号30例;前列腺特异性抗原(PSA)<4ng/ml者14例,PSA 4~10ng/ml 25例,PSA>10ng/ml者35例。同时对每个可疑病灶进行1~2针靶向穿刺。回顾性分析穿刺的阳性率和并发症。结果:成功对74例患者进行徒手"12+X"法TRUS引导下经会阴前列腺活检术。年龄43~81岁,中位年龄72岁;PSA 1.9~500ng/ml,中位PSA17.8ng/ml。经病理诊断,前列腺癌23例,阳性率31.1%,穿刺阴性病例中3例TURP术后病理诊断结果为前列腺癌;2例首次穿刺阴性,6个月后重复穿刺时发现前列腺癌。低危前列腺癌(Gleason≤6分)、中危前列腺癌(Gleason=7分)和高危前列腺癌(Gleason≥8分)分别为13.1%、30.4%和56.5%。其余51例为良性前列腺增生或合并前列腺炎症。术后短暂和轻度的肉眼血尿6例(8.1%),均在1~3d后缓解,5例(6.8%)轻度发热,2例(2.7%)会阴部轻度不适。无脓毒症、急性尿潴留等严重并发症的发生。结论:徒手"12+X"法TRUS引导下经会阴前列腺活检安全可行,阳性率稳定,值得在临床上进一步推广。     

模板定位下经会阴前列腺穿刺活检在经直肠途径初次活检阴性患者检查中的应用

目的 探讨模板定位下经会阴前列腺穿刺活检术在对经直肠前列腺穿刺活检阴性患者检查中的有效性及安全性.方法 收集2010年1月至2012年1月经直肠前列腺穿刺活检阴性患者42例.年龄50 ～81岁,平均67岁.PSA 0.9 ～27.3 μg/L,平均13.1 μg/L.入组条件:曾行前列腺穿刺活检≥1次,结果为阴性或前列腺上皮内瘤(PIN)或非典型小细胞腺泡样增生(AAH),但术后tPSA仍＞10 μg/L和(或)PSA速率仍＞0.75 μg/L.取膀胱截石位,会阴部皮下及前列腺尖部包膜浸润麻醉下,行经直肠超声引导下模板定位经会阴前列腺穿刺活检术.分析模板定位下经会阴前列腺穿刺活检术的阳性率、影响因素及并发症.结果 本组行前列腺穿刺16 ～ 44针,平均18.7针.穿刺阳性率为44％ (19/42),Gleason评分4～9分,平均6分.穿刺阳性者前列腺体积27～67 ml,平均44 ml;阴性者37 ～104 ml,平均71 ml,两组比较差异有统计学意义(P＜0.05).穿刺阳性率与患者是否为PIN和AHH、前列腺穿刺针数、PSA值无相关性(P＞0.05).穿刺阳性者前列腺癌在移行区的发生率为74％(14/19),其中36％(5/14)只发生在移行区.穿刺后1周内血尿发生率为29％(12/42),尿潴留发生率为9％ (4/42),无严重感染等并发症发生.结论 模板定位下经会阴前列腺穿刺活检术诊断经直肠途径初次活检阴性患者安全、有效.     

12+X法超声引导下经会阴前列腺穿刺活检术35例报告

目的:进一步验证12+X法超声引导下经会阴前列腺穿刺活检术的应用价值及其安全性。方法:于2012年1月~2014年4月期间对35例可疑前列腺癌患者行12+X法超声引导下经会阴前列腺穿刺活检术。结果:确诊为前列腺癌患者18例(阳性率51.4%),其中PSA10μg/L组、PSA10~20μg/L组、PSA20~100μg/L组、PSA100μg/L组穿刺阳性率分别为20%、28.6%、70%、87.5%。前列腺体积小于25ml组前列腺癌阳性率为75%;大于50ml组阳性率为42.1%。并发症包括血管迷走神经反射1例(2.86%),血尿11例(31.4%),尿潴留5例(14.3%),无直肠出血、泌尿系感染及发热等。结论:12+X法超声引导下经会阴前列腺穿刺活检术是一种安全有效、简单易行的前列腺癌确诊方法,值得在临床上使用。     

直肠超声引导经会阴模版12+X针前列腺穿刺活检术临床研究

目的:评价直肠超声引导下经会阴模版12+X针前列腺穿刺活检术的临床价值和安全性。方法:2009年9月~2014年5月,对临床怀疑为前列腺癌的1 300例患者行直肠超声引导下经会阴模板前列腺穿刺活检术。1 300例患者平均年龄70.5岁,穿刺前均行血清PSA监测(不少于2次)、前列腺直肠指诊、经直肠前列腺超声及前列腺磁共振平扫加动态增强。所有患者取截石位,1%利多卡因注射液10~20ml会阴皮下及前列腺尖部局部浸润麻醉973例,骶管阻滞麻醉75例,硬膜外麻醉252例。共937例采用12+X针穿刺,363例采用常规12针穿刺。结果:所有患者均顺利完成操作,活检针数12~24针,平均14.5针;活检时间15~30 min,平均20.4min。术后发生一过性血尿201例,会阴部血肿14例,尿潴留21例,发热5例。穿刺病理结果:前列腺癌540例(41.5%),其中腺癌527例,其他类型肿瘤13例;前列腺上皮内瘤(PIN)57例(4.4%);前列腺增生及各类前列腺炎703例(54.1%)。T-PSA4μg/L、4~10μg/L、10~20μg/L及20μg/L组的穿刺阳性率分别为:13.1%、17.1%、31.9%、73.8%。TPSA 4~10μg/L组(灰区)293例患者分别以F/T PSA和PSAD分组,F/T≥0.16和0.16组的穿刺阳性率分别为12.0%、18.8%,PSAD≥0.15和0.15组的穿刺阳性率分别为9.8%、21.5%。直肠指诊异常、经直肠超声异常及前列腺MRI异常患者的穿刺阳性率分别为:24.0%、30.1%、59.2%。12+X针组穿刺阳性率为47.2%,12针组为34.5%。结论:直肠超声引导下经会阴12+X针前列腺穿刺活检术阳性率高,并发症少,是诊断前列腺癌的理想方法。     

经会阴B型超声引导下前列腺穿刺活检的临床价值研究

目的:探讨经会阴扇型B型超声引导下前列腺6针穿刺活检术诊断前列腺癌的临床价值。方法:对经直肠指检或经腹部B超检查发现前列腺结节、血清总前列腺特异性抗原(tPSA)在4μg/L以上或游离PSA(fPSA)/tP-SA<0.16的可疑前列腺癌104例患者,经会阴扇型B超引导下18G自动穿刺活检针行双侧叶6点法穿刺,对穿刺的阳性率和并发症及影响穿刺阳性率的因素进行分析。结果:经病理诊断,检出前列腺癌24例,检出率23%,前列腺癌分级评分中位数为7分,高分化癌(2~4分)、中分化癌(5~7分)和低分化癌(8~10分)分别为12.5%(3/24)、62.5%(15/24)和25%(6/24);其余80例为良性前列腺增生(BPH)。术后短暂和轻度的肉眼血尿5例(4.8%),均在1~3 d后缓解,4例(3.8%)发热37.2℃~38.0℃,术后会阴部轻度不适5例(4.8%)。术后无1例出现血便、血精、前列腺脓肿、高热、败血症、急性尿潴留等严重并发症。经分析发现tPSA、fPSA、fPSA/tPSA、前列腺抗原密度(PS-AD)和前列腺体积是影响前列腺穿刺阳性率的重要因素(P<0.05),经会阴穿刺优势主要反映在tPSA≥10μg/L、fP-SA≥2μg/L、fPSA/tPSA<0.16、PSAD≥0.2和前列腺体积<40 m l时提示应行会阴穿刺术。结论:经会阴扇型B型超声引导下6针前列腺穿刺活检,是一种安全准确的前列腺癌检出方法。     

经会阴10点以下或以上前列腺活检诊断效率和并发症比较

目的 分析经会阴<10点与≥10点前列腺活检的诊断效率和并发症情况. 方法 经直肠超声引导下经会阴前列腺穿刺活检900例,分2组,<10点组759例(A组),平均活检8点;≥10点组141例(B组),平均活检12点.分析2组间总活检阳性率、PSA分层活检阳性率和并发症的差异. 结果 A、B组前列腺癌检出总阳性率分别为41.6%(316/759)和51.8%(73/141),PSA≤10.0 ng/ml患者中活检阳性率分别为6.8%(16/235)和17.8%(8/45),2组比较差异有统计学意义(P<0.05).并发症发生情况:A组出现肉眼血尿者274例(36.1%),尿潴留2例;B组肉眼血尿53例(37.6%),尿潴留1例,2组并发症比较差异无统计学意义(P>0.05). 结论 ≥10点前列腺活检的诊断效率高于<10点,并发症发生率无明显差异.     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

经会阴及经直肠前列腺穿刺活检术的临床应用分析

目的:比较经直肠及经会阴两种前列腺穿刺活检术的阳性率及并发症。方法:回顾性分析2009年1月至2014年1月间156例前列腺穿刺活检病例,其中经直肠径路97例,经会阴径路59例。结果:经直肠径路组穿刺阳性率为48.4%,经会阴径路组为44.1%。根据不同的PSA水平分层,两种径路穿刺活检的阳性率无显著性差异(P0.05)。穿刺后经直肠径路组与经会阴径路组血尿发生率分别为54.6%、42.4%,尿频尿急尿痛发生率分别为17.5%、22.0%,排尿困难发生率分别为9.3%、6.8%,急性尿潴留发生率分别为7.2%、6.8%,上述并发症发生率在两组间差异无统计学意义(P0.05);发热发生率分别为15.5%、3.4%,血便发生率分别为50.5%、3.4%,经直肠径路组要显著高于经会阴径路组(P0.05及P0.01);会阴肿胀发生率分别为3.1%、13.6%,经会阴径路组显著性增高(P0.05)。结论:超声引导下经直肠和经会阴前列腺穿刺活检术都是诊断前列腺癌的有效方法。两种方式的穿刺阳性率无显著性差异,但并发症发生率各有特点,具体方式选择应根据患者情况决定。     

Transrectal ultrasound-guided transperineal 14-core systematic biopsy detects apico-anterior cancer foci of T1c prostate cancer

AIM: The optimal biopsy strategy for prostate cancer detection, especially in men with isolated prostate-specific antigen (PSA) elevation, remains to be defined. We evaluated diagnostic yield and safety of transrectal ultrasound (TRUS)-guided transperineal systematic 14-core biopsy and compared the spatial distribution of cancer foci detected with this technique in men with and without abnormality on digital rectal examination (DRE). METHODS: In a prospective study, 289 men aged between 50 and 87 years (median age, 70 years) underwent TRUS-guided transperineal systematic 14-core prostate biopsy because of elevated PSA and/or abnormal DRE findings. Using the fan technique, 12 cores from the peripheral zone and two cores from the transition zone were obtained systematically. To characterize the spatial distribution of cancer positive cores, site-specific overall and unique cancer detection rates were compared between stage T1c and T2 cancers. RESULTS: Prostate cancer was detected in 105 of the 289 patients (36%). Major complications requiring prolonged hospital stay or re-hospitalization during a 4-week postbiopsy period were rare (1.4%). Sixty-seven stage T1c cancers were identified. These cancers were associated with significantly lower PSA and a smaller number of cancer positive cores when compared with stage T2 cancers (n= 38). The overall cancer detection rate was highest at the anterior peripheral zone and the posterior peripheral zone in stage T1c and stage T2 cancers, respectively. The unique cancer detection rate at the anterior peripheral zone was significantly higher in stage T1c cancers than in stage T2 cancers. Therefore, when the prostate is extensively biopsied using the transperineal approach, cancer positive cores are characteristically distributed anteriorly in stage T1c cancers and posteriorly in stage T2 cancers. CONCLUSIONS: TRUS-guided transperineal systematic 14-core biopsy showed an apico-anterior distribution of cancer foci in stage T1c prostate cancers.     

The potential impact of prostate volume in the planning of optimal number of cores in the systematic transperineal prostate biopsy

OBJECTIVES: We compared the detection rates of different transperineal prostate biopsy protocols with the aim to optimize the number of cores to sample according to prostate volume. MATERIAL AND METHODS: From October 2002 to October 2004 we evaluated 480 consecutive patients with PSA between 2.5 and 20 ng/ml undergoing the first set of prostate biopsy. All patients underwent a 14-core TRUS-guided transperineal prostate biopsy, including 12 cores in the peripheral and two in the transitional zone. The detection rate of the 14-core scheme was compared to the one of the other biopsy schemes obtained through the exclusion of pairs of cores. Data were stratified according to the different TRUS estimated prostate volumes. RESULTS: The detection rate of the standard sextant was 35.2%, while those of the 8-core schemes ranged from 37.1 to 38.8%. The 10-core schemes yielded detection rates of 39.6-40.8% and the protocol with 12 biopsies in the peripheral zone diagnosed prostate cancer in 42.1% of the patients. In patients with <30 cc prostate volume, the detection rate of the 14-core scheme was 43.8% and resulted statistically overlapping to the 8-peripheral cores protocol. In patients with 30.1-50 cc prostate volume a 12-peripheral core biopsy reproduced the results of the 14-core sampling. In prostates larger than 50 cc, an even more extensive procedure was mandatory, considering the low detection rate of the 14-core scheme (24.2%). CONCLUSION: Transperineal prostate biopsy is a safe procedure with a very low complication rate and high cancer detection rate. Prostate volume is the most relevant variable in the planning of the optimal number of cores in the extensive first biopsy set. A protocol with more than 8 peripheral cores) is recommended only in patients with prostate volume larger than 30 cc.     

超声引导下12+x针前列腺穿刺活检单中心407例临床分析

目的:分析单中心超声引导下12+x针前列腺穿刺活检结果,比较不同穿刺途径的临床效果。方法:回顾分析2016年6月~2019年12月我院完成的407例前列腺穿刺活检的临床资料,经直肠前列腺穿刺290例(经直肠组),经会阴前列腺穿刺117例(经会阴组),均采用超声引导下12+x针法,前列腺影像学正常者行系统穿刺,影像学异常者行系统+靶向穿刺。比较两组前列腺癌(PCa)的检出率及并发症差异,分析两组按PSA、影像学分层PCa检出率的差异,比较靶向穿刺与系统穿刺癌检出率的差异,分析临床有意义前列腺癌(csPCa)的检出情况。结果:(1)PCa总检出率为44.0%(179/407),经直肠组与经会阴组PCa检出率比较差异无统计学意义[44.8%(130/290)vs.41.9%(49/117),P>0.05]。其中,PSA≤4 ng/mL、4 ng/mL20 ng/mL各水平分层中,两组PCa检出率比较差异无统计学意义(P>0.05)。两组中前列腺影像学异常者的PCa检出率均高于影像学正常者(P<0.05)。影像学异常者中,经直肠组与经会阴组PCa检出率比较差异无统计学意义(P>0.05)。(2)前列腺影像学异常者总的PCa检出率为57.5%(111/193),靶向穿刺PCa检出率为42.0%(81/193),系统穿刺为47.7%(92/193),两者比较差异无统计学意义(P>0.05),但靶向穿刺单针阳性率比系统穿刺更高(P<0.01)。同一途径下的靶向穿刺与系统穿刺PCa检出率比较差异无统计学意义(P>0.05)。两组中分别比较靶向穿刺、系统穿刺的PCa检出率,差异均无统计学意义(P>0.05)。(3)在所有患者中,经直肠途径csPCa检出率为36.9%(107/290),经会阴途径csPCa检出率为40.2%(47/117),两者比较差异无统计学意义(P>0.05)。靶向穿刺与系统穿刺在csPCa的检出率上比较差异无统计学意义。csPCa在诊断出的PCa患者中的占比,经会阴途径占比高于经直肠途径[95.9%(47/49)vs.82.3%(107/130),P<0.05]。(4)经直肠组总并发症发生率显著高于经会阴组[39.3%(114/290)vs.20.5%(24/117),P<0.01]。经直肠组发热、血便发生率比经会阴组更高,分别为[10.3%(30/290)vs.3.4%(4/117),P<0.05]、[14.1%(41/290)vs.1.7%(2/117),P<0.01],两组在血尿、下尿路症状、尿潴留、迷走反射发生率上比较差异均无统计学意义(P>0.05)。结论:超声引导下12+x针前列腺穿刺活检PCa检出率较好,影像学异常者靶向穿刺与系统穿刺PCa、csPCa检出率差异均无统计学意义,靶向穿刺单针阳性率较高。经直肠途径与经会阴途径在PCa、csPCa检出率比较差异无统计学意义,经会阴途径并发症更少。在诊断出的PCa中,经会阴途径可检出更多的csPCa。     

超声引导下前列腺12针系统穿刺活检增加前列腺癌检出率的研究

目的:探讨不同年龄及前列腺特异性抗原(PSA)分组对12针穿刺活检前列腺癌检出率及肿瘤特征的影响。方法:临床表现怀疑前列腺癌患者210例,按照患者的年龄分为≤59岁组、60～69岁组、70～79岁组、≥80岁组,按照PSA水平分为0～4μg/L组、4.1～10μg/L组、10.1～20μg/L组、20.1～50μg/L组、>50μg/L组,记录患者临床资料及活检结果。提出不同的穿刺方案并计算其检出率。结果:210例怀疑为前列腺癌患者,检出前列腺癌91例,总的前列腺癌检出率为43.3%,随着年龄的增长,PSA水平的提高,检出率逐渐提高。年龄的增长、PSA水平的提高与体积较大、分级较高的肿瘤密切相关。外周带穿刺与旁正中矢状尖部穿刺有较高的前列腺癌检出率。当患者年龄<60岁,PSA水平<20μg/L时,12针穿刺活检为较佳方案。结论:12针穿刺活检可以弥补6针穿刺活检的缺陷,随着患者年龄的增长,PSA水平的提高,肿瘤的体积增大、病理分级较差。传统6针穿刺法与12针相比,受患者年龄、PSA水平的影响较大。     

Ultrasound-guided transrectal extended prostate biopsy： a prospective study

AIM: To evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer. Methods: One hundred and fifty-two patients with suspected prostate cancer were included in the study. Patients were entered in the study because they presented with high levels of prostate specific antigen (PSA) (over 4 ng/mL) and/or had undergone an abnormal digital rectal examination (DRE). In addition to sextant prostate biopsy cores, four more biopsies were obtained from the lateral peripheral zone with additional cores from each suspicious area revealed by transrectal ultrasound. Sextant, lateral peripheral zone and suspicious area biopsy cores were submitted separately to the pathological department. Results: Cancer detection rates were 27.6% (42/152) and 19.7% (30/152) for the 10-core and sextant core biopsy protocols, respectively. Adding the lateral peripheral zone (PZ) to the sextant prostate biopsy showed a 28.6% (12/42) increase in the cancer detection rate in patients with positive prostate cancer (P < 0.01). The cancer detection rate in patients who presented with elevated PSA was 29.3% (34/116). When serum PSA was 4-10 ng/mL TRUS-guided biopsy detected cancer in 20.6%, while the detection rate was 32.4% and 47.0% when serum PSA was 10-20 ng/mL and above 20 ng/mL, respectively. Conclusion: The 10 systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer by 28.6% when compared with the sextant biopsy technique alone, without increase in the morbidity. We therefore recommend the 10-core biopsy protocol to be the preferred method for early detection of prostate cancer.     

Transperineal extended biopsy improves the clinically significant prostate cancer detection rate: A comparative study of 6 and 12 biopsy cores

BACKGROUND: We evaluated the improvement in the rate of prostate cancer detection when using a 12-core transperineal biopsy protocol including transitional zone biopsy. METHODS: Between April 2003 and November 2004, 247 consecutive men underwent transperineal systemic 12-core biopsy of the prostate. Six cores were obtained at the peripheral zone, four at the transitional zone and two at the apex. We examined the cancer detection rate in each of the 12 cores, and also determined the improvement of cancer detection resulting from the extensive 12-core versus standard 6-core biopsy. RESULTS: Using the extensive 12-core biopsy, prostate cancer was detected in 98 cases (39.7%). Prostate-specific antigen (PSA), PSA density, the positive rate in digital rectal examination and transrectal ultrasound findings were significantly higher in the prostate cancer group than in the non-prostate cancer group, and prostate volume was larger in non-prostate cancer group. Every site showed almost the same positive rate, between 17.8 and 21.5%. There were 20 cases which were positive in the extended biopsy, but negative in the sextant. The detection improved significantly (20.4%). The improvement of cancer detection in extended biopsy was better in men with PSA levels of 10 ng/mL or less (28.9%), PSA density 0.3 or less (25.8%), negative digital rectal examination (23.3%), and negative transrectal ultrasound (21.6%). Of these twenty patients, no cases with insignificant tumor were detected in the six prostatectomy cases. In particular, three cases of the six were transitional-zone-only cancer. CONCLUSION: Transperineal extended 12-core biopsy including 4 transitional zone cores is a more useful procedure than transperineal 6-core biopsy. Routine transitional zone biopsy, that is different from transrectal biopsy, might be useful for detecting biologically significant cancer.     

Short-term prophylaxis with ciprofloxacin in extended 16-core prostate biopsy

Objective

To evaluate the safety, efficacy and possible complications of 16-core transrectal prostate biopsies using two doses of ciprofloxacin for prophylaxis of infectious complications.

Materials and Methods

Sixteen-core prostate biopsies were performed on a number of patients with different signs of potential prostate cancer. Complications were assessed both during the procedure and one week later. After the procedure, urine samples were collected for culture. The rate of post-biopsy complications, hospital visits and hospitalizations were also analyzed. Ciprofloxacin (500 mg) was administered two hours before, and eight hours after the procedure.

Results

The overall rate of post-biopsy complications was 87.32%, being 5.4% of those considered major complications due to hemorrhage, or to urinary retention. Eight patients required hospital treatment post-biopsy. Fever occurred in just one patient (0.29%). There was no incidence of orchitis, epididymitis, prostatitis, septicemia, hospitalization, or death. The urine culture showed positive results in five patients (2.15%).

Conclusion

One-day prophylaxis with ciprofloxacin proved to be safe and effective in the prevention of infectious complications following 16-core prostate biopsies.     

Transperineal 12-core systematic biopsy in the detection of prostate cancer

BACKGROUND: The present study was designed to determine the clinical value of transperineal 12-core systematic prostate biopsy guided by transrectal ultrasonography (TRUS) in the detection of prostate cancer. METHODS: A total of 679 consecutive patients underwent systematic prostate biopsies because of abnormal results on digital rectal examination and/or TRUS and/or an elevated serum prostate-specific antigen level. Systematic six- and 12-core biopsies were taken in 138 patients between April 1994 and February 1995 and in the remaining 541 between March 1995 and February 2000, respectively. Twelve-core biopsy included two samples from the lateral portion of the peripheral zone and four from the anterior portion of the transition zone in addition to the conventional six-core biopsy. RESULTS: In the series overall, systematic biopsy revealed 156 cases of prostate cancer (23.0%). The detection rate increased by 5.2%, although this was statistically not significant, from 18.8% (26/138) by six-core biopsy to 24.0% (130/541) by 12-core biopsy. Out of 130 patients in whom prostate cancer was detected by 12-core biopsy, it was supposed that conventional six-core biopsy would have missed 18 cases (13.8%). CONCLUSIONS: Systematic 12-core biopsy might improve the detection rate for prostate cancer. However, further studies are needed to determine its clinical value in the diagnosis of the disease.