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。     

MRI-spectroscopy-guided prostate biopsy

Prostate cancer is currently one of the main causes of urological practice workload. Patients with negative prostate biopsies may pose serious problems to the urologist in the decision making process for follow-up due to the lack of definitive data in the follow-up algorithm. MRI spectroscopy seems to open a diagnostic window evaluating prostatic metabolic changes. The performance of perineal prostatic biopsy with stabilizer and template enables selective biopsy of the suspect voxels following the spectroscopic study, simulating the Rubick's cube.     

经直肠直视下穿刺法在前列腺穿刺活检中的应用

目的探讨经直肠直视下前列腺穿刺活检方法的可行性。方法采用改良的俯卧位前列腺直视下穿刺方法行经直肠前列腺穿刺活检56例。利用庤上黏膜环形缝扎器（PPH）套件中的部分组件,即环形肛管扩张器及镜芯、肛镜缝扎器以协助显露直肠段前列腺。结果经直肠直视下前列腺穿刺活检方法可直视穿刺,穿刺深度和方向易控制。针刺布局规范,患者体位舒适,耐受适应好。无严重并发症发生。穿刺效果良好。结论经直肠直视下俯卧位前列腺穿刺活检方法简便,穿刺准确,值得推广。     

Defining prostate cancer risk before prostate biopsy

Prostate cancer is the most commonly diagnosed cancer in men. At present, patients are selected for prostate biopsy on the basis of age, serum prostate specific antigen (PSA), and prostatic digital rectal examination (DRE) findings. However, due to limitations in the use of PSA and DRE, many patients undergo unnecessary prostate biopsy. A further problem arises as many patients are diagnosed and treated for indolent disease. This review of the literature highlights the strengths and weaknesses of existing methods of prebiopsy risk stratification and evaluates promising serum, urine, and radiologic prostate cancer biomarkers, which may improve risk stratification for prostate biopsy in the future.     

Aspiration biopsy of prostate

Needle biopsy of the prostate has been widely practiced for more than twenty-five years, whereas transrectal aspiration biopsy, first described fifty years ago, has not. We describe our experience using the transrectal aspiration biopsy and correlate the results with histologic studies of the prostate obtained by conventional needle biopsy and surgical specimens. Aspiration needle biopsy of the prostate has a high degree of diagnostic accuracy, it causes minimal inconvenience and discomfort, the results are rapidly available, the ease of entering the suspected area in the prostate is more precise than with conventional needle biopsy, and sampling of prostate can be greater. The disadvantages of aspiration biopsy are that the technique, being unfamiliar to most urologists, must be learned and requires an experienced cytologist for interpretation. Cytologic evaluation by aspiration biopsy and the histologic diagnosis by conventional needle biopsy are complementary.     

Local anesthesia in transrectal prostate biopsy

The administration of local anesthesia both topical and injectable before transrectal ultrasound-guided prostate biopsy is safe and efficacious. We describe our technique and review the relevant published data on this topic.     

Fusion prostate biopsy outperforms 12-core systematic prostate biopsy in patients with prior negative systematic biopsy: A multi-institutional analysis

Introduction and objectives

Patients with persistently elevated prostate specific antigen (PSA) and prior negative 12-core TRUS prostate biopsy (or biopsies) (systematic biopsy—SBx) are a diagnostic challenge. Repeat SBx or saturation biopsy in this cohort has been shown to have an even lower yield. The aim of our study is to compare the prostate cancer yield of magnetic resonance imaging (MRI) fusion biopsy (FBx) to SBx in a multi-institutional cohort comprised of patients with prior negative biopsies.

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.     

Aspiration biopsy of the prostate

Summary Fine needle aspiration biopsy of the prostate was performed on 158 patients and compared to histological material. All patients had Tru-cut needle biopsies; 83 had subsequent prostatectomies, 82 transurethral, 1 suprapubic, and 1 patient had a cystoprostatectomy. Fine needle aspiration biopsies had a sensitivity of 90% and a specificity of 100%. Core biopsies were compared to prostatectomy histologies with a sensitivity of 82% and a specificity of 100%. Fine needle aspiration biopsy is an accurate and well-tolerated method of diagnosing carcinoma of the prostate gland.     

Optimized standards for prostate biopsy

As individual risk assessment mainly depends on the correct prediction of the tumor's biological behavior, primary diagnosis plays a key role in the clinical management of prostate cancer patients. Prostate core needle biopsy, as a primary diagnostic tool, should not only confirm clinical suspicion but also supply the urologist with information which is necessary for risk-adapted therapy. The experience and competence of both the urologist and the pathologist are crucial for the quality of prostate core needle biopsy diagnosis. Optimized handling and submission of prostate core needle biopsy specimens by the urologist to the pathologist are of outstanding importance for improving the number of cancer cases detected. Increasing availability of molecular markers leads to the necessity of developing new tissue sampling procedures which allow prostate core needle biopsy specimens to be simultaneously studied histologically and by molecular approaches.     

Update on prostate biopsy technique

PURPOSE OF REVIEW: Over the past decade, a considerable number of modifications have been made to the techniques for prostate cancer biopsy. In this review, we discuss the developments reported in the literature since January 2003. RECENT FINDINGS: The addition of laterally directed biopsies has enhanced the diagnostic performance of the conventional sextant biopsy approach. Several models of the extended biopsy technique have been introduced that increase the number of cores by combining sextant and lateral biopsies to enhance the cancer detection rate. Several reports have shown that the cancer detection rate decreases as prostate volume increases, compared with an increasing cancer detection rate on repeat biopsy in men with large prostate gland volumes. Other studies have shown that the percentage of positive cores and the total percentage of tumor found at biopsy are significant independent predictors of pathological outcome on multivariate analysis. In randomized, double-blind studies, infiltration of the neurovascular bundles with lidocaine significantly reduces pain associated with extended biopsies. SUMMARY: Current reports have suggested that: (1) extended biopsy schemes decrease the false-negative rate compared with conventional sextant biopsy; (2) laterally directed biopsies from the anterior horn should be included in extended biopsy protocols; and (3) local anesthesia reduces pain associated with extended biopsy.