- 作者：Guillaume Ploussard ; Nathalie Nicolaiew ; Charles March ; St茅phane Terry ; Francis Vacherot ; Dimitri Vordos ; Yves Allory ; Claude-Cl茅ment Abbou ; Laurent Salomon ; Alex ; re de la Taille
- 关键词：Prostate cancer ; Biopsy ; Detection rate ; Core number ; Low risk ; Insignificant
- 刊名：European Urology
- 出版年：January, 2014
- 年：2014
- 卷：65
- 期：1
- 页码：154-161
- 全文大小：1455 K
Background
The debate on the optimal number of prostate biopsy core samples that should be taken as an initial strategy is open.Objective
To prospectively evaluate the diagnostic yield of a 21-core biopsy protocol as an initial strategy for prostate cancer (PCa) detection.
Design, setting, and participants
During 10 yr, 2753 consecutive patients underwent a 21-core biopsy scheme for their first set of biopsy specimens.
Intervention
All patients underwent a standardized 21-core protocol with cores mapped for location.
Outcome measurements and statistical analysis
The PCa detection rate of each biopsy scheme (6, 12, or 21 cores) was compared using a McNemar test. Predictive factors of the diagnostic yield achieved by a 21-core scheme were studied using logistic regression analyses.
Results and limitations
PCa detection rates using 6 sextant biopsies, 12 cores, and 21 cores were 32.5%, 40.4%, and 43.3%, respectively. The 12-core procedure improved the cancer detection rate by 19.4% (p = 0.004), and the 21-biopsy scheme improved the rate by 6.7% overall (p < 0.001). The six far lateral cores were the most efficient in terms of detection rate. The diagnostic yield of the 21-core protocol was >10% in prostates with volume >70 ml, in men with a prostate-specific antigen level < 4 ng/ml, with a prostate-specific antigen density (PSAD) <0.20 ng/ml per gram. A PSAD <0.20 ng/ml per gram was the strongest independent predictive factor of the diagnostic yield offered by the 21-core scheme (p < 0.001). The 21-core protocol significantly increased the rate of PCa eligible for active surveillance (62.5% vs 48.4%; p = 0.036) than those detected by a 12-core scheme without statistically increasing the rate of insignificant PCa (p = 0.503).
Conclusions
A 21-core biopsy scheme improves significantly the PCa detection rate compared with a 12-core protocol. We identified a cut-off PSAD (0.20 ng/ml per gram) below which an extended 21-core scheme might be systematically proposed to significantly improve the overall detection rate without increasing the rate of detected insignificant PCa.