经直肠和经会阴前列腺穿刺对前列腺癌诊断价值的比较

A comparison of the diagnostic value of transrectal and transperineal prostate biopsies for prostate cancer

摘要:

目的 比较超声引导下经直肠前列腺系统穿刺（transrectal prostate systematic biopsy，TR-SB）和磁共振-超声引导下经会阴前列腺融合靶向穿刺（transperineal prostate targeted biopsy，TP-TB）对前列腺癌（prostate cancer，PCa）检出率的差异，探讨两者的诊断价值。方法 回顾性地分析重庆医科大学附属第一医院2020年12月至2022年5月的行经直肠和经会阴前列腺穿刺活检术的患者共310例，按穿刺方式将患者分为TR-SB组和TS-TB组，比较2种穿刺方式对前列腺癌、临床有意义的前列腺癌（clinically significant prostate cancer，CSPCa）检出率和并发症的差异。结果 在总前列腺特异性抗体（total prostate specific antigen，tPSA）4~50 ng/mL的患者中，TR-SB和TP-TB2种穿刺方式对PCa和CSPCa的检出率差异无统计学意义（P>0.05）。当tPSA水平处于4~<10 ng/mL或10~<20 ng/mL，且在游离/总前列腺特异性抗原（free/total prostate specific antigen，f/tPSA）小于0.16时，TP-TB组对PCa和CSPCa的检出率高于TR-SB组（P<0.05），tPSA水平处于10~<20 ng/mL时，TP-TB组对CSPCa的检出率高于TR-SB组（P<0.05）。TR-SB组和TP-TB组在并发症总发生率上无差异（P>0.05），TR-SB组术后出现发热、感染的风险高于TP-TB组（P<0.05）。结论 TP-TB在tPSA 4~<10 ng/mL、10~<20 ng/mL，且f/tPSA<0.16时具有更高的PCa检出率。当tPSA 10~<20 ng/mL，尤其同时f/tPSA<0.16时，TP-TB对高侵袭度的CSPCa有更高的检出率，且术后感染的风险更低，可作为一种高效且更安全的穿刺方法应用于临床。

Abstract:

Objective To compare the difference in the detection rate of prostate cancer（PCa） between ultrasound-guided transrectal prostate systematic biopsy（TR-SB） and magnetic resonance/ultrasound-guided transperineal prostate targeted biopsy（TP-TB），and to evaluate the diagnostic value of both methods.Methods A retrospective analysis was conducted on 310 patients who underwent transrectal and transperineal prostate biopsies in the First Affiliated Hospital of Chongqing Medical University from December 2020 to May 2022. The patients were divided into TR-SB group and TP-TB group based on the biopsy methods. The two biopsies were compared for the differences in the detection rates of PCa and clinically significant prostate cancer（CSPCa），as well as the incidence of complications.Results There was no significant difference in the detection rates of PCa and CSPCa between the TR-SB and TP-TB groups in patients with a total prostate-specific antigen（tPSA） level of 4-50 ng/mL（P>0.05）. The detection rates of PCa and CSPCa were significantly higher in the TP-TB group than in the TR-SB group when the tPSA level was between 4-<10 ng/mL or 10-<20 ng/mL and the free/total prostate-specific antigen（f/tPSA） level was less than 0.16（P<0.05）. The detection rate of CSPCa was significantly higher in the TP-TB group than in the TR-SB group when the tPSA level was between 10-<20 ng/mL（P<0.05）. There was no significant difference in the overall incidence of complications between the two groups（P>0.05）. The risk of postoperative fever and infections was significantly higher in the TR-SB group than in the TP-TB group（P<0.05）.Conclusion TS-TB has a higher detection rate for PCa and CSPCa in patients with a tPSA level of 4-<10 ng/mL or 10-<20 ng/mL and an f/tPSA level of less than 0.16. For patients with a tPSA level of 10-<20 ng/mL，especially accompanied by an f/tPSA level of less than 0.16，TP-TB has a higher detection rate for highly invasive CSPCa and has a lower risk of postoperative infections，making it an efficient and safer biopsy method in clinical practice.