Transrectal Saturation Technique May Improve Cancer Detection as an Initial Prostate Biopsy Strategy in Men with Prostate-specific Antigen
A partir des données de registres médicaux portant sur 3 776 hommes ayant subi une biopsie de la prostate entre 2002 et 2011, cette étude montre qu'une biopsie initiale de saturation par voie transrectale peut, par rapport à une biopsie à schéma étendu, améliorer la détection d'un cancer de la prostate chez les hommes ayant un niveau sanguin de l'antigène prostatique spécifique inférieur à 10 ng/ml
Background : Using transrectal saturation prostate biopsy (SPBx) as an initial strategy remains a controversial topic.
Objective : To compare SPBx with extended prostate biopsy (EPBx) as an initial biopsy template in a large sequential cohort study.
Design, setting, and participants : We reviewed 438 men with initial SPBx and 3338 men who underwent initial EPBx between January 2002 and October 2011.
Intervention : Office-based SPBx under periprostatic local anesthesia.
Outcome measurements and statistical analysis : The yield of SPBx was compared with EPBx. Multivariable logistic regression models addressed cancer detection (CD) and cancer characteristics.
Results and limitations : Overall CD was 51.6% and 42.6% in men who underwent initial SPBx and EPBx, respectively. Multivariate analysis confirmed that SPBx was an independent predictor factor correlated with the CD (odds ratio [OR]: 1.66; 95% confidence interval [CI], 1.30–1.92). Stratified by prostate-specific antigen (PSA) values, CD was higher in SPBx compared with EPBx, 47.1% versus 32.8% (OR: 2.00; 95% CI, 1.19–3.38) in patients with a PSA <4 ng/ml and 50.9% versus 42.9% in patients with a PSA from 4 ng/ml to 9.9 ng/ml (OR: 1.62; 95% CI, 1.20–2.20). By contrast, SPBx did not increase CD in men with a PSA >10 ng/ml (60.0% vs 61%; OR: 1.42; 95% CI, 0.70–2.89). There was no significant difference in the detection of insignificant cancer (p = 0.223) or low-risk cancer (p = 0.077) between the two biopsy schemes. The limitation of our study is its retrospective nature and inhomogeneity.
Conclusions : Compared with EPBx, SPBx significantly increases CD as an initial biopsy strategy in men with a PSA <10 ng/ml without a significant increase in the detection of insignificant cancer. These findings suggest that SPBx may merit further investigation as an initial biopsy strategy in men with a PSA <10 ng/ml in hopes of avoiding repeat biopsy for missed malignancy during the initial biopsy.
Take Home Message : Compared with extended prostate biopsy, saturation prostate biopsy significantly increases prostate cancer detection as an initial biopsy strategy in men with prostate-specific antigen <10 ng/ml without a significant increase in the detection of insignificant cancer.
European urology , résumé, 2012