HACI İBRAHİM ÇİMEN, Ali Fuat ATMACA, Abidin Egemen İŞGÖREN, Abdullah Erdem CANDA, Mevlana Derya BALBAY

Prostat kanser tespitinde ilk seferde transrektal ultrason eşliğinde alınan 6 ve 8 kadran prostat biyopsi teknikleri 10 veya 12 kadrana göre yetersizdir

Amaç: Prostat kanseri (PCa) tespitinde transrektal ultrason eşliğinde (TRUS-Bx) alınan 6,8,10 ve 12 kadran biyopsi tekniklerini karşılaştıran sınırlı sayıda veri vardır. Bu çalışmanın amacı aynı hasta kohortunda 6,8,10 ve 12 kadran prostat TRUS-Bx tekniklerinin kanser tespit oranı açısından karşılaştırmaktır. Gereç ve Yöntemler: Şubat 2005 ile Ocak 2011 tarihleri arasında, serum prostat spesifik antijen (PSA) değeri 2.5 ng/mL üzeri ve/veya anormal tuşe bulguları olan 2033 erkeğe prostat TRUS-Bx uygulandı. İlk seferde 12 kadran prostat biyopsisi alınan 1131 (%55.6) hasta çalışmaya dahil edildi. Hasta patolojileri hastalara 12 kadran biyopsi yerine 6,8 ve 10 kadran alınmış gibi tekrar değerlendirildi. Bu tekniklerin PCa tespit oranları karşılaştırıldı. Bulgular: Toplamda hastaların %20.9’unda (236/1131) 12 kadran biyopsi ile PCa tespit edildi. Altı kadran, 8 kadran ve 10 kadran biyopsilerin kanser tespit oranı sırasıyla %16.4, %20 .1 ve %20.4 olarak hesaplandı. On ve 12 kadran biyopsi teknikleri arasında PCa tespiti açısından anlamlı bir farklılık saptanmadı (p=0.006). Ancak 12 kadran biyopsinin PCa tespit oranı hem 6 kadran (p < 0.0001) hem de 8 kadran (p=0.0039) biyopsiye göre anlamlı olarak yüksekti. Sonuç: Standart 6 ve 8 kadran prostat biyopsisi PCa tespitinde 10 yada 12 kadran prostat biyopsisine kıyasla değersiz görünmektedir. Bundan dolayı ilk prostat biyopsisi 12 kadranı içermelidir.

Anahtar Kelimeler:

Biyopsi, prostat, prostat neoplazmı

Initial 6 and 8 cores transrectal ultrasound guided prostate biopsy techniques are inadequate compared to 10 or 12 cores in detecting prostate cancer

Objectives: Limited data exist regarding the comparison of 6, 8, 10 and 12 cores of transrectal ultrasound guided biopsy (TRUS-Bx) of the prostate in detecting prostate cancer (PCa). The purpose of this study was to compare the cancer detection rates of 6, 8, 10 and 12 cores TRUS-Bx of the prostate on the same cohort of patients. Material and Methods: Between February 2005 and January 2011, 2033 men with serum PSA levels higher than 2.5 ng/mL and/or with an abnormal digital rectal examination underwent TRUS-Bx of the prostate. Of the patients, 1131 (55.6%) who underwent initial 12 cores TRUS-Bx of the prostate were included in the study. Patients’ pathology results were re-evaluated if they had undergone 6, 8, and 10 cores biopsies rather than 12 cores. PCa detection rates of these techniques were compared. Results: Overall, 20.9% (236 of 1131) of the patients had PCa detected on 12 cores biopsy. Cancer detection rates of 6 cores, 8 cores and 10 cores biopsies were calculated as 16.4%, 20.1% and 20.4%, respectively. No significant difference was detected between 10 and 12 cores biopsy techniques in detecting PCa (P = 0.06). However, 12 cores biopsy had significantly higher PCa detection rate compared to both 6 (P < 0.0001) and 8 (P = 0.0039) cores biopsies. Conclusion: Standard 6 and 8 cores of prostate biopsy seem to be inferior compared to 10 or 12 cores of TRUS-Bx of the prostate in detecting PCa. Therefore, 12 cores should be included in the initial TRUS-Bx of the prostate.

Keywords:

Biopsy, prostate, prostate neoplasm,

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1. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989; 142: 71-74.
2. Presti JC Jr, Chang JJ, Bhargava V, Shinohara K. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 2000; 163: 163-167.
3. Gore JL, Shariat SF, Miles BJ, Kadmon D, Jiang N, Wheeler TM et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 2001; 165: 1554-1559.
4. Serefoglu EC, Ozdemir AT, Balbay MD. Re: The 20-core prostate biopsy protocol--a new gold standard?: V. Ravery, S. Dominique, X. Panhard, M. Toublanc, L. Boccon-Gibod and L. Boccon-Gibod. J Urol 2008; 179: 504-507. J Urol 2008; 180 : 2256-2257.
5. Presti JC Jr. Prostate biopsy: how many cores are enough? Urol Oncol 2003; 21: 135-140.
6. Terris MK, Stamey TA. Determination of prostate volume by transrectal ultrasound. J Urol 1991; 145: 984 – 987.
7. Eskew LA, Bare RL, McCullough DL. Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 1997; 157: 199-202.
8. Levine MA, Ittman M, Melamed J, Lepor H. Two consecutive sets of transrectal ultrasound guided sextant biopsy cores of the prostate for the detection of prostate cancer. J Urol 1998; 159: 471- 475.
9. Naughton CK, Smith DS, Humphrey PA, Catalona WJ, Keetch DW. Clinical and pathological tumor characteristics of prostate cancer as a function of the number of biopsy cores: a retrospective study. Urology 1998; 52: 808-813.
10. Chang JJ, Shinohara K, Bhargava V, Presti JC Jr. Prospective evaluation of lateral biopsy cores of the peripheral zone for prostate cancer detection. J Urol 1998; 160: 2111-2114.
11. Ravery V, Goldblatt L, Royer B, Blanc E, Toublanc M, Boccon-Gibod L. Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol 2000; 164: 393-396.
12. Bauer JJ, Zeng J, Weir J, Zhang W, Sesterhenn IA, Connerly RR et al. Three-dimensional computer-simulated prostate models: lateral prostate biopsy cores increase the detection rate of prostate cancer. Urology 1999; 53: 961-967.
13. Eskicorapcı SY, Baydar DE, Akbal C, Sofikerim M, Günay M, Ekici S et al. An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. Eur Urol 2004; 45: 444-448.
14. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R et al. A comparative analysis of sextant and extended 11-core multiside directed biopsy strategy J Urol 2000; 163: 152-7.
15. Mottet N, Bellmunt J, Briers E, Bolla M, Cornford P, De Santis M et al. EAU-ESTRO-SIOG guidelines on prostate cancer.
16. van Hove A, Savole PH, Maurin C, Brunelle S, Gravis G, Salem N et al. Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of welldesigned studies. World J Urol 2014; 32: 847-58.
17. Bratan F, Niaf E, Melodelima C, Chesnais AL, Souchron R, Mege-Lechevallier F et al. Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 2013; 23: 2019-29.
18. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and metaanalysis. Eur Urol 2015; 68: 438-50.
19. Catala V, Salas D, Esquena S, Mateu S, Algaba F, Palou J et al. Questions and answers on prostate multiparameter magnetic resonance imaging: everything a urologist should know. Actas Urol Esp 2016; 40: 339-352.