Abstract
Background Recently, most studies on the spatial distribution of the prostate cancer are based on the samples confirmed by transrectal prostate biopsy (TRBx), which could distinguish the distribution of cancer lesions between the apex, middle and basal parts of the prostate, but the distinction between lesions in the left and right sides of prostate cancer and the transitional and peripheral bands remains to be considered. Further, there has been little research on the specific proportion of cancer in prostate biopsy tissue. The current study aimed to analyze the clinical characteristics, diagnostic efficacy of relevant indicators, and reveal the spatial distribution of prostate cancer in transperineal prostate biopsy (TPBx).
Methods A total of 810 patients underwent TPUS-guided 10-core prostate biopsy in our hospital from Oct. 2016-to Feb. 2019, participants' clinical data and the diagnostic yield of the cores were recorded and retrospectively analyzed as a cross-sectional study.
Results Age, total prostate specific antigen (t-PSA), prostate volume (PV), prostatic inflammation, dysuria, hematuria, asymptomatic and MRI were independent factors in prostate cancer (Pca) patients compared with non-Pca patients (P<0.05). The cut-off points for age, t-PSA, free prostate specific antigen (f-PSA), PSA density (PSAD), free/total prostate specific antigen (f/t PSA) and PV were 73years old, 15.43ng/ml, 4.545ng/ml, 0.475ng/ml*cm3, 0.123 and 41.45ml, respectively. The PRPN of left peripheral zone (LPZ) prostate tumor was elevated regardless of the Gleason score. However, the PRPN of left transitional zone (LTZ) was lower than LPZ and similar to right peripheral zone (RZ), but PRCF and CFVR were significantly higher, especially in tumors with higher Gleason score (≥8).
Conclusions For Chinese, the t-PSA standard and the PSAD standard in the puncture indication should be increased, while the f/t PSA standard should be reduced. At the same time, multi-factor assessment is needed to determine whether patients need a prostate biopsy or not. The spatial distribution of prostate cancer is asymmetrical, with more cancer lesion on the left than on the right. The PRPN of LPZ is relatively higher. LTZ has higher PRCF, and most of them were large lesions with high Gleason score (≥8).
Is transperineal prostate biopsy more accurate than transrectal biopsy in determining final Gleason score and clinical risk category? A comparative analysis