Sistematik ve kognitif hedefe yönelik biyopsi: klinik olarak anlamlı prostat kanseri ile ilgili parametrelerinin değerlendirilmesi ve tespit oranlarının karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, kognitif hedefe yönelik biyopsi (KHB) ve sistematik biyopsinin (SB) klinik anlamlı prostat kanseri (kaPKa) tespit oranlarını karşılaştırmak ve kaPKa tespit oranlarını etkileyen faktörleri ortaya çıkarmaktır.
Gereç ve Yöntemler: 2016-2019 yılları arasında lokalize prostat kanseri tanısı alan hastalar retrospektif olarak değerlendirildi. KHB ve SB yapılan hastalar kaydedildi. İndeks lezyondan alınan KHB kor sayısı, yaş, prostat spesifik antijen (PSA) seviyesi, gleason skoru, ISUP (International Society of Urological Pathology) derecesi, PIRADS (Prostate Imaging and Data Reporting System) skoru, indeks lezyonun büyüklüğü ve parmakla rektal muayene (PRM) bulguları kaydedildi. Ayrıca lezyonun magnetik rezonans görüntüleme (MRG)’ deki lokalizasyonu ile PRM ile tespit edilen nodülün lokalizasyonu arasında bir uyum olup olmadığı da araştırıldı.
Bulgular: Seksen hasta çalışmaya dahil edildi. SB’li 55 (%68.7) hastada kaPKa saptanırken, tek başına KHB ile 35 (%43.7) hastada kaPKa saptandı (p<0.01). SB ile 2 kaPKa hastası atlanmasına karşın KHB ile kaPKa hastaların % 35’ine tanı konulamadı. SB ve KHB’de kaPKa tespit oranları, PRM ve mpMRG arasında bir uyum olan hastalarda anlamlı olarak daha yüksekti (sırasıyla p= 0.012 ve p<0.01). KHB’de kaPKa saptanan hastalarda ortalama yaş, prostat hacmi, PSA, lezyon çapı, kor sayısı ve (PGVRS) skoru açısından anlamlı farklılıklar saptandı ( sırasıyla p=0.005, p=0.02, p=0.005, p=0.003, p=0.017 ve p=0.002).
Sonuç: SB, kaPKa tanısında önemini korumaktadır. Daha büyük lezyonları olan hastalarda KHB tercih edilebilir.

Keywords

• Prostat kanseri
• prostat biyopsisi
• manyetik rezonans görüntüleme
• hedefe yönelik biyopsi

Systematic versus cognitive targeted biopsy: evaluation of parameters related to clinically significant prostate cancer and comparison of detection rates

Abstract

Objective: This study aims to compare the clinically significant prostate cancer (csPCa) detection rates of cognitive targeted biopsy (CTB) and systematic biopsy (SB) and to reveal the factors affecting csPCa detection rates.
Material and Methods: Patients diagnosed with localized prostate cancer between 2016-2019 were evaluated retrospectively. Patients who underwent SB and concomitant CTB were recorded. The number of cores taken from the index lesion in CTB, age, prostate-specific antigen (PSA) level, Gleason score, International Society of Urological Pathology (ISUP) grade, Prostate Imaging and Data Reporting System (PIRADS) score, the diameter of index lesion, and digital rectal examination (DRE) findings was recorded. We also studied whether there was a concordance between the localization of the lesion on MRI (magnetic resonance imaging) and the localization of the nodule detected on DRE.
Results: Eighty patients were included in the study. csPCa was detected in 55 (68.7%) patients with SB, whereas CTB alone detected csPCa in 35 (43.7%) patients (p<0,01). SB missed 2 patients with csPCa, but 35% of the men with csPCa would be missed by CTB. Detection rates of csPCa in SB and CTB were significantly higher in patients with a concordance between DRE and mpMRI (p= 0.012 and p<0.01, respectively). In patients who had csPCa in CTB, significant differences were detected in the mean age, prostate volume, PSA, lesion diameter, number of cores, and PIRADS score (p=0.005, p=0.02, p=0.005, p=0.003, p=0.017, and p=0.002, respectively)
Conclusion: SB maintains its importance in the diagnosis of csPCa. CTB can be preferred in patients with larger lesions.

Keywords

• Prostate cancer
• prostate biopsy
• magnetic resonance imaging
• targeted biopsy

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