| Prostate cancer is one of the most common malignancies in the male genitourinary system.Because of the characteristics of multifocal and heterogeneous in prostate cancer,the choice of appropriate systematic and targeted biopsy protocol is of great importance in clinical practice.However,there is no consensus on this issue currently.In view of the current status of prostate biopsy,this study was divided into four parts to discuss.Firstly,the study discussed the diagnosis value of different systematic biopsy protocols under the guidance of transrectal ultrasonography(TRUS)in prostate cancer.Then we compared conventional TRUS targeted biopsy with pathology to explore the role of conventional TRUS in the detection of prostate cancer lesions.For the shortcomings of systematic biopsy and conventional TRUS targeted biopsy in the detection of prostate cancer,further exploration of the diagnostic value of multiparametric magnetic resonance imaging(MRI)in prostate cancer was studied.MRI-TRUS image fusion targeted biopsy was performed for suspicious lesions detected by MRI,we explored the application value of MRI-TRUS fusion navigation in the detection of prostate cancer.Part One Value of Different Systematic Biopsy Protocols in the Diagnosis of Prostate Cancer Objective: To investigate the value of different systematic biopsy protocols in the diagnosis of prostate cancer.Methods: 429 male patients between June 2015 and March 2017 with abnormal prostate specific antigen(PSA)and/or abnormal digital rectal examination(DRE),and referred to a prostate biopsy were enrolled in this study.Compared with the results of biopsy pathology,the detection rate of prostate cancer and the positive rate of biopsy cores were analyzed in 6-,8-,10-and 12-point transperineal systematic biopsy.Results: The detection rates of prostate cancer of 6-,8-,10-and 12-point systematic biopsy were 35.20%,37.53%,40.33% and 44.29%,respectively.With the increasing of biopsy number,the positive biopsy rate was on the rise(P=0.041).The detection rates of prostate cancer among groups were not significantly different except between 12-and 6-,8-point systematic biopsy(P=0.007,P=0.044).The positive rates of biopsy cores in four systematic biopsy protocols were low,and the difference was not statistically significant(P?0.05).Conclusion:The positive rate of systematic biopsy increased with the increased biopsy number from 6-to 12-point,especially by increasing the biopsy cores in the transition zone of prostate.The detection rate of systematic biopsy cores was low,and increasing the biopsy cores did not improve the positive rate of biopsy cores.Part Two Value of Conventional TRUS in the Detection of Prostate Cancer Lesions Objective: To investigate the diagnostic value of conventional TRUS in prostate cancer.Methods: 429 male patients between June 2015 and March 2017 with abnormal PSAs and/or abnormal DRE and referred to a prostate biopsy were enrolled in this study.All patients underwent conventional TRUS examination before operation,and conventional TRUS targeted biopsy was performed for suspicious lesions.The diagnostic efficacy of conventional TRUS in prostate cancer was analyzed,and the detection rate of prostate cancer,the positive rate of biopsy cores and distribution of positive biopsy cores of conventional TRUS targeted biopsy were compared with those of systematic biopsy.Results: 216 were diagnosed with prostate cancer,213 were benign prostatic disease.190 prostate cancers were detected by systematic biopsy and 94 were detected by conventional TRUS targeted biopsy.The detection rate of systematic biopsy was significantly higher than that of conventional TRUS targeted biopsy(P<0.05).The Gleason score of prostate cancer detected by conventional TRUS targeted biopsy was significantly higher than that detected by systematic biopsy(P=0.006).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of conventional TRUS were 53.24%,55.40%,54.31%,54.76% and 53.88%,respectively.The detection rate of conventional TRUS targeted biopsy cores and systematic biopsy cores were 32.22% and 14.64%,the former was significantly higher than the latter(P<0.0001).Of all positive cores of conventional TRUS targeted biopsy,149(69.95%)cores were in the peripheral zone,41(19.24%)in the apex,and 23(10.80%)in the transition zone.Of all positive cores of systematic biopsy,489(64.85%)cores were in the peripheral zone,129(17.11%)in the apex,and 136(18.04%)in the transition zone.Most of positive cores were located in the peripheral zone,the conventional TRUS targeted biopsy detected less lesions in transition zone than systematic biopsy(P=0.030).Conclusion:The sensitivity of conventional TRUS in the diagnosis of prostate cancer was low,and the combination of conventional TRUS targeted biopsy and systematic biopsy increased the detection rate of prostate cancer to a certain extent.Conventional TRUS targeted biopsy significantly improved the detection rate of biopsy cores,and detected more high-grade prostate cancer,but the detection rate of the lesion in the transition zone was not high.Part Three Value of Multiparametric MRI in the Detection of Prostate Cancer Lesions Objective: To investigate value of multiparametric MRI in prostate cancer lesion detection.Methods: 105 male patients between May 2015 and March 2017 with abnormal PSAs and/or abnormal DRE and referred to a prostate biopsy were enrolled in this study.All patients underwent multiparametric MRI examination before operation,and MRI-TRUS image fusion targeted biopsy was performed for suspicious lesions.The diagnostic efficacy of MRI in prostate cancer was analyzed,and compare the value of T2 WI,DWI and DCE-MRI in the detection of prostate cancer lesions.Results: Among 105 patients,53 cases were diagnosed as prostate cancer,52 cases were benign prostatic disease.Of the 76 patients with positive MRI results,47 cases were confirmed to be prostate cancer,29 cases were confirmed to be benign prostatic disease.Of the 29 patients with negative MRI results,6 cases were confirmed to be prostate cancer,23 cases were confirmed to be benign prostatic disease.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of multiparametric MRI were 88.68%,44.23%,66.67%,61.84% and 79.31%,respectively.A total of 45 cases of prostate cancer were detected by multiparametric MRI in patients with suspected lesions of prostate cancer.The detection rate of prostate cancer was 42.86%.39 cases of prostate cancer were detected by systematic biopsy,the detection rate of prostate cancer was 37.14%,and the detection rate of prostate cancer by multiparametric MRI was higher than that of systematic biopsy,the difference was not statistically significant(P=0.398).The prostate cancer detection rates of T2 WI,DWI and DCE-MRI were 38.10%,41.90% and 40.95%,respectively.Prostate cancer detection rate of DWI was the highest,DCE-MRI followed,T2 WI lowest,the difference between three parameters was not statistically significant(P=0.853).Multiparametric MRI detected 91 suspicious lesions,55 were confirmed prostate cancer lesions,accounting for 60.44%.36 were benign prostatic disease,accounting for 39.56%.The detection rates of cancer lesion of T2 WI,DWI and DCE-MRI in MRI detected suspicious lesions were 51.64%,58.24% and 54.95%,respectively,and the difference between three parameters was not statistically significant(P=0.671).Besides,the number of prostate cancer lesions detected by DWI was the highest in the suspicious lesions detected by MRI both in the peripheral and transition zone and there was no significant difference between the three groups(P?0.05).Conclusion:The sensitivity of multiparametric MRI in prostate cancer was high and provided more effective information on suspicious lesions for targeted biopsy,thereby improving the detection rate of prostate cancer.For the suspicious lesions found by multiparametric MRI,the number of prostate lesions detected by DWI was the highest in both peripheral and transition zone compared with T2 WI and DCE-MRI,but difference was not significant.Part Four Value of MRI-TRUS Fusion Navigation in Diagnosis of Prostate Cancer Objective: To investigate value of MRI-TRUS fusion navigation in diagnosis of prostate cancer.Methods: 105 male patients between May 2015 and March 2017 with abnormal PSAs and/or abnormal DRE and referred to a prostate biopsy were enrolled in this study.All patients underwent multiparametric MRI and conventional TRUS before operation,and MRI-TRUS image fusion targeted biopsy and conventional TRUS targeted biopsy were performed for suspicious lesions.Compared with conventional TRUS targeted biopsy and systematic biopsy,the diagnostic value of MRI-TRUS image fusion targeted biopsy for prostate cancer was analyzed.Results: Among 105 patients,53 cases were diagnosed as prostate cancer,52 cases were benign prostatic disease.The detection rates of prostate cancer of MRI-TRUS image fusion targeted biopsy,conventional TRUS targeted biopsy and 12-point systematic biopsy were 42.86%,15.24% and 37.14%,respectively.The difference of detection rate of prostate cancer was statistically significant(P<0.0001).The detection rate of prostate cancer of MRI-TRUS image fusion targeted biopsy was significantly higher than that of conventional TRUS targeted biopsy(P<0.0001),but not statistically significant with 12-point systematic biopsy(P=0.398).The positive rate of biopsy cores of MRI-TRUS image fusion targeted biopsy,conventional TRUS targeted biopsy and systematic biopsy were 46.69%,36.11% and 9.60%,respectively.The detection rate for MRI-TRUS image fusion targeted biopsy cores was significantly higher than that for systematic biopsy cores(P<0.0001),but there was no significant difference with the conventional TRUS targeted biopsy(P=0.063).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of multiparametric MRI and conventional TRUS were 88.68%,44.23%,66.67%,61.84%,79.31% and 47.17%,59.62%,53.33%,54.35%,52.54%,respectively.The sensitivity of multiparametric MRI in the diagnosis of prostate cancer was significantly higher than that of conventional TRUS(P=0.044).By construction of ROC curve analysis,the AUC of multiparametric MRI,conventional TRUS and the combined diagnosis of prostate cancer were 0.665,0.544 and 0.616,respectively.The difference of AUC between multiparametric MRI and conventional TRUS was statistically significant(P=0.005).There was no statistically significant difference between the other groups.The lesions detected by MRI-TRUS image fusion targeted biopsy were mainly located in the transition zone,while the lesions detected by conventional TRUS were mainly located in the peripheral zone,and the difference was significant(P<0.0001).The prostate cancer detection rate of MRI-TRUS image fusion targeted biopsy was significantly higher than that of 6-point systematic biopsy(P=0.031),and there was no statistically significant difference between MRI-TRUS image fusion targeted biopsy and 8-,10-,12-point systematic biopsy.Conclusion: MRI-TRUS image fusion targeted biopsy increased the detection rate of prostate cancer and reduced the number of unnecessary cores.The efficacy of multiparametric MRI in diagnosis of prostate cancer was significantly higher than conventional TRUS,and increased the detection of prostate cancer in the transition zone to some extent.MRI-TRUS image fusion targeted biopsy might replace the 8-or more point systematic biopsy in the future. |
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