Design An Individualized Transrectal Ultrasound Guided Prostate Biopsy Scheme For Chinese Patient

Objective:To individually design the transrectal ultrasound guided prostate biopsy scheme for Chinese male patient with suspected prostate cancer by comprehensively considering the factors such as the PSA, PSAD, age, the prostate MRI, the health condition of the patient.Methords:The present study included 204 Chinese patient who underwent transrectal ultrasound guided prostate biopsy for the first time. All patients were between 50 and 88 years old, mean 68.8 years old. PSA 0.36-120ng/ml, an average of 32.23ng/ml, including PSA<4ng/ml for 7 cases, PSA>4ng/ml for 197 cases. Prostate volume 10.14-215.42ml, an average of 66.82ml. All patients underwent the same 10-core biopsy protocol. In addition to the Hodge sextant technique, four more biopsies were obtained from the base and middle regions of bilateral peripheral zones. Respectively compare the prostate cancer detection rate of 10-core biopsy with the 6-core biopsy protocol including the right and left para-sagittal basal,middle and apical biopsies, 4-core biopsy protocol including the right and left para-sagittal basa and apical biopsies,2-core biopsy protocol including the right and left para-sagittal middle biopsies by different PSA value and PSAD.Results:The prostate cancer detection rates of 10-core biopsy and 6-core biopsy were 38.7%(79/204) and 34.3%(70/204) respectively, which meant that the 10-core biopsy make the prostate cancer detection rates 11.4%(9/79) higher and show significant difference (P<0.05). But the increased cancer detection rate decreased by the elevated PSA value. The cancer detection rate difference is more clearly in the cases with PSA≤20ng/ml or PSAD≤0.3. In patients whose PSA levels were greater than 50 ng/mL, the 10-core biopsy strategy could detect the same number of cancers as the 10-core strategy did.The prostate cancer detection rates of 10-core biopsy and 4-core biopsy were 38.7%(79/204) and 32.4%(66/204) respectively, which meant that the 10-core biopsy make the prostate cancer detection rates 16.5% (13/79) higher and show significant difference (P<0.05). The cancer detection rate difference is more clearly in the cases with PSA≤50ng/ml or PSAD≤1.The prostate cancer detection rates of 10-core biopsy and 2-core biopsy were 38.7%(79/204) and 31.4%(64/204) respectively, which meant that the 10-core biopsy make the prostate cancer detection rates 19.0%(15/79) higher and show significant difference (P<0.05). The cancer detection rate difference is more clearly in the cases with PSA≤70ng/ml or PSAD≤1.5.Conclusions:For the patient who would undergo the TRUS prostate biopsy, the extended 10-core biopsy is strongly recommended for Chinese patient with PSA≤20ng/ml or PSAD≤0.3. For Chinese patient with PSA levels ranging from 20ng/mL to 50ng/mL or PSAD ranging from 0.3 to 1, we recommend that the 10-core biopsy should be applied in patients who would undergo the radical prostatectomy, the 6-core strategy should be applied in the rest of patients. For Chinese patient with PSA>50ng/ml or PSAD>1, we recommend the 6-core biopsy or the 4-core biopsy by comprehensively considering the factors such as the PSA, PSAD, age, the prostate MRI, the health condition of the patient. For Chinese patient with PSA>70ng/ml or PSAD>1.5, we recommend the 2-core biopsy by comprehensively considering the factors such as the PSA, PSAD, age, the prostate MRI, the health condition of the patient.