Accuracy Of Modified Trans-perineal Template-guided Mapping Biopsy(m TTMB)in Simulating The Spatial Distribution Of Prostate Cancer

Objective: Prostate cancer is the second most common male malignancy worldwide.In recent years,the incidence of prostate cancer in China keeps rising,which has become a major health problem in aged men.Currently,the treatment strategies for localized prostate cancer mainly focus on active surveillance or radical surgery,but both of them have certain defects.Therefore,accurate focal treatment of localized prostate cancer that can not only retain prostate function,but also reduce cancer focus is the focus of clinical research on prostate cancer.The purpose of this study was to verify the accuracy of the modified transperineal template-guided mapping biopsy(m TTMB)in the localization and qualitative spatial distribution of prostate cancer lesions,so as to provide a feasible biopsy scheme for orientating the prostate cancer lesions before focal treatment.Methods: From October 2017 to December 2018,m TTMB was conducted under the guidance of TPS system for suspected prostate cancer patients admitted to Northern Jiangsu People’s Hospital,and 10 patients with positive pathological results were treated with laparoscopic radical prostatectomy,followed by pathological examination of large tissue section from isolated prostate.Then,AUTO-CAD software was used to restore the spatial distribution of prostate cancer lesions found by the biopsy pathology of m TTMB and those found by the biopsy pathology of large tissue sections,and the "gold standard" was used to verify the accuracy of the simulation of cancer lesions with m TTMB.Results: 32 patients successfully completed m TTMB under the guidance of TPS software system,with an average of 68(46~116)punctures per prostate.28 patients presented hematuria,3 perineal hematoma,1 hematospermia and 2 fever after biopsy,all of which improved after treatment.The pathological results of 14 patients were positive,and 10 of these patients underwent subsequent laparoscopic radical prostatectomy.Among the 14 cases of prostate cancer,10 cases were evaluated for further laparoscopic radical prostatectomy.All the 10 patients had prostate adenocarcinoma,and the Gleason score averaged 7.5(3+4~5+4).In which 3 + 4 = 7 in 3cases,4 + 3 = 7 in 4cases,4 + 4 = 8 in 1case,4 + 5 = 9 in 1 case,5 + 4 = 9 in 1 case.A total of 24 lesions were found in m TTMB,with an average of 2.3 lesions,including 2 in the apex,2 in the basement,15 in the peripheral zone,and 5 in the central zone and transitional zone.Postoperative pathological examination of large tissue sections was successfully performed in 10 patients,and a total of 26 clinically significant cancer foci were found,with an average of 2.6,including 3 in the apex,2 in the basement,16 in the peripheral zone,5 in the central zone and 5 in the transitional zone.The average Gleason score of 10 cases was 7.6(3+4~5+4).There were 1 case of tumor invading unilateral seminal vesicle gland,1 case of bilateral seminal vesicle gland,3 cases of positive resection margin.All the 10 patients successfully used AUTO-CAD software to restore the spatial distribution of lesions in m TTMB pathology and large tissue section pathology.Through comparison,it is found that m TTMB can better simulate the spatial distribution of prostate cancer.A total of 24 clinically significant cancer lesions were found in 10 patients by m TTMB,with a detection rate of 92%,and a total of 25 "accurate lesions" were found,with an accuracy rate of 96% for spatial distribution reduction.Conclusion:(1)The spatial distribution model of prostate cancer can comprehensively and accurately restore prostate cancer focus,which can not only provide feedback and guide clinical practice,but also facilitate the construction of harmonious doctor-patient relationship;(2)The m TTMB technology has the characteristics of high accuracy,good safety and strong repeatability in locating and characterizing prostate cancer lesions.It can be used for the accurate diagnosis of suspected prostate cancer patients(especially the patients with negative initial biopsy and no obvious abnormality in imaging,but the monitoring of PSA continuously increased).(3)Under the guidance of TPS software system,m TTMB can favorably simulate the spatial distribution of prostate cancer lesions,providing a certain theoretical basis for precise localization and qualitation of prostate cancer lesions before local treatment.