| Context:Prostate cancer(PCa)is the second most common malignancy worldwide,and it is also currently one of the leading causes of cancer death in men.At present,the early screening of prostate cancer plays an important role in the diagnosis and treatment of prostate cancer.The early screening of prostate cancer is mainly accomplished by digital rectal examination(DRE)and detection of serum prostate specific antigen(PSA),and the main method to diagnose prostate cancer is to obtain pathological diagnosis through prostate biopsy.At the beginning of this century,prostate puncture was mainly a systematic 6-needles puncture method.With the continuous exploration of clinical practice,the systematic 8-needles,10-needles,12-needles and 13-needles puncture methods have appeared.At present,the common approach of prostate puncture is the 10-12 needles system puncture biopsy(SB)of prostate guided by transrectal ultrasound.However,some studies have shown that the positive rate of this technique for clinically significant prostate cancer(CSPCa)is low,and the positive rate of puncture is not high when the PSA value is 4-20 ng/m L.With the continuous development of medical technology,The appearance of multiparametric magnetic resonance imaging(mp MRI)has promoted the innovation of diagnosis and treatment of prostate cancer,and magnetic resonance imaging targeted prostate biopsy(MRI-TB)based on mp MRI has received more attention as a new prostate biopsy method.At present,there are three main methods for magnetic resonance imaging targeted prostate biopsy(MRI-TB),which are as follows: Magnetic resonance imaging/transrectal ultrasound(MRI/TRUS)cognitive fusion targeted puncture biopsy(COG-TB),magnetic resonance imaging(MRI)realtime guided targeted puncture biopsy,magnetic resonance imaging/transrectal ultrasound(MRI/TRUS)software fusion targeted puncture biopsy.Among them,the cognitive fusion targeted puncture biopsy method is simple,convenient and quick to operate,and has no additional equipment cost.Therefore,it is easier to popularize and apply in clinical work.Objective:The differences of puncture positive rate and postoperative complications under different prostate puncture methods were comparatively analyzed.The study evaluated the effective value of cognitive fusion targeted puncture in patients with PSA≤20 ng/m L,and discussed its effectiveness and safety.It is expected to provide a safer and more effective prostate puncture method for clinical practice.Methods:Retrospective analysis was made in the patients with prostate diseases treated by transrectal ultrasound-guided prostate biopsy in Department of Urology,Huaihe Hospital of Henan University from December 2017 to September 2021.According to the relevant inclusion and exclusion criteria,121 patients were selected in this study.Patients were divided into an observation group and a control group according to different puncture methods.The observation group was treated with cognitive fusion-guided 1-3-needles targeted puncture combined with 6-needle systematic puncture,and the control group was treated with 12-needles systematic puncture guided by transrectal ultrasound.There were 53 patients in the observation group and 68 patients in the control group.The collected data included: age,PSA,prostate volume,PI-RADS v2 score of preoperative MRI report,puncture method,number of puncture needles,pathological results and Gleason score after puncture,complications after puncture,etc.The SPSS 23.0 software was used to analyze the data statistically.The differences of PCa positive rate,CSPCa positive rate,single needle positive rate and complications after puncture between the two groups at the level of PSA≤ 20 ng/m L were compared.Results:(1)This study has 121 patients.58 patients were diagnosed with PCa,and the cancer detection rate was 47.93%.Among of them,31 patients in the observation group were diagnosed with PCa,and the cancer detection rate(58.49%)was higher than that of the control group(39.71%),and the difference was statistically significant(P=0.04).31 patients were diagnosed with CSPCa after puncture in the observation group,and the observation group cancer detection rate(58.49%)was still higher than the control group(17.65%),and the difference was statistically significant(P < 0.001).(2)At the level of PSA≤10 ng/m L,the cancer detection rates of PCa and CSPCa in the observation group were higher than those in the control group(60%vs30.30%,60% vs6.06%;P=0.033,P<0.001).At the level of 10 < PSA≤20 ng/m L,the cancer detection rates of PCa and CSPCa in the observation group were also higher than those in the control group(57.58%vs48.57%,57.58% vs28.57%;P=0.457,P =0.016).(3)In this study,there were 126 targeted puncture needles.Among of them,66 needles are PCa,and the cancer detection rate was 52.38%.There were 1135 non-targeted puncture needles,and the cancer detection rate was 16.83%,and the difference was statistically significant(P < 0.001).(4)The cancer detection rate of PCa in the observation group was 58.49%(31/53),and PCa positive rate of cognitive fusion targeted puncture in the the observation group was 53.72%(29/53).A consistency test for PCa diagnosis of both showed that the Kappa value was 0.923,P < 0.05.(5)In this study,Gleason score distribution of patients with different PI-RADS v2 scores was analyzed: In the patients with PI-RADS v2 score of 3,32 patients(36.78%)were diagnosed with PCa,and21 patients(24.14%)of them were CSPCa;In the patients with PI-RADS v2 score of 4,29 patients(71.43%)were diagnosed with PCa and 9 patients(32.14%)were diagnosed with CSPCa;In the patients with PIRADS v2 score of 5,6 patients(100.00%)were diagnosed with PCa,and 4 patients(66.67%)were diagnosed with CSPCa.(6)In this study,46 patients had Hemorrhage(mainly including bloody stool and hematuria)after puncture,including 17 patients(32.08%)in the observation group and 29 patients(42.65%)in the control group,and the difference was no statistically significant(P = 0.235).Uroschesis occurred in 21 patients,including 6 patients(11.32%)in the observation group and 15 patients(22.06%)in the control group,and the difference was no statistically significant(P = 0.122).Postoperative fever occurred in 4 patients,including1 patient(1.89%)in the observation group and 3 patients(4.41%)in the control group,and the difference was no statistically significant(P=0.630).Conclusion:(1)In the patients with PSA≤20 ng/m L,the positive detection rate of PCa and CSPCa was higher the cognitive fusion-guided 1-3-needles targeted puncture combined with 6-needles system puncture than the single 12-needles system puncture guided by transrectal ultrasound,and there was no difference in postoperative complications between them.This indicates that cognitive fusion targeted puncture combined with systematic puncture biopsy has a good diagnostic value for PCa.(2)In the clinical practice,for patients with PSA≤20 ng/m L,cognitive fusion targeted puncture combined with systematic puncture biopsy may be a safer and more effective way of prostate puncture. |
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