Abstract：
OBJECTIVE: To compare transperineal (TP) vs transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion-guided prostate biopsy (PBx) in a large, ethnically diverse and multiracial cohort.
METHODS: Consecutive patients who underwent multiparametric (mp) MRI followed by TP or TR TRUS-fusion guided PBx, were identified from a prospective database (IRB #HS-13-00663). All patients underwent mpMRI followed by 12-14 core systematic PBx. A minimum of two additional target-biopsy cores were taken per PIRADS≥3 lesion. The endpoint was the detection of clinically significant prostate cancer (CSPCa; Grade Group, GG≥2). Statistical significance was defined as p<0.05.
RESULTS: A total of 1491 patients met inclusion criteria, with 480 undergoing TP and 1011 TR PBx. Overall, 11% of patients were Asians, 5% African Americans, 14% Hispanic, 14% Others, and 56% White, similar between TP and TR (p=0.4). For PIRADS 3-5, the TP PBx CSPCa detection was significantly higher (61% vs 54%, p=0.03) than TR PBx, but not for PIRADS 1-2 (13% vs 13%, p=1.0). After adjusting for confounders on multivariable analysis, Black race, but not the PBx approach (TP vs TR), was an independent predictor of CSPCa detection. The median maximum cancer core length (11 vs 8mm; p<0.001) and percent (80% vs 60%; p<0.001) were greater for TP PBx even after adjusting for confounders.
CONCLUSIONS: In a large and diverse cohort, Black race, but not the biopsy approach, was an independent predictor for CSPCa detection. TP and TR PBx yielded similar CSPCa detection rates; however the TP PBx was histologically more informative.
METHODS: Consecutive patients who underwent multiparametric (mp) MRI followed by TP or TR TRUS-fusion guided PBx, were identified from a prospective database (IRB #HS-13-00663). All patients underwent mpMRI followed by 12-14 core systematic PBx. A minimum of two additional target-biopsy cores were taken per PIRADS≥3 lesion. The endpoint was the detection of clinically significant prostate cancer (CSPCa; Grade Group, GG≥2). Statistical significance was defined as p<0.05.
RESULTS: A total of 1491 patients met inclusion criteria, with 480 undergoing TP and 1011 TR PBx. Overall, 11% of patients were Asians, 5% African Americans, 14% Hispanic, 14% Others, and 56% White, similar between TP and TR (p=0.4). For PIRADS 3-5, the TP PBx CSPCa detection was significantly higher (61% vs 54%, p=0.03) than TR PBx, but not for PIRADS 1-2 (13% vs 13%, p=1.0). After adjusting for confounders on multivariable analysis, Black race, but not the PBx approach (TP vs TR), was an independent predictor of CSPCa detection. The median maximum cancer core length (11 vs 8mm; p<0.001) and percent (80% vs 60%; p<0.001) were greater for TP PBx even after adjusting for confounders.
CONCLUSIONS: In a large and diverse cohort, Black race, but not the biopsy approach, was an independent predictor for CSPCa detection. TP and TR PBx yielded similar CSPCa detection rates; however the TP PBx was histologically more informative.
摘要：
目的：比较经会阴（TP）与经直肠（TR）磁共振成像（MRI）和经直肠超声（TRUS）融合引导下的前列腺活检（PBx）。种族多样化和多种族队列。
方法：连续接受多参数（mp）MRI，然后进行TP或TR-TRUS融合引导的PBx的患者，从前瞻性数据库(IRB#HS-13-00663)中确定。所有患者均接受mpMRI，然后进行12-14核心系统PBx。每个PIRADS≥3个病变至少额外取两个靶活检核心。终点是临床上有意义的前列腺癌的检测(CSPCa;GradeGroup,GG≥2)。统计学显著性定义为p<0.05。
结果：共有1491例患者符合纳入标准，480接受TP和1011TRPBx。总的来说,11%的病人是亚洲人,5%的非洲裔美国人，14%的西班牙裔,14%其他56%是白人，TP和TR之间相似(p=0.4)。对于3-5岁的PIRADS，TPPBxCSPCa检测明显更高（61％vs54％，p=0.03)比TRPBx，但不适用于1-2岁的猪（13%对13%，p=1.0)。在多变量分析中调整了混杂因素后，黑人种族，但不是PBx方法(TP与TR)，是CSPCa检测的独立预测因子。即使在校正混杂因素后，TPPBx的中位最大癌核心长度（11vs8毫米；p<0.001）和百分比（80％vs60％；p<0.001）也更大。
结论：在一个庞大且多样化的队列中，黑人种族，但不是活检方法，是CSPCa检测的独立预测因子。TP和TRPBx的CSPCa检出率相似；但是TPPBx在组织学上提供了更多信息。
方法：连续接受多参数（mp）MRI，然后进行TP或TR-TRUS融合引导的PBx的患者，从前瞻性数据库(IRB#HS-13-00663)中确定。所有患者均接受mpMRI，然后进行12-14核心系统PBx。每个PIRADS≥3个病变至少额外取两个靶活检核心。终点是临床上有意义的前列腺癌的检测(CSPCa;GradeGroup,GG≥2)。统计学显著性定义为p<0.05。
结果：共有1491例患者符合纳入标准，480接受TP和1011TRPBx。总的来说,11%的病人是亚洲人,5%的非洲裔美国人，14%的西班牙裔,14%其他56%是白人，TP和TR之间相似(p=0.4)。对于3-5岁的PIRADS，TPPBxCSPCa检测明显更高（61％vs54％，p=0.03)比TRPBx，但不适用于1-2岁的猪（13%对13%，p=1.0)。在多变量分析中调整了混杂因素后，黑人种族，但不是PBx方法(TP与TR)，是CSPCa检测的独立预测因子。即使在校正混杂因素后，TPPBx的中位最大癌核心长度（11vs8毫米；p<0.001）和百分比（80％vs60％；p<0.001）也更大。
结论：在一个庞大且多样化的队列中，黑人种族，但不是活检方法，是CSPCa检测的独立预测因子。TP和TRPBx的CSPCa检出率相似；但是TPPBx在组织学上提供了更多信息。
