Feasibility of prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques
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摘要
BACKGROUND Routinely, after receiving prostate specific antigen(PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging(mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy.AIM To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.METHODSFrom June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68 GaPSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients.RESULTS All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year,the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 m L, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively.CONCLUSION The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.
BACKGROUND Routinely, after receiving prostate specific antigen(PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging(mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy.AIM To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.METHODSFrom June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68 GaPSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients.RESULTS All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year,the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 m L, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively.CONCLUSION The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.
BACKGROUND Routinely, after receiving prostate specific antigen(PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging(mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy.AIM To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.METHODSFrom June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68 GaPSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients.RESULTS All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year,the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 m L, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively.CONCLUSION The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.
引文
1 Ahmed HU,El-Shater Bosaily A,Brown LC,Gabe R,Kaplan R,Parmar MK,Collaco-Moraes Y,Ward K,Hindley RG,Freeman A,Kirkham AP,Oldroyd R,Parker C,Emberton M;PROMIS study group.Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer(PROMIS):a paired validating confirmatory study.Lancet 2017;389:815-822[PMID:28110982 DOI:10.1016/S0140-6736(16)32401-1]
2 Caverly TJ,Hayward RA,Reamer E,Zikmund-Fisher BJ,Connochie D,Heisler M,Fagerlin A.Presentation of Benefits and Harms in US Cancer Screening and Prevention Guidelines:Systematic Review.J Natl Cancer Inst 2016;108:djv436[PMID:26917630 DOI:10.1093/jnci/djv436]
3 Abraham NE,Mendhiratta N,Taneja SS.Patterns of repeat prostate biopsy in contemporary clinical practice.J Urol 2015;193:1178-1184[PMID:25444971 DOI:10.1016/j.juro.2014.10.084]
4 Loeb S,Vellekoop A,Ahmed HU,Catto J,Emberton M,Nam R,Rosario DJ,Scattoni V,Lotan Y.Systematic review of complications of prostate biopsy.Eur Urol 2013;64:876-892[PMID:23787356DOI:10.1016/j.eururo.2013.05.049]
5 Berger I,Annabattula C,Lewis J,Shetty DV,Kam J,Maclean F,Arianayagam M,Canagasingham B,Ferguson R,Khadra M,Ko R,Winter M,Loh H,Varol C.68Ga-PSMA PET/CT vs.mpMRI for locoregional prostate cancer staging:correlation with final histopathology.Prostate Cancer Prostatic Dis2018;21:204-211[PMID:29858591 DOI:10.1038/s41391-018-0048-7]
6 Nestler S,Bach T,Herrmann T,Jutzi S,Roos FC,Hampel C,Thüroff JW,Thomas C,Neisius A.Surgical treatment of large volume prostates:a matched pair analysis comparing the open,endoscopic(ThuVEP)and robotic approach.World J Urol 2018[PMID:30515596 DOI:10.1007/s00345-018-2585-z]
7 Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240:205-213[PMID:15273542]
8 Liao X,Qiao P,Tan Z,Shi H,Xing N."Total reconstruction"of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy.Int Braz J Urol 2016;42:215-222[PMID:27256174 DOI:10.1590/S1677-5538.IBJU.2014.0666]
9 Halpern JA,Sedrakyan A,Dinerman B,Hsu WC,Mao J,Hu JC.Indications,Utilization and Complications Following Prostate Biopsy:New York State Analysis.J Urol 2017;197:1020-1025[PMID:27856226 DOI:10.1016/j.juro.2016.11.081]
10 Ljungberg B,Bensalah K,Canfield S,Dabestani S,Hofmann F,Hora M,Kuczyk MA,Lam T,Marconi L,Merseburger AS,Mulders P,Powles T,Staehler M,Volpe A,Bex A.EAU guidelines on renal cell carcinoma:2014 update.Eur Urol 2015;67:913-924[PMID:25616710 DOI:10.1016/j.eururo.2015.01.005]
11 Sooriakumaran P,Pini G,Nyberg T,Derogar M,Carlsson S,Stranne J,Bjartell A,Hugosson J,Steineck G,Wiklund PN.Erectile Function and Oncologic Outcomes Following Open Retropubic and Robotassisted Radical Prostatectomy:Results from the LAParoscopic Prostatectomy Robot Open Trial.Eur Urol2018;73:618-627[PMID:28882327 DOI:10.1016/j.eururo.2017.08.015]
12 Coughlin GD,Yaxley JW,Chambers SK,Occhipinti S,Samaratunga H,Zajdlewicz L,Teloken P,Dunglison N,Williams S,Lavin MF,Gardiner RA.Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy:24-month outcomes from a randomised controlled study.Lancet Oncol2018;19:1051-1060[PMID:30017351 DOI:10.1016/S1470-2045(18)30357-7]
13 Yaxley JW,Coughlin GD,Chambers SK,Occhipinti S,Samaratunga H,Zajdlewicz L,Dunglison N,Carter R,Williams S,Payton DJ,Perry-Keene J,Lavin MF,Gardiner RA.Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy:early outcomes from a randomised controlled phase 3 study.Lancet 2016;388:1057-1066[PMID:27474375 DOI:10.1016/S0140-6736(16)30592-X]
14 Turkbey B,Brown AM,Sankineni S,Wood BJ,Pinto PA,Choyke PL.Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer.CA Cancer J Clin 2016;66:326-336[PMID:26594835 DOI:10.3322/caac.21333]
15 Weinreb JC,Barentsz JO,Choyke PL,Cornud F,Haider MA,Macura KJ,Margolis D,Schnall MD,Shtern F,Tempany CM,Thoeny HC,Verma S.PI-RADS Prostate Imaging-Reporting and Data System:2015,Version 2.Eur Urol 2016;69:16-40[PMID:26427566 DOI:10.1016/j.eururo.2015.08.052]
16 Godley KC,Syer TJ,Toms AP,Smith TO,Johnson G,Cameron D,Malcolm PN.Accuracy of high bvalue diffusion-weighted MRI for prostate cancer detection:a meta-analysis.Acta Radiol 2018;59:105-113[PMID:28376634 DOI:10.1177/0284185117702181]
17 Li L,Wang L,Feng Z,Hu Z,Wang G,Yuan X,Wang H,Hu D.Prostate cancer magnetic resonance imaging(MRI):multidisciplinary standpoint.Quant Imaging Med Surg 2013;3:100-112[PMID:23630657 DOI:10.3978/j.issn.2223-4292.2013.03.03]
18 van Leeuwen PJ,Emmett L,Ho B,Delprado W,Ting F,Nguyen Q,Stricker PD.Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer.BJU Int 2017;119:209-215[PMID:27207581DOI:10.1111/bju.13540]
19 Rauscher I,Maurer T,Beer AJ,Graner FP,Haller B,Weirich G,Doherty A,Gschwend JE,Schwaiger M,Eiber M.Value of 68Ga-PSMA HBED-CC PET for the Assessment of Lymph Node Metastases in Prostate Cancer Patients with Biochemical Recurrence:Comparison with Histopathology After Salvage Lymphadenectomy.J Nucl Med 2016;57:1713-1719[PMID:27261524 DOI:10.2967/jnumed.116.173492]
20 Chen M,Zhang Q,Zhang C,Zhao X,Marra G,Gao J,Lv X,Zhang B,Fu Y,Wang F,Qiu X,Guo H.Combination of 68Ga-PSMA PET/CT and multiparameter MRI improves the detection of clinically significant prostate cancer:a lesion by lesion analysis.J Nucl Med 2018[PMID:30552201 DOI:10.2967/jnumed.118.221010]
21 Ferretti M,Phillips J.Prostatectomy for benign prostate disease:open,laparoscopic and robotic techniques.Can J Urol 2015;22 Suppl 1:60-66[PMID:26497345]
22 Zhang MW,El Tayeb MM,Borofsky MS,Dauw CA,Wagner KR,Lowry PS,Bird ET,Hudson TC,Lingeman JE.Comparison of Perioperative Outcomes Between Holmium Laser Enucleation of the Prostate and Robot-Assisted Simple Prostatectomy.J Endourol 2017;31:847-850[PMID:28637364 DOI:10.1089/end.2017.0095]
2 Caverly TJ,Hayward RA,Reamer E,Zikmund-Fisher BJ,Connochie D,Heisler M,Fagerlin A.Presentation of Benefits and Harms in US Cancer Screening and Prevention Guidelines:Systematic Review.J Natl Cancer Inst 2016;108:djv436[PMID:26917630 DOI:10.1093/jnci/djv436]
3 Abraham NE,Mendhiratta N,Taneja SS.Patterns of repeat prostate biopsy in contemporary clinical practice.J Urol 2015;193:1178-1184[PMID:25444971 DOI:10.1016/j.juro.2014.10.084]
4 Loeb S,Vellekoop A,Ahmed HU,Catto J,Emberton M,Nam R,Rosario DJ,Scattoni V,Lotan Y.Systematic review of complications of prostate biopsy.Eur Urol 2013;64:876-892[PMID:23787356DOI:10.1016/j.eururo.2013.05.049]
5 Berger I,Annabattula C,Lewis J,Shetty DV,Kam J,Maclean F,Arianayagam M,Canagasingham B,Ferguson R,Khadra M,Ko R,Winter M,Loh H,Varol C.68Ga-PSMA PET/CT vs.mpMRI for locoregional prostate cancer staging:correlation with final histopathology.Prostate Cancer Prostatic Dis2018;21:204-211[PMID:29858591 DOI:10.1038/s41391-018-0048-7]
6 Nestler S,Bach T,Herrmann T,Jutzi S,Roos FC,Hampel C,Thüroff JW,Thomas C,Neisius A.Surgical treatment of large volume prostates:a matched pair analysis comparing the open,endoscopic(ThuVEP)and robotic approach.World J Urol 2018[PMID:30515596 DOI:10.1007/s00345-018-2585-z]
7 Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240:205-213[PMID:15273542]
8 Liao X,Qiao P,Tan Z,Shi H,Xing N."Total reconstruction"of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy.Int Braz J Urol 2016;42:215-222[PMID:27256174 DOI:10.1590/S1677-5538.IBJU.2014.0666]
9 Halpern JA,Sedrakyan A,Dinerman B,Hsu WC,Mao J,Hu JC.Indications,Utilization and Complications Following Prostate Biopsy:New York State Analysis.J Urol 2017;197:1020-1025[PMID:27856226 DOI:10.1016/j.juro.2016.11.081]
10 Ljungberg B,Bensalah K,Canfield S,Dabestani S,Hofmann F,Hora M,Kuczyk MA,Lam T,Marconi L,Merseburger AS,Mulders P,Powles T,Staehler M,Volpe A,Bex A.EAU guidelines on renal cell carcinoma:2014 update.Eur Urol 2015;67:913-924[PMID:25616710 DOI:10.1016/j.eururo.2015.01.005]
11 Sooriakumaran P,Pini G,Nyberg T,Derogar M,Carlsson S,Stranne J,Bjartell A,Hugosson J,Steineck G,Wiklund PN.Erectile Function and Oncologic Outcomes Following Open Retropubic and Robotassisted Radical Prostatectomy:Results from the LAParoscopic Prostatectomy Robot Open Trial.Eur Urol2018;73:618-627[PMID:28882327 DOI:10.1016/j.eururo.2017.08.015]
12 Coughlin GD,Yaxley JW,Chambers SK,Occhipinti S,Samaratunga H,Zajdlewicz L,Teloken P,Dunglison N,Williams S,Lavin MF,Gardiner RA.Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy:24-month outcomes from a randomised controlled study.Lancet Oncol2018;19:1051-1060[PMID:30017351 DOI:10.1016/S1470-2045(18)30357-7]
13 Yaxley JW,Coughlin GD,Chambers SK,Occhipinti S,Samaratunga H,Zajdlewicz L,Dunglison N,Carter R,Williams S,Payton DJ,Perry-Keene J,Lavin MF,Gardiner RA.Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy:early outcomes from a randomised controlled phase 3 study.Lancet 2016;388:1057-1066[PMID:27474375 DOI:10.1016/S0140-6736(16)30592-X]
14 Turkbey B,Brown AM,Sankineni S,Wood BJ,Pinto PA,Choyke PL.Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer.CA Cancer J Clin 2016;66:326-336[PMID:26594835 DOI:10.3322/caac.21333]
15 Weinreb JC,Barentsz JO,Choyke PL,Cornud F,Haider MA,Macura KJ,Margolis D,Schnall MD,Shtern F,Tempany CM,Thoeny HC,Verma S.PI-RADS Prostate Imaging-Reporting and Data System:2015,Version 2.Eur Urol 2016;69:16-40[PMID:26427566 DOI:10.1016/j.eururo.2015.08.052]
16 Godley KC,Syer TJ,Toms AP,Smith TO,Johnson G,Cameron D,Malcolm PN.Accuracy of high bvalue diffusion-weighted MRI for prostate cancer detection:a meta-analysis.Acta Radiol 2018;59:105-113[PMID:28376634 DOI:10.1177/0284185117702181]
17 Li L,Wang L,Feng Z,Hu Z,Wang G,Yuan X,Wang H,Hu D.Prostate cancer magnetic resonance imaging(MRI):multidisciplinary standpoint.Quant Imaging Med Surg 2013;3:100-112[PMID:23630657 DOI:10.3978/j.issn.2223-4292.2013.03.03]
18 van Leeuwen PJ,Emmett L,Ho B,Delprado W,Ting F,Nguyen Q,Stricker PD.Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer.BJU Int 2017;119:209-215[PMID:27207581DOI:10.1111/bju.13540]
19 Rauscher I,Maurer T,Beer AJ,Graner FP,Haller B,Weirich G,Doherty A,Gschwend JE,Schwaiger M,Eiber M.Value of 68Ga-PSMA HBED-CC PET for the Assessment of Lymph Node Metastases in Prostate Cancer Patients with Biochemical Recurrence:Comparison with Histopathology After Salvage Lymphadenectomy.J Nucl Med 2016;57:1713-1719[PMID:27261524 DOI:10.2967/jnumed.116.173492]
20 Chen M,Zhang Q,Zhang C,Zhao X,Marra G,Gao J,Lv X,Zhang B,Fu Y,Wang F,Qiu X,Guo H.Combination of 68Ga-PSMA PET/CT and multiparameter MRI improves the detection of clinically significant prostate cancer:a lesion by lesion analysis.J Nucl Med 2018[PMID:30552201 DOI:10.2967/jnumed.118.221010]
21 Ferretti M,Phillips J.Prostatectomy for benign prostate disease:open,laparoscopic and robotic techniques.Can J Urol 2015;22 Suppl 1:60-66[PMID:26497345]
22 Zhang MW,El Tayeb MM,Borofsky MS,Dauw CA,Wagner KR,Lowry PS,Bird ET,Hudson TC,Lingeman JE.Comparison of Perioperative Outcomes Between Holmium Laser Enucleation of the Prostate and Robot-Assisted Simple Prostatectomy.J Endourol 2017;31:847-850[PMID:28637364 DOI:10.1089/end.2017.0095]