根治性前列腺切除术前是否一定要穿刺活检—新的理念与临床实践

Is prostate biopsy necessary before radical prostatectomy?New concept and clinical practice

前列腺癌的诊治理念是通过一种或多种检查方法怀疑前列腺癌后,均要行前列腺穿刺活检确诊后再给予后续治疗。随着前列腺多参数磁共振成像(mpMRI)和前列腺特异性膜抗原(PSMA)正电子发射计算机断层扫描(PET/CT)(PSMA PET/CT)的应用,前列腺癌影像学诊断水平进一步提升,联合这些检查,临床有意义前列腺癌的诊断准确率几乎达到100%。并且腹腔镜及机器人辅助腹腔镜为代表的微创技术及手术技术改进发展迅速,根治性前列腺切除手术安全性明显提升,术后恢复明显加快。因此,我们提出了前列腺免活检的理念,即对于前列腺mpMRI和PSMA PET/CT高度怀疑的前列腺癌,可直接手术治疗。前期初步临床实践也证实了这个理念是可行的。然而前列腺免活检并不是适合所有的前列腺癌患者,任何一个新理念的提出均需要经过长期的临床论证,需要高质量的临床研究支撑。将来或许免活检根治性前列腺切除将会成为临床上一个新的选择,产生良好的经济和社会效益。

The current diagnosis and treatment concept of prostate cancer is that if prostate cancer is suspected through one or more examination methods,prostate biopsy should be performed to confirm the diagnosis of prostate cancer and then subsequent treatment should be given.Nowadays,the application of multi-parameter magnetic resonance imaging(mpMRI)and prostate-specific membrane antigen(PSMA)PET/CT has further improved the imaging diagnosis of prostate cancer,and the diagnostic accuracy of clinically significant prostate cancer has reached almost 100%.In addition,minimally invasive techniques represented by robot-assisted laparoscopic surgery have developed rapidly,and the safety and postoperative recovery of radical prostatectomy have been significantly improved.Therefore,we proposed the concept of radical prostatectomy avoiding biopsy(RPAB),that is,the patients with high suspicion of prostate cancer by multi-parameter MRI and PSMA PET/CT can be directly treated by radical surgery.Preliminary clinical practice confirmed that this concept is feasible.However,RPAB is not suitable for all prostate cancer patients,and any new concept needs to be supported by long-term and high-quality clinical studies.We predict that RPAB will become a new clinical option and produce good economic and social benefits.