Re: Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy

摘要

The authors demonstrate the unreliability of systematic transrectal ultrasound (TRUS) guided biopsies to fully evaluate the prostate. There has been increasing recognition that even experienced physicians are unable to sample the gland accurately and repeatedly via TRUS guided biopsy alone. While the systematic approach using transrectal biopsies spaced uniformly in the prostate theoretically ensures that few lesions 0.5 cm or greater are missed,1 Han et al have shown that even within a controlled setting of simulation urologists had a mean targeting error of 7.1 mm, which led to a statistically significant poorer detection rate of lesions with a volume of 0.5 cm or greater. In a clinical setting-where one cannot control for patient factors including intolerance of the procedure, variable gland size, nonuniform distribution of cancer grade within a lesion, prostate deformity and relative inaccessibility of the anterior gland-it is not unreasonable to expect this value to be even greater.