| Prostate cancer is the second most common cancer in the world and ranks fifth in mortality.In western countries the incidence rate of PCa was significantly higher than in Asian countries.In recent years,The morbidity and mortality of PCa in China are continuously increasing.Most of the newly diagnosed PCa patients have higher proportion of advanced patients than those in Europe and america,which will directly affect the therapeutic effect of PCa patients,reduce the survival of patients.How to improve the rate of early diagnosis is an important problem in clinical diagnosis and treatment of PCa.The development of new tumor markers and the continuous optimization of imaging methods have increasingly high sensitivity and specificity in the diagnosis of PCa.But as of now,the pathological diagnosis is still the golden standard for the diagnosis of PCa.TRUS guided transrectal 10 ~ 12 cores systemic biopsy is the first choice for the initial diagnosis of suspicious PCa patients,However,conventional methods mainly take samples around peripheral zone,.Because of the randomness of the method of sampling,it is impossible to avoid false negative,and the 22% to 47% PCa is missed in the initial biopsy.How to improve the positive rate of biopsy is an important problem to be solved in the early diagnosis of PCa.On the basis of the qualitative diagnosis of PCa,multi parameter MRI can locate the suspicious foci by the multi b value DWI sequence.At present,according to the different methods of image fusion,the accurate prostate biopsy with MRI suspicious foci mainly includes three kinds: cognitive fusion,MRI/MRI fusion,MRI/TRUS fusion.MRI targeting biopsy can improve the detection rate of high-risk prostate cancer and reduce the detection of low-risk prostate cancer,but the operation is complicated,with long operation time and high equipment requirements,it is difficult to large-scale application.This topic is based on the discovery of multi parameter MRI,then explore an effective method for targeted biopsy of suspicious lesions,and to evaluate the value of different targeting methods in improving the positive rate of puncture and avoiding the risk of missed diagnosis of high risk prostate cancer.Furthermore,through the 3D reconstruction and quantitative evaluation of the patients missed by the system biopsy,the reasons for the missed diagnosis of the system biopsy were analyzed,and a new method of prostate targeted biopsy with clinical value was formed.Part 1:Objective: The effective organization and detailed record of prostate biopsy related information is very important in the diagnosis and treatment of prostate cancer,but in clinical work,the record of the information about the biopsy is not systematic and normative,so it can not provide good support for clinical research.This study intends to establish a standardized and perfect information recording of prostate biopsy through the PC-Follow database and lay the foundation for clinical research.Methods: According to the clinical characteristics and related scientific research needs of prostate biopsy patients,the data of prostate biopsy were processed by granulation and field,and the prostate biopsy information recording module based on B/S structure was developed.Results: The biopsy information was divided into the biopsy information table and the pathological table.A graphical position information recording interface was established and the data transfer and training test were successfully carried out at PC-Follow V3.0.Conclusion: This study has successfully established a national multi center clinical information management system based on B/S framework,which has 47 centers to join the system,with a total of more than 19360 cases.Among them,3190 patients were treated with single center in our hospital.At present,PC-Follow is the most widely used,the largest data storage of prostate cancer clinical information management system.The establishment of prostate biopsy module provides a convenient,standardized and effective way for the entry of biopsy information,which provides strong support for clinical and scientific research.Part 2:Objective: To evaluate the feasibility and effectiveness of targeted biopsy based on multi parameter MRI in the diagnosis of prostate cancer.Methods: from April 2014 to March 2017,a total of 2415 cases of patients with prostate biopsy indications,multiparameter MRI examination was performed in 1093 patients,PI-RADS scores were then performed on the MRI findings,a total of 168 patients with suspected prostate cancer were detected by multiparameter MRI.The age of the patients ranged from 44 to 85 years,with a median age of 67 years.PSA before biopsy ranged from 1.11 to 120ng/ml,with a median PSA 12ng/ml.42 patients had previous TRUS guided negative history of systemic biopsy,and the number of negative biopsy was 1~6 times.The blood,urine,stool and blood coagulation function were checked before operation,so as to avoid the contraindication of operation.Results: 132 cases(78.6%%)were diagnosed as prostate adenocarcinoma,1 with nonspecific granulomatous prostatitis,and the others were benign prostatic hyperplasia.Prostate cancer was detected only by systematic biopsy in 15 cases,30 cases were only detected by target biopsy,and 87 cases were found both by systemic biopsy and target biopsy.In patients with PI-RADS scores of 3,4,and 5,the positive rate of biopsy was 55.7%(34/61),87.7%(59/68),100%(39/39),the average Gleason scores were 6.97,7.31,7.92.Gleason score ≥8 were respectively 26.5%(9/34),33.9%(20/59),64.1%(25/39)Conclusion: multi parameter MRI based targeted biopsy can improve the positive rate of biopsy,and avoid the misdiagnosis of high-risk prostate cancer,The PI-RADS score was positively correlated with the positive rate of biopsy and the occurrence of high-risk prostate cancer.Part 3:Objective: To study the clinical characteristics of patients with repeated biopsy,and compare the diagnostic efficacy of the systematic biopsy + target biopsy(strategy 1)、system biopsy only(strategy 2)and target biopsy only(strategy 3)in the repeated biopsy patients.Methods: from April 2014 to March 2017,a total of 168 patients with suspected prostate cancer through multiple MRI were treated by prostate targeted biopsy.Among them,42 were repeated biopsy and 126 were primary biopsy.The value of different strategies in primary and repeated biopsy were compared.Results: the number of patients with repeated biopsy was 1 to 6 times,the average number of negative biopsy was 1.62 times.The median age of the primary biopsy group and the repeat biopsy group was 64 years and 66.5 years,respectively.The median PSA were 9.12,ng/m L and 12.52 ng/m L,respectively,and the repeated biopsy group increased significantly.In the primary biopsy group,the patients with PI-RADS score of 3,4 and 5 were 36.51%,40.48% and 23.01%,respectively,and the repeated biopsy group was 35.7%,40.5% and 23.8% respectively..The positive rate of primary biopsy and repeated biopsy group was 80.16%(101/126)and 73.81%(31/42),respectively.Three biopsy strategies were simulated in the primary and repeated biopsy groups.For patients with primary biopsy,the positive rates of strategy 1,strategy 2 and strategy 3 were 80.16%,68.23% and 69.84% respectively,and 73.81%,38.1%,and 66.67% for the repeated biopsy group,respectively.Conclusion:Patients with repeated biopsy has the characteristics of high PSA,Gleason score ≥8 were relatively less。Target biopsy can not replace the system biopsy in primary biopsy patients.But in repeated biopsy,target biopsy based on multi parameter MRI can reduce the number of biopsy needles without significantly reducing the positive rate.Part 4:Objective: To evaluate the location of MRI suspicious foci in primary and repeated biopsy,and to investigate the effects of suspicious sites at different locations on the results of the biopsy,and to explore a more optimal strategy based on the location of the suspicious MRI foci.Methods: from April 2014 to March 2017,a total of 168 patients with suspected prostate cancer were treated by prostate targeted biopsy through multiple MRI.Among them,42 were repeated biopsy and 126 were primary biopsy.According to the location of suspicious foci,the suspicious foci were divided into peripheral,apex and central lobe.Results: 168 cases with suspicious prostate cancer patients,suspicious lesions located in the peripheral zone,apex,central lobe were 84 cases,32 cases,52 cases,the positive rate of biopsy was 73.81%(62/84),78.13%(25/32),86.54%(45/52),the average Gleason Score was 7.76,7.4,6.89.In suspicious foci located in the peripheral zone,12.9% were found by systematic biopsy only,8.06% by target biopsy only,and 79.03% by both systematic biopsy and targeted biopsy;The suspicious foci of apex were 4%,32% and 64%,respectively.The suspicious foci in the central lobe were 13.3%,37.78% and 48.89% respectively.Of the 132 patients,101 were diagnosed by initial biopsy and 31 by repeated biopsy.The tumors in the peripheral,apex and central lobe of the initial biopsy were 70.3%,22.77% and 6.93%,respectively.The repeated biopsy was 19.35%,19.35% and 61.29% respectively.Conclusion: Tumors located at the apex and central lobe of the prostate are easily missed by systematic biopsy.In repeated biopsy patients,the tumor was mostly located in the central lobe.Multi parameter MRI based target biopsy can effectively avoid the missed diagnosis of prostate cancer. |
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