| Objective1.To explore diagnostic value of transperineal prostate projection supersaturated needle(TPPSN)after initial negative biopsy result and to assess the efficacy and safety.2.To evaluate the clinical significance of permanent 125I prostate brachytherapy in patients with CRPC.3.To evaluate the erectile function following transperineal template-guided prostate saturation biopsy(TTPSB).Methods1.A total of 218 patients were enrolled in this study.These patients were diagnosed with benign prostatic hyperplasia by transperineal template biopsy but were suspected to have prostate cancer through the abnormal prostate specific antigen(PSA),digital rectal examination(DRE)or MRI.All patients were divided into the TPPSN group and the TTPSB group according to different way of puncture.According to the different prostate volume(<40ml,40-80ml,>80ml),we contrasted the positive rate of two groups and compared the incidence of postoperative complications such as gross hematuria,fever,urinary retention and perineum discomfort of two groups.For the TPPSN group,5-item version of the International Index of Erectile Function(IIEF-5)was used to compare erectile dysfunction before the puncture with 1 month,3 months and 6 months after the puncture.2.31 patients with CRPC from our hospital were included in the study.All patients were divided into two groups according to different treatment methods.14 patients of endocrine therapy group received endocrine therapy alone.17 patients of brachytherapy group underwent brachytherapy combined with endocrine therapy.The PSA-progression-free survival(PSA-PFS),overall survival(OS)and quality of life of two groups were compared.3.From June 2013 to October 2015 413 patients underwent prostate biopsy.All patients were divided into observation group(TTPSB)and control group(template-guided prostate biopsy,TTPB)according to patient condition,subjective and anatomical conditions of pubis.And patients were evaluated for erectile function prebiopsy with the IIEF-5.We excluded patients with positive results because of anxiety in this part of the patient may affect erectile function.And patients who withdrew from the trial and used the drugs such as 5-phosphodiesterase inhibitors to improve sexual activity were also excluded.Finally,97 patients and 84 patients in observation group and control group reported to be benign prostatic hyperplasia underwent further evaluation with the IIEF-5 questionnaire at baseline,1,3 and 6 months postbiopsy.Results1.The total cancer detection rate of the TPPSN group was higher than that of the TTPSB group(46.1%Vs 32.8%,P=0.044),the improvement of cancer detection rate was higher only when the prostate volume was greater than 80 ml(P=0041).Compared to the TTPSB group,the incidence of complication such as gross hematuria,fever,retention of urine and perineum discomfort by TPPSN was low,but there was no significant difference(P>0.05).Before TPPSN,the median IIEF-5 scores of patients was 18.7.One month after puncture,the median IIEF-5 scores was 17.3 and there was statistically significant difference compared with preoperative.But the median IIEF-5 scores respectively were 18.2 and 18.5 after three months and six months and there were no significant difference compared with preoperative(P>0.05).2.The median PSA-PFS and OS of the brachytherapy group were 29(25-37)months and 37(30-50)months respectively.Which were significantly longer than that of endocrine therapy group,respectively(both P<0.05).For the quality of life after treatment,urinary symptoms/problems at 1 month after brachytherapy compared with the endocrine therapy group had statistically significant difference and clinically relevant deterioration,but after 6 months there were no statistically significant difference and clinically relevant deterioration.Compared with the endocrine therapy group,the physical functioning,social functioning,global health and general physical discomfort of brachytherapy group were significantly improved.3.Before biopsy,the IIEF-5 score of the observation group and the control group were 19.1±4.5 and 19.7±4.3 respectively.And there was a significant difference(t=-0.890,P=0.375).One month after biopsy,the IIEF-5 of two group respectively were 17.4±4.8 and 18.2±4.5 and there were statistically significant compared with prebiopsy.But there were no statistical significance after three and six months.And there were no statistical significance between the observation group and the control group each time period.Conclusion1.For the patients who were initial negative biopsy but highly suspected with prostate cancer,The TPPSN can improve the positive rate of prostate biopsy.It can more accurate positioning the prostate cancer and is a safe and effective diagnostic method for prostate cancer.TPPSN can be a safe and reliable way to prostate biopsy.2.Brachytherapy with 1251 seeds implantation can effectively prolong survival for patients with CRPC.To a certain extent,it improves the patient's quality of life.3.TTPSB may lead to a temporary(1 month)IIEF-5 score decreased,but compared with the transperineal template prostate biopsies(TTPB),it didn't increase the impact on erectile function.And erectile function would restore to pre-puncture level after 3 to 6 months. |
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