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Häufige Fehler, „Pitfalls“ und Komplikationsmanagement der Prostatabiopsie

Die häufigsten diagnostischen und prozeduralen Herausforderungen der transrektalen Fusionsbiopsie der Prostata bei Erstdiagnose eines klinisch signifikanten Prostatakarzinoms

Common errors, pitfalls, and management of complications of prostate biopsy

The most common diagnostic and procedural challenges of transrectal fusion prostate biopsy in the initial diagnosis of clinically significant prostate cancer

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Zusammenfassung

Hintergrund

Die transrektale (TR) Prostatastanzbiopsie ist der bisherige Goldstandard in der Diagnostik des Prostatakarzinoms (PCa) und stellt hohe Anforderungen an Untersucher, um eine möglichst präzise und sichere Durchführung sicherzustellen.

Fragestellung

Es werden Ansätze diskutiert, wie Überdiagnostik, falsch-negative Ergebnisse und Komplikationen vermieden werden können.

Material und Methoden

Nationale und europäische Leitlinien sowie mehrere systematische Übersichtsarbeiten, Metaanalysen, prospektive und retrospektive Studien werden hinsichtlich der aktuellen Entwicklungstendenzen in der Indikationsstellung und Durchführung von Biopsien analysiert.

Ergebnisse

Die Anwendung von Risikokalkulatoren und Magnetresosnanztomographie (MRT) trägt maßgeblich zur Reduktion der Prostatabiopsieraten und somit zu einer präziseren Diagnostik klinisch signifikanter PCa (csPCa) bei. Die höchste diagnostische Sicherheit der Biopsie kann durch die Kombination von randomisierter und MRT-gesteuerter Fusionsbiopsie (FBx), Radiuserweiterung der Target-Biopsie um 10 mm und einen transperinealen (TP-)Zugang erreicht werden. Blutungsereignisse treten nach der Prostatabiopsie am häufigsten auf und sind in der Regel selbstlimitierend. Das Infektionsrisiko kann durch eine TP-Probenentnahme reduziert werden.

Schlussfolgerung

Die TR MRT-gestützte FBx der Prostata ist eine gut bewährte Methode in der Primärdiagnostik von csPCa. Eine höhere Präzision und Sicherheit können durch einen TP-Zugang erreicht werden.

Abstract

Background

Transrectal (TR) prostate biopsy is the gold standard in diagnosis of prostate cancer (PC). It requires a precise and safe technique for sample acquisition.

Objective

Several approaches will be discussed to avoid overdiagnosis, false-negative results, and complications of the procedure.

Materials and methods

We analyzed national and European guidelines, systematic reviews, meta-analyses, as well as prospective and retrospective studies to describe current trends in indication and performance of biopsies.

Results

Incorporation of risk calculators and magnetic resonance imaging (MRI) into daily routine reduces biopsy rates and results in a more precise diagnosis of clinically significant prostate cancer (csPC). Combination of random- and MRI-fusion guided biopsy—but also extending the radius of sampling by 10 mm beyond the MRI lesion and a transperineal (TP) sampling approach – lead to a higher tumor-detection rate. Bleeding is the most common complication after prostate biopsy and is usually self-limiting. Postbiopsy infection rates can be reduced through TP biopsy.

Conclusion

TR MRI-fusion guided biopsy is a widely acknowledged tool in primary diagnostics of csPC. Higher detection rates and safety can be achieved through a TP sampling approach.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland

    Benazir Enzinger, Paulo Leonardo Pfitzinger, Benedikt Ebner, Troya Ivanova, Yannic Volz, Maria Apfelbeck, Christian Stief & Michael Chaloupka

  2. Klinik und Poliklinik für Radiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland

    Philipp Kazmierczak

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  1. Benazir Enzinger
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Correspondence to Benazir Enzinger.

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Interessenkonflikt

B. Enzinger, P.L. Pfitzinger, B. Ebner, T. Ivanova, Y. Volz, M. Apfelbeck, P. Kazmierczak, C. Stief und M. Chaloupka geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Enzinger, B., Pfitzinger, P.L., Ebner, B. et al. Häufige Fehler, „Pitfalls“ und Komplikationsmanagement der Prostatabiopsie. Urologie 62, 479–486 (2023). https://doi.org/10.1007/s00120-023-02063-y

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