Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1403-1409
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1403
Feasibility of prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques
Nian-Zeng Xing, Ming-Shuai Wang, Qiang Fu, Fei-Ya Yang, Chang-Ling Li, Ya-Jian Li, Su-Jun Han, Ze-Jun Xiao, Hao Ping
Nian-Zeng Xing, Fei-Ya Yang, Chang-Ling Li, Ya-Jian Li, Su-Jun Han, Ze-Jun Xiao, Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Ming-Shuai Wang, Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Qiang Fu, Department of Urology, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
Hao Ping, Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
Author contributions: All authors helped to perform the study; Xing NZ and Wang MS are co-first authors; Xing NZ contributed to study conception and design and manuscript writing; Wang MS contributed to study design, manuscript writing, and data analysis; Yang FY, Li YJ, Han SJ, Xiao ZJ, and Li CL contributed to data collection and manuscript writing; Ping H and Fu Q contributed to manuscript writing and data analysis.
Institutional review board statement: As the retrospective study and data analysis were performed anonymously, this study was exempt from the ethical approval.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nian-Zeng Xing, MD, PhD, Chairman, Professor, Surgeon, Director, Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Pan Jia Yuan Nan Li, Chaoyang District, Beijing 100021, China. xingnianzeng@hotmail.com
Telephone: +86-18612023952
Received: February 17, 2019
Peer-review started: February 18, 2019
First decision: April 18, 2019
Revised: April 25, 2019
Accepted: May 10, 2019
Article in press: May 11, 2019
Published online: June 26, 2019
Abstract
BACKGROUND

Routinely, after receiving prostate specific antigen (PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy.

AIM

To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.

METHODS

From June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68Ga-PSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients.

RESULTS

All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year, the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 mL, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively.

CONCLUSION

The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.

Keywords: Prostate cancer, Biopsy, Prostatectomy, Magnetic resonance imaging, Prostate-specific membrane antigen positron emission tomography/computed tomography

Core tip: The ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Maybe prostate biopsy can be exempt before surgery when multi-parameter prostate magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography/computed tomography are both positive. The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques.