Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1403
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
Prostate cancer is one of the most common malignant tumors. When the total PSA and/or digital rectum examination are positive, prostate biopsy is routinely proposed to patients. However, the detection ability of the transrectal ultrasound guided (TRUS) prostate biopsy is limited. While clinically insignificant cancers are often detected, clinically significant cancers are sometimes missed after prostate biopsy. TRUS-biopsy also carries significant morbidity and can cause life-threatening sepsis. The reported sensitivity of multi-parameter prostate magnetic resonance imaging for the detection of clinically significant disease was 93% (95%CI 88-96), and 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography had a 100% detection rate for index lesions at radical prostatectomy.
Nowadays, many imaging techniques with a very high detection rate for prostate cancer are applied clinically. Some patients are afraid of prostate biopsy, and they really want to remove the prostate immediately when they were told that they might have prostate cancer. For elder men, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So it might be no longer necessary to perform prostate biopsy before radical prostatectomy.
The main objective of the study was to explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.
A retrospective study was designed. The cases of laparoscopic radical prostatectomy without prostate biopsy before surgery were collected at the three medical centers involved in this study between June 2014 and December 2018. The perioperative outcomes and pathology results were analyzed.
All surgeries were successfully accomplished without open conversion. The pathological results showed ten cases of prostatic adenocarcinoma and one case of benign prostatic hyperplasia. Lower urinary tract symptoms disappeared when the patient with benign prostatic hyperplasia underwent laparoscopic radical prostatectomy.
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.
It might be no longer necessary to perform prostate biopsy before radical prostatectomy. However, large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.