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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
