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Master Thesis

Intérêt des biopsies ciblées de prostate par rapport aux biopsies standards dans une cohorte de patients afro-caribéens

Abstract : Introduction: Several studies have demonstrated the contribution or even the superiority of targeted biopsies (TB) by elastic fusion in the detection of clinically significant prostate cancers. We wanted to study the interest of targeted biopsies compared to standard biopsies (SB) in our population. Methods: This is a retrospective study of patients who received both standard biopsies and targeted biopsies on lesions identified by multiparametric MRI with an elastic fusion system in the urology department of Pointre-à-Pitre Hospital. The primary endpoint was clinically significant (CS) cancer rates between SB, TB, and combination targeted and standard (TB / SB) biopsies. Secondary endpoints were the prostate cancer detection rate and the maximum cancer core length (MCCL). Results: 241 patients were included between February 2017 and November 2018 with an average age of 66,9 years, an average PSA of 8,57 ng / mL and a prostatic volume of 59,6 cm3. The rate of CS cancers was significantly higher in the BC / BS group compared with the SB group and the TB group (85 (35%) versus 71 (29,5%) and 55 (22,8%), p <0,001). There was no significant difference between the TB and SB groups (p = 0,145). Prostate cancer detection rates were 66% versus 59,3% and 42,3% in the combined groups, SB and TB respectively (p <0,001). There was no significant difference between the two types of biopsies for maximum cancer core length. Predictors of clinically significant cancers identified in univariate analysis are PSA (11,2ng / mL ± 12,8 versus 7,8ng / mL ± 6,0 p= 0,02), PSA density (0,27ng / mL2 ± 0,39 versus 0,15ng / mL2 ± 0,12, p <0,001) and MCCL (5,6mm ± 3,7 versus 3,6mm ± 3,3 p = 0,003). Only the latter is an independent predictive factor of CS on TB (OR = 1,16, CI 1,02-1,34, p = 0,025). The tumor invasion rate is significantly higher in the TB group compared to the SB group with 21,48% versus 7,19% (p <0,001). 34% (16/47) of patients presented an "up grading" on the pathological analysis of prostatectomy specimens compared to the combined biopsy system. Conclusion: This first cohort study of Afro-Caribbean patients between targeted biopsies group and standard biopsies group for the detection of clinically significant prostate cancers do not find any difference. The combination of standard and targeted biopsies on MRI lesions improves this detection rate.
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https://dumas.ccsd.cnrs.fr/dumas-02870500
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Submitted on : Tuesday, June 16, 2020 - 5:18:07 PM
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Yvanne Sadreux. Intérêt des biopsies ciblées de prostate par rapport aux biopsies standards dans une cohorte de patients afro-caribéens. Médecine humaine et pathologie. 2019. ⟨dumas-02870500⟩

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