Introduction

Prostate and colorectal cancers are the second and third most common malignancies affecting men globally [1]. Abdominoperineal resection is the standard of care surgical treatment for patients with malignancy of the distal rectum or anal canal, while pan-proctocolectomy may be indicated for patients with inflammatory bowel disease and familial adenomatous polyposis [2]. Both these procedures require the removal of the rectum and anal sphincteric complex, with the formation of a permanent end colostomy, which negates the possibility for (transrectal ultrasound) TRUS imaging to guide diagnostic prostate biopsy. The current literature (mostly based on small patient cohorts) describes prostatic biopsies performed via the transperineal or transgluteal approach under radiological guidance with the use of transperineal (or less commonly transurethral or transabdominal) ultrasonography, MRI, or CT imaging (Table 1).

Table 1. Summary of reported series of diagnostic prostatic biopsies on patients with no anal canal.

Report	Sample size (n)	Technique/approach	Results (% with cancer detected)	Number of biopsy cores	Grade Group (GG)
Schapira 1982 (1)	1	IVU-US guided	Single case	NA	NA
Krauss 1993 (2)	1	CT guided	Single case	3 each side	GG 1
Twidwell 1993 (3)	10	TP-US guided	20% (2/10)	1–4	NA; evidence nodal disease
Filderman 1994 (4)	5	TP-US guided	40% (2/5)	NA	NA
Fornage 1995 (5)	1	TP-US guided	Single case	7	GG 4
Seamen 1996 (6)	5	TP-Transurethral U guided	60% (3/5)	Sextant + targeted biopsies	NA
Papanicolaou 1996 (7)	10	Transgluteal CT-guided	60% (6/10)	NA	NA
D’Amico 2000 (8)	1	TP-MRI guided	Single case	6 random + 1 targeted	GG 1
Shinohara 2003 (9)	28	TP-US guided	82% (23/38)	6–12	GG 1–5
Morlacco 2013 (10)	2	Combined TP- SP US approach	Two cases (1/2)	6	NA
Kongnyuy 2016 (11)	1	TP-MRI guided	Single case	4	GG 4
Hansen 2016 (12)	11	TP US-guided	64% (7/11)	11–27	GG 1–5
Caglic 2016 (13)	1	Transgluteal CT-guided	Single case	4	GG 3–4
Amin 2019 (14)	1	MRI-US fusion-guided TP	Single case	4 (Left) + 3 (Right)	GG 3
Vulder 2021 (15)	1	MRI-US fusion-guided TP	Single case	6	GG 4
Kailavasan 2021 (16)	3	MRI-US fusion-guided TP	Three cases (3/3)	12–15	GG 2–4

• Two reported series with more than 10 patients are presented in bold. (IVU – intravenous urogram, US – ultrasound, CT – computerised tomography, MRI – magnetic resonance imaging, TP – transperineal, SP – suprapubic). References cited in Table 1 are presented in supplementary information (and not included in the references of the main text). For majority of the reports included in this table, information on tumour stage was not provided. When available, information on tumour grade (presented as Grade Group) is included. (NA, not available).

Regardless of the imaging technique, all reported approaches require significant investment in resources (theatre and imaging equipment) as well as technical knowhow (urological and imaging). Among the reported series, only two have presented more than 10 patients for whom transperineal ultrasonography was employed to guide prostatic biopsies (Table 1). There remains no consensus on the optimal approach for securing histological diagnosis of prostate cancer when TRUS is not possible, especially when transperineal ultrasonography is not readily available [3]. Here, we describe our technique for grid-based cognitive diagnostic prostatic biopsy without TRUS.

中文翻译：

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基于网格的认知诊断前列腺活检，无需经直肠超声检查

介绍

前列腺癌和结直肠癌是影响全球男性的第二和第三大常见恶性肿瘤[ 1 ]。腹会阴切除术是远端直肠或肛管恶性肿瘤患者的标准手术治疗，而全直肠结肠切除术可能适用于炎症性肠病和家族性腺瘤性息肉病患者[ 2 ]。这两种手术都需要切除直肠和肛门括约肌复合体，形成永久性末端结肠造口术，这就否定了（经直肠超声）TRUS 成像指导诊断性前列腺活检的可能性。目前的文献（主要基于小规模患者队列）描述了在放射学指导下通过经会阴或经臀方法进行的前列腺活检，并使用经会阴（或不太常见的经尿道或经腹部）超声检查、MRI 或 CT 成像（表 1）。

表 1.对无肛管患者进行的一系列诊断性前列腺活检的报告摘要。

报告	样本量（n）	技术/方法	结果（检测出癌症的百分比）	活检核心数量	年级组 (GG)
夏皮拉 1982 (1)	1	IVU-美国引导	单例	不适用	不适用
克劳斯 1993 (2)	1	CT引导	单例	每边 3 个	GG 1
特威德韦尔 1993 (3)	10	TP-US引导	20% (2/10)	1-4	不适用；证据淋巴结疾病
菲尔德曼 1994 (4)	5	TP-US引导	40% (2/5)	不适用	不适用
火炉 1995 (5)	1	TP-US引导	单例	7	GG 4
海员1996 (6)	5	TP-经尿道U引导	60% (3/5)	六分仪+靶向活检	不适用
巴帕尼科拉乌 1996 (7)	10	CT引导下经臀肌	60% (6/10)	不适用	不适用
达米科 2000 (8)	1	TP-MRI引导	单例	6 个随机 + 1 个目标	GG 1
筱原 2003 (9)	28	TP-US引导	82% (23/38)	6–12	GG 1–5
摩拉科 2013 (10)	2	TP-SP US 组合方法	两个案例（1/2）	6	不适用
孔纽2016 (11)	1	TP-MRI引导	单例	4	GG 4
汉森 2016 (12)	11	TP美国引导	64% (7/11)	11-27日	GG 1–5
卡利奇 2016 (13)	1	CT引导下经臀肌	单例	4	GG 3–4
阿明 2019 (14)	1	MRI-US 融合引导 TP	单例	4（左）+ 3（右）	GG 3
沃尔德 2021 (15)	1	MRI-US 融合引导 TP	单例	6	GG 4
凯拉瓦桑 2021 年 (16)	3	MRI-US 融合引导 TP	三种情况（3/3）	12–15	GG 2–4

• 两个报道的包含超过 10 名患者的系列以粗体显示。 （IVU – 静脉尿路造影，US – 超声波，CT – 计算机断层扫描，MRI – 磁共振成像，TP – 经会阴，SP – 耻骨上）。表 1 中引用的参考文献出现在补充信息中（不包含在正文的参考文献中）。对于该表中包含的大多数报告，未提供有关肿瘤分期的信息。如果有的话，包括肿瘤分级的信息（以分级组的形式呈现）。 （NA，不可用）。

无论采用哪种成像技术，所有报道的方法都需要对资源（手术室和成像设备）以及技术知识（泌尿科和成像）进行大量投资。在报道的系列中，只有两个报道了超过 10 名采用经会阴超声检查指导前列腺活检的患者（表 1）。当无法进行 TRUS 时，特别是当经会阴超声检查不易获得时，对于确保前列腺癌组织学诊断的最佳方法尚未达成共识 [ 3 ]。在这里，我们描述了无需 TRUS 的基于网格的认知诊断前列腺活检技术。