a. Voie d’abord transrectale de la partie postérieure de la prostate.
b. Aiguille de ponction 18 Gauge avec mécanisme à déclenchement automatique. L’avancement de l’aiguille est de 23mm, prélevant une carotte d’environ 17mm. c. Schéma de 12 biopsies sous contrôle échographique en coupes prostatiques frontales obliques ou transverses obtenues avec une sonde dont le faisceau est dans l’axe de la sonde, au tiers supérieur, à la base (a), au tiers moyen, au milieu (b), et au tiers inférieur, à l’apex (c). Les prélèvements se font au niveau de chaque secteur postérieur, à mi-distance entre le bord latéral et le milieu de la prostate (site médiolobaire) et latéralement (site latéral), suivant l’axe postéro-antérieur de la sonde, oblique vers le haut. La sonde est tournée de 180° sur son axe pour biopsier le lobe controlatéral. Les biopsies latérales prélèvent uniquement la zone périphérique (en rose). Les biopsies médiolobaires prélèvent la zone périphérique et la zone de transition antérieure (en bleu).
Illustrations reproduites avec l’aimable autorisation du Professeur Arnaud VILLERS.
Annexe 6
Homme de 70 ans. PSA initial : 0,35 ng/mL. Biopsie initiale : une carotte de 1,5 mm. Gleason 3+3 en apex droit. PSI initial : 15 ng/mL. IRM à 12 mois avec augmentation du PSA à 20 ng/mL : plage suspecte Likert 5 apicale antérieure de 17 mm au maximum, d’environ 1,9 cc. Les biopsies de surveillance randomisées (6 carottes) n’ont pas retrouvé de CaP. La biopsie ciblée (une carotte) a retrouvé un CaP non significatif avec 1 mm Gleason 3+3. La prostatectomie radicale a mis en évidence un adénocarcinome Gleason 7 (3+4) antérieur, bilatéral allant de la base à l’apex pT3a.
Annexe 7
Homme de 74 ans. PSA initial à 5,38 ng/mL. PSAD initial à 0,09. Biopsies initiales : 12 biopsies randomisées dont une carotte positive en base gauche Gleason 3+3 sur 0,5 mm et deux carottes antérieures dont une positive à gauche Gleason 3+3 sur 0,5 mm. IRM de surveillance à 30 mois : lésion Likert 5 antérieure droite de 26 mm de plus grand axe. La première série de biopsie de surveillance randomisée non ciblée a retrouvé un CaP non significatif (1 carotte d’1 mm de CaP Gleason 3+3). La seconde série de biopsie randomisée et ciblée sur la zone
antérieure a mis en évidence en CaP non significatif sur les biopsies randomisées (2 carottes de 0,5 et 1 mm Gleason 3+3) et un CaP significatif sur les biopsies ciblées (2 carottes de 12 et 4 mm Gleason 3+3).
Annexe 8
Homme de 55 ans. PSA initial : 10,5 ng/mL. PSAD initial : 0. 12 Biopsies initiales : 1 carotte Gleason 3+3 apicale gauche de 2 mm de long. Ascension du PSA à 16 ng/mL. L’IRM à 23 mois retrouve une vaste plage en zone périphérique gauche étendue de la base à l’apex Likert 4. Les biopsies de surveillance (12 carottes
randomisées) retrouvent des lésions de prostatite chronique multifocale en base, milieu et apex gauche et base droite sans CaP.
Annexe 9
Homme de 78 ans, antécédent de Résection Trans-Urétrale de Prostate. PSA initial : 0,32. Biopsie initiale : 1 carotte positive de 1 mm de longueur Gleason 3+3 an apex droit. IRM à 13 mois : une plage en base droite suspecte uniquement en séquence T2, Likert 3. Biopsies de surveillance (10 carottes randomisées) : 2 carottes Gleason 3+3 de 1 mm de longueur chacune en base gauche.
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