Biopsy Cores Research Articles

MP55-11 PSMA-GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP55-11 PSMA-GUIDED PROSTATE BIOPSY David Kuppermann, Jeremie Calais, Elizabeth Tran, Samantha Gonzalez, Merdie Delfin, and Leonard Marks David KuppermannDavid Kuppermann More articles by this author , Jeremie CalaisJeremie Calais More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Samantha GonzalezSamantha Gonzalez More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA scanning is a most accurate method for detection of metastatic PCa. PSMA scanning may also reveal intra-prostatic cancer (PCa). Since MRI-guided biopsy (MRGB) may miss 15-20% of clinically-significant csPCa (≥GG2), we postulated that biopsy targeting PSMA foci in the prostate (PSMA-guided biopsy, PSMA-GB) might provide PCa detection in cases where MRGB failed. METHODS: 48 men with negative MRI-guided biopsy (MRGB), but continued suspicion of PCa (increased PSA density), underwent PSMA scanning within 6 months of MRGB. In the 23 with focal PSMA uptake in the prostate, a PSMA-GB was performed using PET/CT images instead of MR images for fusion with ultrasound. 4-8 biopsy cores were taken from each PSMA ‘hot spot’(Figure 1). Method of PSMA-GB was identical to MRGB, but employed US fusion with PET/CT instead of MRI, as detailed in the original case report (PMID: 28607878). Method of Ga-PSMA image acquisition via PET/CT scanning has been reported (PMID: 30920593). Contouring of PSMA foci within the prostate was via Profuse software by co-author J.C. Image fusion and trans-rectal targeted biopsy was via Artemis device (LSM). Detection rate of csPCa by PSMA-GB was primary endpoint. RESULTS: Among the 23 study patients, mean age=67 yrs (Range: 53-81); prostate volume=58.5cc (22.7-109.3); PSA=13.8 ng/ml (4.5- 34.8); PSA density=0.245 ng/ml/cc (0.073- 0.57). At first biopsy (MRGB), PIRADS score = 0-2 in 19 men and >3 in 4. PSMA-GB was successfully completed in all 23. Overall detection rate of csPCa was 15/23 (65.22%): GG2 in 6, GG3 in 6, GG4 in 2, and GG5 in 1. Median SUVmax (standardized uptake value) was 12.5 (5.8-28.7) in men whose PSMA hotspot revealed csPCa vs 5.8 (3.2-10.4) in men with negative PSMA-GB. Of 12 men whose PSMA focus was highly suspicious, i.e., Emmett’s Primary Score of 4 or 5 (PMID: 34373749 ), 11 had csPCa. CONCLUSIONS: Prostate biopsy, which targets PSMA ‘hot spots’ via PET/CT-US fusion, often leads to detection of csPCa missed by MRI-guided biopsy. Source of Funding: Jean Perkins Foundation; NCI-R01 CA 195505; and Department of Nuclear Medicine, UCLA. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e767 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Kuppermann More articles by this author Jeremie Calais More articles by this author Elizabeth Tran More articles by this author Samantha Gonzalez More articles by this author Merdie Delfin More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

Ultrasound frequency sonication facilitates high-throughput and uniform dissociation of cellular aggregates and tissues.

A sample preparation step involving dissociation of tissues into their component cells is often required to conduct analysis of nucleic acids and other constituents from tissue samples. Frequently, the extracellular matrix and cell-cell adhesions are disrupted via treatment with a chemical dissociating reagent or various mechanical forces. In this work, a new, high-throughput, multiplexed method of dissociating tissues and cellular aggregates into single cells using ultrasound frequency bath sonication is explored and characterized. Different operating parameters are evaluated, and a treatment protocol with potential for uniform, high-throughput tissue dissociation is compared to the existing best chemical and orbital plate shaking protocol. Metrics such as percent dissociation, cellular recovery, average aggregate size, proportion of various aggregate sizes, membrane circularity, and cellular viability are subsequently assessed and found to be favorable. In optimized conditions, 53 ± 8% of 1 mm biopsy cores are dissociated within 30 min using sonication alone, surpassing leading high-throughput orbital plate shaking techniques five-fold. Chemical digestion is also 2 times more effective when complexed with sonication rather than orbital plate shaking. RNA content, quality, and expression are found to be superior to the standard protocol in terms of transcriptional preservation.

MP20-13 NOVEL PLATFORM FOR MRI-TARGETED BIOPSY AND SAMPLING OF FRESH EX-VIVO PROSTATE CANCER TISSUE

You have accessJournal of UrologyCME1 Apr 2023MP20-13 NOVEL PLATFORM FOR MRI-TARGETED BIOPSY AND SAMPLING OF FRESH EX-VIVO PROSTATE CANCER TISSUE Goran Rac, Steven M. Shea, and Gopal N. Gupta Goran RacGoran Rac More articles by this author , Steven M. SheaSteven M. Shea More articles by this author , and Gopal N. GuptaGopal N. Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003245.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obtaining fresh, viable prostate cancer tissue in a clinical pathology setting is difficult due to lack of optically visible contrast between benign and cancerous tissue. Building on prior methods used to aid correlation of MRI results and whole-mount pathology findings, we have developed an inexpensive and easy to implement means with which 3D-printed molds can be created for any prostate to enable targeted ex-vivo sampling of biopsy-proven cancer lesions seen on MRI. The potential applications for a platform that can reliably sample living prostate cancer tissue are numerous, including the ability to facilitate future cancer research. METHODS: STL files of the prostate boundary and target lesions are exported from the UroNav fusion biopsy system. A custom macro was developed for use with SolidWorks (Dassault Systèmes, France), a computer-aided design application. This creates a material-optimized mold around the prostate with needle guides that allow for targeted sampling of up to 4 regions of interest. The guides are customizable in terms of location and dimensions to accommodate different biopsy needles. The parts are then exported and 3D-printed. Following prostate extraction at time of radical prostatectomy, the seminal vesicles are removed. The prostate is then placed into the mold, and samples are taken by inserting a biopsy needle into a guide up to the predetermined depth. The prostate is then passed to pathology for standard processing, while the live tissue in the biopsy cores is available for a variety of purposes. RESULTS: The resulting platform allows for a prostate of any size or morphology to be precisely sampled as long as there is a pre-acquired MRI dataset. The prostate mold allows for accurate sampling of target cancer lesions and is optimized in size for each prostate to allow for minimal material waste. CONCLUSIONS: This novel platform provides the unique ability to obtain fresh prostate cancer tissue. The utility of this is not necessarily limited to prostate cancer alone but may be of use in other solid-organ malignancies with targetable lesions as well. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e280 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Goran Rac More articles by this author Steven M. Shea More articles by this author Gopal N. Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE Daniel Nemirovsky, Zoe Blake, Jacob Enders, Alexander Kenigsberg, Neil Mendrihatta, Michael Rothberg, Michael Daneshvar, Lindsey Hazen, Charisse Garcia, Sheng Xu, Baris Turkbey, Bradford Wood, Peter Pinto, and Sandeep Gurram Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Jacob EndersJacob Enders More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Lindsey HazenLindsey Hazen More articles by this author , Charisse GarciaCharisse Garcia More articles by this author , Sheng XuSheng Xu More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter PintoPeter Pinto More articles by this author , and Sandeep GurramSandeep Gurram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monitoring MRI-invisible prostate cancer remains a challenge for patients on active surveillance (AS) due to an inability to reliably re-biopsy tumors without an associated lesion on MRI. In this study, we sought to describe our experience using a prostate image-fusion platform in tracking MRI-invisible lesions in patients on AS, as well as to determine differences in cancer detection and upgrading rates between systematic, MRI-targeted, and tracked biopsies. METHODS: A prospectively maintained AS database was queried for patients with ≥1 tracked prostate biopsy session. Needle trajectories of all biopsy cores were saved using the UroNav™ (Philips) platform. Patients underwent MRI/US guided biopsies of systematic and MRI-targeted lesions via transperineal or transrectal approaches. Tracked biopsy was defined as a repeat MRI/US fusion-guided biopsy which re-targeted regions corresponding to previously positive systematic cores not associated with MRI visible lesions. Gleason grade was compared between initial and subsequent biopsy sessions for all three biopsy modalities: systematic, MRI-targeted, and tracked. RESULTS: Between 2009-2022, 271 patients on AS with ≥1 tracked biopsy sessions were identified. 101/271 (37.3%) had two tracked biopsy sessions and 31/271 (11.4%) had three. The median time from initial to subsequent biopsy session was 19 months (IQR: 13-29). Among 271 patients, there were 83 upgrading events captured by the three modalities on first repeat biopsy (Table 1). On first repeat biopsy, 31/83 (37.3%) upgrading events were identified by tracking, with 11/83 (13.3%) identified only on tracking biopsy. Of the 110 total upgrading events between the three repeat tracked biopsy sessions, 41/110 (37.3%) were captured on tracking, with 16/110 (14.5%) discovered solely by tracking. The median number of biopsy cores for systematic, MRI-targeted, and tracked approaches were 12, 4 (IQR: 2-4), and 2 (IQR: 2-4), respectively. CONCLUSIONS: In this series, a significant portion of upgrading events for patients on AS were uniquely identified on tracked biopsy and would have otherwise been missed on repeat systematic and MRI-targeted biopsy. Notably, given the low number of additional biopsy cores required for tracking, this approach may be an appropriate and low-risk supplement to standard AS protocols. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e527 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Jacob Enders More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Michael Rothberg More articles by this author Michael Daneshvar More articles by this author Lindsey Hazen More articles by this author Charisse Garcia More articles by this author Sheng Xu More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Sandeep Gurram More articles by this author Expand All Advertisement PDF downloadLoading ...

MP09-03 COMPARATIVE STUDY OF SIGNIFICANT CANCER DETECTION IN MAGNETIC RESONANCE IMAGING-TRANSRECTAL ULTRASOUND FUSION IMAGE-GUIDED PROSTATE TARGET BIOPSY AND TRANSPERINEAL TEMPLATE-GUIDED SYSTEMATIC BIOPSY: A 15-CENTER PROSPECTIVE STUDY IN JAPAN

You have accessJournal of UrologyCME1 Apr 2023MP09-03 COMPARATIVE STUDY OF SIGNIFICANT CANCER DETECTION IN MAGNETIC RESONANCE IMAGING-TRANSRECTAL ULTRASOUND FUSION IMAGE-GUIDED PROSTATE TARGET BIOPSY AND TRANSPERINEAL TEMPLATE-GUIDED SYSTEMATIC BIOPSY: A 15-CENTER PROSPECTIVE STUDY IN JAPAN Sunao Shoji, Mayura Nakano, Kazuya Oda, Tatsuo Kano, Tatsuya Umemoto, Masayoshi Kawakami, Masahiro Nitta, Masanori Hasegawa, and Akira Miyajima Sunao ShojiSunao Shoji More articles by this author , Mayura NakanoMayura Nakano More articles by this author , Kazuya OdaKazuya Oda More articles by this author , Tatsuo KanoTatsuo Kano More articles by this author , Tatsuya UmemotoTatsuya Umemoto More articles by this author , Masayoshi KawakamiMasayoshi Kawakami More articles by this author , Masahiro NittaMasahiro Nitta More articles by this author , Masanori HasegawaMasanori Hasegawa More articles by this author , and Akira MiyajimaAkira Miyajima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective of the present study was to evaluate the usefulness of magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion image-guided prostate target biopsy in detecting biopsy-proven clinically significant prostate cancer (csPC) in a multicenter prospective study. METHODS: Patients with serum prostate specific antigen (PSA) levels ≤ 20 ng/m and suspected prostate cancer on multi-parametric MRI were enrolled from 2020 to 2021. For cancer-suspicious areas, each patient underwent a target biopsy and transperineal template-guided 12-core systematic biopsy. The csPC detection rates between target and systematic biopsies were compared. RESULTS: The study included 400 patients (15 centers). The median age was 69 years (47-85), median PSA was 7.32 ng/mL (1.41-19.98), median prostate volume was 35 cc (7.4-131), median number of target biopsies per patient was 1 (1-4), and median biopsy time was 9 minutes (5-41). CsPC detection rates of patients’ target and systematic biopsies were 59.3% and 49%, respectively (p<0.0001). In the pathological findings of target and systematic biopsy cores, csPC detection (57% vs. 10.4%, p<0.0001), cancer core length (6 mm vs. 3 mm, p<0.0001), and cancer core percent (38% vs. 18%, p<0.0001) were significantly higher in target biopsies than in systematic biopsies. On multivariable logistic regression analysis to predict csPC, age (OR 1.054, P=0.002), PSA value (OR 1.097, p=0.033), PSA density (OR 2.068, p<0.0001), highest PI-RADS category (OR 5.105, p<0.0001), and location of the lesion with highest PI-RADS category (TZ vs. PZ) (OR 0.488, p=0.004) were significant risk factors for detecting csPC. On multivariable logistic regression analysis to predict csPC in patients with PI-RADS categories 2 and 3, PSAD was a significant risk factor for detecting csPC (OR 3.665, p<0.0001). Areas under the receiver operating characteristic curve (AUC) for PSAD was significantly greater than non-discrimination for the detection of csPC in patients with PI-RADS categories 2 and 3 (AUC 0.751, p<0.0001). Using cut-off value: 0.150 ng/mL/cc, sensitivity, specificity, positive predictive value, and negative predictive value for detecting csPC were 92.5%, 45.3%, 41.6%, and 93.5%, respectively. CONCLUSIONS: MRI-TRUS fusion image-guided target biopsy was superior to systematic biopsy in detecting patients with csPC. Using a cut-off value of PSAD would avoid unnecessary biopsies for regions with PI-RADS categories 2 and 3. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e104 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunao Shoji More articles by this author Mayura Nakano More articles by this author Kazuya Oda More articles by this author Tatsuo Kano More articles by this author Tatsuya Umemoto More articles by this author Masayoshi Kawakami More articles by this author Masahiro Nitta More articles by this author Masanori Hasegawa More articles by this author Akira Miyajima More articles by this author Expand All Advertisement PDF downloadLoading ...

PD39-09 IMPACT OF PROSTATE IMAGING QUALITY (PI-QUAL) SCORE ON THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER IN MEN UNDERGOING MRI-TARGETED BIOPSY

PD39-09 IMPACT OF PROSTATE IMAGING QUALITY (PI-QUAL) SCORE ON THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER IN MEN UNDERGOING MRI-TARGETED BIOPSY

MP77-08 PROSTATE CANCER PRESENTATION IN A COMMUNITY SETTING A DECADE SINCE THE USPSTF GRADE D RECOMMENDATION

You have accessJournal of UrologyCME1 Apr 2023MP77-08 PROSTATE CANCER PRESENTATION IN A COMMUNITY SETTING A DECADE SINCE THE USPSTF GRADE D RECOMMENDATION Franklin Gaylis, Edward Cohen, Paul Dato, Rose Prime, Julie Cramer, Katayune Golshan, Sonia Romo, Sepi Mahooti, Michael Leapman, Robert Topp, and William Catalona Franklin GaylisFranklin Gaylis More articles by this author , Edward CohenEdward Cohen More articles by this author , Paul DatoPaul Dato More articles by this author , Rose PrimeRose Prime More articles by this author , Julie CramerJulie Cramer More articles by this author , Katayune GolshanKatayune Golshan More articles by this author , Sonia RomoSonia Romo More articles by this author , Sepi MahootiSepi Mahooti More articles by this author , Michael LeapmanMichael Leapman More articles by this author , Robert ToppRobert Topp More articles by this author , and William CatalonaWilliam Catalona More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The United States Preventative Services Task Force (USPSTF) issued a grade “D” recommendation against PSA-based prostate cancer (PCa) screening in 2012. We present an analysis of a prospectively collected data repository including PCa tumor burden, Gleason score group, PSA and prostate biopsy positivity rates in a community setting a decade since the Task Force recommendation METHODS: We identified 7,914 patients undergoing prostate biopsy between April 2011 and December 2021 from the Genesis Healthcare Partner’s (large urology group practice) electronic medical record (EMR). For 2011, we annualized the number of biopsies performed based on an imputed estimate from April through December of 2011. We compiled the number of prostate biopsies and proportions of biopsies demonstrating cancer, Gleason score (6, 7, 8-10), and the maximum positive biopsy core percentage involvement with cancer. Statistical analysis included Chi Square and a one-way ANOVA. RESULTS: The annual biopsy rate was significantly higher in 2011 (997 cases [748 actual cases plus 249 estimated cases] than for all other years. Chi Square analysis indicated a significant consistent increase (p<0.001) in the percentage of positive biopsies between 2011 (44.25%) and 2021 (65.91%). The proportion of low grade disease significantly decreased (p<0.001) between 2011 and 2021 from 49.12% to 33.33%, while the proportion high grade disease significantly increased (p<0.001) from 16.47% to 27.59%. The proportion of intermediate grade disease significantly increased (p<0.001) from 34.41% in 2011 to 39.08% in 2021. The mean maximum positive biopsy core percentage was lower in 2011 (48.00+.33%) versus 2021 (55.00+.29%) (p<0.001). A non-parametric independent samples Kruskal-Wallis test with Bonferroni post hoc comparisons indicated that the median PSA levels were similar during 2011-2012 (6.7 – 6.9 ng/ml) and were significantly lower (p<.05) than the median PSA values measured during 2020-2021 (8.5 – 9 ng/ml). Study limitations include uncertainty about the extent of adoption of USPSTF guidelines in the practices, possible inaccurate attribution of causality (versus imaging and biomarker effects). Its strengths include prospective acquisition of granular data and findings that align with studies showing increases in metastatic disease and PCa-specific mortality during this interval. CONCLUSIONS: We identified a temporal association between the USPSTF 2012 recommendation against screening and increasing volume and proportion of high-grade prostate cancer. This trend was not reversed following the 2018 ‘Grade C’ revision to the USPSTF guideline. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1104 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Franklin Gaylis More articles by this author Edward Cohen More articles by this author Paul Dato More articles by this author Rose Prime More articles by this author Julie Cramer More articles by this author Katayune Golshan More articles by this author Sonia Romo More articles by this author Sepi Mahooti More articles by this author Michael Leapman More articles by this author Robert Topp More articles by this author William Catalona More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-08 AVOIDING UNNECESSARY TARGETED PROSTATE BIOPSIES USING MACHINE LEARNING

You have accessJournal of UrologyCME1 Apr 2023PD38-08 AVOIDING UNNECESSARY TARGETED PROSTATE BIOPSIES USING MACHINE LEARNING Roxana Esmaili, Ghazal Khajir, Michael Leapman, Preston Sprenkle, Darryl Martin, and John Onofrey Roxana EsmailiRoxana Esmaili More articles by this author , Ghazal KhajirGhazal Khajir More articles by this author , Michael LeapmanMichael Leapman More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , Darryl MartinDarryl Martin More articles by this author , and John OnofreyJohn Onofrey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI)-targeted transrectal ultrasound (TRUS) guided needle biopsy is the current gold standard for diagnosing prostate cancer in patients with suspicion for prostate cancer. This leads to a frequent needle biopsy to determine the presence of clinically significant prostate cancer (csPCa) with a high rate of invasive overdiagnosis in patients with non-aggressive cancer. Supervised machine learning (ML) algorithms provide a mathematical framework to make predictions about csPCa in order to make personalized decisions to perform a biopsy or not and avoid unnecessary targeted needle biopsies. METHODS: From January 2016 to February 2020, 1099 patients underwent multiparametric MRI before TRUS fusion biopsy. We included PI-RADS score (version 2), gland volume, lesion region of interest volume before biopsy, PSA value, PSA density, and patient age at the time of biopsy as input variables to calculate the probability of csPCa for each lesion for each patient before biopsy using different ML classification algorithms: logistic regression (LR); random forest (RF); naïve Bayes (NB); and nearest neighbor (NN). Gleason Grade Group ≥2 was used as a reference for the presence of csPCa. Ten-fold cross-validation stratified over patients validated the ML approaches and compared to univariate models. RESULTS: Area under the receiver operating characteristic curves (AUC) and net reduction curves show that multivariate LR (AUC 81.3%) outperformed RF (AUC 79.2%), NN (AUC 71.8%) and NB (AUC 78.3%) and outperformed standard univariate LR using PSA density (AUC 71.4%) and PI-RADS (AUC 73.9%). The algorithms were evaluated at a point on the ROC curve for high sensitivity. Using the multivariate LR model, 636 (41.38%) targeted biopsies could have been avoided while missing only 90 (5.86%) csPCa, which is reasonable with a threshold probability of 25% and a net benefit of 0.21. CONCLUSIONS: Our findings suggest that multivariate ML models using clinical data can be used to avoid unnecessary targeted biopsy cores among patients with suspicion of prostate cancer undergoing prostate biopsy. Source of Funding: JAO supported by NIH R42 CA224888. DTM supported by DoD W81XWH-19-PCRP-IDA. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e996 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roxana Esmaili More articles by this author Ghazal Khajir More articles by this author Michael Leapman More articles by this author Preston Sprenkle More articles by this author Darryl Martin More articles by this author John Onofrey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP38-19 FOCAL THERAPY CANDIDACY: AN EVALUATION OF INITIAL AND CONTINUED ELIGIBILITY FOR FOCAL THERAPY IN AN ACTIVE SURVEILLANCE COHORT

You have accessJournal of UrologyCME1 Apr 2023MP38-19 FOCAL THERAPY CANDIDACY: AN EVALUATION OF INITIAL AND CONTINUED ELIGIBILITY FOR FOCAL THERAPY IN AN ACTIVE SURVEILLANCE COHORT Alexander P. Kenigsberg, Daniel Nemirovsky, Neil Mendhiratta, Zoe Blake, Jacob J. Enders, Samuel A. Gold, Michael B. Rothberg, Daniel Nethala, Brad Wood, Baris Turkbey, Sandeep Gurram, and Peter A. Pinto Alexander P. KenigsbergAlexander P. Kenigsberg More articles by this author , Daniel NemirovskyDaniel Nemirovsky More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Zoe BlakeZoe Blake More articles by this author , Jacob J. EndersJacob J. Enders More articles by this author , Samuel A. GoldSamuel A. Gold More articles by this author , Michael B. RothbergMichael B. Rothberg More articles by this author , Daniel NethalaDaniel Nethala More articles by this author , Brad WoodBrad Wood More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal Therapy (FT) for Gleason grade group (GG) 1 prostate cancer (PCa) is controversial, given almost all of these patients are suitable active surveillance (AS) candidates. Little is known about how many AS GG 1 patients retain focal therapy eligibility (FTE) over time. The objective of this study is to evaluate initial and long-term FTE for patients with GG1 disease. METHODS: A prospectively maintained AS cohort was retrospectively queried for patients initiated on AS between 2009 and 2020 with GG1 PCa. Patients with a unilateral, biopsy-concordant, MRI-visible PIRADS or PIRADS-equivalent 2-5 lesions amenable to hemiablation who had a PSA<20, <4 positive systematic biopsy cores were considered FTE. Patients who remained GG1 were considered to have maintained FTE. Those who progressed were reassessed at time of progression for FTE. Patients with ≥GG4 disease, bilateral GG≥2, or MRI-invisible GG≥2 lost FTE. Univariate and multivariate analyses were conducted to evaluate factors associated with FTE. RESULTS: 282 GG1 PCa patients were identified, 164 of whom (58%) were FT candidates, with a mean follow-up of 4.9 years (range 1.0-13.4 years). 81/164 (49%) progressed to GG≥2 or higher on a subsequent biopsy. At the time of PCa upgrading, 36/164 (22%) of the FT candidate cohort lost FTE. Baseline characteristics are shown in Table 1. Patients who lost FTE trended toward increased PSA (6.3 vs 5.3, p=0.062 and MRI lesions (2.6 vs 2.0, p=0.007), and were more likely to have transitional or central zone (TZ/CZ) lesions (30.6% vs 14.1%, p=0.022) relative to those who maintained FTE. On logistic regression (Table 2), the number of MRI lesions and TZ/CZ lesions were associated with FTE loss (p=0.033 and 0.047, respectively). CONCLUSIONS: While approximately half of GG1 FT candidates demonstrate disease progression, almost 80% maintain FTE. Given the demonstrated safety of AS and relatively small number of patients who lose FTE while on surveillance, routine FT for GG1 disease would result in a large number of unnecessary procedures. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e532 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander P. Kenigsberg More articles by this author Daniel Nemirovsky More articles by this author Neil Mendhiratta More articles by this author Zoe Blake More articles by this author Jacob J. Enders More articles by this author Samuel A. Gold More articles by this author Michael B. Rothberg More articles by this author Daniel Nethala More articles by this author Brad Wood More articles by this author Baris Turkbey More articles by this author Sandeep Gurram More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

MP77-11 THE ONCOLOGIC RISK OF MRI-TARGETED AND SYSTEMATIC CORES IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP77-11 THE ONCOLOGIC RISK OF MRI-TARGETED AND SYSTEMATIC CORES IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY Christopher Gaffney, Amy Tin, Jonathan Fainberg, Ghalib Jibara, Karim Touijer, James Eastham, Peter Scardino, Vicent Laudone, Andrew Vickers, and Behfar Ehdaie Christopher GaffneyChristopher Gaffney More articles by this author , Amy TinAmy Tin More articles by this author , Jonathan FainbergJonathan Fainberg More articles by this author , Ghalib JibaraGhalib Jibara More articles by this author , Karim TouijerKarim Touijer More articles by this author , James EasthamJames Eastham More articles by this author , Peter ScardinoPeter Scardino More articles by this author , Vicent LaudoneVicent Laudone More articles by this author , Andrew VickersAndrew Vickers More articles by this author , and Behfar EhdaieBehfar Ehdaie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-targeted prostate biopsy (MR-Bx) in combination with systemic biopsy (S-Bx) improves detection of higher grade group (GG) prostate cancer compared to either modality alone. However, prognostic models using GG rely on pre-MRI era data; it is unknown whether upgrading with MRI-targeted cores portends increased oncologic risk or if this precise targeting and increased sampling is causing grade migration. We sought to define the relative oncologic risk of systematic and MRI-targeted biopsy cores in men treated with radical prostatectomy (RP) as defined by adverse pathology (AP) and biochemical recurrence (BCR). METHODS: We retrospectively reviewed all patients who had MR-Bx and S-Bx prior to RP (2014-2022). We created two multivariable logistic regression models with AP (defined as primary pattern 4, any pattern 5, SVI or LNI) as the primary outcome. Pre-RP PSA, positive cores on S-Bx, negative cores on S-Bx, GG on S-Bx, and GG on MR-Bx. The second model excluded GG on MR-Bx. We derived the risk of AP for an average patient based on each combination of GG on S-Bx and MR-Bx in the first model and the risk of AP based on S-Bx GG in the second. As a secondary analysis, we used Cox instead of logistic regression for the outcome of BCR and presented risk at 12-months. RESULTS: We identified 991 patients (median age 64) evaluated with MR-Bx and S-Bx and treated with RP. 359 (36%) had AP. MR-Bx GG portends additional risk compared to S-Bx GG alone (p<0.001) but confers less risk than S-Bx of the same GG. The risk of AP is greatest when the highest GG is concordant between MR-Bx and S-Bx compared to when the highest GG is found on S-Bx or MR-Bx alone. For example, the risk of AP for GG2 S-Bx / GG2 MR-Bx, GG2 S-Bx / GG3 MR-Bx, GG3 S-Bx / GG2 MR-Bx, and GG3 S-Bx / GG3 MR-Bx are 18%, 47%, 50% and 80% respectively (Table 1). 158 patients experienced BCR. Results for the outcome of BCR were like those for AP. CONCLUSIONS: Where grade is discordant between systematic and MRI-targeted biopsy, risk is intermediate between the two grades. This casts doubt on the current practice of defining pathologic risk based on the highest grade. Prospective multicenter studies are required to accrue samples sizes large enough to estimate risk separately for all combinations of MRI and systematic grade. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1106 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Gaffney More articles by this author Amy Tin More articles by this author Jonathan Fainberg More articles by this author Ghalib Jibara More articles by this author Karim Touijer More articles by this author James Eastham More articles by this author Peter Scardino More articles by this author Vicent Laudone More articles by this author Andrew Vickers More articles by this author Behfar Ehdaie More articles by this author Expand All Advertisement PDF downloadLoading ...

MP25-16 EVALUATING THE LEARNING CURVE FOR IN-OFFICE COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP25-16 EVALUATING THE LEARNING CURVE FOR IN-OFFICE COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY Sofia Gereta, Michael Hung, and Jim C. Hu Sofia GeretaSofia Gereta More articles by this author , Michael HungMichael Hung More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In-office MRI-ultrasound cognitive fusion targeted transperineal biopsy (CTPB) is a cost-effective approach to a percutaneous, clean wound classification approach to biopsy. However, because transrectal biopsy remains the predominant U.S. approach to CTPB, the barriers to the adoption of the relatively novel CTPB include the learning curve to proficiency and comparative detection rates of clinically significant prostate cancer (csPC, Gleason Grade Group (GG) ≥2). Therefore, our study objective was to define the CTPB learning curve, which is heretofore unstudied, by assessing cancer detection, biopsy core quantity, procedure times, and adverse events (AEs) over time. METHODS: We performed a retrospective review for 110 consecutive CTPB performed using PrecisionPoint (Cumberland, MD) without antibiotic prophylaxis between March 2021 and September 2022, excluding biopsies performed after focal therapy. All CTPB were performed by a single urologist (JCH) without prior experience with the platform. The cohort was divided into quarters and analyzed by univariate methods. RESULTS: There was no significant difference in demographic or MRI characteristics between quarters. There was no difference in the detection of csPC (Q1 50%, Q2 52%, Q3 50%, Q4 48%, p=0.99) or GG upgrading by targeted biopsy across quarters (Figure 1B, 1D). The median number of cores sampled per biopsy significantly decreased after approximately 28 cases (Q1 18, Q2 16, Q3 16, Q4 15, p=0.01). There was no change in the proportion of fibromuscular (non-prostate) cores sampled across quarters (Figure 1B). Total procedure time decreased from a median of 4:06 min in Q3 to 3:00 min in Q4 (p=0.04). Rates of AEs did not differ and remained low across quarters. A single patient reported UTI with irritative voiding symptoms was found to have a negative urine culture (Figure 1C). CONCLUSIONS: Our novel study demonstrates that MRI-ultrasound cognitive fusion targeted transperineal biopsy is safe and effective without a significant learning curve, as shown by consistent csPC detection across the study period. There was a significant decrease in the number of cores obtained after approximately 28 cases with a shorter procedure time, suggesting greater procedural efficiency or refinement in the core sampling approach. Source of Funding: There was no direct funding from an outside organization or sponsor. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e349 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sofia Gereta More articles by this author Michael Hung More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

PD39-06 INTEGRATING INDEX LESION VOLUME TO BETTER CLASSIFY MEN WITH INDOLENT PROSTATE CANCER AMONG PATIENTS WITH INTERMEDIATE RISK DISEASE. RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

PD39-06 INTEGRATING INDEX LESION VOLUME TO BETTER CLASSIFY MEN WITH INDOLENT PROSTATE CANCER AMONG PATIENTS WITH INTERMEDIATE RISK DISEASE. RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

MP09-01 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ON MRI: A COMPARISON OF AN ARTIFICIAL INTELLIGENCE MODEL VERSUS RADIOLOGISTS

You have accessJournal of UrologyCME1 Apr 2023MP09-01 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ON MRI: A COMPARISON OF AN ARTIFICIAL INTELLIGENCE MODEL VERSUS RADIOLOGISTS Simon John Christoph Soerensen, Richard E. Fan, Indrani Bhattacharya, David S. Lim, Sarir Ahmadi, Xinran Li, Sulaiman Vesal, Mirabela Rusu, and Geoffrey A. Sonn Simon John Christoph SoerensenSimon John Christoph Soerensen More articles by this author , Richard E. FanRichard E. Fan More articles by this author , Indrani BhattacharyaIndrani Bhattacharya More articles by this author , David S. LimDavid S. Lim More articles by this author , Sarir AhmadiSarir Ahmadi More articles by this author , Xinran LiXinran Li More articles by this author , Sulaiman VesalSulaiman Vesal More articles by this author , Mirabela RusuMirabela Rusu More articles by this author , and Geoffrey A. SonnGeoffrey A. Sonn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Automated detection of prostate cancer on magnetic resonance imaging (MRI) may help target biopsies and avoid unnecessary biopsies of false-positive lesions. We sought to develop an artificial intelligence (AI) model to rapidly and accurately identify cancer foci on MRI and compare its performance against radiologists. METHODS: A total of 1504 subjects underwent multiparametric MRI at more than 30 institutions in the US, followed by MRI-ultrasound fusion biopsy at one institution. We used T2-weighted images (T2WI), apparent diffusion coefficient maps (ADC), and diffusion-weighted imaging (DWI) from 1404 cases to train an AI model. MRI lesions were initially identified and outlined by a radiologist using T2WIs, DWIs, ADC, and contrast enhanced images (DCE). Cancers were confirmed by biopsy. Only lesions containing Gleason 3+3 (≥ 40% cancer core length) or Gleason ≥3+4 (any amount) in at least one targeted biopsy core were considered for training and testing the model. All other MRI lesions were removed. Systematic cores with significant cancer were also included for model training. We tested the AI model on 100 independent cases and compared it against trained radiologists. We computed lesion-level AUC, sensitivity, specificity, and negative predictive value (NPV). RESULTS: AI and radiologists had similar performances across all metrics, and all differences were non-significant. The AI model had an AUC of 0.79±0.22, NPV of 0.66±0.26, sensitivity of 0.34±0.41, and specificity of 0.99±0.05. Radiologists had an AUC of 0.81±0.22, NPV of 0.69±0.28, sensitivity of 0.37±0.45, and specificity of 0.99±0.05. CONCLUSIONS: In this study, we trained and tested an AI model on a large and diverse multi-institutional cohort of MRIs. The model matched the performance of radiologist experts. In future work, we envision comparing model performance against radiologists at different skill levels and comparing radiologist + AI vs radiologist performance alone. Source of Funding: Departments of Radiology and Urology, Stanford University, National Cancer Institute of the National Institutes of Health (R37CA260346 to M.R), and the generous philanthropic support of our patients (G.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e103 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon John Christoph Soerensen More articles by this author Richard E. Fan More articles by this author Indrani Bhattacharya More articles by this author David S. Lim More articles by this author Sarir Ahmadi More articles by this author Xinran Li More articles by this author Sulaiman Vesal More articles by this author Mirabela Rusu More articles by this author Geoffrey A. Sonn More articles by this author Expand All Advertisement PDF downloadLoading ...

PD10-09 A NOVEL MODEL INTEGRATING CLINICAL, MP-MRI, AND EPIGENOMIC FEATURES TO PREDICT LYMPH NODE INVASION IN PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY AND PELVIC LYMPH NODE DISSECTION

PD10-09 A NOVEL MODEL INTEGRATING CLINICAL, MP-MRI, AND EPIGENOMIC FEATURES TO PREDICT LYMPH NODE INVASION IN PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY AND PELVIC LYMPH NODE DISSECTION

Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy?

We clarified the predictive factors for changes in the status of medications for lower urinary tract symptoms (LUTS) 2 years after local radiotherapy for nonmetastatic prostate cancer. We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016. Patients were divided into the medication and no-medication group based on the use of drugs for LUTS before radiotherapy. We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration when medication was required in the no-medication group. Logistic regression analysis was used to evaluate predictive factors for changes in medication status. Altogether, 505 patients were divided into a no-medication group (n = 352) and a medication group (n = 153). The number of patients with deterioration and improvement in LUTS was 49 (14%) and 36 (23%), respectively. In the multivariate analysis, the predictive variables for deterioration were the International Prostate Symptom Score (≥8; odds ratio [OR], 2.21; p = 0.014) and the biopsy Gleason score (≤3 + 4 = 7; OR, 2.430; p = 0.008) in the no-medication group, whereas those for improvement were age (<75 years old; OR, 5.81; p = 0.002), the quality of life score (<3; OR, 3.15; p = 0.028), and a positive biopsy core rate (≥50%; OR, 2.530; p = 0.027) in the medication group. These predictive factors for changes in the status of medications for LUTS at 2 years after external radiotherapy may help determine the definitive therapy for nonmetastatic prostate cancer.

Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center.

Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018-2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D'Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.

Isolated Light Chain-restricted Germinal Centers are Common in Follicular Hyperplasia by Ultrasensitive In Situ Hybridization.

Ultrasensitive bright-field RNA in situ hybridization (BRISH) can be used to detect lower levels of light chain expression than immunohistochemical stains or conventional colorimetric RNA in situ hybridization. In this study, we retrospectively reviewed 77 lymph node specimens with follicular hyperplasia and kappa/lambda BRISH performed as part of the diagnostic evaluation. Thirty-two of the specimens had ≥1 germinal center(s) (GC) showing light chain restriction (14 specimens with lambda-restricted GC, 9 with kappa-restricted GC, and 9 with separate kappa-restricted or lambda-restricted GC). In all but 1 specimen, the light chain-restricted GC represented a minority of the total GC (average: 10%, range: 0.2% to 60%). There was no significant difference in age, sex, type of biopsy (core vs. excision), number of GCs, proportion of cases with a light chain-restricted B-cell population by flow cytometry, or proportion of cases with a positive IgH gene rearrangement study between the specimens with and without restricted GCs. In our cohort of follicular hyperplasia cases, BRISH identified light chain-restricted GC more frequently than flow cytometry identified a monotypic B-cell population. Our findings highlight the potential for overinterpretation of light chain restriction in limited samplings such as fine needle aspiration cell blocks or core needle sampling and reinforce that interpretation of BRISH staining needs to occur in the context of the morphologic features including tissue architecture and results of additional immunohistochemical stains.

Development and Validation of a Mixed-Reality Simulator for Reducing Biopsy Core Deviation During Simulated Freehand Systematic Prostate Biopsy.

We describe the development and validation of a mixed-reality prostate biopsy (PBx) simulator with built-in guidance aids and real-time 3-dimensional visualization. We evaluated our simulator during one-on-one training sessions with urology residents and attendings from 2018 to 2022. Participants performed freehand, side-fire, double-sextant transrectal ultrasound-guided systematic prostate biopsy (sPBx). After a baseline assessment (first set of 12 biopsy cores), participants trained for 25 minutes with visualization and cognitive aids activated. Training was followed by an exit set of 12 biopsy cores without visualization or cognitive aids and afterward, subjective assessment by trainees of the simulator. Deviation is the shortest distance of the center of a core from its intended template location. Baseline deviations (mean ± SD) for residents (n = 24) and attendings (n = 4) were 13.4 ± 8.9 mm and 8.5 ± 3.6 mm ( P < 0.001), respectively. Posttraining deviations were 8.7 ± 6.6 mm and 7.6 ± 3.7 mm ( P = 0.271), respectively. Deviations between baseline and exit were decreased significantly for residents ( P < 0.001) but not for attendings ( P = 0.093). Overall feedback from participants was positive. Confidence in performing a PBx increased in novices after training ( P = 0.011) and did not change among attendings ( P = 0.180). A new PBx simulator can quantify and improve accuracy during simulated freehand sPBx while providing visualization and graphical feedback. Improved simulated sPBx accuracy could lead to more even distribution of biopsy cores within the prostate when performed in clinical settings, possibly reducing the high risk of missing an existing lesion and thus decreasing the time to initiating treatment, if indicated.

Is systematic prostate biopsy an overkill in metastatic prostate carcinoma ? A prospective validation.

To assess the efficacy of 2-core prostate biopsy in advanced prostate cancer patients. This included a retrospective analysis of 12-core prostate biopsies and a prospective validation that a reduced number of cores are sufficient for histopathological diagnosis. The first phase analyzed retrospective data from 12-core prostate biopsies between January 2013 and 2018. In the second phase, from January 2018 to January 2022, in a prospective setting, patients with PSA > 75ng/dl underwent bone scans first. Those with positive bone scans underwent a 2-core biopsy. Cancer detection rate and complications were analyzed to validate the findings of the first phase. In the retrospective analysis, the number of positive cores in metastatic disease was 12 in 93 (73.8%), 11 in 14 (11.1%), and 10 in 7 (5.6%) patients. Using probability analysis, 94% of patients with metastasis could be detected with a single core and 97.8% with a 2-core biopsy. In the prospective analysis, 52 patients with PSA > 75 were enrolled. 3/52 (5.7%) patients had a negative bone scan. 49 were assigned for 2-core biopsy, out of which 48 (97.9%) had a positive result. One patient underwent a repeat 12-core biopsy. The prospective cohort's complications (p = 0.003) and pain score (p = 0.03) were lower compared to patients who underwent standard 12-core biopsies during phase one of the study period. A 2-core biopsy is adequate in almost all patients with metastatic prostate cancer with PSA > 75, and this avoids excess complications and morbidity associated with a systematic 12-core prostate biopsy.