Anterior Prostate Cancer Research Articles

Modified Retzius-sparing robot-assisted radical prostatectomy for cases with anterior tumor: a propensity score-matched analysis

ObjectiveTo compare the outcomes between a modified Retzius-sparing robot-assisted radical prostatectomy (mRS-RARP) technique and conventional robot-assisted radical prostatectomy (Con-RARP) technique for cases with anterior prostate cancer (PCa), especially positive surgical margin (PSM) rates and urinary continence (UC).Patients and methodsWe retrospectively included 193 mRS-RARP and 473 Con-RARP consecutively performed by a single surgeon for anterior PCa. Perioperative complications, pathology, and continence were compared after propensity score matching using 9 variables.ResultsAfter matching (n = 193 per group), PSM were not significantly different in the two groups (16.1% in mRS-RARP group vs. 15.0% in Con-RARP group, p = 0.779). The UC at catheter removal and at 1-month was significantly higher in the mRS-RARP (24.9% vs. 9.8%, p < 0.001; 29.0% vs. 13.5%, p < 0.001, respectively), but not at 3-, 6-, and 12-month follow-ups (p = 0.261, 0.832, and 0.683, respectively).ConclusionmRS-RARP seems to be an oncologically safe approach for patients with anterior PCa. Compared with the conventional approach, mRS-RARP approach shows benefits in the short-term postoperative UC recovery.

Low-Density Lipoprotein Cholesterol and Prostate Cancer: A Retrospective Study.

This work aimed to investigate the potential role of abnormal lipid metabolism in the development of prostate cancer (PCa). A retrospective study design was used. The clinical data of 520 patients who underwent rectal prostate biopsy in our hospital from January 2020 to June 2023 were analysed. The patients were enrolled and divided into the anterior PCa group including 112 patients and benign prostatic hyperplasia (BPH) group including 408 patients. Univariate and multivariate logistic regression analyses were performed for the two patient groups, and further comparisons were made according to the Gleason score and TNM staging. Low-density lipoprotein cholesterol (LDL-C) level may be an independent risk factor for PCa, and it was significantly associated with the risk of PCa (odds ratio (OR) = 1.363, p = 0.030). Patients with PCa were further divided into the low risk group and the high risk group according to the Gleason score. Univariate analysis (p = 0.047) and logistic regression analysis (OR = 2.249, p = 0.036) revealed that LDL-C was a significant factor influencing the Gleason score. Patients with PCa were categorised into four groups based on TNM staging. One-way analysis of variance (ANOVA) analysis (p = 0.015) and ordinal logistic regression analysis (OR = 2.414, p = 0.007) demonstrated that LDL-C was a significant factor influencing TNM staging. This study revealed the important role of LDL-C in the development of PCa, highlighting its influence as an independent risk factor. Thus, LDL-C may promote the proliferation and invasion of PCa cells.

Detection of anterior prostate cancer using a magnetic resonance imaging-transrectal ultrasound fusion biopsy in cases with initial biopsy and history of systematic biopsies

BackgroundProstate cancer in the anterior region may be missed on a transrectal systematic biopsy (SBx). Therefore, this study aimed to evaluate the performance of magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion targeted biopsy (TBx) in detecting anterior region cancer in patients with a history of SBxs. MethodsProstate biopsies were performed in 224 patients after multiparametric MRI, among whom 119 patients with prostate imaging reporting and data system (PI-RADS version 2) scores of 3 to 5 underwent MRI-TRUS fusion TBxs. Afterward, cancer detection rates (CDRs) and TBx-positive core regions were compared by categorizing patients into those with or without a history of SBxs. ResultsTotal CDR was 68.8% (44/64 cases) in the initial biopsy group (Initial-Bx group) and 47.3% (26/55 cases) in the previous-negative-systematic biopsy group (Pre-Neg-SBx group) (P = 0.018). Interestingly, both TBx- and SBx-core positive cases were more common in the Initial-Bx group than in the Pre-Neg-SBx group (Initial-Bx group: 75% [33/44 cases] vs. Pre-Neg-SBx group: 42.3% [11/26 cases], P = 0.006). However, only TBx-core positive cases were more common in the Pre-Neg-SBx group than in the Initial-Bx group (Initial-Bx group: 11.4% [5/44 cases] vs. Pre-Neg-SBx group: 30.8% [8/26 cases], P = 0.043). In addition, the proportion of anterior lesions detected by TBx cores was higher in the Pre-Neg-SBx group than in the Initial-Bx group (Initial-Bx group: 26.3% [10/38 cases] vs. Pre-Neg-SBx group: 52.6% [10/19 cases], P = 0.049). ConclusionUsing MRI-TRUS fusion TBx in the evaluation of previously negative SBx cases improved the detection rate of anterior lesions, which might have been missed in previous SBxs. Especially in patients with a history of SBxs mpMRI should be performed to screen for anterior lesions.

Racial differences in the utilization of MRI-guided biopsy before prostate cancer diagnosis.

5093 Background: Most low-risk prostate cancer (PCa) patients undergo active surveillance (AS). Compared with Whites, Blacks are more likely to opt for AS and suffer a higher risk of cancer progression while on AS. A primary concern of AS is the likelihood of missing clinically significant cancer. Transrectal ultrasound-guided biopsy is the most common method for diagnosing and grading PCa; however, this method often misses anterior PCa. Magnetic resonance imaging (MRI) allows clinicians to identify better and detect PCa; however, current guidelines on MRI-guided biopsy (MRI-GB) are inconsistent. This population-based study aimed to examine the utilization of MRI-GB 6 months before PCA diagnosis over time by race in the US. Methods: We used SEER-Medicare data to identify men diagnosed with PCa between January 1, 2012, to December 31, 2017, and excluded patients missing the date of diagnosis, being diagnosed at death, enrolled in HMO, or having no continuous A and B coverage six months before diagnosis. We used the CPT codes to identify prostate biopsy and MRI use. Multivariable logistic regression was used to evaluate racial disparity in MRI use six months before PCa. The model included covariates age, race, SEER region, marital status, state buy-in for Medicare (a poverty indicator), education, income, Charlson comorbidity index, and procedure (MRI) year. Results: Among 38,612 eligible men, MRI use six months before PCa diagnosis increased from 2012 to 2017 (3.2% to 24.3% among Whites, 1.8% to 14.2% among Blacks). Compared with Whites, Blacks were 38% less likely to receive pre-diagnosis MRI (OR=0.62, 95% CI 0.52-0.74). Besides race, having state buy-in for Medicare (OR=0.44; 95% CI 0.30-0.65) and geographic regions (Central vs. West OR=0.40; 95% CI 0.34-0.45) were strong predictors of lower utilization of MRI. Conclusions: The gap in the utilization of MRI may exacerbate racial disparities in PCa. Future studies are needed to identify potential barriers to adopting MRI for PCa workups.

Clinicopathologic Significance of Anterior Prostate Cancer: Comparison With Posterior Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging.

Anterior prostate cancer (APC) has been considered an indolent tumor, most commonly arising in the transition zone (TZ). More recently, detection of APC has been facilitated through multiparametric magnetic resonance imaging and improved biopsy techniques, enabling earlier detection. The pathologic features and clinical significance of pure APC in a large contemporary series of well-characterized tumors have, to date, not been elucidated. Cases with APC defined as cancer present anterior to the urethra only were identified from 1761 consecutive radical prostatectomy specimens accessioned between January 2015 and August 2016. The clinicopathologic features of these cases were compared with those of pure posterior prostate cancer (PPC) and the features of anterior peripheral zone (APZ) cancers were compared with those of TZ cancers. In addition, the tumor series from 2015 to 2016 was compared with a cohort of 1054 patients accessioned before the utilization of multiparametric magnetic resonance imaging in the routine workup of patients with prostate cancer. In the 2015-2016 series, there were 188 (10.7%) patients with APC compared with 5.4% in the series from the pre-multiparametric magnetic resonance imaging era. No difference was observed between APC and PPC with regards to patient age or mean serum prostate-specific antigen at presentation. Mean tumor volume and positive surgical margin (PSM) rates were significantly higher in APC. In contrast, PPC was more commonly high grade with more frequent extraprostatic extension (EPE). None of the cases of APC had infiltration of the seminal vesicle or lymph node involvement, in contrast to PPC, with almost 14% of cases in each category. The 3- and 5-year biochemical recurrence-free survival was significantly higher in APC when compared with PPC, although this was not retained on multivariable analysis which included tumor location. On division of APCs according to anatomic zone of origin, 45% were APZ cancer and 37% TZ cancer. On comparison of APZ and TZ cancers, there were no significant differences in mean age and serum prostate-specific antigen at presentation as well as tumor volume, Gleason score, and PSM rate. High-grade malignancy (Gleason score >3 + 4=7) was seen in 26% of TZ cancers which compared with 44% of APZ cancers and 56% of PPC cancers. The rate of EPE was significantly higher in APZ when compared with TZ cancer ( P< 0.0005); however, the biochemical recurrence rate was not significantly different between the groups. The prevalence of APC in radical prostatectomy specimens has increased in recent times, in association with earlier detection at a stage amenable to curative surgical treatment. APC, when compared with PPC, is less commonly high grade with less frequent EPE, despite the APC group having larger tumors and a higher PSM rate at presentation. However, not all anterior cancers are indolent. Anterior cancers are more commonly seen in the APZ than the TZ and APZ cancers appear more locally aggressive than TZ cancers.

Clinical outcomes of anterior prostate cancers treated with robotic assisted radical prostatectomy.

A prospective cohort study comparing peri- and postoperative outcomes for patients with predominantly anterior prostate cancer (APC) identified preoperatively against non-anterior prostate cancer (NAPC) treated via robotic-assisted radical prostatectomy (RARP). Of the 757 RARP's completed between January 2016 and April 2018, two comparative cohorts for anterior and an equivalent group of non-anterior prostate tumours each consisting of 152 patients were compared against each other. Data were collected on the following variables: patient age; operating consultant; preoperative PSA, ISUP grade, degree of nerve sparing; tumour staging; presence and location of positive surgical margins; PSA density, postoperative ISUP grade; treatment paradigm and postoperative PSA, erectile function, and continence outcomes with 2-year follow-up. APCs were found to have significantly lower ISUP grading postoperatively; increased diagnosis via active surveillance over new diagnosis; more frequently undertaken bilateral nerve-sparing and long-term poorer continence outcomes at 18 and 24 months postoperatively (p < 0.05). Pre- and post-op PSA levels, erectile function, PSA density, positive surgical margins (PSM), age and tumour staging showed no significant differences between the APC and NAPC cohorts (p > 0.05). The lower ISUP grading could indicate APC as overall being less aggressive than NAPC, whereas the poorer long-term continence outcomes require further investigating. The non-significant differences amongst tumour staging, PSA density, preoperative PSA levels and PSM rates suggest that APC may not be as significant as predicted in diagnostic evaluation. Overall, this study provides useful information on the growing literature of anterior prostate cancer. Being the largest comparative cohort study to date on APC post-RARP, these results indicate the true characteristics of anterior tumours and their functional outcomes to help improve education, patient expectations and management.

Feasibility of Robotic Partial Prostatectomy for Isolated Anterior Prostate Cancer

Feasibility of Robotic Partial Prostatectomy for Isolated Anterior Prostate Cancer

Impact of Zone of Origin in Anterior Dominant Prostate Cancer: Long-Term Biochemical Recurrence-Free Survival in an Anatomically Well-Characterized Cohort.

Our goal was to determine whether zonal origin of anterior dominant prostate cancers is associated with clinical outcome among patients treated with radical prostatectomy. We investigated the clinical outcomes of 197 patients with previously well-characterized anterior dominant prostatic tumors on radical prostatectomy. Univariable Cox proportional hazards models were used to test for an association between anterior peripheral zone (PZ) or transition zone (TZ) tumor location and clinical outcomes. Zonal origin of anterior dominant tumors: 97/197 (49%) anterior PZ, 70 (36%) TZ, 14 (7%) both zones and 16 (8%) indeterminate zone. Comparing anterior PZ and TZ tumors, there were no significant differences in Grade group, incidence of extraprostatic extension or surgical margin positivity rate. Overall, 19 (9.6%) patients experienced biochemical recurrence (BCR), including 10 with anterior PZ origin and 5 with TZ origin. Median followup time among those without BCR was 9.5 years (IQR 7.2, 12.7). BCR-free survival at 5 and 10 years was 91% and 89% for anterior PZ tumors, and 94% and 92% for TZ tumors, respectively. On univariate analysis, there was no evidence of a difference in time to BCR between anterior PZ and TZ tumor zone of origin (p=0.5). In this anatomically well-characterized cohort of anterior dominant prostate cancers, long-term BCR-free survival was not significantly associated with zone of origin. Future studies utilizing zone of origin as a parameter should consider separating anterior and posterior PZ localization, as outcomes may differ.

PD57-09 THE IMPORTANCE OF MRI-TARGETED BIOPSY FOR TUMORS IN ANTERIOR FIBROMUSCULAR STROMA

You have accessJournal of UrologyCME1 May 2022PD57-09 THE IMPORTANCE OF MRI-TARGETED BIOPSY FOR TUMORS IN ANTERIOR FIBROMUSCULAR STROMA Hayato Yamamoto, Teppei Okamoto, Toru Yoneyama, and Chikara Ohyama Hayato YamamotoHayato Yamamoto More articles by this author , Teppei OkamotoTeppei Okamoto More articles by this author , Toru YoneyamaToru Yoneyama More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002637.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior prostate cancers are frequently missed since they can be neither palpable nor tangible on physical examination. The objective of this study was to analyze the MRI/transrectal ultrasound-fusion biopsies to detect and to characterize significant prostate cancer in the anterior fibromuscular stroma (AFS) and in the transition zone of the prostate. METHODS: One hundred and fourteen patients underwent prebiopsy 3 T multi parametric (mp) MRI and transperineal biopsy between February 2019 and May 2021. MRI images were analyzed using PIRADS (Prostate Imaging-Reporting and Data System) ver 2. All patients had systematic biopsies and targeted biopsies with rigid software registration in case of MRI-suspicious lesions. RESULTS: The positive rates of systematic and targeted biopsies were 10% and 29%, respectively with a significant difference. The cancer occupancy rate of the biopsy specimens was higher in the targeted biopsy, 22.2% and 36.3%, respectively. There were AFS tumors in 23 of 114 patients, and they harbored 23 lesions (10%) in AFS on mpMRI. The positive rate of targeted biopsy by PI-RADs category was 77% for PI-RADs 5, 42% for PI-RADs 4, and 16% for PI-RADs 3. The positive rate by target region were 24%, 31%, and 83% for peripheral zone (PZ), transition zone (TZ), and AFS, respectively. Especially, in PIRADs category 3 region, the positive rate in AFS region was a high positivity rate of 100%. CONCLUSIONS: Targeted biopsy has improved cancer detection rates. However, we should also pay attention to lesions of low PIRADs category in the AFS region. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e964 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hayato Yamamoto More articles by this author Teppei Okamoto More articles by this author Toru Yoneyama More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement PDF DownloadLoading ...

Anterior or Posterior Prostate Cancer Tumor Nodule Location Predicts Likelihood of Certain Adverse Outcomes at Radical Prostatectomy.

Effect of tumor nodule (TN) location in the prostate on adverse radical prostatectomy (RP) outcomes is not well studied in contemporary cohorts. To investigate the significance of TN location with respect to extraprostatic extension (EPE), seminal vesicle invasion (SVI), and positive surgical margin (SM+) in 1388 RPs. Each TN at RP was independently graded, staged, and volumetrically assessed. TNs with at least 80% of their volume occupying either the anterior or posterior part of the prostate were categorized accordingly and included in our study, while all other TNs were excluded. A total of 3570 separate TNs (median = 3 per RP; range = 1-7 per RP) were scored. There were 1320 of 3570 (37%) anterior TNs and 2250 of 3570 (63%) posterior TNs. Posterior TNs were more likely to be higher grade, and exhibit EPE (18% versus 9.4%) and SVI (4% versus 0.15%), all P < .001. Anterior TNs with EPE were more likely to exhibit SM+ than posterior TNs with EPE (62% versus 30.8%, P < .001). TN location, grade, and volume were significant factors associated with adverse RP outcomes in our univariable analysis. When we controlled for grade and tumor volume in a multivariable analysis using anterior TN location as a reference, posterior TN location was an independent predictor of EPE and SVI and was less likely to be associated with SM+ (odds ratio = 3.1, 81.5, and 0.7, respectively). These associations may be useful in preoperative surgical planning, particularly with respect to improving radiographic analysis of prostate cancer.

MRI-guided Focal Treatment of Prostate Cancer.

HomeRadiology: Imaging CancerVol. 3, No. 5 PreviousNext Research HighlightsFree AccessMRI-guided Focal Treatment of Prostate CancerXiaoyang LiuXiaoyang LiuXiaoyang LiuPublished Online:Sep 17 2021https://doi.org/10.1148/rycan.2021219022MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: Phase II clinical trial of safety and oncologic outcome of focal treatment with high-intensity focused US (HIFU) under MRI guidance on intermediate-risk, clinically significant prostate cancer.■ Key Results: Ninety-three percent of patients (44 total) remained disease free at biopsy performed 5 months after treatment. No significant change was found in median erectile function score, although larger ablation volumes were associated with decreased erectile function.■ Impact: This study demonstrated the safety and favorable oncologic and functional outcomes of MRI-guided HIFU focal treatment for intermediate-risk prostate cancer. Future studies are needed with a larger cohort and better optimization of focal therapy treatment volumes.Whole-gland prostatectomy or radiation remains the standard of care for localized clinically significant prostate cancer. However, whole-gland therapies commonly are associated with multiple adverse effects, such as erectile dysfunction. Focal therapies, including HIFU and cryotherapy, may produce good outcomes with fewer side effects.This prospective phase II trial focused on men with unifocal, intermediate-risk, clinically significant prostate cancer visible at MRI. Forty-four patients underwent transrectal HIFU targeted at the tumor under MRI guidance to improve accuracy. MRI thermography was used to monitor the zone of treatment during the procedure.Follow-up at 5 months showed only one patient with a grade 3 adverse event, with no major procedure-related adverse event. Ninety-three percent of patients were disease free at biopsy performed 5 months after treatment. While no statistically significant drop in overall score of erectile function or International Prostate Symptom Score occurred after treatment, targeted volume larger than or equal to 15 cm3 correlated with decreased erectile function at 6 weeks. These encouraging results represent a significant step toward wider acceptance of focal therapy in prostate cancer. Future prospective studies with larger cohorts of patients and follow-up time will need to focus on optimizing treatment volume and/or margin to minimize adverse effects and prevent residual or recurrent disease.Highlighted ArticleGhai S, Finelli A, Corr K, et al. MRI-guided focused ultrasound ablation for localized intermediate-risk prostate cancer: early results of a phase II trial. Radiology 2021;298(3):695–703. [Published correction appears in Radiology 2021;299(2):E258]. doi: https://doi.org/10.1148/radiol.2021202717Highlighted Article1. Ghai S, Finelli A, Corr K, et al. MRI-guided focused ultrasound ablation for localized intermediate-risk prostate cancer: early results of a phase II trial. Radiology 2021;298(3):695–703.[Published correction appears in Radiology 2021;299(2):E258]. doi: https://doi.org/10.1148/radiol.2021202717 Link, Google ScholarArticle HistoryPublished online: Sept 17 2021 FiguresReferencesRelatedDetailsCited ByApplications of Focused Ultrasound in the Treatment of Genitourinary CancersJohnPanzone, TimothyByler, GennadyBratslavsky, HananGoldberg2022 | Cancers, Vol. 14, No. 6Recommended Articles Image-guided Irreversible Electroporation of Localized Prostate Cancer: Functional and Oncologic OutcomesRadiology2019Volume: 292Issue: 1pp. 250-257Focal Treatment of Prostate Cancer: MRI Helps Guide the Way ForwardRadiology2021Volume: 298Issue: 3pp. 704-706MRI-guided Focused Ultrasound Ablation for Localized Intermediate-Risk Prostate Cancer: Early Results of a Phase II TrialRadiology2021Volume: 298Issue: 3pp. 695-703Multiparametric MR Imaging of the Prostate after Treatment of Prostate CancerRadioGraphics2018Volume: 38Issue: 2pp. 437-449Focal Therapy for Prostate Cancer with In-Bore MR–guided Focused Ultrasound: Two-Year Follow-up of a Phase I Trial—Complications and Functional OutcomesRadiology2017Volume: 285Issue: 2pp. 620-628See More RSNA Education Exhibits MR Imaging of Prostate After Focal Therapy: What Is Normal and What Is Recurrence?Digital Posters2018Tools for "Superactive Surveillance" for Local Focal Ablation of Low Grade Prostate CancerDigital Posters2018Magnetic Resonance Imaging of the Prostate Before and After Focal TherapyDigital Posters2020 RSNA Case Collection Anterior transition zone prostate adenocarcinomaRSNA Case Collection2020Peripheral Zone Prostate Cancer with PseudocapsuleRSNA Case Collection2022Radioembolization of Liver Metastasis RSNA Case Collection2020 Vol. 3, No. 5 Metrics Altmetric Score PDF download

The Impact of Body Mass Index on Freedom From Therapeutic Intervention and Quality of Life in Active Surveillance Prostate Cancer Patients.

The objective of this study was to evaluate the impact of body mass index (BMI) on overall survival, freedom from distant metastases, rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients. Three hundred forty consecutive, prospectively evaluated AS patients underwent a staging transperineal template-guided mapping biopsy before AS enrollment and were stratified by BMI (<25, 25 to 29.9, 30 to 34.9, and >35 kg/m2). Evaluated outcomes included overall survival, freedom from distant metastases, TI, QOL to include urinary, bowel, sexual function and depression and serial postvoid residual urine measurements. The relationship between BMI and anterior prostate cancer distribution was evaluated. Repeat biopsy was based on prostate specific antigen kinetics, abnormal digital rectal examination and patient preference. Of the 340 patients, 323 (95%) were Gleason 3+3 and 17 patients (5.0%) were Gleason 3+4. The median follow-up was 5.2 years (range: 1 to 14 y). At 10 years, TI was instituted in 4.7%, 2.2%, 9.5%, and 25.0% of patients in BMI cohorts <25, 25 to 29.9, 30 to 34.9, and ≥35 (P=0.075). No patient has developed distant metastases. The median time to TI was 4.86 years. In multivariate analysis, TI was most closely predicted by prostate specific antigen density (P=0.071). At 8 years, no statistical differences in urinary function, bowel function, depression or postvoid residual were noted. However, a trend for erectile dysfunction was identified (P=0.106). At 10 years, BMI did not statistically predict for TI, geographic distribution of prostate cancer or QOL parameters.

V59 - Transperineal Targeted Microwave Ablation (TMA) of anterior midline prostate cancer using minigrid and Organ Based Tracking (OBT)

V59 - Transperineal Targeted Microwave Ablation (TMA) of anterior midline prostate cancer using minigrid and Organ Based Tracking (OBT)

The Added Value of Dynamic Contrast-enhanced Sequences in Prostate MRI.

HomeRadiology: Imaging CancerVol. 2, No. 5 PreviousNext Research HighlightsFree AccessThe Added Value of Dynamic Contrast-enhanced Sequences in Prostate MRISamuel J Withey, Ashik AmlaniSamuel J Withey, Ashik AmlaniSamuel J WitheyAshik AmlaniPublished Online:Sep 25 2020https://doi.org/10.1148/rycan.2020209031MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: To assess the additional value of dynamic contrast-enhanced (DCE) sequences above T2-weighted and diffusion-weighted imaging (DWI) at MRI for suspected prostate cancer.■ Key Result: Addition of DCE to T2-weighted and DWI did not improve diagnostic accuracy.■ Impact: Noncontrast biparametric prostate MRI appears to be an acceptable alternative to multiparametric MRI in assessment of suspected prostate cancer.Prostate MRI has become an established test in assessing patients suspected of having prostate cancer and is performed prior to biopsy. Imaging allows biopsy to be targeted to areas of concern and safely avoided in patients with a low probability of clinically significant cancer. However, the use of contrast agent, while recommended in Prostate Imaging Reporting and Data System (PI-RADS) v2.1, remains contentious. If MRI could be performed without contrast agent without it having a substantial impact on diagnostic performance, it would lead to quicker, cheaper, and safer imaging.El-Shater Bosaily and colleagues compared the performance of biparametric MRI (T2-weighted and DWI) with multiparametric MRI (T2-weighted, DWI, and DCE) using systematic prostate biopsies as the ground truth. This was a large, multicenter, prospective study including 497 biopsy-naive men referred for investigation of suspected prostate cancer. Patients underwent prostate MRI with a 1.5-T system using a pelvic phased-array coil. Radiology assessment was on the likelihood of clinically significant prostate cancer being present. The prostate was divided into 12 segments, each of which was scored using a five-point Likert scale. Scores were assigned to the following imaging groups: (a) T2-weighted alone, (b) T2-weighted with DWI, and (c) T2-weighted, DWI, and DCE, with no retrospective revisions allowed. Overall Likert score was based on the highest segment score given. A limitation of the study was that MRI examinations received only a single read at their local center by radiologists of varying experience. While the radiologists were blinded to the histopathologic results, they had knowledge of the serum prostate specific antigen level, which could inflate the performance of MRI.A major strength of this work was the robust reference standard, with transperineal mapping biopsies performed at 5-mm intervals in all patients. Two pathologic definitions for clinically significant cancer were used: (a) Gleason score of greater than or equal to 4 + 3 or greater than or equal to 6-mm maximum length of any grade, and a lower threshold and (b) Gleason score of greater than or equal to 3 + 4 or greater than or equal to 4-mm maximum length of any grade.For both pathologic criteria, there was no significant difference in sensitivity, specificity, positive predictive value, or negative predictive value when using biparametric MRI versus multiparametric MRI. All (n = 53) dominant Gleason pattern 4 lesions were identified (scored Likert ≥3) with multiparametric MRI compared with 98.1% (52 of 53) without use of DCE. There were fewer Likert 3 reports using multiparametric MRI compared with biparametric MRI (28% and 32%, respectively), indicating that there can be a role for DCE, particularly in more equivocal cases.This well-designed study encourages us to question the necessity of performing DCE sequences as part of standard prostate MRI. Further work is required to determine if similar results will be seen when using PI-RADS v2.1, as one would expect.Highlighted ArticleEl-Shater Bosaily A, Frangou E, Ahmed HU, et al. Additional value of dynamic contrast-enhanced sequences in multiparametric prostate magnetic resonance imaging: data from the PROMIS study. Eur Urol 2020;78(4):503–513. doi: https://doi.org/10.1016/j.eururo.2020.03.002Highlighted ArticleEl-Shater Bosaily A, Frangou E, Ahmed HU, et al. Additional value of dynamic contrast-enhanced sequences in multiparametric prostate magnetic resonance imaging: data from the PROMIS study. Eur Urol 2020;78(4):503–513. doi: https://doi.org/10.1016/j.eururo.2020.03.002 Crossref, Medline, Google ScholarArticle HistoryPublished online: Sept 25 2020 FiguresReferencesRelatedDetailsRecommended Articles The Current State of MR Imaging–targeted Biopsy Techniques for Detection of Prostate CancerRadiology2017Volume: 285Issue: 2pp. 343-356Abbreviated Biparametric Prostate MR Imaging in Men with Elevated Prostate-specific AntigenRadiology2017Volume: 285Issue: 2pp. 493-505Cost-effectiveness of MR Imaging–guided Strategies for Detection of Prostate Cancer in Biopsy-Naive MenRadiology2017Volume: 285Issue: 1pp. 157-166Focal Therapy for Prostate Cancer with In-Bore MR–guided Focused Ultrasound: Two-Year Follow-up of a Phase I Trial—Complications and Functional OutcomesRadiology2017Volume: 285Issue: 2pp. 620-628Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant CancersRadiology2016Volume: 280Issue: 1pp. 108-116See More RSNA Education Exhibits When There is No Rectum: CT-Guided Targeted and Sextant Prostate Biopsy Digital Posters2019Everything a Radiologist Should Know About European Prostate Cancer Guidelines: A Multimodal ReviewDigital Posters2020Clinical Implementation of MRI-Ultrasound Fusion-Guided Prostate Biopsy in the Management of Prostate Cancer: What Radiologists Should KnowDigital Posters2019 RSNA Case Collection Anterior transition zone prostate adenocarcinomaRSNA Case Collection2020Peripheral Zone Prostate Cancer with PseudocapsuleRSNA Case Collection2022Locally advanced, metastatic prostate adenocarcinomaRSNA Case Collection2020 Vol. 2, No. 5 Metrics Altmetric Score PDF download

Focal HIFU therapy for anterior compared to posterior prostate cancer lesions

ObjectiveTo compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach.Materials and methodsIn a prospectively maintained national database, 598 patients underwent focal HIFU (Sonablate®500) (March/2007–November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing in the first year with PSA, every 6–12 months with mpMRI with biopsy for MRI-suspicion of recurrence. Treatment failure was any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), tumour recurrence with Gleason ≥ 3 + 4 on prostate biopsy without further treatment or metastases/prostate cancer-related mortality. Cases with anterior cancer were compared to those with posterior disease.Results267 patients were analysed following eligibility criteria. 45 had an anterior focal-HIFU and 222 had a posterior focal-HIFU. Median age was 64 years and 66 years, respectively, with similar PSA level of 7.5 ng/ml and 6.92 ng/ml. 84% and 82%, respectively, had Gleason 3 + 4, 16% in both groups had Gleason 4 + 3, 0% and 2% had Gleason 4 + 4. Prostate volume was similar (33 ml vs. 36 ml, p = 0.315); median number of positive cores in biopsies was different in anterior and posterior tumours (7 vs. 5, p = 0.009), while medium cancer core length, and maximal cancer percentage of core were comparable. 17/45 (37.8%) anterior focal-HIFU patients compared to 45/222 (20.3%) posterior focal-HIFU patients required further treatment (p = 0.019).ConclusionTreating anterior prostate cancer lesions with focal HIFU may be less effective compared to posterior tumours.

Anterior gland focal cryoablation: proof-of-concept primary prostate cancer treatment in select men with localized anterior cancers detected by multi-parametric magnetic resonance imaging

BackgroundDue to their location away from the nerve bundles, anterior prostate cancers (APC) represent a rational target for image-guided cryoablation. This report describes the feasibility and short-term outcomes of anterior focal cryosurgery.MethodsA retrospective review between 2012 and 2016 of patients with clinically localized APC treated with anterior gland cryoablation was performed. Descriptive statistics were used to report: age, PSA, prostate volume, prostate cancer grade group (PGG), median time to follow-up, and changes in functional status measured with the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) score.ResultsA total of 17 patients underwent anterior focal cryoablation with a median follow-up of 15 months. Median age and PSA at diagnosis were 67 years and 8.7 ng/mL. Pre-operative PGG1 was identified in 12 (71%) men and PGG2 in 5 (29%) men. Median (IQR) lesion volume was 2 mL(0.86, 3.1). Preoperative median IIEF-5 and IPSS scores were 19.5 and 5, and decreased to 19 and 4, post-operatively. All patients remained continent with no change in sexual function. All post-procedure targeted biopsies of the treated cancers were negative.ConclusionOur pilot study demonstrates the feasibility of treating APCs with image-guided targeted focal cryoablation as a good balance between short-term oncologic control and near complete preservation of genitourinary function. Further follow-up is necessary to examine the potential benefits long-term.

Comparative study of freehand and template-guided transperineal prostate biopsy in the detection rate of prostate cancer

Objective This retrospective study compared the detection rates of prostate cancer between freehand transperineal biopsy(FTPB) and template-guided transperineal biopsy(TTPB) in the patients with PSA levels<20 ng/ml. Methods From April 2017 to April 2019, 768 patients with PSA levels <20 ng/ml were included into this study. Of these patients, 406 underwent FTPB procedures and 362 underwent TTPB procedures. There were no significant differences of median age [66.00(61.00, 70.00)vs. 66.00(61.00, 71.25)years], height [170.00(165.00, 172.00)vs. 170(165.00, 173.00)cm], weight [70.00(63.88, 75.00)vs. 70.00(63.75, 75.00)kg], BMI [24.22(22.22, 25.95)vs. 24.22(22.49, 25.82)kg/m2], PSA [8.75(6.49, 12.40)vs. 8.69(6.49, 11.96)ng/ml], fPSA [1.18(0.33, 2.15)vs. 1.15(0.76, 1.88)ng/ml], prostate volume [39.79(25.55, 53.94)vs. 39.88(24.46, 55.11)ml] between two groups. Patients’ biopsy results were recorded, the differences of prostate cancer detection rates between these two groups were analyzed, specifically including the cancer with Gleason score≥7 and the anterior zone cancer. Results The total prostate cancer detection rates were 33.7%(137/406) and 39.0%(141/362, P=0.134) in FTPB group and TTPB group respectively, and the detection rates of cancer with Gleason score≥7 were 23.9%(97/406) and 32.0%(116/362, P=0.012) respectively. The detection rates of anterior zone prostate cancer were 15.5% (63/406) and 27.3% (99/362, P<0.001). Moreover, in the patients with PSA <10 ng/ml, the prostate cancer detection rates were 29.8%(74/248) and 36.2%(81/224, P=0.144) respectively, while the detection rates of cancer with Gleason score≥7 were 19.4%(48/248) and 29.9%(67/224, P=0.008) respectively. Conclusions There was no significant difference in the total prostate cancer detection rates between 12-core TTPB group and 20-core FTPB group in the patients with PSA <20 ng/ml, but for the detection rate of cancer with Gleason score≥7, TTPB group was significantly higher than FTPB group, especially in the patients with PSA<10 ng/ml. In addition, for anterior zone prostate cancer, the detection rate of TTPB group was also higher than FTPB group. Key words: Prostatic neoplasms; Diagnosis; Freehand biopsy; Template-guided biopsy; Transperineal

Prediction of extraprostatic extension on multi-parametric magnetic resonance imaging in patients with anterior prostate cancer

To validate how established markers of extraprostatic extension (EPE) are applied to anterior prostate cancers (APCs), and to investigate other novel markers if available. Among 614 histopathologically confirmed APCs from 2011 to 2016, 221 lesions with PiRADS (verion 2) scores ≥4 on 3-T multi-parametric MRI were analyzed retrospectively. Two radiologists independently assessed capsular morphology qualitatively with 5-point scale (normal, thinning, bulging, loss, extracapsular disease), and capsule contact length (arc), tumor dimension, and their ratio (arc-dimension ratio) quantitatively. Reproducibility in measurement was assessed with κ and intra-class correlation coefficients (ICCs). Logistic regression analysis was done to find meaningful indicators of EPE. Diagnostic performance of markers was compared to one another with generalized linear model and multi-reader multi-case ROC analysis. Reproducibility was moderate to substantial (κ 0.45-0.73) for qualitative, and moderate to almost perfect (ICC 0.50-0.87) for quantitative features of EPE. Capsular morphology (odds ratio [OR] 1.818), capsule contact length (OR 1.115), tumor dimension (OR 1.035), and arc-dimension ratio (OR 1.846) were independently associated with EPE (p≤0.019). Capsular bulging and capsule contact length of 10mm as thresholds of EPE demonstrated sensitivity/specificity of 0.58/0.85 and 0.77/0.68, respectively. Capsule contact length yielded greatest AUC (0.784), followed by capsular morphology (0.778), arc-dimension ratio (0.749), and tumor dimension (0.741). Diagnostic performance of capsular morphology, capsule contact length, and arc-dimension ratio was comparable in predicting EPE. Existing markers of EPE applicable regardless of locations of tumors apply similarly to APCs. Arc-dimension ratio may be a novel marker of EPE of APCs. • Existing imaging markers of extraprostatic extension (EPE) which have been applied regardless of locations of tumors are reflected similarly to anterior prostate cancers (APCs). • Measuring tumor dimension without capsular assessment may result in insufficient pre-operative prediction of EPE of APCs. • Arc-dimension ratio (capsule contact length divided by tumor dimension) exhibited highest OR and comparable performance to existing features in predicting EPE of APCs.

Robot-assisted transvesical partial prostatectomy using a purpose-built single-port robotic system.

To evaluate the feasibility of robot-assisted single-port (SP) transvesical partial prostatectomy (TVPP) using a novel purpose-built SP surgical platform in a pre-clinical model. The cadavers were placed in the lithotomy position. A 3-cm midline incision was made in the suprapubic area 4-cm from the symphisis pubis. After opening the Retzius space, an access mini device (GelPOINT; Applied Medical, Rancho Margarita, CA, USA) was introduced percutaneously directly into the bladder. The da Vinci SP1098 robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was docked to the GelPOINT by inserting a novel SP cannula through the GelSeal Cap. The surgical steps for en bloc anterior prostatectomy were performed in the following order: (i) antegrade dissection of the transition zone at the bladder neck; (ii) lateral excision of the peripheral zone; and (iii) urethrovesical anastomosis. Primary outcomes, such as intra-operative complications, rate of conversion to standard techniques and operating times, were recorded. The SP-TVPP procedure was technically completed in three male cadavers. All cases were completed successfully using the da Vinci SP1098 surgical system without conversion or the need for additional ports. There were no intra-operative complications. The mean total operating time was 49.3 min. Robot-assisted TVPP is feasible using a novel purpose-built SP surgical platform in a cadaver model. Future clinical evaluation in humans is needed for assessment on patients with anterior localized prostate cancer. Prospective comparison with other surgical platforms and standard techniques is warranted.

V08-09 ROBOTIC TRANSVESICAL PARTIAL PROSTATECTOMY USING A PURPOSE-BUILT SINGLE PORT ROBOTIC SYSTEM

You have accessJournal of UrologyProstate & Renal Oncology II1 Apr 2018V08-09 ROBOTIC TRANSVESICAL PARTIAL PROSTATECTOMY USING A PURPOSE-BUILT SINGLE PORT ROBOTIC SYSTEM Jihad Kaouk, Daniel Sagalovich, and Juan Garisto Jihad KaoukJihad Kaouk More articles by this author , Daniel SagalovichDaniel Sagalovich More articles by this author , and Juan GaristoJuan Garisto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1975AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial prostatectomy has been proposed as an alternative treatment for energy-based ablation of localized prostate cancer. The objective of our study was to evaluate the feasibility of a single port transvesical robotic approach for partial prostatectomy (SP-TVPP) using a novel purpose-built single port surgical platform in a pre-clinical model. METHODS The cadavers were placed in a lithotomy position. A 3-cm midline incision was made in the suprapubic area 4-cm from the symphisis pubis. After opening the Retzius space, a single-port mini device (GelPOINT, Rancho Margarita, California, USA) was introduced percutaneously directly into the bladder. The da Vinci SP1098 robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was docked to the GelPOINT by inserting a novel single port cannula through the GelSeal Cap. The surgical steps for en bloc anterior prostatectomy were performed in the following order: 1) Retrograde dissection of transition zone at the bladder neck; 2) lateral excision of the peripheral zone; 3) urethrovesical anastomosis. Primary outcomes such as intraoperative complications, rate of conversion to standard techniques and operative times were recorded. RESULTS SP-TVPP was technically completed in three male cadavers. All cases were completed successfully using the da Vinci SP1098 surgical system without conversion or the need for additional ports. There were no intraoperative complications. The mean total operative time was 49.3 min. Step-specific times are listed in Table 1. CONCLUSIONS Transvesical robotic partial prostatectomy is feasible using a novel purpose-built single port surgical platform in a cadaver model. Future clinical evaluation in humans is needed for assessement on patients with anterior localized prostate cancer. Prospective comparison with other surgical platforms and standard techniques are warranted. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e822 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jihad Kaouk More articles by this author Daniel Sagalovich More articles by this author Juan Garisto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...