PCa Detection Rate Research Articles

Diagnostic performance of MRI/TRUS fusion-guided biopsies vs. systematic prostate biopsies in biopsy-naïve, previous negative biopsy patients and men undergoing active surveillance.

We aimed to assess the detection rate of overall PCa and csPCa, and the clinical impact of MRI/TRUS fusion targeted biopsy (FUSION-TB) compared to TRUS guided systematic biopsy (SB) in patients with different biopsy settings. Three hundred and five patients were submitted to FUSION-TB, divided into three groups: biopsy naïve patients, previous negative biopsies and patients under active surveillance (AS). All patients had a single suspicious index lesion at mpMRI. Within these groups, we enrolled men underwent both to FUSION-TB and SB in the same session. Overall detection rate of PCa and csPCa for the two biopsy methods were compared separately between the three groups of patients. No differences were observed between the three groups concerning clinical and radiological characteristics. We found no differences in terms of overall PCa detection (66% vs. 63.8%, P=0.617) and csPCa detection (56.4% vs. 51.1%; P=0.225) concerning biopsy naïve patients. In patients previously submitted to a negative biopsy, FUSION-TB showed higher detection rate of csPCa compared to SB alone (41,3% vs. 27% respectively, P=0.038). In patients under AS, no differences were observed between FUSION-TB and SB in terms of overall PCa (50% vs. 73.1%) and csPCa (30.8% vs. 26.9%, respectively; P=0.705) detection. Our results suggest that in men with previously negative biopsy, FUSION-TB showed significantly higher diagnostic performance for clinically significant PCa as compared to SB. Combination of FUSION-TB and SB should be recommended in AS population to offer higher chance of csPCa diagnosis.

The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy.

BackgroundThis study aimed to estimate whether multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion biopsy (FUS-TB) increases the detection rates of clinically significant prostate cancer (csPCa) compared with TRUS-guided systematic biopsy (TRUS-GB).MethodsThis retrospective study focused on patients who underwent mpMRI before prostate biopsy (PB) with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scores ≥3 and prostate-specific antigen (PSA) level between 2.5 and 20 ng/mL. Before FUS-TB, the biopsy needle position was checked virtually using three-dimensional mapping. After confirming the position of the target within the prostate, biopsy needle was inserted and PB was performed. Suspicious lesions were generally targeted with 2 to 4 cores. Subsequently, 10–12 cores were biopsied for TRUS-GB. The primary endpoint was the PCa detection rate (PCDR) for patients with PCa who underwent combined FUS-TB and TRUS-GB.ResultsAccording to PI-RADS v2, 76.7% of the patients with PI-RADS v2 score ≥3 were diagnosed with PCa. The PCDRs in patients with PI-RADS v2 score of 4 or 5 were significantly higher than those in patients with PI-RADS v2 score of 3 (3 vs. 4, P<0.001; 3 vs. 5, P<0.001; 4 vs. 5, P=0.073). According to PCDR, the detection rates of PCa and csPCa in the FUS-TB were significantly higher than that in the TRUS-GB.ConclusionsFollowing detection of suspicious tumor lesions on mpMRI, FUS-TB use detects a higher number of PCa cases compared with TRUS-GB.

Comparison of MRI, PET, and 18F-choline PET/MRI in patients with oligometastatic recurrent prostate cancer

ObjectivesThe aims of the study were (i) to examine the PCa detection rate of 18F-choline (FCH) PET/MRI and (ii) to assess the impact of PET/MRI findings in patients with PCa who develop OMD using PSA response as a biomarker.MethodsWe retrospectively analyzed a cohort of 103 patients undergoing FCH PET/MRI for biochemical recurrence of PCa. The inclusion criteria were (1) previous radical prostatectomy (RP) with or without adjuvant radiotherapy (RT); (2) PSA levels available at the time of PET; (3) OMD, defined as a maximum of 5 lesions on PET/MRI; and (4) follow-up data available for at least 6 months after PET. All images were reviewed by two nuclear medicine physicians and interpreted with the support of two radiologists.ResultsSeventy patients were eligible for the study: 52 patients had a positive FCH PET/MRI and 18 had a negative scan. The overall PCa detection rates for MRI, PET, and PET/MRI were 65.7%, 37.1%, and 74.3%, respectively. Thirty-five patients were treated with radiotherapy (RT), 16 received hormonal therapy (HT), 3 had a combined therapy (RT + HT), and 16 (23%) underwent PSA surveillance. At follow-up, PSA levels decreased in 51 patients (73%), most of whom had been treated with RT or RT + HT. Therapeutic management was guided by PET/MRI in 74% of patients, which performed better than MRI alone (68% of patients).ConclusionFCH PET/MRI has a higher detection rate than MRI or PET alone for PCa patients with OMD and PSA levels > 0.5 ng/mL, prompting a better choice of treatment.

In-bore MRI-guided prostate biopsy in a patient group with PI-RADS 4 and 5 targets: A single center experience

PurposeTo determine the diagnostic yield of magnetic resonance imaging (MRI) guided in-bore biopsy in patients with high likelihood multiparametric MRI (mpMRI) findings, regarding overall and clinically significant prostate cancer (csPCa) detection rates and concordance of biopsy and radical prostatectomy (RP) Gleason scores (GS). MethodsThis retrospective study consisted of 277 Prostate Imaging Reporting and Data System (PI-RADS) assessment category 4 and 5 targets in 246 patients (mean age, 65.7 years; median prostate specific antigen value, 7.75 ng/mL) who had undergone in-bore biopsy at our institution between 2012 and 2020. Eighty-one patients who underwent RP were eligible for the concordance analysis of biopsy and RP specimen GS. ResultsOverall PCa detection rates were 80.5 % per patient (198/246) and 78 % per target (216/277) and 83.5 % and 67.4 % in primary (biopsy naive) and secondary (at least one negative prior biopsy) settings. csPCa was found in 63 % overall, 66 % of patients (132/200) in the primary, and 50 % of patients (23/46) in the secondary biopsy settings (p < 0.001). The prostate cancer detection rate was 68 % and 92 % in PI-RADS 4 and 5, respectively (p < 0.001).In the radical prostatectomy subcohort, 27.2 % of patients were upgraded, 8.6 % of patients were downgraded from needle biopsy. Significant complications occurred in 1.2 % of patients. ConclusionsMRI-guided in-bore prostate biopsy has a high detection rate of csPCa in primary and secondary biopsy cohorts. Biopsy results were satisfactory in terms of the number of positive cores, cancer percentage in positive cores, and concordance of GS in needle biopsy and RP specimen.

Systematic Biopsy of the Prostate can Be Omitted in Men with PI-RADS™ 5 and Prostate Specific Antigen Density Greater than 15.

We evaluated the prostate cancer and clinically significant prostate cancer detection on systematic biopsy (SB), target biopsy (TB) alone and combined SB and TB in men with Prostate Imaging Reporting and Data System™ (PI-RADS™) 5 lesion. From a prospectively maintained prostate biopsy database, we identified consecutive patients with PI-RADS 5 lesion on multiparametric magnetic resonance imaging. The patients underwent multiparametric magnetic resonance imaging followed by transrectal TB of PI-RADS 5 lesion and 12-core SB. The prostate cancer and clinically significant prostate cancer (Grade Group, GG ≥2) detection on SB, TB and SB+TB were determined for all men and accordingly to prostate specific antigen density. Statistic significant was set a p <0.05. Overall, 112 patients met inclusion criteria. The detection rate of prostate cancer for SB, TB and SB+TB was 89%, 93% and 95%, respectively, and for clinically significant prostate cancer it was 72%, 81% and 85%, respectively. SB added 2% prostate cancer and 4% clinically significant prostate cancer detection to TB. A total of 78 patients had prostate specific antigen density >0.15 ng/ml2, and the detection rate of PCa for SB, TB and SB+TB was 92%, 97% and 97%, respectively, and for clinically significant prostate cancer it was 79%, 91% and 95%, respectively. In this population, if SB was omitted, 0 prostate cancer and only 4% (3) of clinically significant prostate cancer would be missed. The clinically significant prostate cancer detection rate improved with increased prostate specific antigen density for SB (p=0.01), TB (p <0.0001) and combined SB+TB (p=0.002). In patients with PI-RADS 5 on multiparametric magnetic resonance imaging and prostate specific antigen density >0.15 ng/ml2, SB marginally increases clinically significant prostate cancer detection, but not overall prostate cancer detection in comparison to TB alone. Systematic biopsy did not affect patients' management and can be omitted on this population.

Multicenter transperineal MRI-TRUS fusion guided outpatient clinic prostate biopsies under local anesthesia

IntroductionTransperineal Prostate biopsies (TPBx) are usually performed under general anesthesia without image fusion. This study aimed to evaluate prostate cancer (Pca) detection rates (CDR), pain, and adverse events using a novel, free-hand TPBx technique, based on elastic fusion of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) under local anesthesia. Materials and methodsThis multicenter retrospective study included all consecutive patients scheduled for a TPBx. All had clinical suspicion of Pca, active surveillance scheduled for a re-biopsy, or suspicion of local recurrence after previous treatment. Bi-parametric or multiparametric MRI was performed in all patients and classified as positive in the case of Prostate Imaging-Reporting and Data System (PIRADS) suspicion ≥3. At least 1 targeted TPBx was realized from each PIRADS ≥3 index lesion. Six to 12 systematic random TPBx were done in patients with negative MRI. All biopsies were performed under local anesthesia in an outpatient clinic with MRI-TRUS fusion and the 3D navigation system Trinity Perine (Koelis, France). Any- and clinically significant Pca (csPca) (ISUP gr. ≥2) was recorded. Biopsy-related pain and adverse events were reported according to a visual analogue score of 0–10. ResultsIn total, 377 patients were included for analyses. The mean age was 67 years (95% Confidence Interval: 66–68) and the median prostate-specific antigen was 7.2 ng/ml (interquartile range [IQR] 4.8–11.0). MRI was negative in 6% and positive in 94%. The median MRI prostate volume was 43 ml (IQR 31–60) and the median MRI index tumor volume was 0.9 ml (IQR 0.5–2.1). The median number of TPBx was 4 (IQR 3–4). The overall detection of any- and csPca was 64% and 52%, respectively. The overall CDR according to PIRADS 3, 4, and 5 was 30%, 70%, and 94%, respectively. In patients with negative MRI, any- and csPca was detected in 23% and 9%, respectively. The median visual analogue score score was 2 (IQR 1–3, range 0–7). Two patients (0.5%) developed postbiopsy infection, of which one developed urosepsis. Treatment requiring haematuria or urinary retention did not occur. ConclusionFree-hand MRI/TRUS fusion-guided and systematic random TPBx in LA is a feasible, safe, and well-tolerated technique for diagnosing Pca.

Efficacy of 3T Multiparametric MR Imaging followed by 3T in-Bore MR-Guided Biopsy for Detection of Clinically Significant Prostate Cancer Based on PIRADSv2.1 Score

PurposeTo evaluate the diagnostic yield of 3T in-Bore magnetic resonance-guided biopsy (3T IB-MRGB) for detection of clinically significant prostate cancer (csPCa), based on assessment using the Prostate Imaging Reporting and Data System version 2.1 (PIRADSv2.1). Materials and MethodsThis single-center study examined individuals who underwent 3T multiparametric prostate magnetic resonance (MR) imaging and subsequent 3T IB-MRGB. The final study cohort included 379 men (with 475 targets) divided into 3 subcohorts: biopsy-naïve men (n = 123), individuals with a history of negative trans-rectal-ultrasonography (TRUS) biopsy results (n = 106), and men with low-grade PCa under active surveillance (n = 150). csPCa was defined as having a Gleason score (GS) ≥3+4. Results3T IB-MRGB detected PCa and csPCa in 69.1% (262 of 379) and 50.3% (193 of 379) of patients, respectively. The PCa and csPCa detection rates per target were 64.2% (305 of 475) and 43.8% (208 of 475), respectively. The rate of urosepsis, treated with intravenous antibiotics, was 1% (4 patients). In TRUS biopsy negative results and biopsy-naïve subcohorts, csPCa was found in 36.8% (39 of 106) and 52.8% (65 of 123), respectively. In 50.7% (76 of 150) of the active surveillance subcohort, 3T IB-MRGB upgraded the GS assigned in prior TRUS biopsies. Positive predictive values of PIRADSv2.1 categories 3, 4, and 5 for csPCa detection were 24.8%, 44.4%, and 67.1%, respectively. Higher PIRADSv2.1 categories were significantly associated with PCa (odds ratio [OR], 3.97; 95% confidence interval [CI], 2.98–5.28) and csPCa (OR, 1.41; 95% CI, 1.03–1.94) detection. Of 137 PIRADSv2 category 3 lesions, 28 were downgraded to PIRADSv2.1 category 2, in which there were no occurrences of csPCa in histology. ConclusionsUse of 3T IB-MRGB resulted in detection of csPCa in 50.9% of individuals. 3T IB-MRGB has a high diagnostic yield in individuals with negative TRUS biopsy results and those under active surveillance. The PIRADSv2.1 category is a strong predictor of PCa and csPCa detection.

Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

To evaluate the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI), alone or combined with Prostate-Specific Antigen density (PSAd) to exclude clinically significant prostate cancer (csPCa). We performed a retrospective chart review of all the patients who had transrectal ultrasound-guided biopsy (TRUSGB) in our center between January 2014 and March 2019. We included patients who had nonsuspicious prebiopsy mpMRI defined as Prostate Imaging-Reporting and Data System (PI-RADS) ≤ 2. MRI was performed using a 1.5 or 3-Tesla Magnetic Resonance scanners with external phased-array coil. The primary outcome was the detection of csPCa, defined as a Gleason score 3+4 (ISUP 2) or higher on at least one biopsy core. One hundred and ninety-one consecutive men (median age: 65 years, median PSA level: 9.3 ng/mL) underwent TRUSGB following negative prebiopsy mpMRI corresponding to 126 (66%) biopsy-naïve patients, 36 (18.8%) patients with prior negative biopsy, and 29 (15.2%) patients under active surveillance with confirmatory biopsies. The overall PCa and csPCA detection rates were 26.7% and 5.2%, conferring a NPV of 73.3% and 94.8%, respectively. The NPV of negative mpMRI improved to 95.8% in patients with PSAd < 0.15 ng/mL/cm3 and to 100% in patients with PSAd < 0.10 ng/mL/cm3. A negative prebiopsy mpMRI had an overall NPV of 94.8% for csPCa when mpMRI was used alone to 95.8% when combined with PSAd < 0.15 ng/mL/cm3. Future studies are needed to balance the low benefit of a biopsy in this indication with the morbidity of the procedure.

68Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study

Purpose68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is valuable for detecting primary and recurrent prostatic lesions. This study aimed to evaluate the efficacy of 68Ga-PSMA-11 PET/CT as a triage tool for prostate biopsy (PSMA-TB) and compare with transrectal ultrasound-guided biopsy (TRUS-GB) for the diagnosis of clinically significant prostate cancer (csPCa).MethodsThis single-centre study randomly allocated 120 patients with elevated serum prostate-specific antigen (PSA) levels (> 4 ng/ml) to PSMA-PET or TRUS group. Patients with PSMA-avid lesions (SUVmax ≥ 8.0) underwent PSMA-TB via a single-puncture percutaneous transgluteal approach (n = 25), whilst patients with negative PSMA-PET underwent systematic TRUS-GB (n = 35). All patients in the TRUS group underwent TRUS-GB directly (n = 60).ResultsPCa and csPCa were detected in 26/60 (43.3%) and 24/60 (40.0%) patients in the PSMA-PET group and 19/60 (31.6%) and 15/60 (25.0%) in the TRUS group, respectively. In the PSMA-PET group, the detection rate of PCa and csPCa were significantly higher in PSMA-PET-positive than negative patients (PCa, 23/25 (92.0%) vs 3/35 (8.6%), P < 0.01; csPCa, 22/25 (88.0%) vs 2/35 (5.7%), P < 0.01). PSMA-TB detected significantly more PCa and csPCa than TRUS-GB in the TRUS controls (PCa, 21/25 (84.0%) vs 19/60 (31.6%), P < 0.01; csPCa, 20/25 (80.0%) vs 15/60 (25.0%), P < 0.01). PSMA-PET detected significantly more cases of csPCa amongst patients with PSA 4.0–20.0 ng/ml than TRUS (27.02% vs 8.82%, P < 0.05). No haematuria, urinary retention or pelvic infection was observed after PSMA-TB compare with TRUS-GB.Conclusions68Ga-PSMA-11 PET/CT is a feasible imaging technique that may serve as a triage tool for prostate biopsy, and may improve the detection rate of csPCa compared with TRUS-GB, especially in patients with serum PSA 4.0–20.0 ng/ml.

PD38-10 ADDING SYSTEMATIC BIOPSY (SBX) TO MAGNETIC RESONANCE ULTRASOUND FUSION TARGETED BIOPSY (TBX) OF THE PROSTATE IN MEN WITH PREVIOUS NEGATIVE BIOPSY OR ENROLLED IN ACTIVE SURVEILLANCE PROGRAMS: A PROSPECTIVE SINGLE CENTER, RANDOMIZED, ANALYSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (PD38)1 Apr 2020PD38-10 ADDING SYSTEMATIC BIOPSY (SBX) TO MAGNETIC RESONANCE ULTRASOUND FUSION TARGETED BIOPSY (TBX) OF THE PROSTATE IN MEN WITH PREVIOUS NEGATIVE BIOPSY OR ENROLLED IN ACTIVE SURVEILLANCE PROGRAMS: A PROSPECTIVE SINGLE CENTER, RANDOMIZED, ANALYSIS Angelo Porreca, Francesco Del Giudice*, Marco Giampaoli, Daniele D'Agostino, Daniele Romagnoli, Alessandro Del Rosso, Paolo Corsi, Martina Maggi, Matteo Ferro, Ottavio De Cobelli, Giuseppe Lucarelli, Riccardo Schiavina, Ettore De Berardinis, Alessandro Sciarra, and Gian Maria Busetto Angelo PorrecaAngelo Porreca More articles by this author , Francesco Del Giudice*Francesco Del Giudice* More articles by this author , Marco GiampaoliMarco Giampaoli More articles by this author , Daniele D'AgostinoDaniele D'Agostino More articles by this author , Daniele RomagnoliDaniele Romagnoli More articles by this author , Alessandro Del RossoAlessandro Del Rosso More articles by this author , Paolo CorsiPaolo Corsi More articles by this author , Martina MaggiMartina Maggi More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Ottavio De CobelliOttavio De Cobelli More articles by this author , Giuseppe LucarelliGiuseppe Lucarelli More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Ettore De BerardinisEttore De Berardinis More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , and Gian Maria BusettoGian Maria Busetto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000917.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) targeted biopsy (TBx) of the prostate demonstrated to improve detection rate (DR) of clinically significant prostate cancer (csPCa) in biopsy-naïve patients achieving strong level of evidence. Nevertheless, the csPCa yield for TBx alone versus TBx plus systematic biopsy (SBx) after accounting for overlapping of SBx cores with TBx cores, in prior-negative or active surveillance (AS) patients has not been well established. Objective is to investigate benefits in terms of detection rate and pathological stratification of PCa using contextual SBx during MRI-TBx. METHODS: Patients previously submitted to negative-SBx (cohort A) and those enrolled in an AS program (cohort B) who showed at least one suspicious area with a PIRADSv2 score ³ 3 were prospectively and randomly assigned to only TBx strategy vs TBx plus SBx strategy. SBx locations could not encompass the TBx sites, so that the results of each type of biopsy was independent and did not overlap. RESULTS: A total of 312 patients were included in the two cohorts (cohort A: 213 cases; cohort B: 99 cases). No significant differences were found in terms of overall PCa-DR (77,6% vs 69,6% respectively; p=0,36) and csPCa-DR (48,2% vs 60,9% respectively; p=0,12). The MRI-TBx alone cohort showed higher csPCa/PCa ratio (87,5% vs 62,2%; p=0,03). The MRI-TBx plus SBx group sub-analysis showed significantly higher csPCa-DR obtained at the MRI-TBx cores when compared to the SBx cores (43,7% vs 24,1%, respectively; p=0.01). Independently to age, PSA and PI-RADS score, either in re-biopsy (OR 0.43, 0.21 – 0.97) or AS (OR 0.46, 0.32 – 0.89) setting, SBx cores were negatively associated with the csPCa-DR when combined to TBx cores. CONCLUSIONS: MRI-TBx should be considered the elective method to perform prostate biopsy in patients with previous negative SBx and those considered for an AS program. Adding SBx samples to MRI-TBx didn’t improvedetection rate of csPCa. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e805-e806 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Porreca More articles by this author Francesco Del Giudice* More articles by this author Marco Giampaoli More articles by this author Daniele D'Agostino More articles by this author Daniele Romagnoli More articles by this author Alessandro Del Rosso More articles by this author Paolo Corsi More articles by this author Martina Maggi More articles by this author Matteo Ferro More articles by this author Ottavio De Cobelli More articles by this author Giuseppe Lucarelli More articles by this author Riccardo Schiavina More articles by this author Ettore De Berardinis More articles by this author Alessandro Sciarra More articles by this author Gian Maria Busetto More articles by this author Expand All Advertisement PDF downloadLoading ...

Detection of significant prostate cancer through magnetic resonance imaging targeted biopsy of PI-RADS3 lesions in African American patients based on prostate specific antigen density threshold of 0.15 ng/ml2: Analysis of patient population from the Vattikuti Urology Institute.

286 Background: A prostate specific antigen density (PSAD) threshold of 0.15 ng/ml2 have been suggested for significant cancer detection in PI-RADS 3 lesions to avoid unnecessary magnetic resonance imaging targeted biopsy (MRI-TB) of these lesions. However, the performance of this threshold in African American (AA) patients is not well characterized. Methods: We analyzed our institutional data base of MRI-TB to identify the rate of significant prostate cancer (Pca) detection in PI-RADS3 lesions in AA patients stratified by PSAD threshold of &lt; 0.15 vs. ≥0.15 ng/ml2 and lesion size of &lt; 1 cm vs ≥ 1 cm. Significant prostate cancer was defined as Gleason grade group 2 or higher on MRI-TB of the PI-RADS 3 lesion. Results: Of 768 patients included in the database, 211 (27.5%) patients identified themselves as AAs. Mean age of AA patients was 63 years and mean PSAD was 0.21. Sixty nine (32.7%) AA patients were found to have PI-RADS 3 lesions. Mean PSAD of AA patients with PI-RADS 3 lesions was 0.21 ng/ml2 as well. Fifty percent of AA patients with PI-RADS 3 lesions had PSAD ≥0.15 ng/ml2. Significant Pca detection rate for AA patients with PI-RADS 3 lesions was 9% for PSAD of ≥ 0.15 vs. 0.03% percent for AA patients with PSAD &lt; 0.15 ng/ml2 (OR 7.056, CI 1.017-167.9, P=0.04). Stratification by lesion size (&lt; 1 cm vs. &gt; 1 cm) resulted in missing 0% percentage of significant Pca when only AA patients with PSAD ≥ 0.15 ng/ml2 and lesion size ≥ 1 cm received MRI-TB. Conclusions: We report on the performance of a reported PSAD density threshold in detecting significant Pca in one of the largest series of AA patients receiving MRI-TB of the prostate. Our results have direct clinical implications when counseling AA patients with PI-RADS 3 lesion on whether they should undergo MRI-TB of such lesions.

The role of MRI/TRUS fusion biopsy in the diagnosis of clinically significant prostate cancer.

Background:The aim of this work is to evaluate the detection rate of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion-guided biopsy for clinically significant prostate cancers (Cs PCas), with particular interest in biopsy-naive patients and patients in active surveillance. MRI-targeted biopsy improves cancer detection rate (DR) in patients with prior negative biopsies; the current literature focuses on biopsy naive patients. We also evaluated the pathologic concordance between biopsies and surgical specimens.Methods:MRI/TRUS fusion-guided biopsies were performed between February 2016 and February 2019. Patients with previous negative biopsies, biopsy-naive or in active surveillance (AS) were included. Cs PCas were defined through Epstein’s criteria.Results:A total of 416 men were enrolled. The overall DRs and Cs PCa DRs were 49% and 34.3%, respectively. Cs PCas were 17.2%, 44.9% and 73.4%, respectively for PI-RADS 3, 4 or 5. Among biopsy-naive patients, 34.8% were found to have a Cs PCa, while a 43.6% tumour upgrading was achieved in men with a low risk of PCa. In patients who underwent radical prostatectomy (RP), the concordance between biopsy Gleason score (GS) (bGS) and pathological GS (pGS) was 90.8%.Conclusion:Our study highlights the role of MRI/TRUS fusion prostate biopsy in the detection of PCa in patients with previous negative biopsies focusing on Cs PCa diagnosis. The MRI/TRUS fusion biopsy is also emerging as a diagnostic tool in biopsy-naïve patients and deserves a fundamental role in AS protocols. A greater concordance between bGS and pGS can be achieved with targeted biopsies.

Joint Scanning Laser Thermography Defect Detection Method for Carbon Fiber Reinforced Polymer

In this paper, a new inspection method, joint scanning laser thermography (JSLT) as well as its data reconstruction and processing algorithm, is proposed. The new inspection method is utilized to detect and characterize the flat-bottom holes (FBH) in carbon fiber composites by using joint laser scanning scheme. By analyzing the nature of the thermal image sequences sampled under such a scanning scheme, a quick and simple reconstruction method is developed to characterize the buried depth of defects based on 1D heat conduction model. The processed thermal images are expected to get higher temporal resolution and spatial resolution. It can inspect larger area within shorter acquisition time than the pulse thermography. Thus, the study solves the dilemma between the inspection speed and the inspection capacity. Later, a joint laser scanning thermography test is set up to test the algorithm on a carbon fiber composite panel with defects buried at different depth. The experimental results show that the reconstructed data almost behave as those under pulse excitation. The tendency of temperature to change in the logarithmic domain over time is similar to the curve in the TSR method. But, unlike the pulse thermography data, the defect detection rate of PCA based on reconstructed data is higher than that of fast Fourier transform (FFT) amplitude image, independent component analysis (ICA) and FFT phase image. The JSLT system is used to detect FBHs and the diameter-depth ratio reached 3.33.

Performing Precise Biopsy in Naive Patients With Equivocal PI-RADS, Version 2, Score 3, Lesions: An MRI-based Nomogram to Avoid Unnecessary Surgical Intervention.

The primary objective of the present study was to avoid unnecessary prostate biopsy in biopsy-naive patients with Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2), score 3, lesions. We reviewed our prospectively maintained database from January 2012 to July 2018. Logistic regression analyses were performed to test different clinical factors as predictors of clinically significant prostate cancer (CSPCa) and build nomograms. Calibration curves were used to assess the concordance between the predictive value and the true risk. Decision curves were created to measure the overall net benefit. The prostate cancer (PCa) and CSPCa detection rates were 37.2% (81 of 218) and 23.9% (52 of 218) in the PI-RADS v2, score 3, cohort. More PCa cases (61.7%; 50 of 81) and CSPCa cases (75%; 39 of 52) were found in the peripheral zone than in the transitional zone. Multivariate analysis showed that age, prostate-specific antigen density, lesion region, and apparent diffusion coefficient (ADC) were predictive factors for CSPCa and PCa. Internally validated calibration curves showed that the predicted risk of CSPCa was closer to the actual probability when the threshold was > 60%. Decision curves showed that a better net benefit was achieved when the model was used to guide clinical practice. More cases of PCa and CSPCa were seen in the peripheral zone than in the transitional zone among patients with PI-RADS v2, score 3. The positive predictive value for a positive ADC (< 900 μm2/s) for the detection of CSPCa and PCa improved with an increasing prostate-specific antigen density. Biopsy can be avoided if the equivocal lesion has a negative ADC (> 900 μm2/s) and was in the transition zone.

Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate: an original technique with a good cancer detection rate

BackgroundTo report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB) .MethodsWe present a retrospective review of consecutive patients undergoing multiparametric magnetic resonance (mpMRI) imaging of the prostate with subsequent transperineal prostate biopsy from January 2016 to December 2018. A free-hand 12-core SB was performed for each patient. PI-RADS 3–5 lesions were further targeted for biopsy with our TB technique. Firstly, a central point of suspicious lesion (B′) was registered cognitively on a transverse section of transrectal ultrasound (TRUS). Then, biopsy gun punctured vertically through a fixed pioneer site (A) on skin of perineum, and deep into the TRUS section to get A’. Next, targeted site (B), the surface-projection of B′, would be determined on skin of perineum by A and distance from B′ to A’. Finally, puncture through B to reach B′. Pathological findings of SB and TB were analyzed.ResultsA total of 126 patients underwent transperineal prostate biopsy (47 SB only, 79 SB + TB). The age of the patients was 68.7 ± 9.2 years. The median preoperative PSA value was 11.8 ng/mL. Preoperative prostate volume was 60.5 ± 50.0 mL. The numbers of patients with PI-RADS scores of 1 through 5 were 4, 43, 27, 21 and 31, respectively. The overall detection rate of cancer was 61/126 (48.4%), and it was significantly higher in the combination cohort (56/79, 70.9%) compared with the SB only cohort (5/47, 10.6%, p<0.001). When focused on the combination cohort, TB detected a similar overall rate of PCa (53/79, 67.1% vs 52/79, 65.8%; p = 0.87) compared with SB. The clinically significant PCa (csPC) detection rate was 52/79 (65.8%), while for TB and SB the csPC/PC rate was 51/53 (96.2%) and 48/52 (92.3%), respectively(p = 0.44). TB demonstrated a better sampling performance (positive rate for each core) compared with SB (51.0% vs 31.3%, p < 0.001).ConclusionsSurface-projection-based transperineal cognitive fusion targeted biopsy of the prostate has a good efficacy in detecting PCa.

Development and internal validation of PI-RADs v2-based model for clinically significant prostate cancer

BackgroundOur objective is to build a model based on Prostate Imaging Reporting and Data System version 2 (PI-RADs v2) and assess its accuracy by internal validation.MethodsPatients who took prostate biopsy from 2014 to 2015 were retrospectively collected to compose training cohort according to the inclusion criteria and patients in 2016 composing validation cohort. Diagnostic performance was evaluated by analyzing the area under the curve (AUC), calibration curves, and decision curves.ResultsOf the 441 patients involved, the clinically significant prostate cancer (csPCa) detection rate were 40.6% (114/281) and 43.8% (70/160) in the training and validation cohort, respectively. Meanwhile, PCa detection rate were 50.2% (141/281) and 53.8% (86/160). Age, prostate-specific antigen density (PSAD)*10 and PI-RADs v2 score composed the model for PCa (model 1) and csPCa (model 2). The area under the curve of models 1 and 2 was 0.870 (95% CI 0.827–0.912) and 0.753 (95% CI 0.717–0.828) in the training cohort, while 0.845 (95% CI 0.786–0.904) and 0.834 (95% CI 0.787–0.882) in the validation cohort. Both models illustrated good calibration, and decision curve analyses showed good performance in predicting PCa or csPCa when the threshold was 0.35 or above.ConclusionsThe model based on age, PSAD*10 and PI-RADs v2 score showed internally validated high predictive value for both PCa and csPCa. It could be used to improve the diagnostic performance of suspicious PCa.

MP57-04 THE GERMAN RISK-ADAPTED PROSTATE CANCER SCREENING TRIAL (PROBASE) – FIRST RESULTS AFTER RECRUITMENT OF 30.000 MEN

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2018MP57-04 THE GERMAN RISK-ADAPTED PROSTATE CANCER SCREENING TRIAL (PROBASE) – FIRST RESULTS AFTER RECRUITMENT OF 30.000 MEN Christian Arsov, Nikolaus Becker, Kathleen Herkommer, Jürgen Gschwend, Florian Imkamp, Markus Kuczyk, Boris Hadaschik, Markus Hohenfellner, Roswitha Siener, Glen Kristiansen, Lars Schimmöller, Gerald Antoch, and Peter Albers Christian ArsovChristian Arsov More articles by this author , Nikolaus BeckerNikolaus Becker More articles by this author , Kathleen HerkommerKathleen Herkommer More articles by this author , Jürgen GschwendJürgen Gschwend More articles by this author , Florian ImkampFlorian Imkamp More articles by this author , Markus KuczykMarkus Kuczyk More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , Roswitha SienerRoswitha Siener More articles by this author , Glen KristiansenGlen Kristiansen More articles by this author , Lars SchimmöllerLars Schimmöller More articles by this author , Gerald AntochGerald Antoch More articles by this author , and Peter AlbersPeter Albers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1816AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Population-based PSA screening still is controversially discussed. A risk-adapted approach using a baseline PSA value at age 45 may improve the number needed to screen and to treat. The German risk-adapted PCa screening trial PROBASE is currently the largest ongoing screening trial and aims to accrue 50,000 men within 5 yrs in a prospective and randomized fashion. The trial opened in April 2014. METHODS The PROBASE trial is powered for superiority in terms of specificity of risk-adapted PSA screening starting at age 50 (arm B) as compared to 45 yrs (arm A) with non-inferiority in terms of metastasis from PCa. 45 yrs old men are randomly assigned to risk-adapted screening beginning at age 45 or five years later at age 50. Both groups receive risk-adapted PSA screening based on baseline PSA values: < 1.5 ng/ml (low risk) - 5-yearly PSA (expected 90%), 1.5-2.99 ng/ml (intermediate risk) - 2-yearly PSA (expected 7.5%), >=3.0 ng/ml (high risk) MRI and combined systematic and MRI/TRUS fusion-guided biopsy recommended (expected 2.5%). Screening ends at age 60. RESULTS Overall 30,298 men have been enrolled until October 2017 of which 15,152 were randomized into trial arm A. The majority of the PSA values of trial arm A were < 1.5 ng/ml (n=13,506, 89.1%), few in the range of 1.5 to 2.99 ng/ml (n=1,427, 9.4%) and at 3.0 ng/ml or above (n=219, 1.5%). In the latter group, a PSA value >=3.0 ng/ml was confirmed by a second test in 115/219 subjects (52.5%, 0.8% of all trial arm A participants). Median PSA of these participants was 4.1 ng/ml (range 3.0-28.1).Subsequently, 81 subjects out of the 115 PSA-suspicious men underwent MRI (70.4%). PI-RADS v2 scores were as follows: PI-RADS 1 n=2 (2.5%) PI-RADS 2 n=32 (39.6%), PI-RADS 3 n=23 (28.4%), PI-RADS 4 n=16 (19.8%), PI-RADS 5 n=3 (3.7%).Until now, 81.5% (66/81) also underwent combined biopsy with a PCa detection rate of 33.3% (22/66). Thus, the overall PCa incidence in trial arm A at the first screening round is 0.15%. The rate of cancers with a Gleason score of at least 3+4=7 was 68.2% (15/22). So far, 561 participants initially assigned to the intermediate risk group underwent a second screening round two years later. Altogether, 6.6% (37/561) had a confirmed PSA increase >=3.0 ng/ml (median 3.9, range 3.1-15.7). During this workup, 24 out of these 37 participants had an MRI with combined biopsy. PCa detection rate was 37.5% (9/24) with 5 PCa having a Gleason pattern 4. CONCLUSIONS PROBASE started with a rapid recruitment and the expected distribution of risk-groups could be confirmed. The overall PCa incidence in 45 yrs old men is very low (<1%). Increased PSA levels should be confirmed before performing prostate biopsy. However, men with a confirmed baseline PSA >=3.0 ng/ml or those initially assigned to the intermediate risk group and exceeding the biopsy cut off two years later have a high risk of harbouring significant PCa. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e765 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christian Arsov More articles by this author Nikolaus Becker More articles by this author Kathleen Herkommer More articles by this author Jürgen Gschwend More articles by this author Florian Imkamp More articles by this author Markus Kuczyk More articles by this author Boris Hadaschik More articles by this author Markus Hohenfellner More articles by this author Roswitha Siener More articles by this author Glen Kristiansen More articles by this author Lars Schimmöller More articles by this author Gerald Antoch More articles by this author Peter Albers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP77-05 UROLOGIST LEARNING CURVE HAS AN IMPACT ON INCREASING PROBABILITY OF CLINICALLY SIGNIFICANT CANCER DETECTION RATE AT MPMRI-TRUS FUSION TARGET BIOPSY: A PROSPECTIVE STUDY IN A SINGLE HIGH VOLUME INSTITUTION

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2018MP77-05 UROLOGIST LEARNING CURVE HAS AN IMPACT ON INCREASING PROBABILITY OF CLINICALLY SIGNIFICANT CANCER DETECTION RATE AT MPMRI-TRUS FUSION TARGET BIOPSY: A PROSPECTIVE STUDY IN A SINGLE HIGH VOLUME INSTITUTION Giuliana Lista, Giovanni Lughezzani, Massimo Lazzeri, Davide Maffei, Pasquale Cardone, Piergiuseppe Colombo, Nicolò Buffi, Rodolfo Hurle, Alberto Saita, Paolo Casale, and Giorgio Guazzoni Giuliana ListaGiuliana Lista More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Pasquale CardonePasquale Cardone More articles by this author , Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , and Giorgio GuazzoniGiorgio Guazzoni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2593AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Targeted fusion biopsy using multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) learning curve (LC) has not been yet evaluated for large series of patients. We tested the hypothesis that urologist experience may improve clinically significant Pca (csPCa) detection rate of targeted mpMRI-US fusion biopsy METHODS This is a prospective, longitudinal study including 394 consecutive patients who underwent mpMRI-US targeted (TB) and transrectal standard biopsy (SB) for suspicion of PCa at a single institution from April 2015 to September 2017. All the procedures were carried out by two urologists using the Bio-Jet™ fusion system and software (D&K Technologies, Barum, Germany) while mpMRI studies were reported by different experienced radiologists. Biopsies were performed either in a transrectal or transperineal setting depending on the location of the primary lesion on the mpMRI. The cohort was divided into sestiles representing consecutive times during the study period. Overall targeted biopsy PCa detection rate (TB-CDR) and csCDR at TB were reported and stratified according to progression groups. Sensitivity, specificity and negative predictive value of MRI-US TB were calculated. Chi square for trend analyses were used to assess the statistical significance of CDR Linear regression analyses were performed to estimate the impact of LC on the ability to diagnose csPCa. RESULTS Median patient age was 65 yrs (R:32-86) and median PSA at biopsy was 7 ng/ml (R: 3.4-56 ng/ml). Cancer detection rate at TB was 43.7% (n=172), of these patients 76% (n=130) had csPCa. Targeted biopsy CDR increased from 36.9 % (n=24) to 62.1 % (n=41) from group A to group F (p=0.004). Similarly, csCDR at TB increased significantly from group A (23.1%, n=15) to group F (44%, n=29) (p=0.01). Sensitivity, specificity, NPV and PPV of TB in detecting csPCa was 75.6%, 93.2%, 83% and 90% respectively. At linear regression analyses, assessing learning curve impact, diagnostic accuracy of TB showed a significant trend on csCDR (R2=0.3 p<0.001). CONCLUSIONS Our findings suggested that the operator LC may have an impact on csCDR of TB in larger series. Consequently, mpMRI/US fusion biopsies appear to have "a steep learning curve", as the diagnostic accuracy of the procedure appears to progress over time even after a high number (>300) of procedures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1028-e1029 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Giuliana Lista More articles by this author Giovanni Lughezzani More articles by this author Massimo Lazzeri More articles by this author Davide Maffei More articles by this author Pasquale Cardone More articles by this author Piergiuseppe Colombo More articles by this author Nicolò Buffi More articles by this author Rodolfo Hurle More articles by this author Alberto Saita More articles by this author Paolo Casale More articles by this author Giorgio Guazzoni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP20-20 BETTER PREDICTION OF TUMOR AGGRESSIVENESS IN MRI/ULTRASOUND-FUSION-BIOPSY COMPARED TO SYSTEMATIC PROSTATE BIOPSY

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2018MP20-20 BETTER PREDICTION OF TUMOR AGGRESSIVENESS IN MRI/ULTRASOUND-FUSION-BIOPSY COMPARED TO SYSTEMATIC PROSTATE BIOPSY Angelika Borkowetz, Ivan Platzek, Marieta Toma, Theresa Renner, Michael Froehner, Stefan Zastrow, and Manfred Wirth Angelika BorkowetzAngelika Borkowetz More articles by this author , Ivan PlatzekIvan Platzek More articles by this author , Marieta TomaMarieta Toma More articles by this author , Theresa RennerTheresa Renner More articles by this author , Michael FroehnerMichael Froehner More articles by this author , Stefan ZastrowStefan Zastrow More articles by this author , and Manfred WirthManfred Wirth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.690AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate tumor assessment is essential in counselling patients with prostate cancer (PCa) for further treatment. Therefore, we compared transperineal MRI/ultrasound-fusion biopsy (fusPbx) with systematic transrectal prostate biopsy (sysPbx) for prediction of final histopathology. Furthermore, we assessed the prediction of extracapsular extension (ECE) and infiltration of seminal vesicles (SvI) in multiparametric MRI (mpMRI) compared to prostatectomy specimen (PrS). METHODS 320 patients undergoing radical prostatectomy were investigated. In all patients, PCa was proven by transperineal fusPbx combined with transrectal sysPbx (comPbx). Lesions detected in mpMRI were evaluated according to PI-RADS. PCa-detection rate in all biopsy modalities were evaluated. Tumour grading of the biopsy specimen (fusPbx, sysPbx and comPbx) and the PrS were compared. Finally, the concordance of ECE and SvI in mpMRI and PrS was investigated. Significant PCa was defined as Gleason score (GS) ≥ 7(3+4). RESULTS PCa detection rate was 88% (n=280) in fusPbx and 73% (n=235) in sysPbx (p<0.005). Significant PCa was detected in 72% (n=231) in fusPbx and in 60% (n=193) in sysPx (p=0.001). In PrS, 5% (n=15) of patients presented a GS=6 and 95% (n=305) of patients presented a GS ≥7 PCa. FusPbx alone would have missed 40 tumors (GS=6: 10% (n=4), GS≥7: 90% (n=36)), sysPbx alone would have missed 85 tumors (GS=6: 6% (n=5), GS≥7: 94% (n=80). Concordance on GS between biopsy and PrS was 50% (n=159), 40% (n=127) and 56% (n=180) in fusPbx, sysPbx and comPbx, respectively. Upgrading on GS between biopsy and PrS occurred in 38% (n=122), 48% (n=152) and 27% (n=85) in fusPbx, sysPbx and comPbx, respectively. Gamma correlation for detection of any cancer was 0.7 for comPbx, 0.6 for fusPbx alone and 0.4 for sysPbx alone. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for ECE and SvI in mpMRI were 26%, 91%, 54%, 73%, 71% and 22%, 99%, 57%, 96%, 95%; respectively. CONCLUSIONS FusPbx is associated with a higher detection rate while sysPbx would miss a higher proportion of PCa with a GS≥7. FusPbx shows a higher concordance and a lower GS upgrading than sysPbx. But the combination of both presents the best concordance of GS in PrS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e261 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Angelika Borkowetz More articles by this author Ivan Platzek More articles by this author Marieta Toma More articles by this author Theresa Renner More articles by this author Michael Froehner More articles by this author Stefan Zastrow More articles by this author Manfred Wirth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical efficacy of transrectal ultrasound-guided prostate biopsy in men younger than 50 years old with an elevated prostate-specific antigen concentration (>4.0 ng/mL)

BackgroundProstate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate-specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA-triggered transrectal ultrasonography-guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital. MethodsWe reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008–December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow-up were reviewed and analyzed according to the Epstein criteria. ResultsA total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40–50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy. ConclusionFrom our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age.