Prostate Cancer Detection Rate Research Articles

Comparison of MRI artificial intelligence-guided cognitive fusion-targeted biopsy versus routine cognitive fusion-targeted prostate biopsy in prostate cancer diagnosis: a randomized controlled trial.

Cognitive fusion MRI-guided targeted biopsy (cTB) has been widely used in the diagnosis of prostate cancer (PCa). However, cTB relies heavily on the operator's experience and confidence in MRI readings. Our objective was to compare the cancer detection rates of MRI artificial intelligence-guided cTB (AI-cTB) and routine cTB and explore the added value of using AI for the guidance of cTB. This was a prospective, single-institution randomized controlled trial (RCT) comparing clinically significant PCa (csPCa) and PCa detection rates between AI-cTB and cTB. A total of 380 eligible patients were randomized to the AI-cTB group (n = 191) or the cTB group (n = 189). The AI-cTB group underwent AI-cTB plus systematic biopsy (SB) and the cTB group underwent routine cTB plus SB. The primary outcome was the detection rate of csPCa. The reference standard was the pathological results of the combination of TB (AI-cTB/cTB) and SB. Comparisons of detection rates of csPCa and PCa between groups were performed using the chi-square test or Fisher's exact test. The overall csPCa and PCa detection rates of the whole inclusion cohort were 58.8% and 61.3%, respectively. The csPCa detection rates of TB combined with SB in the AI-cTB group were significantly greater than those in the cTB group at both the patient level (58.64% vs. 46.56%, p = 0.018) and per-lesion level (61.47% vs. 47.79%, p = 0.004). Compared with cTB, the AI-cTB could detect a greater proportion of patients with csPCa at both the per-patient level (69.39% vs. 49.71%, p < 0.001) and per-lesion level (68.97% vs. 48.57%, p < 0.001). Multivariate logistic analysis indicated that compared with the cTB, the AI-cTB significantly improved the possibility of detecting csPCa (p < 0.001). AI-cTB effectively improved the csPCa detection rate. This study successfully integrated AI with TB in the routine clinical workflow and provided a research paradigm for prospective AI-integrated clinical studies. ClinicalTrials.gov, NCT06362291.

Clinical value of contralateral biopsies in men with unilateral MRI foci undergoing targeted biopsy.

To evaluate the additional prostate cancer detection yield and clinical implications of performing contralateral systematic biopsies in men with unilateral suspicious magnetic resonance imaging (MRI) findings undergoing MRI-guided transperineal (TP) biopsies in an outpatient clinic. A prospective study of 655 consecutive men with unilateral MRI suspicious findings undergoing office-based MRI-guided TP biopsies between May 2022 and December 2023. All men had pre-biopsy MRI followed by MRI-guided TP fusion biopsies with at least four targeted cores per lesion plus five contralateral systematic biopsies. The primary objective was the clinically significant prostate cancer (csPCa) detection rate of contralateral systematic biopsies in men with no or insignificant PCa on targeted biopsies. Secondary objectives included the impact of contralateral biopsies on PCa grade upgrading, additional insignificant PCa diagnoses, and the clinical implications of multifocal csPCa detected on both targeted and contralateral cores. Any and csPCa (Gleason Grade Group [GG] ≥2) was detected in 564/655 (85%) and 471/655 (71%) men with a median age of 66 years and PSA level of 7.6 ng/mL. Overall, seven of 655 (1%) men had csPCa detected by contralateral systematic biopsies missed on MRI-targeted biopsy, all of whom had low-volume Gleason GG 2 PCa eligible for active surveillance. Furthermore, 70/464 (15%) men with csPCa on MRI-targeted biopsy had matching Gleason GG 2-5 PCa on contralateral biopsy, and another seven had higher Gleason GG. However, the additional information from contralateral biopsies did not seem to influence whole-gland treatment allocation and nerve-sparing during surgery. Contralateral systematic biopsies in men with unilateral MRI findings undergoing MRI-guided TP targeted biopsies have limited value for csPCa detection and risk assessment for whole-gland treatment but may be important for determining PCa multifocality considering focal therapy eligibility.

Transperineal prostate biopsy guided by which ultrasound transducer: transrectal or transperineal: a retrospective study.

Prostate biopsies are primarily conducted using either the transrectal or transperineal approach, with the ultrasound probe positioned in the rectum to obtain a clear view of the prostate. Reports on the utilization of transperineal prostate biopsies with the ultrasound probe placed on the perineal skin are limited. A retrospective investigation was conducted on 119 patients who underwent transperineal ultrasound guided transperineal prostate biopsy (TP-TPPB). Additionally, 85 patients who underwent transrectal ultrasound guided transperineal prostate biopsy (TR-TPPB) were included as controls. The prostate cancer detection rates (PCDRs) and postoperative complication rates were compared between the two groups, and their application values were also evaluated. The overall PCDRs were 35.3% (42/119) in the TP-TPPB and 32.9% (28/85) in the TR-TPPB group (χ2=0.122, p=0.727). When categorized by PSA level, there was no significant difference between the two groups in PCDRs in any category (p>0.05). However, the single-needle PCDRs in some regions (L4, L5, R2, and apex) showed significant differences (p<0.05). There was no difference in postoperative complication rates between the groups. The PCDRs and the postoperative complication rates of TP-TPPB and TR-TPPB are similar. However, TP-TPPB requires simpler equipment and does not require intestinal preparation, which is especially useful for patients with rectal contraindications, such as those with severe hemorrhoids and rectal/anal diseases.

Multiparametric MRI targeted prostate biopsy: When omit systematic biopsy?

Introduction: To evaluate the detection rate for prostate cancer (PCa) performing multiparametric magnetic resonance imaging (mpMRI) fusion targeted biopsy (TPBx) combined only with ipsilateral systematic prostate biopsy (SPBx). Materials and Methods: From January 2023 to December 2023, 495 men with clinical suspicion of PCa underwent transperineal SPBx plus TPBx in the presence of PI-RADS score lesions ≥ 3. Results: In 250/495 men (50.5%) a PCa was found, while 36/250 (14.4%) men had negative mpMRI. In comparison to TPBx, SPBx diagnosed a higher number of indolent PCa, 38.5 vs. 5.8%, respectively; conversely, SPBx demonstrated a higher detection rate for clinically significant PCa (97.3 vs. 85.4%) in the presence of ISUP Grade Group 2 (GG2). In details, rates were higher in the presence of GG2 (100 vs. 76%), GG3 (85.7 vs. 75.8%) and GG4 (100 vs. 86.4%) tumors. However, in GG5, both SPBx and TPBx diagnosed 100% of csPCa. Furthermore, 89.4% of the cases showed csPCa on the negative mpMRI side. Conclusions: SPBx combined with TPBx maximized csPCa diagnosis; the use of reduced biopsy scheme limited to ipsilateral side of mpMRI lesion plus TPBx missed 11.6% csPCa. Only in the presence of PI-RADS score 5 SPBx and TPBx diagnosed both 100% of csPCa.

Prostate-specific antigen, digital rectal examination, and prostate cancer detection: A study based on more than 7000 transrectal ultrasound-guided prostate biopsies in Ghana

Purpose of the studyThis study aims to determine the role of serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE) in predicting the histological outcomes of prostate biopsies by analyzing a database of over 7000 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsies. MethodsWe conducted a retrospective analysis of men who underwent TRUS-guided prostate biopsies at Korle Bu Teaching Hospital, a tertiary referral center in Accra, Ghana, from July 2005 to December 2022. The biopsies, which included 10 to 12 core samples, were prompted by PSA levels greater than 4.0 ng/mL, abnormal DRE findings, or both. We then correlated histopathology results with PSA and DRE findings. ResultsOut of 7,338 patients who presented for biopsy, 76.3% were between the ages of 60 and 79. Histology reports were available for 5,289 patients, of whom 2,564 (48.5%) were diagnosed with prostate cancer. Cancer detection rates based on PSA levels were as follows: 21.6% for PSA <4 ng/mL, 21.7% for PSA 4-10 ng/mL, 32.7% for PSA 10-20 ng/mL, 53.0% for PSA 20-50 ng/mL, 71.5% for PSA 50-100 ng/mL, and 92.0% for PSA >100 ng/mL. When DRE findings were classified according to the 2016 TNM System (AJCC 8th Edition) as T1, T2, T3, and T4, cancer detection rates were 26.8%, 51.8%, 87.6%, and 95.7%, respectively. The overall cancer detection rate was significantly higher with abnormal DRE findings (64.6% vs. 26.7%, p < 0.001). Additionally, 78.2% of the detected cancers were high-grade (Gleason score of 7 or more). ConclusionThis extensive study of Ghanaian men undergoing TRUS biopsies reveals a high prostate cancer detection rate, with nearly 80% of the detected cancers being high-grade. These findings underscore the importance of PSA and DRE in the early detection of prostate cancer and should be considered in patient counseling and discussions regarding the implementation of prostate cancer screening programs in this population.

Unlocking Precision Enhancing Prostate Cancer Detection and Reducing Unnecessary Biopsies with Combined Prostate-Specific Antigen Density and PI-RADS Score.

To determine clinically significant prostate cancer (csPCa) detection rate by combining the prostate-specific antigen density (PSAD) and prostate imaging-reporting and data system (PI-RADS) scores. Descriptive study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Ankara Oncology Training and Research Hospital, from January 2018 to April 2023. Patients who underwent prostate biopsies after multiparametric magnetic resonance imaging (mpMRI) were included in the study. PI-RADS 4 and 5 lesions were considered as MR positive. The cut-off values for PSAD were also determined to evaluate csPCa. csPCa detection rates were evaluated by grouping the patients based on the PSAD and mpMRI findings. PSAD cut-off value of 0.165 ng/mL/mL (sensitivity 80%, specificity 72%) was detected to predict csPCa (AUC = 0.81, 95% CI:0.756-0.866, p<0.001). csPCa detection rate was low (3%) in patients who have low PI-RADS scores (1-3) and a PSAD <0.165 ng/mL/mL. On the other hand, csPCa detection rate was high (50.5%) in patients who have a high PI-RADS score (4-5 lesions) and with a PSAD ≥0.165 ng/mL/mL. csPCa detection rates are low in patients with PI-RADS 1-3 lesions and low PSAD values. Unnecessary biopsy may be avoided in these patients. Gleason score, PI-RADS, Prostate cancer, Prostate-specific antigen, Prostate-specific antigen density.

Abstract C180: Not all PIRADS 3s are equal; fusion biopsy outcomes by PIRADS score and ethnicity in a diverse population

Abstract Introduction and Objective: Magnetic resonance imaging (MRI) is increasingly utilized in the diagnosis of prostate cancer (PCa). Although PIRADS 3 lesions have been associated with a lower likelihood of detecting clinically significant prostate cancer (csPCa) at the time of targeted fusion biopsy (FB), existing data on multiethnic populations are sparse. We assessed the pathologic concordance of PIRADS 3 vs 4 or 5 lesions in detection of PCa and csPCa in comparison to PSA density in a diverse population. Methods: A retrospective study of all patients who underwent image-guided FB for PIRADS 3-5 lesions from 2016-2022 was conducted. Demographic, clinical, and pathologic data were extracted from electronic medical records. Mixed-effects logistic regression models were used to examine the association of race/ethnicity and PSA density with risks of overall PCa and csPCa. A stratified analysis by PIRADS score (3 vs 4 or 5) was also carried out to explore the associations between detection rates of PCa and race/ethnicity. Results: A total of 565 men with 997 lesions were analyzed, with average age 63.2 years (SD: 7.5) at the time of biopsy. Of the men, 279 (49.4%) were Non-Hispanic Black (NHB), 112 (19.8%) were Non-Hispanic White, and 174 (30.8%) were Hispanic. 520 (52.16%), 310 (31.09%), and 167 (16.75%) individual MRI lesions were PIRADS 3, 4, and 5, respectively with distributions of PIRADS scores being similar across all race/ethnicities. The overall rates of PCa detection were 44.8% in NHB, 37.6% in Hispanics, and 33.0% in NHW. Compared to NHW, NHB has 2.52 higher odds of detecting overall PCa (95% CI 1.10-5.78; p = 0.03), whereas Hispanic men had an OR = 1.18 (p = 0.72). Interestingly, the increase in PCa detection among NHB was only observed for PIRADs 3 lesions (OR = 4.84 95% CI 1.11-21.2, p = 0.04). NHB men also had 2.1-fold higher odds of detecting csPCa (95% CI 0.92-4.77; p = 0.08) in comparison to NHW with a similar trend mimicking association with PRIADS scores, although results were not statistically significant. Conclusions: We report that NHB men have higher odds of detection rates of overall PCa in FB in comparison to NHW and Hispanic men, albeit only at PIRADS 3 scores. These findings may serve to improve risk stratification and assist with shared decision making when discussing triggers for biopsy. Source of funding: None Citation Format: David G. Hanelin, Andrewe Baca, Priya Dave, Rutul Patel, Ilir Agalliu, Alexander Sankin, Ahmed Aboumohamed, Kara Watts. Not all PIRADS 3s are equal; fusion biopsy outcomes by PIRADS score and ethnicity in a diverse population [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C180.

Image-guided multiparametric magnetic resonance imaging-transrectal ultrasound fusion biopsy augmented with a sextant versus an extended template random biopsy: Comparison of cancer detection rates, complication and functional outcomes.

To compare the efficacy of a novel fusion template "reduced six-core systemic template and multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion targeted biopsy" (TBx+6c), with mpMRI/TRUS fusion-targeted biopsy and 12-core systematic biopsy template (TBx+12c) in the diagnosis of prostate cancer (PCa). This is an institutional review board approved single-center observational study involving adult men undergoing fusion-targeted biopsies for the diagnosis of PCa. Patients were sorted into cohorts of TBx+6c or TBx+12c based on the systematic biopsy template used. The study's main objective was to determine the cancer detection rate (CDR) for overall PCa and clinically significant PCa (csPCa) and the secondary objectives were to compare complication rates and functional outcome differences between the cohort. A total of 204 patients met study's inclusion criteria. TBx+6c group had 120 patients, while TBx+12c cohort had 84 patients. The groups had similar baseline characteristics and overall CDR in the TBx+6c cohort was 71.7% versus 79.8%, compared to the TBx+12c (p = 0.18) whereas, the csPCa detection rate in the TBx+6c group was 50.8% versus 54.8% in the TBx+12c group (p = 0.5). TBx+6c cohort had lower overall complication rate of 3% versus 13%, (p = 0.01) and ≥ grade 2 complication rates (1 (1%) vs. 3(4%), p = 0.03) compared to the TBx+12c cohort. There were no differences in IIEF-5 (p = 0.5) or IPSS (p = 0.1) scores at baseline and 2-weeks and 6-weeks post-biopsy. TBx+6c cohort, when compared to the TBx+12c cohort, demonstrated comparable diagnostic performance along with similar functional outcomes and lower complication rates. These results suggest the importance of further exploring the clinical implications of adopting a TBx+6c schema for PCa diagnosis in comparison to the widely used TBx+12c schema through a multicenter randomized controlled trial.

Optimizing prostate cancer detection in transition zone: an analysis of apparent diffusion coefficient values in prostate magnetic resonance imaging evaluation with Prostate Imaging Reporting and Data System (PI-RADS) assessment.

Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for the early detection of clinically significant prostate cancer (csPCa). However, the achievement of accurate detection rates, particularly for transition zone (TZ) lesions, remains challenging. We investigated the relationship between apparent diffusion coefficient (ADC) values in Prostate Imaging Reporting and Data System (PI-RADS) 3-5 lesions and csPCa within the TZ. We retrospectively evaluated TZ lesions in patients who underwent 3.0 Tesla MRI followed by MRI-targeted/transrectal ultrasound fusion biopsies (MRI-FBx). Fusion biopsies were performed for potentially cancerous lesions, defined as lesions with PI-RADS scores 3-5. We analyzed 196 lesions for which fusion biopsies were performed. The overall prostate cancer (PCa) detection rate was 53.6% (105/196); csPCa constituted 33.7% (66/196) of cases. The minimum ADC value was significantly lower for patients with csPCa (484.9±112.3 µm2/s) than for patients with benign histology or non-csPCa (P<0.001). Older age, higher initial prostate-specific antigen level, larger region of interest, and minimum and mean ADC values were associated with the presence of csPCa. Multivariate analysis indicated that only the minimum ADC value was an independent predictor of csPCa. Using a cutoff minimum ADC value <561 µm2/s to detect csPCa in TZ lesions increased the detection rate to 57.4% (54/94). The minimum ADC value provides substantial additional information regarding the presence of csPCa in the TZ, potentially improving the detection rates for lesions rated as PI-RADS 3-5 and informing the need for follow-up biopsies in areas that are initially cancer-free.

Lesion size may affect diagnostic capabilities of MRI-guided ultrasound fusion biopsy and cognitive targeted biopsy for clinically significant prostate cancer

MRI-guided targeted biopsy (MRGB) was recommended as part of biopsy paradigm of prostate cancers by current guidelines. This study aimed to analyze the diagnostic efficacy of MRGB and systemic biopsy (SB), and to compare diagnostic capabilities within subgroups of MRGB: MRI-cognitive biopsy (MRCB) and MRI-fusion biopsy (MRFB). We retrospectively enrolled patients who underwent MRGB for suspicious malignant lesion(s) identified on MRI in a single tertiary center, sample size was 74 patients. An mpMRI was performed prior to biopsy and reviewed by an experienced radiologist specialized in prostate cancer. Per-person results of MRGB and each concomitant SB were analyzed as independent biopsies for its positive biopsy rate and positive core percentage. Per-lesion results of MRFB and MRCB were compared for the detection rate. Variables of interest were analyzed with t-test, chi-squared test, and logistic regression analysis. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS), Version 23 (IBM, Armonk, New York). Total of 74 patients fulfilled the inclusion criteria and were enrolled. MRFB had higher PCa detection rate comparing to both MRCB and SB (56.1%, 30.3%, and 33.9% respectively, p value = 0.036); clinically significant prostate cancer (csPCa) detection rate was also significantly higher in MRFB group (43.9%, 24.2%, and 16.9% in each group respectively, p value = 0.011). In per-lesion analysis, MRCB and MRFB had no significant difference in PCa and csPCa detection rate (41.0% vs. 26.2% and 29.5% vs. 16.7% respectively, p value = 0.090 and 0.103). In the lesion ≦ 1.3 cm group, MRFB could achieve higher PCa detection rate, comparing to MRCB (36.4% vs. 14.3%, p value = 0.047); there were also higher positive rates for PCa and csPCa per biopsied cores (22.1% vs. 6.8% and 15.6% vs. 2.7%, p value = 0.029 and 0.028, respectively). Further logistic regression of multi-variate analysis in subgroup of lesion ≦ 1.3 cm revealed that PIRADS score and biopsy method were significant predictors of positive biopsy result for PCa (p value = 0.045 and 0.026, respectively) and for csPCa (p value = 0.043 and 0.025, respectively). In patients receiving trans-perineal prostate biopsy, MRFB had higher cancer detection rate than MRCB and SB. In per lesion comparison, MRFB and MRCB had similar diagnostic accuracy. However, in lesions with diameter less than 1.3 cm, MRFB can provided better diagnose value for PCa and csPCa than MRCB.

Management considerations and treatment outcomes for newly diagnosed prostate cancer in advanced age patients (≥80 years): real-world data from a single urological center over a 10-year period.

There is ongoing debate regarding prostate cancer (PCa) screening in advanced age males, leading to treatment decisions often based on tumor staging and life expectancy. A critical gap in clinical evidence and tailored guidelines for the advanced age with PCa persists. This study aims to compare survival outcomes of various treatment approaches in this demographic. We analyzed data from a large urological center for advanced age patients suspected of having PCa between 2012 and 2022. We collected clinical and pathological characteristics and evaluated treatment modalities, including palliative therapy and definitive therapy. Propensity score matching (PSM) analysis was implemented to reduce bias between treatment modalities. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were conducted to evaluate progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Out of 4,333 suspected patients, 376 individuals aged 80 years and older underwent prostate biopsy. The overall detection rate of PCa was 78.7%, with a high prevalence of high-grade tumors [International Society of Urological Pathology (ISUP) grade ≥2]. Most patients (86.5%) received palliative therapy, while 13.5% underwent definitive therapy. Patients in the definitive therapy group had lower prostate-specific antigen (PSA) values, lower tumor stage, and Charlson Comorbidity Index (CCI), longer life expectancy, and a higher Geriatric 8 (G8) score compared to the palliative therapy group. The median OS for the entire cohort was 72.0 months, with 70.0 months for palliative therapy and 96.0 months for definitive therapy. Multivariable analyses identified lymphatic and bone metastasis, as well as definitive therapy, as independent prognostic factors for PFS, CSS, and OS. Advanced age patients, although a small group, have distinct characteristics, including higher PSA levels, positive biopsy rates, and pathological grading and staging. In medically fit elderly patients, especially those with localized PCa and a life expectancy of ≥5 years, definitive therapy could improve survival outcomes.

Prostate Cancer Screening in Young Men.

Background: Prostate cancer (PCa) screening strategies are being developed and evaluated in several countries. However, most of the evidence regarding PCa screening has been generated in study populations aged 50 and older. Aims: This study summarizes findings of a screening trial in younger men and discuss those findings in the context of other screening trials. Methods: Non-systematic review. Results: Screening of 45-year-old men resulted in a low PCa detection rate. Nonetheless, almost 70% of screen-detected PCa at this age was clinically significant. In young men ISUP GG 1 screen-detected cancers warrant rigorous follow-up. A baseline, midlife prostate-specific antigen (PSA) value at age 45 may safely exclude the vast majority of men from further screening investigations for at least 5 years. At age 45, a confirmatory PSA value reduces the number of subsequent tests almost by half. Sequential magnetic resonance imaging (MRI) as a reflex test subsequent to an elevated PSA ≥ 3 ng/mL needs further investigation in young men. Conclusions: Screening in young men needs to be carefully investigated in order to avoid overscreening and overdiagnosis.

Clinically significant prostate cancer detection rate in biopsy-naïve patients with mpMRI and microultrasound topographically discordant lesions: A single-center retrospective analysis

Introduction and objectivesMultiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer (csPCa), and microultrasound (micro-US) shows promise in enhancing detection rates. We compared mpMRI-guided targeted biopsy (MTBx) and micro–US-guided targeted biopsy (micro–US-TBx) in biopsy-naïve patients with discordant lesions at micro-US and mpMRI to detect csPCa (grade group ≥2) and clinically insignificant PCa (ciPCa; grade group 1) and assessed the role of nontargeted systematic biopsy (SBx). Material and MethodsWe analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57–70), median prostate-specific antigen level was 7 ng/mL (IQR, 5–9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35–64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa. ResultsMicro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26–46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36–50), resulting in a -8% difference (95% CI: −10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a −3% difference (95% CI: −2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004). ConclusionsIn conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and assess micro-US's role in reducing unnecessary biopsies.

Does the type of the previous biopsy affect the fusion prostate biopsy results?

BackgroundIt has been more than a decade since fusion prostate biopsy (FPB) has been used in the diagnosis of prostate cancer (PCa). Therefore, patients with a previous history of negative FPB and ongoing suspicion of PCa are beginning to emerge. This study investigated whether the first biopsy type (standard or fusion) should be effective in deciding on a second biopsy. MethodsMale patients aged 40–75, with a serum prostate-specific antigen (PSA) value of less than 10 ng/mL and a negative biopsy history within the last 24 months, who underwent FPB in our clinic due to persistent PSA elevation and/or suspicious multiparametric prostate magnetic resonance imaging (MpMRI) findings were included to the study. Patients were divided into groups according to the type of first biopsy (Group 1; those whose first biopsy was FPB, Group 2; those whose first biopsy was standard prostate biopsy). Some demographic and clinical data of the groups, as well as PCa detection rates, were compared. A p value of less than 0.05 was considered statistically significant. ResultsA total of 275 patients (Group 1: 84, Group 2: 191) were included in this study. The groups were similar in terms of age, PSA values before the first biopsy, PSA values before the second biopsy, family history of PCa, and prostate volume. PCa was detected at a higher rate in Group 2 than Group 1 (23% vs 15.5%, p = 0.044). ConcluisonThe data obtained from this study indicate that the type of initial biopsy should be taken into account when deciding on FPB in secondary patients with a previous negative biopsy history.

A 2-year prospective evaluation of the Prostate Health Index in guiding biopsy decisions in a large cohort.

To prospectively evaluate how the Prostate Health Index (PHI) impacts on clinical decision in a real-life setting for men with a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and normal digital rectal examination. Since 2016, the PHI has been available at no cost to eligible men in all Hong Kong public hospitals. All eligible patients who received PHI testing in all public Urology units (n = 16) in Hong Kong between May 2016 and August 2017 were prospectively included and followed up. All included men had a PHI test, with its result and implications explained; the subsequent follow-up plan was then decided via shared decision-making with urologists. Patients were followed up for 2 years, with outcomes including prostate biopsy rates and biopsy findings analysed in relation to the initial PHI measurements. A total of 2828 patients were followed up for 2 years. The majority (82%) had PHI results in the lower risk range (score <35). Knowing the PHI findings, 83% of the patients with elevated PSA decided not to undergo biopsy. In all, 11% and 45% opted for biopsy in the PHI score <35 and ≥35 groups, respectively. The initial detection rate of International Society of Urological Pathology (ISUP) Grade Group (GG) ≥2 cancer was higher in the PHI score ≥35 group (23%) than in the PHI score <35 group (7.9%). Amongst patients with no initial positive biopsy findings, the subsequent positive biopsy rate for ISUP GG ≥2 cancer was higher in the PHI score ≥35 group (34%) than the PHI score <35 group (13%) with a median follow-up of 2.4 years. In a real-life setting, with the PHI incorporated into the routine clinical pathway, 83% of the patients with elevated PSA level decided not to undergo prostate biopsy. The PHI pathway also improved the high-grade prostate cancer detection rate when compared to PSA-driven strategies. Higher baseline PHI predicted subsequent biopsy outcome at 2 years. The PHI can serve as a tool to individualise biopsy decisions and frequency of follow-up visits.

Investigation of the Effectiveness of Prostate Biopsy Density in Predicting Prostate Cancer Under Cognitive and Systematic Biopsy in Multi-Parametric Magnetic Resonance Imaging (mpMRI).

To explore the effectiveness of prostate biopsy density in predicting prostate cancer under cognitive and systematic biopsy mode in multi-parametric magnetic resonance imaging (mpMRI). A retrospective analysis was conducted on clinical data of 204 patients who were suspected of having prostate cancer with prostate-specific antigen (PSA) levels less than 50 ng mL-1 and underwent cognitive and systematic biopsy through the perineal approach in our hospital from 2022 to 2023. Univariate and multivariate logistic regression analyses were used to evaluate the odds ratios of prostate biopsy density and relevant clinical indicators. Logistic regression analysis was performed to establish a predictive model combining indicators with predictive value. The predictive value of each indicator and the new model was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The detection rate of prostate cancer in the study population was 32.35%. Multivariate analysis showed that age, PSAD, PI-RADS 2.1 score, and prostate biopsy density were independent predictors of prostate cancer. The ROC curve analysis revealed an AUC of 0.707 (95% CI 0.625-0.790) for biopsy density, with a cutoff value of approximately 0.22 needle mL-1. The best predictive model consisted of age, PSAD, PI-RADS 2.1 score, and biopsy density, with an AUC of 0.857. Biopsy density is associated with the detection of prostate cancer, with a critical value of 0.22 needle mL-1. Combining biopsy density with other clinical indicators can significantly improve the ability to predict prostate cancer and avoid unnecessary prostate biopsy cores.

The detection rate for prostate cancer in systematic and targeted prostate biopsy in biopsy-naive patients, according to the localization of the lesion at the mpMRI: A single-center retrospective observational study.

Evaluate the detection rates of systematic, targeted and combined cores at biopsy according to tumor positions in biopsy-naïve patients. A retrospective analysis of a single-center patient cohort (n = 501) that underwent transrectal prostate biopsy between January 2017 and December 2019 was performed. Multi-parametric MRI was executed as a prebiopsy investigation. Biopsy protocol included, for each patient, 12 systematic cores plus 3 to 5 targeted cores per lesion identified at the mpMRI. Pearson and McNemar chi-squared tests were used for statistical analysis to compare tumor location-related detection rates of systematic, targeted and combined (systematic + targeted) cores at biopsy. Median age of patients was 70 years (IQR 62-72), with a median PSA of 8.5 ng/ml (IQR 5.7-15.6). Positive biopsies were obtained in 67.7% of cases. Overall, targeted cores obtained higher detection rates compared to systematic cores (54.3% vs. 43.1%, p < 0.0001). Differences in detection rates were, however, higher for tumors located at the apex (61.1% vs. 26.3%, p < 0.05) and anteriorly (44.4% vs. 19.3%, p < 0.05). Targeted cores similarly obtained higher detection rates in the posterior zone of the prostate gland for clinically significant prostate cancer. A poor agreement was reported between targeted and systematic cores for the apex and anterior zone of the prostate with, respectively κ = 0.028 and κ = -0.018. A combined approach of targeted and systematic biopsy delivers the highest detection rate in prostate cancer (PCa). The location of the tumor could however greatly influence overall detection rates, indicating the possibility to omit (as for the base or posterior zone of the gland) or add (as for the apex or anterior zone of the gland) further targeted cores.

Prostate cancer detection rate with MRI-targeted biopsy alone using outpatient transperineal prostate biopsy.

We aimed to compare the detection rate of prostate cancer (PCa) and clinically significant (cs) PCa by magnetic resonance imaging-guided targeted biopsy (MTBx) alone and MTBx plus systematic biopsy (SBx) using an outpatient transperineal (TP) approach under local anesthesia. A retrospective study of patients who underwent outpatient TP prostate biopsy under local anesthesia at our tertiary institution between 2019 and 2022 was performed. To compare the proportions of PCa and csPCa in both pathways, McNemar's tests were used. Multivariable logistic regression model was fitted to determine the predictors of csPCa. Of 255 men included, 177 (69%) underwent MTBx alone. MTBx had similar detection rate for PCa (56%) and csPCa (47%) compared to the combination of MTBx and SBx (PCa 61%; csPCa 49%; p=0.1 and p=0.3, respectively). MTBx had lower median number of biopsy cores compared to the combination of MTBx and SBx (6 vs. 11, p<0.001). At multivariable logistic regression analysis, age (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13, p<0.001), prior negative biopsy (OR 0.19, 95% CI 0.09-0.44, p<0.001), prostate-specific antigen density cutoff ≥0.15 (OR 3.17, 95% CI 1.67-6.01, p<0.001), and prostate imaging reporting and data system ≥4 (OR 12.2, 95% CI 4.21-35.6, p<0.001) were independent predictors of csPCa. MTBx showed similar diagnostic performance to the combination of MTBx and SBx in patients undergoing outpatient TP prostate biopsy. Future studies are needed to evaluate the role of MTBx in avoiding unnecessary biopsies.

Radical Prostatectomy Without Prior Biopsy in Selected Patients Evaluated by 18F-Labeled Prostate-Specific Membrane Antigen-Ligand Positron Emission Tomography/Computed Tomography and Multiparameter Magnetic Resonance Imaging: A Single-Center, Prospective, Single-Arm Trial.

This study aimed to verify the feasibility and short-term prognosis of prostatectomy without biopsy. Patients with a rising PSA level ranging from 4 to 30 ng/mL were scheduled for multiparametric (mp) MRI and 18F-labeled prostate-specific membrane antigen (PSMA) positron emission tomography (PET). Forty-seven patients (cT2N0M0) with Prostate Imaging Reporting and Data System ≥ 4 and molecular imaging PSMA score ≥ 2 were enrolled. All candidates underwent robot-assisted laparoscopic radical prostatectomy without biopsy. Prostate cancer detection rate, index tumors localization correspondence rate, positive surgical margin, complications, postoperative hospital stay, and PSA level in a 6-week postoperative follow-up visit were collected. All the patients with positive mpMRI and PSMA PET were diagnosed with clinically significant prostate cancer. A total of 80 lesions were verified as cancer by pathology, of which 63 cancer lesions were clinically significant prostate cancer. Fifty-one lesions were simultaneously found by mpMRI and PSMA PET. A total of 23 lesions were invisible on either image, and all lesions were ≤ International Society of Urological Pathology 2 or ≤ 15 mm. Forty-five (95.7%) index tumors found by mpMRI combined with PSMA PET were consistent with pathology. Nine patients reported positive surgical margin. Biopsy-free prostatectomy is safe and feasible for patients with evaluation strictly by mpMRI combined with 18F-PSMA PET/CT.

Effect of polygenic risk score for clinically significant prostate cancer in a screening program: The BARCODE 1 study results.

10500 Background: Incidence of prostate cancer (PCa) is increasing, but there is no internationally agreed population screening program. Studies using an age-based PSA approach show a high rate of false-positive results as well as over-diagnosis of indolent PCa. Genome wide association studies identify common germline variants to calculate a polygenic risk score (PRS) associated with PCa risk. The BARCODE1 study used PRS to target PCa screening to those at higher risk based on genotype. Methods: European men aged 55-69yrs were recruited via Primary Care in the UK. PRS was constructed by summing weighted risk alleles for 130 PCa risk variants using germline DNA from saliva samples via mailed kits. Men with a PRS &gt; 90th centile were invited for PCa screening using MRI and 12-core transperineal biopsy (including MRI fusion to target additional lesions where identified) irrespective of PSA result. Results: Invitation letters were sent to 40,292 men. 8,953 (22%) expressed an interest; 8,014 were eligible and sent a saliva kit. 6,644 consented; 6,393 were genotyped; 251 failed QC. A total of 6,142 participants had PRS calculated: 745 (12.1%) had a PRS &gt; 90th centile and were invited to screening. 558/745 participants attended screening (121 declined, 66 excluded on health grounds). 551 underwent MRI and 468 had prostate biopsy resulting in 187 (40.0%) diagnoses of PCa, overall PCa detection rate 2.8%. Mean age at diagnosis 64.1yrs (range 57-73; median 64). Using NCCN criteria (2023) 103/187 (55.1%) of cancers were Intermediate or High Risk; 40/187 (21.4%) were Intermediate Unfavourable/High/Very High Risk. 119/187 (63.6%) men had a PSA &lt;3.0ug/L; PPV of biopsy for PSA &gt; 3.0ug/L was 49.6%. PPV of MRI (presence of PI-RADS 3-5 lesion) 60.4%. PPV of PRS alone 40%. 103/187 (55.1%) had Gleason &gt;7; compared with 360/1014 (35.5%) p &lt; 0.001 in the PSA directed ERSPC study. Conclusions: A population PCa screening program using PRS risk-stratification enriches for clinically significant PCa requiring treatment. It detects a high proportion of clinically significant disease compared with PSA or MRI based screening programs and MRI missed a significant proportion (17-67%) of cancers found on biopsy. This is the first study to assess if this approach will be useful in population screening programs. Clinical trial information: NCT03857477 . [Table: see text]