Fusion Prostate Biopsy Research Articles

Remote surgical education using synthetic models combined with an augmented reality headset

ObjectiveThe objective was to investigate the use of an augmented reality headset to remotely train clinicians on medical devices using anatomic models. DesignDisease-specific phantoms were developed to train physicians in mpMRI-guided fusion prostate biopsy, brachytherapy, and rectal spacer insertion. Training was remotely demonstrated using 1-way virtual video conferencing format. Participants responded to an educational content survey. A heads-up display with software and augmented reality was used for remote 2-way training with the proctor and student using on their own phantoms. SettingThe virtual video meeting took place during a prostate cancer conference in 2020, while the augmented reality training occurred in 2021. The proctor and student wore a heads-up display containing a projector and webcam where the ultrasound image was displayed onto a see-through optic along with the physician's hands. The heads-up display allowed the proctor to teach by line-of-sight while the student watched and repeated the steps. ParticipantsFaculty with expertise with the medical devices used in these procedures provided training to urologists unfamiliar with these techniques. ResultsParticipants responded that the 1-way training on the phantoms was realistic and mimicked human tissue. A total of 70.9% requested more training or training on the phantoms. The remote training platform was successfully beta tested at the 2 locations in transperineal prostate biopsy and rectal spacer insertion. ConclusionRemote training using augmented reality eliminates the need for travel. For training programs and workshops, this technology may mitigate the risk of infectious exposures, reduce training cost, and increase proctor availability, allowing training from their own institution or clinic.This investigation qualifies for the Accreditation Council for Graduate Medical Education competency in medical knowledge.

Abstract 2222: Detecting clinically significant prostate cancers: Tissue metabolomics refines multiparametric MRI-ultrasound fusion prostate biopsy

Abstract The advent of prostate specific antigen (PSA) testing led to increased early prostate cancer (PCa) detection and has decreased PCa-related death. However, PSA is not cancer-specific, and the challenge persists of differentiating those PCa patients with indolent tumors from those requiring definitive therapy. Metabolomic profiles have the potential to capture molecular dynamics of disease and to reflect disease status before cellular manifestations become observable by histopathology. With clinical, multiparametric magnetic resonance imaging (mpMRI)-positive, fusion biopsy-targeted tissue cores and mpMRI-negative controls in a training-testing cohort design, we studied the potential of magnetic resonance spectroscopy (MRS) to yield cancer metabolomic profiles that could help discriminate likely indolent from clinically significant disease. Using MRS-based PCa metabolomic analyses, performed prior to histology, our approach is able to: determine metabolomic relevations identified in fusion biopsy targets, estimate the scale of PCa metabolomic fields, and detect clinically significant disease in tissues deemed benign or low-risk PCa by pathology and imaging. Our intact tissue MRS metabolomics evaluations indicated significant differences in individual prostate tissue metabolites based on Target-Contralateral (Contral) paired comparisons for both Training and Testing cohorts. We identified metabolomic differences among Target prostate biopsy cores obtained from mpMRI lesions of different PI-RADS scores, and between Target and non-target Contral cores. As a retrospective study, we also analyzed data collected at the time of the initial prostate biopsy alongside patient status across follow up. By introducing metabolomics, as compared with using PSAd or PI-RADS alone, the sensitivity predictions increased by 80.0% and 25.0%, respectively; NPV increased by 18.1% and 8.0%; and accuracy for PSAd increased by 13.0%. PI-RADS accuracy stayed the same Our results show that tissue metabolomic profiles could augment current MR-based imaging findings and histopathological evaluations of fusion biopsies for certain patient populations by more accurately characterizing them into clinically significant or insignificant subgroups. In our analyses, tissue metabolomics alone, or its combination with other clinical parameters, improved sensitivity and negative predictive values, as well as overall accuracy, for our testing cohort. This method, which relies on performing tissue MRS of needle biopsy cores prior to histopathologic analysis, causes no interruption to patient care. Findings from our study demonstrate the utility and translational potential of cancer metabolomics in personalized treatment for PCa and encourages the development of in vivo PCa metabolomic imaging to enhance the diagnostic utility of mpMRI. Citation Format: Leo L. Cheng, Adam S. Feldman, Lindsey A. Vandergrift, Isabella H. Muti, Florian Rumpf, Andrew Gusev, Yannick Berker, Marcella R. Cardoso, Taylor L. Fuss, Emily D. Negroponte, Shulin Wu, Felix Ehret, Christopher A. Dietz, Sarah S. Dinges, Thitinan Chulroek, Edouard Nicaise, Piet Habbel, Martin Ayree, Johannes Nowak, Douglas M. Dahl, Chin-Lee Wu, Mukesh Harisinghani. Detecting clinically significant prostate cancers: Tissue metabolomics refines multiparametric MRI-ultrasound fusion prostate biopsy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2222.

Concordance of MRI-Guided Fusion and Systematic 12-Core Prostate Biopsy for the Detection of Prostate Cancer.

BackgroundMRI-guided fusion biopsy is increasingly utilized over systematic 12-core biopsy for men with MRI-visible prostate lesions.Patients and MethodsPatients with MRI visible lesions who underwent MRI-guided fusion and systematic 12-core biopsy from 2016-2020 in the Intermountain Healthcare (IHC) system were consecutively analyzed. This was in the setting of a continuous quality assurance initiative among the reading radiologists. Primary outcome was prostate cancer (PCa) detection defined by Gleason grade group (GGG) 1 or higher. Clinically significant cancer (CSC) was defined as GGG 2 or higher. Patients were stratified by biopsy date, 2016-2017 and 2018-2021, and lesions were stratified by PI-RADS v2 category.ResultsA total of 184 patients with 324 MRI-detectable lesions underwent both biopsy modalities in the IHC system from 2016 to 2021. CSC was detected in 23.5% of MRI-guided fusion biopsies. Comparing PI-RAD v2 categories 1-3 to categories 4-5, rate of CSC was 10% and 42% respectively. MRI-guided fusion and systematic 12-core biopsies were concordant for PCa in 77% of men and CSC in 83%. MRI-guided fusion biopsy detected PCa in 26/103 and CSC in 20/131 men in whom systematic 12-core biopsy was negative. Systematic 12-core biopsy detected PCa in 17/94 and CSC in 11/122 men in whom MRI-guided fusion was negative.ConclusionsOmitting MRI-guided fusion or systematic 12-core biopsy would have resulted in underdiagnosis of CSC in 11% or 6% of patients respectively. Combining biopsies increased detection rate of CSC. This was in the setting of a continuous quality assurance program at a large community-based hospital.

Fusion versus cognitive MRI-guided prostate biopsies in diagnosing clinically significant prostate cancer

Objective: This study assesses whether fusion or cognitive magnetic resonance imaging (MRI)-guided prostate targeted and systematic transperineal biopsies (TPB) increase detection of clinically significant prostate cancer (csPCa). Materials and Methods: A retrospective analysis was completed of patients (2018–2020) undergoing 3-Tesla multiparametric prostate MRI informing targeted (either cognitive or MIM software fusion approach) and systematic TPB. ISUP (International Society of Urological Pathology) grade group ⩾ 2 was considered csPCa. Results: A total of 355 cases from 4 urologists were included; 131 were fusion and 224 were cognitive MRI-guided biopsies. Of all csPCa found, 86.8% ( n = 171) of cases were confirmed to be at the MRI-indicated location and 11.6% were found as part of active surveillance. In all, 45.0% of the fusion group were found to have csPCa, compared to 62.05% ( n = 139) in the cognitive group ( p = 0.002). csPCa detection rates varied between urologists (41% to 78%, p < 0.001), so a subgroup analysis was performed on Urologist A; 45.0% of fusion and 41.3% of cognitive biopsies had csPCa ( p = 0.644). Multinomial logistic regression analysis showed that biopsy type, being on active surveillance, number of biopsy cores, iPSA (initial Prostate Specific Antigen) value or PIRADS (Prostate Imaging-Reporting and Data System) score made no significant difference in whether csPCa was found. Conclusion: Cognitive and fusion targeting had similar csPCa detection rates. Further prospective studies would be beneficial to validate these findings. Level of evidence: 2b (according to Oxford Centre for Evidence-Based Medicine)

MP43-06 COMPARING MRI/US FUSION TO STANDARD PROSTATE BIOPSY IN DETERMINING GRADE RECLASSIFICATION AT CONFIRMATORY BIOPSY IN A MULTI-INSTITUTIONAL ACTIVE SURVEILLANCE COHORT: A PENNSYLVANIA UROLOGY REGIONAL COLLABORATIVE (PURC) ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP43-06 COMPARING MRI/US FUSION TO STANDARD PROSTATE BIOPSY IN DETERMINING GRADE RECLASSIFICATION AT CONFIRMATORY BIOPSY IN A MULTI-INSTITUTIONAL ACTIVE SURVEILLANCE COHORT: A PENNSYLVANIA UROLOGY REGIONAL COLLABORATIVE (PURC) ANALYSIS David Strauss, Rohit Reddy, Matthew Loecher, Kaynaat Syed, John Danella, Serge Ginzburg, Laurence Belkoff, Jeffrey Tomaszewski, Edouard Trabulsi, Eric Singer, Bruce Jacobs, Jay Raman, Thomas Guzzo, Robert Uzzo, and Adam Reese David StraussDavid Strauss More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Matthew LoecherMatthew Loecher More articles by this author , Kaynaat SyedKaynaat Syed More articles by this author , John DanellaJohn Danella More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Laurence BelkoffLaurence Belkoff More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Eric SingerEric Singer More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Jay RamanJay Raman More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Adam ReeseAdam Reese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) has emerged as the optimal management of low-risk prostate cancer (CaP) patients, and relies on an accurate confirmatory biopsy to stratify disease risk. The literature is conflicting regarding whether multiparametric (mp) MRI/fusion biopsy improves detection of clinically significant cancers compared to standard 12-core trans rectal ultrasound (TRUS) at time of confirmatory AS biopsy. We aimed to analyze a prospectively maintained multi-institutional AS database with the intent to compare clinically significant reclassification rates between biopsy groups at confirmatory biopsy. METHODS: The Pennsylvania Urological Regional Collaborative (PURC) database, a prospectively maintained consortium CaP database, was retrospectively queried for all low-risk CaP men on AS. Patients were categorized by modality of confirmatory biopsy (either standard 12 core TRUS prostate biopsy or mpMRI targeted/ultrasound fusion prostate biopsy). The primary outcome of interest was grade group reclassification at the time of confirmatory biopsy. RESULTS: The study cohort included 469 low risk men on AS, with 339 (72%) undergoing standard 12-core TRUS confirmatory biopsy and 130 (28%) undergoing fusion confirmatory biopsy. There were no differences between groups at index biopsy, regarding demographic or disease characteristics. (Table 1) Clinically significant grade reclassification, defined as GG2 or greater, was seen on 42% (54) of mpMRI biopsies vs. only 22% (74) of standard biopsies (p < 0.001) (Table 2). CONCLUSIONS: The use of mp-MRI for AS confirmatory biopsy, compared to standard 12-core TRUS biopsy, improved the detection of clinically significant cancer. These findings suggest the value of MRI/US fusion biopsy to appropriately identify higher risk men on AS who may benefit from definitive treatment. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e742 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Strauss More articles by this author Rohit Reddy More articles by this author Matthew Loecher More articles by this author Kaynaat Syed More articles by this author John Danella More articles by this author Serge Ginzburg More articles by this author Laurence Belkoff More articles by this author Jeffrey Tomaszewski More articles by this author Edouard Trabulsi More articles by this author Eric Singer More articles by this author Bruce Jacobs More articles by this author Jay Raman More articles by this author Thomas Guzzo More articles by this author Robert Uzzo More articles by this author Adam Reese More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD41-07 LEARNING CURVE FOR TRANSPERINEAL ULTRASOUND/MRI FUSION BIOPSY FOR THE DETECTION OF PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD41-07 LEARNING CURVE FOR TRANSPERINEAL ULTRASOUND/MRI FUSION BIOPSY FOR THE DETECTION OF PROSTATE CANCER Yuval Elkun, Henry Dumke, Vincent Wong, Daniel Bassily, Nathan Wong, and Christopher Dixon Yuval ElkunYuval Elkun More articles by this author , Henry DumkeHenry Dumke More articles by this author , Vincent WongVincent Wong More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Nathan WongNathan Wong More articles by this author , and Christopher DixonChristopher Dixon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002602.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transrectal ultrasound guided prostate biopsy has long been the diagnostic standard; however, inherent limitations along with technological advancements have paved the way for multiparametric Magnetic Resonance Imaging (MRI) and fusion biopsy to be used as diagnostic tools. Few studies have examined the learning curve associated with MRI-ultrasound (US) guided fusion biopsy, with most examining the transrectal (TR) biopsy approach. There is a paucity of data describing the learning curve using the transperineal (TP) approach. Herein, we seek to describe the learning curve associated with MRI-US TP guided fusion biopsy. METHODS: After institutional review board approval, a retrospective review was performed for consecutive men who underwent MRI-US TP fusion biopsy between June 2018 and October 2020 involving 5 different urologists. All men had an elevated prostate specific antigen (PSA) (> 4.0 ng/mL) or abnormal digital rectal exam and underwent MRI demonstrating a lesion using the Prostate Imaging Reporting and Data System (PIRADS) version 2 guidelines. All men subsequently underwent TP targeted biopsy with the KOELIS TrinityTM prostate fusion biopsy system. The overall cohort was separated into quartiles (N=40 per group) and was also stratified by urologist and PIRADS score. RESULTS: A total of 160 patients underwent MRI-US TP fusion biopsy. The learning curve for overall cancer detection rate (Gleason Grade Group (GG) 1-5) was approximately 80 cases (cancer detection rate per quartile=57.5, 50, 62.5 and 65%, p<0.01) and was approximately 40 cases (cancer detection rate per quartile=22.5, 40, 47.5 and 40%, p<0.01) for clinically significant prostate cancer (csPC) (defined as Gleason GG 2-5). When stratified by urologist of varying experience and volume, there was no appreciable difference in the cancer detection rate or learning curve for csPC (p=0.6). When stratified by PIRADS score, cancer detection rates typically stabilized after 25 cases for PIRADS 3 and 4 lesions with minimal to no learning curve for PIRADS 5 lesions (Figure 1). CONCLUSIONS: The learning curve for csPC detection rate using the KOELIS TrinityTM prostate fusion biopsy system via a TP approach was approximately 40 cases which did not vary based on user. Lower PIRADS scores of 3-4 were associated with a longer learning curve. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e691 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuval Elkun More articles by this author Henry Dumke More articles by this author Vincent Wong More articles by this author Daniel Bassily More articles by this author Nathan Wong More articles by this author Christopher Dixon More articles by this author Expand All Advertisement PDF DownloadLoading ...

V07-04 SINGLE PORT TRANSVESICAL PARTIAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022V07-04 SINGLE PORT TRANSVESICAL PARTIAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER Ethan Ferguson, Mahmoud Abou Zeinab, Alp Tuna Beksac, Aaron Kaviani, Christopher Weight, Eric Klein, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Aaron KavianiAaron Kaviani More articles by this author , Christopher WeightChristopher Weight More articles by this author , Eric KleinEric Klein More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cross-sectional imaging guided prostate biopsy has allowed for more accurate diagnosis of clinically localized prostate cancer. Appropriately counseled patients with low or intermediate risk localized disease may opt for focal or ablative therapies. Recently, partial prostatectomy has been shown to be safe and effective for anterior prostate tumors. The single port da Vinci surgical platform with a transvesical approach allows for anterograde dissection of the prostate gland with minimal disturbance to the space of retzius and has recently been adapted for simple and radical prostatectomy. In 2018, cadaver studies demonstrated that partial prostate gland excision was feasible using a single port transvesical approach. Here we present the case of a patient undergoing single port transvesical partial prostatectomy. METHODS: A patient with localized Gleason 3+4 prostate cancer in the left lateral peripheral zone diagnosed on MRI fusion prostate biopsy. The procedure was performed with intraoperative MRI fusion using the KOELISâ mobile fusion imaging platform. The following surgical steps were described: (1) anterograde bladder neck dissection, (2) endopelvic fascia incision, (3) unilateral vascular pedicle ligation, (4) partial DVC ligation, (5) lateral lobe excision, (6) Surgical margin assessment, (7) bladder neck reconstruction. RESULTS: The patient underwent an uncomplicated single port robotic partial prostatectomy with removal of the left lateral lobe and seminal vesical. Intraoperative frozen sections of medial and lateral margins were negative for malignancy. He was discharged after spending 3.8 hours in recovery and did not require narcotics at discharge. His foley catheter was removed on postop day 3 and he was fully continent within 7 days of foley removal. He had good erectile function preoperatively and was fully potent within seven days of surgery. 6 month follow up data shows a stable PSA of 0.88 and no lesions on prostate MRI. CONCLUSIONS: Single port transvesical partial prostatectomy is feasible and safe in carefully selected men with localized prostate cancer. Close attention to ongoing postoperative follow up is imperative to determine long-term oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e660 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Mahmoud Abou Zeinab More articles by this author Alp Tuna Beksac More articles by this author Aaron Kaviani More articles by this author Christopher Weight More articles by this author Eric Klein More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF DownloadLoading ...

Concordance between biparametric MRI, transperineal targeted plus systematic MRI-ultrasound fusion prostate biopsy, and radical prostatectomy pathology

We aimed to confirm the reliability of the results of bi-parametric magnetic resolution imaging-ultrasound fusion targeted and systematic biopsies (bpMRI-US transperineal FTSB) compared to prostatectomy specimens. We retrospectively analyzed the records of 80 men who underwent bpMRI-US transperineal FTSB with region of interest (ROI) and subsequent robot-assisted radical prostatectomy. Changes in the grade group determined by MRI and biopsy versus surgical specimens were analyzed. Thirty-five patients with insignificant prostate cancer and 45 with significant cancer were diagnosed using bpMRI-US transperineal FTSB. Among those with insignificant PCa, 25 (71.4%) were upgraded to significant PCa in prostatectomy specimens: 9/12 (75.0%) with Prostate Imaging Reporting and Data System (PI-RADS) 3, 12/16 (75.0%) with PI-RADS 4, and 4/7 (57.1%) with PI-RADS 5. In the PI-RADS 3 group, the upgraded group showed higher prostate specific antigen (PSA) and PSA density (PSAD) than the concordance group; PSA 8.34(2.73) vs. 5.31(2.46) (p = 0.035) and PSAD 0.29(0.11) vs. 0.18(0.09) (p = 0.025). The results of prostate biopsy and prostatectomy specimens were inconsistent and underestimated in patients with MRI-visible lesions. Therefore, for precise and individualized treatment strategies for PCa with MRI-visible lesions, careful interpretation of biopsy result is required.

MRI/US fusion transperineal versus transrectral biopsy of prostate cancer: Outcomes and complication rates, a tertiary medical center experience in the Middle East.

To report on the outcomes of transperineal versus transrectal magnetic resonance imaging/ultrasound fusion biopsy of the prostate including detection of clinically significant cancer and complications. This is the first and largest series in the Middle East. Between May 2019 and June 2020, 145 patients with suspicious lesions on magnetic resonance imaging underwent magnetic resonance imaging/ultrasound fusion prostate biopsy at our center. Transperineal biopsy was performed under light sedation, while transrectal biopsy patients had a periprostatic block for anesthesia. Clinically significant cancer was defined as Gleason ≥3+4 Results: In all, 98 transperineal biopsies and 47 transrectal magnetic resonance imaging/ultrasound fusion prostate biopsies were done. Patients had similar prebiopsy parameters (transperineal vs. transrectal): median age (64.5 vs. 66 years; P=.68), median prostate-specific antigen value (7.5 vs. 7.5; P=.42), and median prostate volume (51 vs. 52.5; P=.83). Those that underwent transperineal biopsy had fewer average total number of cores compared to transrectal ultrasound-guided biopsy (11 vs. 13; P=.025) fewer average number of random cores (3 vs. 6; P < .0001), and the detection rate of clinically significant cancer was similar between the groups (44% vs. 48.9%; P=.57). No difference in hematuria, retention, and sepsis rate requiring admission (1 vs. 2; P=.2) was observed. However, more patients had urinary tract infection in the transrectal ultrasound-guided biopsy group compared to transperineal biopsy group (5 vs. 1; P=.006) that were treated with antibiotics on outside basis. Magnetic resonance imaging/ultrasound transperineal fusion biopsy has similar detection rate of clinically significant cancer compared to transrectal ultrasound-guided biopsy with less urinary tract infection post biopsy.

The application of intraoperative frozen section examination in multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy during a major pandemic.

To investigate the value of intraoperative frozen section examination (IFSE) in multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion prostate biopsy in a major pandemic. A total of 35 patients were prospectively enrolled in our hospital from March 2020 to January 2021. The mpMRI/TRUS fusion system was used to perform a targeted biopsy, and the collected specimens were examined by IFSE (Observation Group 1). Then, a targeted biopsy was performed again for routine pathological examination (Observation Group 2). Finally, a systemic biopsy was performed, and the obtained specimens were routinely examined (Control Group). The positive rate, single core positive rate, Gleason score, and time to obtain pathological reports were compared between the groups. The positive rate was 48.6% (17/35) in the control group, 48.6% (17/35) in Observation Group 1, and 51.4% (18/35) in Observation Group 2, showing no significant difference (P>0.05). The single core positive rates were 17.8%, 44.6%, and 47.1% in the Control Group, Observation Group 1, and Observation Group 2, respectively. Observation Group 1 and Observation Group 2 were significantly different from the Control Group (P<0.001). No participants in Observation Group 1 had increased or decreased Gleason scores compared with those in Observation Group 2. The time to obtain the pathological report was 0.025±0.014 days and 4.216±1.073 days for Observation Group 1 and Observation Group 2, respectively, showing a significant difference (P<0.001). This study showed that IFSE can not only rapidly obtain the pathological report of an mpMRI/TRUS biopsy, but can also ensure the accuracy of the pathological diagnosis. CHICTR, Identifier: ChiCTR2000040789. Registered 10 December 2020 - Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=63252&htm=4.

T2 mapping for the characterization of prostate lesions

PurposePurpose of this study is to evaluate the diagnostic accuracy of quantitative T2/ADC values in differentiating between PCa and lesions showing non-specific inflammatory infiltrates and atrophy, features of chronic prostatitis, as the most common histologically proven differential diagnosis.MethodsIn this retrospective, single-center cohort study, we analyzed 55 patients suspected of PCa, who underwent mpMRI (3T) including quantitative T2 maps before robot-assisted mpMRI-TRUS fusion prostate biopsy. All prostate lesions were scored according to PI-RADS v2.1. Regions of interest (ROIs) were annotated in focal lesions and normal prostate tissue. Quantitative mpMRI values from T2 mapping and ADC were compared using two-tailed t tests. Receiver operating characteristic curves (ROCs) and cutoff were calculated to differentiate between PCa and chronic prostatitis.ResultsFocal lesions showed significantly lower ADC and T2 mapping values than normal prostate tissue (p < 0.001). PCa showed significantly lower ADC and T2 values than chronic prostatitis (p < 0.001). ROC analysis revealed areas under the receiver operating characteristic curves (AUCs) of 0.85 (95% CI 0.74–0.97) for quantitative ADC values and 0.84 (95% CI 0.73–0.96) for T2 mapping. A significant correlation between ADC and T2 values was observed (r = 0.70; p < 0.001).ConclusionT2 mapping showed high diagnostic accuracy for differentiating between PCa and chronic prostatitis, comparable to the performance of ADC values.

Biomechanical modelling of the pelvic system: improving the accuracy of the location of neoplasms in MRI-TRUS fusion prostate biopsy

BackgroundAn accurate knowledge of the relocation of prostate neoplasms during biopsy is of great importance to reduce the number of false negative results. Prostate neoplasms are visible in magnetic resonance images (MRI) but it is difficult for the practitioner to locate them at the time of performing a transrectal ultrasound (TRUS) guided biopsy. In this study, we present a new methodology, based on simulation, that predicts both prostate deformation and lesion migration during the biopsy.MethodsA three-dimensional (3-D) anatomy model of the pelvic region, based on medical images, is constructed. A finite element (FE) numerical simulation of the organs motion and deformation as a result of the pressure exerted by the TRUS probe is carried out using the Code-Aster open-source computer software. Initial positions of potential prostate lesions prior to biopsy are taken into consideration and the final location of each lesion is targeted in the FE simulation output.ResultsOur 3-D FE simulations show that the effect of the pressure exerted by the TRUS probe is twofold as the prostate experiences both a motion and a deformation of its original shape. We targeted the relocation of five small prostate lesions when the TRUS probe exerts a force of 30 N on the rectum inner wall. The distance travelled by these lesions ranged between 5.6 and 13.9 mm.ConclusionsOur new methodology can help to predict the location of neoplasms during a prostate biopsy but further studies are needed to validate our results. Moreover, the new methodology is completely developed on open-source software, which means that its implementation would be affordable to all healthcare providers.

Initial experience and cancer detection rates of office-based transperineal magnetic resonance imaging-ultrasound fusion prostate biopsy under local anesthesia.

We aimed to demonstrate feasibility and cancer detection rates of office-based ultrasound-guided transperineal magnetic resonance imaging-ultrasound (MRI-US) fusion (TFB) prostate biopsy under local anesthesia. With institutional review board approval, records of men undergoing TFB in the office setting under local anesthesia were reviewed. Baseline patient characteristics, MRI findings, cancer detection rates, and complications were recorded. The PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD, U.S.), along with UroNav 3.0 image-fusion system (Invivo International, Best, The Netherlands) were used for all procedures. Following biopsy, men were surveyed to assess patient experience. Between January 2019 and February 2020, 200 TFBs were performed, of which 141 (71%) were positive for prostate cancer, with 117 (83%) Gleason grade group 2 or higher. A total of 259 of 265 MRI lesions were biopsied, with 127 (49%) positive overall. Prostate Imaging-Reporting and Data System (PI-RADS) 4-5 lesions were positive for prostate cancer in 59% of cases. The mean procedural time was 20 minutes, with a patient enter-to-exit room time of 54 minutes. There were no septic complications, no patients required post-procedure hospital admission, and all procedures were successfully completed. Seventy-five percent of patients surveyed reported complete resolution of pain at three days following the procedure. Office-based TFB represents a viable approach to prostate cancer detection following prostate MRI. Larger-scale assessment is needed to categorize cancer detection rates more accurately by PI-RADs subset, patient selection factors, complication rate, and cost relative to TFB under anesthesia.

Artificial intelligence trained with integration of multiparametric MR-US imaging data and fusion biopsy trajectory-proven pathology data for 3D prediction of prostate cancer: A proof-of-concept study.

We aimed to develop an artificial intelligence (AI) algorithm that predicts the volume and location of clinically significant cancer (CSCa) using convolutional neural network (CNN) trained with integration of multiparametric MR-US image data and MRI-US fusion prostate biopsy (MRI-US PBx) trajectory-proven pathology data. Twenty consecutive patients prospectively underwent MRI-US PBx, followed by robot-assisted radical prostatectomy (RARP). The AI algorithm was trained with the integration of MR-US image data with a MRI-US PBx trajectory-proven pathology. The relationship with the 3D-cancer-mapping of RARP specimens was compared between AI system-suggested 3D-CSCa mapping and an experienced radiologist's suggested 3D-CSCa mapping on MRI alone according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2. The characteristics of detected and undetected tumors at AI were compared in 22,968 image data. The relationships between CSCa volumes and volumes predicted by AI as well as the radiologist's reading based on PI-RADS were analyzed. The concordance of the CSCa center with that in RARP specimens was significantly higher in the AI prediction than the radiologist' reading (83% vs. 54%, p = 0.036). CSCa volumes predicted with AI were more accurate (r = 0.90, p < 0.001) than the radiologist's reading. The limitations include that the elastic fusion technology has its own registration error. We presented a novel pilot AI algorithm for 3D prediction of PCa. AI was trained by integration of multiparametric MR-US image data and fusion biopsy trajectory-proven pathology data. This deep learning AI model may more precisely predict the 3D mapping of CSCa in its volume and center location than a radiologist's reading based on PI-RADS version 2, and has potential in the planning of focal therapy.

A0750 - Micro-ultrasound-guided biopsy for prostate cancer reduces underestimation of index lesion extension at final pathology compared to mri/ultrasound prostate fusion biopsy: Impact on ablation therapy templates

A0750 - Micro-ultrasound-guided biopsy for prostate cancer reduces underestimation of index lesion extension at final pathology compared to mri/ultrasound prostate fusion biopsy: Impact on ablation therapy templates

A0467 - Diagnostic performance of Fusion (US/MRI guided) prostate Biopsy: Comparison of elastic transrectal versus rigid transrectal versus rigid transperineal fusion system

A0467 - Diagnostic performance of Fusion (US/MRI guided) prostate Biopsy: Comparison of elastic transrectal versus rigid transrectal versus rigid transperineal fusion system

A0478 - Interreader agreement with Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1 to improve the detection rate of prostate cancer in MRI/TRUS software fusion prostate biopsy

A0478 - Interreader agreement with Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1 to improve the detection rate of prostate cancer in MRI/TRUS software fusion prostate biopsy

Development of a nomogram combining multiparametric magnetic resonance imaging and PSA-related parameters to enhance the detection of clinically significant cancer across different region.

Prostate cancer (PCa) is the most prevalent cancer among males. This study attempted to develop a clinically significant prostate cancer (csPCa) risk nomogram including Prostate Imaging-Reporting and Data System (PI-RADS) score and other clinical indexes for initial prostate biopsy in light of the different prostate regions, and internal validation was further conducted. A retrospective study was performed including 688 patients who underwent ultrasound-guided transperineal magnetic resonance imaging fusion prostate biopsy from December 2016 to July 2019. We constructed nomograms combining PI-RADS scoreand clinical variables (prostate-specific antigen [PSA], prostate volume (PV), age, free/total PSA,and PSA density) through univariate and multivariate logistic regression to identify patients eligible for biopsy. The performance of the predictive model was evaluated by bootstrap resampling. The area under the curve (AUC) of the receiver-operating characteristic (ROC) analysis was appointed to quantify the accuracy of the primary nomogram model for csPCa. Calibration curves were used to assess the agreement between the biopsy specimen and the predicted probability of the new nomogram. The χ2 test was also applied to evaluate the heterogeneity between fusion biopsy and systematic biopsy based on different PI-RADS scores and prostate regions. A total of 320 of 688 included patients were diagnosed withcsPCa. csPCa was defined as Gleason score ≥7. The ROC and concordance-index both presented good performance. The nomogram reached an AUC of 0.867 for predicting csPCa at the peripheral zone; meanwhile, AUC for transitionaland apex zones were 0.889 and 0.757, respectively. Statistical significance was detected between fusion biopsy and systematic biopsy for PI-RADS score >3 lesions and lesions at the peripheraland transitional zones. We produced a novel nomogram predicting csPCa in patients with suspected imaging according to different locations. Our results indicated that PI-RADS score combined with other clinical parametersshowed a robust predictive capacity for csPCa before prostate biopsy. The new nomogram, which incorporates prebiopsy data including PSA, PV, age, and PI-RADS score, can be helpful for clinical decision-making to avoid unnecessary biopsy.

Diagnostic performance of fusion (US/MRI guided) prostate biopsy: propensity score matched comparison of elastic versus rigid fusion system.

Many software for US/MRI guided fusion prostate biopsy (FPB), have been developed in the last years. However, there are few data comparing diagnostic accuracy of different fusion systems. We assessed diagnostic performance of elastic (EF) versus rigid fusion (RF) PB in a propensity score matched (PSM) analysis. A total of 314 FPB were prospectively collected from two different centers. All patients were biopsy naïve and all mpMRI reported a single suspicious area. Overall, 211PB were performed using a RF system and 103 using an EF software. The two groups were compared for the main clinical features. A 1:1 PSM analysis was employed to reduce covariate imbalance to < 10%. Detection rate (DR) for any prostate cancer (PCa) and clinically significant (cs) PCa were compared and stratified for PI-RADS Score. A per target univariable and multivariable regression analyses were applied to identity predictors of anyPCa and csPCa. After applying the PSM, two cohorts of 83 cases were selected. DR of any PCa cancer and csPCa were comparable between the two cohorts (all p > 0.077) as well as DR of csPCa for every PIRADS score. At univariable regression analysis lesion size, PI-RADS Score, PSA Density and EF system were predictors of any PCa (all p < 0.001); however, at multivariable analysis only PI-RADS Score was independent predictor of any PCa (p = 0.027). At multivariable analysis only PI-RADS score was independent predictor of csPCa. Fusion PB guarantees high diagnostic accuracy for csPCa, regardless of the fusion technology. Prospective randomized study is needed to confirm these data.

Saturation target biopsy can overcome the learning curve of magnetic resonance imaging/ultrasound fusion biopsy of the prostate

Background: Magnetic resonance imaging (MRI) has emerged as a promising tool for diagnosing prostate cancer. Magnetic resonance imaging/ultrasound (MRI/US) fusion target biopsy (TB) can increase the detection rate of clinically significant prostate cancer (csPC) and decrease the detection rate of clinically insignificant PC (ciPC) compared with systematic biopsy (SB). However, the MRI/US fusion biopsy had a steep learning curve. A new biopsy template, saturation TB (sTB), was reported to provide a cancer detection rate comparable to that of the combination of TB and SB. This study reports our experience with MRI/US fusion prostate biopsy and investigates the role of sTB in MRI/US fusion biopsy. Methods: We prospectively enrolled males with elevated prostate-specific antigen or abnormal digital rectal examination (DRE) and Prostate Imaging Reporting &amp; Data System (PI-RADS) score ≥3 who underwent MRI/US fusion prostate biopsy in a tertiary referral center. We compared cancer detection rates among different biopsy templates, including TB, SB, sTB, and the combination of TB and SB. The biopsy results and complications were recorded. Results: The detection rate of csPC by sTB was significantly higher than that of TB (53% vs. 44%; p = 0.008) or SB (53% vs. 43%; p = 0.002). The median biopsy cores were 6, 15, and 26 for TB, sTB, and the combination of TB and SB, respectively. In other words, sTB could decrease 11 biopsy cores without compromising the cancer detection rate compared with the combination of TB and SB. There were no Clavien-Dindo score of ≥3 complications in any of the patients. Conclusion: The sTB template can overcome targeting errors during MRI/US fusion biopsy, offering a cancer detection rate equal to the combination of TB and SB with reduced biopsy cores.