Gleason Score Research Articles

Multi-parametric magnetic resonance imaging of prostate cancer: correlation between Ktrans, Gleason score, and PI-RADS score

PurposeTo measure Ktrans and correlate it with Gleason score (GS) and PI-RADS score in patients with prostate cancer.MethodsThis retrospective study included patients with pathologically proven prostate cancer who had undergone clinically indicated 1.5 Tesla multi-parametric magnetic resonance imaging (MRI) examination between February and December 2020. T2-weighted (T2w) images, diffusion-weighted images (DWI), and dynamic contrast-enhanced (DCE) sequences were obtained. PI-RADS score was calculated for all tumor lesions. From DCE-MRI dataset, Ktrans was computed and compared between patients with clinically insignificant (GS ≤ 6) and clinically significant (GS ≥ 7) prostate cancer. Spearman rank-order correlation coefficient (ρ) was used to assess the correlation strength between Ktrans and GS and between Ktrans and PI-RADS score.ResultsTwenty-one patients (age: 67 ± 12 years; BMI: 26.63 ± 4.04 kg/m2) with a PSA of 7.91 ± 3.01 were included in the study. Seven patients (33.3%) had clinically insignificant prostate cancer, while 14 patients (66.7%) were diagnosed with clinically significant prostate cancer. Mean Ktrans value was 0.42 ± 0.20 min−1 (range: 0.15–0.75). Ktrans was significantly higher (0.50 ± 0.17 min−1) in clinically significant prostate cancer compared to clinical insignificant prostate cancer (0.23 ± 0.15 min−1; P = 0.001). Ktrans showed moderate significant correlation with GS (ρ = 0.575, P = 0.006), but showed no significant correlation with PI-RADS (ρ = 0.386, P = 0.069).ConclusionKtrans may discriminate between clinically insignificant and significant prostate cancer and shows moderate correlation with GS. Thus, MP-MRI may serve as an imaging biomarker in prostate cancer.

Fast Multiphoton Microscopic Imaging Joint Image Super-Resolution for Automated Gleason Grading of Prostate Cancers.

Gleason grading system is dependable for quantifying prostate cancer. This paper introduces a fast multiphoton microscopic imaging method via deep learning for automatic Gleason grading. Due to the contradiction between multiphoton microscopy (MPM) imaging speed and quality, a deep learning architecture (SwinIR) is used for image super-resolution to address this issue. The quality of low-resolution image is improved, which increased the acquisition speed from 7.55 s per frame to 0.24 s per frame. A classification network (Swin Transformer) was introduced for automated Gleason grading. The classification accuracy and Macro-F1 achieved by training on high-resolution images are respectively 90.9% and 90.9%. For training on super-resolution images, the classification accuracy and Macro-F1 are respectively 89.9% and 89.9%. It shows that super-resolution image can provide a comparable performance to high-resolution image. Our results suggested that MPM joint image super-resolution and automatic classification methods hold the potential to be a real-time clinical diagnostic tool for prostate cancer diagnosis.

Prediction of biochemical recurrence after radical prostatectomy from primary tumour characteristics.

To construct and externally calibrate a predictive model for early biochemical recurrence (BCR) after radical prostatectomy (RP) incorporating clinical and modern imaging characteristics of the primary tumour. Patients who underwent RP following multiparametric magnetic resonance imaging, prostate biopsy and prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT), from two centres in Australia and the Netherlands. The primary outcome was biochemical recurrence-free survival (BRFS), where BCR was defined as a rising PSA level of ≥0.2 ng/mL or initiation of postoperative treatment per clinician discretion. Proportional hazards models to predict time to event were developed in the Australian sample using relevant pre- and post-surgical parameters and primary tumour maximum standardised uptake value (SUVmax) on diagnostic PSMA-PET/CT. Calibration was assessed in an external dataset from the Netherlands with the same inclusion criteria. Data from 846 patients were used to develop the models. Tumour SUVmax was associated with worse predicted 3-year BRFS for both pre- and post-surgical models. SUVmax change from 4 to 16 lessened the predicted 3-year BRFS from 66% to 42% for a patient aged 65 years with typical pre-surgical parameters (PSA level 8 ng/mL, Prostate Imaging-Reporting and Data System score 4/5 and biopsy Gleason score ≥4 + 5). Considering post-surgical variables, a patient with the same age and PSA level but pathological stage pT3a, RP Gleason score ≥4 + 5 and negative margins, SUVmax change from 4 to 16 lessened the predicted 3-year BRFS from 76% to 61%. Calibration on an external sample (n = 464) showed reasonable performance; however, a tendency to overestimate survival in patients with good prognostic factors was observed. Tumour SUVmax on diagnostic PSMA-PET/CT has utility additional to commonly recognised variables for prediction of BRFS after RP.

Dual hyperpolarized [1-13C]pyruvate and [13C]urea magnetic resonance imaging of prostate cancer

BackgroundAlthough multiparametric (mp) 1H magnetic resonance imaging (MRI) is increasingly used to detect and localize prostate cancer (PC), its correlation with tumor grade is limited. Hyperpolarized (HP) carbon-13 (13C) MR is an emerging imaging technique, which can be used to interrogate key biologic processes through in vivo detection of various HP probes. A distinct attribute of HP 13C MRI is the ability to detect multiple HP probes within a single acquisition. Here we report on the first simultaneous dual HP [1-13C]pyruvate and [13C]urea MRI with correlations to histopathologic findings in a patient with localized PC scheduled for radical prostatectomy. Material and methodsPaired HP 13C and standard mp 1H MRI were performed in a patient with biopsy-proven Gleason score 4 + 3 = 7 adenocarcinoma of the prostate scheduled for radical prostatectomy through a first-in-human pilot study of dual-agent HP MRI (NCT02526368). HP 13C MRI was performed using a clinical 3T scanner with 13C transmit-and-receive capabilities. Dynamic series of HP 13C pyruvate, lactate and urea imaging were acquired following intravenous (IV) injection of co-hyperpolarized [13C]urea (25 mM) and [1–13C]pyruvate (125 mM). The [1-13C]pyruvate-to-[1-13C]lactate conversion rate (kPL) was calculated using an inputless two-site exchange model; AUCurea was the [13C]urea signal summed over time. Following radical prostatectomy, whole-mount prostate histopathological slides were prepared and reviewed by an experienced genitourinary pathologist. ResultsFollowing informed consent, the patient underwent paired mp 1H MRI and dual-agent HP MRI. mp 1H MRI revealed a 1.2 cm lesion in the left apical posterior zone. Dual-agent HP MRI identified a focus of increased [1-13C]pyruvate-to-[1-13C]lactate conversion rate (kPL) extending from the left apical posterior peripheral zone to the right gland. A corresponding area of abnormal tissue perfusion (AUCurea) was seen in the left gland. Metabolism-perfusion mismatch (with several foci of increased kPL/AUCurea) was observed throughout the tumor. Tumor extension to the right midgland was confirmed at the time of radical prostatectomy and staining for lactate dehydrogenase-A was increased throughout the tumor relative to surrounding benign prostatic tissue. ConclusionThis first-in-human radiopathologic study demonstrates the feasibility of dual-agent HP MRI in PC patients. Simultaneous assessment of tumor metabolism and perfusion was able to detect occult disease as well as to show a significant mismatch between intra-tumoral metabolism and tissue perfusion in high-grade PC. Prospective validation of these findings is warranted.

Long-term oncological outcomes after radical prostatectomy in a non-university teaching hospital

The evaluation of oncological outcomes after radical prostatectomy (RP) is a major component of quality control in prostate cancer (PCa) centres. To evaluate the oncological outcomes after RP in a non-university teaching hospital and compare them with other high-volume PCa centres. This study included 1,161 patients after RP who were divided into two risk groups. Low-risk: localised PCa (pT2) and prostate-specific antigen (PSA)≤ 20 ng/ml, Gleason score (GS) 6-7b and pN0. High-risk: locally advanced PCa (≥pT3a) and/or PSA >20 ng/ml and/or GS≥ 8 and/or pN1. Risk groups and clinicopathological features were correlated to biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS) und overall survival (OS). The 10-year BCR-free survival, CSS und OS were 68.4%, 47.0% and 100% in the low-risk group and 87.4%, 89.0% and 73.9% in the high-risk group, respectively; the outcomes between risk groups were statistically significant (p<0.05). A multivariate Cox regression analysis was performed. GS was the most significant prognostic factor for CSS (p=0.00001) und BCR-free survival (p=0.00036). Nodal involvement (pN1) was strongly associated with CSS (p=0.00004). Age was the most important factor for overall survival in the high-risk group (p=0.0011). RP could be a curative treatment option for advanced PCa in selected cases. GS is the most important prognostic factor. Good oncological outcomes can also be achieved in non-university teaching hospitals.

The impact of benign tissue within cancerous regions in the prostate: Characterizing sparse and dense prostate cancers on whole-mount histopathology and on multiparametric MRI

PurposeTo establish the incidence, size, zonal location and Gleason Score(GS)/Gleason Grade Group(GG) of sparse versus dense prostate cancer (PCa) lesions and to identify the imaging characteristics of sparse versus dense cancers on multiparametric MRI (mpMRI). MethodsSeventy-six men with untreated PCa were scanned prior to prostatectomy with endorectal-coil 3 T MRI including T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Cancerous regions were outlined and graded on the whole-mount, processed specimens, with tissue compositions estimated. Regions with cancer comprising <50 % and ≥ 50 % of the tissue were considered sparse and dense respectively. Regions of interest (ROI) were manually drawn on T2-weighted MRI. Within each patient, area-weighted ROI averages were calculated for each imaging measure for each tissue type, GS/GG, and sparse/dense composition. ResultsA large number of cancer regions were identified on histopathology (n = 1193: 939 (peripheral zone (PZ)) and 254 (transition zone (TZ))). Thirty-seven percent of these lesions were sparse. Sparse lesions were primarily low-grade with the majority of PZ and 100 % of TZ sparse lesions ≤GS3 + 3/GG1. Dense lesions were significantly larger than sparse lesions in both PZ and TZ, p < 0.0001. On imaging, 246/45 PZ and 109/8 TZ dense/sparse 2D cancerous ROIs were drawn. Sparse GS3 + 3 and sparse ≥GS3 + 4 cancers did not have significantly different MRI intensities to dense GS3 + 3 cancers, while sparse GS3 + 3/GG1 cancers differed from benign, p < 0.05. ConclusionHistopathologically identified prostate cancer lesions were sparse in 37 % of cases. Sparse cancers were entirely low grade in TZ and predominantly low-grade in PZ and generally small, thus likely posing lower risk for spread and progression than dense lesions. Sparse lesions were not distinguishable from dense lesions on mpMRI, but could be distinguished from benign tissues.

Histopathological evaluation and grading for prostate cancer: current issues and crucial aspects.

A crucial aspect of prostate cancer grading, especially in low- and intermediate-risk cancer, is the accurate identification of Gleason pattern 4 glands, which includes ill-formed or fused glands. However, there is notable inconsistency among pathologists in recognizing these glands, especially when mixed with pattern 3 glands. This inconsistency has significant implications for patient management and treatment decisions. Conversely, the recognition of glomeruloid and cribriform architecture has shown higher reproducibility. Cribriform architecture, in particular, has been linked to the worst prognosis among pattern 4 subtypes. Intraductal carcinoma of the prostate (IDC-P) is also associated with high-grade cancer and poor prognosis. Accurate identification, classification, and tumor size evaluation by pathologists are vital for determining patient treatment. This review emphasizes the importance of prostate cancer grading, highlighting challenges like distinguishing between pattern 3 and pattern 4 and the prognostic implications of cribriform architecture and intraductal proliferations. It also addresses the inherent grading limitations due to interobserver variability and explores the potential of computational pathology to enhance pathologist accuracy and consistency.

The added value of 68Ga-PSMA PET/CT in anatomical staging of prostatic carcinoma in correlation with the histopathological zonal staging

BackgroundProstate cancer is well known as the commonest cancer in men and the second leading cause of cancer-related death. CT, MRI and bone scintigraphy are considered the commonly widely used imaging diagnostic tools for detection, staging and follow-up of prostate cancer. Prostate-specific membrane antigen (PSMA) is a membrane glycoprotein, that can be concentrated in prostate cancer cells up to 100 times higher than in normal cells. PSMA-targeted imaging modalities have now proven their efficacy in diagnosis, staging and follow-up of prostate cancer. The use of 68Ga PSMA PET-CT has efficiently improved the detection of loco-regional and metastatic disease. 68Ga PSMA PET-CT also has an effective role in the primary diagnosis, staging, and detecting biochemical recurrence after curative treatment and in metastasis-targeted therapy. This work aims to review the role of 68Ga PSMA PET-CT in anatomical staging of prostate cancer in correlation with histopathological staging.ResultsZonal correlation between 68Ga PSMA findings and biopsy results showed sensitivity ranging between 76.9 and 90.6% and specificity ranging from 85.7 to 100%. There was high significant correlation between the SUVmax uptake and the biopsy results, between the SUVmax uptake and the local staging as well as between the Gleason score and 68Ga PSMA PET/CT findings.Conclusions68Ga PSMA PET/CT is a highly promising imaging modality with an effective role in detection of prostate cancer showing high sensitivity and specificity in prediction of zonal histopathological results and loco-regional Gleason score staging with significant positive correlation between the SUV uptake results, Gleason score and the PSA levels.

[18F]AlF-PSMA-11 PET in diagnosing prostate cancer: a head-to-head comparison with [68Ga]Ga-PSMA-11 PET and an exploration of dual-phase scanning

PurposeTo evaluate the physiological distribution and tumour detection ability of [18F]AlF-PSMA-11 positron emission tomography (PET) dual-phase scans in patients with prostate cancer (PCa).MethodsAs a retrospective study, clinical and PET data of PCa patients who underwent dual-phase [18F]AlF-PSMA-11 PET of routine scan (45–50 min) and delayed scan (120 min) from November 2020 to June 2021 were collected, and physiological and pathological regions of interest were quantified to determine the time-dependent maximum standardized uptake value (SUVmax) of [18F]AlF-PSMA-11. Part of the above subjects who underwent [68Ga]Ga-PSMA-11 PET in the following 6 months were included in a head-to-head comparison. The difference with a p-value < 0.05 was defined as statistical significance. Diagnosis accuracy of primary and metastatic lesions was measured referring to the surgical findings, pathology, and follow-up imaging.Results[68Ga]Ga-PSMA-11 and [18F]AlF-PSMA-11 were of the comparable uptake in glands in head, but the latter was of a significant lower distribution in liver and spleen. For the 25 patients initially diagnosed with prostate cancer and 3 patients with biochemical recurrence after radical surgery, the SUVmax of the primary lesions, lacrimal glands, parotid glands and submandibular glands was higher at 120 min compared to that at 45–50 min, but not a significant difference. SUVmax of the liver, spleen and bladder decreased significantly at 120 min, but the bladder SUVmax remained higher than that of primary lesions. SUVmax of the kidneys and centrum was the same in dual-phase scans. For the 31 primary lesions detected in [18F]AlF-PSMA-11 PET, both the SUVmax of the two phases kept the positive correlation with PSA, Gleason score and initial risk stratification. For the 39 distant metastatic lesions, 94.87% accuracy of routine scan and 100% accuracy of delayed scan were acquired, and 7.14% patients (2/28) benefited from the dual-phase [18F]AlF-PSMA-11 scans that revealed novel information on metastatic lesions compared to the routine scan.Conclusion[18F]AlF-PSMA-11 PET expanded the time window and further decreased metabolic background of [68Ga]Ga-PSMA-11 PET. The dual-phase scan of [18F]AlF-PSMA-11 PET can benefit prostate cancer diagnosis via providing more PSMA-specific information.

The Relationship between D'Amico and ISUP Risk Classifications and 68Ga-PSMA PET/CT SUVmax Values in Newly Diagnosed Prostate Cancers.

This study aimed to evaluate the relationship between pathological and clinical risk classifications in newly diagnosed prostate cancer patients, and 68Ga-PSMA PET/CT data and serum Prostate Specific Antigen (PSA) values. A total of 203 patients who were diagnosed with prostate cancer between 2019 and 2023, who had not yet received treatment and who underwent 68Ga-PSMA PET/CT for staging purposes were included in this study. There was a substantial correlation between D'Amico risk classification, Gleason score, ISUP classification, and the presence or absence of metastasis (p < 0.0001). The median SUVmax value of the prostate gland and the D'Amico risk classification were statistically significantly correlated. (p < 0.0001). There was a statistically significant correlation between the ISUP classification and the PSA value and prostate gland SUVmax value (p < 0.0001). There was a significant correlation between the median SUVmax values of the prostate gland at the time of diagnosis and the patients with and without metastases (p < 0.0001). According to the data obtained from ROC analysis, patients with prostate gland SUVmax values of 8.75 and above were found to have a high probability of metastasis with a sensitivity of 78.9% and a specificity of 59.05%. Our study showed that 68Ga-PSMA PET/CT is a highly effective method for staging newly diagnosed high-risk prostate cancer. The probability of metastasis was found to be dramatically increased in Gleason 8 and above. According to D'Amico risk classification, metastasis was detected in at least half of high-risk patients. Since the sensitivity of metastasis was 78.9% in patients with prostate gland SUVmax value above 8.75, we think that these patients should be carefully reported in terms of metastasis.

Consistency between Gleason score of prostate biopsy and radical prostatectomy: predictors of increased tumour grading

Introduction. Gleason grading is one of the key parameters for determining the prostate cancer (risk group after receiving the results of a prostate biopsy in addition to the level of prostate-specific antigen (PSA). However, an important clinical issue arises from changes in this grading following radical surgery. In some cases, such discrepancies in data can lead to a shift in patient management tactics from radical surgery to active follow-up recommended for patients with low cancer risk.Objective. To assess the consistency of the results of prostate biopsy and radical prostatectomy with an assessment of possible predictors of increased tumor Gleason grading.Materials &amp; methods. Between 2019 and 2021, 193 patients with prostate cancer were selected for treatment at the Medical Centre of Moscow State University. Of these, 139 patients were chosen for the final analysis of Gleason tumour grading consistency after biopsy and radical prostatectomy.Results. The results of prostate biopsy and radical prostatectomy were comparable in 54.7% of patients (n = 76), while the remaining 45.3% (n = 63) showed a change in Gleason gradaing after radical prostatectomy: 29.5% (n = 41) patients showed an increased gradation, and 15.8% (n = 22) — decrease. Most often, the data were consistent for patients with a Gleason score 7: 63.6% for 3 + 4 = 7 and 57.9% for 4 + 3 = 7. The highest percentage of graduation increase was observed for patients from the group 3 + 3 = 6 and amounted to 48%. Cohen's kappa value was 0.351 (p &lt; 0.001), indicating poor consistency between the results of the two studies. The total number of biopsies was associated with an increase in Gleason score after radical prostatectomy (OR = 0.816; 95% CI = 0.680 – 0.978). For example, the odds of Gleason tumour grading decreases by 18.4% when the number of biopsy specimens per unit increasesConclusion. The concordance of Gleason grading of prostate cancer after prostate biopsy and radical prostatectomy remains poor. The only predictor of improved concordance is the biopsy count, thereby reflecting biopsy quality and encouraging clinicians to move away from sextant biopsies to systematic and targeted biopsies. Increasing the consistency of results can provide more accurate staging and classification of patients according to cancer risk, thereby influencing future management.

A RARE CASE OF COEXISTING BLADDER SMALL CELL NEUROENDOCRINE CARCINOMA AND PROSTATE ADENOCARCINOMA: CASE REPORT AND LITERATURE REVIEW

Objective: We present a case of synchronous malignancies of rare bladder small cell neuroendocrine carcinoma (SCNC) and prostate adenocarcinoma and provide literature review of bladder SCNC. Case(s) presentation: A 72-year-old male smoker presented with 3 months history of gross hematuria. Ultrasonography showed a large hypoechoic mass in the right bladder. TURBT was performed and histopathology of the TURBT specimen showed a high-grade papillary urothelial carcinoma. Abdominal contrast-enhanced computed tomography (CECT) demonstrated an isodense heterogenous undefined mass, with irregular border at right anterolateral side of bladder wall. Radical cystoprostatectomy, bilateral radical lymph node dissection and bilateral ureterocutaneostomy was performed. Histopathology and immunohistochemical examination after radical cystoprostatectomy revealed bladder small cell neuroendocrine carcinoma coexisting with prostate adenocarcinoma (Gleason score 3+3=6, group 1). The patient eventually succumbed to disease after having symptomatic disease progression and metastatic disease five months after the surgery. Discussion: Bladder SCNC is a rare malignancy with an incidence of 1–9/1,000,000 reported. This tumor has an aggressive clinical course with high incidence of metastasis, and it tends to confer dismal prognosis. No specific clinical symptom exists. Histopathological recognition and immunohistochemistry is required to differentiate this rare entity. Conclusion: Clinicians and pathologists should be alert to the possibility of bladder SCNC despite extremely scarce incidence. Keywords: Bladder cancer, small cell neuroendocrine carcinoma, synchronous malignancy, case report.

Construction of a cuproptosis‑related lncRNA signature to predict biochemical recurrence of prostate cancer.

Biochemical recurrence (BCR) is common in prostate cancer (PCa), and patients with BCR usually have a poor prognosis. Cuproptosis is a unique type of cell death, and copper homeostasis is crucial to the occurrence and development of malignancies. The present study aimed to explore the prognostic value of cuproptosis-related long non-coding RNAs (lncRNAs; CRLs) in PCa and to develop a predictive signature for forecasting BCR in patients with PCa. Using The Cancer Genome Atlas database, transcriptomic, mutation and clinical data were collected from patients with PCa. A total of 121 CRLs were identified using Pearson's correlation coefficient. Subsequently, a 6-CRL signature consisting of AC087276.2, CNNM3-DT, AC090198.1, AC138207.5, METTL14-DT and LINC01515 was created to predict the BCR of patients with PCa through Cox and least absolute shrinkage and selection operator regression analyses. Kaplan-Meier curve analysis demonstrated that high-risk patients had a low BCR-free survival rate. In addition, there was a substantial difference between the high- and low-risk groups in the immune microenvironment, immune therapy, drug sensitivity and tumor mutational burden. A nomogram integrating the Gleason score, 6-CRL signature and clinical T-stage was established and evaluated. Finally, the expression of signature lncRNAs in PCa cells was verified through reverse transcription-quantitative PCR. In conclusion, the 6-CRL signature may be a potential tool for making predictions regarding BCR in patients with PCa, and the prognostic nomogram may be considered a practical tool for clinical decision-making.

Correlation of Transrectal Ultrasonography Guided Prostate Biopsy Gleason Score Results with Prostate Volume in Patients with Prostate Specific Antigen Level Between 2.5-10 ng/mL

Correlation of Transrectal Ultrasonography Guided Prostate Biopsy Gleason Score Results with Prostate Volume in Patients with Prostate Specific Antigen Level Between 2.5-10 ng/mL

A Multi-Institutional Study of Magnetic Resonance/Ultrasound Fusion-Guided Nanoparticle-Directed Focal Therapy for Prostate Ablation.

Focal therapy aims to provide a durable oncologic treatment option for men with prostate cancer (PCa), while preserving their quality of life. Most focal therapy modalities rely on the direct tissue effect, resulting in a possible nontargeted approach to ablation. Here, we report the results of the first human feasibility trial utilizing nanoparticle-directed focal photothermal ablation for PCa. A prospective, open-label, single-arm, multicenter study of men with localized PCa in Gleason Grade Group 1 to 3 was conducted. Men received a single infusion of gold nanoparticles (AuroShells), followed by magnetic resonance (MR)/ultrasound (US) fusion-guided laser excitation of the target tissue to induce photothermal ablation. MRI was used to assess the effectiveness of prostate tissue ablation at 48 to 96 hours, 3 months, and 12 months post treatment. At 3 months, a targeted fusion biopsy of the lesion(s) was conducted. At 12 months, a targeted fusion biopsy and standard templated biopsy were performed. Treatment success was determined based on a negative MR/US fusion biopsy outcome within the treated area. Forty-six men were enrolled in the study, and 44 men with 45 lesions completed nanoparticle infusion and laser treatment. The mean PSA level at baseline was 9.5 ng/mL, which decreased to 5.9 ng/mL at 3 months and to 4.7 ng/mL at 12 months (P < .0001). The oncologic success rates at 3 and 12 months resulted in 29 (66%) and 32 (73%) of 44 patients, respectively, being successfully treated, confirmed with negative MR/US fusion biopsies within the ablation zone. Among Gleason Grade Group, maximum lesion diameter on MRI, prostate volume, and Prostate Imaging Reporting and Data System scoring, the maximum lesion diameter was significantly associated with the odds of treatment failure at 12 months (P = .046). Nanoparticle-directed focal laser ablation of neoplastic prostate tissue resulted in 73% of patients with successful treatment at 12 months post treatment, confirmed by negative MR/US fusion biopsy of the treated lesion and a systematic biopsy. 02680535.

Prostate cancer treatment recommendation study based on machine learning and SHAP interpreter.

This study utilized data from 140,294 prostate cancer cases from the Surveillance, Epidemiology, and End Results (SEER) database. Here, 10 different machine learning algorithms were applied to develop treatment options for predicting patients with prostate cancer, differentiating between surgical and non-surgical treatments. The performances of the algorithms were measured using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value. The Shapley Additive Explanations (SHAP) method was employed to investigate the key factors influencing the prediction process. Survival analysis methods were used to compare the survival rates of different treatment options. The CatBoost model yielded the best results (AUC = 0.939, sensitivity = 0.877, accuracy = 0.877). SHAP interpreters revealed that the T stage, cancer stage, age, cores positive percentage, prostate-specific antigen, and Gleason score were the most critical factors in predicting treatment options. The study found that surgery significantly improved survival rates, with patients undergoing surgery experiencing a 20.36% increase in 10-year survival rates compared with those receiving non-surgical treatments. Among surgical options, radical prostatectomy had the highest 10-year survival rate at 89.2%. This study successfully developed a predictive model to guide treatment decisions for prostate cancer. Moreover, the model enhanced the transparency of the decision-making process, providing clinicians with a reference for formulating personalized treatment plans.

Application of proton density fat fraction imaging in risk stratification of prostate cancer.

Prostate cancer (PCa) as one of the most prevalent malignancies in men. We introduced a non-invasive quantitative measurement of intraprostatic fat content based on magnetic resonance proton density fat fraction (PDFF) imaging. The study aims to determine the fat fraction (FF) of PCa using proton density magnetic resonance imaging (MRI), gather clinical and routine MRI characteristics, and identify risk factors for high-risk PCa through multifactorial logistic regression. Clinical and imaging data from 191 pathologically confirmed PCa patients were collected. Patients were stratified based on Gleason score (GS), with 63 in the intermediate- and low-risk group (GS =3+3, 3+4) and 128 in the high-risk group (GS ≥4+3). All patients underwent routine prostate MRI and FF imaging. Clinical and imaging data related to PCa were analyzed, including age, body mass index (BMI), prostate volume (PV) measured by MRI, smoking history, alcohol history, diabetes history, serum prostate-specific antigen (PSA) level, apparent diffusion coefficient (ADC) value, T2 signal intensity (T2SI), Prostate Imaging Reporting and Data System 2.1 (PI-RADS 2.1) score, GS, lesion FF, whole gland FF, periprostatic fat thickness (PPFT), and subcutaneous fat thickness (SFT). Independent risk factors for stratifying PCa risk were identified through multivariate logistic regression analysis, and a predictive model was established. Receiver operating characteristic (ROC) curve analysis was conducted for visual analysis. Significant differences were found in BMI, PV, PSA, tumor ADC value, standard T2SI, PI-RADS score, lesion FF, and PPFT between low- and medium-risk and high-risk groups (P<0.05). No significant differences were observed in age, smoking history, drinking history, diabetes history, and SFT between the two groups (P>0.05). GS correlated significantly with FF (ρ=0.6, P<0.001), PSA (ρ=0.432, P<0.001), ADC value (ρ=-0.379, P<0.001), and PI-RADS (ρ=0.366, P<0.001). Multiple logistic regression analysis revealed that an increase in FF, a PI-RADS score increase of 5 points, and a decrease in ADC value and PV were independent predictors of high-risk PCa (P<0.05). The ROC curve showed that the best cut-off value for the model was 0.67, with an area under the curve (AUC) of 0.907, sensitivity of 78.1%, and specificity of 88.9%. The FF of PCa determined by proton density MRI is significantly associated with GS, serving as an independent predictor of high-risk PCa.

Prediction of high-risk prostate cancer based on the habitat features of biparametric magnetic resonance and the omics features of contrast-enhanced ultrasound

Rationale and objectivesTo predict high-risk prostate cancer (PCa) by combining the habitat features of biparametric magnetic resonance imaging (bp-MRI) with the omics features of contrast-enhanced ultrasound (CEUS). Materials and methodsThis study retrospectively collected patients with PCa confirmed by histopathology from January 2020 to June 2023. All patients underwent bp-MRI and CEUS of the prostate, followed by a targeted and transrectal systematic prostate biopsy. The cases were divided into the intermediate-low-risk group (Gleason score ≤7, n = 59) and high-risk group (Gleason score ≥8, n = 33). Radiomics prediction models, namely, MRI_habitat, CEUS_intra, and MRI-CEUS models, were developed based on the habitat features of bp-MRI, the omics features of CEUS, and a merge of features of the two, respectively. Predicted probabilities, called radscores, were then obtained. Clinical-radiological indicators were screened to construct clinic models, which generated clinic scores. The omics–clinic model was constructed by combining the radscore of MRI-CEUS and the clinic score. The predictive performance of all the models was evaluated using the receiver operating characteristic curve. ResultsThe area under the curve (AUC) values of the MRI-CEUS model were 0.875 and 0.842 in the training set and test set, respectively, which were higher than those of the MR_habitat (training set: 0.846, test set: 0.813), CEUS_intra (training set: 0.801, test set: 0.743), and clinic models (training set: 0.722, test set: 0.611). The omics–clinic model achieved a higher AUC (train set: 0.986, test set: 0.898). ConclusionsThe combination of the habitat features of bp-MRI and the omics features of CEUS can help predict high-risk PCa.

Prognostic factors in post-prostatectomy salvage radiotherapy setting with and without hormonotherapy: An individual patient data analysis of randomized trials from ICECaP database

BackgroundEarly salvage radiotherapy (SRT) is the standard of care for biochemical recurrence post-prostatectomy but outcomes are heterogeneous. ObjectiveTo develop a risk scoring system based on relevant standard-of-care clinico-pathological prognostic factors for patients treated with SRT with and without hormonal therapy (HT). Design, setting, and participantsThe Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) database included three randomized trials (Individual patients’ data from 1647 subjects) assessing SRT (GETUG-AFU-16; NRG/RTOG-9601, and a subset of EORTC-22911). Outcome measurements and statistical analysisOutcomes were clinical progression (CP). metastasis free-survival (MFS) and overall survival (OS). Clinico-pathological factors, including pathological Gleason Score (GS), PSA at SRT start, margin status, persistent PSA post-RP and time from RP to SRT were evaluated by multivariable models stratified by type of treatment. Results and limitationsOn multivariable analysis PSA ≥ 0.5 ng/mL at SRT start, GS ≥ 8 and negative margin status were the three strongest prognostic factors. Three prognostic groups defined by number of these risk features (high risk: 2 or 3; intermediate risk: 1 and low risk: 0) were strongly associated with OS, MFS and CP outcomes with SRT alone or with HT. This prognostic group definition was also relevant for patients with persistent PSA post RP and for patients treated < 1 year from RP to SRT and with and without HT. ConclusionA risk score for patients receiving SRT with or without HT, using three standard-of-care clinico-pathological risk factors provides refined prognostic information for individual patient counselling. Patient summaryBy using a composite score of pathology grading (Gleason Score), PSA at start of salvage radiation and margin status data, physicians can provide patients with more refined information on the risk of a second relapse after receiving radiation to the prostate bed after a prostatectomy for a rising or persistent PSA, both with and without hormonal therapy.

Salvage local treatment for recurrent prostate cancer after focal therapy: A systematic review and meta-analysis

ObjectivesTo evaluate the role of salvage local treatment in managing recurrent PCa following FT, focusing on oncological and functional outcomes. MethodsA systematic review and meta-analysis were performed following the PRISMA framework. A comprehensive literature search using the PubMed/MEDLINE and EMBASE databases was performed until July 2023. Eligible studies included patients with clinically localised PCa initially treated with FT, who experienced relapse during surveillance and subsequently underwent salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT) or salvage focal therapy (sFT). The primary endpoint was the biochemical recurrence rate post-salvage treatment. The secondary endpoints were functional outcomes, including urinary incontinence and erectile dysfunction rates. ResultsIn 26 retrospective studies including 990 patients, the overall pooled biochemical recurrence rate postsalvage treatment was 26%. The subgroup analysis revealed a biochemical recurrence rate of 20%, 22%, and 42% after sRP, sEBRT, and sFT, respectively. The overall pooled rate of urinary incontinence was 20%. Salvage FT had the lowest prevalence of urinary incontinence, followed by sRP and sEBRT. The overall pooled rate of erectile dysfunction was 43%. Salvage RP had the highest prevalence of erectile dysfunction, followed by sFT and sEBRT. Substantial heterogeneity was observed among the studies, primarily due to different sample sizes. Meta-regression analysis revealed no to low contributions of salvage treatment modalities, extent of ablation, age, prostatic specific antigen level before salvage treatment, proportion of patients with Gleason score ≥7 at recurrence, and time between the primary and salvage therapies to heterogeneity. ConclusionSalvage local treatment for recurrent PCa after FT is feasible, and it provides acceptable oncological and functional outcomes. Among all treatment modalities, sRP and sEBRT appeared to have the lowest biochemical recurrence rates, whereas sFT was associated with improved functional outcomes.