Insignificant Cancer 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.

Targeted Prostate Biopsy: How, When, and Why? A Systematic Review.

Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as "targeted prostate biopsy", "fusion prostate biopsy", "cognitive prostate biopsy", "MRI-guided biopsy", and "transrectal ultrasound prostate biopsy". Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life.

Management of Patients With a Negative Multiparametric Prostate MRI Examination: AJR Expert Panel Narrative Review.

Multiparametric MRI (mpMRI) of the prostate aids risk stratification of patients with elevated PSA levels. Although most clinically significant prostate cancers are detected by mpMRI, insignificant cancers are less evident. Thus, multiple international prostate cancer guidelines now endorse routine use of prostate MRI as a secondary screening test before prostate biopsy. Nonetheless, management of patients with negative mpMRI results (defined as PI-RADS category 1 or 2) remains unclear. This AJR Expert Panel Narrative Review summarizes the available literature on patients with an elevated screening PSA level and a negative prostate mpMRI result and provides guidance for these patients' management. Systematic biopsy should not be routinely performed after a negative mpMRI examination in patients at average risk but should be considered in patients at high risk. In patients who undergo PSA screening rather than systematic biopsy after negative mpMRI, clear triggers should be established for when to perform a repeat MRI examination. Patients with a negative MRI result followed by negative biopsy should follow their health care practitioners' preferred guidelines concerning subsequent PSA screening for the patient's risk level. Insufficient high-level data exist to support routine use of adjunctive serum or urine biomarkers, artificial intelligence, or PSMA PET to determine the need for prostate biopsy after a negative mpMRI examination.

A new parameter to increase the predictive value of multiparametric prostate magnetic resonance imaging for clinically significant prostate cancer in targeted biopsies: lesion density

AimTo investigate the predictive value of lesion length in multiparametric prostate magnetic resonance imaging with respect to prostate volume for clinically significant prostate cancer diagnosis in targeted biopsies. Materials and methodsThe data of biopsy-naïve patients in the Turkish Urooncology Association Prostate Cancer Database who underwent targeted prostate biopsies were included in this study. Lesion density is calculated as the ratio of lesion length (mm) in MR to prostate volume (cc). The biopsy results were divided into either clinically significant or insignificant cancer and benign groups. The difference in parameters between groups is evaluated by multivariable analysis to determine independent risk factors for clinically significant prostate cancer diagnosis. ResultsA total of 590 lesion biopsies were included in the study. In univariable analysis, prostate-specific antigen (PSA), PSA density, number of cores taken, lesion length, lesion density, patient age, and digital rectal examination findings were found to be different at a statistically significant level between groups (P values, respectively: 0.001, <0.001, <0.001, <0.001, <0.001, 0.012, 0.001). Subgroup analysis demonstrated that the lesion density was still significantly different between groups for all Prostate Imaging - Reporting and Data System (PI-RADS) 3, 4, and 5 subgroups (P values, respectively: 0.001, <0.001, <0.001). The multivariable analysis demonstrated that lesion density, along with the number of cores taken and the PI-RADS score of the lesion is an independent risk factor for predicting clinically significant prostate cancer, with the highest odds ratio among all parameters (OR: 27.31 [CI: 7.9–94.0]). ConclusionThis study demonstrated that lesion size with respect to prostate volume is an important independent risk factor for the prediction of clinically significant prostate cancer in the lesion-targeted biopsy. Combined with the PI-RADS score and parameters like digital rectal examination (DRE) findings and PSA density may further increase predictive power and help clinicians decide whether to perform a biopsy in low-risk patients or perform a re-biopsy for high-risk patients subsequent to an initial negative biopsy.

Biomarker vs MRI-Enhanced Strategies for Prostate Cancer Screening

Prostate cancer guidelines often recommend obtaining magnetic resonance imaging (MRI) before a biopsy, yet MRI access is limited. To date, no randomized clinical trial has compared the use of novel biomarkers for risk estimation vs MRI-based diagnostic approaches for prostate cancer screening. To evaluate biomarker-based risk estimation (Stockholm3 risk scores or prostate-specific antigen [PSA] levels) with systematic biopsies vs an MRI-enhanced strategy (PSA levels and MRI with systematic and targeted biopsy) for the detection of clinically significant prostate cancer in a screening setting. This open-label randomized clinical trial conducted in Stockholm, Sweden, between April 4, 2018, and December 10, 2020, recruited men aged 50 to 74 years with no history of prostate cancer. Participants underwent blood sampling for PSA and Stockholm3 tests to estimate their risk of clinically significant prostate cancer (Gleason score ≥3 + 4). After the blood tests were performed, participants were randomly assigned in a 2:3 ratio to receive a Stockholm3 test with systematic biopsy (biomarker group) or a PSA test followed by MRI with systematic and targeted biopsy (MRI-enhanced group). Data were analyzed from September 1 to November 5, 2023. In the biomarker group, men with a Stockholm3 risk score of 0.15 or higher underwent systematic biopsies. In the MRI-enhanced group, men with a PSA level of 3 ng/mL or higher had an MRI and those with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3 or higher (range: 1-5, with higher scores indicating a higher likelihood of clinically significant prostate cancer) underwent targeted and systematic biopsies. Primary outcome was detection of clinically significant prostate cancer (Gleason score ≥3 + 4). Secondary outcomes included detection of clinically insignificant cancer (Gleason score ≤6) and the number of biopsy procedures performed. Of 12 743 male participants (median [IQR] age, 61 [55-67] years), 5134 were assigned to the biomarker group and 7609 to the MRI-enhanced group. In the biomarker group, 8.0% of men (413) had Stockholm3 risk scores of 0.15 or higher and were referred for systematic biopsies. In the MRI-enhanced group, 12.2% of men (929) had a PSA level of 3 ng/mL or higher and were referred for MRI with biopsies if they had a PI-RADS score of 3 or higher. Detection rates of clinically significant prostate cancer were comparable between the 2 groups: 2.3% in the biomarker group and 2.5% in the MRI-enhanced group (relative proportion, 0.92; 95% CI, 0.73-1.15). More biopsies were performed in the biomarker group than in the MRI-enhanced group (326 of 5134 [6.3%] vs 338 of 7609 [4.4%]; relative proportion, 1.43 [95% CI, 1.23-1.66]), and more indolent prostate cancers were detected (61 [1.2%] vs 41 [0.5%]; relative proportion, 2.21 [95% CI, 1.49-3.27]). Findings of this randomized clinical trial indicate that combining a Stockholm3 test with systematic biopsies is comparable with MRI-based screening with PSA levels and systematic and targeted biopsies for detection of clinically significant prostate cancer, but this approach resulted in more biopsies as well as detection of a greater number of indolent cancers. In regions where access to MRI is lacking, the Stockholm3 test can aid in selecting patients for systematic prostate biopsy. ClinicalTrials.gov Identifier: NCT03377881.

Varnishing prostate cancer acinar (adenocarcinoma of the prostate gland pt0) in prostate biopsy specimen which subsequently becomes diagnosed as no prostate cancer or pt0 prostate cancer in a prostatectomy specimen: review and update

Taking into consideration the increased undertaking of screening tests for serum prostate-specific antigen (PSA), it would be envisaged that the diagnosis of prostate cancer at an early clinical stage and small tumour-size had been appreciably increased over recent years and as a consequence, the volume of tumour within radical prostatectomy (RP) specimens had decreased in size. Pathological stage pT0 is referred to as no evidence of residual tumour within a radical prostatectomy (RP) specimen from a patient in whom biopsy-proven prostate carcinoma had been histologically confirmed as a diagnosis. This entity was given a terminology of the "vanishing cancer phenomenon" by Goldstein and associates. The pT0 stage of prostate cancer had been noted ensuing hormone therapy or prior transurethral resection of the prostate (TURP) for benign prostatic hyperplasia before the undertaking of RP. Even though much research had addressed these two scenarios of pT0 stage prostate cancer, patients that manifest with pT0 status in cases other than the aforementioned two scenarios occur on very rare occasions which had been iterated to be in between 0.2% and 0.8% of all prostate cancer patients). Only few studies had examined such patients. The clinical significance of pT0 staging has remained not to be clear. Nevertheless, many reports had documented that that pT0 stage patients do portend a highly satisfactory clinical outcome. pT0 at RP is extremely rare. Although most pT0 patients had tended to have low serum PSA levels, low clinical stage, low biopsy Gleasson Score (GS), and only one positive biopsy core, those with more aggressive characteristics could still harbour pT0 at RP. In order to prevent the undertaking of unnecessary treatment of such clinically insignificant cancers, it would be important to ascertain preoperative clinical and pathologic characteristics which might help the Urologists and oncologist to pre-operatively ascertain patients with a high probability of pT0 staging upon RP specimens. The ensuing article has discussed general overview aspects as well as miscellaneous narrations and discussions from some case reports, case series and studies related to the varnishing prostate cancer in order to provide recent educative material on the varnishing prostate cancer to all readers.

Repeated Prostate Cancer Screening Using Prostate-Specific Antigen Testing and Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) has been proposed to enhance the benefit-to-harm ratio of prostate cancer screening, but data on repeated screening outcomes are lacking. To describe outcomes of prostate-specific antigen (PSA)-based screening with MRI and prostate biopsies at repeat screening. This secondary analysis examined the population-based, screen-by-invitation STHLM3-MRI randomized clinical trial, which recruited Swedish men aged 50 to 74 years. Men were eligible for repeat screening at 2 to 3 years if they had PSA levels of 1.5 ng/mL or greater at trial inclusion, were randomized to the MRI-targeted group (including screening using biomarkers and MRI), and were not diagnosed with prostate cancer after the first screening round. Repeat screening was performed between November 10, 2021, and February 20, 2023. Data analysis was performed between May and August 2023. Participants underwent blood sampling, including PSA testing. A biparametric MRI scan was performed if PSA levels were 3 ng/mL or greater, and men with lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3 or greater were referred for targeted and systematic biopsies. The primary outcome was clinically significant prostate cancer (Gleason score of ≥3 + 4). Secondary outcomes included the proportion of men with clinically insignificant cancer (Gleason score of 6), the number of elevated PSA tests, MRI scans, and biopsy procedures. Of 7609 men from the first screening round, 2078 (27.3%) were eligible for and were invited for rescreening. Among the invitees, 1500 (72.2%) participated. Their median age was 67 (IQR, 61-72) years. Of 1094 men with PSA levels between 1.5 and 2.9 ng/mL in the first screening round, 326 (29.8%) had levels of 3 ng/mL or greater in the second round. Overall, 667 men (44.5%) had PSA levels of 3 ng/mL or greater: 617 underwent MRI (92.5%), revealing 51 (7.6%) with equivocal lesions (PI-RADS score of 3) and 33 (4.9%) with suspicious lesions (PI-RADS score of ≥4). Only 10 of 383 men (2.6%) with a prior negative MRI result had a lesion with a PI-RADS score of 4 or greater. Among the 1500 rescreened men, 48 (3.2%) had a Gleason score of 3 + 4 or greater, including 19 (1.3%) with a score of 4 + 3 or greater and 11 (0.7%) with a score of 6. In this secondary analysis of the STHLM3-MRI randomized clinical trial, cancer detection during the second screening round in biennial PSA and MRI-based prostate cancer screening was limited, and the detection of low-grade tumors remained low. A substantial proportion of men exhibited elevated PSA levels during rescreening, and a considerable portion of MRI scans performed lacked lesions suggestive of cancer. Future studies should explore strategies to reduce MRI-related resource use. ClinicalTrials.gov Identifier: NCT03377881.

The impact of pre-biopsy MRI and additional testing on prostate cancer screening outcomes: A rapid review.

This work aims to examine the latest evidence on the impact of pre-biopsy MRI, in addition to prostate-specific antigen (PSA) testing, on health outcomes and quality of life. We conducted a literature search including PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) databases, with a limited scan of (i) guidelines and (ii) references from trial reports, from January 2005 to 25th January 2023. Two independent reviewers selected randomised controlled trials (RCT) and cohort studies which met our inclusion criteria. One hundred thirty-seven articles were identified, and seven trial articles were selected. Trial interventions were as follows: (i) PSA blood test, (ii) additional tests such as pre-biopsy multiparametric magnetic resonance imaging (mpMRI) and Biparametric MRI (bpMRI), and (iii) MRI targeted biopsy and standard biopsy. Compared with standard biopsy, MRI-based interventions led to increased detection of clinically significant cancers in three studies and decreased detection of clinically insignificant cancer (Gleason grade 3 + 3) in four studies. However, PROstate Magnetic resonance Imaging Study (PROMIS) and Stockholm3 with MRI (STHLM3-MRI) studies reported different trends depending on the scenario studied in PROMIS (MRI triage and MRI directed biopsy vs. MRI triage and standard biopsy) and thresholds used in STHLM3-MRI (≥0·11 and ≥0·15). MRI also helped 8%-49% of men avoid biopsy, in six out of seven studies, but not in STHLM3-MRI at ≥0.11. Interestingly, the proportion of men who experienced sepsis and UTI was low across studies. This review found that a combination of approaches, centred on the use of pre-biopsy MRI, may improve the detection of clinically significant cancers and reduce (i) the diagnosis of clinically insignificant cancers and (ii) unnecessary biopsies, compared with PSA testing and standard biopsy alone. However, the impact of such interventions on longer term outcomes such as prostate cancer-specific mortality has not yet been assessed.

Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center.

The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy, 41 patients would have avoided biopsy (31.5%), but 5 cases of CsPCa would not have been detected (3.4%). We could not identify any statistical significance between other clinical and imagiological variables and CsPCa detection. PI-RADS 3 lesions were associated with a low likelihood of CsPCa detection. A systematic biopsy associated or not with target biopsy is essential in PI-RADS 3 lesions, and targeted biopsy did not demonstrate to be superior in the detection of CsPCa. The presence of abnormal DRE and lesions localized in PZ potentially predict the presence of CsPCa in biopsied PI-RADS 3 lesions.

Risk stratification of prostate cancer with MRI and prostate-specific antigen density-based tool for personalized decision making.

MRI is now established for initial prostate cancer diagnosis; however, there is no standardized pathway to avoid unnecessary biopsy in low-risk patients. Our study aimed to test previously proposed MRI-focussed and risk-adapted biopsy decision models on a real-world dataset. Single-centre retrospective study performed on 2055 biopsy naïve patients undergoing MRI. Diagnostic pathways included "biopsy all", "MRI-focussed" and two risk-based MRI-directed pathways. Risk thresholds were based on prostate-specific antigen (PSA) density as low (<0.10 ng mL-2), intermediate (0.10-0.15 ng mL-2), high (0.15-0.20 ng mL-2), or very high-risk (>0.20 ng mL-2). The outcome measures included rates of biopsy avoidance, detection of clinically significant prostate cancer (csPCa), missed csPCa, and overdiagnosis of insignificant prostate cancer (iPCa). Overall cancer rate was 39.9% (819/2055), with csPCa (Grade-Group ≥2) detection of 30.3% (623/2055). In men with a negative MRI (Prostate Imaging-Reporting and Data System, PI-RADS 1-2), the risk of cancer was 1.2%, 2.6%, 9.0%, and 12.9% in the low, intermediate, high, and very high groups, respectively; for PI-RADS score 3 lesions, the rates were 10.5%, 14.3%, 25.0%, and 33.3%, respectively. MRI-guided pathway and risk-based pathway with a low threshold missed only 1.6% csPCa with a biopsy-avoidance rate of 54.4%, and the risk-based pathway with a higher threshold avoided 62.9% (1292/2055) of biopsies with 2.9% (61/2055) missed csPCa detection. Decision curve analysis found that the "risk-based low threshold" pathway has the highest net benefit for probability thresholds between 3.6% and 13.9%. Combined MRI and PSA-density risk-based pathways can be a helpful decision-making tool enabling high csPCa detection rates with the benefit of biopsy avoidance and reduced iPCa detection. This real-world dataset from a large UK-based cohort confirms that combining MRI scoring with PSA density for risk stratification enables safe biopsy avoidance and limits the over-diagnosis of insignificant cancers.

Prostagram magnetic resonance imaging in a screening population: Prostate Imaging-Reporting and Data System or Likert?

To compare biopsy recommendation rates and accuracy of the Prostate Imaging-Reporting and Data System, version 2 (PI-RADSv2) with the Likert scale for detection of clinically significant and insignificant prostate cancer in men screened within the Imperial Prostate 1 Prostate Cancer Screening Trial Using Imaging (IP1-PROSTAGRAM). Men aged 50-69 years were screened with Prostagram MRI. Scans were prospectively reported using both PI-RADSv2 (excluding dynamic contrast-enhanced sequence score) and 5-point Likert scores by expert uro-radiologists. Systematic and targeted transperineal biopsy was recommended if the scan was scored ≥ 3, based on either reporting system. The proportion of patients recommended for biopsy and detection rates for Grade Groups (GGs) 1 and ≥ 2 were compared. Receiver operating characteristic (ROC) analysis was performed to compare performance. A total of 406 men underwent Prostagram MRI. The median (interquartile range) age and prostate-specific antigen level were 57 (53-61) years and 0.91 (0.56-1.74) ng/mL, respectively. At MRI score ≥ 3, more patients were recommended for biopsy based on Likert criteria (94/406; 23%, 95% confidence interval [CI] 19.2%-27.6%) compared to PI-RADSv2 (72/406; 18%, 95% CI 14.2%-21.9%; P = 0.03). For MRI scores ≥ 4, PI-RADSv2 and Likert scales led to 43/406 (11%, 95% CI 7.9%-14.1%) and 35/406 (9%, 95% CI 6.2%-11.9%) men recommended for biopsy (P = 0.40). For GG ≥ 2 detection, PIRADSv2 and Likert detected 22% (95% CI 11.4%-30.8%, 14/72) and 16% (95% CI 9.5%-25.3%, 15/94), respectively (P = 0.56). For GG1 cancers detection these were 11% (95% CI 4.3%-19.6%, seven of 72) vs 11% (95% CI 4.7%-17.8%, nine of 94; P = 1.00). The accuracy of PI-RADSv2 and Likert scale was similar (area under the ROC curve 0.64 vs 0.65, P = 0.95). In reporting non-contrast-enhanced Prostagram MRI in a screening population, the PI-RADSv2 and Likert scoring systems were equally accurate; however, Likert scale use led to more men undergoing biopsy without a subsequent increase in significant cancer detection rates. To improve reporting of Prostagram MRI, either the PI-RADSv2 or a modified Likert scale or a standalone scoring system should be developed.

Prostate Biopsies Can Be Omitted in Most Patients with a Positive Stockholm3 Test and Negative Prostate Magnetic Resonance Imaging

BackgroundMagnetic resonance imaging (MRI) combined with the Stockholm3 test can be used to inform biopsy decision-making in patients with a suspicion of prostate cancer. ObjectiveTo determine the consequence of omitting biopsies in men with a positive Stockholm3 test and a negative MRI. Design, setting, and participantsIn a real-life setting, 438 men with a positive Stockholm3 test and a negative MRI underwent systematic biopsies from 2017 to 2020. Outcome measurements and statistical analysisThe Stockholm3 test result is a percentage risk score with or without a prostate volume cutoff. The main outcomes were the number of clinically significant (Gleason grade group [GG] ≥2) and nonsignificant (GG 1) prostate cancers. Results and limitationsMedian prostate-specific antigen was 4.5 ng/ml (interquartile range 2.8–6.4 ng/ml) and the median age was 69 yr. Systematic biopsies detected grade group (GG) ≥2 disease in 48 men (11%, 95% confidence interval [CI] 8.4–14.2%) and GG 1 disease in 94 men (21.5%, 95% CI 17.9–25.6%). Of 256 patients without a volume cutoff in the test report, GG ≥2 was detected in 37 men (14.5%, 95% CI 10.7–19.3%). Omitting biopsies in patients with a volume cutoff would miss 11 GG ≥2 cases (6%, 95% CI 3.4–10.5%), reduce the number of GG 1 cases detected by 37 (39.4%, 95% CI 30.1–49.5%), and avoid a total of 182 biopsies (41.6%, 95% CI 37.0–46.2%). Limitations include the lack of follow-up data. ConclusionsSystematic biopsies can be omitted in patients with a positive Stockholm3 test and a negative MRI when there is a volume cutoff in the test report. With no volume cutoff, biopsies can be considered with shared decision-making. Patient summaryWhen investigated on suspicion of prostate cancer with a positive Stockholm3 test and a negative MRI (magnetic resonance imaging), prostate biopsies are only necessary for a subgroup of patients. This can spare some men from undergoing biopsies and reduce the detection of clinically insignificant cancers.

864 Does the PROMIS Trial Deliver What It Promised? Validation in a North West Population

Abstract Aim The PROMIS trial changed the landscape on how men with raised PSA are evaluated. We changed the pathway at a North West hospital, utilising multiparametric MRI (MP-MRI) scans and incorporated additional safety parameters (family history and PSA density) to maintain the advantage of avoiding unnecessary biopsy whilst not missing significant cancers. We present the performance of this pathway. Method We retrospectively reviewed 596 referrals of men with high PSA level between January - December 2021. Variables audited included demographics, PSA level, PSA density, Prostate Imaging-Reporting and Data System (PI-RADS) score on MP-MRI, biopsy results, Gleason score and prognostic grade grouping. Results Of 596 patients, 65.9% of men were aged between 50-75 years. The most common quintile of presenting PSA was 4.00-9.99 (53.2%). Of the 381 patients with non-metastatic prostate cancer who underwent MP-MRI, 38.3% were classed as PI-RAD 1-2, 16% PI-RAD 3 and 45.7% PI-RAD 4-5. Overall, 48.3% of patients did not undergo biopsy. Biopsy rates in PI-RAD 1-5 were 2.3%, 3.9%, 52.5%, 92.5% and 91.5% respectively, the decision made to monitor PSA instead in some cases due to co-morbidities or patient preference. Of 197 biopsies, 79.2% were positive, 87.8% initially classed as PI-RADS 4 or 5. Of the cancers picked up, 82.1% were clinically significant (Gleason score ≥3+4). Conclusions This study shows the pathway incorporating MP-MRI, family history and PSA density enables 48.3% of patients to avoid unnecessary biopsy and therefore overdiagnosis of clinically insignificant cancers. The PROMIS trial delivers what it promised.

Computed Tomography-Guided Prostate Sampling and Fiducial Marker Insertion in Patients With Absent Rectums.

We aimed to present our experience and the outcomes of a novel technique, computed tomography (CT)-guided prostate biopsy and fiducial marker insertion in patients with absent rectums. Patients who underwent CT-guided prostate biopsy at a single institution from November 2010 to November 2022 were retrospectively reviewed. Patients were included if they had a clinical suspicion of prostate cancer and had absent rectums from previous surgical resection. Contrast-enhanced CT scan was used to perform transgluteal prostate biopsy. Patient demographics, multiparametric magnetic resonance imaging, and biopsy details were recorded. Thirteen biopsy procedures and 1 CT-guided fiducial marker insertion were performed on 12 unique patients. The reasons for the absence of rectums included surgical resection for rectal cancer (n = 10) and surgical resection for inflammatory bowel disease (n = 2). Clinically significant cancer was found in 7 of 13 biopsy results (52.8%), clinically insignificant cancer in 3 of 13 (23.1%), and benign cancer in 3 of 13 (23.1%). No complications were recorded. Our data support CT-guided prostate biopsy as an accurate and effective technique for investigating prostate cancer that requires tissue sampling in patients with absent rectums.

A Cost-Benefit Comparison of Biparametric Magnetic Resonance Imaging Versus Conventional Prostate Cancer Screening

Purpose: : This study aimed to compare the cost-effectiveness and feasibility of biparametric magnetic resonance imaging (bp MRI) for prostate cancer screening to prostate-specific antigen (PSA)-based screening.Materials and Methods: We retrospectively reviewed the data from 602 men who had PSA-based prostate cancer screening between July 2014 and April 2017 and 621 men who underwent bp MRI-based prostate cancer screening between May 2017 and December 2020. Of them, 467 men with Prostate Imaging Reporting and Data System scores of 3 or higher underwent magnetic resonance imaging/ultrasound fusion transrectal biopsy and random transrectal prostate biopsy. The remaining 154 patients underwent random prostate biopsies only. Patient demographics, digital rectal examination, staging, PSA level, PSA density, bp MRI findings associated with prostate cancer detection on biopsy, admission rate for complications after prostate biopsy, and associated medical costs were analyzed.Results: Prebiopsy demographics were comparable. The MRI-based screening had a higher prostate cancer detection rate (62.7%) than conventional screening (45.1%). Biparametric MRI was more sensitive for clinically significant prostate cancer (csPCa) (40.6% vs. 23.5%). In 154 men who lacked a targetable prostate lesion, 47 and 14 patients (9.1%) had insignificant and significant prostate cancer, respectively. None of the patients had more than Gleason 8 (4+4). MRI-based screening costs more than conventional screening. However, the cost of detecting csPCa can be reduced by 49.4% (United States dollar [USD] 14,883.5 vs. USD 7,355.0).Conclusions: MRI-based screening is sensitive for csPCa and is cost-effective. It can also reduce unnecessary biopsies to detect insignificant prostate cancer

Do Concomitant Systematic Biopsies Add to Fusion Targeted Biopsies in the Diagnosis and Management of Clinically Significant Prostate Cancer?

Magnetic resonance imaging targeted biopsy clearly detects more clinically significant prostate cancer than systematic biopsy. Whether concomitant systematic biopsy adds to targeted biopsy in the detection of clinically significant prostate cancer remains uncertain. The primary outcome measure of this study was to ascertain the percentage of clinically significant prostate cancer on systematic biopsy missed by targeted biopsy. Furthermore, we sought to determine whether systematic biopsy results influenced the clinical management of patients. This prospective observational study included all men undergoing Fusion targeted biopsy in our Health Board. All men had PI-RADS scores of 3-5 on magnetic resonance imaging. Histology from targeted biopsy and systematic biopsy was reviewed to determine any additional benefit of performing systematic biopsy. Clinical outcomes were also reviewed. Clinically significant prostate cancer was defined by (i) International Society of Urological Pathology ≥ 2 and (ii) UCL criteria of any primary Gleason 4 or core length ≥ 6 mm. A total of 104 men were included in the study of whom 18 patients were biopsy naïve, 65 had at least 1 previous negative biopsy, and 20 had previous biopsies that showed clinically insignificant cancer. The percentage of clinically significant prostate cancer missed on targeted biopsy was between 9.1% and 11.1%. Moreover, 17.1% of patients with clinically significant prostate cancer would not have proceeded to radical treatment if the systematic biopsy had not been performed. Our data support a growing field of evidence that although magnetic resonance imaging targeted biopsy is more sensitive than systematic biopsy at detecting clinically significant prostate cancer, systematic biopsy adds to the number of patients diagnosed with clinically significant prostate cancer in those already undergoing prostate biopsy.

Fluoride and Metals in the Agricultural Soils of Mica Mining Areas of Jharkhand, India: Assessing the Ecological and Human Health Risk

ABSTRACT The concentration of metals and fluoride in the agricultural soils of the mica mining areas of Jharkhand was estimated for human health risk assessment and source apportionment studies. The elemental concentrations of As, Co, Cu, Fe, Ni, Pb and Zn in the study area exceeded the world average values. The sources of the metals and fluoride in soil were suggested to be from both natural and human-induced activities as per principal component analysis (PCA) and cluster analysis (CA). The sources of Al, Fe, Mn and F in the soil were ascribed to the mica mining–related activities as indicated by PCA and CA. Potential ecological risk assessment suggested moderate risk with respect to Cd, Cu and Pb at few locations. Considering metals and fluoride content of the soils, non-cancer risk assessment suggested considerable risk to the child population which was largely due to Al and Fe. Taking into account all the pathways and elements, the HIs for the study area were calculated to be 0.586 and 3.58 for the adult and child residents, respectively. The carcinogenic risk assessment evaluated the cancer risk to be within the target risk of 1 × 10−4, suggesting insignificant cancer risk to the residents.

Surgical Treatment at an Academic Medical Center is Associated with Statistically Insignificant Lung Cancer Survival Outcome Differences Related to ZIP Code.

Low socioeconomic status is a well-characterized adverse prognostic factor in large lung cancer databases. However, such characterizations may be confounded as patients of lower socioeconomic status are more often treated at low-volume, non-academic centers.We evaluated whether socioeconomic status, as defined by ZIP code median income, was associated with differences in lung cancer resection outcomes within a high-volume academic medical center. Consecutive patients undergoing resection for non-small cell lung cancer were identified from a prospectively maintained database (2011-18).Patients were assigned an income value based on the median income of their ZIP code as determined by census-based geographic data. We stratified the population into income quintiles representative of SES and compared demographics (chi-square), surgical outcomes, and survival (Kaplan-Meier). We identified 1,693 patients, representing 516 ZIP codes. Income quintiles were Q1: $24,421-53,151; Q2:$53,152-73,982; Q3:$73,983-99,063; Q4:$99,064-123,842; and Q5:$123,843-250,001. Compared to Q5 patients, Q1 patients were younger (median 69 vs. 73, p < 0.001), more likely male (44 vs. 36%, p = 0.035), and more likely Asian, Black, or self-identified as other than white, Asian, or Black. (67 vs. 11%, p = < 0.001). We found minor differences in surgical outcomes and no significant difference in 5-year survival between Q1 and Q5 patients (5-year: 86 vs. 85%, p = 0.886). Surgical care patterns at a high-volume academic medical center are similar among patients from varying ZIP codes.Surgical treatment at such a center is associated with no survival differences based upon socioeconomic status as determined by ZIP code.Centralization of lung cancer surgical care to high-volume centers may reduce socioeconomic outcome disparities.

MP17-07 VALIDATION OF MICHECK PROSTATE FOR SIGNIFICANT PROSTATE CANCER IN AN AUSTRALIAN POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP17-07 VALIDATION OF MICHECK PROSTATE FOR SIGNIFICANT PROSTATE CANCER IN AN AUSTRALIAN POPULATION David Gillatt, Dmitry Polikarpov, Ian Smith, Howard Lau, Lawrence Kim, Chi Can Huynh, Kheng Sit Lim, Jaya Siddireddy, Yanling Lu, Ninantao Deng, Douglas Campbell, Brad Walsh, and Manish Patel David GillattDavid Gillatt More articles by this author , Dmitry PolikarpovDmitry Polikarpov More articles by this author , Ian SmithIan Smith More articles by this author , Howard LauHoward Lau More articles by this author , Lawrence KimLawrence Kim More articles by this author , Chi Can HuynhChi Can Huynh More articles by this author , Kheng Sit LimKheng Sit Lim More articles by this author , Jaya SiddireddyJaya Siddireddy More articles by this author , Yanling LuYanling Lu More articles by this author , Ninantao DengNinantao Deng More articles by this author , Douglas CampbellDouglas Campbell More articles by this author , Brad WalshBrad Walsh More articles by this author , and Manish PatelManish Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003237.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSA screening and multi parametric MRI are widely used to identify patients with suspected prostate cancer who may benefit from prostate biopsy. Patients with PIRADs scores 3-5 are typically biopsied, however up to 17% of patients with PIRADs scores of 1-2 will harbour clinically significant cancers that would remain undiagnosed using these criteria, while up to 80% of PIRADs 3 patients do not have clinically significant cancers. Hence there is a requirement for additional tests better able to guide prostate biopsy decisions. MiCheck Prostate is a serum-based test for aggressive prostate cancer (GS3+4 or higher) developed by Minomic International that uses a proprietary algorithm to combine results from three standard blood markers with clinical factors to provide a risk score for clinically significant cancer. The current study was designed to assess the test performance of MiCheck Prostate in an Australian study cohort. METHODS: The study was conducted at Macquarie University Hospital (MUH, Ethics approval 5201500707). Serum samples were collected from patients undergoing prostate biopsies. Blood markers were measured at Douglass Hanley Moir (DHM) laboratories using Abbott Architect and Alinity immunoassays. RESULTS: 192 patient samples were collected: 78 (41%) had no cancer, 37 (19%) had insignificant cancer (Gleason 3+3) and 77 (40%) had Gleason 3+4 or higher. 2 (1%) patients had PIRADs 1, 16 (8%) had PIRADS 2, 23 (12%) PIRADs 3, 88 (46%) had PIRADs 4 and 55 (29%) had PIRADs 5 and 8 (4%) patients had no PIRADs data. When used prior to MRI, MiCheck Prostate had 92% sensitivity for detection of clinically significant cancers. The AUC for MiCheck Prostate was significantly higher than PSA (0.71 vs 0.58, p=0.03). When used post MRI, MiCheck Prostate showed sensitivity of 94% and specificity of 39% for detection of significant prostate cancer in the overall patient population. The AUC for MiCheck Prostate was significantly higher than PSA (0.79 vs 0.58, p<0.0001). In 49 patients with PIRADs score of 3 or lower, MiCheck Prostate showed sensitivity of 92% and specificity of 65%, with NPV of 96%. CONCLUSIONS: The current study demonstrates MiCheck Prostate has high sensitivity for detection of significant prostate cancer in an Australian population. MiCheck Prostate has high sensitivity in both the pre-MRI and post-MRI settings as well as in the PIRADs 1-3 subgroup. MiCheck Prostate provides additional information to urologists and patients in the decision to proceed to prostate biopsy with patients suspected of having prostate cancer. Source of Funding: Minomic International Ltd, Australian Government SIEF © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e215 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Gillatt More articles by this author Dmitry Polikarpov More articles by this author Ian Smith More articles by this author Howard Lau More articles by this author Lawrence Kim More articles by this author Chi Can Huynh More articles by this author Kheng Sit Lim More articles by this author Jaya Siddireddy More articles by this author Yanling Lu More articles by this author Ninantao Deng More articles by this author Douglas Campbell More articles by this author Brad Walsh More articles by this author Manish Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

Prospective study of prostate cancer detection using multiparametric magnetic resonance imaging ultrasound-guided fusion, standard, and saturation biopsy

Background. Currently, about 80 % of men with low-grade prostate cancer (per ISUP 1 (International Society of Urological Pathology)) have indications for radical treatment. Overdiagnosis of low-grade cancer is associated with the use of systematic biopsy methods (standard transrectal, saturation) under ultrasound control for diagnosis verification. To improve prostate cancer diagnosis, the European Association of Urology (2019) recommended multiparametric magnetic resonance imaging before biopsy, and in case of detection of a suspicious lesion magnetic resonance imaging (MRI)-targeted biopsy. In clinical practice, the most common method of MRI-targeted biopsy is multiparametric MRI ultrasound-guided (mpMRI/US) fusion biopsy. However, some studies show contradictory results in detection of prostate cancer using systematic and MRI-targeted biopsy techniques.Aim. To compare detection of clinically significant prostate cancer (ISUP ≥2) using mpMRI/US fusion, standard, and saturation biopsy.Materials and methods. The study included 96 patients. The following inclusion criteria were applied: prostate-specific antigen &gt;2 ng/mL and/or detection of a suspicious lesion during digital rectal and/or transrectal ultrasound examination, and PI-RADS (Prostate Imaging Reporting and Data System) v.2.1 score ≥3. At the first stage, “unblinded” urologist performed a transperineal mpMRI/US fusion and saturation biopsies. At the second stage, “blinded” urologist performed standard transrectal biopsy. Clinically significant cancer was defined as ISUP ≥2.Results. Median age was 63 years, prostate volume – 47 cm3, prostate-specific antigen – 6.82 ng/mL. MpMRI/US fusion, standard, and saturation biopsies were comparable in regard to the rate of detection of clinically significant (29, 24, 28 %; p = 0.81) and clinically insignificant (25, 26, 35 %; p = 0.43) cancer. Overall prostate cancer detection rates were also similar: 54, 50, 63 %, respectively (p = 0.59). The percentages of positive cores in mpMRI/US fusion, standard, and saturation biopsies were 33, 10 and 13 %, respectively (p &lt;0.01). The maximal core length in mpMRI/US was 6.4 mm, in standard biopsy – 6.35 mm, in saturation biopsy – 5.1 mm (p = 0.7).Conclusion. Detection rates of clinically significant, clinically insignificant prostate cancer and overall detection rate are comparable between systematic biopsy techniques and mpMRI/US fusion biopsy.