ISUP Grade Research Articles

A side-specific nomogram for extraprostatic extension may reduce the positive surgical margin rate in radical prostatectomy.

Nomograms predicting side-specific extraprostatic extension (EPE) may be applied to reduce positive surgical margin (PSM) rates in patients planned for radical prostatectomy (RP). This study evaluates the impact of implementing an externally validated nomogram for side-specific EPE on PSM rate and degree of nerve-sparing. In patients planned for RP, the side-specific nomogram predictions (based on MRI, ISUP grade group, and PSA density), with an advised threshold of 20% for safe nerve-sparing, were presented preoperatively to the urological surgeon. The surgeon completed a survey before RP about the planning with respect to side-specific nerve-sparing and change of management due to the result of the nomogram. PSM rates and degree of nerve-sparing were compared to a retrospective control group treated in the months prior to the introduction of the nomogram. A total of 100 patients were included, 50 patients in both groups representing 200 prostate lobes. Of the patients, 37% had histologically confirmed EPE, and 40% a PSM. In 12% of the 100 lobes planned after nomogram presentation, a change in management due to the nomogram was reported. A per-prostate lobe analysis of all the lobes showed comparable rates of full nerve-sparing (45% vs. 30%; p = 0.083) and lower rates of PSM on the lobes with histological EPE (45% vs. 85%; p < 0.05) in the intervention (nomogram) group versus the control group. Implementing a predictive nomogram for side-specific EPE in the surgical planning for nerve-sparing leads to lower rates PSM on the side of the histological EPE without compromising nerve-sparing.

PSOR4 Presentation Time: 11:45 AM: Salvage High-Dose-Rate Brachytherapy for Prostate Cancer Local Recurrence: Comparison of Two Fractionation Schedules

<h3>Purpose</h3> Salvage high-dose-rate brachytherapy (sHDR-BT) is an efficient option administered for relapsing prostate cancer patients in our department since 2008. We decided to shorten and intensify our schedule with an equivalent total dose based on the available data in 2016. The aim is to compare two schedules of sHDR-BT in terms of efficacy. <h3>Materials and Methods</h3> A retrospective analysis of patients treated with sHDR-BT due to local recurrence (LR) of prostate cancer. All patients were treated with perineal interstitial HDR-BT under epidural or general anaesthesia in the lithotomy position. Schedule one ("3 × 10 Gy"; 2008-2016) consisted of three fractions of 10 Gy in 28 days, while schedule two ("2 × 13 Gy"; 2016-present) was two fractions of 13 Gy in 7-14 days. Biochemical recurrence was defined according to Phoenix criteria. Biochemical control (BC), local control (LC), distant metastasis-free survival (DMFS) and disease-free survival (DFS) were calculated. In statistical analysis, Kaplan-Meier estimator, log-rank test and Mann-Whitney U test were used. Two hundred thirty-three patients were enrolled in this analysis. Median age was 71 years (range: 42-84 years). Median follow-up was 44 months (range: 2-159). Median PSA max at recurrence was 2.9 ng/mL (range: 0.04-21.0 ng/mL). ISUP grade 1 was diagnosed in 15% of patients, 2 - in 17%, 3 - in 10%, ≥4 - in 16%, and in 42%, it was not determined. The comparison of groups with different fractionation revealed that patients in the "2 × 13 Gy" group were significantly older (p=0.04), their PSA level and Gleason score at recurrence were significantly higher (p=0.026 and p=0.044, respectively), the disease was more advanced (p=0.0000) and overall treatment time (OTT) was significantly shorter (p=0.0000). In the "3 × 10 Gy" group, there were 154 patients. Median age was 70 years (range: 42-80 years). Median follow-up was 62 months (range: 8-159 months). Median PSA max at recurrence was 2.7 ng/mL (range: 0.04-20.0 ng/mL). ISUP grade 1 was diagnosed in 17% of patients, 2 - in 18%, 3 - in 7%, ≥4 - in 12%, and in 45%, it was not determined. At the time of LR diagnosis, only one patient (0.65%) had regional lymph node metastases, and one patient (0.65%) had distant metastases. Both patients had oligometastases treated with SBRT. In the "2 × 13 Gy" group, there were 79 patients. Median age was 72 years (range: 55-80 years). Median follow-up was 24 months (range: 2-42 months). Median PSA max at recurrence was 3.2 ng/mL (range: 0.2-21.0 ng/mL). ISUP grade 1 was diagnosed in 11.4% of patients, 2 - in 13.9%, 3 - in 16.5%, ≥4 - in 24%, in 34.2% it was not determined. At the time of LR diagnosis, 73% of patients were diagnosed with LR only, 13% had regional lymph node metastases and 14% had distant metastases. All these patients had oligometastases treated with SBRT. <h3>Results</h3> In the whole group, median BC was 91 months, 2- and 5-year BC was 77% and 61%, respectively. Median LC was 108 months. Two- and 5-year LC was 93% and 76%, respectively. Median DMFS and DFS was 117 months and 70 months, respectively. Two- and 5-year DMFS was 86% and 71%, respectively; 2- and 5-year DFS was 81% and 67%, respectively. There was statistically significant difference in LC (p=0.017), DMFS (p=0.001) and DFS (p=0.0005) between "3 × 10 Gy" and "2 × 13 Gy" groups. Similar differences were observed between "OTT≤14 days" and "OTT>14 days" groups (p=0.011, p=0.01, p=0.004, respectively) (Table 1). <h3>Conclusions</h3> Salvage HDR-BT is an efficient treatment of localised prostate cancer relapse after primary irradiation. OTT>14 days and 3 × 10 Gy fractionation appear to be more effective in comparison to shorter OTT and 2 × 13 Gy fractionation. However, a longer follow-up is needed to confirm these findings, and a prospective trial would be of great value.

P049 - Clinical progress of patients with ISUP Grade 1 prostate adenocarcinoma, single-center results

P049 - Clinical progress of patients with ISUP Grade 1 prostate adenocarcinoma, single-center results

P097 - A comparison of morphologic grading system based on architectural patterns and WHO/ ISUP grading system in clear cell renal cell carcinomas

P097 - A comparison of morphologic grading system based on architectural patterns and WHO/ ISUP grading system in clear cell renal cell carcinomas

P026 - Discrepancy between needle biopsy and radical prostatectomy ISUP grade group in patients with prostate cancer - 12 years’ experience in a tertiary prostate cancer center

P026 - Discrepancy between needle biopsy and radical prostatectomy ISUP grade group in patients with prostate cancer - 12 years’ experience in a tertiary prostate cancer center

P011 - The diagnostic added value of PSMA PET/CT in men with newly diagnosed ISUP grade group 3 prostate cancer

P011 - The diagnostic added value of PSMA PET/CT in men with newly diagnosed ISUP grade group 3 prostate cancer

122. Prostate cancer and other clinical features by polygenic risk score

Prostate cancer is the second most common cancer in American men and the second leading cause of cancer death in the USA. Genome-wide association studies (GWAS) have identified more than 170 single nucleotide polymorphisms (SNPs) associated with prostate cancer, which can be combined to make a Polygenic Risk Score (PRS) and give an individual their risk to develop prostate cancer. To our knowledge, studies have not been done to determine if there is a relationship between PRS and features of prostate cancer in men ascertained in a clinical setting. Thus, this study aims to investigate risk factors associated with prostate cancer including: age of diagnosis, ISUP Grade Group, metastatic status, histology, and family history of prostate cancer, to determine how they correlate with PRS amongst men who do not have a germline pathogenic variant in a known prostate cancer related gene. A quantitative retrospective chart review of 175 men diagnosed with prostate cancer, who received genetic counseling services at the Ohio State University's Genitourinary Cancer Genetics Clinic, and a PRS through Ambry Genetics was generated. Men diagnosed over 60 years of age were more likely to have a low PRS (57%) than a high PRS (32%) (p-value of 0.009). This supports the hypothesis that men diagnosed with prostate cancer at younger ages will have higher PRS and vice versa. We did not find a significant relationship between PRS and ISUP GG, metastatic status, histology, or family history in a first or second-degree relative.

P024 - Prostate cancer diagnosis composite probability index (pPCacomp): A novel multi-parametric mathematical model for predicting detection and ISUP grading of prostatic carcinoma on TRUS biopsy

P024 - Prostate cancer diagnosis composite probability index (pPCacomp): A novel multi-parametric mathematical model for predicting detection and ISUP grading of prostatic carcinoma on TRUS biopsy

Clinical outcomes of anterior prostate cancers treated with robotic assisted radical prostatectomy.

A prospective cohort study comparing peri- and postoperative outcomes for patients with predominantly anterior prostate cancer (APC) identified preoperatively against non-anterior prostate cancer (NAPC) treated via robotic-assisted radical prostatectomy (RARP). Of the 757 RARP's completed between January 2016 and April 2018, two comparative cohorts for anterior and an equivalent group of non-anterior prostate tumours each consisting of 152 patients were compared against each other. Data were collected on the following variables: patient age; operating consultant; preoperative PSA, ISUP grade, degree of nerve sparing; tumour staging; presence and location of positive surgical margins; PSA density, postoperative ISUP grade; treatment paradigm and postoperative PSA, erectile function, and continence outcomes with 2-year follow-up. APCs were found to have significantly lower ISUP grading postoperatively; increased diagnosis via active surveillance over new diagnosis; more frequently undertaken bilateral nerve-sparing and long-term poorer continence outcomes at 18 and 24 months postoperatively (p < 0.05). Pre- and post-op PSA levels, erectile function, PSA density, positive surgical margins (PSM), age and tumour staging showed no significant differences between the APC and NAPC cohorts (p > 0.05). The lower ISUP grading could indicate APC as overall being less aggressive than NAPC, whereas the poorer long-term continence outcomes require further investigating. The non-significant differences amongst tumour staging, PSA density, preoperative PSA levels and PSM rates suggest that APC may not be as significant as predicted in diagnostic evaluation. Overall, this study provides useful information on the growing literature of anterior prostate cancer. Being the largest comparative cohort study to date on APC post-RARP, these results indicate the true characteristics of anterior tumours and their functional outcomes to help improve education, patient expectations and management.

Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?

In prostate cancer (PC) diagnosis, additional systematic biopsy (SB) is recommended to complement MRI-targeted biopsy (TB) to address the limited sensitivity of TB alone. The combination of TB+SB is beneficial for diagnosing additional significant PC (sPC) but harmful in terms of the additional diagnosis of indolent PC (iPC), morbidity, and resource expenditures. We aimed to investigate the benefit of additional SB and to identify predictors for this outcome. We analyzed the frequency of upgrading to sPC by additional SB in a retrospective single-center cohort of 1043 men. Regression analysis (RA) was performed to identify predictors for this outcome. Reclassification rates of ISUP grade groups between prostate biopsy and a subsequent radical prostatectomy were assessed. Additional SB led to upgrading to sPC in 98/1043 men (9.4%) and to the additional diagnosis of iPC in 71/1043 (6.8%). In RA, men harboring a PI-RADS 2-4 lesion were more likely to have TB results upgraded by SB (p &lt; 0.01) compared to PI-RADS 5 men. When analyzing reclassification rates, additional SB reduced the upgrading to sPC from 43/214 (20.1%) to 8/214 (3.7%). In the PI-RADS 5 subgroup, this difference decreased: 4/87 (4.7%) with TB only vs. 1/87 (1.2%) with TB+SB. Men with a PI-RADS 5 lesion may obviate additional SB.

The Prognostic Value of the Size and the Sub-Site of the Local Failure at DCE-MRI before Salvage Radiotherapy for Prostate Cancer

<h3>Purpose/Objective(s)</h3> To investigate predictors of biochemical failure after salvage radiotherapy (sRT) in the context of a presumed local failure at dynamic contrast-enhancement-magnetic resonance imaging (DCE-MRI) post radical prostatectomy (RP). <h3>Materials/Methods</h3> All patients referred for sRT at our Institution with a biochemical failure after RP have been consistently offered restaging with both PET/CT and multiparametric MRI since January 2014. Those with a presumed local failure at DCE-MRI as well as no regional/distant disease at PET/CT (either choline and/or PSMA) were selected for the present study. Exclusion criteria were history of androgen deprivation (AD) before sRT and positive nodes at RP. All patients underwent 3T DCE-MRI without endorectal coil and the lesion(s) transferred to the planning CT after co-registration. sRT consisted in 73.5 Gy to the presumed local lesion and 66-69 Gy to the prostatic bed in 30 fxs. Pelvic nodes (PN) were covered to 54 Gy/30 fxs in selected patients. The endpoint of the study was the development of a biochemical failure after sRT defined as a 0.2 ng/ml PSA rise above the nadir. Various covariates (age, pre-RP PSA, pT and pN stages at RP, margins status at RP, ISUP grade group, time from RP to sRT, PSA doubling time, PSA detectability after RP, PSA at sRT, the location, number and volume of the detected recurrence(s), AD use, PN coverage, EUA risk category) were investigated at univariate analysis (UVA) on the time to biochemical failure (bNED-survival). Covariates with a p value <0.2 at UVA were entered a Cox proportional hazards regression analysis. <h3>Results</h3> Up to June 2020, 146 patients satisfying all selection criteria have been treated with sRT. Median (IQR) PSA at sRT was 0.60 ng/ml (0.38-1.05 ng/ml) and only 17 patients (11.6%) received AD along with sRT. A total of 168 local lesions have been detected, 92 (54.8%), 40 (23.8%) and 36 (21.4%) at the vesicourethral anastomosis (VUA), the bladder neck and the retrovesical space, respectively. At the median (IQR) follow-up of 48.1 months (31.3-60.6 months), 22 biochemical failures have been observed for a 4-yr bNED survival of 84.4% (95%CI: 77.9-90.9%). On UVA, bNED-survival after sRT was significantly more likely for patients with VUA-only lesions (VUA-only vs others, HR=0.307, 95%CI: 0.120-0.784, p=0.014) and with smaller lesions (for every cc, HR: 1.071, 95%CI: 1.025-1.119, p=0.002). These associations remained significant (p< 0.01) on multivariate analysis as well. For patients with VUA-only disease or with lesions smaller than 0.5cc, 4-yr bNED survival rates were 90.7% (95%CI: 83.4-98.0%) and 90.6% (95%CI: 83.9-97.3%), respectively. The 46 patients with both favorable features had a 4-yr bNED rate of 94.6% (95%CI: 87.3-100%). <h3>Conclusion</h3> These data support local restaging with DCE-MRI before sRT in the setting of a biochemical failure after RP. Patients with VUA-only and/or small volume lesions have an excellent outcome after dose-escalated sRT.

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy.

When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2-4 cores per target) followed by SBx (12-14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI-RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni- and multivariable logistic regression analyses were performed to identify predictors of CDR. CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per-patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI-RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI-RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per-lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. The addition of systematic mapping to TBx contributes to a minority of per-patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA-density significantly increases the risk of PCa, both in the whole cohort and in PI-RADS 3 cases.

Modern paradigms for prostate cancer detection and management.

Early detection and management of prostate cancer has evolved over the past decade, with a focus now on harm minimisation and reducing overdiagnosis and overtreatment, given the proven improvements in survival from randomised controlled trials. Multiparametric magnetic resonance imaging (mpMRI) is now an important aspect of the diagnostic pathway in prostate cancer, improving the detection of clinically significant prostate cancer, enabling accurate localisation of appropriate sites to biopsy, and reducing unnecessary biopsies in most patients with normal magnetic resonance imaging scans. Biopsies are now performed transperineally, substantially reducing the risk of post-procedure sepsis. Australian-led research has shown that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has superior accuracy in the staging of prostate cancer than conventional imaging (CT and whole-body bone scan). Localised prostate cancer that is low risk (International Society for Urological Pathology [ISUP] grade 1, Gleason score 3 + 3=6; and ISUP grade group 2, Gleason score 3 + 4=7 with less than 10% pattern 4) can be offered active surveillance, reducing harms from overtreatment. Prostatectomy and definitive radiation remain the gold standard for localised intermediate and high risk disease. However, focal therapy is an emerging experimental treatment modality in Australia in carefully selected patients. The management of advanced prostate cancer treatment has evolved to now include several novel agents both in the metastatic hormone-sensitive and castration-resistant disease settings. Multimodal therapy with androgen deprivation therapy, additional systemic therapy and radiotherapy are often recommended. PSMA-based radioligand therapy has emerged as a treatment option for metastatic castration-resistant prostate cancer and is currently being evaluated in earlier disease states.

The Role of [18F]F-Choline PET/CT in the Initial Management and Outcome Prediction of Prostate Cancer: A Real-World Experience from a Multidisciplinary Approach.

Initial staging of prostate cancer (PCa) is usually performed with conventional imaging (CI), involving computed tomography (CT) and bone scanning (BS). The aim of this study was to analyze the role of [18F]F-choline positron emission tomography (PET)/CT in the initial management and outcome prediction of PCa patients by analyzing data from a multidisciplinary approach. We retrospectively analyzed 82 patients who were discussed by the uro-oncology board of the University Hospital of Ferrara for primary staging newly diagnosed PCa (median age 72 (56–86) years; median baseline prostate specific antigen (PSA) equal to 8.73 ng/mL). Patients were divided into three groups based on the imaging performed: group A = only CI; group B = CI + [18F]F-choline PET/CT; group C = only [18F]F-choline PET/CT. All data on imaging findings, therapy decisions and patient outcomes were retrieved from hospital information systems. Moreover, we performed a sub-analysis of semiquantitative parameters extracted from [18F]F-choline PET/CT to search any correlation with patient outcomes. The number of patients included in each group was 35, 35 and 12, respectively. Patients with higher values of initial PSA were subjected to CI + PET/CT (p = 0.005). Moreover, the use of [18F]F-choline PET/CT was more frequent in patients with higher Gleason score (GS) or ISUP grade (p = 0.013). The type of treatment performed (surgery n = 33; radiation therapy n = 22; surveillance n = 6; multimodality therapy n = 6; systemic therapy n = 13; not available n = 2) did not show any relationship with the modality adopted to stage the disease. [18F]F-choline PET/CT induced a change of planned therapy in 5/35 patients in group B (14.3%). Moreover, patients investigated with [18F]F-choline PET/CT alone demonstrated longer biochemical recurrence (BCR)-free survival (30.8 months) in comparison to patients of groups A and B (15.5 and 23.5 months, respectively, p = 0.006), probably due to a more accurate selection of primary treatment. Finally, total lesion choline kinase activity (TLCKA) of the primary lesion, calculated by multiplying metabolic tumor volume and mean standardized uptake value (SUVmean), was able to more effectively discriminate patients who had recurrence after therapy compared to those without (p = 0.03). In our real-world experience [18F]F-choline PET/CT as a tool for the initial management of PCa had a relevant impact in terms of therapy selection and was associated with longer BCR-free survival. Moreover, TLCKA of the primary lesion looks a promising parameter for predicting recurrence after curative therapy.

SC170 - When can we de-intensify treatments in isup grade group 5 prostate cancer? long-term results of a single center, high volume series

SC170 - When can we de-intensify treatments in isup grade group 5 prostate cancer? long-term results of a single center, high volume series

Confirmatory transperineal saturation prostate biopsy combined with mpMRI decrease the reclassification rate in men enrolled in Active Surveillance: Our experience in 100 men submitted to eight-years scheduled biopsy.

The reclassification rate for clinically significant prostate cancer (csPCa) in men enrolled in Active Surveillance (AS) as been prospectively evaluated. One hundred patients with very low risk PCa underwent after 8 years a scheduled transperineal prostate biopsy (SPBx = 20 cores) combined with additional mpMRI/TRUS fusion biopsies (4 cores) of lesions PI-RADS scores ≥ 3. All the patients, after initial diagnosis, previously had mpMRI evaluation combined with transperineal saturation prostate biopsy (confirmatory and 3-year scheduled biopsy). Risk reclassification at repeat biopsy triggering the recommen-dation for active treatment was defined as over 3 or more than 10% of positive cores, Gleason score > 6/ISUP Grade Group ≥ 2, greatest percentage of cancer (GPC) > 50%. Multiparametric MRI was suspicious (PI-RADS ≥ 3) in 30 of 100 cases (30.0%); 70 (70.0%) vs. 20 (20.0%) vs. 10 (10.0%) patients had a PI-RADS score ≤ 2 vs. 3 vs. 4, respec-tively. Two (2.0%) patients with PI-RADS score 3 and 4 were upgraded (ISUP Grade Group 2); SPBx and MRI/TRUS fusion biopsy diagnosed 100% and 0% of csPCa, respectively. Transperineal SPBx combined with mpMRI at ini-tial confirmatory biopsy allow to select an high number of men at very low risk of reclassification during the AS follow up (2.0%of the cases at 8 years from diagnosis); these data could be use-ful to reduce the number of scheduled repeated prostate biopsy during the AS follow up.

Value of magnetic resonance imaging/ultrasound fusion prostate biopsy to select patients for focal therapy.

To investigate the role of transrectal MRI fusion biopsy to select patients for prostate cancer focal therapy. Patients with suspected prostate cancer underwent transrectal MRI fusion biopsy with the Koelis trinity device. Two focal therapy eligibility criteria were subsequently defined: Group 1: PSA ≤ 15ng/ml, unilateral csPCa, ISUP grade ≤ 2, no contralateral PIRADS 3-5 lesion; Group 2: same criteria but ISUP grade 3. These subgroups were correlated with histopathological post-prostatectomy parameters for stage pT2, unilateral csPCa, no ISUP upgrading. In addition, parameters of csPCa detection were analyzed for patients undergoing primary and re-biopsy. Four hundred fourteen consecutive patients were analyzed (314 for primary biopsy, 100 for re-biopsy). Post-prostatectomy whole mount section analysis was available from 155 patients. 39 and 62 of these patients met focal therapy inclusion criteria for group 1 and group 2, respectively. A correlation with final pathology parameters following radical prostatectomy (stage pT2, unilateral csPCa, no ISUP upgrading) revealed a positive predictive value of only 53.8% and 64.5% for Group 1 and 2, respectively. The overall csPCa detection rate was 73.7%. In the re-biopsy group 20% additional patients with csPCa were detected by targeted biopsy. Despite high csPCa detection rates following MRI fusion biopsy our study demonstrated that, using final pathology to confirm locally advanced tumor stage, presence of bilateral csPCa and ISUP upgrading, between 35.5 and 46.2% of patients would have been incorrectly selected for focal therapy.

Outcomes of radical prostatectomy in a 20-year localized prostate cancer single institution series in China.

The long-term survival outcomes of radical prostatectomy (RP) in Chinese prostate cancer (PCa) patients are poorly understood. We conducted a single-center, retrospective analysis of patients undergoing RP to study the prognostic value of pathological and surgical information. From April 1998 to February 2022, 782 patients undergoing RP at Queen Mary Hospital of The University of Hong Kong (Hong Kong, China) were included in our study. Multivariable Cox regression analysis and Kaplan-Meier analysis with stratification were performed. The 5-year, 10-year, and 15-year overall survival (OS) rates were 96.6%, 86.8%, and 70.6%, respectively, while the 5-year, 10-year, and 15-year PCa-specific survival (PSS) rates were 99.7%, 98.6%, and 97.8%, respectively. Surgical International Society of Urological Pathology PCa grades (ISUP Grade Group) ≥4 was significantly associated with poorer PSS (hazard ratio [HR] = 8.52, 95% confidence interval [CI]: 1.42-51.25, P = 0.02). Pathological T3 stage was not significantly associated with PSS or OS in our cohort. Lymph node invasion and extracapsular extension might be associated with worse PSS (HR = 20.30, 95% CI: 1.22-336.38, P = 0.04; and HR = 7.29, 95% CI: 1.22-43.64, P = 0.03, respectively). Different surgical approaches (open, laparoscopic, or robotic-assisted) had similar outcomes in terms of PSS and OS. In conclusion, we report the longest timespan follow-up of Chinese PCa patients after RP with different approaches.

Impact of dynamic contrast-enhanced MRI in 1.5 T versus 3 T MRI for clinically significant prostate cancer detection

PurposeThis study analyzes the value of dynamic contrast-enhanced MRI (DCE) of the prostate on 1.5 T and 3 T examinations in patients within PI-RADS category 4. MethodsIn this retrospective, bi-centric, cohort study all consecutive patients classified as PI-RADS 4 in mpMRI with 100 verified prostate cancers (PCa) in subsequent MRI/US-guided fusion biopsy were included for 1.5 T and 3 T, each. PCa detection in index lesions (IL) upgraded to PI-RADS 4 based on positive DCE findings was compared between 1.5 T and 3 T. Secondary objectives are subgroup analysis of PZ lesions and comparison of ISUP grade group distribution between 1.5 T and 3 T. ResultsIn total, 293 patients within PI-RADS category 4, including 152 (mean 66 ± 8y; median PSA 6.4 ng/ml;116 PZ IL) in the 1.5 T group and 141 (mean 65 ± 8y; median PSA 7.2 ng/ml;100 PZ IL) in the 3 T group were included. Overall amount of PCa (66 % vs 71 %; p = 0.346) and portion of upgraded IL (28 % vs 21 %; p = 0.126) did not differ significantly. At 1.5 T PCa detection was higher in upgraded PZ lesions compared to 3 T (23 % vs 14 %; p = 0.048). The amount of upgraded PZ lesions with ISUP grade group 2–5 PCa was significantly higher at 1.5 T versus 3 T (13.8 % vs 4.0 %; p = 0.007). 33 % (11/33; 1.5 T) and 32 % (10/31; 3 T) of the ISUP grade group 1 PCa of the PZ lesions were detected in upgraded lesions (10% of all PZ index lesions, respectively). ConclusionDCE enabled the detection of a substantial amount of additional clinically significant PCa in prostate mpMRI at 1.5 T. The effect was smaller at 3 T and was accompanied in relation to 1.5 T by higher risk of overdiagnosis due to detection of additional low-risk PCa.

Comparison of malignancy and spatial distribution between latent and clinical prostate cancer: an 8-year biopsy study

BackgroundCurrent prostate cancer (PCa) screening may detect nonprogressive lesion, leading to overdiagnosis and overtreatment. The purpose of the present study is to investigate whether the tumor pathological origin of latent prostate cancer (lPCa) and clinical prostate cancer (cPCa) are consistent, and to verify the current clinically significant prostate cancer criteria.MethodsProstate specimens were obtained from postmortem autopsy between 2014 and 2021 and patients who went through radical prostatectomy from 2013 to 2021. The pathological characteristics and spatial distribution of the lPCa group and cPCa group were compared and analyzed through SPSS software with P < 0.05 representing statistical significant.ResultsIn lPCa group, a total of 45 tumor lesions from 24 lPCa cases were included, 54.2% of lPCa patients were ISUP ≥ 2, 12.5% had tumor volume ≥ 0.5 ml, and 16.7% had extraprostatic extension (EPE). In cPCa group, there were a total of 429 tumor lesions in 126 cases, 92.1% of cPCa patients were ISUP ≥ 2, and 82.5% had tumor volume of ≥ 0.5 ml. 36.3% had EPE. LPCa and cPCa have the same spatial distribution characteristics, and no significant difference was detected between the anterior and posterior zone. Peripheral zone tumors were significantly more common than transitional zone tumors. Tumors in apical 1/3 and middle 1/3 were significantly more common than basal 1/3.ConclusionThe malignancy of cPCa is significantly higher than that of lPCa, and the spatial distribution of cPCa and lPCa is consistent. ISUP grade 2 is not sufficient to determine clinical significance of tumor.