Lower Prostate Volume Research Articles

A novel pelvis-prostate model BPPP predicts immediate urinary continence after Retzius-sparing robotic-assisted laparoscopic radical prostatectomy

This study aimed to construct a novel pelvis-prostate model BPPP which consists of body mass index (BMI), prostate volume (PV), pelvic cavity index (PCI) and prostate-muscle index (PMI) to predict the immediate urinary continence after Retzius-sparing robot assisted laparoscopic radical prostatectomy (RS-RARP). The perioperative data of patients with prostate cancer who underwent RS-RARP in the department of urology of Nanjing Drum Tower Hospital from June 2018 to June 2022 were retrospectively analyzed. 280 patients were eligible for this study in total. Multivariate analysis showed that BMI, PV, PCI, PMI and NVB preservation were significantly associated with immediate urinary continence after RS-RARP. Subgroup analysis showed that patients with low BMI, low PV, high PCI and high PMI had a higher recovery rate of immediate urinary continence. The area under the curve of BPPP (BMI + PV + PCI + PMI) for predicting the immediate recovery of urinary continence after RS-RARP was 0.726. Delong test showed that the area under the curve of the combined test for predicting the immediate urinary continence after RS-RARP was better compared with single parameter (p < 0.05). In conclusion the novel pelvis-prostate model BPPP may predict the immediate urinary continence after RS-RARP, providing information for preoperative decision-making.

Novel composite BPH3 trifecta for robotic assisted simple prostatectomy (RASP) versus BPH6: A multicenter outcomes comparison.

To assess disobstructive proficiency of BPH3 trifecta in RASP according to different techniques. Baseline prostate volume (PV), uroflowmetry parameters and Validated questionnaires: IIEF, Incontinence severity index score (ISI), International prostatic symptoms score (IPSS), MSHQ, Quality of recovery (QOR), were recorded preoperatively and 12 months postoperatively. RASP was conducted using both the urethra-sparing (Madigan) technique and a non-urethral-sparing transvesical (Freyer) approach. Two groups were evaluated for achievement rates in terms of BPH-3 and BPH-6. BPH-3 was defined by a combination of: a reduction of ⩾30% in IPSS compared to baseline, ISI score ⩽ 4, and absence of complications beyond Clavien grade 1. About 158 patients underwent RASP, with 93 undergoing the Madigan procedure and 65 the Freyer approach. Patients in the Madigan group were younger, with lower PV, baseline IPSS score, overactive symptoms (ISI score), but higher MSHQ and IIEF score, when compared to the Freyer population (all p < 0.02). At 12-month follow-up, patients who underwent the Madigan procedure reported shorter bladder irrigation time and time to catheter removal (both p < 0.001). As expected, Madigan patients also demonstrated superior postoperative IIEF and MSHQ scores (all p < 0.001). Postoperative complication incidence was higher in the Madigan cohort, mainly due to UTI (p < 0.001). Although there were no differences in postoperative IPSS and Q-max between groups, the Madigan cohort presented with higher post void residue (p < 0.001). BPH6 achievement was higher in the Madigan cohort (48% vs 28%) (p < 0.001), while no difference was observed in BPH3 achievement rate. The BPH3 composite trifecta appears to be more suitable than BPH6 in assessing the proficiency in disobstructive symptoms relief after RASP.

Evaluation of the non-invasive indicators in predicting detrusor underactivity in individuals with small-volume prostatic hyperplasia and lower urinary tract symptoms

This study was aimed to retrospectively analyze the potential of non-invasive serum biomarkers in clinically predicting the detrusor underactivity (DU) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and low prostate volume (PV). The study enrolled 196 patients with BPH and LUTS at our hospital in the period from January 2018 to October 2023. The patients were divided into two groups based on the projected isovolumetric pressure (PIP): the DU and the control groups. The patients included in the study had PV of less than 50 mL. A total of 93 and 103 cases were placed in the DU and control groups, respectively. Univariate analysis exhibited that the age was associated with DU occurrence (p = 0.004), and the serum prostate specific antigen (PSA) might act as DU protective factor (p = 0.001). However, there was no statistically significant relation between pre-selected serum hematological parameters and the DU diagnosis accuracy. Multivariate analysis suggested that only the age (OR (odds ratio) 1.07, 95% CI (confidence interval) 1.03–1.12, p = 0.001) and PSA (OR 0.79, 95% CI 0.69–0.90, p &lt; 0.001) were the independent predictors of DU. In this study, it was observed that the pre-selected serum hematological parameters had no relevance in diagnosing DU in low PV male patients. Nonetheless, it was found that the age and PSA could be the independent non-invasive predictors of male patients with LUTS and low PV, who were unable to undergo urodynamic examinations.

Metabolic Syndrome is Associated with Prostate Cancer Diagnosed on Biopsy but not the Gleason Score and the Number of Cancer-Positive Cores: A Prospective Controlled Study.

We aimed to investigate the association between metabolic syndrome (MetS) and prostate cancer (PCa) in patients undergoing prostate biopsy. Between January 2018 and December 2022, MetS was investigated according to Adult Treatment Panel III (ATP III) criteria in men who underwent prostate biopsy with transrectal ultrasound (TRUS). Clinicopathological factors such as, digital rectal examination (DRE), prostate-specific antigen (PSA), prostate volume, waist circumference, body mass index (BMI), age, blood pressure, testosterone, lipid profiles, fasting blood glucose level, C-reactive protein (CRP) and MetS were analyzed. A total of 908 men underwent biopsies, of which 492 (51.5%) had MetS according to ATP III criteria. The number of patients diagnosed with PCa in biopsy was 270 (29.7%). PCa cases were significantly older, with a lower prostate volume and a higher PSA value and higher blood pressure compared to patients without PCa (p < 0.001). 146 of 416 (35.0%) patients with MetS had PCa while 124 of 492 (25.2%) patients without MetS had PCa (p < 0.001). Out of 270 patients with PCa, 174 (64.4%) had Gleason score <7 and 96 (35.6%) had Gleason score ≥7. In patients with a Gleason score ≥7, PSA, DRE(+) and core positive number were significantly higher compared to patients with Gleason score <7, while glycemia and high-density lipoprotein (HDL) cholesterol levels were significantly lower (p < 0.001). Multivariate analysis showed that age, PSA, positive DRE, prostate volume (p < 0.001), diastolic blood pressure, CRP and MetS were the only independent parameters associated with a higher risk of cancer on biopsy (p < 0.05). Our findings show that MetS is associated with PCa diagnosed on biopsy but not with the Gleason score and the number of cancer-positive cores. However, these results should be confirmed by larger, multicenter and prospective studies.

Evaluation of Semen Self-Sampling Yield Predictors and CTC Isolation by Multi-Color Flow Cytometry for Liquid Biopsy of Localized Prostate Cancer.

Liquid biopsy (LB) for prostate cancer (PCa) detection could represent an alternative to biopsy. Seminal fluid (SF) is a source of PCa-specific biomarkers, as 40% of ejaculate derives from the prostate. We tested the feasibility of an SF-based LB by evaluating the yield of semen self-sampling in a cohort of >750 patients with clinically localized PCa. The overall SF collection yield was 18.2% (39% when considering only compliant patients), with about a half of the patients (53.15%) not consenting to SF donation. Independent favorable predictors for SF collection were younger age and lower prostate volume. We implemented a protocol to enrich prostate-derived cells by multi-color flow cytometry and applied it on SF and urine samples from 100 patients. The number of prostate-enriched cells (SYTO-16+ PSMA+ CD45-) was variable, with higher numbers of cells isolated from SF than urine (p value < 0.001). Putative cancer cells (EpCAMhigh) were 2% of isolated cells in both specimens. The fraction of EpCAMhigh cells over prostate-enriched cells (PSMA+) significantly correlated with patient age in both semen and urine, but not with other clinical parameters, such as Gleason Score, ISUP, or TNM stage. Hence, enumeration of prostate-derived cells is not sufficient to guide PCa diagnosis; additional molecular analyses to detect patient-specific cancer lesions will be needed.

MP59-09 NOVEL COMPOSITE ‘BPH3’trifecta FOR ROBOTIC ASSISTED SIMPLE PROSTATECTOMY (RASP) VS BPH6; A MULTICENTER OUTCOMES COMPARISON

You have accessJournal of UrologyCME1 Apr 2023MP59-09 NOVEL COMPOSITE ‘BPH3’trifecta FOR ROBOTIC ASSISTED SIMPLE PROSTATECTOMY (RASP) VS BPH6; A MULTICENTER OUTCOMES COMPARISON Alfredo Maria Bove, Aldo Brassetti, Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Simone D'Annunzio, Mariaconsiglia Ferriero, Leonardo Misuraca, Iannuzzi Andrea, Prata Francesco, Alberto Ragusa, Michele Gallucci, Simone Giuseppe, Porpiglia Francesco, Daniele Amparore, Sabrina De Cillis, Alberto Quarà, Michele Ortenzi, Cristian Fiori, and Checcucci Enrico Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Simone D'AnnunzioSimone D'Annunzio More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Iannuzzi AndreaIannuzzi Andrea More articles by this author , Prata FrancescoPrata Francesco More articles by this author , Alberto RagusaAlberto Ragusa More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Simone GiuseppeSimone Giuseppe More articles by this author , Porpiglia FrancescoPorpiglia Francesco More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Alberto QuaràAlberto Quarà More articles by this author , Michele OrtenziMichele Ortenzi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Checcucci EnricoCheccucci Enrico More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: BPH6 is a comprehensive metric to assess outcomes after treatment for BPO. Since the BPH6 includes: reduction of <6 points in International Index of Erectile Function (IIEF) and persistence of antegrade ejaculation at Male Sexual Health Questionnaire (MSHQ), only a small percentage of disobstructive procedures can lead to its achievement. We tested our novel BPH3 trifecta, in assessing the disobstructive proficiency of RASP according to different techniques. METHODS: Baseline prostate volume (PV), flowmetry parameters and Validated questionnaires: IIEF, Incontinence severity index score (ISI), International prostatic symptoms score (IPSS), MSHQ, Quality of recovery (QOR), were recorded preoperatively and 12 months postoperatively. RASP were performed according to the urethra-sparing (Madigan) technique and a non urethra-sparing trans-vescical (Freyer) approach. The 2 cohorts were tested for our novel composite BPH-3 achievement rate as well as for BPH-6 achievement rate. BPH3 was defined as: ΔIPSS≥30%, ISI score≤4, and No complications Clavien>1. RESULTS: 158 patients underwent RASP (93 Madigan and 65 Freyer). Patients scheduled for Madigan procedure were younger, with lower PV, baseline IPSS score, overactive symptoms (ISI score), but higher MSHQ and IIEF score, when compared to the Freyer population (all p<0.02) (Table 1). At 12 months follow-up, Madigan patients reported a shorter bladder irrigation time and time to catheter removal (both p<0.001). A superiority in postoperative IEEF and MSHQ score were reported by the Madigan patients as expected (all p<0.001). Postoperative complication incidence was higher in the Madigan cohort, mainly due to UTI (p<0.001). Although there were no differences in postoperative IPSS and Q-max between groups, the Madigan cohort presented with higher post void residue (p<0.001) (Table 2). BPH6 achievement was higher in the Madigan cohort (48% vs 28%) (p<0.001), while no difference was found in BPH3 achievement rate. CONCLUSIONS: Novel BPH3 composite trifecta appears to be more suitable than BPH6 in assessing the proficiency in disobstructive symptoms relief after RASP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e810 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Simone D'Annunzio More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Iannuzzi Andrea More articles by this author Prata Francesco More articles by this author Alberto Ragusa More articles by this author Michele Gallucci More articles by this author Simone Giuseppe More articles by this author Porpiglia Francesco More articles by this author Daniele Amparore More articles by this author Sabrina De Cillis More articles by this author Alberto Quarà More articles by this author Michele Ortenzi More articles by this author Cristian Fiori More articles by this author Checcucci Enrico More articles by this author Expand All Advertisement PDF downloadLoading ...

PD39-10 THE ASSOCIATION BETWEEN PSA DENSITY AND THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PIRADS SCORES IN MEN WITH POSITIVE MPMRI. WHEN PSA DENSITY CAN HELP AVOIDING PROSTATE BIOPSY?

PD39-10 THE ASSOCIATION BETWEEN PSA DENSITY AND THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PIRADS SCORES IN MEN WITH POSITIVE MPMRI. WHEN PSA DENSITY CAN HELP AVOIDING PROSTATE BIOPSY?

MP38-02 THE IMPACT OF GENOMIC BIOMARKERS ON A VALIDATED CLINICAL RISK PREDICTION MODEL FOR UPGRADING/UPSTAGING AMONG MEN WITH LOW-RISK PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP38-02 THE IMPACT OF GENOMIC BIOMARKERS ON A VALIDATED CLINICAL RISK PREDICTION MODEL FOR UPGRADING/UPSTAGING AMONG MEN WITH LOW-RISK PROSTATE CANCER Avery Braun, June Chan, John Neuhaus, Janet Cowan, Stacey Kenfield, Erin Van Blarigan, Imelda Tenggara, Jeanette Broering, Jeff Simko, Matthew Cooperberg, and Peter Carroll Avery BraunAvery Braun More articles by this author , June ChanJune Chan More articles by this author , John NeuhausJohn Neuhaus More articles by this author , Janet CowanJanet Cowan More articles by this author , Stacey KenfieldStacey Kenfield More articles by this author , Erin Van BlariganErin Van Blarigan More articles by this author , Imelda TenggaraImelda Tenggara More articles by this author , Jeanette BroeringJeanette Broering More articles by this author , Jeff SimkoJeff Simko More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The challenge of distinguishing indolent from aggressive tumors in clinically low-risk patients may complicate decision-making for men on active surveillance. Genomic classifiers (GCs) may improve clinical risk stratification by predicting the risk of upgrading or upstaging (UG/US) in this setting. We assessed the impact of GCs on UG/US risk prediction added to a rich clinical model to better guide disease management for low-risk patients. METHODS: We used multivariate logistic regression with backward stepwise regression to eliminate non-predictive variables and compute AUC (area under the receiver operating characteristic curve) to develop a prediction model for UG/US in 864 men who were potential candidates for AS. Participants had low risk, low volume prostate cancer (cT1-2, PSA<15ng/ml, GG1 or low volume GG2 defined as <33% core involvement). The model was validated in an independent cohort of 2,267 men with similar risk characteristics. We then tested predictive ability for 9 additional models, each containing the base variables plus 1 GC (OncoType Dx Genomic Prostate Score, Decipher score, and 7 selected Decipher GRID scores) for the development cohort. RESULTS: Among 864 patients in the development cohort, 450 (52%) experienced US/UG. The prediction model included five diagnostic variables that were significantly associated with risk of UG/US: diagnostic grade group (OR 5.83, 95% CI 3.73-9.10), prostate specific antigen (PSA) per 1 ng/ml (OR 1.10, 95% CI 1.01-1.20), percent positive cores (OR 1.01, 95% CI 1.01-1.02), TRUS prostate volume in ccs (OR 0.98, 95% CI 0.97-0.99), and age in years (OR 1.05, 95% CI 1.02-1.07). The pooled AUC was 0.72 for 10 iterations of the prediction model. When the addition of each GC was applied to this model, Genomic Prostate Score was the only one independently associated with risk of UG/US (OR 1.42, 95%CI 0.02-0.07, p=0.02). The pooled AUC for this model was 0.71, indicating comparable predictive performance to the risk prediction model. CONCLUSIONS: The addition of GCs to a validated rich model incorporating detailed clinical variables, when applied to men with low-risk PCa did not substantially improve prediction of UG/US. Our findings suggest that widespread use of biomarkers to guide management or intensity of follow up may not be supported in men with low-risk, low-volume disease pursuing AS. However, GCs may be valuable in those with higher risk disease. Source of Funding: DOD TIA #(W81XWH-13-2-0074) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e523 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author June Chan More articles by this author John Neuhaus More articles by this author Janet Cowan More articles by this author Stacey Kenfield More articles by this author Erin Van Blarigan More articles by this author Imelda Tenggara More articles by this author Jeanette Broering More articles by this author Jeff Simko More articles by this author Matthew Cooperberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...

Is Low-risk Prostate Cancer Really Low-risk? Consider Factors Affecting Biochemical Recurrence and Tumour Upgrade.

To evaluate the demographics, preoperative or pathological factors, and findings of magnetic resonance imaging (MRI) to predict the factors affecting biochemical recurrence and tumour upgrade in low-risk prostate cancer. A descriptive study. Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey, from January 2017 to December 2021. The data of 135 patients, who underwent radical prostatectomy for low-risk prostate cancer according to prostate-specific antigen (PSA) level, biopsy result and clinical stage, were analysed. Preoperative clinicopathological factors, MRI findings, and the final pathological results were analysed. Prognostic factors affecting the biochemical recurrence in the follow-up and tumour upgrade in the final pathology according to the International Society of Urological Pathology (ISUP) were evaluated. Mean age and preoperative PSA level were 61.37 ± 5.53 (46-74) years and 6.74 ± 1.97 (range 1.88-9.9) ng/dL, respectively. Multivariate analysis showed that the prostate volume and diameter of lesions were statistically significant in the patients with ISUP upgrade (p=0.006, p=0.025, respectively), and surgical margin positivity in the final pathology specimen was statistically significant for biochemical recurrence (p=0.016). Logistic regression analysis revealed that prostate volume and diameter of the lesion in MRI were independent predictors of ISUP score upgrade. Receiver operating characteristic (ROC) curve analysis showed that tumour size on the MRI had 49.4% sensitivity and 77.8% specificity at 10 mm (AUC:0.634, p=0.009 for predicting). Lower prostate volume, higher diameter of lesions in multiparametric MRI and surgical margin positivity were associated factors affecting the ISUP score upgrade and biochemical recurrence. Therefore, patients should be evaluated preoperatively and patient-based factors should be considered in the choice of a treatment plan. Prostate cancer, Cancer upgrade, Tumour size.

Negative multiparametric magnetic resonance imaging for prostate cancer: further outcome and consequences

PurposeEAU guidelines recommend multiparametric MRI of the prostate (mpMRI) prior to biopsy to increase accuracy and reduce biopsies. Whether biopsy can be avoided in case of negative mpMRI remains unclear. Aim of this study is to evaluate predictors of overall prostate cancer (PCa) in negative mpMRI.MethodsA total of 216 patients from 2018 to 2020 with suspicion of PCa and negative mpMRI (PI-RADS ≤ 2) were interviewed by telephone about outcome and further follow-up. Clinically significant PCa (csPCa) was defined as ISUP ≥ 2. Patients with vs. without biopsy and with vs. without PCa were compared. Univariate and multivariate analyses were performed to evaluate predictors of PCa occurrence in patients with negative mpMRI.Results15.7% and 5.1% of patients with PI-RADS ≤ 2 on mpMRI showed PCa and csPCa, respectively. PCa patients had higher PSAD (0.14 vs. 0.09 ng/ml2; p = 0.001) and lower prostate volume (50.5 vs. 74.0 ml; p = 0.003). Patients without biopsy (25%) after MRI were older (69 vs. 65.5 years; p = 0.027), showed lower PSA (5.7 vs. 6.73 ng/ml; p = 0.033) and lower PSA density (0.09 vs. 0.1 ng/ml2; p = 0.027). Multivariate analysis revealed age (OR 1.09 [1.02–1.16]; p = 0.011), prostate volume (OR 0.982 [0.065; 0.997]; p = 0.027), total PSA level (OR 1.22 [1.01–1.47], p = 0.033), free PSA (OR 0.431 [0.177; 0.927]; p = 0.049) and no PI-RADS lesion vs PI-RADS 1–2 lesion (OR 0.38 [0.15–0.91], p = 0.032.) as predictive factors for the endpoint presence of PCa.ConclusionsBiopsy for selected patient groups (higher age, prostate volume and free PSA as well as lower PSA-Density) with negative mpMRI can be avoided, if sufficient follow-up care is guaranteed. Detailed counseling regarding residual risk for undetected prostate cancer should be mandatory.

Comparison of Gleason score of Prostate Cancer at Ultrasound/MRI Fusion Target Biopsy vs. Systematic Transrectal Ultrasound Guided Biopsy with Final Gleason score at Radical Prostatectomy

Purpose: To compare accuracy in predicting final Gleason Grade Group (GGG) of Prostate Cancer (PCa) of US/MRI fusion guided target (fBx) vs. systematic Transrectal Ultrasound-Guided (TRUS) biopsy, using histopathologic analysis at prostatectomy as the gold standard. Materials and methods: After obtaining IRB approval, we retrospectively reviewed records of patients who underwent Radical Prostatectomy (RP) from January 2014 through May 2019 with prior US/MRI fusion guided target or TRUS biopsy. The rates of upgrading (RP GGG &gt; BX GGG), downgrading (RP GGG &lt; BX GGG), and concordance (RP GGG = BX GGG) were compared between the fBx and TRUS groups. Age, PSA, PSA density, and prostate volume were also noted for all patients. Statistical analysis was utilized to assess the data. Results: A total of 348 men with complete clinical data were included in this study. The rate of downgrading and upgrading in the fBx group was less than in the TRUS biopsy group (14% vs. 19.6%, and 13.2% vs. 19.6%, respectively). The concordance rate was higher in the US-MR fBx group (72.9% vs. 60.7%, p &lt; 0.05)) across all GGG. Notably, lower rates of concordance were found for GGG 1 (24.1%) and GGG 4 (3.6%) in the TRUS Bx group. Patients who underwent US-MR fBx had higher average PSA (9.4 vs. 6.5 ng/ml), higher PSA density (0.3 vs. 0.2 ng/ml2), and lower prostate volume (31 vs. 42 cc). Additionally, biopsy results showed a lower rate of GGG 1 (3.1% vs. 13.2%) and a higher rate of GGG 5 (14.7% vs. 5.5%) in the US-MR fBx group. Conclusions: Target biopsy has a higher GGG concordance compared to TRUS biopsy (72.9% vs. 60.7%, p &lt; 0.05). In addition, there was less downgrading or upgrading of final PCa GGG in the fBx groups compared to TRUS Bx (14% vs. 19.6%, 13.2% vs. 19.6%, respectively). This finding may have important implications for treatment decisions.

Pathological Accuracy in Prostate Cancer: Single-Center Outcomes of 3 Different Magnetic Resonance Imaging-Targeted Biopsy Techniques and Random Systematic Biopsy.

The aim of this study is to compare systematic, cognitive fusion, in-bore, and software fusion prostate biopsies regarding rates of and risk factors for pathological upgrading. Charts of 291 patients with systematic biopsy (n = 105), magnetic resonance imaging- targeted cognitive fusion (n = 58), in-bore (n = 68), and software fusion biopsy (n = 60), and who subsequently underwent radical prostatectomy were retrospectively evaluated. The degree of similarity between the grade groups reported in the biopsy and radical prostatectomy pathology results was recorded. Analyses of the associated factors for concordance and discordance were performed with univariate and multivariate methods. The concordance rates were as follows: systematic biopsy = 42.8%, cognitive fusion-targeted biopsy = 50%, in-bore fusion-targeted biopsy = 61.8, and software fusion biopsy = 58.4%. The upgrade rate of systematic biopsy (46.6%) was higher than cognitive fusion-targeted biopsy (27.6%), in-bore fusiontargeted biopsy (26.4%), and software fusion-targeted biopsy (18.3%). The number of positive cores was significantly associated with grade group concordance for the systematic biopsy group (P = .040). Within the cognitive fusion-targeted biopsy cohort, number of positive cores was the only parameter that exhibited a significant association with grade group concordance in multivariate analysis (P = .044). Considering the in-bore fusion-targeted biopsy group, maximum tumor length was statistically significant (P = .021). In the software fusion-targeted biopsy group, low prostate volume was found to be the only significant predictor for grade group accordance (P = .021). Magnetic resonance imaging-targeted biopsy techniques showed higher concordance and lower upgrade rates compared to systematic biopsy. For systematic biopsy and cognitive fusion-targeted biopsy, the number of positive cores was associated with grade group concordance, while maximum tumor length in in-bore fusion-targeted biopsy and low prostate volume for in-bore fusion-targeted biopsy were associated with grade group concordance. Among the MRI-targeted biopsy methods, in-bore fusion-targeted biopsy and software fusion-targeted biopsy were more accurate than cognitive fusion-targeted biopsy in terms of grade group.

Incidence and associated factors for incidental prostate cancer among patients who underwent surgery for benign prostatic hyperplasia: first report from Somalia

BackgroundThe incidence rate of incidental prostate cancer (IPC) differs significantly among the reported studies in the relevant literature. There is a scarcity of studies regarding IPC reported from Sub-Saharan African Countries, including Somalia. The present is the first study that evaluates the incidence and associated factors for IPC among patients who had surgery for benign prostatic hyperplasia at a tertiary hospital in Somalia.MethodThis retrospective study reviewed the data of 538 patients with benign prostate hyperplasia, 464 patients who underwent transurethral resection of the prostate (TURP), and 74 patients with open prostatectomy (OP) over 5 years. A binary logistic regression model was used to investigate the association between perioperative factors such as age, prostate volume, total prostate-specific antigen (TPSA) levels, type of surgery, specimen weight, and the finding of IPC.ResultsIPC was detected in 17.6%, 18.3% of TURP, and 13.5% of OP patients (p = 0.002). The mean age of the patients was 71.82 ± 7.4; IPC patients had a significantly higher mean age than the BPH group (74 ± 10.9 vs. 71.3 ± 10.8, p < 0.001). Sixty-two percent of the patients were T1b, while 57.8% had ISUP grade groups 1 and 2. Patients with T1a had significantly higher International Society of Urological Pathology (ISUP) grades 1 and 2 than those with T1b (69.4% in T1a vs. 50.8% in T1b, p < 0.001). Increased age, higher TPSA levels, low prostate volume, and specimen weight were independently associated with the finding of incidental prostate carcinoma (OR 1.978, 95% CI 0.95–1.60, P < 0.04; OR 1.839, 95% CI 0.99–2.02, P < 0.001; OR 1.457, 95% CI 0.7102.99, P < 0.001, OR 0.989, 95% CI 1.07–2.94, P = 0.01). IPC was most commonly managed by active surveillance (54.7%), followed by androgen deprivation therapy in 28.4%. The overall survival rate for a 5-year follow-up in the entire cohort was 79%. The cancer-specific mortality was 8.4%.ConclusionThe study findings revealed a higher incidence and cancer-specific mortality rate of incidental prostate carcinoma. T1b stage, higher ISUP grade, older age, and higher preoperative TPSA were significantly associated with the overall mortality and cancer-specific mortality rate. More than half of the cases were managed by active surveillance, and it is a safe management strategy, particularly in low-income countries like Somalia.

Microfocal prostate cancer: a clinicopathological analysis of 206 cases

Objective: To investigate the clinical and pathological features and prognosis of patients with microfocal prostate adenocarcinoma. Methods: Clinical and pathological data of the patients diagnosed with microfocal adenocarcinoma on prostate biopsy at the West China Hospital from 2013 to 2019 were collected. Microfocal adenocarcinoma was defined as follows: Gleason score of 3+3=6, total number of the cores ≥10, number of the positive cores ≤2, and proportion of the tumor in each positive core<50%. Clinicopathological parameters, treatment plans and follow-up data were collected. Pathological information of the biopsy and radical resection specimens was used to analyze the correlation between pathological parameters in the biopsy report and adverse pathological features of radical resection specimens, including increased Gleason score, capsule invasion, positive surgical margin and perineural invasion. Results: A total of 206 cases of microfocal adenocarcinoma were diagnosed on prostate biopsies from 2013 to 2019, accounting for 6.7% of all adenocarcinoma cases. There were 139 cases of 1 positive core and 67 cases of 2 positive cores. Patients with microfocal adenocarcinoma were younger than those with non-microfocal adenocarcinoma (69 years versus 71 years, P<0.001). Compared with patients with non-microfocal adenocarcinoma, the pre-biopsy total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) levels in patients with microfocal adenocarcinoma were both lower (11.2 μg/L2 versus 23.7 μg/L2; 1.4 μg/L2 versus 3.0 μg/L2, P<0.001), the fPSA/tPSA level was higher (12.9% versus 10.7%, P<0.05), the prostate volume was larger (38.9 mL versus 34.3 mL, P<0.05), and the PSA density was lower (0.3 μg/L2 versus 0.8 μg/L2, P<0.001). 130 patients underwent radical prostatectomy, 30 patients chose active monitoring, 31 patients chose endocrine or radiation therapy, and 15 patients were lost to follow-up. Three patients in the active surveillance group underwent radical prostatectomy for disease progression after 21-39 months observation. Biochemical relapses occurred in two patients in the radical prostatectomy group. The remaining patients have no disease progression or recurrence at present. Compared with radical prostatectomy specimens, Gleason score in the biopsy material was increased in 64/115 patients (55.7%). Among resection excision specimens, 14 cases (12.2%) had extraprostatic extension (EPE), 35 cases (30.4%) had perineural invasion, and 16 cases (13.9%) had a positive margin. Univariate and multivariate analyses showed that low fPSA/tPSA ratio and 2 positive cores were independent risk factors for Gleason score increase in the radical prostatectomy specimens. A low fPSA/tPSA ratio was an independent risk factor for perineural invasion. Low fPSA/tPSA ratio and low prostate volume were associated with a positive margin in radical prostatectomy specimens. Conclusions: In this study, patients diagnosed with microfocal adenocarcinoma on prostate biopsy account for a high proportion of the patients with increased Gleason score in the radical prostatectomy specimens, and there is a certain proportion of adverse pathological features in the radical specimens. Therefore, for the patients with only a small amount of low-grade adenocarcinoma found in biopsy, PSA levels and PSA density should be taken into consideration in treatment selection.

MP01-08 CONVECTIVE WATER VAPOR THERMAL THERAPY (CWVTT) IMPROVES NOCTURIA AND SUBJECTIVE SLEEP QUALITY

You have accessJournal of UrologyCME1 May 2022MP01-08 CONVECTIVE WATER VAPOR THERMAL THERAPY (CWVTT) IMPROVES NOCTURIA AND SUBJECTIVE SLEEP QUALITY Aya Bsatee, Gaurav Pahouja, Michael Felice, Hiten D. Patel, and Kevin T. McVary Aya BsateeAya Bsatee More articles by this author , Gaurav PahoujaGaurav Pahouja More articles by this author , Michael FeliceMichael Felice More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , and Kevin T. McVaryKevin T. McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nocturia and disrupted sleep are common motivating complaints for men to seek lower urinary tract symptom (LUTS) treatment. We previously reported a cross-sectional and longitudinal association between the bother and severity of LUTS, and the severity of sleep disturbances. Convective water vapor thermal therapy (CWVTT) is a new minimally invasive surgical therapy (MIST) for LUTS. Currently, there is a lack of data examining the relationship between nocturia and disrupted sleep following MIST for LUTS, including CWVTT. In this study, we aimed to assess nocturia and subjective sleep quality in men prior to and following CWVTT treatment. METHODS: Patients who underwent CWVTT between 2018-2021 were eligible for inclusion in the study. Patient demographics, peri-operative data, and clinical outcomes data were extracted. Exclusion criteria included missing pre or post-operative symptom scores, and starting or stopping obstructive sleep apnea (OSA) treatment during the follow-up period. Nocturia was assessed via International Prostate Symptom Score – Nocturia question (IPPS-N). Sleep quality was assessed via Jenkins Sleep Score (JSS). Pre-operative IPSS-N and JSS were compared to early (<60 days) and late (>120) post-operative scores using the Student’s t-tests. Further analysis was also conducted with linear regression. RESULTS: A total of 107 patients qualified for analysis. The median age of patients was 69 years. Approximately 9.3% of the patients had a diagnosis of OSA. In the early postoperative period, there was a significant improvement in IPSS-N (preoperative IPSS-N=3 vs postoperative IPSS-N=2, p=0.003), and JSS (preoperative JSS=9.5 vs postoperative JSS=8, p=0.030) following CWVTT. These results were sustained in the late postoperative period for both IPSS-N (preoperative IPSS-N=3 vs postoperative IPSS-N= 2, p <0.001) and JSS (preoperative JSS=9 vs postoperative JSS=6, p<0.001). On multivariable logistic regression, higher age was associated with improvement in IPSS-N (OR 1.06 [95% CI 1.0-1.14], p=0.04) and lower prostate volume was associated with improvement in JSS (OR -0.07 [95% CI -0.12-(-0.02)], p=0.009). CONCLUSIONS: There is a clinically significant improvement in nocturia and subjective sleep quality following CWVTT. Physiologic mechanisms responsible for a global improvement in sleep beyond simply reduced nocturia deserve further study. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e4 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aya Bsatee More articles by this author Gaurav Pahouja More articles by this author Michael Felice More articles by this author Hiten D. Patel More articles by this author Kevin T. McVary More articles by this author Expand All Advertisement PDF DownloadLoading ...

Plasma IL-6 and TNF-α levels correlate significantly with grading changes in localized prostate cancer.

To study the effect of inflammatory markers in blood such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) on the Gleason score (GS) changes in patients with prostate cancer (PCa) after radical prostatectomy (RP), we conducted this study. From November 2012 to September 2021, a total of 237 patients underwent RP at our institution. Blood samples from all patients were collected within 1week before surgery. Preoperative clinical characteristics include age, serum IL-6 and TNF-α, neutrophil-to-lymphocyte ratio, C-reactive protein, the platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, the prostate imaging reporting and data system (PI-RADS) score, prostate-specific antigen, and biopsy GS were assessed. Univariate and multivariate logistic regression analyzes were used to determine the risk factors of GS changes after RP. The efficiency of this prediction model was identified with the area under the curveof the receiver operating characteristic curve. Seventy-three patients (30.8%) had GS upgraded in the overall cohort, and 55 patients (23.2%) had GS downgraded. In comparing PCa patients with and without GS upgraded, multivariate logistic regression analysis showed that serum TNF-α (odds ratio [OR]: 2.518, p = 0.019) and IL-6 (OR: 0.478, p = 0.023) were independent factors predicting the occurrence of GS upgrade. We also compared the characteristics of patients with GS upgraded and GS downgraded; multivariate logistic regression analysis also demonstrated significant differences in serum IL-6 and TNF-α between these two groups (all p < 0.05). In addition, we found that low prostate volume and biopsy GS ≥ 7 were significantly associated with higher PI-RADS sores in multivariate analysis. The high expression of serum TNF-α level is positively correlated with GS upgraded in PCa patients. High expression of serum IL-6 level is negatively correlated with GS upgraded in PCa patients and positively related with GS downgraded.

FACTORS PREDICTING A POSSIBLE INCREASE OF GLEASON SCORE AFTER RADICAL PROSTATECTOMY IN PATIENTS WITH WELL-DIFFERENTIATED PROSTATE CANCER

Introduction The discrepancy between the Gleason score (GS) of the prostate biopsy and those after the radical prostatectomy (RP) is a well-known event. This is important for the patients because some of them, at least initially, prefer active surveillance, not active treatment. Aim To investigate the factors which can predict a possible increase in GS after RP in patients with well-differentiated (GS ≤ 6) prostate cancer (PCa). Methods The patients are divided into three groups. Group 1-GS of the biopsy is equal to those of the RP. Group 2- GS of the biopsy increases after the RP. Group 3- GS of the biopsy decreases after the RP. The information was collected and analyzed using IBM SPSS version 23. Results The patients available for analysis are 78- 32 patients in group 1, 34 patients in group 2, and 12 patients in group 3. A statistically significant difference in the prostate volumes and PSA density (PSAD) of the patients of the three groups is found. Discussion According to literature data patients with well-differentiated PCa (GS ≤ 6) are most likely to have their GS upgraded. That is why we studied several preoperative parameters (age, PSA, PSAD, prostate volume and presence of a palpable nodule in the prostate) in order to find a possible association with a GS-upgrade. Conclusion Higher PSAD and lower prostate volume are associated with a possible increase in GS. PSA, age, and the presence of a palpable nodule do not demonstrate a difference between the three groups.

Establishment and evaluation of a model for predicting ISUP pathological grade≥2 before radical prostatectomy

Objective: Based on the 2014 version of the International Association of Urological Pathology (ISUP) pathological classification standards, a prediction model that can predict the pathological classification of ISUP ≥2 in patients with prostate cancer (PCa) before radical prostatectomy (RP) was established and evaluated. Methods: The clinical data of 171 patients who had undergone RP from January 2017 to September 2020 in the Second Affiliated Hospital of Soochow University and obtained postoperative pathological results of all specimens were retrospectively collected. The patients were 46-83 (70±7) years old. For patients with RP ISUP pathologic stage as the gold standard, according to the pathological grading is level 2 or higher is divided into two groups(42 patients with ISUP grade=1 and 129 patients with ISUP grade ≥2). the predictors of ISUP pathology grade ≥2 after RP were screened by logistics regression analysis, predictive models were established and ROC curves were used to evaluate the efficacy of each model in diagnosing RP with pathological grade ≥2, and comparisons were conducted by DeLong test. Results: Compared with patients with ISUP grade=1, patients with ISUP grade≥2 had higher prostate specific antigen (PSA) and prostate specific antigen density (PSAD) (14.21(8.57, 24.98)ng/ml vs 7.98(5.41, 12.54)ng/ml, 0.33(0.20, 0.74)μg.L-1.ml-1 vs 0.16(0.12, 0.24)μg.L-1.ml-1), lower prostate volume (PV) (48.62(34.17,73.99)ml vs 38.94(28.15,54.84)ml)(all P<0.05). Multi-parameter magnetic resonance imaging (mp-MRI) prostate imaging and reporting system (PI-RADS) score, the positive ratio of puncture needles and the pathological grade of puncture ISUP were also significantly different between the two groups (all P<0.05). The combined mp-MRI PI-RADS score (OR=3.337, 95%CI: 1.990-5.593, P<0.001) and puncture ISUP pathological grading (OR=4.041, 95%CI: 1.960-8.334, P<0.001) had the highest diagnostic efficacy for pathological grading ≥2 after RP (AUC=0.916, P<0.05). Conclusion: The combined mp-MRI PI-RADS score and puncture ISUP pathological grading had the highest diagnostic efficacy for pathological grading ≥2 after RP.

The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy in clinically significant prostate cancer detection in patients with biopsy-naïve men according to PSA levels: Apropensity score matching analysis.

ObjectivesTo evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.Materials and methodsWe retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4–10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.ResultsData from a total of 670 males were included in the analysis (standard TRUS, n = 333; MRI/US fusion, n = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4–10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, P = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31–4.60, P = 0.005) were significantly associated with a detection of csPCa.ConclusionsDetection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4–10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.

Post-Operative Acute Urinary Retention After Greenlight Laser. Analysis of Risk Factors from A Multicentric Database.

Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP. In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention. The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89-0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR. In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal.