Malignant Prostatic Lesions Research Articles

Efficacy of 68Ga-PSMA-11 PET/CT with biparametric MRI in diagnosing prostate cancer and predicting risk stratification: a comparative study.

This retrospective study aimed to investigate the efficacy of the combined application of biparametric magnetic resonance imaging (bpMRI) and 68Ga-PSMA-11 positron emission computed tomography/computed tomography (bpMRI/PET) in the qualitative diagnosis of intermediate- to high-risk prostate cancer (PCa). The 105 patients with suspected PCa included in the study underwent bpMRI and PET/CT. BpMRI examinations included conventional sequences and diffusion-weighted imaging (DWI) sequences. Major lesions were qualitatively diagnosed according to the Prostate Imaging Reporting and Data System (PI-RADS). A PET/CT scan was started 60 min after intravenous 68Ga-PSMA-11 injection. The area with the highest radioactivity on PET/CT images was defined as the major lesion, and the maximum standard uptake value (SUVmax) was measured. All cases were confirmed by biopsy and pathology. Receiver operating characteristic curve (ROC) analysis was performed on the data to calculate sensitivity, specificity, and the Youden index. Of the 105 patients, 68 patients were diagnosed with PCa, and 37 patients had benign prostatic lesions. With a PI-RADS score ≥3 as the diagnostic threshold, the accuracy of bpMRI in identifying benign and malignant prostate lesions was similar to that of PET/CT (SUVmax threshold ≥10.9), and the Youden indices were 0.60 and 0.64, respectively. The sensitivity and specificity of bpMRI in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 63% and 88%, respectively, and the Youden index was 0.51. With an SUVmax ≥12.9 as the diagnostic threshold, the sensitivity and specificity of PET/CT in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 74% and 94%, respectively, and the Youden index was 0.68. The sensitivity and specificity of bpMRI/PET in diagnosing PCa were 94% and 81%, respectively, and the Youden index was 0.75. The sensitivity and specificity of bpMRI/PET in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 80% and 88%, respectively, and the Youden index was 0.68. The combined application of bpMRI and PET improves the accuracy of the qualitative diagnosis of prostate lesions, and its diagnostic efficacy for risk stratification in patients with intermediate- to high-risk PCa is similar to that of PET/CT and higher than that of bpMRI alone.

Role of Multiparametric Magnetic Resonance Imaging in the Evaluation of Prostatic Pathologies on 3 Tesla Machine

Background and objectives Prostate diseases with an overall incidence of 9% are the leading cause affecting millions of males worldwide, with prostate cancer being the primary cause of death in males owing to benign prostatic hypertrophy being the primary cause of morbidity in the older age group. In light of this, we aimed to evaluate the utility of Magnetic Resonance Imaging in evaluating and characterization prostatic pathologies and grading prostatic cancer using PIRADS v2. Methods This was a study carried out on 50 patients with the age group ranging from 50 to 90 years with clinical suspicion or ultrasonographically demonstrable prostatic pathology and correlation of multiparametric MRI findings on various sequences with clinical features and histopathological findings and classification into groups of benign and malignant prostatic lesions and according to the PIRADS v2 scoring. Results Out of our study group, 4 cases were diagnosed with prostatitis and prostatic abscess, and 46 cases were categorized into PI-RADS, out of which most cases were classified into PI-RADS category V, followed by PI-RADS II and III. These were then evaluated with MR spectroscopy, of which 30 cases showed choline peak, and 16 cases showed citrate peak. The sensitivity and specificity for multiparametric MRI sequences combination detect the carcinoma of the prostate was calculated, and the Positive Predictive Value (PPV) & Negative Predictive Value (NPV) was found as 76% and 92%, respectively. Conclusion Based on our findings, we found out that the multiparametric MRI approach gives a wealth of practical information that has dramatically enhanced the detection and characterization of prostatic lesions. We also found out that morphological and functional sequencing improves the sensitivity and specificity of the lesions' identification and characterization.

Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions.

BackgroundTo date, the results of studies into the effectiveness of positron emission tomography (PET) combined with computed tomography (CT) and bone scan (BS) in the diagnosis of malignant prostate lesions have been inconsistent, and the advantages and disadvantages of the two methods cannot be accurately judged.MethodsArticles were retrieved from the China National Knowledge Infrastructure (CNKI) database, Wan Fang Medical Network, PubMed, Excerpta Medica data BASE (EMBASE), Medline, and Cochrane database. The keywords used in the search were: 68Ga-prostate specific membrane antibody (68Ga-PSMA), PET/CT, prostate lesions, prostate adenocarcinoma, bone metastasis, and BS.ResultsUltimately, 3 publications were selected for inclusion in the meta-analysis. A total of 215 patients were considered in the 3 articles that met the inclusion criteria. All of the included articles were small sample studies, with sample sizes ranging from 28 to 113 cases. In this study, from the 3 randomized controlled trials, only 2 (66.67%) randomized controls described the correct randomized allocation method, and only 1 (33.33%) described the hidden allocation scheme in detail. The highest sensitivity for 68Ga-PSMA PET/CT was 0.96, with 95% CI: 0.87, 1.00, and the highest specificity was 1.00, with 95% CI: 0.96, 1.00. The highest sensitivity and specificity of BS were 0.92 with 95% CI: 0.81, 0.98 and 0.96 with 95% CI: 0.78, 1.00, respectively. The results of meta-analysis of 68Ga-PSMA PET/CT diagnosis with confirmation by surgical and histopathological examination showed that the area under the summary receiver operating characteristics (SROC) curve (AUC) =0.826 and standard error (SE) (AUC) =0.0425. The results of meta-analysis of BS diagnosis with confirmation by surgical and histopathological examination showed that the area under the SROC curve (AUC) =0.714 and SE (AUC) =0.0034.DiscussionThe meta-analysis showed that 68Ga-PSMA PET/CT has clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve the diagnostic accuracy of bone metastases.

MRI-based radiomics models to assess prostate cancer, extracapsular extension and positive surgical margins

PurposeTo investigate the performance of magnetic resonance imaging (MRI)-based radiomics models for benign and malignant prostate lesion discrimination and extracapsular extension (ECE) and positive surgical margins (PSM) prediction.Methods and materialsIn total, 459 patients who underwent multiparametric MRI (mpMRI) before prostate biopsy were included. Radiomic features were extracted from both T2-weighted imaging (T2WI) and the apparent diffusion coefficient (ADC). Patients were divided into different training sets and testing sets for different targets according to a ratio of 7:3. Radiomics signatures were built using radiomic features on the training set, and integrated models were built by adding clinical characteristics. The areas under the receiver operating characteristic curves (AUCs) were calculated to assess the classification performance on the testing sets.ResultsThe radiomics signatures for benign and malignant lesion discrimination achieved AUCs of 0.775 (T2WI), 0.863 (ADC) and 0.855 (ADC + T2WI). The corresponding integrated models improved the AUC to 0.851/0.912/0.905, respectively. The radiomics signatures for ECE achieved the highest AUC of 0.625 (ADC), and the corresponding integrated model achieved the highest AUC (0.728). The radiomics signatures for PSM prediction achieved AUCs of 0.614 (T2WI) and 0.733 (ADC). The corresponding integrated models reached AUCs of 0.680 and 0.766, respectively.ConclusionsThe MRI-based radiomics models, which took advantage of radiomic features on ADC and T2WI scans, showed good performance in discriminating benign and malignant prostate lesions and predicting ECE and PSM. Combining radiomics signatures and clinical factors enhanced the performance of the models, which may contribute to clinical diagnosis and treatment.

Bi-parametric magnetic resonance imaging based radiomics for the identification of benign and malignant prostate lesions: cross-vendor validation.

The purpose of this study was to develop Bi-parametric Magnetic Resonance Imaging (BP-MRI) based radiomics models for differentiation between benign and malignant prostate lesions, and to cross-vendor validate the generalization ability of the models. The prebiopsy BP-MRI data (T2-Weighted Image [T2WI] and the Apparent Diffusion Coefficient [ADC]) of 459 patients with clinical suspicion of prostate cancer were acquired using two scanners from different vendors. The prostate biopsies are the reference standard for diagnosing benign and malignant prostate lesions. The training set was 168 patients' data from Siemens (Vendor 1), and the inner test set was 70 patients' data from the same vendor. The external test set was 221 patients' data from GE (Vendor 2). The lesion Region of Interest (ROI) was manually delineated by experienced radiologists. A total of 851 radiomics features including shape, first-order statistical, texture, and wavelet features were extracted from ROI in T2WI and ADC, respectively. Two feature-ranking methods (Minimum Redundancy Maximum Relevance [MRMR] and Wilcoxon Rank-Sum Test [WRST]) and three classifiers (Random Forest [RF], Support Vector Machine [SVM], and the Least Absolute Shrinkage and Selection Operator [LASSO] regression) were investigated for their efficacy in building single-parametric radiomics signatures. A biparametric radiomics model was built by combining the optimal single-parametric radiomics signatures. A comprehensive diagnosis model was built by combining the biparametric radiomics model with age and Prostate Specific Antigen (PSA) value using multivariable logistic regression. All models were built in the training set and independently validated in the inner and external test sets, and the performances of models in the diagnosis of benign and malignant prostate lesions were quantified by the Area Under the Receiver Operating Characteristic Curve (AUC). The mean AUCs of the inner and external test sets were calculated for each model. The non-inferiority test was used to test if the AUC of model in external test was not inferior to the AUC of model in inner test. Combining MRMR and LASSO produced the best-performing single-parametric radiomics signatures with the highest mean AUC of 0.673 for T2WI (inner test AUC = 0.729 vs. external test AUC = 0.616, p = 0.569) and the highest mean AUC of 0.810 for ADC (inner test AUC = 0.822 vs. external test AUC = 0.797, p = 0.102). The biparametric radiomics model produced a mean AUC of 0.833 (inner test AUC = 0.867 vs. external test AUC = 0.798, p = 0.051). The comprehensive diagnosis model had an improved mean AUC of 0.911 (inner test AUC = 0.935 vs. external test AUC = 0.886, p = 0.010). The comprehensive diagnosis model for differentiating benign from malignant prostate lesions was accurate and generalizable.

Diagnostic efficiency of hybrid imaging using PSMA ligands, PET/CT, PET/MRI and MRI in identifying malignant prostate lesions

ObjectiveThe objective of this study was to assess the accuracy of 68Ga-PSMA-11 PET/MRI, 18F-PSMA-1007 PET/CT, 68Ga-PSMA-11 PET/CT, and multiparametric (mp)MRI for the delineating of dominant intraprostatic lesions (IPL).Materials and methods35 patients with organ-confined prostate cancer who were assigned to definitive radiotherapy (RT) were divided into three groups based on imaging techniques: 68Ga-PSMA-PET/MRI (n = 9), 18F-PSMA-PET/CT (n = 16) and 68Ga-PSMA-PET/CT (n = 10). All patients without PSMA-PET/MRI received an additional mpMRI. PSMA-PET-based automatic isocontours and manual contours of the dominant IPLs were generated for each modality. The biopsy results were then used to validate whether any of the prostate biopsies were positive in the marked lesion using Dice similarity coefficient (DSC), Youden index (YI), sensitivity and specificity. Factors that can predict the accuracy of IPLs contouring were analysed.ResultsDiagnostic performance was significantly superior both for manual and automatic IPLs contouring using 68Ga-PSMA-PET/MRI (DSC/YI SUV70%—0.62/0.51), 18F-PSMA-PET/CT (DSC/YI SUV70%—0.67/0.53) or 68Ga-PSMA-PET/CT (DSC/YI SUV70%—0.63/0.51) compared to mpMRI (DSC/YI—0.47/0.41; p < 0.001). The accuracy for delineating IPLs was not improved by combination of PET/CT and mpMRI images compared to PET/CT alone. Significantly superior diagnostic accuracy was found for large prostate lesions (at least 15% from the prostate volume) and higher Gleason score (at least 7b) comparing to smaller lesions with lower GS.ConclusionIPL localization was significantly improved when using PSMA-imaging procedures compared to mpMRI. No significant difference for delineating IPLs was found between hybrid method PSMA-PET/MRI and PSMA-PET/CT. PSMA-based imaging technique should be considered for the diagnostics of IPLs and focal treatment modality.

Utility of p63 and AMACR in Differentiating Benign and Malignant Prostatic Lesions

Background: Prostate cancer is the sixth most common cancer in the world. Since treatment options and prognosis of prostatic adenocarcinomas and benign lesions differ significantly, so, the current study using p63and AMACR was carried out with aim to evaluate the utility of immunohistochemistry in resolving ambiguous lesions of prostate.&#x0D; Methods: The study was conducted on 130 prostatic specimens which included prostate biopsy, TURP and prostatectomy specimens. Routine hematoxylin and eosin staining and immunohistochemical staining using AMACR, p63 monoclonal antibody marker were performed.&#x0D; Results: Total of 130 cases of prostate samples were studied out of which benign lesions were seen in 102 cases (78.5%) and malignant carcinoma in 28 cases (21.5%). This study showed p63 had a sensitivity of 92.86% and specificity of 100% whereas AMACR has a sensitivity of 96.4% and specificity of 95%. BPH with prostatitis was a common finding in majority of benign lesions. All cases of LGPIN 15 cases (11.5%) were histologically associated with BPH, showing complete positivity in 12 cases (80%) and partial positivity in 3 cases (20%) with p63 immunostaining. HGPIN (1.5%) were associated with prostatic adenocarcinoma showing focal positivity whereas adenocarcinoma showed complete negativity of p63 expression (100%) and positive cytoplasmic staining with AMACR. Comparative study done between DRE, PSA, final histopathological diagnosis, expression of p63 and AMACR immunostaining gives highly significant p value of 0.001(&lt;0.05).&#x0D; Conclusion: p63 and AMACR are reliable markers which can be used in morphologically difficult cases.

DOES TRANS RECTAL ULTRASOUND (TRUS) HELPS IN DIFFERENTIAL DIAGNOSIS OF PROSTATE LESIONS? A STUDY AT TERTIARY CARE CENTER.

BACKGROUND: There are successions of investigations used in evaluation of prostatic pathology. Currently digital rectal examination &amp; serum PSA levels are used for screening of prostatic cancer. Many conventional imaging techniques like plain radiography, computed tomography, radionuclide scintigraphy and transabdominal sonography were proved to be ineffective in detection of many prostatic conditions specially cancer at an early stage. Transrectal ultrasound (TRUS) has traditionally been considered as the pivotal imaging test for the prostate, providing clinically important information regarding benign and malignant conditions. OBJECTIVES: to evaluate the TRUS and colour Doppler ndings in various benign and malignant prostatic lesions with respect to its site, echo pattern, capsular status, local invasion, vascularity and to correlate with other investigations, like digital rectal examination and serum PSA etc. and also to study the accuracy of TRUS in differentiating benign from malignant lesions. METHODOLOGY: A prospective observational study carried out over a period of 1.5 years at a tertiary care hospital. All male patient referred to department of radio diagnosis with prostate related complains referred from surgery department. Study includes clinical symptoms, family and personal history, laboratory examination like PSA, radiological examination, digital rectal examination. . Various statistical characteristics of the test such as sensitivity, specicity, positive predictive value, negative predictive value were calculated whenever applicable. Out of total 64 patients' recruited OBSERVATIONS: commonest age group was 61 – 70 years (39.1%). Commonest prostatic pathology encountered was BPH (56.2%) followed by prostatic carcinoma (31.3%), prostatitis (4.7%), prostatic abscess &amp; calculus (3.1%) prostatic cyst (1.6%). 75% patients of prostatic carcinoma and 13.9% of Benign Prostate Hypertrophy show PSA value greater than 10ng/ml. Echotexture pattern found on TRUS, in prostatic carcinoma patients was hypoechoic echotexture in 70% patients followed by mixed echotexture in 20% patients. Examination in Color Doppler found, 80 % patients of prostatic carcinoma show increased vascularity and 25 % of benign lesion also shows increased vascularity including all three cases of prostatitis and one out of two case of prostatic abscess. Any single test alone is not helpful in arriving at a diagnosis, but all the thr CONCLUSION: ee tests i.e. PSA level, digital rectal examination, and transrectal ultrasound, together give very conrmatory result, specically to differentiate benign from malignant condition of prostate. . Considering that the initial screening of patients will help in reducing the number of negative biopsies (unnecessary), without impairing the cancer detection capacity.

Clinicopathological correlation of pre-biopsy quantitative PSMA uptake in patients with persistently raised serum PSA: initial experience in 74 patients with simultaneous 68-Ga PSMA PET/MRI

Objective: To analyze 68-Ga prostate-specific membrane antigen (PSMA) uptake pattern of the prostate and its correlation with prostate-specific antigen (PSA), digital rectal examination (DRE), and Gleason’s score in the diagnosis of carcinoma of the prostate (CaP). Methods: This was a retrospective study conducted between June 2015 and August 2017. Patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous positron emission tomography (PET) or magnetic resonance imaging (MRI) for the diagnosis or staging of CaP were eligible. Patients who presented with persistently raised serum PSA (&gt;4 ng/mL) and normal urine routine and negative culture were included in the study. Results: A total of 74 patients were included in the study. Significant positive correlation was observed between PSMA delayed uptake with the Prostate Imaging Reporting and Data System (PI-RADS) score ( p&lt;0.001, ρ=0.750), PSA level ( p&lt;0.001, ρ=0.414), DRE ( p&lt;0.002, ρ=0.400), and Gleason’s score ( p&lt;0.300, ρ=0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions ( p&lt;0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an area under curve (AUC) of 0.91. Combined receiver operating characteristic analysis of PI-RADS score derived from multiparametric MRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion: Results demonstrated that the correlation with clinicopathological features (PSA, DRE, and Gleason’s score) could be used in prognostication of prostatic lesion along with PSMA PET/MRI.

Diagnostic Utility of AMCAR and p63 Cocktail Antibody in the Benign and Malignant Lesions of Prostate

Background: Histopathological examination of prostatic specimen is gold standard for the diagnosis of prostate cancer. Current study evaluates the expression of AMACR and p63 in the prostate lesions using AMACR and p63 cocktail.&#x0D; Materials and Method: Total of 180 cases were collected and Haematoxylin and Eosin staining performed followed by immunohistochemical analysis using AMACR and p63 antibody.&#x0D; Result: Out of 180 cases, Benign Prostatic Hyperplasia is the most common lesion noted in about 120 cases. In this study, the predominant population was in the 6th to 7th decade of age. Most of the patients presented with difficulty in micturition. Immunohistochemistry revealed that p63 expression is positive in all normal basal cells, 118 cases (98.33%) were negative for AMACR and only 2 cases were showing focal and weak AMACR immunoreactivity. AMACR was positive in all the 6 HGPIN cases with variable intensity. Out of 5 LGPIN cases AMACR was positive in 3 cases with low intensity, remaining 2 cases shows AMACR negative. p63 is positive in all 11 PIN cases (LGPIN &amp; HGPIN) showing discontinuous staining pattern. All 22 cases of Prostatic adenocarcinomas were negative for p63 and all cases expressed positive immunostaining with AMACR. A diagnosis of adenocarcinoma was made in 48% of atypical cases. Cases which were negative for both AMACR and p63 were diagnosed as Atypical Small Acinar Proliferation, for which further follow-up is required.&#x0D; &#x0D; Conclusion: AMACR/p63 Cocktail antibody is very much useful as it saves time, tissue and is cost-effective.

Quantitative colour Doppler and greyscale ultrasound for evaluating prostate cancer.

Although transrectal ultrasound is routinely performed for imaging prostate lesions, colour Doppler imaging visualizing vascularity is not commonly used for diagnosis. The goal of this study was to measure vascular and echogenic differences between malignant and benign lesions of the prostate by quantitative colour Doppler and greyscale transrectal ultrasound. Greyscale and colour Doppler ultrasound images of the prostate were acquired in 16 subjects with biopsy-proven malignant or benign lesions. Echogenicity and microvascular flow velocity of each lesion were measured by quantitative image analysis. Flow velocity was measured over several cardiac cycles and the velocity-time waveform was used to determine microvascular pulsatility index and microvascular resistivity index. The Wilcoxon rank sum test was used to compare the malignant and benign groups. Median microvascular flow velocity of the malignant lesions was 1.25 cm/s compared to 0.36 cm/s for the benign lesions. Median pulsatility and resistive indices of the malignant lesions were 1.55 and 0.68, respectively versus 6.38 and 1.0 for the benign lesions. Malignant lesions were more hypoechoic relative to the surrounding tissue, with median echogenicity of 0.24 compared to 0.76 for the benign lesions. The differences between the malignant and benign groups for each measurement were significant (p < 0.01). Marked differences were observed in flow velocity, microvascular pulsatility, microvascular resistance, and echogenicity of prostate cancer measured with quantitative colour Doppler and greyscale ultrasound imaging. Vascular differences measured together with echogenicity have the combined potential to characterize malignant and benign prostate lesions.

Efectos de la toxina botulínica sobre la porción glandular de la próstata: fundamentos fisiopatológicos, mecanismo de acción y evidencias

La toxina botulínica es una potente neurotoxina que produce la inhibición de las uniones neuromusculares mediante el bloqueo de la liberación de acetilcolina y desensibilización de los nervios sensoriales. En la próstata, sus efectos no solo se limitan a la unión neuromuscular, sino que también se extienden a la unión neuroglandular. Por lo cual la inyección intraprostáticas de toxina botulínica se encuentra entre las nuevas opciones de tratamiento de la hiperplasia prostática benigna. Considerando las potencialidades que esta sustancia posee como una terapia efectiva en afecciones prostáticas, pero considerando que sus mecanismos son poco claros, el objetivo de esta revisión es organizar la evidencia actual y describir los fundamentos fisiopatológicos y mecanismo de acción conocidos hasta ahora, con la finalidad de motivar nuevas investigaciones. Luego de realizar la revisión de la evidencia se pudo concluir que la toxina botulínica puede inducir la involución prostática en ratas, perros y humanos sin causar inflamación local o efectos secundarios sistémicos significativos. Lo cual plantea la posibilidad de su aplicación en lesiones prostáticas benignas o malignas.

Effects of botulinum toxin on the glandular portion of the prostate: pathophysiologic bases, mechanism of action, and evidence

Botulinum toxin is a potent neurotoxin that inhibits neuromuscular junctions by blocking the release of acetylcholine and desensitizes sensory nerves. In the prostate, it effects are not limited to the neuromuscular junction, but also affect the neuroglandular junction, placing the intraprostatic injection of botulinum toxin among the new treatment options for benign prostatic hyperplasia. Considering its potential as an effective therapy in prostate conditions, while at the same time its mechanisms of action are not clear, the aim of the present review was to organize the current evidence and describe the currently known pathophysiologic bases and mechanism of action involved to encourage new research. After conducting the review of the evidence, it was concluded that botulinum toxin could induce involution of the prostate in rats, dogs, and humans, without causing local inflammation or significant systemic side effects, suggesting the possibility of its use in benign or malignant prostate lesions.

PSA and PSA Kinetics Thresholds for the Presence of 68Ga-PSMA-11 PET/CT-Detectable Lesions in Patients With Biochemical Recurrent Prostate Cancer.

68Ga-PSMA-11 positron-emission tomography/computed tomography (PET/CT) is commonly used for restaging recurrent prostate cancer (PC) in European clinical practice. The goal of this study is to determine the optimum time for performing these PET/CT scans in a large cohort of patients by identifying the prostate-specific-antigen (PSA) and PSA kinetics thresholds for detecting and localizing recurrent PC. This retrospective analysis includes 581 patients with biochemical recurrence (BC) by definition. The performance of 68Ga-PSMA-11 PET/CT in relation to the PSA value at the scan time as well as PSA kinetics was assessed by the receiver-operating-characteristic-curve (ROC) generated by plotting sensitivity versus 1-specificity. Malignant prostatic lesions were identified in 77%. For patients that were treated with radical prostatectomy (RP) a PSA value of 1.24 ng/mL was found to be the optimal cutoff level for predicting positive and negative scans, while for patients previously treated with radiotherapy (RT) it was 5.75 ng/mL. In RP-patients with PSA value <1.24 ng/mL, 52% scans were positive, whereas patients with PSA ≥1.24 ng/mL had positive scan results in 87%. RT-patients with PSA <5.75 ng/mL had positive scans in 86% and for those with PSA ≥5.75 ng/mL 94% had positive scans. This study identifies the PSA and PSA kinetics threshold levels for the presence of 68Ga-PSMA-11 PET/CT-detectable PC-lesions in BC patients.

Significance of Serum Prostate Specific Antigen Levels in Evaluating Prostatic Lesions with Histopathological Correlation

Background: Prostate cancer is one of the commonest forms of cancer among men. Serum prostate specific antigen (PSA) used in the diagnosis of prostate cancer is also elevated in other benign and non-malignant diseases of prostate. Objectives: The objectives of the study were to determine the relationship of serum f(PSA) and t(PSA), its correlation with histopathological findings and to assess the PSA cut off variable in various pathological conditions of prostate with clinical relevance. Materials and methods: This study included 141 patients admitted for transurethral resection of prostate and 141 control cases. fPSA was determined on blood samples by sandwich enzyme linked immunosorbent assay and total PSA by Enzyme Linked Fluroscent Assay method. The samples were processed and stained with haematoxylin and eosin. Results: The mean t(PSA) values for benign, premalignant and malignant lesions were 10.3 ng/ml, 20.36 ng/ml and 75.92 ng/ml respectively. The mean serum fPSA values for benign, premalignant and malignant lesions were 3.2 ng/ml, 9 ng/ml and 13.2 ng/ml respectively. The cut off value for tPSA was 12.25 ng/ml and that of fPSA was 9.4ng/ml. The p value(<0.0001) was highly significant in determining premalignant and malignant lesions. Conclusion: Total PSA is raised in premalignant, malignant, inflammatory and benign neoplastic lesions of prostate. In cases where the t(PSA) values are between four - ten ng/ml, f(PSA) is useful marker in cases of malignancies, which were confirmed on histopathology.

Diagnostic Accuracy of Multi-Parametric Magnetic Resonance Imaging for Differentiation of Benign and Malignant Lesions of Prostate Using Radiomics Analysis

Background: Prostate cancer is the second most common cancer-related cause of death in men. Accurate diagnosis of prostate cancer plays an important role in decreasing mortality rates. European Association of Urology (EAU) suggests multiparametric MRI (mp-MRI) of the prostate as a noninvasive method to evaluate prostate lesions. To leverage the interbreeder variability in the interpretation of mp-MRI, computer-aided diagnostic (CAD) systems can be used for automatic detection and characterization of prostate lesions. Objectives: The goal of this article was to design a quantification method based on mp-MRI for the discrimination of benign and malignant prostatic lesions with MR imaging/transrectal ultrasonography fusion-guided biopsy as a reference for pathology validation. Methods: Mp-MR images, including T1- and T2-weighted, diffusion-weighted imaging (DWI), and dynamic contrast enhancement imaging (DCE) MRI were acquired at 1.5T from 27 patients. Then, 106 radiomic features (first-order histogram (FOH), gray-level co-occurrence matrix (GLCM), run-length matrix (RLM), and Gabor filters) were calculated from mp-MRI. Statistical analysis was performed using receiver-operating-characteristic curve analysis for feature filtering, linear discriminant analysis (LDA) for feature extraction, and leave-one-out cross-validation for evaluation of the method in the differentiation of benign and malignant lesions. Results: An accuracy of 96.6% was achieved for discriminating benign and malignant prostate lesions from a subset of texture features derived from ADC and DCE maps (radiomics-based method) with sensitivity and specificity of 100% and 85.7%, respectively. Conclusion: A radiomic quantification method based on T2-weighted images, ADC maps, and quantitative and semiquantitative DCE maps can discriminate benign from malignant prostate lesions with promising accuracy. This method is helpful to avoid unnecessary biopsies in patients and may provide information for CAD systems for the classifications of prostate lesions as an auto-detection technique.

The Relationship Between Prostate Volume and Prostate Specific Antigen in Benign and Malignant Prostatic Lesions

The Relationship Between Prostate Volume and Prostate Specific Antigen in Benign and Malignant Prostatic Lesions

The papillomavirus (HPV) might have a key role in benign and malignant prostate lesions

The papillomavirus (HPV) might have a key role in benign and malignant prostate lesions

Quantitative Analysis of Ultrasound Tissue Diffusion Elastography in The Diagnosis of Benign and Malignant Prostate Lesions.

This study aims to evaluate the value of quantitative analysis of ultrasound real-time tissue diffusion elastography in the diagnosis of benign and malignant prostate lesions. From March 2010 to June 2013, 52 patients suspected with prostate cancer based on laboratory or clinical test results and underwent prostate biopsy in our hospital were enrolled into this study. The age of these patients ranged between 45-82 years, with an average age of 67.2 ± 6.8 years. All patients underwent transrectal real-time ultrasound elastography (TRTE) before biopsy. A total of 63 prostate nodules were detected, and the 11 elastic characteristic quantities of these nodules were quantitatively analyzed via tissue diffusion quantitative analysis. The results of ultrasonography were compared with the results of operation and pathology. Among these 11 characteristic quantities, which include the mean (MEAN) and standard deviation (SD), blue area ratio (AREA%), complexity (COMP), kurtosis (KURT), skewness (SKEW), contrast (CONT), equality (ENT), entropy (IDM), consistency (ASM) and correlation (CORR), except for COMP and CORR, the differences in other nine characteristic quantities between benign and malignant prostatic nodules were statistically significant (P<0.05). Among these, the AREA% and MEAN had the highest correlation, which were 0.791 and -0.791, respectively. The Youden's index (sensitivity and specificity) of AREA% in the ROC curves was the highest, the cutoff value was 80.65% for the diagnosis of prostate cancer, sensitivity was 87.9%, and specificity was 96.6%. Quantitative analysis of ultrasound real-time tissue diffusion elastography is helpful in the diagnosis of benign and malignant prostate lesions, provides a relatively accurate evaluation method in clinical practice, and has broad application prospects.

Diagnostic utility of immunohistochemistry using basal cell markers in distinguishing benign from malignant prostatic lesions

Immunohistochemical detection of basal cells plays a significant role in the diagnosis or exclusion of prostatic carcinoma in diagnostically challenging cases. The objective of this research is to study the expression of immunohistochemical markers p63 and high molecular weight cytokeratin (34βE12) in various prostatic lesions and comparing the sensitivity and specificity of 34βE12 and p63 in prostatic lesions. This was a cross sectional study carried out in our institution on 40 cases of prostatic lesions. It was found that p63 is more sensitive than HMWCK in identifying the basal cells in diagnostically challenging cases.