Negative Biopsy Results Research Articles

Long-term Follow-up and Survival of Patients Following a Recurrence of Melanoma After a Negative Sentinel Lymph Node Biopsy Result

To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result. Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital. A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008. Time to recurrence and overall survival. Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001). Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.

Reevaluation of Negative Cone Biopsy Results After A Positive Cervical Biopsy Finding

This study aimed to evaluate and reexamine materials of the patients with cervical biopsy revealing cervical intraepithelial neoplasia and their cone biopsies revealing no lesion. Twenty-five patients with cervical biopsy revealing cervical intraepithelial neoplasia and cone biopsies revealing no lesion among 202 patients who had undergone cervical conization after colposcopically derived cervical biopsy between 2005 and 2011 were included in this study. Ki67 and P16 were applied to the all biopsy slides. The conization blocks of patients whose reevaluation results of the original biopsy slides were positive were completely sectioned to reexamine the presence of any lesion, and suspicious areas were stained with Ki67 and P16. Of the 25 patients' punch biopsies, no lesion was detected in 13 patients. The false positivity of first punch biopsy (52%) was the main reason for negative cone biopsy result after positive punch biopsy. Punch biopsies of the other 12 patients confirmed the lesions previously diagnosed. The detailed examination of conization specimens of the latter group showed 3 new low-grade cervical intraepithelial neoplasia, which had not been identified before. Discordance between cervical biopsy findings and cervical conization findings could result from misdiagnosis of cervical biopsy, failure in preparation of the whole conization material, and technical difficulties of conization. Ki67 and P16 staining can be used in such cases to clarify the diagnosis.

1176 SMOKING IS ASSOCIATED WITH ACUTE PROSTATIC INFLAMMATION IN MEN WITH A NEGATIVE PROSTATE BIOPSY: RESULTS FROM THE REDUCE STUDY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131176 SMOKING IS ASSOCIATED WITH ACUTE PROSTATIC INFLAMMATION IN MEN WITH A NEGATIVE PROSTATE BIOPSY: RESULTS FROM THE REDUCE STUDY Daniel Moreira, J. Curtis Nickel, Leah Gerber, Roberto Muller, Gerald Andriole, Ramiro Castro-Santamaria, and Stephen Freedland Daniel MoreiraDaniel Moreira Manhasset, NY More articles by this author , J. Curtis NickelJ. Curtis Nickel Ontario, Canada More articles by this author , Leah GerberLeah Gerber Durham, NC More articles by this author , Roberto MullerRoberto Muller Durham, NC More articles by this author , Gerald AndrioleGerald Andriole Saint Louis, MO More articles by this author , Ramiro Castro-SantamariaRamiro Castro-Santamaria King of Prussia, PA More articles by this author , and Stephen FreedlandStephen Freedland Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.813AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cigarette smoking promotes systemic inflammation by increasing the levels of pro-inflammatory markers; however, its direct inflammatory effect on several organs is unknown. The prevalence of acute inflammation in prostate biopsies is estimated to be nearly 40%. The factors associated with inflammatory changes in the prostate of men undergoing biopsy are largely unknown. Therefore, we sought to evaluate the association of smoking status and acute inflammation in the prostate of men undergoing prostate biopsy. METHODS Retrospective analysis of 8098 negative baseline biopsy results of 50-75 years-old men with PSA levels between 2.5 and 10ng/mL enrolled in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study. Smoking status was self-defined as never, former and current smoker. Acute prostate inflammation was assessed by systematic central review blinded to smoking status as present or absent and graded as mild, moderate or marked, though due to low numbers of moderate and marked, inflammation was examined as a binary variable of present/absent. The association of smoking status with inflammation was evaluated with univariable and multivariable logistic regressions controlling for age, race, body-mass index (BMI), digital rectal exam (DRE), prostate volume and baseline prostate-specific antigen (PSA). RESULTS A total of 1220 (15%), 3171 (39%) and 3707 (46%) men were current, former and never smoker, respectively. Current smokers were significantly younger than former and never smokers (P<0.001) but had similar race, DRE, prostate volume, and pre-biopsy PSA (all P>0.01). Former smokers had significantly higher BMI than current and never smokers (P<0.001). Acute prostate inflammation was identified in 1246 (15%) biopsies and graded as mild, moderate and marked in 1220 (98%), 24 (2%) and 2 (<1%), respectively. In univariable analysis, current smokers were more likely to have acute inflammation than former (OR=1.34; P=0.001) and never smokers (OR=1.36; P<0.001). The results were virtually unchanged in multivariable analysis. CONCLUSIONS In a cohort of men undergoing prostate biopsy all with negative biopsies, current smoking status was independently associated with acute inflammatory changes in the prostate. Further studies remain needed to understand the biological mechanisms linking smoking and prostate inflammation. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e480 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Moreira Manhasset, NY More articles by this author J. Curtis Nickel Ontario, Canada More articles by this author Leah Gerber Durham, NC More articles by this author Roberto Muller Durham, NC More articles by this author Gerald Andriole Saint Louis, MO More articles by this author Ramiro Castro-Santamaria King of Prussia, PA More articles by this author Stephen Freedland Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

ACR Appropriateness Criteria Prostate Cancer—Pretreatment Detection, Staging, and Surveillance

Prostate cancer is the most common noncutaneous male malignancy in the United States. The use of serum prostate-specific antigen as a screening tool is complicated by a significant fraction of nonlethal cancers diagnosed by biopsy. Ultrasound is used predominately as a biopsy guidance tool. Combined rectal examination, prostate-specific antigen testing, and histology from ultrasound-guided biopsy provide risk stratification for locally advanced and metastatic disease. Imaging in low-risk patients is unlikely to guide management for patients electing up-front treatment. MRI, CT, and bone scans are appropriate in intermediate-risk to high-risk patients to better assess the extent of disease, guide therapy decisions, and predict outcomes. MRI (particularly with an endorectal coil and multiparametric functional imaging) provides the best imaging for cancer detection and staging. There may be a role for prostate MRI in the context of active surveillance for low-risk patients and in cancer detection for undiagnosed clinically suspected cancer after negative biopsy results. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

A Predictive Score for the Presence of Eosinophils in the Esophagus

M O N D A Y 631 A Predictive Score for the Presence of Eosinophils in the Esophagus Margaret Redmond, MD, Jean Brown, MD, Dale Rhoda, Wei Wang, John Russo, MD, Thomas Platts-Mills, MD, PhD, FAAAAI, FRS, Elizabeth Erwin, MD; Nationwide Children’s Hospital, Columbus, OH, University of South Florida, Tampa, FL, University of Virginia, Charlottesville, VA. RATIONALE: Eosinophilic esophagitis (EoE) is a clinicopathologic diagnosis that weighs heavily on having >15 eosinophils per high power field (hpf) on esophageal biopsy. Our objective was to define clinical features that could be used to predict the diagnosis of EoE reducing the need for esophageal biopsy. METHODS: We reviewed 442 medical records for pediatric patients having esophageal biopsy. Using data on demographics, symptoms, and laboratory results, we performed multivariate logistic regression using complete data from 360 charts. RESULTS: We found that there were four independent predictors for the presence of any eosinophils on esophageal biopsyfemale gender [odds ratio (OR) 0.45, p50.004], having food stuck (OR 6.0, P50.001), the absence of diarrhea (OR 0.40, p50.003), and weighted peripheral blood eosinophil count. Using these parameters for the group of patients we studied, sensitivity and specificity for having eosinophils in the esophagus were 0.18 and 0.97 respectively. The area under the ROC curve was 0.72. For 60 patients, serum specific IgE to foods was available. By univariate analysis, specific IgE to milk >0.35 IU/ml, was associated with EoE (OR 5.7, p50.008). Only having peripheral blood eosinophil count >600/mm3 seemed to have a slight effect on having low eosinophils compared with >15 eos/hpf (OR 3.5, p50.05). CONCLUSIONS: The high specificity we found suggests that in patients with a negative biopsy result, our test model is likely to be negative. There was little clinical evidence in our model to support a distinction between low esophageal eosinophils and >15 eosinophils/hpf.

Impact of total core length on cancer detection rate in a 12 - core prostate biopsy scheme

We retrospectively investigated the core lengths of 768 patients underwent initial prostate biopsy by a lateral zone targetted 12-core protocol between 2006 and 2011, to evaluate the impact of total core length in cancer detection. Cancer was identified in 292 (38.0%) patients. Mean total core length for positive and negative biopsy results were 15.3 cm and 14.6 cm, respectively. Cancer detection rates in groups for total core length 15 cm were 30.9% (55 / 178), 40.6% (96 / 236), and 39.8% (141 / 354) , respectively. When a threshold of 10 cm was selected for total core length, overall cancer detection rate for < 10 cm group was 23.9% (17 / 71) and ≥ 10 cm group was 39.5% (275 / 697). Total core length has a great impact in cancer detection rate and may be used as a reliable adjunctive tool in deciding repeat biopsies for patients with negative biopsy result.

Percutaneous Radiofrequency Ablation of Renal Tumors: A Single-Center Experience

Purpose To evaluate the oncological outcomes, complications, and changes in renal function in patients treated with computed tomography-guided percutaneous radiofrequency ablation (RFA) for small renal tumors.Materials and MethodsThe charts of patients who underwent RFA from 2006 to 2011 at a single institution were reviewed. Oncological and functional outcomes were assessed. Statistical analyses were performed with IBM SPSS ver. 18.0 (IBM Co., Armonk, NY, USA).ResultsA total of 44 RFAs were done in 40 patients. Biopsy prior to RFA was performed in 79.6% of procedures. Of those, 68.6% had renal cell carcinoma (RCC). Mean tumor diameter was 26.2 mm. Grade I complications occurred in 25% of cases (n=11, pain or elevated temperature) and grade II complications in 2.3% (n=1, perirenal bleeding needing two units of blood transfusion). Serum creatinine slightly increased by 0.14 mg/dL at 2 years after RFA (p<0.004). Tumor recurrences were suspected in 8 of 43 cases during follow-up. In five patients, the suspected recurrence was a false-positive as shown by a negative biopsy result or lack of contrast enhancement on subsequent imaging. The verified recurrence rate was 7.7% in all tumors and 2.5% in RCC at a mean follow-up of 2 years. Tumor-free survival was 90% in all patients and 87.5% in those with RCC. Metastasis-free survival was 97.5% and cancer-specific survival was 100%.ConclusionsPercutaneous computed tomography-guided RFA shows promising results at intermediate follow-up. Suspected tumor recurrences are frequently false-positives findings. A longer follow-up is required to verify the durability of these results.

Hospitalization Decreases Serum Prostate-Specific Antigen Values Compared With Outpatient Values in Patients With Benign Prostatic Diseases

PurposeTo investigate whether hospitalization influences serum prostate-specific antigen (PSA) values.Materials and MethodsTransrectal ultrasound-guided prostate biopsies were performed for detecting prostate cancer in 2,017 patients between February 2001 and April 2011 at Ajou University Hospital. Of those patients, 416 patients who were hospitalized for prostate biopsies, whose serum PSA values were measured at the outpatient department within 1 month of admission and also just after admission, and who had negative prostate biopsy results were included in the present study. We retrospectively reviewed the data of the 416 patients and compared the serum PSA values measured in the outpatient department with those measured during hospitalization.ResultsAmong all 416 patients, the interval between the two PSA measurements was 22.2 days (range, 3 to 30 days) and the prostate size measured by transrectal ultrasonography was 53.63 mL (range, 12.8 to 197.9 mL). Among all patients, mean serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department (6.69 ng/mL vs. 8.01 ng/mL, p<0.001). When stratified according to age, the presence or absence of chronic prostatitis in the biopsy pathology, serum PSA levels, and prostate size, the serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department in all subgroups, except in cases aged 20 to 39 years and those with PSA <4 ng/mL, in whom no significant differences were shown.ConclusionsHospitalization decreases serum PSA values compared with those measured on an outpatient basis in patients with benign prostatic diseases. Therefore, serum PSA values should be checked on an outpatient basis for serial monitoring.

Prostate-Specific Antigen Mass and Free Prostate-Specific Antigen Mass for Predicting the Prostate Volume of Korean Men With Biopsy-Proven Benign Prostatic Hyperplasia

PurposeIt has been reported that prostate-specific antigen (PSA) correlates with prostate volume. Recently, some studies have reported that PSA mass (PSA adjusted for plasma volume) is more accurate than PSA at predicting prostate volume. In this study, we analyzed the accuracy of PSA and the related parameters of PSA mass, free PSA (fPSA), and fPSA mass in predicting prostate volume.Materials and MethodsWe retrospectively investigated 658 patients who underwent prostate biopsy from 2006 to 2012 and had a confirmed negative biopsy result. International Prostate Symptom Score (IPSS) questionnaire, PSA, fPSA, and prostate volume were investigated. PSA mass and fPSA mass were calculated by use of established formulas. The association between PSA-related parameters and IPSS and prostate volume was assessed by using Pearson correlation coefficient and receiver operating characteristic curves.ResultsThere was no significant difference between PSA and PSA mass, fPSA, or fPSA mass in predicting prostate volume except in obese patients (p-value of PSA-PSA mass for 40 cm3, 0.54; p-value of fPSA-fPSA mass for 40 cm3, 0.34). fPSA performed significantly better than PSA at predicting prostate volume (p-value for 40 cm3, <0.001). IPSS and the aforementioned PSA-related parameters were not significantly correlated.ConclusionsPSA mass was not a better predictive value than PSA for estimating the prostate volume in Korean men except in obese men. This finding was also applicable to the relationship of fPSA and fPSA mass, which appeared to be more accurate predictors of prostate volume than either PSA or PSA mass.

Vacuum-Assisted Core Biopsy in Diagnosis and Treatment of Intraductal Papillomas

BackgroundThe aim of this study was to assess the value of mammographically-guided and ultrasonographically-guided vacuum-assisted core biopsy (VACB) in the diagnosis and treatment of intraductal papillomas of breast and to answer the question of whether biopsy with the Mammotome (Mammotome; Cincinnati, OH) allows the avoidance of surgery in these patients. Patients and MethodsIn the period 2000 to 2010, a total of 1896 vacuum-assisted core biopsies were performed, of which 1183 were ultrasonographically guided and 713 were mammographically guided (stereotaxic). ResultsIn 62 patients (3.2%) histopathologic examination confirmed intraductal papilloma, and in 12 patients (19.4%) atypical lesions were also found. Open surgical biopsy specimens revealed invasive cancer in 2 women these 12 women (false-negative rate, 16.7%; negative predictive value, 83.3%). Biopsy specimens from the remaining 50 patients (80.6%) revealed papilloma without atypia, and further clinical observation and imaging examinations did not show recurrence or malignant transformation of lesions. Hematoma developed in 3 (4.8%) patients as a complication of biopsy; surgical intervention was not required in any of the patients. ConclusionVACB is a minimally invasive and efficient method for diagnosing intraductal papilloma of the breast. If histopathologic examination confirms a benign lesion and corresponds to the clinical presentation, surgery may be avoided. However in all cases, histopathologic diagnosis of papilloma with atypical hyperplasia or a suspected malignant lesion in imaging examinations, despite negative biopsy results, should always be an indication for surgical excision.

Risk Assessment for Polyomavirus Nephropathy Using Urine Cytology and the Detection of Decoy Cells

Risk Assessment for Polyomavirus Nephropathy Using Urine Cytology and the Detection of Decoy Cells

Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes

PurposeTo evaluate pre-operative prognostic risk factors to predict oncologic outcome of Salvage High-Intensity Focused Ultrasound (S-HIFU) for radiorecurrent prostate cancer (PCa). Methods and materialsA total of 290 men with biopsy-confirmed locally radiorecurrent PCa, underwent S-HIFU. D’Amico risk group before external beam radiotherapy (EBRT), Prostate Specific Antigen (PSA), estimated Gleason score prior HIFU and post HIFU biopsies were analyzed for predictive utility of local cancer control, cancer-specific, metastasis free, and progression free survival rates (PFSR). ResultsLocal cancer control with negative biopsy results was obtained in 81% of the 208 patients who underwent post-S-HIFU biopsies. Median PSA nadir was 0.14ng/ml and 127 patients did not require androgen deprivation therapy (ADT). The mean follow up was 48months for cancer-specific survival rates. The cancer-specific and metastasis-free survival rates at 7years were 80% and 79.6% respectively. The PFSR was significantly influenced by: the pre-HIFU PSA level (hazard ratio (HR): 1.09, 95% CI 1.04–1.13), a Gleason score ⩾8 versus ⩽6 (HR: 1.17, 95% CI 1.03–1.3), and a previous ADT (HR: 1.28, 95% CI 1.09–1.46). The rates of recto-urethral fistula (0.4%) and grade II/III incontinence (19.5%) indicate significant reduction in serious side effects with use of dedicated post-radiation acoustic parameters compared with standard parameters. ConclusionS-HIFU is an effective curative option for radiorecurrent PCa with acceptable morbidity for localized radiorecurrent PCa, but should be initiated early following EBRT failure. Use of prognostic risk factors can optimize patient selection.

Symptom Distress Associated with Biopsy in Women with Suspect Breast Lesions

Purpose. To investigate symptom distress, quality of life, affective states, and inflammatory biomarkers before and after breast biopsy in women undergoing breast biopsy. Methods. A convenience sample of 47 women undergoing breast biopsy was assessed at the pre- and post-biopsy visits. The assessments included evaluation of fatigue, anxiety, depression, sleep disturbances, positive and negative affect, quality of life using validated self report measures, and a blood draw to determine markers of inflammation. Results. At the postbiopsy visit, a total of 15 participants were diagnosed with breast cancer, and 32 participants received negative biopsy result. The mean anxiety and sleep disturbances scores were in the clinically significant range for the total sample and for the biopsy positive (BC+) and biopsy negative (BC−) subgroups at both time points. For both subgroups, anxiety and sleep disturbances scores did not change significantly from pre- to post-biopsy. A subpopulation of participants in both groups reported moderate-to-severe anxiety, depression and fatigue levels at both time points. The inflammatory markers did not show consistent associations with psychosocial symptoms. Conclusions. A subset of participants in BC+ and BC− subgroups experience heightened symptom distress and negative impact on quality of life at both pre- and post-biopsy time points.

Inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer

AbstractBenign changes ranging from atrophy and inflammation to high-grade prostatic intraepithelial neoplasia (HGPIN) are common findings on prostate core needle biopsies. Although atrophy and inflammation may be precursors of prostate cancer, only HGPIN is currently recommended to be included in surgical pathology reports. To determine whether these benign findings increase prostate cancer risk, we conducted a case–control study nested within a historical cohort of 6692 men with a benign prostate specimen collected between 1990 and 2002. The analytic sample included 574 case–control pairs comprised of cases diagnosed with prostate cancer a minimum of 1 year after cohort entry and controls matched to cases on date and age at cohort entry, race, and type of specimen. The initial benign specimen was reviewed for presence of HGPIN, atrophy (simple, lobular, and partial) and inflammation (glandular and/or stromal). HGPIN significantly increased risk for prostate cancer (odds ratio (OR)=2.00; 95% confidence interval (CI)=1.25–3.20). Inflammation within the stromal compartment was associated with decreased risk (OR=0.66; CI=0.52–0.84), and diffuse stromal inflammation of severe grade had the strongest inverse association with risk (OR=0.21; CI=0.07–0.62). In a model adjusted for prostate-specific antigen (PSA) level at cohort entry and inflammation, simple atrophy was associated with a 33% increased prostate cancer risk that was marginally significant (P=0.03). Clinicians should consider patterns and extent of inflammation when managing high-risk patients with negative biopsy results. Identifying benign inflammatory processes that underlie high PSA levels would help to reduce the number of unnecessary repeated prostate biopsies.

Feasibility of MR Imaging/MR Spectroscopy-Planned Focal Partial Salvage Permanent Prostate Implant (PPI) for Localized Recurrence After Initial PPI for Prostate Cancer

To assess the feasibility of magnetic resonance imaging (MRI)-planned partial salvage permanent prostate implant (psPPI) among patients with biopsy-proven local recurrence after initial PPI without evidence of distant disease. From 2003-2009, 15 patients underwent MRI/magnetic resonance spectroscopy (MRS) planning for salvage brachytherapy (psPPI, I-125 [n=14; 144 Gy]; Pd-103 [n=1; 125 Gy]) without hormone therapy. Full dose was prescribed to areas of recurrence and underdosage, without entire prostate implantation. Limiting urethral and rectal toxicity was prioritized. Follow-up was from salvage date to prostate-specific antigen (PSA) concentration failure (Phoenix criteria = nadir + 2.0; ASTRO = 3 consecutive rises), recurrence, distant metastases, or last follow-up PSA level. Progression-free survival (PFS) was defined as no PSA failure or biopsy-proven recurrence without all-cause mortality. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. At salvage, median age was 68 years, and PSA concentration was 3.5 ng/mL (range, 0.9-5.6 ng/mL). Abnormal MRI/MRS findings were evident in 40% of patients. Biopsy-proven recurrences consisted of a single focus (80%) or 2 foci (20%). At recurrence, Gleason score was 6 (67%) or ≥7 (27%). Median interval between initial and salvage implantation was 69 months (range, 28-132 months). psPPI planning characteristics limited doses to the rectum (mean V100 = 0.5% [0.07 cc]) and urethra (V100 = 12% [0.3 cc]). At median follow-up (23.3 months; range, 8-88 months), treatment failure (n=2) resulted only in localized recurrence; both patients underwent second psPPI with follow-up PSA tests at 12 and 26 months, resulting in 0.6 and 0.7 ng/mL, respectively. American Society for Radiation Oncology PFS rates at 1, 2, and 3 years were 86.7%, 78.4%, and 62.7%, respectively, with 5 patients for whom treatment failed (n=3 with negative transrectal ultrasound-guided biopsy results). Phoenix PFS rates at 1, 2, and 3 years were 100%, 100%, and 71.4%. 73%, respectively; achieved PSA nadir of <0.5 ng/mL; and 47% of patients had a nadir of <0.1 ng/mL. Treatment-related toxicity was minimal, with no operative interventions, fistulas, or other grade ≥3 gastrointestinal (GI)/genitourinary (GU) toxicity. Thirteen percent had grade 1 GI and 33% had grade 2 GU toxicities. Postsalvage, 20% of patients had no erectile dysfunction, 67% of patients had medication-responsive erectile dysfunction, and 13% of patients had erectile dysfunction refractory to medication. Focal psPPI with MR-planning in highly selected patients is feasible with short-term control comparable to conventional salvage, with less toxicity. Longer follow-up is needed to confirm its impact on quality of life and treatment.

TU‐A‐BRA‐02: Incorporating PET/CT Images into 3D Ultrasound‐Guided Biopsy of the Prostate

Purpose: Prostate cancer is the second leading cause of cancer mortality in American men. Systematic transrectal ultrasound (TRUS)‐guided prostate biopsy is considered as the standard method for prostate cancer detection. The current biopsy technique has a significant sampling error and can miss up to 30% of cancers. As a Result, a patient may be informed of a negative biopsy Result but may in fact be harboring an occult early‐stage cancer because the current ultrasound imaging technology has difficulty to differentiate carcinoma from benign prostate tissue and because the current TRUS‐guided biopsy is blind and random. We are developing methods to combine PET/CT with three‐dimensional (3D) ultrasound images for targeted biopsy of the prostate with the aim of improving cancer detection rate. Methods: The 3D ultrasound‐guided biopsy system consists of a 3D mechanical localization system and software workstation for image segmentation, registration, and biopsy planning. For PET imaging, we use a new molecular imaging tracer called anti‐1‐amino‐3‐18F‐fluorocyclobutane‐1‐carboxylic acid ([F18]FACBC) that has shown promising results for detecting and localizing prostate cancer in our human clinical trials. In order to plan biopsy, we developed a 3D, automatic segmentation method for the prostate ultrasound images. In order to incorporate PET/CT images into ultrasound‐guided biopsy, we developed image registration methods to fuse TRUS and PET/CT images. Results: The segmentation method was tested in ten patients with a DICE overlap ratio of 92.4% ±1.1%. The registration method has been tested in phantoms. The biopsy system was tested in prostate phantoms. Three‐dimensional ultrasound images were acquired from four human patients. We are integrating the system for PET/CT directed, 3D ultrasound‐guided, targeted biopsy in human patients. Conclusions: A PET/CT image‐directed, 3D ultrasound‐guided biopsy system has been developed for the prostate. This research is supported in part by NIH grant R01CA156775 (PI: Fei), Georgia Cancer Coalition Distinguished Clinicians and Scientists Award (PI: Fei), and the Emory Molecular and Translational Imaging Center (NIH P50CA128301).

Use of PCA3 in detecting prostate cancer in initial and repeat prostate biopsy patients

The PCA3 urinary assay has shown promise in predicting the presence of prostate cancer. We evaluated the value of this test in patients undergoing initial and repeat prostate biopsy. PCA3 and PSA levels were obtained from 456 men with no known personal history of prostate cancer prior to prostate biopsy. Two hundred eighty-nine men underwent an initial prostate biopsy and 167 underwent a repeat prostate biopsy. PCA3 and PSA levels were compared to the prostate biopsy results. PCA3 score was shown to be independent of prostate volume (P = 0.162) and PSA level (P = 0.959). PCA3 scores were significantly higher in patients with cancer on prostate biopsy compared to patients with negative biopsy results (P < 0.0001). In logistic regression, PCA3 showed a significantly higher AUC than PSA (0.726 vs. 0.512, P = 0.0001). This difference persisted when examining the initial biopsy subgroup, with PCA3 out-performing PSA (AUC 0.772 vs. AUC = 0.552, P < 0.0001), but not in the repeat biopsy subgroup (AUC = 0.605 vs. AUC = 0.500, P = 0.2488). PCA3 was found to be a better predictor of prostate cancer than PSA in the total population as well as the initial biopsy population, but was not superior to PSA in the repeat biopsy population. Prostate 73: 48-53, 2013. © 2012 Wiley Periodicals, Inc.

Role of biopsies in patients with residual rectal cancer following neoadjuvant chemoradiation after downsizing: can they rule out persisting cancer?

The study aimed to determine the value of postchemoradiation biopsies, performed after significant tumour downsizing following neoadjuvant therapy, in predicting complete tumour regression in patients with distal rectal cancer. A retrospective comparative study was performed in patients with rectal cancer who achieved an incomplete clinical response after neoadjuvant chemoradiotherapy. Patients with significant tumour downsizing (> 30% of the initial tumour size) were compared with controls (< 30% reduction of the initial tumour size). During flexible proctoscopy carried out postchemoradiation, biopsies were performed using 3-mm biopsy forceps. The biopsy results were compared with the histopathological findings of the resected specimen. UICC (Union for International Cancer Control) ypTNM classification, tumour differentiation and regression grade were evaluated. The main outcome measures were sensitivity and specificity, negative and positive predictive values, and accuracy of a simple forceps biopsy for predicting pathological response after neoadjuvant chemoradiotherapy. Of the 172 patients, 112 were considered to have had an incomplete clinical response and were included in the study. Thirty-nine patients achieved significant tumour downsizing and underwent postchemoradiation biopsies. Overall, 53 biopsies were carried out. Of the 39 patients who achieved significant tumour downsizing, the biopsy result was positive in 25 and negative in 14. Only three of the patients with a negative biopsy result were found to have had a complete pathological response (giving a negative predictive value of 21%). Considering all biopsies performed, only three of 28 negative biopsies were true negatives, giving a negative predictive value of 11%. In patients with distal rectal cancer undergoing neoadjuvant chemoradiation, post-treatment biopsies are of limited clinical value in ruling out persisting cancer. A negative biopsy result after a near-complete clinical response should not be considered sufficient for avoiding a radical resection.

Magnetic Resonance Imaging Targeted Biopsy in Men with Previously Negative Prostate Biopsy Results

To evaluate the efficacy of targeted prostate biopsy using magnetic resonance imaging (MRI) and to characterize clinicopathologic features of tumors detected with targeted prostate biopsy in men with previous negative prostate biopsy results. We prospectively studied 87 patients with a persistently increasing level of serum prostate-specific antigen (PSA), at least one previous set of negative 12-core prostate biopsies, and normal digital rectal examination. All patients were examined with combined T2-weighted and diffusion-weighted MRI before undergoing the prostate biopsy. Prostate biopsy was performed using transrectal ultrasonography-guided standard 12 cores plus targeted biopsy to suspicious region(s) as identified on T2 images on their MRI. Of a total of 87 cases, 82 (94.2%) patients had suspicious lesion(s) on their MRI. Of these 82 patients, 46 (56.0%) patients had prostate cancer (PCA) as determined by the biopsy. The patients with PCA showed a significantly higher incidence of having suspicious lesion(s) (the anterior or apex) on MRI than the patients without PCA (P<0.05). On analysis by dividing all biopsy cores into the targeted cores and standard cores, PCA was found in 149/518 (28.8%) MRI-targeted cores and in 32/903 (3.6%) standard cores (P=0.012) Of 43 patients who underwent radical prostatectomy, 37 (86.0%) patients were detected with PCA located at the anterior or apex portion of the prostate. For tumor characteristics according to tumor locations, there was no significant correlation between tumor location and Gleason scores or pathologic stage. Our data suggest that a MRI-targeted prostate biopsy after prostate MRI might be considered for the identification of cancer foci and the detection of PCA, for patients with a previous negative standard prostate biopsy result despite a persistently elevated PSA value.

2108 PREOPERATIVE URINARY EXOSOME DETECTION OF TMPRSS2:ERG MRNA CLOSELY CORRELATES WITH TISSUE EXPRESSION AT RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Markers I1 Apr 20122108 PREOPERATIVE URINARY EXOSOME DETECTION OF TMPRSS2:ERG MRNA CLOSELY CORRELATES WITH TISSUE EXPRESSION AT RADICAL PROSTATECTOMY Piruz Motamedinia, Anna Scott, Kendall Bate, Guillermo Salazar, Michael Lipsky, Neda Sadeghi, Wayne Comper, James McKiernan, and Leileata Russo Piruz MotamediniaPiruz Motamedinia New York, NY More articles by this author , Anna ScottAnna Scott New York, NY More articles by this author , Kendall BateKendall Bate New York, NY More articles by this author , Guillermo SalazarGuillermo Salazar New York, NY More articles by this author , Michael LipskyMichael Lipsky New York, NY More articles by this author , Neda SadeghiNeda Sadeghi New York, NY More articles by this author , Wayne ComperWayne Comper New York, NY More articles by this author , James McKiernanJames McKiernan New York, NY More articles by this author , and Leileata RussoLeileata Russo New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2276AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Exosomes (including microvesicles) are lipid bilayer vesicles that are released into biofluids such as urine and carry high integrity RNA from the parent cell. We have recently shown that urinary exosomes can be isolated and found to contain prostate specific mRNA transcripts. Here we examine the concordance of our detection of TMPRSS2:ERG (T:E) in urinary exosomes versus prostatectomy tissue and determine the rate of T:E detection in various prostate cancer related groups. METHODS Following Columbia University IRB approval, random urine samples (without prostate massage) were collected from 163 men who were stratified into 4 groups: TRUS prostate biopsy negative (Bx Neg, n=39), TRUS biopsy positive (Bx Pos, n=47), post-radical prostatectomy (RP, n=37) and controls (males <35 yrs, n=40). Additionally, whole-mount paraffin embedded prostate sections were obtained from 11 patients who underwent RP and had pre-RP urine specimens available (7 T:E positive, 4 T:E negative in pre-RP urine). Urine samples were stored at 4°C and 0.8 μm filtration was used to remove whole cells and debris. Urinary exosomal RNA and tissue RNA were isolated using an in-house technique (Exosome Diagnostics, NY) and analyzed using RP-qPCR. RESULTS Mean serum PSA levels were similar in the Bx Neg and Bx Pos groups. All groups except the control (males <35 yrs) were age matched. T:E fusion events were found to occur in 68% of Bx Pos and 44% of Bx Neg patients. Only 5% of controls expressed T:E and no patient in the post RP group had positive T:E detection. Furthermore, T:E expression was lost in the 4 Bx Pos patients that underwent prostatectomy and were retested following surgery. Tissue analysis revealed positive T:E in 8 of 11 prostates. T:E expression concordance between urine and tissue occurred in 10 of 11 (91%) patients with a sensitivity and specificity of 89% and 100%, respectively. CONCLUSIONS The detection rate of the T:E fusion in the Bx Pos group using urinary exosomal RNA was consistent with previous reports using tissue analyses. Our study exhibited near perfect concordance between urinary exosomal mRNA with matched prostate tissue analysis. The detection of T:E expression in the urine of patients with a negative TRUS biopsy may be due to false negative biopsy results or assay detection of T:E expression in premalignant lesions. The unique stability and yield of urinary exosomal RNA will broaden the role of exosomes in future diagnostic testing and simplify sample handing without the variability and patient discomfort inherent to prostate massage. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e850-e851 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piruz Motamedinia New York, NY More articles by this author Anna Scott New York, NY More articles by this author Kendall Bate New York, NY More articles by this author Guillermo Salazar New York, NY More articles by this author Michael Lipsky New York, NY More articles by this author Neda Sadeghi New York, NY More articles by this author Wayne Comper New York, NY More articles by this author James McKiernan New York, NY More articles by this author Leileata Russo New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...