Number Of Biopsy Cores Research Articles

A Nomogram for Predicting Prostate Cancer with Lymph Node Involvement in Robot-Assisted Radical Prostatectomy Era: A Retrospective Multicenter Cohort Study in Japan (The MSUG94 Group).

Background: To create a nomogram for predicting prostate cancer (PCa) with lymph node involvement (LNI) in the robot-assisted radical prostatectomy (RARP) era. Methods: A retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP at nine institutions in Japan between September 2012 and August 2021. A multivariable logistic regression model was used to identify factors strongly associated with LNI. The Bootstrap-area under the curve (AUC) was calculated to assess the internal validity of the prediction model. Results: A total of 1855 patients were enrolled in this study. Overall, 93 patients (5.0%) had LNI. On multivariable analyses, initial prostate-specific antigen, number of cancer-positive and-negative biopsy cores, biopsy Gleason grade, and clinical T stage were independent predictors of PCa with LNI. The nomogram predicting PCa with LNI has been demonstrated (AUC 84%). Using a nomogram cut-off of 6%, 492 of 1855 patients (26.5%) would avoid unnecessary pelvic lymph node dissection, and PCa with LNI would be missed in two patients (0.1%). The sensitivity, specificity, and negative predictive values associated with a cutoff of 6% were 74%, 80%, and 99.6%, respectively. Conclusions: We developed a clinically applicable nomogram for predicting the probability of patients with PCa with LNI.

MRI-targeted biopsy cores from prostate index lesions: assessment and prediction of the number needed

BackgroundMagnetic resonance imaging (MRI) is used to detect the prostate index lesion before targeted biopsy. However, the number of biopsy cores that should be obtained from the index lesion is unclear. The aim of this study is to analyze how many MRI-targeted biopsy cores are needed to establish the most relevant histopathologic diagnosis of the index lesion and to build a prediction model.MethodsWe retrospectively included 451 patients who underwent 10-core systematic prostate biopsy and MRI-targeted biopsy with sampling of at least three cores from the index lesion. A total of 1587 biopsy cores were analyzed. The core sampling sequence was recorded, and the first biopsy core detecting the most relevant histopathologic diagnosis was identified. In a subgroup of 261 patients in whom exactly three MRI-targeted biopsy cores were obtained from the index lesion, we generated a prediction model. A nonparametric Bayes classifier was trained using the PI-RADS score, prostate-specific antigen (PSA) density, lesion size, zone, and location as covariates.ResultsThe most relevant histopathologic diagnosis of the index lesion was detected by the first biopsy core in 331 cases (73%), by the second in 66 cases (15%), and by the third in 39 cases (9%), by the fourth in 13 cases (3%), and by the fifth in two cases (<1%). The Bayes classifier correctly predicted which biopsy core yielded the most relevant histopathologic diagnosis in 79% of the subjects. PI-RADS score, PSA density, lesion size, zone, and location did not independently influence the prediction model.ConclusionThe most relevant histopathologic diagnosis of the index lesion was made on the basis of three MRI-targeted biopsy cores in 97% of patients. Our classifier can help in predicting the first MRI-targeted biopsy core revealing the most relevant histopathologic diagnosis; however, at least three MRI-targeted biopsy cores should be obtained regardless of the preinterventionally assessed covariates.

Correlation Between Long-Term Acetylsalicylic Acid Use and Prostate Cancer Screening with PSA. Should We Reduce the PSA Cut-off for Patients in Chronic Therapy? A Multicenter Study.

PurposeTo evaluate the prostate cancer (PCa) detection rate in men with chronic use of Aspirin and to compare it with the detection rate of non-users.Patients and MethodsProspectively maintained database regarding patients undergoing prostate biopsy over the last 10 years in five institutions. Patients were divided into two groups according to their exposure to Aspirin. We relied on multivariable linear and logistic regression models to test whether Aspirin administration was associated with lower PSA values at prostate biopsy, higher PCa diagnosis, and higher Gleason Grade Grouping (GGG) at biopsy.ResultsWere identified 1059 patients, of whom 803 (76%) did not take Aspirin vs 256 (24%) were taking it. In multivariable log-linear regression analysis, Aspirin administration was associated with lower PSA levels (OR 0.83, 95% CI 0.71–0.97, p = 0.01), after controlling for age, prostate volume, smoking history, associated inflammation at prostate biopsy, presence of PCa at biopsy, and GGG. In multivariable logistic regression analysis, Aspirin administration was not found to be a predictor of PCa at prostate biopsy (OR 1.40, 95% CI 0.82–2.40, p = 0.21) after controlling for age, PSA, smoking history, prostate volume, findings at digital rectal examination and the number of biopsy cores. In patients with PCa at prostate biopsy (n = 516), Aspirin administration was found to predict higher GGG (OR 2.24, 95% CI 1.01–4.87, p = 0.04).ConclusionAspirin administration was found to be a predictor of more aggressive GGG. These findings suggest that a lower PSA threshold should be considered in patients taking Aspirin, as, despite low PSA levels, they might harbour aggressive PCa.

The Detection of Prostate Cancer with Magnetic Resonance Imaging-Targeted Prostate Biopsies is Superior with the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-Institutional Study.

Our aim was to evaluate whether transperineal (TP) MRI-targeted prostate biopsy (TBx) may improve the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology ≥2, in comparison to transrectal (TR) TBx. A multicenter retrospective cohort study comprising patients who underwent MRI-guided prostate biopsy was conducted. To address possible benefits of TP-TBx in the detection of prostate cancer (PCa) and csPCa, a cohort of patients undergoing TP-TBx were compared to patients undergoing TR-TBx. Multivariable logistic regression analyses were performed to assess predictors of PCa and csPCa detection. Overall, 1,936 and 3,305 patients who underwent TR-TBx vs TP-TBx at 10 referral centers were enrolled. The rate of PCa and csPCa diagnosed was higher for TP-TBx vs TR-TBx (64.0% vs 50%, p <0.01 and 49% vs 35%, p <0.01). At multivariable analysis adjusted for age, biopsy naïve/repeated biopsy, cT stage, Prostate Imaging-Reporting and Data System®, prostate volume, PSA, and number of biopsy cores targeted, TP-TBx was an independent predictor of PCa (odds ratio [OR] 1.37, 95% CI 1.08-1.72) and csPCa (1.19, 95% CI 1.12-1.50). When considering the approach according to the site of the index lesion, TP-TBx had a significantly higher likelihood than TR-TBx to detect csPCa in the apex (OR 4.81, 95% CI 1.03-6.27), transition/central zone (OR 2.67, 95% CI 1.42-5.00), and anterior zone (OR 5.62, 95% CI 1.74-8.13). The use of TP-TBx allows a better cancer grade definition and PCa risk assessment. This has important implication in the decision-making process and in patient counseling for further therapies.

External Validation of Models for Prediction of Side-specific Extracapsular Extension in Prostate Cancer Patients Undergoing Radical Prostatectomy

BackgroundPredicting the risk of side-specific extracapsular extension (ECE) is essential for planning nerve-sparing radical prostatectomy (RP) in patients with prostate cancer (PCa). ObjectiveTo externally validate available models for prediction of ECE. Design, setting, and participantsSixteen models were assessed in a cohort of 737 consecutive PCa patients diagnosed via multiparametric magnetic resonance imaging (MRI)-targeted and systematic biopsies and treated with RP between January 2016 and November 2021 at eight referral centers. Outcome measurements and statistical analysisModel performance was evaluated in terms of discrimination using area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). Results and limitationsOverall, ECE was identified in 308/1474 (21%) prostatic lobes. Prostatic lobes with ECE had higher side-specific clinical stage on digital rectal examination and MRI, number of positive biopsy cores, and International Society of Urological Pathology grade group in comparison to those without ECE (all p < 0.0001). Less optimistic performance was observed in comparison to previous published studies, although the models described by Pak, Patel, Martini, and Soeterik achieved the highest accuracy (AUC ranging from 0.73 to 0.77), adequate calibration for a probability threshold <40%, and the highest net benefit for a probability threshold >8% on DCA. Inclusion of MRI-targeted biopsy data and MRI information in models improved patient selection and clinical usefulness. Using model-derived cutoffs suggested by their authors, approximately 15% of positive surgical margins could have been avoided. Some available models were not included because of missing data, which constitutes a limitation of the study. ConclusionsWe report an external validation of models predicting ECE and identified the four with the best performance. These models should be applied for preoperative planning and patient counseling. Patient summaryWe validated several tools for predicting extension of prostate cancer outside the prostate gland. These tools can improve patient selection for surgery that spares nerves affecting recovery of sexual potency after removal of the prostate. They could potentially reduce the risk of finding cancer cells at the edge of specimens taken for pathology, a finding that suggests that not all of the cancer has been removed.

Surgeon volume and patient-reported urinary incontinence after radical prostatectomy. Population-based register study in Sweden

Objective To investigate the association between surgeon volume and urinary incontinence after radical prostatectomy. Methods A total of 8326 men in The National Prostate Cancer Register of Sweden (NPCR) underwent robot-assisted radical prostatectomy (RARP) between 2017 and 2019 of whom 56% (4668/8 326) had responded to a questionnaire one year after RARP. The questionnaire included the question: ‘How much urine leakage do you experience?’ with the response alternatives ‘Not at all’, ‘A little’, defined as continence and ‘Moderately’, ‘Much/Very much’ as incontinence. Association between incontinence and mean number of RARPs/year/surgeon was analysed with multivariable logistic regression including age, Charlson Comorbidity Index (CCI), PSA, prostate volume, number of biopsy cores with cancer, cT stage, Gleason score, lymph node dissection, nerve sparing intent and response rate to the questionnaire. Results 14% (659/4 668) of the men were incontinent one year after RARP. There was no statistically significant association between surgeon volume and incontinence. Older age (>75 years vs. < 65 years, OR 2.29 [95% CI 1.48–3.53]), higher CCI (CCI 2+ vs. CCI 0, OR 1.37 [95% CI 1.04–1.80]) and no nerve sparing intent (no vs. yes OR 1.53 [95% CI 1.26–1.85]) increased risk of incontinence. There were large differences in the proportion of incontinent men between surgeons with similar annual volumes, which remained after adjustment. Conclusions The lack of association between surgeon volume and incontinence and the wide range in outcome between surgeons with similar volumes underline the importance of individual feedback to surgeons on functional results.

MRI Extraprostatic Extension Grade: Accuracy and Clinical Incremental Value in the Assessment of Extraprostatic Cancer.

Objective The purpose was to compare the accuracy of extraprostatic extension (EPE) grade on MRI predicting EPE with Partin tables, Memorial Sloan Kettering Cancer Center nomogram (MSKCCn), and combined models and to analyze the clinical incremental value of EPE grade. Materials and Methods 105 prostate cancer patients confirmed by pathology after radical prostatectomy in our hospital from 2017 to 2021 were selected. The clinical stage, PSA, Gleason score, number of positive biopsy cores, and percentage of positive biopsy cores were recorded. Evaluate EPE grade according to EPE grade criteria, and calculate the probability of predicting EPE with Partin tables and MSKCCn. EPE grade is combined with Partin tables and MSKCCn to construct EPE grade+Partin tables and EPE grade+MSKCCn models. Calculate the area under the curve (AUC), sensitivity, and specificity of EPE grade, Partin tables, MSKCCn, EPE grade+Partin tables, and EPE grade+MSKCCn and compare their diagnostic efficacy. The clinical decision curve was used to analyze the clinical net income of each prediction scheme. Results The AUC of EPE grade was 0.79, Partin tables was 0.50, MSKCCn was 0.78, the EPE grade+Partin table model was 0.79, and the EPE grade+MSKCCn model was 0.83. After EPE grade was combined with Partin tables and MSKCCn, the diagnostic efficiency of clinical model was significantly improved (P < 0.05). There was no significant difference in the diagnostic efficacy of the combined model compared with the single EPE grade (P > 0.05). The calibration curve of the combined model shows that it has a good calibration degree for EPE. In the analysis of the decision curve, the net income of the EPE grade is higher than that of Partin tables and MSKCCn and is equal to the EPE grade+Partin tables and is slightly lower than that of EPE grade+MSKCCn. The clinical net income of the combined model is obviously higher than that of individual clinical models. Conclusion The accuracy of EPE classification in predicting prostate cancer EPE is high, and combined with the clinical model, it can significantly improve the diagnostic efficiency of the clinical model and increase the clinical benefit.

Precision-guidance vs Systematic Sampling: Optimizing Biopsy Assessment of Secondary Prostate Cancer Suspicious Multiparametric Magnetic Resonance Imaging Lesions.

We assessed the diagnostic yield of consecutive transperineal targeted biopsy of multiparametric magnetic resonance imaging index lesion and secondary lesion and additive systematic biopsy in patients who received combined targeted biopsy+systematic biopsy of prostate. Of 1,467 patients with targeted biopsy+systematic biopsy, analyses were restricted to 571 patients with index lesion+secondary lesion, Prostate Imaging-Reporting and Data System score ≥3. Index lesion was defined as having the greatest Prostate Imaging-Reporting and Data System score and/or lesion volume as opposed to secondary lesion. We retrospectively compared clinically significant prostate cancer rates (ie, Gleason Grade Group ≥2) between index lesion+secondary lesion and index lesion+secondary lesion+systematic biopsy. Subgroup analyses in men with ipsilateral index lesion+secondary lesion focused on contralateral systematic biopsy. Multivariable logistic regression analyses to predict any clinically significant prostate cancer included age, previous biopsies, prostate specific antigen density, respective index lesion/secondary lesion volumes, side relation, Prostate Imaging-Reporting and Data System strata, and number of targeted biopsy and systematic biopsy cores. Clinically significant prostate cancer rates for index lesion+secondary lesion vs index lesion+secondary lesion+systematic biopsy were 38% vs 42% (P = .2) at expense of significantly higher median number of biopsy cores (9 vs 25, P < .001). In the subgroup with ipsilateral index lesion+secondary lesion (n = 236), contralateral systematic biopsy detected clinically significant prostate cancer in 17%. In the narrower subgroup with ipsilateral index lesion+secondary lesion (n = 131) without any clinically significant prostate cancer, contralateral systematic biopsy detected clinically significant prostate cancer in 3.8%. Multivariable logistic regression analyses confirmed contralateral systematic biopsy as independent predictor, but performed similarly without systematic biopsy information (area under the curve 87.1% vs 86.6%). Targeted biopsy of secondary lesion should be included in targeted biopsy protocols due to added diagnostic information. However, for targeted biopsy of index lesion+secondary lesion additional systematic biopsy is of limited informative value in terms of overall clinically significant prostate cancer detection. However, when index lesion+secondary lesion are ipsilateral, contralateral systematic biopsy should be recommended for purpose of prostate lobe information. Our results indicate great potential to reduce systematic biopsy cores and associated potential morbidity, and warrant prospective evaluation.

An Magnetic Resonance Imaging–directed Targeted-plus-perilesional Biopsy Approach for Prostate Cancer Diagnosis: “Less Is More”

BackgroundConsidering that most men benefit diagnostically from increased sampling of index lesions, limiting systematic biopsy (SBx) to the region around the index lesion could potentially minimize overdetection while maintaining the detection of clinically significant prostate cancer (csPCa). ObjectiveTo evaluate the diagnostic performance of a hypothetical magnetic resonance imaging (MRI)-directed targeted-plus-perilesional biopsy approach. Design, setting, and participantsThis single-center, retrospective analysis of prospectively generated data included all biopsy-naïve men with unilateral MRI-positive lesions (Prostate Imaging Reporting and Data System category ≥3), undergoing both MRI-directed targeted biopsies and SBx. Grade group 2–5 cancers were considered csPCa. Outcome measurements and statistical analysisThe diagnostic performance of a targeted-plus-perilesional biopsy approach was compared with that of a targeted-plus-systematic biopsy approach. The primary outcome was the detection of csPCa. Secondary outcomes included the detection of clinically insignificant prostate cancer (ciPCa) and the number of total biopsy cores. Results and limitationsA total of 235 men were included in the analysis; csPCa and ciPCa were detected, respectively, in 95 (40.4%) and 86 (36.6%) of these 235 men. A targeted-plus-perilesional biopsy approach would have detected 92/95 (96.8%; 95% confidence interval [CI] 91.0–99.3%) csPCa cases. At the same time, detection of systematically found ciPCa would be reduced by 11/86 (12.8%; 95% CI 6.6–21.7%). If a targeted-plus-perilesional biopsy approach would have been performed, the number of biopsy cores per patient would have been reduced significantly (a mean difference of 5.2; 95% CI 4.9–5.6, p < 0.001). ConclusionsAn MRI-directed targeted-plus-perilesional biopsy approach detected almost all csPCa cases, while limiting overdiagnosis and reducing the number of biopsy cores. Prospective clinical trials are needed to substantiate the withholding of nonperilesional SBx in men with unilateral lesion(s) on MRI. Patient summaryLimiting systematic biopsies to the proximity of the suspicious area on magnetic resonance imaging helps detect an equivalent number of aggressive cancers and fewer indolent cancers. These findings may help patients and physicians choose the best biopsy approach.

Intensity of observation with active surveillance or watchful waiting in men with prostate cancer in the United States.

Population-based studies assessing various active surveillance (AS) protocols for prostate cancer, to date, have inferred AS participation by the lack of definitive treatment and use of post-diagnostic testing. This is problematic as evidence suggests that most men do not adhere to AS protocols. We sought to develop a novel method of identifying men on AS or watchful waiting (WW) independent of post-diagnostic testing and aimed to identify possible predictors of follow-up intensity in men on AS/WW. A predictive model was developed using SEER watchful waiting data to identify men ≥66 years on AS between 2010-2015, irrespective of post-diagnostic testing, and applied to SEER-Medicare database. AS intensity among different variables including age, prostate-specific antigen (PSA) level, number of total and positive biopsy cores, Charlson comorbidity index, race (Black vs. non-Black), US census region, and county poverty, income, and education levels were compared using multivariable regression analyses for PSA testing, surveillance biopsy, and magnetic resonance imaging (MRI). A total of 2238 men were identified as being on AS. Of which, 81%, 33%, and 10% had a PSA test, surveillance biopsy, and MRI scan within 1-2 years, respectively. On multivariable analyses, Black men were less likely to have a PSA test (adjusted rate ratio [ARR] 0.60, 95% CI: 0.53-0.69), MRI scan (ARR 0.40, 95% CI: 0.24-0.68), and surveillance biopsy (ARR 0.71, 95% CI: 0.55-0.92) than non-Black men. Men within the highest income quintile were more likely to undergo PSA test (ARR 1.16, 95% CI: 1.05-1.27) and MRI scan (ARR 1.60, 95% CI 1.15-2.27) compared to men with the lowest income. Black men and men with lower incomes on AS underwent less rigorous monitoring. Further study is needed to understand and ameliorate differences in AS rigor stemming from sociodemographic differences.

Fusion versus cognitive MRI-guided prostate biopsies in diagnosing clinically significant prostate cancer

Objective: This study assesses whether fusion or cognitive magnetic resonance imaging (MRI)-guided prostate targeted and systematic transperineal biopsies (TPB) increase detection of clinically significant prostate cancer (csPCa). Materials and Methods: A retrospective analysis was completed of patients (2018–2020) undergoing 3-Tesla multiparametric prostate MRI informing targeted (either cognitive or MIM software fusion approach) and systematic TPB. ISUP (International Society of Urological Pathology) grade group ⩾ 2 was considered csPCa. Results: A total of 355 cases from 4 urologists were included; 131 were fusion and 224 were cognitive MRI-guided biopsies. Of all csPCa found, 86.8% ( n = 171) of cases were confirmed to be at the MRI-indicated location and 11.6% were found as part of active surveillance. In all, 45.0% of the fusion group were found to have csPCa, compared to 62.05% ( n = 139) in the cognitive group ( p = 0.002). csPCa detection rates varied between urologists (41% to 78%, p &lt; 0.001), so a subgroup analysis was performed on Urologist A; 45.0% of fusion and 41.3% of cognitive biopsies had csPCa ( p = 0.644). Multinomial logistic regression analysis showed that biopsy type, being on active surveillance, number of biopsy cores, iPSA (initial Prostate Specific Antigen) value or PIRADS (Prostate Imaging-Reporting and Data System) score made no significant difference in whether csPCa was found. Conclusion: Cognitive and fusion targeting had similar csPCa detection rates. Further prospective studies would be beneficial to validate these findings. Level of evidence: 2b (according to Oxford Centre for Evidence-Based Medicine)

Are Diabetic Patients at Increased Risk for Biochemical Recurrence After Radical Prostatectomy?

IntroductionDiabetic patients are at a lower risk for prostate cancer. However, the relationship between diabetes mellitus (DM) and biochemical recurrence (BCR) after radical prostatectomy (RP) is less clear. The goal of our study was to determine diabetes's value as a biochemical recurrence predictor.Materials and methodsWe conducted a retrospective analysis of 117 patients who had undergone open radical prostatectomy between 1999 and 2021 at our institution. Univariate and multivariate statistical analyses were used to identify factors associated with biochemical recurrence.ResultsOn univariate analysis, factors associated with biochemical recurrence were diabetes (p=0.002), preoperative prostate-specific antigen (PSA) levels (p=0.022), positive digital rectal exam (p=0.035), number of positive biopsy cores (p<0.001), unfavorable intermediate risk group (p=0.014), peri-neural invasion (PNI) on RP specimen (p=0.043), tumor volume (p=0.011), and positive surgical margins (p<0.001). Multivariate analysis showed that factors independently associated with biochemical recurrence were diabetes (p=0.039; OR=2.788), number of positive cores (p=0.016; OR=4.124), and positive surgical margins (p=0.008; OR=3.876).ConclusionA history of diabetes mellitus should be taken into consideration when assessing patients’ risk of biochemical recurrence after radical prostatectomy. More research on a larger scale is needed to determine diabetes' value as a biochemical predictor.

MP15-06 RISK OF ADVERSE RADICAL PROSTATECTOMY OUTCOMES IN PATIENTS DIAGNOSED WITH IUSP ≤2 PROSTATE CANCER ON MRI/TRUS FUSION BIOPSY

You have accessJournal of UrologyCME1 May 2022MP15-06 RISK OF ADVERSE RADICAL PROSTATECTOMY OUTCOMES IN PATIENTS DIAGNOSED WITH IUSP ≤2 PROSTATE CANCER ON MRI/TRUS FUSION BIOPSY Claudia Kesch, Vlad Pantea, Timo Soeterik, Alessandro Marquis, Giulia La Bombarda, Allesandro Morlacco, Francesco Barletta, Felix Preisser, Fabio Zattoni, Giancarlo Marra, Roderik C.N. van den Bergh, Jan Philipp Radtke, Boris Hadaschik, and Giorgio Gandaglia Claudia KeschClaudia Kesch More articles by this author , Vlad PanteaVlad Pantea More articles by this author , Timo SoeterikTimo Soeterik More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Giulia La BombardaGiulia La Bombarda More articles by this author , Allesandro MorlaccoAllesandro Morlacco More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Felix PreisserFelix Preisser More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Roderik C.N. van den BerghRoderik C.N. van den Bergh More articles by this author , Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , and Giorgio GandagliaGiorgio Gandaglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002544.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To avoid overtreatment, active surveillance (AS) is recommended for prostate cancer (PC) patients with low- to favorable intermediate-risk features. However, previous studies based on 12-core transrectal ultrasound (TRUS) biopsy have demonstrated high upgrading rates (up to 70%) at radical prostatectomy (RP) in men potentially suitable for AS. We aim at exploring rate and risk factors for adverse pathologic outcomes in patients with multiparmetric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy confirmed ISUP ≤2 PC. METHODS: Multicentre, retrospective analysis of 477 consecutive patients with ISUP ≤2 PC on mpMRI/TRUS fusion biopsy treated with RP. Adverse outcomes (AO) were defined as any ISUP upgrading, upgrading to ISUP ≥3, ≥pT3 at RP, any AO (=ISUP upgrading to ≥ 3 and/or ≥pT3 and/or N1) or biochemical recurrence (BCR) in men with available follow-up (n=327). Rates of AO were calculated for the overall cohort, biopsy ISUP 1 (n=149) and biopsy ISUP 2 (n=328) PC. Groups were compared using Qui-square test. Logistic regression was used to determine predictive factors. RESULTS: The overall rates of ISUP upgrading, ISUP upgrading to ≥ 3, ≥pT3 on RP and any AO were 39%, 21%, 32% and 43%, respectively. Compared to biopsy ISUP 2, men with biopsy ISUP 1 PC experienced more frequently ISUP upgrading (27% vs. 67%, p<0.001), but less ISUP upgrading to ≥ 3 (27% vs. 10%, p<0.001) and any AO (48% vs. 32%, p=0.001). No differences were recorded for ≥pT3 on RP (34% vs. 26%, p=0.052). PSA density, PIRADS score on mpMRI, number of positive targeted biopsy (TB) cores, ISUP of TB cores, overall number of biopsy cores and positive biopsy cores were all predictive factors for ISUP upgrading to ≥3, ≥pT3 at RP as well as for any AO. Neither PSA nor positive digital rectal examination significantly predicted AOs. Median time of follow-up was 12 months. The 1-year BCR-free survival was 94%. No significant differences in BCR rates were observed comparing men with biopsy ISUP 1 and biopsy ISUP 2 (5% vs. 7%, p=0.518). Positive TB cores, ISUP at RP, ISUP upgrading, ISUP upgrading to ≥3, ≥pT3 on RP and any AO were all predictive for BCR. CONCLUSIONS: In men with mpMRI/TRUS fusion biopsy confirmed ISUP ≤ 2 PC adverse outcomes at RP are still frequent. When counseling patients regarding AS, especially PSA density, ISUP, mpMRI findings and number of positive biopsy cores should be taken into account to identify the men at higher risk of AO. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e243 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudia Kesch More articles by this author Vlad Pantea More articles by this author Timo Soeterik More articles by this author Alessandro Marquis More articles by this author Giulia La Bombarda More articles by this author Allesandro Morlacco More articles by this author Francesco Barletta More articles by this author Felix Preisser More articles by this author Fabio Zattoni More articles by this author Giancarlo Marra More articles by this author Roderik C.N. van den Bergh More articles by this author Jan Philipp Radtke More articles by this author Boris Hadaschik More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF DownloadLoading ...

How many cores are enough? Optimizing the transperineal prostate biopsy template

Most urologists use a 10-12 core template during transrectal ultrasound guided prostate biopsy (TRUS-B). A similar consensus template does not exist for transperineal prostate biopsy (TP-B) including the optimal number and location of biopsy cores. We examined our institutional cohort to develop an optimal systematic template for TP-B. We prospectively monitored our first 200 consecutive free-hand TP-B. These included men who were biopsy naïve (n = 117), had elevated PSA with prior negative biopsy (n = 18), and men on active surveillance (n = 65). All men underwent a 20 core TP-B with each core placed in a separate specimen container. This allowed the 20-core TP-B to be easily broken down as though fewer cores had been taken in each patient. Ten, 12, and 16 core templates were designed a priori and compared within each patient to the 20 core template. The highest Grade Group (GG) at pathologic analysis was assigned to each biopsy. Primary outcome was detection of clinically significant prostate cancer, defined as ≥GG2. Secondary outcome was detection of GG1 prostate cancer. We performed sub-group analyses of biopsy naïve men and biopsy naïve men stratified by PSA density (<0.15 vs. ≥0.15 ng/mL/cc). An historic institutional cohort of 10-12 core TRUS-B (n = 170) was used to compare prostate cancer detection between techniques. P value of ≤0.05 was considered statistically significant. Clinically significant cancers were detected in 98 men (49%) using a 20 core TP-B technique. Had we sampled fewer cores we would have identified clinically significant cancers in 93 (47%, 16 core), 91 (46%, 12 core), and 82 (41%, 10 core) men. More clinically significant cancers were detected by the 20 core template compared to the 10 core template for both the whole cohort (49% vs. 41%, P = 0.02) and the biopsy naïve subset (48% vs. 40%, P = 0.05). Additional cores did not result in an increased detection of GG1 cancers (20-core: 35% vs. 10-core: 44%, P = 0.09). Less than one quarter of biopsy naïve men with a PSA density <0.15 were found to have clinically significant cancers. More clinically significant cancers were detected in the 12-core TP-B cohort compared to the 12-core TRUS-B series (46% vs. 38%, P < 0.001). A 20 core TP-B systematic biopsy template detected a greater number of clinically significant prostate cancers compared to a 10 core TP template. Cancer detection was similar for 12, 16, and 20 core templates. Higher core numbers did not result in greater detection of GG1 tumors reflecting increased detection of concomitant ≥GG2 with greater sampling. We propose a minimum 12 core systematic biopsy template for men undergoing TP-B.

MP09-11 THE RELATIVE IMPACT OF SPATIAL PARAMETERS ON THE PERFORMANCE OF MRI-US FUSION BIOPSY VS. MRI IN-BORE BIOPSY OF THE PROSTATE

You have accessJournal of UrologyCME1 May 2022MP09-11 THE RELATIVE IMPACT OF SPATIAL PARAMETERS ON THE PERFORMANCE OF MRI-US FUSION BIOPSY VS. MRI IN-BORE BIOPSY OF THE PROSTATE Mitch Hayes, Solange Bassale, Sudhir Isharwal, Christopher Amling, Bryan Foster, Fergus Coakley, and Jen-Jane Liu Mitch HayesMitch Hayes More articles by this author , Solange BassaleSolange Bassale More articles by this author , Sudhir IsharwalSudhir Isharwal More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Bryan FosterBryan Foster More articles by this author , Fergus CoakleyFergus Coakley More articles by this author , and Jen-Jane LiuJen-Jane Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) has improved the accuracy of prostate cancer detection. Prior data suggests that in-bore biopsy may have improved accuracy over other fusion modalities, such as MRI-US fusion using software registration. We sought to compare the relative impact of selected MRI spatial parameters on prostate cancer detection between MRI-US fusion and MRI in-bore biopsy. METHODS: Patients with at least one PIRADS 4 or higher lesion on mpMRI that underwent MRI-US or MRI in-bore biopsy at one institution between 2013 and 2020 were included. The majority of patients had 3T MRI with endorectal coil. Patients on active surveillance were excluded. The primary endpoint was the detection of Gleason Grade Group 2 or higher (GG2+) on targeted biopsy on a per lesion basis. Propensity score matching was performed, and the overall GG2+ detection rate was compared using the Chi-square test. Generalized estimated equations were used to test interaction terms between biopsy modality and pre-specified variables: maximum lesion dimension, lesion volume, prostate volume, and lesion location (transitional zone vs. peripheral zone). Inclusion of number of biopsy cores to each model was also pre-specified. Analysis was performed using SAS, version 9.4. RESULTS: 53 MRI-US fusion patients and 133 MRI in-bore patients were evaluated for matching. 68 patients and 84 lesions were then matched for clinical and MRI factors, and all prebiopsy covariates were balanced. Overall GG2+ detection rate was higher amongst lesions sampled with in-bore biopsy compared to MRI-US fusion biopsy (59.5% v 45.2%, p=0.190). Lesion maximum dimension, lesion volume, prostate volume, and lesion location did not affect GG2+ detection for in-bore biopsy technique. However, the interaction between biopsy modality and lesion volume (OR 1.2, CI 1.03-1.43, p-value 0.024) and between modality and prostate volume were significant for the detection of GG2+ with MRI-US fusion biopsy (OR 0.97, CI 0.96-1.00, p-value 0.030). CONCLUSIONS: In a propensity score matched cohort of patients without prostate cancer undergoing MRI-US fusion biopsy or in-bore biopsy for PIRADS 4 or 5 lesions, overall GG2+ detection rate was higher for patients undergoing in-bore biopsy, which was independent of lesion volume or prostate size. GG2+ detection rate was lower for MRI-US fusion biopsy patients with smaller lesions or larger prostates, which may reflect inaccurate coregistration or increased tissue deformation with this approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e139 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitch Hayes More articles by this author Solange Bassale More articles by this author Sudhir Isharwal More articles by this author Christopher Amling More articles by this author Bryan Foster More articles by this author Fergus Coakley More articles by this author Jen-Jane Liu More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP09-01 THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN TRANSPERINEAL PROSTATE BIOPSY: A SYSTEMATIC REVIEW AND METANALYSIS

You have accessJournal of UrologyCME1 May 2022MP09-01 THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN TRANSPERINEAL PROSTATE BIOPSY: A SYSTEMATIC REVIEW AND METANALYSIS Spyridon Basourakos, Mark Alshak, Patrick Lewicki, Emily Cheng, Michael Tzeng, Antonio DeRosa, Matthew Allaway, Ashley Ross, Edward Schaeffer, Hiten Patel, Jim Hu, and Michael Gorin Spyridon BasourakosSpyridon Basourakos More articles by this author , Mark AlshakMark Alshak More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Emily ChengEmily Cheng More articles by this author , Michael TzengMichael Tzeng More articles by this author , Antonio DeRosaAntonio DeRosa More articles by this author , Matthew AllawayMatthew Allaway More articles by this author , Ashley RossAshley Ross More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Hiten PatelHiten Patel More articles by this author , Jim HuJim Hu More articles by this author , and Michael GorinMichael Gorin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy (TPB) is associated with a significantly lower risk of infectious complications as compared to the transrectal approach. In fact, the risk of infectious complications with TPB is so low that the utility of administering peri-procedure antibiotics with this procedure has come under question. Thus, we performed a systematic review and metanalysis to assess for differences in the rates of infectious complications (septic, non-septic, overall) after TPB performed with and without administration of antibiotic prophylaxis. METHODS: Three electronic databases (PubMed, EMBASE and MEDLINE) were searched, and studies were included if they included men who underwent TPB, were published after January 2000, included information on periprocedural antibiotic administration, and reported post-biopsy complications. Preferred Reporting Items for Systematic Reviews and Metanalyses and Agency for Healthcare Research and Quality guidelines were utilized. RESULTS: A total of 106 unique studies describing 112 cohorts of patients were identified where 98 (37,805 men) received antibiotic prophylaxis and 14 (4,772 men) did not receive antibiotic prophylaxis. All men were included in the analysis of septic complications. In total there were 19 (0.05%) episodes of sepsis in the group of antibiotics. The event rate was similar to the no antibiotic group, in which only 4 (0.08%) patients experienced sepsis (p=0.2). For overall infections (septic plus non-septic), there were 58 (1.22%) events versus 403 (1.35%) among 29,880 men with evaluable data who did and did not receive antibiotic prophylaxis, respectively (p=0.8). Restricting to our analysis to studies with a comparable number of biopsy cores, there remained no difference in the rates of sepsis between groups. In this analysis we also observed a small but statistically significant lower risk of infectious complications with antibiotic administration (0.55 vs. 1.22%, p<0.01). CONCLUSIONS: The likelihood of septic infections after TPB is low with and without antibiotic prophylaxis. The omission of periprocedural antibiotics with this procedure stands to benefit patients by avoiding potential drug reactions. Furthermore, this practice is in line with calls throughout the medical community for improved antibiotic stewardship. Source of Funding: Jim Hu receives research support from the Dow Wallace Fund of the New York Community Trust and salary support from NIH CA241758, PCORI CER-2019C1-15682 and CER-2019C2-17372 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e135 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spyridon Basourakos More articles by this author Mark Alshak More articles by this author Patrick Lewicki More articles by this author Emily Cheng More articles by this author Michael Tzeng More articles by this author Antonio DeRosa More articles by this author Matthew Allaway More articles by this author Ashley Ross More articles by this author Edward Schaeffer More articles by this author Hiten Patel More articles by this author Jim Hu More articles by this author Michael Gorin More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD41-03 ANTIBIOTIC-FREE TRANSPERINEAL PROSTATE BIOPSY: UROLOGY’S CONTRIBUTION TO RESPONSIBLE ANTIMICROBIAL STEWARDSHIP

PD41-03 ANTIBIOTIC-FREE TRANSPERINEAL PROSTATE BIOPSY: UROLOGY’S CONTRIBUTION TO RESPONSIBLE ANTIMICROBIAL STEWARDSHIP

The Effect of Different Types of Prostate Biopsy Techniques on Post-Biopsy Infectious Complications.

The aim of our study was to compare infectious complication rates between different prostate biopsy techniques with various number of biopsy cores. In this retrospective study, all patients from 2 hospitals who underwent prostate biopsy between 2012 and 2019 were identified. Cohorts with different types of prostate biopsies were compiled within these hospitals. Primary outcome measure was any registered infectious complication within 7 days post-biopsy. Secondary outcomes were infectious complications within 30 days, hospitalization and bacteremia. To compare the risk of infection following different prostate biopsy techniques, data was fitted into a logistic regression model adjusting for potential confounders. In total, 4,233 prostate biopsies in 3,707 patients were included. After systematic transrectal ultrasound-guided prostate biopsy (TRUSPB; 12±1.4 biopsy cores), 4.0% (2,607) of all patients had infectious complications within 7 days post-biopsy. Transperineal magnetic resonance imaging (MRI)-ultrasound fusion guided prostate biopsy (16±3.7 biopsy cores) was associated with significantly lower infection rates than systematic TRUSPB (adjusted OR: 0.29 [0.09-0.73] 95% confidence interval [CI]). Transrectal targeted MRI-ultrasound fusion guided prostate biopsy (3.1±0.8 biopsy cores) and transrectal targeted in-bore MRI guided prostate biopsy (2.8±0.8 biopsy cores) also showed fewer infectious complications than systematic TRUSPB (adjusted OR: 0.41 [0.12-1.12] 95% CI and 0.68 [0.37-1.20] 95% CI, respectively). Transperineal prostate biopsy, or transrectal prostate biopsy with reduced number of biopsy cores, could lower the risk of infectious complications.

The Dilemma of Misclassification Rates in Senior Patients With Prostate Cancer, Who Were Treated With Robot-Assisted Radical Prostatectomy: Implications for Patient Counseling and Diagnostics.

ObjectivesThere is a recent paradigm shift to extend robot-assisted radical prostatectomy (RARP) to very senior prostate cancer (PCa) patients based on biological fitness, comorbidities, and clinical PCa assessment that approximates the true risk of progression. Thus, we aimed to assess misclassification rates between clinical vs. pathological PCa burden.Materials and MethodsWe compared senior patients with PCa ≥75 y (n = 847), who were propensity score matched with younger patients <75 y (n = 3,388) in a 1:4 ratio. Matching was based on the number of biopsy cores, prostate volume, and preoperative Cancer of the Prostate Risk Assessment (CAPRA) risk groups score. Multivariable logistic regression models (LRMs) predicted surgical CAPRA (CAPRA-S) upgrade, which was defined as a higher risk of the CAPRA-S in the presence of lower-risk preoperative CAPRA score. LRM incorporated the same variables as propensity score matching. Moreover, patients were categorized as low-, intermediate-, and high-risk, preoperative and according to their CAPRA and CAPRA-S scores.ResultsSurgical CAPRA risk strata significantly differed between the groups. Greater proportions of unfavorable intermediate risk (39 vs. 32%) or high risk (30 vs. 28%; p < 0.001) were observed. These proportions are driven by greater proportions of International Society of Urological Pathology (ISUP) Gleason Grade Group 4 or 5 (33 vs. 26%; p = 0.001) and pathological tumor stage (≥T3a 54 vs. 45%; p < 0.001). Increasing age was identified as an independent predictor of CAPRA-S-based upgrade (age odds ratio [OR] 1.028 95% CI 1.02–1.037; p < 0.001).ConclusionApproximately every second senior patient has a misclassification in (i.e., any up or downgrade) and each 4.5th senior patient specifically has an upgrade in his final pathology that directly translates to an unfavorable PCa prognosis. It is imperative to take such substantial misclassification rates into account for this sensitive PCa demographic of senior men. Future prospective studies are warranted to further optimize PCa workflow and diagnostics, such as to incorporate modern imaging, molecular profiling and implement these into biopsy strategies to identify true PCa burden.

A clinical available decision support scheme for optimizing prostate biopsy based on mpMRI.

Combined MRI/Ultrasound fusion targeted biopsy (TBx) and systematic biopsy (SBx) results in better prostate cancer (PCa) detection relative to either TBx or SBx alone, while at the cost of higher number of biopsy cores and greater detection of clinically insignificant PCa. We therefore developed and evaluated a simple decision support scheme for optimizing prostate biopsy based on multiparametric (mp) MRI assessment. Total 229 patients with suspicion of PCa underwent mpMRI before combined TBx/SBx were retrospectively included. Impacts of MRI characteristics such as Prostate Imaging-Reporting and Data System (PI-RADS) score, lesion size, zonal origination, and location on biopsy performance were evaluated. A clinically available decision support scheme relying on mpMRI assessment was subsequently developed as a triage test to optimize prostate biopsy process. Cost (downgrade, upgrade, and biopsy core)-to-Effectiveness (detection rate) was systemically compared. TBx achieved comparable detection rate to combined TBx/SBx in diagnosis of PCa and clinically significant PCa (csPCa) (PCa, 59% [135/229] vs 60.7% [139/229]; csPCa, 45.9% [105/229] vs 47.2% [108/229]; p-values > 0.05) and outperformed SBx (PCa, 42.4% [97/229]; csPCa, 28.4% [65/229]; p-values < 0.001). Specially, in personalized decision support scheme, TBx accurately detected all PCa (72.5% [74/102]) in PI-RADS 5 and larger (≥1 cm) PI-RADS 3-4 observations, adding SBx to TBx only resulted in 1.4% (1/74) upgrading csPCa. For smaller (<1 cm) PI-RADS 3-4 lesions, combined TBx/SBx resulted in relatively higher detection rate (51.2% [65/127] vs 48.0% [61/127]) and lower upgrading rate (30.6% [15/49] vs 36.7% [18/49]) than TBx. The benefit of SBx added to TBx was largely restricted to smaller PI-RADS score 3-4 lesions. Using our personalized strategy of solo TBx for PI-RADS 5 and larger (≥1 cm) PI-RADS score 3-4 lesions would avoid excess SBx in 44.5% (102/229) of all biopsy-naïve patients without compromising detection rate.