Number Of Biopsy Cores Research Articles

Prostate biopsy approach and complication rates.

Prostate biopsy is the gold standard to confirm prostate cancer. In addition to standard 12-core biopsies, magnetic resonance imaging (MRI)-guided prostate biopsies have recently been introduced to improve the detection of clinically significant prostate cancer. The present study aimed to compare the complications after standard transrectal ultrasound-guided and standard plus targeted (MRI-guided) prostate biopsies, to study the impact of the number of biopsy cores on complication rates, and to compare complication rates after transrectal ultrasound-guided prostate biopsies with those following transperineal prostate biopsies from the literature. A prospective study was performed, which included 135 patients who underwent transrectal ultrasound-guided prostate biopsies between April 1 and June 30, 2022, at the Urology Department of the University Hospital of Pointe à Pitre (Pointe à Pitre, Guadeloupe). A total of 51 patients were excluded because of missing information concerning their post-biopsy surveillance. The median age at the time of biopsy was 69 years, median prostate-specific antigen value was 8.9 ng/ml, median prostate volume was 57.5 ml, and median number of cores was 15. A total of 35 of the 84 included patients (41.7%) had a standard biopsy only and 49 (58.3%) had targeted (MRI-guided) plus standard biopsies. A total of 53 patients (63.1%) experienced early side effects, whereas only 24 patients (28.6%) experienced late side effects. Three patients (3.6%) required hospitalization for post-biopsy complications. Early side effects, especially hematuria and hematospermia, occurred significantly more frequently in the targeted plus standard group, with more cores taken, with no significant difference concerning late side effects or infectious complications between the standard and standard plus targeted groups. The admission rate for sepsis after transperineal biopsy has been reported to vary between 0 and 1%, whereas the present study had an admission rate of 2.29% using the transrectal approach. Further studies are required to analyze the complications requiring hospitalization after transrectal and transperineal biopsies.

MRI lesion size is more important than the number of positive biopsy cores in predicting adverse features and recurrence after radical prostatectomy: implications for active surveillance criteria in intermediate-risk patients.

To determine associations between prostate cancer (PCa) tumor burden measured on biopsy or multiparametric magnetic resonance imaging (mpMRI) and outcomes in intermediate-risk (IR) International Society of Urological Pathology (ISUP) grade 2 men managed with primary radical prostatectomy (RP). This retrospective, multicenter study was conducted in eight referral centers. The cohort included IR PCa patients who had ISUP 2 at biopsy. We defined biopsy tumor burden as low/high based on the absence/presence of more than 25% positive cores. Tumor burden on imaging was defined as low/high based on maximum lesion diameter, <15 mm and ≥15 mm at mpMRI, respectively. The histological endpoint of the study was adverse features at RP, defined as ≥pT3a stage and/or lymph node invasion and/or ISUP ≥3 at final pathology. The clinical endpoint was biochemical recurrence (BCR) after RP. A total of 698 IR patients was included, of whom 335 (48%) had adverse features. In multivariate logistic regression analysis, there was no statistical association between tumor burden at biopsy and adverse features (p = 0.7). Tumor size ≥15 mm at mpMRI was significantly associated with adverse pathology (OR 1.65, 95%CI 1.14-2.39; p = 0.01). No significant association was observed between tumor burden at biopsy and BCR (p = 0.4). Tumor size ≥15 mm at mpMRI was significantly associated with BCR (HR 1.96, 95% CI 1.01-3.80; p = 0.04). Our data support extending the inclusion criteria to ISUP 2 men with >25% positive cores, provided they have a low tumor size at mpMRI (<15 mm). Prospective studies should be performed to validate these findings.

Grade Group accuracy is improved by extensive prostate biopsy sampling, but unrelated to prostatectomy specimen sampling or use of immunohistochemistry.

Assessing the accurate Grade Group of a prostate needle biopsy specimen is essential for choosing the adequate therapeutic modality for prostate cancer patients. However, it is well-known that biopsy Grade Group tends to up- or downgrade significantly at radical prostatectomy. We aimed to investigate the correlation between accuracy and biopsy core number, performed immunohistochemical staining (IHC) or prostatectomy specimen sampling, with the latest also being correlated with higher detection rates of adverse pathological features, e.g., positive surgical margins, higher pathological stage or presence of perineural invasion (PnI status). The study cohort consisted of 315 consecutive patients diagnosed with prostate adenocarcinoma via transrectal ultrasound-guided needle biopsy who later underwent radical prostatectomy. We grouped and compared patients based on Grade Group accuracy, presence of IHC on biopsy, margin status, pathological stage, and PnI status. Inter-observer reproducibility was also calculated. Statistical analyzes included ANOVA, Tukey's multiple comparisons post hoc test, Chi-squared test, and Fleiss kappa statistics. Undergraded cases harboured a significantly lower number of biopsy cores (p < 0.05), than accurately graded cases. Using IHC did not affect grading accuracy significantly, nor did the number of slides from prostatectomy specimens. The mean number of slides was virtually identical when margin status, pathological stage and PnI status of prostatectomy specimens were compared. Inter-observer reproducibility at our institute was calculated as fair (overall kappa = 0.29). Grade Group accuracy is significantly improved by obtaining more cores at biopsy but is unrelated to performed IHC. The extent of sampling prostatectomy specimens, however, did not affect accuracy and failed to significantly improve detection of adverse pathological features.

Comparing 12-core and 20-core biopsy for prostate cancer diagnosis with transperineal MR/US fusion biopsy: assessing the effective number of systemic cores using propensity score matching.

For transperineal (TP) prostate biopsy, target biopsy for visible lesions on MRI is important, but there is no consensus of the number of systemic biopsy cores. Our study aimed to confirm the diagnostic efficiency of 20-core systemic biopsy by comparison with 12-core using propensity score matching (PSM). The 494 patients conducted the naive TP biopsy were retrospectively analyzed. There were 293 patients with 12-core biopsy and 201 patients with 20-core biopsy. PSM was performed for minimizing confounding variables, and the established effects' value was analyzed for 'index-positive or negative' clinically significant prostate cancer (csPCa) (Index means PIRADS Score ≥ 3 on multiparametric prostate MRI). At 12-core biopsy, there were 126 cases of prostate cancer (43.0%), and 97 cases of csPCa (33.1%). At 20-core biopsy, there were 91 cases (45.3%) and 63 cases (31.3%). After propensity score matching, for index-negative csPCa, the estimated odds ratio was 4.03 (95% CI 1.35-12.09, p value 0.0128), and for index-positive csPCa, the estimated odds ratio was 0.98 (95% CI 0.63-1.52, p value 0.9308). The 20-core biopsy did not show a higher detection rate for csPCa in comparison with the 12-core biopsy. However, when MRI did not show a suspicious lesion, 20-core biopsy showed higher odd ratio in comparison with 12-core biopsy. Therefore, if there is a suspicious lesion in MRI, 20-core biopsy is excessive and 12-core biopsy is sufficient. Whereas if there is no suspicious lesion in MRI, it is better to proceed with 20-core biopsy.

Factors Associated with Glomerular Yield in Percutaneous Kidney Biopsy.

Percutaneous kidney biopsy is essential for diagnosing various kidney diseases. However, insufficient glomerular yield leads to misdiagnosis, a critical problem. We retrospectively investigated the risk of insufficient glomerular yield in percutaneous kidney biopsies. We included 236 patients who underwent percutaneous kidney biopsies between April 2017 and September 2020. We retrospectively analyzed the relationship between glomerular yield and patient characteristics. After the biopsy, 31 patients produced insufficient glomerular yields (cases with yielded glomeruli <10). Glomerular yield correlated negatively with hypertension (β = -0.13, p = 0.04), and positively with glomerular density (β = 0.59, p < 0.0001) and the volume of the biopsy core (number of punctures, number of biopsy cores, total length of biopsy core, length of core collected by one puncture, and cortical length). Patients yielding <10 glomeruli had lower glomerular densities (14.4 ± 1.6 vs. 22.9 ± 0.6/cm; p < 0.0001). These results suggest that glomerular density is crucial to glomerular yield. Furthermore, glomerular density was negatively correlated with hypertension, diabetes, and age. Hypertension was independently associated with low glomerular density (β = -0.16, p = 0.02). Thus, the glomerular yield was associated with glomerular density and biopsy core length, and hypertension might be related to glomerular yield via low glomerular density.

PD15-06 SYSTEMATIC PROSTATE BIOPSY WITH INSUFFICIENT BIOPSY CORE NUMBER AT DIAGNOSIS LEADS PSA FAILURE AFTER BRACHYTHERAPY AS MONOTHERAPY FOR CLINICAL STAGE T1C PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023PD15-06 SYSTEMATIC PROSTATE BIOPSY WITH INSUFFICIENT BIOPSY CORE NUMBER AT DIAGNOSIS LEADS PSA FAILURE AFTER BRACHYTHERAPY AS MONOTHERAPY FOR CLINICAL STAGE T1C PROSTATE CANCER Yu Ozawa, Sunao Nohara, Ken Nakamura, Seiya Hattori, Yasuto Yagi, Toru Nishiyama, Atsunori Yorozu, Tetsuo Monma, and Shiro Saito Yu OzawaYu Ozawa More articles by this author , Sunao NoharaSunao Nohara More articles by this author , Ken NakamuraKen Nakamura More articles by this author , Seiya HattoriSeiya Hattori More articles by this author , Yasuto YagiYasuto Yagi More articles by this author , Toru NishiyamaToru Nishiyama More articles by this author , Atsunori YorozuAtsunori Yorozu More articles by this author , Tetsuo MonmaTetsuo Monma More articles by this author , and Shiro SaitoShiro Saito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003262.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the American Urological Association (AUA) guideline, systematic 10–12-core biopsy is optimal for detecting clinical stage T1c (cT1c) prostate cancer (PCA) and also for obtaining higher pathological concordance. Smaller number of prostate biopsy (PB) cores can underestimate pathological characteristics of PCA. This study reviews association between number of biopsy cores at diagnosis and clinical outcomes after low dose rate permanent seed implantation brachytherapy with iodine-125 (LDR) monotherapy. METHODS: This single-institution retrospective study included 542 cT1c PCA with Gleason score 3+3=6 or 3+4=7 treated between September 2003 and September 2014 with LDR monotherapy without hormonal therapy. Local extent of disease was evaluated by digital rectal examination and pelvic MRI. All specimens of ultrasound guided trans-rectal or trans-perineal systematic PB were reviewed by urological pathologists in our institute. We statistically analyzed with Kaplan-Meier and compared rate of biochemical-recurrence (BCR)-free survival, using the Phoenix definition, between adequate (≥10 biopsy cores, N=397) and inadequate (≤9 biopsy cores, N=144) biopsy groups. Possible risk factors for BCR, such as PSA, Gleason score, biopsy core number and positive biopsy core rate, were analyzed. RESULTS: The median age was 66 (38–87) years old and median follow up period was 10.6 (1.0–18.5) years. The median number of biopsy cores was 12 (4–46). In the adequate biopsy group, more patients had Gleason score 3+4=7 (31% vs. 15%, p<0.01). The 5- and 10-year rates of BCR-free survival rates in the adequate biopsy group were 98.7% and 96.9%, respectively, while those in the inadequate biopsy group were 98.6% and 95.6%, respectively. BCR-free survival rate was significantly higher than in the inadequate biopsy group (p <0.05). In multivariate analysis, biopsy core number ≥10 (Hazard ratio; HR 2.58, p<0.02) and Gleason score 3+4=7 (HR 3.26, p<0.01) were the significant factors for BCR. CONCLUSIONS: Systematic PB with sufficient core number greater than 9 leads to lower BCR in LDR monotherapy. Number of biopsy cores on PB might be an important factor for treatment outcomes. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e420 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu Ozawa More articles by this author Sunao Nohara More articles by this author Ken Nakamura More articles by this author Seiya Hattori More articles by this author Yasuto Yagi More articles by this author Toru Nishiyama More articles by this author Atsunori Yorozu More articles by this author Tetsuo Monma More articles by this author Shiro Saito More articles by this author Expand All Advertisement PDF downloadLoading ...

MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE Daniel Nemirovsky, Zoe Blake, Jacob Enders, Alexander Kenigsberg, Neil Mendrihatta, Michael Rothberg, Michael Daneshvar, Lindsey Hazen, Charisse Garcia, Sheng Xu, Baris Turkbey, Bradford Wood, Peter Pinto, and Sandeep Gurram Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Jacob EndersJacob Enders More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Lindsey HazenLindsey Hazen More articles by this author , Charisse GarciaCharisse Garcia More articles by this author , Sheng XuSheng Xu More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter PintoPeter Pinto More articles by this author , and Sandeep GurramSandeep Gurram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monitoring MRI-invisible prostate cancer remains a challenge for patients on active surveillance (AS) due to an inability to reliably re-biopsy tumors without an associated lesion on MRI. In this study, we sought to describe our experience using a prostate image-fusion platform in tracking MRI-invisible lesions in patients on AS, as well as to determine differences in cancer detection and upgrading rates between systematic, MRI-targeted, and tracked biopsies. METHODS: A prospectively maintained AS database was queried for patients with ≥1 tracked prostate biopsy session. Needle trajectories of all biopsy cores were saved using the UroNav™ (Philips) platform. Patients underwent MRI/US guided biopsies of systematic and MRI-targeted lesions via transperineal or transrectal approaches. Tracked biopsy was defined as a repeat MRI/US fusion-guided biopsy which re-targeted regions corresponding to previously positive systematic cores not associated with MRI visible lesions. Gleason grade was compared between initial and subsequent biopsy sessions for all three biopsy modalities: systematic, MRI-targeted, and tracked. RESULTS: Between 2009-2022, 271 patients on AS with ≥1 tracked biopsy sessions were identified. 101/271 (37.3%) had two tracked biopsy sessions and 31/271 (11.4%) had three. The median time from initial to subsequent biopsy session was 19 months (IQR: 13-29). Among 271 patients, there were 83 upgrading events captured by the three modalities on first repeat biopsy (Table 1). On first repeat biopsy, 31/83 (37.3%) upgrading events were identified by tracking, with 11/83 (13.3%) identified only on tracking biopsy. Of the 110 total upgrading events between the three repeat tracked biopsy sessions, 41/110 (37.3%) were captured on tracking, with 16/110 (14.5%) discovered solely by tracking. The median number of biopsy cores for systematic, MRI-targeted, and tracked approaches were 12, 4 (IQR: 2-4), and 2 (IQR: 2-4), respectively. CONCLUSIONS: In this series, a significant portion of upgrading events for patients on AS were uniquely identified on tracked biopsy and would have otherwise been missed on repeat systematic and MRI-targeted biopsy. Notably, given the low number of additional biopsy cores required for tracking, this approach may be an appropriate and low-risk supplement to standard AS protocols. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e527 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Jacob Enders More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Michael Rothberg More articles by this author Michael Daneshvar More articles by this author Lindsey Hazen More articles by this author Charisse Garcia More articles by this author Sheng Xu More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Sandeep Gurram More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-06 WHAT IS THE IDEAL NUMBER OF CORES TO COLLECT PER REGION OF INTEREST DURING TARGETED PROSTATE BIOPSY?

You have accessJournal of UrologyCME1 Apr 2023PD38-06 WHAT IS THE IDEAL NUMBER OF CORES TO COLLECT PER REGION OF INTEREST DURING TARGETED PROSTATE BIOPSY? Casey Brodsky, Ji Qi, Kathryn Marchetti, and John Wei Casey BrodskyCasey Brodsky More articles by this author , Ji QiJi Qi More articles by this author , Kathryn MarchettiKathryn Marchetti More articles by this author , and John WeiJohn Wei More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past decade, magnetic resonance imaging (MRI)-guided targeted prostate biopsy has been gaining favor over 12-core systematic biopsy for more accurate detection of clinically significant prostate cancers; however, no guidelines exist regarding the optimal number of biopsy cores that should be taken per region of interest (ROI) identified on MRI. An ideal number of cores balances maximizing cancer detection while minimizing patient discomfort, procedure time, and infection risk. In this project, we analyze the prostate cancer detection rate depending on core number for a large patient cohort. METHODS: Patients receiving targeted prostate cancer biopsy at the University of Michigan between January 2017 and June 2022 were identified. For each biopsy, 12 systematic cores were taken, as well as 4 cores per ROI. Statistical simulation was performed in SAS, using 500 iterations randomizing the order of cores taken, to assess cancer detection rate (CDR) and clinically significant cancer detection rate (CSCDR, defined as Gleason grade group ≥2) if 1, 2, or 3 versus 4 cores were taken per ROI. Chi-square tests were used to compare CDR and CSCDR between different scenarios. RESULTS: We identified 1022 patients, with 1095 total ROIs biopsied. Median age at time of biopsy was 65 (IQR 60-71), and median pre-biopsy PSA was 6.7 ng/mL (IQR 4.9-9.5). On systematic 12-core biopsy, CDR and CSCDR were 60% and 31%, respectively. On targeted biopsy considering all 4 cores, CDR and CSCDR were 59% and 39%, respectively. Combined biopsy considering systematic 12-core plus 4-core targeted biopsy showed CDR and CSCDR of 70% and 44%, respectively. Compared to taking 4 cores per ROI, taking fewer than 4 cores resulted in a decrease in both CDR and CSCDR, with statistically significant decreases seen for 1 and 2 versus 4 cores (Figure 1). This effect is mitigated when both targeted and systematic biopsy were combined. CONCLUSIONS: These analyses indicate that relative to 4 cores per ROI, cancer detection was inferior when only 1 or 2 cores are taken, but that 3 cores was not clinically nor statistically different than 4 cores. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e995 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Casey Brodsky More articles by this author Ji Qi More articles by this author Kathryn Marchetti More articles by this author John Wei More articles by this author Expand All Advertisement PDF downloadLoading ...

Limited Relevance of the Very Low Risk Prostate Cancer Classification in the Modern Era: Results from a Large Institutional Active Surveillance Cohort

Although the American Urological Association recently dropped the very low-risk (VLR) subcategory for low-risk prostate cancer (PCa) and the European Association of Urology does not substratify low-risk PCa, the National Comprehensive Cancer Network (NCCN) guidelines still maintain this stratum, which is based on the number of positive biopsy cores, tumor extent in each core, and prostate-specific antigen density. This subdivision may be less applicable in the modern era in which imaging-targeted prostate biopsies are common practice. In our large institutional active surveillance cohort of patients diagnosed from 2000 to 2020 (n = 1276), the number of patients meeting NCCN VLR criteria decreased significantly in recent years, with no patient meeting VLR criteria after 2018. By contrast, the multivariable Cancer of the Prostate Risk Assessment (CAPRA) score effectively substratified patients over the same period and was predictive of upgrading on repeat biopsy to Gleason grade group ≥2 on multivariable Cox proportional-hazards regression modeling (hazard ratio 1.21, 95% confidence interval 1.05–1.39; p < 0.01), independent of age, genomic test results, and magnetic resonance imaging findings. These findings suggest that the NCCN VLR criteria are less applicable in the targeted biopsy era, and that the CAPRA score or similar instruments are better contemporary risk stratification tools for men on active surveillance. Patient summaryWe investigated whether the National Comprehensive Cancer Network classification of very low risk (VLR) for prostate cancer is relevant in the modern era. We found that in a large group of patients on active surveillance, no man diagnosed after 2018 satisfied the VLR criteria. However, the Cancer of the Prostate Risk Assessment (CAPRA) score discriminated patients by cancer risk at diagnosis and was predictive of outcomes on active surveillance, and thus may be a more relevant classification scheme in the modern era.

Factors impacting on sexual function among men on active surveillance for prostate cancer.

Active surveillance (AS) aims to reduce overtreatment and minimize the negative side effects of radical therapies (i.e., prostatectomy or radiotherapy) while preserving quality of life. However, a substantial proportion of men can experience a decline in sexual function during AS follow-up. The aim of this study was to identify predictors of declining sexual function among men on AS. Men enrolled from 2008 to 2018 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry-a prospective clinical registry-were studied. Sexual function outcomes were measured using expanded prostate cancer index composite (EPIC-26) at baseline and 12-months postdiagnosis. Multivariable regression models adjusted for baseline score and other sociodemographic and clinical factors were applied to identify predictors of sexual function score at 12-months. A total of 554 men were included. Variables that showed significant association with decline in sexual function score at 12-months were: having two or more biopsies after diagnosis (mean change score (MCS): -16.3, p < 0.001) compared with no biopsy, higher number of positive biopsy cores (MCS: -1.6, p = 0.004), being in older age category (above 70 vs. below 60: MCS: -16.7, p < 0.001; 65-70 vs. below 60: MCS: -9.7, p = 0.024), having had depression (MCS: -9.0, p = 0.020), and impaired physical function (MCS: -10.0, p = 0.031). Greater socioeconomic advantage (highest vs. lowest quintile: MCS: 15.7, p = 0.022) and year of diagnosis (MCS: 2.6 for every year, p < 0.001) were positively associated with 12-months sexual function score. Neither biopsy type, biopsy timing nor PSA velocity were associated with declines in sexual function. Our findings suggest that multiple factors affected sexual function during AS. Interventions towardreducing the number of biopsies through less invasive monitory approaches, screening for physical and mental well-being, and targeted emotional support and counseling services may be helpful for men on AS.

Limited relevance of the “very low risk” prostate cancer classification in the modern era: Results from a large institutional active surveillance cohort.

381 Background: Although the American Urological Association recently dropped the “very low risk” (VLR) category for prostate cancer (PCa), the National Comprehensive Cancer Network (NCCN) guidelines still maintain this stratum based on number of positive biopsy cores, tumor extent in each core, and PSA density. This subdivision may be outdated in the modern era in which targeted prostate biopsies are common practice. We identified the proportion of VLR patients at our institution to determine whether an alternative classification may be more appropriate for risk-stratification in the modern era. Methods: Participants were diagnosed from 2000-2019 with cT1-2N0/xM0/x PCa, PSA &lt;20ng/ml, biopsy Gleason grade group (GG) 1-2, and initially managed with AS. VLR PCa was defined as &lt;3 positive cores, ≤50% cancer per core, and PSA density &lt;0.15. UCSF-CAPRA score was calculated for each patient. The primary outcome was major upgrade (≥GG3) on subsequent biopsy. Multivariable Cox proportional hazards regression models were used to calculate associations between CAPRA score and risk of major upgrade, adjusting for age, genomic testing, and prostate MRI finding. Results: Of 1554 patients initially managed with AS, 364 (23%) met NCCN VLR criteria. 49 (3%), 781 (50%), 505 (33%), and 219 (14%) patients had CAPRA scores of 0, 1, 2, and 3, respectively. Proportion of patients deemed VLR decreased over time; among 84 patients initially managed with AS during or after 2018, only one patient (1%) met VLR criteria in 2018, while the stratification by CAPRA demonstrated that 21 (25%), 25 (30%), and 38 (45%) patients had CAPRA scores of 1, 2, and 3, respectively, over the same period. CAPRA score was significantly associated with major upgrade on biopsy on multivariable Cox proportional hazards regression modeling independent of age, genomic testing, and MRI finding (HR 1.46, 95%CI 1.22-1.74, p&lt;0.01). Conclusions: The relevance of VLR PCa in the modern targeted biopsy era has diminished, with no cases meeting VLR criteria in a large AS cohort after 2018. CAPRA score is an option for a more contemporary risk stratification tool for men on AS.

Adverse Pathology after Radical Prostatectomy of Patients Eligible for Active Surveillance-A Summary 7 Years after Introducing mpMRI-Guided Biopsy in a Real-World Setting.

Over the last decade, active surveillance (AS) of low-risk prostate cancer has been increasing. The mpMRI fusion-guided biopsy of the prostate (FBx) is considered to be the gold standard in preoperative risk stratification. However, the role of FBx remains unclear in terms of risk stratification of low-risk prostate cancer outside high-volume centers. The aim of this study was to evaluate adverse pathology after radical prostatectomy (RP) in a real-world setting, focusing on patients diagnosed with Gleason score (GS) 6 prostate cancer (PCa) and eligible for AS by FBx. Between March 2015 and March 2022, 1297 patients underwent FBx at the Department of Urology, Ludwig-Maximilians-University of Munich, Germany. MpMRI for FBx was performed by 111 different radiology centers. FBx was performed by 14 urologists from our department with different levels of experience. In total, 997/1297 (77%) patients were diagnosed with prostate cancer; 492/997 (49%) of these patients decided to undergo RP in our clinic and were retrospectively included. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and histopathological parameters associated with adverse pathology comparing FBx and RP specimens. To compare FBx and systematic randomized biopsies performed in our clinic before introducing FBx (SBx, n = 2309), we performed a propensity score matching on a 1:1 ratio, adjusting for age, number of positive biopsy cores, and initial PSA (iPSA). A total of 492 patients undergoing FBx or SBx was matched. In total, 55% of patients diagnosed with GS 6 by FBx were upgraded to clinically significant PCa (defined as GS ≥ 7a) after RP, compared to 52% of patients diagnosed by SBx (p = 0.76). A time delay between FBx and RP was identified as the only correlate associated with upgrading. A total of 5.9% of all FBx patients and 6.1% of all SBx patients would have been eligible for AS (p > 0.99) but decided to undergo RP. The positive predictive value of AS eligibility (diagnosis of low-risk PCa after biopsy and after RP) was 17% for FBx and 6.7% for SBx (p = 0.39). In this study, we show, in a real-world setting, that introducing FBx did not lead to significant change in ratio of adverse pathology for low-risk PCa patients after RP compared to SBx.

Detection of intraductal carcinoma in prostate cancer patients with small tumor volume.

The purpose of this study was to investigate intraductal carcinoma of the prostate (intraductal carcinoma) and significant cancer (SC) in patients with small tumor volume (<0.5 cm3 ) in prostatectomy specimens. Data from 639 patients undergoing radical prostatectomy between April 2006 and December 2017 at Chiba University Hospital and 2 affiliated institutions were retrospectively reviewed. Tumor volume in prostatectomy specimens was measured, and with a tumor volume of less than 0.5 cm3 , the presence of intraductal carcinoma and SC was examined. SC was defined as one that did not meet the definition of pathological insignificant cancer (organ-confined cancer, Grade Group 1, tumor volume < 0.5 cm3 ). The number of patients who met four active surveillance (AS) protocols was also examined. A total of 83 patients with tumor volume < 0.5 cm3 were identified in this study population (SC: 43 patients [52%], intraductal carcinoma: 5 patients [6%]). The median follow-up was 34.6 months (range: 18-57 months). Four (5%) developed biochemical recurrence. The number of positive biopsy cores ≥ 2 was an independent predictor of SC in patients with tumor volume < 0.5 cm3 (hazard ratio: 4.39; 95% confidence interval: 1.67-11.56; p = 0.003). In tumor volume < 0.5 cm3 , tumor volume was significantly correlated with the International Society of Urological Pathology Grade Group (1 vs. 4-5, p = 0.002) and the presence of intraductal carcinoma (p = 0.004). In intraductal carcinoma-positive cases, four of five patients (80%) had the predictor of SC, which was two or more positive biopsy cores. Of the four AS protocols, the criteria for Prostate Cancer Research International: Active Surveillance were met most frequently in 46 cases (55%) of tumor volume less than 0.5 cm3 if targeted biopsy by magnetic resonance imaging was available. The results of the present study suggest that intraductal carcinoma was present even in cases with small tumor volumes. Grade Group and intraductal carcinoma showed a positive correlation with tumor volume.

Active surveillance in renal transplant patients with prostate cancer: a multicentre analysis

IntroductionDue to medical improvements leading to increased life expectancy after renal transplantation and widened eligibility criteria allowing older patients to be transplanted, incidence of (low-risk) prostate cancer (PCa) is increasing among renal transplant recipients (RTR). It remains to be established whether active surveillance (AS) for PCa represents a safe treatment option in this setting. Therefore, we aim to compare AS discontinuation and oncological outcomes of AS for PCa of RTR vs. non-transplant patients.MethodsMulticentre study including RTR diagnosed with PCa between 2008 and 2018 in whom AS was initiated. A subgroup of non-RTR from the St. Antonius hospital AS cohort was used as a control group. Comparison of RTR vs. non-RTR was performed by 2:1 propensity score matched survival analysis. Outcome measures included tumour progression-free survival, treatment-free survival, metastasis rates, biochemical recurrence rates and overall survival. Patients were matched based on age, year of diagnosis, PSA, biopsy ISUP grade group, relative number of positive biopsy cores and clinical stage.ResultsA total of 628 patients under AS were evaluated, including 17 RTRs and 611 non-RTRs. A total of 13 RTR cases were matched with 24 non-RTR cases. Median overall follow-up for the RTR and non-RTR matched cases was, respectively, 5.1 (IQR 3.2–8.7) years and 5.7 (IQR 4.8–8.1) years. There were no events of metastasis and biochemical recurrence among matched cases. The matched-pair analysis results in a 1-year and 5-year survival of the RTR and non-RTR patients were, respectively, 100 vs. 92%, and 39 vs. 76% for tumour progression, 100 vs. 91% and 59 vs. 76% for treatment-free survival and, respectively, 100 vs. 100% and 88 vs. 100% for overall survival. No significant differences in tumour progression-free survival (p = 0.07) and treatment-free survival were observed (p = 0.3). However, there was a significant difference in overall survival comparing both groups (p = 0.046).ConclusionsAS may be carefully considered in RTR with low-risk PCa. In our preliminary analysis, no major differences were present in AS outcomes between RTR and non-RTR. Overall mortality was significantly higher in the RTR subgroup.

A Comparative Study between Transrectal Ultrasound Guided 6-Core and 12-Core Prostate Biopsy for Detection of Prostate Cancer

Background: Prostate cancer is common in urological practice. Diagnosis of prostate cancer depends on biopsy of the prostate. For the last two decade TRUS guided 6 core (sextant) biopsy is being considered as standard for prostate biopsy. Various studies in different countries showed the drawback of sextant biopsy. The debate remains alive on number of biopsy core which is appropriate for obtaining representative tissue. Moreover, more number of needle biopsy may be associated with more complication. Methods: In this hospital based Quasi experimental study, a total of 50 patients were allocated into two groups by purposive sampling technique where 6 core prostate biopsy in one group and 12 core biopsy in another group. Baseline demographic and clinical data were recorded. Post procedural morbidity &amp; histopathological findings were recorded. All the collected data were compiled. Further Statistical analyses of the results were obtained by using Microsoft Xcel, 2010 and web based computer software - Graph Pad Software, 2017. A probability value (p) of less than 0.05 was considered to indicate statistical significance. Results: The baseline characteristics like age, S.PSA, prostate volume &amp; DRE findings were similar in two groups. Cancer detection rate was not significantly different between the 6 core biopsy group and 12 core biopsy group (48% Vs 60%, p=0.395). Dysuria with difficulty in micturition and hematuria after biopsy significantly more in 12 core biopsy group (24% Vs 44% and 32% Vs 60% respectively). Other post procedural complications like fever, perrectal bleeding was found statistically not significant between two groups Conclusion: Trans rectal ultrasound guided 6 core biopsy is equally effective as Trans rectal ultrasound guided 12 core biopsy for detection of prostate cancer.

Prospective of 18-Core TRUS Biopsy and Detection Rate of Prostate Cancer

Background: A systematic 12-core transrectal ultrasound (TRUS)-guided prostate biopsy is currently recommended for prostate malignancy detection modalities. However, there is limited data about the diagnostic yield of increasing the core number to 18. Objective: To assess the effectiveness of cancer detection and clinical advantages between 12- and 18-core TRUS biopsies. Materials and Methods: The authors conducted a prospective, single-group trial of TRUS biopsies specifically for patients with prostate-specific antigen (PSA) levels between 4.0 and 20.0 ng/mL. Sixty-two consecutive patients were enrolled and received a 12- or an 18-core TRUS biopsy under local anaesthesia. The patients and prostate cancer characteristics, such as serum PSA, free PSA, prostate volume, PSA density, D’Amico risk classification, and Gleason grade group were recorded and analysed. Results: The prostate cancer detection rate using 12 cores for the initial TRUS biopsy was 22.6% (14 patients), while using 18 cores was 24.2% (15 patients). The results were not statistically different (p=0.83). Postoperative complications were two cases of gross haematuria and two case of acute urinary retention, which did not require admission. Infection occurred in two patients and no serious morbidities or mortalities. Conclusion: The present study did not find any significant benefit in increasing the number of biopsy cores from 12 to 18 for the diagnosis of prostate cancer in men with serum PSA levels between 4.0 and 20.0 ng/mL. Keywords: Transrectal prostate biopsy; 12-core; 18-core; Prostate cancer; Cancer detection

Optimizing multiparametric magnetic resonance imaging-targeted biopsy and prostate cancer grading accuracy

To assess the most efficient biopsy method to improve International Society of Urological Pathology (ISUP) grade group accuracy with final pathology of the radical prostatectomy (RP) specimen in the era of magnetic resonance imaging (MRI)-driven pathway. A total of 753 patients diagnosed by transrectal MRI-targeted and systematic biopsies (namely "standard method"), treated by RP, between 2016 and 2021 were evaluated. Biopsy methods included MRI-targeted biopsy, side-specific systematic biopsies relative to index MRI lesion and combination of both. Number of MRI-targeted biopsy cores and positive cores needed per index MRI lesion were assessed. Multivariable analysis was performed to analyze predictive factors of upgrading using MRI targeted and ipsilateral systematic biopsies method. Overall, ISUP grade group accuracy varied among biopsy methods with upgrading rate of 35%, 49%, 27%, and 24% for MRI targeted, systematic, MRI targeted and ipsilateral systematic biopsies and standard methods, respectively (p < 0.001). A minimum of two positive MRI-targeted biopsies cores per index MRI lesion were required when testing MRI targeted and ipsilateral systematic biopsies method to reach equivalent accuracy compared to standard method. Omitting contralateral systematic biopsies spared an average of 5.9 cores per patient. At multivariable analysis, only the number of positive MRI-targeted biopsy cores per index MRI lesion was predictive of upgrading. MRI targeted and ipsilateral systematic biopsies allowed an accurate definition of ISUP grade group and appears to be an interesting alternative when compared with standard method, reducing total number of biopsy cores needed.

The impact of robotic-assisted transperineal biopsy of the prostate on erectile function.

Prostate biopsy represents one of the most frequently performed urologic procedures worldwide and therefore presupposes knowledge on potential effects like on the erectile function, especially in extensive or repeated biopsies. The robotic-assisted biopsy system (Mona Lisa) offers a minimal invasive approach via only two incision points ensuring maximal accuracy combined with protection of the neurovascular bundle of the prostate. Our purpose was to analyse the impact of robotic-assisted transperineal biopsy of the prostate on the erectile function. Our prospective study analyses the outcomes of 210 patients, who had undergone minimal-invasive, transperineal robotic-assisted biopsy of the prostate at the University Hospital Basel from January 2020 to March 2022 and provided sufficient data. Of these, 157 (74.8%) were included in final analysis. Mean (range) age, prostate volume, PSA and IIEF-5 score at baseline were 63.8 years (46.1-83.6), 46.4 ml (9-310), 13.2 ng/ml (0.2-561), and 18.8 points (6-25), respectively. EF before and 1 month after intervention was assessed with the IIEF-5 questionnaire for the whole cohort. No significant change of IIEF-5 was observed for the whole cohort with a mean (± SD) decrease of 0.4 (± 3.1) points. Except for patients > 69 years, subgroup analysis revealed no change of IIEF-5 in statistically significant manner for all subgroups. Number of biopsy cores (< 20 and ≥ 20), previous biopsies and active surveillance showed no significant influence. Our results suggest that the minimally invasive and highly precise robotic technique can spare the erectile function without limiting the extent of biopsy and without compromising diagnostic accuracy.

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.