Occult Prostate Cancer Research Articles

Enhancing surgical outcomes: accurate identification and removal of prostate cancer with B7-H3-targeted NIR-II molecular imaging.

One of the main reasons for prostate cancer (PCa) recurrence is the difficulty in identifying and removing cancerous lesions during surgery. Accurately localizing and excising cancerous tissue remains a significant challenge. The second near-infrared window (NIR-II, 1000-1700nm) fluorescence offers enhanced resolution, a high signal-to-noise ratio, and the potential for deeper tissue penetration. However, this technology is not currently employed for intraoperative imaging of PCa. This study aims to construct a new NIR-II probe targeting B7-H3 (AbB7-H3-800CW) for accurate intraoperative identification and resection of PCa. Based on the differential expression of B7-H3 in PCa, we designed a novel imaging probe to accurately identify and guide the resection of preclinical PCa models and ex vivo human PCa tissues using NIR-II fluorescence imaging technology. Analyzing tissue samples from 60 clinical cases of PCa, along with benign prostatic hyperplasia and normal prostate tissue from 22 cases, we observed a significant difference in B7-H3 protein expression levels (P < 0.001). Subcutaneous and orthotopic mouse models of PCa were imaged using NIR-II fluorescence after AbB7-H3-800CW injection, showing promising results with successful tumor targeting and high-contrast images achieved within 24-48h post-injection. The imaging also enabled the detection of occult PCa lesions approximately 1mm in diameter. In addition, imaging analysis of human PCa and adjacent tissues using AbB7-H3-800CW incubation revealed that cancer tissues exhibited a significantly higher fluorescence intensity than adjacent tissues (P < 0.05), which was conducive to the evaluation of tumor resection margin in vitro. The findings revealed that B7-H3 was a compelling imaging target for PCa. The AbB7-H3-800CW molecular imaging probe is capable of accurately identifying PCa lesions and guiding their removal. This approach can potentially reduce the rate of surgical margins under NIR-II fluorescence guidance.

A Case of Occult Prostate Cancer with Low Serum Prostate-specific Antigen That Was Diagnosed by Lung Biopsy

A Case of Occult Prostate Cancer with Low Serum Prostate-specific Antigen That Was Diagnosed by Lung Biopsy

Evaluation of initial prostate cancer biopsies utilizing 3D open-top light-sheet microscopy for detection of early disease.

Open-top light-sheet (OTLS) microscopy is a technique that allows for high-resolution 3D imaging of tissue specimens and can therefore provide a more detailed assessment of tissue architecture. Given that Gleason grading is based on tissue architecture, we hypothesized that OTLS microscopy would enable us to survey a larger amount of tissue and detect occult prostate cancers in men who had prostate core biopsy specimens initially classified as being benign-appearing who later developed clinically significant prostate cancers. Benign appearing tissue (based on routine pathologic evaluation) from 20 patients who subsequently developed a clinically significant prostate cancer (experimental group) was evaluated with OTLS microscopy and compared to tissue from 20 patients who underwent prostate biopsy and never developed a clinically significant prostate cancer (control group). We compared the incidence of detectable prostate cancer between groups. Baseline clinical characteristics were similar between the experimental and control groups. Three patients (15%) in the control group and one (5%) in the experimental group had suspicious findings on low-resolution OTLS microscopy. Higher resolution OTLS imaging revealed two patients (10%) in the control group had an occult prostate cancer, while no occult cancers were found in the experimental group. In spite of a high pretest probability for the presence of an occult prostate cancer, we did not identify cancer in our experimental group. This may be due to under-sampling at the time of prostate needle biopsy.

Fluorescence in prostate cancer surgery

Prostate cancer is different from many other solid tumours, mainly because of its multifocal growth pattern, which precludes a conservative approach during surgery. 1 Mottet N van den Bergh RCN Briers E et al. EAU-EANM-ESTROESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021; 79: 243-262 Summary Full Text Full Text PDF PubMed Scopus (931) Google Scholar Moreover, even when spread to the locoregional lymph nodes, it cannot always be clearly identified during surgery. This has led to two different surgical management scenarios. For organ-confined disease, the inability to identify the boundaries of the tumour within the gland makes the radical excision of the gland necessary, which has a substantial effect on patients’ postoperative functional outcomes and leading to a not negligible rate of positive surgical margins. 2 Lane JA Donovan JL Davis M et al. Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncol. 2014; 15: 1109-1118 Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar For locally advanced disease involving locoregional lymph nodes, the inability to intraoperatively identify metastatic lymph nodes has limited the role of extended pelvic lymph node dissection to a staging procedure. 3 Lestingi JFP Guglielmetti GB Trinh QD et al. Extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: early oncological outcomes from a randomized phase 3 trial. Eur Urol. 2021; 79: 595-604 Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar First-in-patient study of OTL78 for intraoperative fluorescence imaging of prostate-specific membrane antigen-positive prostate cancer: a single-arm, phase 2a, feasibility trialThis first-in-patient study showed that OTL78 was well tolerated and had the potential to improve prostate cancer detection. Optimal dosing was 0·03 mg/kg, 24 h preoperatively. PSMA-directed fluorescence imaging allowed real-time identification of visually occult prostate cancer and might help to achieve complete oncological resections. Full-Text PDF

First-in-patient study of OTL78 for intraoperative fluorescence imaging of prostate-specific membrane antigen-positive prostate cancer: a single-arm, phase 2a, feasibility trial

Targeted real-time imaging during robot-assisted radical prostatectomy provides information on the localisation and extent of prostate cancer. We assessed the safety and feasibility of the prostate-specific membrane antigen (PSMA)-targeted fluorescent tracer OTL78 in patients with prostate cancer. In this single-arm, phase 2a, feasibility trial with an adaptive design was carried out in The Netherlands Cancer Institute, Netherlands. Male patients aged 18 years or older, with PSMA PET-avid prostate cancer with an International Society of Urological Pathology (ISUP) grade group of 2 or more, who were scheduled to undergo robot-assisted radical prostatectomy with or without extended pelvic lymph node dissection were eligible. All patients had a robot-assisted radical prostatectomy using OTL78. Based on timing and dose, patients received a single intravenous infusion of OTL78 (0·06 mg/kg 1-2 h before surgery [dose cohort 1], 0·03 mg/kg 1-2 h before surgery [dose cohort 2], or 0·03 mg/kg 24 h before surgery [dose cohort 3]). The primary outcomes, assessed in all enrolled patients, were safety and pharmacokinetics of OTL78. This study is completed and is registered in the European Trial Database, 2019-002393-31, and the International Clinical Trials Registry Platform, NL8552, and is completed. Between June 29, 2020, and April 1, 2021, 19 patients were screened for eligibility, 18 of whom were enrolled. The median age was 69 years (IQR 64-70) and median prostate-specific antigen concentration was 15 ng/mL (IQR 9·3-22·0). In 16 (89%) of 18 patients, robot-assisted radical prostatectomy was accompanied by an extended pelvic lymph node dissection. Three serious adverse events occurred in one (6%) patient: an infected lymphocele, a urosepsis, and an intraperitoneal haemorrhage. These adverse events were considered unrelated to the administration of OTL78 or intraoperative fluorescence imaging. No patient died, required a dose reduction, or required discontinuation due to drug-related toxicity. The dose-normalised maximum serum concentration (Cmax/dose) in patients was 84·1 ng/mL/mg for the 0·03 mg/kg dose and 79·6 ng/mL/mg for the 0·06 mg/kg dose, the half-life was 5·1 h for the 0·03 mg/kg dose and 4·7 h for the 0·06 mg/kg dose, the volume of distribution was 22·9 L for the 0·03 mg/kg dose and 19·5 L for the 0·06 mg/kg dose, and the clearance was 3·1 L/h for the 0·03 mg/kg dose and 3·0 L/h for the 0·06 mg/kg dose. This first-in-patient study showed that OTL78 was well tolerated and had the potential to improve prostate cancer detection. Optimal dosing was 0·03 mg/kg, 24 h preoperatively. PSMA-directed fluorescence imaging allowed real-time identification of visually occult prostate cancer and might help to achieve complete oncological resections. On Target Laboratories.

PD41-01 DETECTION OF OCCULT PROSTATE ADENOCARCINOMA USING STEREOTACTIC TRANSPERINEAL BIOPSY FOLLOWING NEGATIVE TRANSRECTAL ULTRASOUND-GUIDED BIOPSIES

You have accessJournal of UrologyCME1 May 2022PD41-01 DETECTION OF OCCULT PROSTATE ADENOCARCINOMA USING STEREOTACTIC TRANSPERINEAL BIOPSY FOLLOWING NEGATIVE TRANSRECTAL ULTRASOUND-GUIDED BIOPSIES Russell Maxwell, Roksana Tech, Manuj Agarwal, and Brian Moran Russell MaxwellRussell Maxwell More articles by this author , Roksana TechRoksana Tech More articles by this author , Manuj AgarwalManuj Agarwal More articles by this author , and Brian MoranBrian Moran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002602.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There remains concern for prostate cancer in men who have a persistently elevated or rising serum PSA despite having a non-diagnostic transrectal ultrasound-guided biopsy (TRUS-B). Stereotactic transperineal prostate biopsy (STPB) may address this challenging clinical dilemma. Using transrectal ultrasound guidance and a transperineal template allows for comprehensive prostatic tissue sampling and lower likelihood of underestimating disease volume and grade. This study sought to determine occult prostate cancer detection rates utilizing STPB in men following negative TRUS-B. METHODS: Consecutive patients at a single institution between 2004 to 2020 who underwent STPB following a non-diagnostic TRUS-B were included. Patients who had primary STPB, non-STPB biopsy, a prior positive biopsy, or no core sampling were excluded. Well-protocolized STPB using prostate brachytherapy clinical setup and systematic comprehensive tissue sampling has been previously described in detail (Moran et al. Urology 2009). Multivariate logistic regression models were constructed to evaluate potential predictors of positive STPB. RESULTS: Out of 3756 patients, 2647 (70%) met final inclusion criteria and were analyzed (median age: 64 years, IQR: 59-69 years). Included patients had at least one prior negative TRUS-B (median 1, IQR: 1-2) before STPB and had median pre-STPB serum PSA levels of 8.1 ng/mL (IQR: 5.7-11.6 ng/mL). Median prostate size and number of cores sampled were 47 cc (IQR: 36-63 cc) and 37 (IQR: 30-44), respectively. STPB detected prostate adenocarcinoma in 956 of the 2647 patients (36%, 95% CI: 34-38%) with a median of 2 cores positive (IQR: 1-3). Of those with positive STPB, pathology findings revealed grade group 1-5 disease rates of 51%, 22%, 14%, 9%, and 4%, respectively. On multivariate analyses, older age (OR 1.79, 95% CI: 1.59-2.01, p <0.001) and higher pre-STPB PSA levels (OR 1.35, 95% CI: 1.19-1.52, p <0.001) were associated with higher odds of obtaining a positive STPB result, while large prostate size (OR 0.38, 95% CI: 0.34-0.44, p <0.001) and higher number of prior negative biopsies (OR 0.89, 95% CI: 0.82-0.97, p=0.011) were associated with lower odds. CONCLUSIONS: STPB can detect a significant number of occult and clinically significant prostate cancer in men with prior negative TRUS-B. This is the largest series to date and further supports the use of STPB to address this difficult clinical dilemma. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e689 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russell Maxwell More articles by this author Roksana Tech More articles by this author Manuj Agarwal More articles by this author Brian Moran More articles by this author Expand All Advertisement PDF DownloadLoading ...

Paraneoplastic Hyperfibrinolysis: Detection of Occult Prostate Cancer with 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography.

Hyperfibrinolysis caused by abnormal over-activation of the fibrinolytic system can be associated with occult cancer. We present an interesting case of a 48-year-old man with paraneoplastic hyperfibrinolysis, where 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) was able to detect occult prostate-specific antigen-negative metastatic prostate cancer as the underlying etiology. This shows that while 18F-FDG PET-CT has overall poor sensitivity for prostate cancer, it can be useful in certain clinical situations.

Pattern of failure in prostate cancer previously treated with radical prostatectomy and post-operative radiotherapy: a secondary analysis of two prospective studies using novel molecular imaging techniques

BackgroundProstate Membrane Specific Antigen (PSMA) positron emission tomography (PET) and multiparametric MRI (mpMRI) have shown high accuracy in identifying recurrent lesions after definitive treatment in prostate cancer (PCa). In this study, we aimed to outline patterns of failure in a group of post-prostatectomy patients who received adjuvant or salvage radiation therapy (PORT) and subsequently experienced biochemical recurrence, using 18F-PSMA PET/CT and mpMRI.MethodsPCa patients with biochemical failure post-prostatectomy, and no evident site of recurrence on conventional imaging, were enrolled on two prospective trials of first and second generation 18F-PSMA PET agents (18F-DCFBC and 18F-DCFPyL) in combination with MRI between October 2014 and December 2018. The primary aim of our study is to characterize these lesions with respect to their location relative to previous PORT field and received dose.ResultsA total of 34 participants underwent 18F-PSMA PET imaging for biochemical recurrence after radical prostatectomy and PORT, with 32/34 found to have 18F-PSMA avid lesions. On 18F-PSMA, 17/32 patients (53.1%) had metastatic disease, 8/32 (25.0%) patients had locoregional recurrences, and 7/32 (21.9%) had local failure in the prostate fossa. On further exploration, we noted 6/7 (86%) of prostate fossa recurrences were in-field and were encompassed by 100% isodose lines, receiving 64.8–72 Gy. One patient had marginal failure encompassed by the 49 Gy isodose.Conclusions18F-PSMA PET imaging demonstrates promise in identifying occult PCa recurrence after PORT. Although distant recurrence was the predominant pattern of failure, in-field recurrence was noted in approximately 1/5th of patients. This should be considered in tailoring radiotherapy practice after prostatectomy.Trial registrationwww.clinicaltrials.gov, NCT02190279 and NCT03181867. Registered July 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02190279 and June 8 2017, https://clinicaltrials.gov/ct2/show/NCT03181867.

Incidental Prostatic Adenocarcinoma in Open Prostatectomy Specimens: An Institutional Experience.

Prostatic diseases cause significant morbidity and mortality in African men. Most Nigerian patients presenting with huge prostate enlargement are availed open prostatectomy to relieve symptoms of prostatism. Some prostates removed for benign enlargement have indolent cancers that are only discovered after histopathological examination. The incidence of these incidental adenocarcinomas of the prostate varies widely. We carried out a 10-year retrospective review of open prostatectomy specimens received in the Department of Pathology, from January 2009 to December 2018. At grossing, a minimum of 6 cassettes were used depending on size, and tissue was taken from representative areas for microscopic examination. The data was analysed for the presence of, and the relationship between, incidental adenocarcinoma of the prostate and clinicopathological parameters in each case using relevant statistical tools in the SPSS version 23. Incidental adenocarcinoma of the prostate was found in 5.7% of 158 open prostatectomy specimens seen during the study period. High-grade prostatic intraepithelial neoplasm (HGPIN) was present in 1.9% of cases. Patients in the 7th and 8th decade accounted for 88.8% of all incidental adenocarcinomas. The mean weight of the excised glands was 89.8g (range10-500g). The weight of the prostate did not predict diagnosis of incidental adenocarcinoma. In-hospital consultation accounted for 66.9% of open prostatectomy samples received in the department but the majority (72.7%) of incidental adenocarcinomas were seen in specimens form external consultations. The tumours were mostly ISUP grade group one tumours. The rate of diagnosis of occult prostate cancer is low with majority of the tumours being well differentiated. Organ weight had no relationship with histological diagnosis. Cases managed outside the teaching hospital were more likely to have incidental prostate cancer.

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: Endorsing organization: European Society of Endocrinology.

Evidence regarding functional hypogonadism, previously referred to as 'late-onset' hypogonadism, has increased substantially during the last 10year. To update the European Academy of Andrology (EAA) guidelines on functional hypogonadism. Expert group of academicians appointed by the EAA generated a series of consensus recommendations according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. The diagnosis of functional hypogonadism should be based on both the presence of clinical symptoms supported by repeatedly low morning fasting serum total testosterone (T) measured with a well-validated assay, after exclusion of organic causes of hypogonadism. Lifestyle changes and weight reduction should be the first approach in all overweight and obese men. Whenever possible, withdrawal/modification of drugs potentially interfering with T production should be advised. Testosterone replacement therapy (TRT) is contraindicated in men with untreated prostate or breast cancer, as well as severe heart failure. Severe low urinary tract symptoms and haematocrit >48%-50% represent relative contraindications for TRT. Prostate-specific antigen and digital rectal examination of the prostate should be undertaken in men >40years of age before initiating TRT to exclude occult prostate cancer. Transdermal T should be preferred for initiation of TRT, whereas gonadotrophin therapy is only recommended when fertility is desired in men with secondary hypogonadism. TRT is able to improve sexual function in hypogonadal men. Other potential positive outcomes of TRT remain uncertain and controversial. TRT can reliably improve global sexual function in men with hypogonadism in the short term. Long-term clinical benefits, and safety of TRT in functional hypogonadism, remain to be fully documented. Clinicians should therefore explicitly discuss the uncertainties and benefits of TRT and engage them in shared management decision-making.

Localising occult prostate cancer metastasis with advanced imaging techniques (LOCATE trial): a prospective cohort, observational diagnostic accuracy trial investigating whole\u2013body magnetic resonance imaging in radio-recurrent prostate cancer

BackgroundAccurate whole-body staging following biochemical relapse in prostate cancer is vital in determining the optimum disease management. Current imaging guidelines recommend various imaging platforms such as computed tomography (CT), Technetium 99 m (99mTc) bone scan and 18F-choline and recently 68Ga-PSMA positron emission tomography (PET) for the evaluation of the extent of disease. Such approach requires multiple hospital attendances and can be time and resource intensive. Recently, whole-body magnetic resonance imaging (WB-MRI) has been used in a single visit scanning session for several malignancies, including prostate cancer, with promising results, providing similar accuracy compared to the combined conventional imaging techniques. The LOCATE trial aims to investigate the application of WB-MRI for re-staging of patients with biochemical relapse (BCR) following external beam radiotherapy and brachytherapy in patients with prostate cancer.Methods/designThe LOCATE trial is a prospective cohort, multi-centre, non-randomised, diagnostic accuracy study comparing WB-MRI and conventional imaging. Eligible patients will undergo WB-MRI in addition to conventional imaging investigations at the time of BCR and will be asked to attend a second WB-MRI exam, 12-months following the initial scan. WB-MRI results will be compared to an enhanced reference standard comprising all the initial, follow-up imaging and non-imaging investigations. The diagnostic performance (sensitivity and specificity analysis) of WB-MRI for re-staging of BCR will be investigated against the enhanced reference standard on a per-patient basis. An economic analysis of WB-MRI compared to conventional imaging pathways will be performed to inform the cost-effectiveness of the WB-MRI imaging pathway. Additionally, an exploratory sub-study will be performed on blood samples and exosome-derived human epidermal growth factor receptor (HER) dimer measurements will be taken to investigate its significance in this cohort.DiscussionThe LOCATE trial will compare WB-MRI versus the conventional imaging pathway including its cost-effectiveness, therefore informing the most accurate and efficient imaging pathway.Trial registrationLOCATE trial was registered on ClinicalTrial.gov on 18th of October 2016 with registration reference number NCT02935816.

37-Year-Old Man With Fatigue and Erectile Dysfunction

37-Year-Old Man With Fatigue and Erectile Dysfunction

MP24-01 MULTIPARAMETRIC MRI FINDINGS IN PATIENTS WITH NEGATIVE CONFIRM MDX TISSUE TESTING

INTRODUCTION AND OBJECTIVES:DNA promoter hypermethylation (Confirm MDX) may pick up occult prostate cancer due to a field defect the tumor exerts on normal tissue. The reported negative predictive ...

Clinically occult prostate cancer cases may distort the effect of testosterone replacement therapy on risk of PCa.

Although prostate cancer (PCa) screening is conducted before testosterone replacement therapy (TRT), clinically occult PCa cases may exist. To evaluate whether the possible inclusion of occult PCa cases distorts the effect of TRT on risk of PCa, we followed 776 hypogonadal males (TRT = 400, non-TRT = 376) from a urology center in Germany from 2004 to 2016, with a mean follow-up period of 7years. We assumed occult cases might take 1-2years (latency period) to become clinically detectable after receiving TRT. We selected several latency periods (12/18/24months) and compared the risk of PCa in the TRT and non-TRT group over the latency period, from the end of latency period till the end of follow-up, and over the whole follow-up time. Overall, 26 PCa cases occurred in the non-TRT group vs 9 cases in the TRT group. Within 18months of follow-up, 9 cases occurred in the TRT group vs 0 cases in the non-TRT group; from the end of 18months till the end of follow-up, 26 cases occurred in the non-TRT group vs 0 cases in the TRT group. The adjusted table showed seemingly adverse effects of TRT on PCa development within 18months (p = 0.0301) and beneficial effects from the end of 18months till the end of follow-up (p = 0.0069). Similar patterns were observed for 12 or 24months as the latency period. TRT may make occult PCa cases detectable within early phase of treatment and present a beneficial effect in the long run. Future longitudinal studies are needed to confirm findings from our exploratory analyses.

First Postprostatectomy Ultrasensitive Prostate-specific Antigen Predicts Survival in Patients with High-risk Prostate Cancer Pathology

BackgroundUltrasensitive prostate-specific antigen (uPSA) has untapped potential for optimizing management following radical prostatectomy (RP) in terms of facilitating early salvage, minimizing overtreatment, and identifying those at risk of occult systemic disease. ObjectiveTo test first postoperative uPSA for prediction of outcome in patients with adverse pathology after RP. Design, setting, and participantsPatients with extraprostatic extension and/or a positive margin who did not receive immediate adjuvant therapy. Outcome measurements and statistical analysisFirst uPSA was measured at 3 mo after RP. The study endpoints were biochemical relapse (BCR), defined as PSA ≥0.2ng/ml, bone metastasis–free survival (BMFS), prostate cancer–specific survival (PCSS), overall survival (OS), and salvage radiation therapy (SRT) success. Outcome results were compared using the Kaplan-Meier method and multivariate analysis (MVA). Results and limitationsThe cohort consisted of 269 RP patients from 1991–2015 with median follow-up of 77 mo. Sensitivity analysis identified first postoperative uPSA of ≥0.03ng/ml as the optimal threshold for predicting BCR. First postoperative uPSA ≥0.03 versus <0.03ng/ml was associated with worse 5-yr BCR (86%, 95% confidence interval [CI] 71–93% vs 39%, 95% CI 25–51%; p<0.00001), 10-yr BMFS (75%, 95% CI 62–92% vs 95%, 95% CI 88–100%; p=0.0001), 10-yr PCSS (84%, 95% CI 73–96% vs 100%, 95% CI 100–100%; p=0.005), and 10-yr OS (81%, 95% CI 70–93% vs 98%, 95% CI 94–100%; p=0.009). On MVA, first postoperative uPSA ≥0.03ng/ml was an independent predictor of BCR (hazard ratio [HR] 9.4, 95% CI 5.8–15.4; p<0.00001) and the only predictor for BMFS (HR 9.7, 95% CI 2.1–44.6; p=0.0034), PCSS (HR 13.5, 95% CI 1.7–107.9; p=0.014), and OS (HR 5.0, 95% CI 1.4–18.3; p=0.014). Following SRT, first postoperative uPSA ≥0.03ng/ml independently predicted worse BMFS (HR 5.9, 95% CI 1.3–26.9; p=0.021), PCSS (HR 6.9, 95% CI 0.9–55.8; p=0.07), and OS (4.5, 95% CI 1.0–20.1; p=0.057). Limitations include the retrospective design and potential selection bias. ConclusionsFirst postoperative uPSA ≥0.03ng/ml independently predicts BCR, BMFS, PCSS, and OS better than traditional risk factors. SRT alone may be insufficient for patients with high-risk disease when first postoperative uPSA is ≥0.03ng/ml. Patient summaryWhen the first postprostatectomy ultrasensitive prostate-specific antigen level is ≥0.03ng/ml, patients are at higher risk of recurrent and occult prostate cancer. They should be considered for early salvage radiotherapy, possibly with hormone therapy.

Erectile dysfunction and the risk of prostate cancer.

BackgroundProstate cancer (PCa) is the most commonly diagnosed malignancy and the third leading cause of cancer death among men in developed countries. Because some risk factors are common between erectile dysfunction (ED) and PCa, we investigated the association between ED and subsequent PCa.MethodsThis nationwide population-based cohort study used data from the Taiwan National Health Insurance Research Database for the period 2000–2010. We identified patients newly diagnosed with ED by using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.ResultsIn total, 5858 and 23432 patients were enrolled in the ED and non-ED cohorts, respectively. After adjustment for age, sex, and comorbidities, the overall incidence densities of PCa were significantly higher in the ED cohort than in the non-ED cohort, with an adjusted hazard ratio (aHR) of 1.19. The age-specific relative risk of PCa was significantly higher for all age groups in the ED cohort than in the non-ED cohort. Compared with patients without ED, those with organic ED had a 1.27-fold higher risk of PCa.ConclusionED is a harbinger of PCa in some men. Physicians should consider the possibility of occult PCa in patients with ED regardless of age and comorbidities.

MRI-directed cognitive fusion-guided biopsy of the anterior prostate tumors.

We aimed to evaluate the efficacy of magnetic resonance imaging (MRI)-directed cognitive fusion transrectal ultrasonography (TRUS)-guided anterior prostate biopsy for diagnosis of anterior prostate tumors and to illustrate this technique. A total of 39 patients with previous negative TRUS biopsy, but high clinical suspicion of occult prostate cancer, prospectively underwent prostate MRI including diffusion-weighted imaging (DWI). Patients with a suspicious anterior lesion on MRI underwent targeted anterior gland TRUS-guided biopsy with cognitive fusion technique using sagittal probe orientation. PIRADS version 1 scores (T2, DWI, and overall), lesion size, prostate-specific antigen (PSA), PSA density, and prostate gland volume were compared between positive and negative biopsy groups and between clinically significant cancer and remaining cases. Logistic regression analysis of imaging parameters and prostate cancer diagnosis was performed. Anterior gland prostate adenocarcinoma was diagnosed in 18 patients (46.2%) on targeted anterior gland TRUS-guided biopsy. Clinically significant prostate cancer was diagnosed in 13 patients (33.3%). MRI lesion size, T2, DWI, and overall PIRADS scores were significantly higher in patients with positive targeted biopsies and those with clinically significant cancer (P < 0.05). Biopsies were positive in 90%, 33%, and 29% of patients with overall PIRADS scores of 5, 4, and 3 respectively. Overall PIRADS score was an independent predictor of all prostate cancer diagnosis and of clinically significant prostate cancer diagnosis. Targeted anterior gland TRUS-guided biopsy with MRI-directed cognitive fusion enables accurate sampling and may improve tumor detection yield of anterior prostate cancer.

PET of Glucose Metabolism and Cellular Proliferation in Prostate Cancer.

Imaging of the Warburg effect, which is the principal but not the sole cause for enhanced glucose metabolism in tumors, with PET and 18F-FDG has become the mainstay for the imaging evaluation of several cancers. Despite the seemingly prevalent notion that 18F-FDG PET may not be useful in prostate cancer, relatively limited evidence suggests that this imaging modality can be useful for the evaluation of the extent of metastatic disease and the assessment of the therapy response and prognosis in men with castration-resistant prostate cancer. Incidental high focal 18F-FDG uptake in the prostate gland, although generally rare, may also indicate occult prostate cancer that may need to be further scrutinized. In general, 18F-FDG PET is not useful for initial staging and is of limited utility in the clinical setting of biochemical failure after prior definitive therapy for primary cancer. Although more experience is needed, it appears that the imaging of cellular proliferation with PET and 3'-deoxy-3'-18F-fluorothymidine or 2'-18F-fluoro-5-methyl-1-β-d-arabinofuranosyluracil may also allow for targeted biopsy and localization for focal therapy of aggressive prostate tumors as well as assessment of the therapy response to various standard and novel treatment regimens in patients with metastatic disease.

Incidentally Detected Adenocarcinoma Prostate in Transurethral Resection of Prostate Specimens: a Hospital Based Study from India.

Awareness about prostate cancer has increased in the community, and prostate cancer screening examinations, including prostate specific antigen (PSA) assays, are now widely available. Prior to the PSA era, up to 27% of prostate cancers were detected incidentally at the time of transurethral resection of prostate (TURP). After PSA testing became widely available, the incidence of incidentally detected carcinoma prostate in TURP specimens without prior diagnosis reduced to 5-13%. However, the incidence of incidentally detected carcinoma prostate has been reported to vary across the globe since various factors can influence the identification of this malignancy in TURP specimens. In this paper, we focus on rates of incidentally detected prostate cancer in TURP specimens in our hospital and correlate it with various parameters. This retrospective study of histopathological findings of biopsy specimens was conducted for patients undergoing TURP during a period of 5 years from April 2010. The inclusion criteria were patients diagnosed with benign prostatic hyperplasia (BPH) (digital rectal examination (DRE) not showing any abnormally hard areas and normal age adjusted PSA values). Patients with elevated PSA, abnormal DRE, documented urinary tract infection and proved adenocarcinoma prostate (CaP) were excluded from the study. The total weight of prostatectomy specimen, occurrence of carcinoma prostate in the chips, percentage of total tissue resected showing malignancy and Gleason's scores were recorded. A total of 597 patients belonging to the inclusion criteria were studied. The incidence of occult CaP in the study group was 5.2 % (31/597). Out of these, 8 belonged to T1a and 23 belonged to T1b stages. The age group 70 - 79 years had the maximum incidence of occult CaP. It was observed that the clinical grading of prostate did not have a bearing on the incidence of occult CaP whereas the weight of resected specimen correlated with the incidence of CaP. The incidence of occult CaP was greater with low volume prostates (<20 g). (P=0.15). The rate of incidentally detected adenocarcinoma prostate in patients undergoing TURP for clinically diagnosed BPH was found to be only 5.2 % in our study which is low when compared with similar studies done elsewhere. The age of the patient and weight of the resected specimen correlated with incidence of occult prostate cancer. The clinical grading of prostate by DRE however, demonstrated no correlation.

A pilot study of the utility of choline PET-CT in prostate cancer biochemical relapse following radical prostatectomy.

To evaluate the detection rate of positive choline PET-CT and its clinical role in assisting with management decisions and the correlation between positive choline PET-CT and clinical/pathological parameters in prostate cancer patients with biochemical relapse following radical prostatectomy. This was a longitudinal observational pilot study of 34 patients who received choline PET-CT scans with biochemical relapse after radical prostatectomy. Variables including peak PSA, PSA doubling time (DT), Gleason score, age, initial PSA at diagnosis, use of ADT prior to PET and initial clinical staging were statistically analysed to assess for independent predictive factors for positive PET findings. Choline PET-CT was positive in 38.2% of patients (13/34). The only statistically significant predictor for positive PET-CT was the use of ADT prior to PET-CT, with OR 18.7 (95% CI, 2.87-122.45), P<0.01. Mean peak PSA for patients with positive PET-CT was 5.5±4.8ng/mL. Patients with positive PET-CT had a mean PSA DT of 5.1±3.8months and mean total Gleason of 7.6±0.8. Although these variables were not statistically significant, they showed a tendency towards significance. At Receiver Operator Characteristics (ROC) analysis, a peak PSA value of 1.65ng/mL and PSA DT of 4.4months were determined to be the optimal cut-off values predicting positive PET-CT. Choline PET-CT has its potential as a diagnostic modality enabling the detection of occult prostate cancer recurrence and to differentiate localised disease from systemic disease thus guiding management. Use of ADT prior to PET-CT is a significant predictor of positive PET-CT. Patients with a short PSA DT, high-peak PSA and high Gleason score should also be considered for choline PET-CT.