Prostate Biopsy Results Research Articles

Can a prostate biopsy be safely deferred on PI-RADS 1,2 or 3 lesions seen on pre-biopsy mp-MRI?

ABSTRACT Introduction Multi-parametric magnetic resonance imaging (mp-MRI) is currently used to triage patients with suspected prostate cancer, before deciding on prostate biopsies. In our study, we evaluated normal and equivocal pre-biopsy mp-MRIs to see whether it is safe to avoid biopsy with such findings. Methods A retrospective study was conducted at a district general hospital in the UK between August 2017 and July 2018. Patients with negative and equivocal prebiopsy mp-MRI with high clinical suspicion of cancer had proceeded to biopsy. MRI reports with prostate imaging reporting and data system (PI-RADS) scores 1, 2, 3 and normal MRI were evaluated against the transrectal ultrasound-guided prostate biopsy (TRUS-PB) outcomes to demonstrate benign pathology, clinically insignificant or clinically significant cancer (csCa). CsCa was defined as Gleason score (GS) ≥3 + 4. Results Out of 265 mp-MRIs studied, five (1.9%) were PI-RADS 1, 109 (41.1%) and 84 (31.7%) were PI-RADS 2 and 3 lesions respectively; 67 (25.3%) were reported as normal. Seventy-five (27.3%) patients did not have biopsies following their MRI and 73.3% (51/75) of them had benign feeling prostate. Negative MRIs (PI-RADS 1, 2 and normal MRI) showed 8.8% and PI-RADS 3 lesions demonstrated 11.9% csCa. Negative predictive value for normal MRI was 91.2%. Mean PSA density (PSAD) among the benign, GS 3 + 3 and csCa was 0.14, 0.16 and 0.27 ng/ml/ml respectively and this was statistically significant (p < 0.001). The average percentage of cancer found in GS 3 + 3 and csCa was 3.2% and 20.1%, respectively. Conclusion Avoiding TRUS-PB following normal or equivocal mp-MRI should carefully be decided as 18.5% of cancer was demonstrated in this group and 9.8% of those who were diagnosed with cancer were csCa. PSAD and DRE findings provide additional information to help with this decision.

SC278 - Development and validation of a personalized predictive model for fusion prostate biopsy outcomes prediction

SC278 - Development and validation of a personalized predictive model for fusion prostate biopsy outcomes prediction

Clinicopathological Profile of Prostate Adenocarcinoma Cases at Cipto Mangunkusumo Hospital in 2010-2019 with Special Overview of Robotic Biopsy

BackgroundProstate adenocarcinoma is second most common malignancy in men and fourth leading death cause from malignancy worldwide. Prostate biopsy is the gold standard for diagnosing this disease. However, the difficulty of sampling is a weakness in this procedure. In Cipto Mangunkusumo hospital, biopsy technology is now available with robotic techniques for biopsy sampling, which is expected to increase prostate biopsy accuracy. This study was to determine prostate adenocarcinoma case profile in the Department of Pathology Anatomic Cipto Mangunkusumo Hospital for 10 years and to examine differences in sampling of biopsy preparations with robotic and non-robotic techniques. MethodsThis study was an exploratory descriptive study with cross-sectional design to determine prostate adenocarcinoma case profile in the Department of Anatomic Pathology FKUI-RSCM for 10 years. The data obtained between the Gleason score of prostate biopsy preparations and surgery. Robotic prostate biopsy results were compared with prostate imaging reporting and data system (PIRADS) score. ResultsThe mean age of the patients was 67 years old and several patients were aged &lt;50 years old. Many poor differentiation cases were found. It appears that there is a relationship between WHO/ISUP degree and perineural invasion. In 14 patients who underwent histopathological examination more than once, it was found that 9 patients had the same WHO/ISUP degree and 5 patients had a changed WHO/ISUP degree. There are several discrepancies in PIRADS score and histopathological findings from 21 robotic preparations examined. ConclusionThe mean age of patients fit to theory of generalized prostate adenocarcinoma. Many cases of poor differentiation were found, possibly related to RSCM as a national referral center. The repeated sample examination results are similar to the results of other studies. Robotic method biopsy gives the sense of more comprehensive sampling in comparison to non-robotic method.

Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Prostatectomy on Trifecta Outcomes: A Randomized Clinical Trial.

Planning complex operations such as robotic-assisted radical prostatectomy requires surgeons to review 2-dimensional magnetic resonance imaging (MRI) cross-sectional images to understand 3-dimensional (3D), patient-specific anatomy. We sought to determine surgical outcomes for robotic-assisted radical prostatectomy when surgeons reviewed 3D, virtual reality (VR) models for operative planning. A multicenter, randomized, single-blind clinical trial was conducted from January 2019 to December 2020. Patients undergoing robotic-assisted laparoscopic radical prostatectomy were prospectively enrolled and randomized to either a control group undergoing usual preoperative planning with prostate biopsy results and MRI only or to an intervention group where MRI and biopsy results were supplemented with a 3D VR model. The primary outcome measure was margin status, and secondary outcomes were oncologic control, sexual function and urinary function. Ninety-two patients were analyzed, with trends toward lower positive margin rates (33% vs 25%) in the intervention group, no significant difference in functional outcomes and no difference in traditional operative metrics (p >0.05). Detectable postoperative prostate specific antigen was significantly lower in the intervention group (31% vs 9%, p=0.036). In 32% of intervention cases, the surgeons modified their operative plan based on the model. When this subset was compared to the control group, there was a strong trend toward increased bilateral nerve sparing (78% vs 92%), and a significantly lower rate of postoperative detectable prostate specific antigen in the intervention subset (31% vs 0%, p=0.038). This randomized clinical trial demonstrated patients whose surgical planning involved 3D VR models have better oncologic outcomes while maintaining functional outcomes.

Real-world use of MRI for risk stratification prior to prostate biopsy.

The utilization of MRI to risk stratify elevated PSA prior to prostate biopsy has been inconsistently adopted and varies considerably by practice setting. This study aims to evaluate the usage and performance of MRI as an advanced risk stratification tool of elevated PSA prior to biopsy and identify factors associated with differential utilization of MRI at a large academic setting with ready access to 3T multiparametric MRI of the prostate. A retrospective single-center study of 2900 men presenting with elevated PSA 2-20 ng/mL from 2018 through 2021 was conducted. We analyzed trends in MRI utilization and outcomes of prostate biopsy by MRI usage. Univariate and multivariate logistic regressions were performed to calculate odds ratios to identify patient- and provider-level predictors of MRI usage. Rates of prebiopsy MRI utilization increased from 56% in 2018 to 89% in 2021 (p < 0.001). Prebiopsy MRI led to biopsy avoidance in 31% of men. MRI usage enhanced detection of clinically significant prostate cancer by 13% and reduced identification of Gleason Grade Group 1 disease by 3% and negative biopsies by 10% (p < 0.001). Men who received MRI were more likely to be younger than 75 years in age and have private or Medicare insurance, PSA >4 ng/mL, and PHI >27. In both univariate and multivariate analysis, black race and Medicaid insurance were associated with reduced MRI utilization (all p < 0.001). Urologic provider was an independent predictor of MRI usage (p < 0.001). Use of MRI as a risk stratification tool for elevated PSA rose during this 4-year study period. Men who self-identify as black or men with Medicaid coverage have diminished rates of MRI usage. Considerable provider-level variability in MRI use was observed. Future research aimed at identifying factors affecting implementation of MRI as a routine risk assessment tool is warranted.

MP09-09 THE RESULTS OF TRANSPERINEAL VERSUS TRANSRECTAL PROSTATE BIOPSY: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP09-09 THE RESULTS OF TRANSPERINEAL VERSUS TRANSRECTAL PROSTATE BIOPSY: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS Jindong Dai, Jiyu Yang, Xingming Zhang, Pengfei Shen, and Hao Zeng Jindong DaiJindong Dai More articles by this author , Jiyu YangJiyu Yang More articles by this author , Xingming ZhangXingming Zhang More articles by this author , Pengfei ShenPengfei Shen More articles by this author , and Hao ZengHao Zeng More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This updated systematic review was performed to compare the efficacy and complications of transperineal (TP) vs. transrectal (TR) prostate biopsy. METHODS: Systematic research of PUBMED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer (PCa) detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to TR group or TP group. Subgroup analysis was performed according to prostate-specific antigen (PSA) levels, prostate volume, prostate anatomical structure, and digital rectal examination (DRE) findings. The Cochrane Collaboration’s RevMan 5.4 software was used for the meta-analysis. RESULTS: A total of sixteen trials, including eight randomized controlled trials (RCTs) and eight case control studies (CCS), met our inclusion criteria. Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group (risk difference (RD), -0.01; 95% confidence interval (CI), -0.04–0.02; P=0.47). However, the more prostate cancer was detected in TP group with 10≤PSA (RD, 0.03; 95%CI, 0.01-0.05; P=0.009). CONCLUSIONS: In the patients with PSA>10ng/ml, TP has more advantages than TR in cancer detection. Moreover, a significantly lower risk of fever and rectal bleeding was reported for TP prostate biopsy. Source of Funding: 2021YFS0119 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e138 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jindong Dai More articles by this author Jiyu Yang More articles by this author Xingming Zhang More articles by this author Pengfei Shen More articles by this author Hao Zeng More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD11-05 ACQUIRED AND CONGENITAL SPINAL CORD INJURY IS ASSOCIATED WITH LOWER LIKELIHOOD OF PSA SCREENING

You have accessJournal of UrologyCME1 May 2022PD11-05 ACQUIRED AND CONGENITAL SPINAL CORD INJURY IS ASSOCIATED WITH LOWER LIKELIHOOD OF PSA SCREENING Stacy Jeong, Glenn Werneburg, Robert Abouassaly, and Hadley Wood Stacy JeongStacy Jeong More articles by this author , Glenn WerneburgGlenn Werneburg More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , and Hadley WoodHadley Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies have demonstrated lower prevalence of prostate cancer among patients with spinal cord injury but more advanced stage at diagnosis. Current screening practices for prostate cancer in this population are further complicated by greater baseline PSA values, higher rates of bacteriuria, and improving life expectancies. However, there is a lack of literature on prostate cancer screening among these patients. We sought to evaluate prostate cancer screening occurrence in patients with spinal cord injury at our institution compared to a matched, unaffected population. METHODS: We conducted a retrospective review of patients with the criteria: male, age 50-70, and diagnosis of cerebral palsy, paraplegia, quadriplegia, or spina bifida. A control cohort was matched by age, race, insurance, and co-morbidities. PSA screening, PSA value, prostate MRI, prostate biopsy, and biopsy outcome were compared. Multivariate logistic regression analysis was performed to determine the association between patient variables and PSA screening. RESULTS: The study cohort and control cohort included 2180 patients each. Patients with spinal cord injury had significantly lower rates of PSA screening (15% vs 24%, p <0.00001), MRI (0.1% vs 0.6%, p=0.02), and biopsy (0.6% vs 1.3%, p=0.01) compared to control. Spinal cord injury was associated with a lower likelihood of PSA screening (OR = 0.56, CI = 0.48 – 0.65, p <0.00001). There was no significant difference between study and control cohorts in risk stratification on biopsy (p=0.255). Among those who were PSA screened, there was no significant difference in patients who were ultimately diagnosed with prostate cancer between the two cohorts (p=0.076). There were no 30-day readmissions following prostate biopsy in the study cohort, and one readmission for hematuria and urinary tract infection in the control cohort. CONCLUSIONS: Patients with spinal cord injury were less likely to undergo PSA screening compared to a matched control population. Since PSA screening is a shared decision making process, providers should consider individual factors along with overall increasing life expectancies for patients with spinal cord injury. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e191 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stacy Jeong More articles by this author Glenn Werneburg More articles by this author Robert Abouassaly More articles by this author Hadley Wood More articles by this author Expand All Advertisement PDF DownloadLoading ...

Concordance between biparametric MRI, transperineal targeted plus systematic MRI-ultrasound fusion prostate biopsy, and radical prostatectomy pathology

We aimed to confirm the reliability of the results of bi-parametric magnetic resolution imaging-ultrasound fusion targeted and systematic biopsies (bpMRI-US transperineal FTSB) compared to prostatectomy specimens. We retrospectively analyzed the records of 80 men who underwent bpMRI-US transperineal FTSB with region of interest (ROI) and subsequent robot-assisted radical prostatectomy. Changes in the grade group determined by MRI and biopsy versus surgical specimens were analyzed. Thirty-five patients with insignificant prostate cancer and 45 with significant cancer were diagnosed using bpMRI-US transperineal FTSB. Among those with insignificant PCa, 25 (71.4%) were upgraded to significant PCa in prostatectomy specimens: 9/12 (75.0%) with Prostate Imaging Reporting and Data System (PI-RADS) 3, 12/16 (75.0%) with PI-RADS 4, and 4/7 (57.1%) with PI-RADS 5. In the PI-RADS 3 group, the upgraded group showed higher prostate specific antigen (PSA) and PSA density (PSAD) than the concordance group; PSA 8.34(2.73) vs. 5.31(2.46) (p = 0.035) and PSAD 0.29(0.11) vs. 0.18(0.09) (p = 0.025). The results of prostate biopsy and prostatectomy specimens were inconsistent and underestimated in patients with MRI-visible lesions. Therefore, for precise and individualized treatment strategies for PCa with MRI-visible lesions, careful interpretation of biopsy result is required.

Predictive value of PSA density in the diagnosis of prostate cancer in lebanese men.

Being the second most common cancer in men, prostate cancer detection relies on laboratory tests, imaging, and surgical procedures, although biopsy remains the mainstay in diagnosis of prostate cancer. No clear cut-off of prostate specific antigen density (PSAD) for suspecting prostate cancer has been established in the Lebanese population. Our primary objective was to evaluate the diagnostic strength of the PSAD value versus total prostate specific antigen (tPSA) level in the Lebanese men in correlation with biopsy outcome to avoid unnecessary prostate biopsy. A retrospective study of 347 patients with history of prostate biopsy done for cancer suspicion included tPSA, prostate volume, and prostate density values and results of prostate biopsy. Data was collected from Bahman hospital and statistical analysis of the mean values of tPSA, prostate volume and PSAD in different age groups was done. Significance of the results was tested using. On average, patients with negative biopsies were younger and they had lower tPSA levels, lower PSAD values and larger prostate volume compared to patients with positive biopsies. A PSAD cutoff of 0.185 ng/ml2 revealed the highest predictive strength for prostate cancer (6 times risk) compared with other parameters. These findings were mainly referred to patients with PSA > 10 ng/ml. A multifactorial approach must be conducted including all parameters in order to decide upon the need for prostate biopsy. PSAD proved to be a good marker in favor or against a prostate biopsy with a cut-off of 0.185 ng/ml2, especially in patients with tPSA level higher to 10 ng/ml. A multicenter study was recommended for better and more reliable results and more precise cut-offs.

The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy

Introduction and objectivesThis study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens. Materials and methodsA total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed. ResultsThe median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage. ConclusionsThe absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage ≤ 2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.

Integration of Prostate Biopsy Results with Pre-Biopsy Multiparametric Magnetic Resonance Imaging Findings Improves Local Staging of Prostate Cancer.

To assess the added value of histological information for local staging of prostate cancer (PCa) by comparing the accuracy of multiparametric MRI alone (mpMRI) and mpMRI with biopsy Gleason grade (mpMRI+Bx). 133 consecutive patients who underwent preoperative 3T-MRI and subsequent radical prostatectomy for PCa were included in this single-centre retrospective study. mpMRI imaging was reviewed independently by two uroradiologists for the presence of extracapsular extension (ECE) and seminal vesicle invasion (SVI) on a 5-point Likert scale. For second reads, the radiologists received results of targeted fused MR/US biopsy (mpMRI+Bx) prior to re-staging. The median patient age was 63years (interquartile range (IQR) 58-67years) and median PSA was 6.5ng/mL (IQR 5.0-10.0ng/mL). Extracapsular extension was present in 85/133 (63.9%) patients and SVI was present in 22/133 (16.5%) patients. For ECE prediction, mpMRI showed sensitivity and specificity of 63.5% and 81.3%, respectively, compared to 77.7% and 81.3% achieved by mpMRI+Bx. At an optimal cut-off value of Likert score ≥ 3, areas under the curves (AUCs) was .85 for mpMRI+Bx and .78 for mpMRI, P < .01. For SVI prediction, AUC was .95 for mpMRI+Bx compared to .92 for mpMRI; P = .20. Inter-reader agreement for ECE and SVI prediction was substantial for mpMRI (k range, .78-.79) and mpMRI+Bx (k range, .74-.79). MpMRI+Bx showed superior diagnostic performance with an increased sensitivity for ECE prediction but no significant difference for SVI prediction. Inter-reader agreement was substantial for both protocols. Integration of biopsy information adds value when staging prostate mpMRI.

Acquired and Congenital Spinal Cord Injury is Associated With Lower Likelihood of Prostate Specific Antigen Screening

ObjectiveTo evaluate prostate cancer screening occurrence in patients with spinal cord injury at our institution compared to a matched, unaffected population. Materials and MethodsWe conducted a retrospective review of patients with the criteria: male, age 50-70, and diagnosis of cerebral palsy, spina bifida, or quadriplegia. A control cohort was matched by age, race, insurance, and co-morbidities. Prostate specific antigen (PSA) screening, PSA value, prostate MRI, prostate biopsy, and biopsy outcome were compared. Multivariate logistic regression analysis was performed to determine the association between patient variables and PSA screening. ResultsThe study cohort and control cohort included 2180 patients each. Patients with spinal cord injury had significantly lower rates of PSA screening (15% vs 24%, P <.00001), MRI (0.1% vs 0.6%, P = .02), and biopsy (0.6% vs 1.3%, P = .01) compared to control. Spinal cord injury was associated with a lower likelihood of PSA screening (OR = 0.56, CI = 0.48-0.65, P <.00001). There were no significant differences in PSA value and biopsy outcomes. ConclusionPatients with spinal cord injury had a lower likelihood of PSA screening compared to a matched control population. Since PSA screening is a shared-decision making process, providers should consider the increasing life expectancy of patients with spinal cord injury and risks of under-testing for prostate cancer.

The impact of health-policy-driven subsidisation of prostate magnetic resonance imaging on transperineal prostate biopsy practice and outcomes.

BackgroundFrom 1 July 2018, the Australian Medicare Benefits Schedule (MBS) introduced rebates for multi‐parametric magnetic resonance imaging (mpMRI) for the workup for prostate cancer (PCa). We aimed to determine if subsidisation of mpMRI prior to transperineal biopsy altered our institution's prostate biopsy practice patterns and outcomes.MethodsAll patients who underwent transperineal prostate biopsy at an Australian tertiary institution from 1 January 2017 to 1 January 2020 were identified. Patients with known PCa were excluded. Patients were stratified into two groups: a pre‐subsidisation cohort comprising patients biopsied prior to the introduction of mpMRI subsidisation on 1 July 2018 and a post‐subsidisation cohort comprising patients biopsied after 1 July 2018. Histopathological results were compared with further stratification based on mpMRI results. Clinically significant cancer was defined as ISUP Grade Group ≥ 2.ResultsSix hundred and fifty men fulfilled the inclusion criteria. Three hundred and sixty‐one patients were in the pre‐subsidisation cohort and 289 in the post‐subsidisation cohort. Of the patients in the pre‐subsidisation group, 36.3% underwent a pre‐biopsy mpMRI compared with 77.5% in the post‐subsidisation group. Of the patients in the pre‐subsidisation group, 59.6% had positive biopsies (p = 0.024) compared with 68.2% in the post‐subsidisation group. The rate of clinically significant PCa was lower in the pre‐subsidisation group (39.1%) compared with the post‐subsidisation (49.5%, p = 0.008). The negative predictive value of mpMRI for clinically significant PCa was 86.5%.ConclusionOur institution experienced a reduction of negative prostate biopsies and an increase in clinically significant PCa within transperineal biopsy specimens after the Australian healthcare system introduced financial subsidisation of mpMRI.

A0604 - Prospective results of in-office freehand transperineal prostate biopsies under local anaesthesia - leaving the transrectal route behind

A0604 - Prospective results of in-office freehand transperineal prostate biopsies under local anaesthesia - leaving the transrectal route behind

MRI-based nomogram for the prediction of prostate cancer diagnosis: A multi-centre validated patient–physician decision tool

Objective: To update and externally validate a magnetic resonance imaging (MRI)-based nomogram for predicting prostate biopsy outcomes with a multi-centre cohort. Materials and methods: Prospective data from five UK-based centres were analysed. All men were biopsy naïve. Those with missing data, no MRI, or prostate-specific antigen (PSA) &gt; 30 ng/mL were excluded. Logistic regression analysis was used to confirm predictors of prostate cancer outcomes including MRI-PIRADS (Prostate Imaging Reporting and Data System) score, PSA density, and age. Clinically significant disease was defined as International Society of Urological Pathology (ISUP) Grade Group ⩾ 2 (Gleason grade ⩾ 7). Biopsy strategy included transrectal and transperineal approaches. Nomograms were produced using logistic regression analysis results. Results: A total of 506 men were included in the analysis with median age 66 (interquartile range (IQR) = 60–69). Median PSA was 6.6 ng/mL (IQR = 4.72–9.26). PIRADS ⩾ 3 was reported in 387 (76.4%). Grade Group ⩾ 2 detection was 227 (44.9%) and 318 (62.8%) for any cancer. Performance of the MRI-based nomogram was an area under curve (AUC) of 0.84 (95% confidence interval (CI) = 0.81–0.88) for Grade Group ⩾ 2% and 0.85 (95% CI = 0.82–0.88) for any prostate cancer. Conclusion: We present external validation of a novel MRI-based nomogram in a multi-centre UK-based cohort, showing good discrimination in identifying men at high risk of having clinically significant disease. These findings support this risk calculator use in the prostate biopsy decision-making process. Level of evidence: 2c

Elévation du taux de PSA sérique : Corrélation histologique avec les biopsies des tumeurs prostatiques au Togo

INTRODUCTION : Le but de ce travail est de déterminer la corrélation entre le taux sérique de PSA et les résultats anatomopathologiques des biopsies prostatiques dans notre pratique. MATERIELS ET METHODES : Il s’agit d’une étude rétrospective et descriptive allant du 1er janvier 2016 au 31 décembre 2020 (cinq ans) dans les services d’Urologie, les laboratoires d’Anatomie et Cytologie Pathologiques du Centre Hospitalier Universitaire Sylvanus Olympio (CHUSO) et de la clinique Autel d’Élie. Ont été inclus tous les dossiers de patients présentant une tumeur prostatique ayant reçu une biopsie et enregistrés dans les dit-services durant la période d’étude. RESULTATS : Deux cent huit dossiers de biopsie pour tumeurs prostatiques ont été colligés. L’âge moyen des patients était de 66,37 ± 9,85 ans. La tranche d’âge la plus représenté était celle de [60 – 70[ ans. Le taux moyen de PSA des patients était de 793,53 ng/ml. Des 208 biopsies prostatiques réalisées, les adénocarcinomes (ADC) représentaient 64,4% (n=134). Les patients ayant un adénocarcinome avaient un taux moyen de PSA de 1.209,37 ng/ml. Pour les adénomyomes, le taux moyen était de 40,52 ng/ml. Soixante-et-neuf patients ayant un adénocarcinome (33,2%) avaient un taux de PSA ≥100 ng/ml. CONCLUSION : Nous avions noté une relation statistiquement significative entre le taux de PSA total et la découverte de cancer. Ainsi toutes élévation du taux de PSA doit conduire à la réalisation de biopsie pour une confrontation histologique. Cependant, il n’existait pas de relation statistiquement significative entre l’élévation du PSA total et le grade histologique.

Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes.

BackgroundSedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes.MethodsA retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates.ResultsThe cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction.ConclusionSedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.

Comparative study between 1.5 and 3 Tesla multiparametric MRI systems using the PIRADS version 2 classification in the diagnosis of prostate cancer.

The 3-Tesla multiparametric MRI (mpMRI) system represents a diagnostic advance for prostate cancer. Our aim is to demonstrate that the results in 1.5-Tesla mpMRI are not inferior compared to the 3-Tesla for the correct diagnosis of prostate cancer. Non-inferiority comparative cross-sectional study between fusion-guided prostate biopsy results. 344 patients with clinical suspicion of prostate cancer (elevated PSA and/or suspicious DRE) and mpMRI interpreted and verified by the same radiologists in all cases, 270 in 1.5-Tesla and 74 in 3-Tesla, with at least one lesion PIRADSv2≥ 3. Exclusion criteria were positive biopsy or previous prostate treatment. We consider malignancy as ISUP≥ 1 and significant tumor as ISUP≥ 2. We used Wilcoxon and t-student test (central tendency measures), diagnostic test (gold standard: ISUP of targeted biopsy), Chi2 test and Z-test (comparison of prevalences and 95%CI malignancy and significant tumor according to mpMRI). Median prostate volume 50cc(IQR:33.5) and PSA 6.11ng/ml(IQR:3.39). Mean age 67.4±8.1years. Number of suspi-cious lesions/patient: mpMRI 1.3 (1.5-Tesla) and 1.5 (3-Tesla). No differences were found between mpMRI (homogeneous and comparable samples). 57% (1.5-Tesla) vs 66% (3-Tesla) of targeted biopsies were malignant, and 34%vs38% were significant tumor, with no significant differences. Se, Sp, PPV and NPV for malignancy (1.5-Tesla vs 3-Tesla) were 96%vs90%, 38%vs44%, 67%vs76%, and 86%vs69%, with no significant differences. There are no significant differences between 1.5-Tesla vs 3-Tesla mpMRI regarding targeted biopsy results. Not to have 3-Tesla mpMRI may not be a limitation to use 1.5-Tesla as a diagnostic test for the better diagnosis of prostate cancer.

Comparison of 12-Core Prostate Biopsy Results with Corresponding Radical Prostatectomy Specimens

Comparison of 12-Core Prostate Biopsy Results with Corresponding Radical Prostatectomy Specimens

Automated Extracellular Vesicles Extractor Based on Nanotechnology for High Throughput Sample Preparation and Phosphoproteomics Analysis

Extracellular vesicles (EVs) play important roles in the diagnosis and treatment of diseases because of its lavish bioinformatic molecular contents. However, how to separate plentiful of extracellular vesicles in a short time with high consistency is still a problem. Here, we’d like to introduce an automated extracellular vesicles capturing machine named EVenrich (Extracellular Vesicles Enrichment) that helps realize capturing EVs of biosamples in a high-throughput manner. Incorporating EVenrich with EVtraps-a kind of biological magnetic beads capturing extracellular vesicles specifically, we were able to isolate EVs from up to 48 urine samples in 60 min, with similar quality and quantity and superior stability to manual capture. In clinical urine EVs analysis, over 14000 peptide fragments and 2000 proteins were detected by automated capture, which was similar to manual capture and significantly superior to ultracentrifugation. We further collected urine samples from 21 patients with negative prostate biopsy results and 21 patients with confirmed prostate cancer. Every three samples were mixed into a group to make mixed samples of 7 control groups and 7 disease groups. After exosome extraction and exosome proteomics / phosphorylated proteomics analysis, we found 211 overexpressed proteins and 187 overexpressed phosphorylated peptides corresponding to 40 phosphorylated proteins as potential biomarkers for prostate cancer. In addition, qRT-PCR results showed that the ratio of miR-125b to miR-145 could well distinguish prostate cancer patients from non-prostate cancer patients, suggesting that it could be used as a potential marker of prostate cancer.