Prostate Cancer Pathology Research Articles

Luteinizing Hormone Levels Relate to the Unfavorable Pathology of Prostate Cancer.

Purpose: This study analyzed the association between sex hormone concentrations and stage/condition in patients with prostate cancer. Materials and methods: The concentrations of sex hormones, including testosterone (total, free, and bioavailable), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH), were measured in 415 patients diagnosed with prostate cancer. Differences in serum hormone concentrations after receiving androgen deprivation therapy (ADT) and after withdrawal from ADT were evaluated. Pathologic characteristics were assessed in the 225 patients unexposed to ADT with a history of radical prostatectomy. Logistic regression analysis was performed to identify factors predictive of unfavorable pathology (Grade ≥3, ≥T3a, or N1). Results: Of the 415 prostate cancer patients, 130 (31.3%) were assessed before treatment, 171 (41.2%) after surgery, 35 (8.4%) after biochemical recurrence, and 59 (14.2%) during ADT, whereas 20 (4.8%) had castration-resistant prostate cancer. FSH was significantly lower after compared to before prostatectomy (3.229 ± 4.486 vs. 5.941 ± 7.044 mIU/mL, p < 0.001). LH, FSH, and testosterone decreased significantly 3 months after starting ADT, but increased 3 months after ADT withdrawal, whereas SHBG was unchanged. Multivariate analysis showed that high LH (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.03–2.47, p = 0.0376) and prostate-specific antigen (PSA) (OR: 1.13, 95% CI: 1.03–1.24, p = 0.0133) concentrations were significantly associated with a high risk of unfavorable pathology. Conclusions: Sex hormones, including LH, FSH, and testosterone, were affected by ADT. The FSH level decreased after radical prostatectomy. High baseline LH concentration in patients unexposed to ADT was associated with an unfavorable pathology.

Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI.

Objective To compare prostate cancer detection rates (CDRs) and pathology results with targeted prostate biopsy (TB) and systematic prostate biopsy (SB) in biopsy-naive men. Methods An in-patient control study of 82 men undergoing SB and subsequent TB in case of positive prostate MRI between 2015 and 2017 in the Jeroen Bosch Hospital, the Netherlands. Results Prostate cancer (PCa) was detected in 54.9% with 70.7% agreement between TB and SB. Significant PCa (Gleason score ≥7) was detected in 24.4%. The CDR with TB and SB was 35.4% and 48.8%, respectively (p=0.052). The CDR of significant prostate cancer with TB and SB was both 20.7%. Clinically significant pathology upgrading occurred in 7.3% by adding TB to SB and 22.0% by adding SB to TB. Conclusions There is no statistically significant difference between CDRs of SB and TB. Both SB and TB miss significant PCas. Moreover, pathology upgrading occurred more often by adding SB to TB than vice versa. This indicates that the omission of SB in this study population might not be justified.

Correlation Between mpMRI Staging and Final Surgical Pathology in Prostate Cancer

Purpose: We evaluated the role of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of prostate cancer and predicting of surgical staging of prostate cancer.&#x0D; &#x0D; Materials and Methods: The study was done in 110 subjects who got mpMRI before radical prostatectomy in our hospital from 2016 to 2019. Preoperative mpMRI findings of 110 were compared to surgical pathology results following radical Prostatectomy. A comparison was made between pathologic staging of prostate cancer and the mpMRI findings.&#x0D; &#x0D; Results: pathologic evaluation confirmed prostate cancer foci (237) were recognized in 110 subjects. Generally, mpMRI sensitivity of 46.4% was found for prostate cancer detection (110/237). Pathological tumor volume was a significant predictor of prostate cancer detection using mpMRI. In 33% of the cases, the pathologic staging is precisely similar to mpMRI and in 43%of the cases, there was a slight difference between the pathologic staging and staging by mpMRI but the cancer was confined to the prostate.in 24% of the cases, there was a significant difference between the pathologic staging and staging by mpMRI. The mpMRI was not able to identify the significant cancer in 24% of the cases.&#x0D; &#x0D; Conclusion: The preoperative mpMRI was useful in detecting prostate cancer and in predicting surgical staging. However, the detection of 24% of clinically significant cancer was missed using mpMRI. As we move toward personalized medicine, use of MRI to biopsy each man&amp;#39;s prostate differently rather than based on a pre-defined 12 core seems to be supported in the recent literature.

Comparison of PSA profile with positive prostate cancer pathology and Gleason scores in 2015-2017 in Hamadan

Comparison of PSA profile with positive prostate cancer pathology and Gleason scores in 2015-2017 in Hamadan

Molecular pathology of prostate cancer: diagnostic and prognostic value of major markers

Molecular pathology of prostate cancer: diagnostic and prognostic value of major markers

Prostate cancer pathology: What has changed in the last 5 years.

Prostate cancer is the most frequent non-cutaneous malignancy in men in the United States. In the last few years, many recommendations have been made available from the 2014 International Society of Urologic Pathology consensus conference, 2016 World Health Organization blue book and 2018 8th edition of American Joint Committee on Cancer Staging System. Here, we focus on four topics which are considered relevant on the basis of their common appearance in routine practice, clinical importance and 'need to improve communication between pathology reports and clinicians': prostate cancer classification, prostate cancer grading, prostate cancer staging, and current definition of clinically significant prostate cancer. Tissue biomarkers that can predict significant disease and/or upgrading and tissue-based genomics for the purpose of diagnosis and prognosis are mentioned briefly.

The Genomic and Molecular Pathology of Prostate Cancer: Clinical Implications for Diagnosis, Prognosis, and Therapy.

Prostate cancer (PCa) is the most common noncutaneous malignancy affecting American men and the second most common cause of cancer death. The traditional risk classification schemes for PCa are limited due to the vast clinical and molecular heterogeneity of the disease. Fortunately, recent advancements in sequencing technologies have provided us with valuable insight into the genomics of PCa. To date, a wide array of recurrent genomic alterations in PCa have been identified. Incorporating these distinct molecular subtypes of PCa into prediction models provides opportunities for improved risk stratification and ultimately better patient outcomes. In this review, we summarize the key molecular subtypes of PCa and focus on those genomic alterations that have clinical implications for diagnosis, prognosis, and therapeutic response.

The Microbiome and Prostate Cancer Risk.

There is an abundance of evidence that the human microbiome plays an important and nuanced role in controlling human metabolism, immunity, and cancer. Herein we aim to review the most current research looking at prostate cancer and its link with the gut and genitourinary microbiome. There is now a host of evidence for a unique genitourinary (GU) microbiome. The prostate microbiota, to include viral, bacterial, fungal, and parasitic contributions, as assessed from formalin-fixed tissue is described nicely in the study by Banerjee et al. Further hierarchical analysis by this group found a unique microbiome signature for higher Gleason score cancers and validation PCR studies noted a marked number of viral genomic insertions into host DNA. Shretha et al. also recently established unique GU microbiomes in patients with prostate cancer or benign prostate pathology based on urine samples. The gut microbiome likely also has an indirect but significant role in prostate cancer development and treatment. Liss et al. and Golombos et al. found significant associations between specific gut microbiota and prostate cancer. Interestingly, the balance of inflammatory and anti-inflammatory bacterial lipopolysaccharides, production of bile salts, and metabolism of dietary fiber to short chain fatty acids all likely play important roles in creating systemic pro- or anti-carcinogenic states. In terms of prostate cancer treatment effects, Sfanos et al. noted a unique microbial signature in patients undergoing oral androgen deprivation therapy (ADT) as compared with prostate cancer patients not on ADT. Patients undergoing ADT also had enrichment of bacterial metabolic pathways promoting androgen synthesis. Together, these studies have identified a unique GU microbiome and linked both the GU microbiome and unique gut microbial signatures with prostate cancer and prostate cancer treatments. Whether this information can be used in cancer prevention, treatment, or diagnosis are areas of ongoing and active research.

EHMT2 promotes the development of prostate cancer by inhibiting PI3K/AKT/mTOR pathway.

To investigate the expression characteristics and the potential role of euchromatic histone-lysine N-methyltransferase 2 (EHMT2) in the clinical pathology and prognosis of prostate cancer (PCa). Quantitative Real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression of EHMT2 in 55 pairs of PCa tissues and adjacent normal tissues. The relationship between EHMT2 expression and the pathological features, as well as the prognosis of PCa patients was analyzed. EHMT2 expression in PCa cells was determined by qRT-PCR as well. In addition, EHMT2 knockdown model was constructed by transfection of the small interfering RNA in PCa cell lines PC-3 and DU-145. The regulatory effects of EHMT2 on the behaviors of PCa cells were evaluated through cell counting kit-8 (CCK-8), 5-Ethynyl-2'-deoxyuridine (EdU), colony formation assay and flow cytometry. Finally, we detected the protein levels of relative genes in PI3K/AKT/mTOR pathway through Western blot. QRT-PCR results showed that the expression level of EHMT2 in PCa tissues was markedly higher than that in adjacent normal tissues. Compared with PCa patients with low expression of EHMT2, those with high expression of EHMT2 had higher pathological grade and lower overall survival. EHMT2 was also highly expressed in PCa cell lines. Knockdown of EHMT2 inhibited the proliferative potential and induced apoptosis of PCa cells. Western blot results revealed that PCa cells with EHMT2 knockdown presented downregulated p-PI3K, p-AKT and p-mTOR. EHMT2 was highly expressed in PCa, and its expression is closely correlated with tumor stage and poor prognosis of PCa patients. EHMT2 promoted the malignant progression of PCa by inhibiting PI3K/AKT/mTOR pathway.

Abstract 1568: Clinical implications of tmprss2-erg fusion and tumor location in prostate cancer

Abstract Introduction: There is limited data on the impact of race on tumor location and TMPRSS2-ERG (ERG) gene fusion status in Prostate Cancer (PCa). African American men (AAM) often lack the ERG fusion and are likely to experience poor outcomes. Nonetheless, the extent to which ERG status, race, and tumor location impacts PCa outcomes remains unclear. Methods: This multi-institutional study included a retrospective cohort of 495 AAM and 422 European American men (EAM) who received prostatectomy at Moffitt Cancer Center (MCC) and University of Pennsylvania Health system (UPHS). To assess the race-dependent variation in ERG protein expression and its association with tumor location and PCa pathology, ERG antibody staining on 4 micron sections of FFPE blocks were carried out on all samples. ERG expression was categorized as ERGpos and ERGneg by two pathologists. Additionally, the staining pattern of ERG was analyzed within ERGpos tumors. A review of anatomic location of the dominant tumor lesions was performed and analyzed using methods of categorical analysis and logistic regression. Alpha value of &amp;lt; 0.05 was considered as statistically significant. Results: In all samples, analysis of ERG immunohistochemistry (IHC) yielded 39.7% ERGpos and 60.6% ERGneg. Variability in histopathologic expression of ERG was significant between races with AAM being more likely to lack TMPRSS2-ERG fusion (ERGneg) compared to EAM, (62% vs 38%, p &amp;lt; 0.001). Lack of ERG fusion was also associated with anatomically distinct tumor location with 72.1% of anteriorly located tumors having ERGneg staining, while only 27.9% were ERGpos, (p &amp;lt; 0.001). Among ERGpos patients, AAM (65.2%) showed significant heterogeneous expression of ERG compared to EAM (31.8%). Furthermore, ERGneg status was associated with higher pretreatment PSA. In a multivariate logistic regression model adjusted for tumor location and race, ERGneg tumors were more likely to have Gleason Score 4+3=7 (Grade Group 3) or higher compared with ERGpos tumors, Odds ratio 2.07, 95% CI 1.20 - 3.56, p = 0.008. Conclusions: The absence of TMPRSS2-ERG fusion is associated with higher grade disease and is a strong predictor for anatomic tumor location within the prostate gland. The clinical implications of ERGneg tumors among AAM and its association with anteriorly located tumors can be vital in addressing disparities in PCa. Citation Format: Kosj Yamoah, Shivanshu Awasthi, Priti Lal, Arash O. Naghavi, Shelly Mahajan, Jong Y. Park, Rob Rounbehler, Travis Gerke, Anders Berglund, Julio PowSang, Jasreman Dhillon, Timothy R. Rebbeck. Clinical implications of tmprss2-erg fusion and tumor location in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1568.

Association of Low Socioeconomic Status With Adverse Prostate Cancer Pathology Among African American Men Who Underwent Radical Prostatectomy.

We tested for associations between socioeconomic status (SES) and adverse prostate cancer pathology in a population of African American (AA) men treated with radical prostatectomy (RP). We retrospectively reviewed data from 2 institutions for AA men who underwent RP between 2010 and 2015. Household incomes were estimated using census tract data, and patients were stratified into income groups relative to the study population median. Pathologic outcomes after RP were assessed, including the postsurgical Cancer of the Prostate Risk Assessment (CAPRA-S) score and a definition of adverse pathology (stage≥ pT3, Gleason score≥ 4+3, or positive lymph nodes), and compared between income groups. We analyzed data of 347 AA men. Median household income was $37,954. Low-SES men had significantly higher prostate-specific antigen values (mean 10.2 vs. 7.3; P< .01) and CAPRA-S scores (mean 3.4 vs. 2.5; P< .01), more advanced pathologic stage (T3-T4 31.8% vs. 21.5%; P= .03), and higher rates of seminal vesicle invasion (17.3% vs. 8.2%; P< .01), positive surgical margins (35.3% vs. 22.1%; P< .01), and adverse pathology (41.4% vs. 30.1%; P= .03). Linear and logistic regression showed significant inverse associations of SES with CAPRA-S score (P< .01) and adverse pathology (P= .03). In a population of AA men who underwent RP, we observed an independent association of low SES with advanced stage or aggressive prostate cancer. By including only patients in a single racial demographic group, we eliminated the potential confounding effect of race on the association between SES and prostate cancer risk. These findings suggest that impoverished populations might benefit from more intensive screening and early, aggressive treatment of prostatic malignancies.

Artificial intelligence at the intersection of pathology and radiology in prostate cancer.

Pathologic grading plays a key role in prostate cancer risk stratification and treatment selection, traditionally assessed from systemic core needle biopsies sampled throughout the prostate gland. Multiparametric magnetic resonance imaging (mpMRI) has become a well-established clinical tool for detecting and localizing prostate cancer. However, both pathologic and radiologic assessment suffer from poor reproducibility among readers. Artificial intelligence (AI) methods show promise in aiding the detection and assessment of imaging-based tasks, dependent on the curation of high-quality training sets. This review provides an overview of recent advances in AI applied to mpMRI and digital pathology in prostate cancer which enable advanced characterization of disease through combined radiology-pathology assessment.

Automatic pathology of prostate cancer in whole mount slides incorporating individual gland classification

ABSTRACTThis paper presents an automatic pathology (AutoPath) approach to detect prostatic adenocarcinoma based on morphological analysis of high resolution whole mount (WM) histopathology images o...

MpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy

IntroductionUsing multiparametric magnetic resonance imaging (mpMRI), we sought to preoperatively characterize prostate cancer (PCa) in the setting of antiandrogen plus androgen deprivation therapy (AA-ADT) prior to robotic-assisted radical prostatectomy (RARP). We present our preliminary findings regarding mpMRI depiction of changes of disease staging features and lesion appearance in treated prostate. MethodsPrior to RARP, men received 6 months of enzalutamide and goserelin. mpMRI consisting of T2 weighted, b = 2,000 diffusion weighted imaging, apparent diffusion coefficient mapping, and dynamic contrast enhancement sequences was acquired before and after neoadjuvant therapy. Custom MRI-based prostate molds were printed to directly compare mpMRI findings to H&E whole-mount pathology as part of a phase II clinical trial (NCT02430480). ResultsTwenty men underwent imaging and RARP after a regimen of AA-ADT. Positive predictive values for post-AA-ADT mpMRI diagnosis of extraprostatic extension, seminal vesicle invasion, organ-confined disease, and biopsy-confirmed PCa lesions were 71%, 80%, 80%, and 85%, respectively. Post-treatment mpMRI correctly staged disease in 15/20 (75%) cases with 17/20 (85%) correctly identified as organ-confined or not. Of those incorrectly staged, 2 were falsely positive for higher stage features and 1 was falsely negative. Post-AA-ADT T2 weighted sequences best depicted presence of PCa lesions as compared to diffusion weighted imaging and dynamic contrast enhancement sequences. ConclusionmpMRI proved reliable in detecting lesion changes after antiandrogen therapy corresponding to PCa pathology. Therefore, mpMRI of treated prostates may be helpful for assessing men for surgical planning and staging.

125 The Relationship Between PSA and Total Testosterone Levels in Men with Low, Intermediate and High Grade Prostate Cancer

PSA secretion is a testosterone (T) dependent process. Data suggests that low serum total T levels are an independent predictor of higher stage, higher grade prostate cancer. However, the link between men diagnosed with intermediate (I) and high-grade (HG) prostate cancer (PC), PSA values and T deficiency (TD) has not been explored before. The aim of this study was to evaluate the relationship between T and PSA in patients with I and HGPC. All men diagnosed with prostate cancer who underwent a RP since 2000 constituted the study population, who had a record of a morning total T (TT) level measured. Patients were subdivided based on prostate cancer pathology: Gleason 6/7 with favorable pathology; Gleason 6/7 with unfavorable pathology [seminal vesicle invasion (SVI), positive margins (PM), and positive lymph node involvement (LN)]; and Gleason ≥8 (irrespective of pathology). Demographic, clinical and pathological data were analyzed. Baseline PSA levels were evaluated and patients were divided according to their pre-treatment PSA group levels: 0-2; 2.1-4; >4 ng/ml. PSA, as a predictor of total T (TT) levels was evaluated in an ordinal and continuous fashion. T levels were measured before noon using LCMS at a single laboratory, drawn within ± 30 days of RP. Low T was defined as total TT <300 ng/dL; very low T as TT < 200 ng/dl.

Intraductal Carcinoma of Prostate (IDC-P), Grade Group, and Molecular Pathology: Recent Advances and Practical Implication

The Gleason grading system for prostatic carcinoma is widely used internationally and is based on microscopic architectural patterns of tumors. Over the years, there have been modifications to the original grading system established by Donald F Gleason in 1966 and refined in 1974 which have subsequently been established by the World Health Organization in its WHO Classification of Tumors of the Urinary System and Male Genital Organs book, published in 2016. There have been certain practical issues associated with the changes, of note, the addition of intraductal carcinoma of prostate (IDC-P), which unlike its breast counterpart rarely occurs in isolation without association with invasive carcinoma and tends to be associated with high-grade invasive carcinoma. In addition, the Grade group system has been introduced which categorizes tumors into prognostically relevant groups based on the histological grade scores. The grade group system brings to light the importance of making accurate scoring and subsequent grouping of the tumors as it affects the clinical treatment, prognostic implication and stage assignment. Molecular pathology of the prostate is not widely utilized in clinical practice, but is emerging. The most common genomic aberration in prostate cancer includes gene fusion, amplification, deletion, and mutation. In addition, up and down regulation of gene expression in critical cellular pathways is also at play. A series of long noncoding RNA expression changes have been also unveiled from transcriptome sequencing data. They play a regulatory role in prostate cancer and are promising diagnostic and potentially prognostic markers as well as molecular treatment strategy. In this review, we summarize recent advances in molecular pathology of prostate cancer and their emerging clinical utility with currently available molecular tests. In this review article, we discuss the followings: 1) Gleason grading system with its modification, 2) Grade group, 3) Intraductal carcinoma, and 4) molecular pathology. Additionally, we present that molecular studies continue to emerge, and there is significant opportunity for targeted therapeutic options that remains to be explored in depth.

Prostate cancer in young men: Our experience.

133 Background: Prostate cancer (PCa) diagnosis is not uncommon in younger men. The three recognized risk factors for PCa are increasing age, african-american race and a family history (FH). Data about PCa treatment outcomes are controversial, younger men may have more aggressive disease and worse prognosis. On the other hand, more recent studies suggest higher rates of indolent PCa with more favorable outcomes in young men after radical prostatectomy (RP). We aimed to compare younger (G1, ≤ 55 yo) vs. older adults (G2, &gt; 56 yo) who underwent RP for PCa between 2010-2016 in terms of FH, race and tumor aggressiveness. Secondly, to determine if the PCa in G1 is more aggressive when there is a PCa familiar background. Methods: Between 2010-2016, 419 men underwent RP for clinically localized PCa at Central Lisbon Hospitals, of which 49 were aged ≤55 years at the time of RP. Clinical characteristics such as race, FH, PSA level, clinical stage, and biopsy Gleason score (BGS) were recorded before RP. Pathological parameters (pathological stage, GS and PSA) were collected after surgery. Results: In G1, 31% had PCa FH vs. 10% in G2 (p &lt; 0.001). Before RP, the average PSA in G1 was 7.47 vs. 8.08 in G2 (p = 0.371). In BGS, 44,3% had Gleason (G) 6, 37,4% G7, 6.9% G≥8, not significantly different between both groups (p = 0.651). Albeit, G1 had more aggressive tumors after RP: 27% G6, 45% G7 e 29% G≥8 vs. 37%, 53% e 11% respectively in G2 (p = 0.002). The pathological stage (pT) was not significantly different between groups (p = 0.243). Biochemical recurrence (BCR) was higher in G1 20% vs. 9% (p = 0.010). In a multivariate logistic regression model, the G1 had more BCR (p = 0.047) and higher PCa FH incidence (p = 0.002). When comparing african vs. caucasian men, the first group had more aggressive tumor histology (p = 0.021). Conclusions: Our study demonstrated that the youngest had superior pathological grades with higher BCR rates. Also, we found a strong relationship between G1 and FH of PCa. Data regarding pathological findings after RP in young men are still controversial. Recent studies confirm that pathological PCa characteristics in young men are not more aggressive than in older men. The present intends to add to the scientific debate around the impact of patients’ age in PCa aggressiveness and prognosis.

A multibiomarker approach to predict prostate cancer pathology outcomes.

58 Background: Distinguishing indolent from aggressive prostate cancer remains a key challenge for prostate cancer management decision-making. A growing number of biomarkers are now on the market to help address this need, but have rarely been examined together in the same patients to determine their relative value. Methods: We identified men with low-risk cancers defined by biopsy Gleason score ≤3+3, PSA ≤10ng/ml, and clinical stage ≤T2 who underwent immediate prostatectomy. We collected archived prostate tissue and pre-surgical plasma samples from N = 381 cases from UCSF and N = 279 cases from UW. Plasma was analyzed for TGFb1 and IL6SR, previously validated markers for prostate cancer prognosis, using ELISA. From prostate tissue, DNA and RNA were extracted and analyzed for the GEMCaP copy number variation score and the cell cycle progression (CCP) score, respectively, both well-validated and previously reported scores. Pathologic outcomes were minor (pGS 3+4 or pT3a) or major (pGS ≥4+3 or ≥pT3b) upgrading/upstaging (UGUS), and multinomial regression was performed to determine putative markers’ ability to predict these outcomes, controlling for PSA, percent of biopsy cores positive, age, and clinical site. Results: Overall, 357 men had no UGUS event at prostatectomy, 236 had a minor event, and 67 had a major event. Neither TGFb1 nor IL6SR statistically significantly predicted any UGUS or major UGUS. On the other hand, both CCP and GEMCaP were directly associated with minor UGUS on univariate analysis. On multivariable multinomial analysis including both scores, the CCP score predicted minor UGUS (OR 1.70, 95% CI 1.07-2.72, p = .03) and GEMCaP also predicted minor UGUS (OR 1.04, 95% CI 1.01-1.07, p &lt; .01). Neither CCP nor GEMCaP predicted major UG/US, but the number of events was small. Noteworthy, both GEMCaP and the CCP score were statistically significant predictors of outcomes in the same model, suggesting they can complement each other by offering additional information. The other clinical parameters were not significant in this model. Conclusions: Biomarker signatures based on analysis of DNA and RNA significantly and independently predict adverse pathology among men with clinically low-risk prostate cancer undergoing prostatectomy.

Evaluation of the accuracy of multiparametric MRI for predicting prostate cancer pathology and tumour staging in the real world: an multicentre study

To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) for the detection of significant prostate cancer in men undergoing radical prostatectomy (RP) in an Australian multicentre setting, and to assess concordance between mpMRI and RP for local tumour staging and index lesion locations. Men who underwent mpMRI within 12months of RP between January 2013 and August 2016 at three Australian sites were included (Central Coast, NSW, St Vincents Hospital, Melbourne, Vic., and Bendigo Hospital, Vic.). The results of mpMRI were compared with the final RP specimen to analyse the performance of mpMRI for significant prostate cancer detection, index lesion localization, prediction of T3 disease and lymph node metastasis. A comparison between mpMRI cases performed using the technical and reporting specifications of Prostate Imaging Reporting and Data System (PI-RADS) version 1 and version 2 was also performed. Data analysis was performed using spss 24.0. A total of 235 cases were included for analysis. mpMRI PI-RADS score ≥3 had a 91% sensitivity and 95% positive predictive value (PPV) for significant prostate cancer at RP. The overall concordance between index lesion location on mpMRI and RP specimen was 75%. The sensitivity for predication of significant prostate cancer was higher in the PI-RADS version 2 cases compared with PI-RADS version 1 (87-99%; P = 0.005). Index lesion concordance was higher in the PI-RADS version 2 group (68% vs 91%; P = 0.002). mpMRI had a 38% sensitivity, 95% specificity, 90% PPV and 57% negative predictive value for extraprostatic disease. Sensitivity for prediction of T3 disease improved from 30% to 62% (P = 0.008) with PI-RADS version 2. In patients undergoing RP, an abnormal mpMRI is highly predictive (95% PPV) of significant prostate cancer, with an index lesion concordance of 75%. There has been a significant improvement in accuracy after the adoption of PI-RADS version 2 technical specifications and reporting criteria; however; further study is required to determine if this is attributable to improved experience with mpMRI or changes in the PI-RADS system.

Prostate Cancer Survival Estimates by the General Public Using Unrestricted Internet Searches and Online Nomograms

BackgroundPatient understanding of cancer-associated risk influences treatment preferences and is vital for making informed treatment decisions. Although patients traditionally relied on physician visits for cancer information, most adults now use the Internet as a primary source of health information. ObjectiveTo evaluate whether US adults can accurately estimate survival for hypothetical prostate cancer patients using unrestricted Internet searching and an online nomogram. Design, setting, and participantsAdults were recruited at the Minnesota State Fair. Participants were shown a pathology report for a prostatectomy cancer specimen and asked to estimate the patient’s 15-yr survival using an unrestricted Internet search. Participants were then asked to re-estimate using a freely available, validated prostate cancer nomogram. Outcome measurements and statistical analysisParticipants’ answers were compared to a “reference” estimate and a “ballpark” estimate of ±10 percentage points of the “reference” value. Results and limitationsA total of 129 participants met the inclusion criteria and generated complete responses. Only 12% (95% confidence interval [CI] 7.8–19.2%) were within the “ballpark” estimate when using unrestricted Internet searching for overall survival estimates. 23% (95% CI 16.8–31.3%) correctly used the nomogram and 51% (95% CI 42.6–59.6%) estimated within the “ballpark” when using the nomogram. ConclusionsUse of an unrestricted Internet search often yields inaccurate estimations of life expectancy, while estimations significantly improve with nomogram use. Physicians should educate and guide patients towards credible online health resources, facilitate their effective use, and engage in discussion with patients regarding the utility of this information. Patient summaryThe general public finds it difficult to estimate prostate cancer survival using unrestricted Internet searches. Most patients would benefit from Internet guidance from their clinicians to better understand prostate cancer pathology reports.