PI-RADS Score Research Articles

MP40-08 CAN WE AVOID SYSTEMATIC BIOPSIES AND DO ONLY TARGETED BIOPSIES WHEN THERE IS A DISCERNIBLE LESION IN MRI SCAN PROSTATE WITH PIRADS SCORES 4 OR 5? A SINGLE HIGH VOLUME CENTRE RETROSPECTIVE DATA ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP40-08 CAN WE AVOID SYSTEMATIC BIOPSIES AND DO ONLY TARGETED BIOPSIES WHEN THERE IS A DISCERNIBLE LESION IN MRI SCAN PROSTATE WITH PIRADS SCORES 4 OR 5? A SINGLE HIGH VOLUME CENTRE RETROSPECTIVE DATA ANALYSIS Anish Pushkaran, Ray Hsu, Mohamed Hassan, Hassan Kadhim, Rickaz Raheem, Ahsen Razzaq, Farooq Khan, Aza Mohammed, Sanjeev Taneja, and Barnaby Barrass Anish PushkaranAnish Pushkaran More articles by this author , Ray HsuRay Hsu More articles by this author , Mohamed HassanMohamed Hassan More articles by this author , Hassan KadhimHassan Kadhim More articles by this author , Rickaz RaheemRickaz Raheem More articles by this author , Ahsen RazzaqAhsen Razzaq More articles by this author , Farooq KhanFarooq Khan More articles by this author , Aza MohammedAza Mohammed More articles by this author , Sanjeev TanejaSanjeev Taneja More articles by this author , and Barnaby BarrassBarnaby Barrass More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adopting an MRI first approach in prostate cancer diagnostic pathway has helped in decreasing the number of unnecessary prostate biopsies. Guidelines still recommend performing both targeted biopsy (TBx) and systematic biopsies (SBx) even when a lesion is detected in MRI. The prospect of doing only TBx if a definite lesion is seen in MRI is desirable as this decreases the morbidity of the procedure. However this has to be balanced against the risk of missing clinically significant prostate cancer (csPCa). We examined the data of our local anaesthetic transperineal (LATP) prostate biopsies, with MRI scan scores of PIRADS 4 & 5 and targetable lesion, and analysed the percentage of csPCa that would have been missed if only TBx were performed. METHODS: We retrospectively collected the data of 650 patients who underwent LATP biopsies in our institute from February 2019 to July 2022. 329 patients had MRI score of PIRADS 4 or 5. All these patients had SBx and TBx according to the Ginsburg TP protocol. For MRI targetable lesions a four core cognitive guidance TBx was done per target. csPCa was defined as ISUP grade group 2 or more. RESULTS: 329 patients had MRI score of PIRADS 4 or 5. 245 (74.5%) had targetable lesion and underwent both TBx and SBx. Both TBx and SBx were positive for csPCa in 39.6% (97/245). Both TBx and SBx didn’t show csPCa in 46.1% (113/245). In 5.7% (14/245), TBx showed csPCa when SBx was negative. In 8.6% (21/245), csPCa detected by SBx was missed by TBx. 15.9% (21/132) csPCa would have been missed if only TBx was performed for PIRADS 4 & 5 with an MRI targetable lesion. The sensitivity of TBx in this study was 82.2%, with specificity of 89.0% and a negative predictive value of 84.3%. CONCLUSIONS: his study from a high-volume centre suggests that adopting the TBx-only approach for MRI targetable lesions continues to miss a significant level of csPCa. Therefore adopting this strategy remains debatable Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e548 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anish Pushkaran More articles by this author Ray Hsu More articles by this author Mohamed Hassan More articles by this author Hassan Kadhim More articles by this author Rickaz Raheem More articles by this author Ahsen Razzaq More articles by this author Farooq Khan More articles by this author Aza Mohammed More articles by this author Sanjeev Taneja More articles by this author Barnaby Barrass More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-12 NATURAL HISTORY OF SMALL INDEX LESIONS ON MULTIPARAMETRIC MRI: IMPLICATIONS FOR ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023PD38-12 NATURAL HISTORY OF SMALL INDEX LESIONS ON MULTIPARAMETRIC MRI: IMPLICATIONS FOR ACTIVE SURVEILLANCE Anjali Pillai, Zoe Blake, Daniel R. Nemirovsky, Jacob J. Enders, Neil Mendhiratta, Alexander P. Kenigsberg, Michael B. Rothberg, Jibriel Noun, Daniel Nethala, Sandeep Gurram, Bradford J. Wood, Baris Turkbey, and Peter A. Pinto Anjali PillaiAnjali Pillai More articles by this author , Zoe BlakeZoe Blake More articles by this author , Daniel R. NemirovskyDaniel R. Nemirovsky More articles by this author , Jacob J. EndersJacob J. Enders More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Alexander P. KenigsbergAlexander P. Kenigsberg More articles by this author , Michael B. RothbergMichael B. Rothberg More articles by this author , Jibriel NounJibriel Noun More articles by this author , Daniel NethalaDaniel Nethala More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Bradford J. WoodBradford J. Wood More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) has demonstrated utility as an adjunct to active surveillance (AS). However, the optimal time interval between sequential MRIs is not standardized. This aims to analyze index lesion growth rates to potentially inform modern AS imaging practice. METHODS: A prospectively maintained database of patients on AS at our institution was queried for patients with ≥2 mpMRIs with no index lesion or index lesions ≤7 mm, as well as a subset of patients with no index lesion or index lesions ≤5 mm. Both cohorts were limited to patients with paired MRI-targeted biopsy showing benign or Gleason grade group (GG) 1 disease. For MRIs preceding PI-RADS scoring, an internal Likert suspicion scoring system was converted into PI-RADS scores. Imaging intervals were calculated between serial mpMRIs and growth rate was calculated with two-tailed t-tests to assess differences between initial and most recent lesion sizes measured on mpMRI. RESULTS: Between 2003-2021, patients on AS with ≥2 mpMRIs with small index lesions measuring ≤7 mm (n=123) or <5 mm (n=65) were identified (Table 1). Lesions in both the ≤7 mm (p=.015) and ≤5 mm (p=.003) cohorts demonstrated a significant change between first and last mpMRI. For the ≤7 mm cohort, average overall growth rate was 0.44±2.4 mm/year over a mean imaging interval of 1.27±0.09 years. For the ≤5 mm cohort, the average overall growth rate was 0.70±3.05 mm/year over a mean imaging interval of 1.31±0.13 years. There were 11 lesions that grew over 5 mm in the first year after initial mpMRI, however, univariate analysis of age, PSA, PI-RADS, and GG did not identify these variables as significant predictors of growth. The majority of lesions (84.6%) grew <1 mm/year (Figure 1). CONCLUSIONS: Small MRI lesions in patients on AS demonstrate minimal growth between follow up mpMRIs. This may indicate that these lesions can be followed longer surveillance intervals. Further studies are needed to prospectively identify the small subset of lesions that demonstrate more rapid growth. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e998 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anjali Pillai More articles by this author Zoe Blake More articles by this author Daniel R. Nemirovsky More articles by this author Jacob J. Enders More articles by this author Neil Mendhiratta More articles by this author Alexander P. Kenigsberg More articles by this author Michael B. Rothberg More articles by this author Jibriel Noun More articles by this author Daniel Nethala More articles by this author Sandeep Gurram More articles by this author Bradford J. Wood More articles by this author Baris Turkbey More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

Direct comparison between Grade Group assessed on systematic and MRI/ultrasound fusion targeted biopsies correlated to the radical prostatectomy specimens in patients with prostate cancer.

To compare the correlation of Gleason score (GS) and ISUP grade determined by prostate biopsies (PBx) and radical prostatectomy (RP) specimens according to the biopsy technique: ultrasound randomised (RBx) vs. MRI/ultrasound fusion targeted (TBx). Between March 2013 and June 2018, we retrospectively included patients who underwent RP for prostate cancer (PCa) histopathologically proven by RBx and/or TBx. All patients had a prebiopsy MRI by a single radiologist (using PI-RADS score), then transrectal RBx (12cores, blinded to MRI lesions) and TBx (2-4 cores/target) with elastic MRI/ultrasound fusion (UroStation™, Koelis, Grenoble, France). Histological findings were compared: PBx vs. RP. One hundred and four patients underwent RP after RBx and/or TBx. ISUP concordance rate was better with the association RBx+TBx 49% (51/104) vs. 43.3% with TBx (P=0.07) and 43.3% with RBx (P=0.13). With RBx, 50% of the patients were downgraded (52/104) against 42.3% (44/104) with TBx (P=0.088). The association RBx+TBx significantly decreased the rate of downgrading of the ISUP score compared to the ISUP score of RP 35.6% (37/104) vs. RBx (50%, P=0.0001) and vs. TBx (42.3%, P=0.016). In half of cases, the ISUP score was underestimated in RBx compared to RP specimens. Adding TBx to RBx significantly reduced downgrading. The combination of both biopsy techniques appeared to be the best protocol to get closer to ISUP score and GS of the RP specimens. C.

PD10-06 A NOMOGRAM TO PREDICT LYMPH NODE INVOLVEMENT IN CANDIDATES TO ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH IT3 PROSTATE CANCER ON PREOPERATIVE MULTIPARAMETRIC MRI AS UNIQUE HIGH-RISK FEATURE

PD10-06 A NOMOGRAM TO PREDICT LYMPH NODE INVOLVEMENT IN CANDIDATES TO ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH IT3 PROSTATE CANCER ON PREOPERATIVE MULTIPARAMETRIC MRI AS UNIQUE HIGH-RISK FEATURE

PD39-06 INTEGRATING INDEX LESION VOLUME TO BETTER CLASSIFY MEN WITH INDOLENT PROSTATE CANCER AMONG PATIENTS WITH INTERMEDIATE RISK DISEASE. RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

PD39-06 INTEGRATING INDEX LESION VOLUME TO BETTER CLASSIFY MEN WITH INDOLENT PROSTATE CANCER AMONG PATIENTS WITH INTERMEDIATE RISK DISEASE. RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

MP67-07 CAN WE PREDICT THE SITE OF POSITIVE SURGICAL MARGINS (PSM) BASED ON THE SITE OF THE INDEX LESION AT MULTIPARAMETRIC MRI? A TOPOGRAPHIC SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP67-07 CAN WE PREDICT THE SITE OF POSITIVE SURGICAL MARGINS (PSM) BASED ON THE SITE OF THE INDEX LESION AT MULTIPARAMETRIC MRI? A TOPOGRAPHIC SINGLE CENTER STUDY Francesco Pellegrino, Giorgio Gandaglia, Armando Stabile, Elio Mazzone, Giuseppe Rosiello, Gabriele Sorce, Luigi Nocera, Simone Scuderi, Francesco Barletta, Riccardo Leni, Mario De Angelis, Antony Pellegrino, Pietro Scilipoti, Paolo Zaurito, Emanuele Zaffuto, R. Jeffrey karnes, Morgan Roupret, Francesco Montorsi, and Alberto Briganti Francesco PellegrinoFrancesco Pellegrino More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Armando StabileArmando Stabile More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Paolo ZauritoPaolo Zaurito More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , R. Jeffrey karnesR. Jeffrey karnes More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The impact of multiparametric MRI on surgical approach during radical prostatectomy (RP) and on oncological outcomes after surgery is still controversial. We aimed at performing a detailed topographic description of the site of PSM according to the topographic location of IL at MRI. METHODS: Overall, 111 PCa patients undergoing MRI-targeted biopsy and bilateral nerve sparing RP at our centre between 2016 and 2022. All patients had PSM at final pathology. All patients had a single visible suspicious IL at MRI (PIRADS ≥3). We evaluated the site of PSM based on the IL location at MRI. IL and PSM location were categorized using the 3 regions scheme (Right vs Left vs Bilateral). We graphically described the site of PSM based on the IL using the alluvial plot. We evaluated whether the IL was correlated with the location of PSM (right vs left) using Pearson’s chi-square test. RESULTS: PIRADS score was 3, 4, and 5 in 22 (20%), 44 (40%), and 48 (40%) patients, respectively. Median IL volume was 1.3 cc. Overall, 10 (9%), 42 (38%) and 59 (53%) ILs were bilateral, on the left and right hemigland, respectively. Clinically significant PCa (defined as a Gleason score ≥7) was found in 93 (84%) patients at biopsy. At final pathology, extra capsular extension was found in 58 (52%) patients. Overall, 13 (12%), 41 (37%), and 57 (51%) patients had bilateral, left, and right PSM, respectively. The topographic distribution of the site of PSM according to the topographic location of the ROI is reported in Figure 1. The majority of PSMs were ipsilateral to the IL location. For instance, among the 59 patients with IL in the right emigland, 93% (n=55) had ipsilateral PSM, 3% (n=2) had contralateral PSM and 3% (n=2) had bilateral PSM. After excluding bilateral PSM, IL location was strongly associated with the site of PSM (p<0.001). CONCLUSIONS: Our analyses demonstrated that the majority of PSM are located on the same side of the MRI-visible lesion. A conservative nerve sparing RP approach could thus be safely considered to be performed on the contralateral side of IL at mpMRI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e945 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Pellegrino More articles by this author Giorgio Gandaglia More articles by this author Armando Stabile More articles by this author Elio Mazzone More articles by this author Giuseppe Rosiello More articles by this author Gabriele Sorce More articles by this author Luigi Nocera More articles by this author Simone Scuderi More articles by this author Francesco Barletta More articles by this author Riccardo Leni More articles by this author Mario De Angelis More articles by this author Antony Pellegrino More articles by this author Pietro Scilipoti More articles by this author Paolo Zaurito More articles by this author Emanuele Zaffuto More articles by this author R. Jeffrey karnes More articles by this author Morgan Roupret More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

MP12-18 RACIAL DISPARITY IN PROSTATE CANCER DIAGNOSIS: A COMPARISON OF PROSTATE BIOPSY RESULTS IN AFRICAN AMERICAN AND WHITE MEN USING AN MRI-BASED BIOPSY STRATEGY.

You have accessJournal of UrologyCME1 Apr 2023MP12-18 RACIAL DISPARITY IN PROSTATE CANCER DIAGNOSIS: A COMPARISON OF PROSTATE BIOPSY RESULTS IN AFRICAN AMERICAN AND WHITE MEN USING AN MRI-BASED BIOPSY STRATEGY. Ali Kasraeian, Miguel Alcantara, Kaitlyn Mola Alcantara, Adam Brochert, Joshua Yellin, Eliana Namen, Sean Parsons, Jamie Cesaretti, and Ahmad Kasraeian Ali KasraeianAli Kasraeian More articles by this author , Miguel AlcantaraMiguel Alcantara More articles by this author , Kaitlyn Mola AlcantaraKaitlyn Mola Alcantara More articles by this author , Adam BrochertAdam Brochert More articles by this author , Joshua YellinJoshua Yellin More articles by this author , Eliana NamenEliana Namen More articles by this author , Sean ParsonsSean Parsons More articles by this author , Jamie CesarettiJamie Cesaretti More articles by this author , and Ahmad KasraeianAhmad Kasraeian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: African American (AA) men in the United States have an increased burden of morbidity and mortality from prostate cancer (PCa). The roles of factors related to both racial disparities and intrinsic biological traits remain to be determined. We quarried our prospective database of standard and MRI fusion prostate biopsies (tMRI/US FPB) to determine if any pre-biopsy characteristics predicted adverse tumor pathology. METHODS: Between January 2017 and September 2022, 828 men underwent prostate biopsy (PBx) using an MRI-based algorithm. Men with negative MRI underwent standard PBx (n=440), while those with lesion on mpMRI underwent tMRI/US FPB (n=388). All patients underwent mpMRI of the prostate, interpreted by a single radiologist using the PIRADS scoring system. 3D rendering of the regions of interest was performed by the radiologist prior to tMRI/US FPB performed by a single urologist using the Invivo UroNav Fusion Biopsy System. A standard 14-core PBx was performed at the same time in all tMRI/US FPB cases. Prospective data was collected and analyzed. RESULTS: Of the 828 men who underwent standard and tMRI/US FP with 14Bx (tMRI/US FP-14Bx), 593 presented with a rise in PSA, while 235 had a suspicious digital rectal exam. Prostate Cancer was found in 367/608 (60%) of the White men and 104/147 (70.8%) of AA men in our series (p=0.02). 224/608 (36.8%) of White men and 74/147 (50.3%) of AA men had a Gleason score of 7-10 (p=0.003). Age, DRE status, PIRADS score, and the incidence of Gleason 6 PCa were not found to be significantly different by race. 163/608 (26.8%) of White men and 20/147 (13.6%) of AA men had a PSA upon presentation of 0-3.9 ng/ml (p=0.001). The PSA levels of 4.0-9.9 ng/ml and PSA > 10 ng/ml at presentation were not significantly different. Of the 73/828 (8.8%) of men who identify as not White and not Black no significant difference was found for any tested factor but interestingly 19/73 (26%) presented with a PSA between 0-3.9 ng/ml versus Black men (p=0.02) which was almost identical to the effect seen relative to White men. CONCLUSIONS: In this dataset, it appears that AA men present with a higher PSA than White men. It is likely that this is related to disparities in access to care rather than biological intrinsic factors. Also, we did observe a higher incidence of Gleason 7-10 PCa in AA men, which one would expect in a cohort of patients who presented for biopsy in the community with a significantly higher PSA at initial presentation. Continuing education of primary care providers regarding the importance of PSA testing in the AA community should be emphasized by both the urological and primary care professional medical societies. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e140 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Kasraeian More articles by this author Miguel Alcantara More articles by this author Kaitlyn Mola Alcantara More articles by this author Adam Brochert More articles by this author Joshua Yellin More articles by this author Eliana Namen More articles by this author Sean Parsons More articles by this author Jamie Cesaretti More articles by this author Ahmad Kasraeian More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-08 AVOIDING UNNECESSARY TARGETED PROSTATE BIOPSIES USING MACHINE LEARNING

You have accessJournal of UrologyCME1 Apr 2023PD38-08 AVOIDING UNNECESSARY TARGETED PROSTATE BIOPSIES USING MACHINE LEARNING Roxana Esmaili, Ghazal Khajir, Michael Leapman, Preston Sprenkle, Darryl Martin, and John Onofrey Roxana EsmailiRoxana Esmaili More articles by this author , Ghazal KhajirGhazal Khajir More articles by this author , Michael LeapmanMichael Leapman More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , Darryl MartinDarryl Martin More articles by this author , and John OnofreyJohn Onofrey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI)-targeted transrectal ultrasound (TRUS) guided needle biopsy is the current gold standard for diagnosing prostate cancer in patients with suspicion for prostate cancer. This leads to a frequent needle biopsy to determine the presence of clinically significant prostate cancer (csPCa) with a high rate of invasive overdiagnosis in patients with non-aggressive cancer. Supervised machine learning (ML) algorithms provide a mathematical framework to make predictions about csPCa in order to make personalized decisions to perform a biopsy or not and avoid unnecessary targeted needle biopsies. METHODS: From January 2016 to February 2020, 1099 patients underwent multiparametric MRI before TRUS fusion biopsy. We included PI-RADS score (version 2), gland volume, lesion region of interest volume before biopsy, PSA value, PSA density, and patient age at the time of biopsy as input variables to calculate the probability of csPCa for each lesion for each patient before biopsy using different ML classification algorithms: logistic regression (LR); random forest (RF); naïve Bayes (NB); and nearest neighbor (NN). Gleason Grade Group ≥2 was used as a reference for the presence of csPCa. Ten-fold cross-validation stratified over patients validated the ML approaches and compared to univariate models. RESULTS: Area under the receiver operating characteristic curves (AUC) and net reduction curves show that multivariate LR (AUC 81.3%) outperformed RF (AUC 79.2%), NN (AUC 71.8%) and NB (AUC 78.3%) and outperformed standard univariate LR using PSA density (AUC 71.4%) and PI-RADS (AUC 73.9%). The algorithms were evaluated at a point on the ROC curve for high sensitivity. Using the multivariate LR model, 636 (41.38%) targeted biopsies could have been avoided while missing only 90 (5.86%) csPCa, which is reasonable with a threshold probability of 25% and a net benefit of 0.21. CONCLUSIONS: Our findings suggest that multivariate ML models using clinical data can be used to avoid unnecessary targeted biopsy cores among patients with suspicion of prostate cancer undergoing prostate biopsy. Source of Funding: JAO supported by NIH R42 CA224888. DTM supported by DoD W81XWH-19-PCRP-IDA. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e996 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roxana Esmaili More articles by this author Ghazal Khajir More articles by this author Michael Leapman More articles by this author Preston Sprenkle More articles by this author Darryl Martin More articles by this author John Onofrey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP09-09 CORRELATION BETWEEN PROSTATE MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND HIGH-RESOLUTION MICRO-ULTRASOUND

You have accessJournal of UrologyCME1 Apr 2023MP09-09 CORRELATION BETWEEN PROSTATE MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND HIGH-RESOLUTION MICRO-ULTRASOUND Nicholas Pickersgill, M. Hassan Alkazemi, Joel Vetter, Adam Ostergar, Nimrod Barashi, Grant Henning, and Arjun Sivaraman Nicholas PickersgillNicholas Pickersgill More articles by this author , M. Hassan AlkazemiM. Hassan Alkazemi More articles by this author , Joel VetterJoel Vetter More articles by this author , Adam OstergarAdam Ostergar More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , Grant HenningGrant Henning More articles by this author , and Arjun SivaramanArjun Sivaraman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate multiparametric magnetic resonance imaging (pMRI) has emerged as a valuable tool in the diagnostic pathway for prostate cancer. The recent introduction of high-resolution micro-ultrasound (microUS) guided prostate biopsy aims to further improve the detection of clinically significant prostate cancer (CSCaP). The correlation between these two imaging modalities is poorly understood. We investigated correlation in lesion identification between microUS and pMRI. METHODS: We reviewed our prospectively maintained database of 200 consecutive patients who underwent transperineal microUS-guided biopsy with the ExactVu™platform (Exact Imaging, Markham, Canada) between February 2021 and April 2022. The Prostate Risk Identification using MicroUS (PRI-MUS) protocol was utilized to risk stratify prostate lesions, with PRI-MUS 3-5 defined as positive. pMRI lesions were classified according to PI-RADS version 2. Clinicopathologic outcomes were analyzed. Spearman correlation testing was computed to assess the relationship between PRI-MUS and PI-RADS. Patients with sufficient data for analysis were included. RESULTS: A total of 159 patients met inclusion criteria. Of these, 117 were biopsy-naïve, 19 had a prior negative biopsy and 20 were on active surveillance. Mean±standard deviation (SD) age was 66.6±7.7 years and PSA was 10.1±4.4 ng/mL. A total of 112 patients underwent multiparametric magnetic resonance imaging (mpMRI) prior to biopsy, of which 56 were found to have PIRADS 3-5 lesions. There was a weak positive correlation between PRI-MUS and PI-RADS (r=0.23, p=0.013) (Figure 1). CONCLUSIONS: This preliminary comparison between PRI-MUS and PI-RADS scoring demonstrates a weak positive correlation between the two modalities. This may be attributable to a significant number of patients with negative pMRI who were found to have PRI-MUS 3-5 lesions. Given the rising utilization of micro-US-guided prostate biopsy and widespread use of pMRI, further prospective studies are needed to compare their ability to detect clinically significant prostate cancer. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e107 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Pickersgill More articles by this author M. Hassan Alkazemi More articles by this author Joel Vetter More articles by this author Adam Ostergar More articles by this author Nimrod Barashi More articles by this author Grant Henning More articles by this author Arjun Sivaraman More articles by this author Expand All Advertisement PDF downloadLoading ...

Optimizing detection of clinically significant prostate cancer through nomograms incorporating mri, clinical features, and advanced serum biomarkers in biopsy naïve men.

To develop nomograms that predict the detection of clinically significant prostate cancer (csPCa, defined as ≥GG2 [Grade Group 2]) at diagnostic biopsy based on multiparametric prostate MRI (mpMRI), serum biomarkers, and patient clinicodemographic features. Nomograms were developed from a cohort of biopsy-naïve men presenting to our 11-hospital system with prostate specific antigen (PSA) of 2-20 ng/mL who underwent pre-biopsy mpMRI from March 2018-June 2021 (n = 1494). The outcomes were the presence of csPCa and high-grade prostate cancer (defined as ≥GG3 prostate cancer). Using significant variables on multivariable logistic regression, individual nomograms were developed for men with total PSA, % free PSA, or prostate health index (PHI) when available. The nomograms were both internally validated and evaluated in an independent cohort of 366 men presenting to our hospital system from July 2021-February 2022. 1031 of 1494 men (69%) underwent biopsy after initial evaluation with mpMRI, 493 (47.8%) of whom were found to have ≥GG2 PCa, and 271 (26.3%) were found to have ≥GG3 PCa. Age, race, highest PIRADS score, prostate health index when available, % free PSA when available, and PSA density were significant predictors of ≥GG2 and ≥GG3 PCa on multivariable analysis and were used for nomogram generation. Accuracy of nomograms in both the training cohort and independent cohort were high, with areas under the curves (AUC) of ≥0.885 in the training cohort and ≥0.896 in the independent validation cohort. In our independent validation cohort, our model for ≥GG2 prostate cancer with PHI saved 39.1% of biopsies (143/366) while only missing 0.8% of csPCa (1/124) with a biopsy threshold of 20% probability of csPCa. Here we developed nomograms combining serum testing and mpMRI to help clinicians risk stratify patients with elevated PSA of 2-20 ng/mL who are being considered for biopsy. Our nomograms are available at https://rossnm1.shinyapps.io/MynMRIskCalculator/ to aid with biopsy decisions.

Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center.

Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018-2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D'Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.

Impact of prostate MRI central review over the diagnostic performance of MRI-targeted biopsy: should we routinely ask for an expert second opinion?

There is substantial variability in multiparametric MRI (mpMRI) protocols and inter-readers' agreement. We tested the effect of a central mpMRI review on the detection of clinically significant PCa (csPCa) in a tertiary referral center. We retrospectively analyzed a cohort of 364 consecutive men with a positive externally performed mpMRI (PI-RADS ≥ 3) who underwent a targeted biopsy (TBx) plus a systematic biopsy at a single tertiary referral center (2018-2020). Of those mpMRIs, 32% (n = 116) were centrally reviewed. We compared the detection of csPCa between the non-central-reviewed vs reviewed group. Multivariable logistic regression models (MVA) tested the relationship between mpMRI central review and the detection of csPCa at TBx. The detection of csPCa at TBx in non-central-reviewed vs central-reviewed group was 41 vs 63%, respectively (p = 0.001). The distribution of PI-RADS 2, 3, 4, and 5 at initial assessment vs after mpMRI central review was 0, 37, 47, and 16% vs 39, 9, 35, and 16%, respectively (p < 0.004). Of 43 patients with initial PI-RADS 3 score, respectively 67, 21, and 12, and 0% had a revised PI-RADS score of ≤ 2, 3, 4, and 5. At MVA, mpMRI central review (OR: 1.65, CI 0.85-0.98) was significantly associated with higher csPCa detection at TBx. We demonstrated that a central review of external mpMRIs may decrease the overcall of equivocal lesions, namely PI-RADS 3, and should be considered to maximize the clinical benefit of TBx in terms of increasing the detection of csPCa and eventually decreasing the rate of unnecessary biopsies.

The Feasibility and Value of a Focal Therapy Multidisciplinary Tumor Board, Including Radiographic and Pathologic Overreads in Refining the Selection for High Intensity Focused Ultrasound in Prostate Cancer Patients.

Focal therapy (FT) for prostate cancer is increasingly recognized as an acceptable therapeutic option in well selected men. A focal therapy multidisciplinary tumor board (MTB) geared towards improving patient selection is a novel concept, which has not been reported. We describe our institution's initial experience with MTB for FT and its outcomes in terms of patient selection. This was a single-center, prospective study of patients referred to a MTB. All prostate MRI's were re-reviewed by a single radiologist with >10 years of experience, and the number, size, location and PI-RADS scores of lesions visible on MRI were recorded and compared to the original report. Outside histopathology, when requested, was also re-reviewed for cancer grade groups and adverse pathologic features. A descriptive statistical analysis was performed. Seventy-four were presented at our MTB (January-October 2022). Sixty-seven patients were treatment naïve while 7 had prior radiation +/- ADT. MRI over-read was performed on all treatment naïve patients 67/74 (91%) while pathology over-reads on 14/74 (19.9%). Following MTB, 19 patients (25.6%) were deemed suitable candidates for FT. A total of 24 patients (35.8%) were not deemed HIFU FT candidates based exclusively on findings identified at MRI overread. Pathology re-review changed management for 3/14 patients with 2/3 being downgraded to GG1 disease and opting for active surveillance. MTB for FT is feasible. MRI overread is an essential component of this process and demonstrates significant findings that alters eligibility or management in over a third of patients.

Expanding inclusion criteria for active surveillance in intermediate-risk prostate cancer: a machine learning approach.

To develop new selection criteria for active surveillance (AS) in intermediate-risk (IR) prostate cancer (PCa) patients. Retrospective study including patients from 14 referral centers who underwent pre-biopsy mpMRI, image-guided biopsies and radical prostatectomy. The cohort included biopsy-naive IR PCa patients who met the following inclusion criteria: Gleason Grade Group (GGG) 1-2, PSA < 20ng/mL, and cT1-cT2 tumors. We relied on a recursive machine learning partitioning algorithm developed to predict adverse pathological features (i.e., ≥ pT3a and/or pN + and/or GGG ≥ 3). A total of 594 patients with IR PCa were included, of whom 220 (37%) had adverse features. PI-RADS score (weight:0.726), PSA density (weight:0.158), and clinical T stage (weight:0.116) were selected as the most informative risk factors to classify patients according to their risk of adverse features, leading to the creation of five risk clusters. The adverse feature rates for cluster #1 (PI-RADS ≤ 3 and PSA density < 0.15), cluster #2 (PI-RADS 4 and PSA density < 0.15), cluster #3 (PI-RADS 1-4 and PSA density ≥ 0.15), cluster #4 (normal DRE and PI-RADS 5), and cluster #5 (abnormal DRE and PI-RADS 5) were 11.8, 27.9, 37.3, 42.7, and 65.1%, respectively. Compared with the current inclusion criteria, extending the AS criteria to clusters #1 + #2 or #1 + #2 + #3 would increase the number of eligible patients (+ 60 and + 253%, respectively) without increasing the risk of adverse pathological features. The newly developed model has the potential to expand the number of patients eligible for AS without compromising oncologic outcomes. Prospective validation is warranted.

Index lesion contouring on prostate MRI for targeted MRI/US fusion biopsy – Evaluation of mismatch between radiologists and urologists

PurposeMistargeting of focal lesions due to inaccurate segmentations can lead to false-negative findings on MRI-guided targeted biopsies. The purpose of this retrospective study was to examine inter-reader agreement of prostate index lesion segmentations from actual biopsy data between urologists and radiologists. MethodConsecutive patients undergoing transperineal MRI-targeted prostate biopsy for PI-RADS 3–5 lesions between January 2020 and December 2021 were included. Agreement between segmentations on T2w-images between urologists and radiologists was assessed with Dice similarity coefficient (DSC) and 95 % Hausdorff distance (95 % HD). Differences in similarity scores were compared using Wilcoxon test. Differences depending on lesion features (size, zonal location, PI-RADS scores, lesion distinctness) were tested with Mann-Whitney U test. Correlation with prostate signal-intensity homogeneity score (PSHS) and lesion size was tested with Spearman’s rank correlation. ResultsNinety-three patients (mean age 64.9 ± 7.1y, median serum PSA 6.5 [4.33–10.00]) were included. Mean similarity scores were statistically significantly lower between urologists and radiologists compared to radiologists only (DSC 0.41 ± 0.24 vs. 0.59 ± 0.23, p < 0.01; 95 %HD 6.38 ± 5.45 mm vs. 4.47 ± 4.12 mm, p < 0.01). There was a moderate and strong positive correlation between DSC scores and lesion size for segmentations from urologists and radiologists (ρ = 0.331, p = 0.002) and radiologists only (ρ = 0.501, p < 0.001). Similarity scores were worse in lesions ≤ 10 mm while other lesion features did not significantly influence similarity scores. ConclusionThere is significant mismatch of prostate index lesion segmentations between urologists and radiologists. Segmentation agreement positively correlates with lesion size. PI-RADS scores, zonal location, lesion distinctness, and PSHS show no significant impact on segmentation agreement. These findings could underpin benefits of perilesional biopsies.

Magnetic resonance imaging radiomic features for recurrent prostate cancer following proton radiation therapy-A pilot study.

The role of multiparametric MRI (mp-MRI) for postproton radiation evaluation is unclear. In this pilot study, we characterize the mp-MRI features using the Prostate Imaging-Reporting and Data System (PI-RADS) for recurrent prostate cancer (PCa) following proton radiation therapy. After obtaining IRB approval, we identified 163 consecutive cases who underwent MRI-fusion prostate biopsy at our institution from November 2017 to May 2020. This study evaluated patients with prostate cancer (PCa) with biochemical recurrence following proton radiation. Patients were excluded if they had grossly metastatic disease, metal fragments, implanted devices, or with surgically removed prostates. The mpMRI studies were reviewed in depth and scored by 2 fellowship-trained radiologists. Following MRI-fusion biopsy of lesions of interest (LOI), slides were read by fellowship-trained pathologists. We found 14 patients with 16 lesions who met the study inclusion criteria. The median age was 69 years (range 57-79) and median time to biochemical recurrence was 7.3 years (range 3-13). On post-treatment imaging, decreases in prostate size and diffusely decreased T2 signal intensity were observed, making the use of apparent diffusion coefficient (ADC) and early enhancement at dynamic contrast enhanced (DCE) imaging often necessary for diagnosis of disease recurrence. We identified a total of 16 lesions with PIRADS scores of 3 or higher. Of these lesions, there were 5 PIRADS 3 lesions (4/5 (80%) without prostate cancer), 7 PIRADS 4-5 lesions (6 (86%) had high risk Pca), and 4 lesions with unassigned PIRADS scores (100% had high risk cancers). Among the MRI variables, diffusion weighted imaging (DWI) heterogeneity had the strongest association with recurrence of PCa (P < 0.001). Results of our pilot study showed that the PIRADS scoring system in the postproton radiation therapy setting has some correlations with prostate cancer recurrence; However, the clinical value of these findings are unclear. While definitive PIRADS categorization of lesions demonstrated expected frequency of cancer consistent with the scoring system, all unassigned lesions also harbored malignancy suggesting a cautious approach to PIRADS scoring system in postproton radiation setting. The findings from this study may be validated using a larger cohort.

The Severity of Pain in Prostate Biopsy Depends on the Biopsy Sector.

The pain experienced by a patient during a prostate fusion biopsy is cumulative and can also be modulated by many factors. The aim of the study was to assess the association between the degree of pain intensity during prostate biopsy and the region of the biopted organ. The study included a group of 143 patients who underwent prostate fusion biopsy under local analgesia followed by blockage of the periprostatic nerve. After a biopsy, the patients completed the original questionnaire about the pain experienced during the procedure. There was a statistically significant difference in pain score between cores taken in the apex (median 5 (IQR 2-5)), medium level (median 1 (IQR 1-2)), and prostate base (median 1 (IQR 1-3)) (p < 0.001). The malignancy scale ISUP ≥ 2 (p = 0.038) and lower PSA value (r = -0.17; p = 0.046) are associated with higher pain during procedure. Biopsy time was correlated with discomfort (r = 0.19; p = 0.04). Age (p = 0.65), lesion size (p = 0.29), PI-RADS score (p = 0.86), prostate volume (p = 0.22), and the number of cores (p = 0.56) did not correspond to the pain scale. The apex is the most sensitive sector of the prostate. ISUP ≥ 2 and patients with low PSA levels more often indicated higher values on the pain rating scale.

Short term pathologic outcomes and biochemical recurrence rates of single port transvesical retzius-sparing radical prostatectomy as compared to multiport radical prostatectomy.

369 Background: Single port radical prostatectomy with a transvesical Retzius-sparing approach (SPRP) has shown technical feasibility and early evidence of improved time to urinary continence. How this novel approach leads to differences in pathologic outcomes and biochemical recurrence rates (BCR) as compared to multiport radical prostatectomy (MPRP) has yet to be investigated. Our goal was thus to study the pathologic and short term survival outcomes of patients undergoing SPRP as compared to those undergoing MPRP. Methods: Single center, single surgeon retrospective review of prospectively collected data on 169 patients with low and intermediate risk prostate cancer, whom either underwent SPRP or MRPR (2017-2022). Preoperative clinicopathologic and radiographic characteristics were compared. Following RP, pathologic outcomes, including T stage, grade group (GG), margin status, extraprostatic extension (EPE), seminal vesical invasion (SVI), node retrieval rates, lymph node invasion (LNI) and other adverse histopathologic features were compared between both groups. Cox proportional hazards univariate analysis was used to evaluate the impact of SPRP on biochemical recurrence free survival as compared to MPRP with a three year follow up. Results: A total of 84 patients underwent MPRP and 85 patients underwent SPRP. The SPRP cohort had a higher proportion of clinical T stage one as compared to the MPRP cohort (99% vs 85%, p=0.04), however both groups did not differ preoperatively in terms of median total PSA (6.9 MPRP vs 6.2 SPRP, p=0.24), PI-RADS score (p=0.60) or biopsy GG (p=0.52). Following RP, both groups had similar pathologic outcomes including final grade group, T stage, EPE rates, SVI and Cribriform/intraductal rates (p&gt;0.05). SPRP did yield a lower median number of nodes as compared to MPRP (2 (0-5) vs 6(4-9), p&lt;0.001), but this did not translate to differences in LNI (p=0.08). At a median of approximately 12 months of follow up, there were no differences in the biochemical recurrence-free survival rates among both groups (p=0.38). Cox proportional hazards univariate analysis did not consider SPRP to be an independent predictor of biochemical recurrence (HR 0.53, 95% CI 0.13-2.23, p=0.39). Conclusions: In well selected men, SPRP yields similar short term oncologic control as MPRP with equal rates of margin status, EPE/SVI invasion rates and rates of biochemical recurrence at 1 year. In this small, early, single surgeon experience, SPRP appears to be oncologically safe for low and intermediate risk prostate cancer patients, however longer follow up is necessary, larger numbers and multi- institutional comparisons are needed.

Multi-reader evaluation of different image quality scoring systems in prostate MRI

ObjectivesTo evaluate different image quality scoring systems in the assessment of factors limiting diagnostic accuracy of prostate MRI. MethodsThis retrospective IRB-approved study included 281 patients undergoing prostate MRI prior to biopsy. Four readers (2 experienced, 2 novice) independently reviewed all MRI examinations (n = 295) and assigned scores for subjective image quality (1–5; 1:poor, 5:excellent), the PI-QUAL and the PSHS scoring system. The original PI-RADS scores were extracted from the report and transperineal template saturation biopsy served as histopathological reference. ResultsInter-reader agreement was found to be good, with PSHS showing highest agreement (kappa: 0.65). The PSHS scoring system performed well assessing the influence of image quality on sensitivity of MR for clinically-significant cancer for the experienced readers using a PI-RADS score cut-off ≥ 3/≥4, as did the PI-QUAL scoring system with a PI-RADS cut-off ≥ 4. For the less experienced radiologist, this was true for PSHS (clinically-significant and all cancers) and PI-QUAL scores (clinically-significant cancers) for a PI-RADS score ≥ 3. PSHS scores were positively associated with the detection of clinically-significant cancer based on a PI-RADS cut-off ≥ 4, OR 1.86 (95 % CI 1.22–2.82), and had the highest Somers’ D. ConclusionsThe PSHS scoring system performed well in assessing the effect of image quality on detection rates, as did the PI-QUAL system. Since both systems focus on different aspects of image quality, their incorporation into prostate MRI reports could further enhance standardization and allow for a reliable assessment of image quality as a potential confounder in prostate MRI.

Can we replace systematic prostate biopsies with targeted biopsy only strategies in PiRADS score 4 or 5? A single high volume centre retrospective data analysis

Can we replace systematic prostate biopsies with targeted biopsy only strategies in PiRADS score 4 or 5? A single high volume centre retrospective data analysis