Previous Prostate Biopsy Research Articles

Is there any association between prostate-specific antigen screening frequency and uptake of active surveillance in men with low or very low risk prostate cancer?

BackgroundPatient-related factors such as concern about cancer are believed to influence both men’s decisions to undergo prostate specific antigen (PSA) testing and to have definitive treatment if diagnosed with low risk prostate cancer (PCa). The potential link between screening frequency and choice of active surveillance (AS) for low risk disease has not been studied previously. Our aim was to investigate whether there is any association between PCa screening frequency or previous negative prostate biopsy and uptake of AS among men with low risk PCa.MethodsThis register-based study included all men ≤75 years from Stockholm who were diagnosed with low risk PCa from 2008 to 2014 (n = 4336). Pre-diagnostic PSA testing and biopsy histories were obtained from the Stockholm PSA and Biopsy Register, a population-based register for the Stockholm country. The association between previous screening/biopsy history and AS uptake (based on primary treatment recorded in the National Prostate Cancer Register) was examined using multivariable logistic regression.ResultsForty seven percent of men with low risk PCa underwent AS. Uptake was associated with older age, very low risk disease, more recent diagnosis and absence of family history. None of the screening/biopsy measures (testing frequency, mean interval, PSA velocity, highest pre-diagnostic PSA or prior negative biopsy) were associated with uptake of AS among men with low risk PCa. Generalisability to settings with different policies and practices may be limited.ConclusionWe found no evidence that screening frequency and negative biopsy influence uptake of AS among Swedish men with low risk PCa. Further research is required to determine factors that still present barriers for men taking up AS.

Comparison of classical transrectal prostate biopsy versus cognitive registration in rebiopsy

IntroductionThe aim of this study is to compare performance of two biopsy approaches in patients with at least one previous negative prostate biopsy (PB): classical transrectal biopsy (ClTB) versus cognitive registration biopsy (COG-TB). Material and methodsA retrospective study of 205 patients with at least one negative PB. 144 (70.2%) patients underwent a prior mpMRI and 61 (29.8%) patients did not.Nodule classification was carried out according PI-RADS version 2. Peripheral zone (PZ) grouped pZa, pZpl and pZpm areas, transition zone (TZ) Tza, Tzp and Cz areas, and anterior zone (AZ) AS areas.COG-TB was conducted in patients with previous mpMRI (144); while in the remaining 61 (29.8%) patients a ClTB of PZ and TZ was performed.Statistical analysis was performed using Chi square and T-student tests for qualitative and quantitative variables, respectively. Multivariate analysis was carried out in order to identify predictive variables of prostate cancer. ResultsMedian patient age was 68 (IQR 62–72) years, median PSA was 8.3 (IQR 6.2–11.7) ng/ml and median previous biopsies was 1 (IQR 1–2). Digital rectal examinations (DRE) findings were normal in 169 (82.4%) patients and suspicious in 36 (17.6%) patients (cT2a-b in 34 patients and cT2c in 2). Median prostate volume was 48 (IQR 38–65) cc. Statistically significant differences in PSAD between both groups were found (p=0.03).Transrectal ultrasound (TRUS) showed hypoechoic nodules in 8 (13.1%) ClTB patients and in 62 (43.1%) COG-TB patients (p=0.0001).The median number of biopsy cylinders per set of prostate biopsies was 10 (IQR 10–10) in ClTB group and 11 (IQR 9–13) in COG-TB group (p=0.75).Cancer was diagnosed in 74 (36.1%) patients: of them, 10 (16.4%) were ClTB patients and 64 (44.4%) COG-TB (p=0.0001).Tumors classification was as follow: ISUP-1: 34 (45.9%), ISUP-2: 21 (28.4%), ISUP-3: 9 (12.2%), ISUP-4: 7 (9.5%) and ISUP-5: 3 (4.1%). No significant statistical differences were found (p=0.89). The median number of biopsy cylinders impaired per set of prostate biopsies was 1 (IQR 1–5) in ClTB group and 2 (IQR 1–4) in COG-TB group (p=0.93).Regarding independent predictive variables for prostate cancer the results were: age (OR=12.05; p=0.049), suspicious DRE (OR=2.64; p=0.04), hypoechoic nodule (OR=2.20; p=0.03) and mpMRI +COG-TB sequence (OR=3.49; p=0.003). ConclusionsIn patients with at least one negative PB, mpMRI+COG-TB sequence improves 3.5 (OR=3.49) times the diagnosis prostate vs. ClTB.

22 - mpMRT and transrectal ultrasound-$$$ guided transperineal prostate biopsy in men with previous negative prostate biopsy: A single-center two years’ experience

22 - mpMRT and transrectal ultrasound-$$$ guided transperineal prostate biopsy in men with previous negative prostate biopsy: A single-center two years’ experience

Comparación del rendimiento entre biopsia transrectal clásica y biopsia «cognitiva» ecodirigida en la rebiopsia de la próstata

IntroductionThe aim of this study is to compare performance of two biopsy approaches in patients with at least one previous negative prostate biopsy (PB): classical transrectal biopsy (ClTB) versus cognitive registration biopsy (COG-TB). Material and methodsA retrospective study of 205 patients with at least one negative PB. 144 (70.2%) patients underwent a prior mpMRI and 61 (29.8%) patients did not.Nodule classification was carried out according PI-RADS version 2. Peripheral zone (PZ) grouped pZa, pZpl and pZpm areas, transition zone (TZ) Tza, Tzp and Cz areas, and anterior zone (AZ) AS areas.COG-TB was conducted in patients with previous mpMRI (144); while in the remaining 61 (29.8%) patients a ClTB of PZ and TZ was performed.Statistical analysis was performed using Chi square and T-student tests for qualitative and quantitative variables, respectively. Multivariate analysis was carried out in order to identify predictive variables of prostate cancer. ResultsMedian patient age was 68 (IQR 62-72) years, median PSA was 8.3 (IQR 6.2-11.7) ng/ml and median previous biopsies was 1 (IQR 1-2). Digital rectal examinations (DRE) findings were normal in 169 (82.4%) patients and suspicious in 36 (17.6%) patients (cT2a-b in 34 patients and cT2c in 2). Median prostate volume was 48 (IQR 38-65) cc. Statistically significant differences in PSAD between both groups were found (P=.03).Transrectal ultrasound (TRUS) showed hypoechoic nodules in 8 (13.1%) ClTB patients and in 62 (43.1%) COG-TB patients (P=.0001).The median number of biopsy cylinders per set of prostate biopsies was 10 (IQR 10-10) in ClTB group and 11 (IQR 9-13) in COG-TB group (P=.75).Cancer was diagnosed in 74 (36.1%) patients: of them, 10 (16.4%) were ClTB patients and 64 (44.4%) COG-TB (P=.0001).Tumors classification was as follow: ISUP-1: 34 (45.9%), ISUP-2: 21 (28.4%), ISUP-3: 9 (12.2%), ISUP-4: 7 (9.5%) and ISUP-5: 3 (4.1%). No significant statistical differences were found (P=.89). The median number of biopsy cylinders impaired per set of prostate biopsies was 1 (IQR 1-5) in ClTB group and 2 (IQR 1-4) in COG-TB group (P=.93).Regarding independent predictive variables for prostate cancer the results were: age (OR=12.05; P=.049), suspicious DRE (OR=2.64; P=.04), hypoechoic nodule (OR=2.20; P=.03) and mpMRI +COG-TB sequence (OR=3.49; P=.003). ConclusionsIn patients with at least one negative PB, mpMRI +COG-TB sequence improves 3.5 (OR=3.49) times the diagnosis prostate vs. ClTB.

04:21 PM Abstract No. 382 MRI-fused cone-beam CT-guided biopsy of the prostate as a safe and novel method of prostate biopsy

3D fluoroscopy guidance using cone-beam CT (CBCT) can be fused to MRI images, allowing direct coaxial needle placement into an MRI target using the real time fluoroscopy. We describe our experience using MRI fused CBCT guidance for prostate biopsy. There are no published reports on the use of CBCT guidance in prostate biopsies. We hypothesize this technique will have an adequate safety profile while accurately detecting prostate cancer. Patients were selected for this study if they had an MRI lesion graded as PiRads 3 or greater and was clinically suspected of protate cancer by the oncologic urologist. All of our prostate biopsies were completed using MRI fused CBCT as a navigation system using a transgluteal approach. Dedicated software (XperGuide, Philips Imaging) was used to plan the approach and confirm the location of the coaxial needle prior to biopsy. Biopsies were performed using a 17/18 gauge coaxial system. The patient did not receive pre-procedure antibiotics or bowel preparation. The immediate and 30 day complication rate and biopsy results were recorded. In total, 70 patients underwent CBCT-guided biopsy. The only observed immediate or 30 day complications were 2 transient events of hematuria that were self-resolving, and one event of urinary retention treated with 1 week of indwelling Foley catheter. There were no complications related to infection or sepsis. Gleason score ≥7 was observed in 1/5 (20%) patients with a PiRads 3 lesions, 6/31 (19.4%) patients with a PiRads 4 lesion, 18/34 (52.9%) patients with a PiRads 5 lesion. When compared to previous transrectal ultrasound-guided prostate (TRUSP) biopsy, PiRads 5 lesions were more likely to be upgraded to Gleason score ≥7 (18/34 patients) then PiRads 3 (1/5) or PiRads 4 lesions (6/31). MRI fused CBCT guidance targeted biopsy of suspected prostate cancer is technically feasible in our experience with 70 patients. Its complication profile is favorable when compared to TRUSP biopsies. It has the potential to upstage disease in patients with high PI-RADS lesions on MRI and previously negative or low Gleason score on TRUSP biopsies.

Addition of magnetic resonance imaging to real time trans-rectal ultrasound-based treatment planning for prostate implants.

PurposeThe greater soft tissue contrast of magnetic resonance imaging (MRI) allows improved accuracy in prostate contouring compared to transrectal ultrasound (TRUS) and helps in identifying specific regions within the prostate. This study attempts to evaluate the potential benefit of MRI-TRUS fusion in treatment planning for more accurate prostate contouring and tumor dose escalation.Material and methods14 patients with previous MRI-guided prostate biopsy and an low-dose-rate (LDR) permanent prostate seed implant have been selected. The prostate and tumor (5 patients) were contoured on the MRI images by a radiologist. The prostate was also contoured on TRUS images during LDR procedure together by a urologist and radiation oncologist. MRI and TRUS images were rigidly fused to compare prostate contours in MRI and TRUS. Prostate was then re-contoured by the radiation oncologist using this fusion. Moreover, V100, V150, and D90 differences were evaluated for localized tumor compared to prostate with negative values indicating cold tumor regions. These cases were re-planned to simulate dose escalation.ResultsThe prostate volume was contoured 8 ±10% smaller in TRUS images, compared to MRI images. The mean percent difference in tumor (compared to prostate) V100 was 0.3 ±–0.4%, V150 was –0.7 ±–24.8%, and D90 was 0.2 ±–12.1%. For the posteriorly located tumors (2 cases), V100 was 0.0 ±–0.3%, D90 was 9.5 ±–3.0%, and V150 was 26.1 ±–5.4%. For anteriorly located tumors (3 cases), V100 was 0.4 ±–0.4%, D90 was –6.0 ±–11.9%, and V150 was –18.5 ±–14.4% (became 15.6 ±14.6% after re-plan).ConclusionsThe MRI-TRUS image fusion is a feasible tool for the visualization of the prostate gland, particularly at the apex and base of the gland. Tumor identification presents the potential for dose escalation using fusion, especially for anteriorly located tumors.

Reduced Core Targeted (RCT) biopsy: Combining multiparametric magnetic resonance imaging - transrectal ultrasound fusion targeted biopsy with laterally-directed sextant biopsies – An alternative template for prostate fusion biopsy

Purpose: To introduce and assess the efficacy of a Reduced Core Targeted (RCT) biopsy template (image-targeted + laterally directed sextant biopsy) to detect clinically-significant cancer in patients with elevated PSA and a previous negative biopsy or on active surveillance. The performance and added value of either targeted alone vs random sextant vs combined biopsy template was appraised.Methods: Data from 113 patients with a suspicious lesion on mpMRI and previous history of extended 10–12 core standard biopsy who subsequently had a RCT-biopsy were analyzed. These patients had at least one prior negative standard 10–12 core biopsy (n = 70) or were on active surveillance (n = 43). At least two samples were taken from each mpMRI lesion as a targeted biopsy together with the classic laterally-directed sextant biopsy.Results: In patients having previous negative biopsy (n = 70), the RCT biopsy detected any cancer versus clinically-significant cancer in 62.9% versus 32.9%, respectively. Targeted biopsy diagnosed more clinically-significant cancers than sextant biopsy (31.4% versus 25.7%, p < 0.01). In this cohort, the use of targeted fusion biopsy upgraded the biopsy grade group (GrGp) in 15 (21.4%) patients compared to sextant biopsy. In patients on active surveillance, the RCT biopsy identified any cancer versus clinically-significant cancer for detection rates of 74.4% versus 39.5%, respectively. Fusion targeted biopsy diagnosed more clinically-significant cancers than sextant biopsy did (37.2% versus 18.6%, p = 0.002). The use of targeted biopsy upgraded the biopsy GrGp in 12 (27.9%) patients.Conclusion: As a preliminary study, among men with MRI suspicious lesions and previous negative prostate biopsy or those under active surveillance, an image-targeted plus sextant biopsy platform can be associated with increased efficiency of detecting clinically-significant prostate cancer with fewer random cores. Future large series are needed to validate the clinical implication of this reduced core template in comparison with targeted fusion biopsy plus standard 12-core schema.

Comparison of Single and Prolonged Fluoroquinolone Prophylaxis and Risk Factors for Infectious Complications After Transrectal Prostate Biopsy

Background:The ideal prophylaxis duration for transrectal ultrasonography-guided prostate biopsy is incompletely defined.Aims:To compare the infectious complications of transrectal ultrasonography-guided prostate biopsy with and without extended antibiotic prophylaxis. The secondary aim was to evaluate the risk factors for infectious complications.Study Design:Prospective observational study.Methods:Four hundred patients who underwent transrectal ultrasonography-guided prostate biopsy were recruited. Patients orally received either 750 mg ciprofloxacin 60 min before the procedure or 500 mg ciprofloxacin twice a day for a duration of 7 days with the initial dose administered 24 h prior to the procedure. All patients were followed-up for 4 weeks after the transrectal ultrasonography-guided prostate biopsy procedure for infectious complications. Screening of urine was carried out in all patients on the 3rd and 7th day after the procedure. Medical histories of all patients were collected prior to biopsy. Information on medical history include the following: hospitalization, urethral catheterization, or urinary tract infections within the past 12 months; antibiotic use within the last 3 months, prior urinary tract interventions, and previous transrectal ultrasonography-guided prostate biopsy and Charlson comorbidity indexes. Ultrasound-guided biopsy was carried out using General Electric’s 7 MHz transrectal ultrasound device in the left decubitus position. Patients received one of the two ciprofloxacin-based prophylaxis regimens. Subsequent transrectal ultrasonography-guided prostate biopsy to all patients were followed-up for 30 days. Further follow-up of patients was carried out on the second and fourth weeks after transrectal ultrasonography-guided prostate biopsy, and symptoms, such as dysuria, rectal bleeding, fever, hematospermia, hematuria, and pollakiuria, were recorded.Results:Both groups presented similar baseline characteristics and medical history. Infectious complication rates within the 4-week follow-up were similar in both groups (single dose: 3% vs prolonged: 3%) (p>0.05). In both groups, infectious complications significantly increased than that at previous antibiotic usage (single: p=0.028; prolonged: p=0.040). Non-infectious complication ratios showed no significant variation (p>0.05).Conclusion:Pre-operative single dose of 750 mg oral ciprofloxacin compared with 7 days prolonged treatment resulted in similar infectious complication outcomes in patients undergoing transrectal ultrasonography-guided prostate biopsy. The use of antibiotics within the last 3 months increases the risk for post-transrectal ultrasonography-guided prostate biopsy infectious complications.

MultiParametric Magnetic Resonance Imaging-Based Nomogram for Predicting Prostate Cancer and Clinically Significant Prostate Cancer in Men Undergoing Repeat Prostate Biopsy.

Objective To develop and internally validate nomograms based on multiparametric magnetic resonance imaging (mpMRI) to predict prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in patients with a previous negative prostate biopsy. Materials and Methods The clinicopathological parameters of 231 patients who underwent a repeat systematic prostate biopsy and mpMRI were reviewed. Based on Prostate Imaging and Reporting Data System, the mpMRI results were assigned into three groups: Groups “negative,” “suspicious,” and “positive.” Two clinical nomograms for predicting the probabilities of PCa and csPCa were constructed. The performances of nomograms were assessed using area under the receiver operating characteristic curves (AUCs), calibrations, and decision curve analysis. Results The median PSA was 15.03 ng/ml and abnormal DRE was presented in 14.3% of patients in the entire cohort. PCa was detected in 75 patients (32.5%), and 59 (25.5%) were diagnosed with csPCa. In multivariate analysis, age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE), and mpMRI finding were significantly independent predictors for PCa and csPCa (all p < 0.01). Of those patients diagnosed with PCa or csPCa, 20/75 (26.7%) and 18/59 (30.5%) had abnormal DRE finding, respectively. Two mpMRI-based nomograms with super predictive accuracy were constructed (AUCs = 0.878 and 0.927, p < 0.001), and both exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of probability thresholds. Conclusion mpMRI combined with age, PSA, PV, and DRE can help predict the probability of PCa and csPCa in patients who underwent a repeat systematic prostate biopsy after a previous negative biopsy. The two nomograms may aid the decision-making process in men with prior benign histology before the performance of repeat prostate biopsy.

The transrectal ultrasound/MRI fusion biopsy for prostate cancer diagnosis after previous negative biopsy: a case report

Introduction: The adoption of multiparametric MRI (mpMRI) guided fusion biopsy is becoming an important tool to improve the diagnostic yield in those suspected of having prostate cancer, especially for patients with suspicious lesion located at the anterior region that is uncommonly sampled at randomized biopsy. Methods: Herein we report a case of a man with persistent elevated PSA and a previous negative randomized prostate biopsy. His PSA was 8.1 ng/dL and a multiparametric MRI showed a 2cm suspicious PIRADS-4 lesion located at the anterior region of the right transition zone at base and mid gland. A transrectal ultrasound/MRI (TRUS/mpMRI) fusion biopsy was performed and its pathologic report showed a Gleason 3+4 (ISUP II) that was present only in the fragments that sampled the suspected area at MRI. We review the role of mpMRI in the diagnosis of prostate cancer at rebiopsy.

12 - Multiparametric MRI targeted and transrectal ultrasound guided transperineal prostate biopsy in men with previous negative prostate biopsy

12 - Multiparametric MRI targeted and transrectal ultrasound guided transperineal prostate biopsy in men with previous negative prostate biopsy

The Association of Previous Prostate Biopsy Related Complications and the Type of Complication with Patient Compliance with Rebiopsy Scheme

Prostate biopsy complications have important consequences that may affect patient compliance with rebiopsy schemes. However, to our knowledge this has not been studied in earnest. Thus, we evaluated whether previous prostate biopsy related complications and the type of complication were associated with repeat prostate biopsy compliance in a clinical trial with study mandated systematic biopsies. We retrospectively analyzed the records of 4,939 men 50 to 75 years old who underwent 2-year prostate biopsy and were recommended to undergo 4-year prostate rebiopsy in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study. The analyzed biopsy complications were hematuria, urinary tract infection, acute urinary retention and hemospermia. A total of 260 men (5.3%) had a 2-year prostate biopsy related complication, including hematuria in 180 (3.6%), urinary tract infection in 36 (0.7%), acute urinary retention in 26 (0.5%) and hemospermia in 102 (2.1%). A total of 474 men (9.6%) were noncompliant with 4-year rebiopsy. On univariable analysis any previous complication (OR 1.56, 95% CI 1.08-2.24, p = 0.018), urinary tract infection (OR 2.72, 95% CI 1.23-6.00, p = 0.013), acute urinary retention (OR4.24, 95% CI 1.83-9.81, p = 0.016) and hemospermia (OR 1.78, 95% CI 1.03-3.06, p = 0.037) were associated with rebiopsy noncompliance. Hematuria was not associated with rebiopsy noncompliance (OR 1.19, 95% CI 0.74-1.91, p=0.483). Results were unchanged on multivariable analysis, including for any complication (OR 1.65, 95% CI 1.08-2.26, p = 0.018), for urinary tract infection (OR 2.62, 95% CI 1.07-3.21, p = 0.029), for acute urinary retention (OR 4.51, 95% CI 1.93-10.54, p = 0.001), for hemospermia (OR 1.85, 95% CI 1.07-3.21, p=0.029) and for hematuria (OR 1.19, 95% CI 0.74-1.93, p = 0.472). In men who undergo repeat prostate biopsy a previous biopsy related complication and the type of complication were associated with lower compliance with rebiopsy schemes. Patients who experience biopsy related complications are ideal candidates to receive intervention regarding the importance of prostate rebiopsy to prevent noncompliance.

PSA-density does not improve bi-parametric prostate MR detection of prostate cancer in a biopsy naïve patient population

PurposeBi-parametric prostate MR (bp-MR) is a valuable tool for detection and characterization of prostate cancer (PCa). Recent studies suggested that PSA-density (PSA-D) in combination with multi-parametric prostate MR as well as bp-MR may achieve a higher diagnostic accuracy than either alone. We aimed to evaluate the diagnostic performance of bp-MR, PSA-D and their combination in biopsy-naïve patients. Methods and materialsWe retrospectively analyzed 334 consecutive patients who underwent prostate MR on a 3T scanner. Only patients (n = 114) who underwent TRUS-biopsy within 30 days following MR with no previous prostate biopsies were considered. Our protocol included T2-weighted and DWI sequences. A Likert score based on PI-RADS v2 was used for bp-MR evaluation. Lesions were graded histopathologically using the ISUP score. We assessed three scenarios: detection of lesions independently of ISUP score (ISUP ≥ 1), detection of both intermediate and clinically significant lesions (ISUP ≥ 2) and detection of clinically significant lesions alone (ISUP ≥ 3). Predictive value of bp-MR and PSA-D was evaluated by ROC curves and logistic regression analysis. A p value < 0.05 was considered statistically significant. ResultsIn all evaluated scenarios, bp-MR showed a significantly higher predictive power (AUC = 0.87-0.95) compared to the performance of PSA-D (AUC = 0.73–0.79), while their combination (AUC = 0.91-0.95) showed no statistically significant improvement compared to bp-MR alone. ConclusionOur results confirm that bp-MR is a powerful tool in detection of clinically significant PCa. Contrary to findings in the recent literature, PSA-D does not appear to significantly improve its diagnostic performance.

MP57-09 SURGICAL AND FUNCTIONAL OUTCOMES OF RADICAL RETROPUBIC PROSTATECTOMY AFTER BIOPSY RELATED ACUTE PROSTATITIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2018MP57-09 SURGICAL AND FUNCTIONAL OUTCOMES OF RADICAL RETROPUBIC PROSTATECTOMY AFTER BIOPSY RELATED ACUTE PROSTATITIS Sukru Kumsar, Feridun Sengor, and Omer Yuksel Sukru KumsarSukru Kumsar More articles by this author , Feridun SengorFeridun Sengor More articles by this author , and Omer YukselOmer Yuksel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1821AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the morbidity and functional results after radical retropubic prostatectomy withand without previous transrectal prostate biopsy related acute prostatitis history. METHODS From May 2010 to June 2016, data available 320 patients underwent radical retropubic prostatectomy, of whom 23 (7.2%) had previous transrectal prostate biopsy related acute prostatitis history were included for this study. The perioperative and postoperative data were compared between group 1 (with previous prostatitis) and group 2 (without previous prostatitis).The functional results were assessed by self-administered questionnaires at 12 months after surgery. RESULTS Table 1 lists the baseline characteristics of the 320 included patients. In group 1, the operative time, hospitalization and bladder catheterization time was statistically increased by 40 minutes, 1.9 days, and 2.5 days, respectively (p<0.001, p<0.001, p=0.02) (Table 2). The positive margin rate was not signficantly different between the two groups (p=0.64) (Table 2).The number of complications with Clavien > 2 (Urirnary fistula, sepsis, lymphocele, cardiopulmonary resuscitation (CPR), rectal injury) occurred in 26 % of group 1 and 12% of group 2 (p=0.02) (Table 2).The continence rate was 88.9% in group 1 and 94.8% in group 2 respectively, 12 months after the surgery (p =0.57), and the potency rate with neurovascular bundle preservation was 63.1% and 68.9% respectively, (p=0.61) (Table 2).However, neurovascular bundle preservation was performed after previous prostatitis in only 56.5% of group 1 vs 78.9% in group 2 (p=0.02) (Table 2). CONCLUSIONS Radical retropubic prostatectomy can be performed in patients with prostatitis history without compromising the oncologic results. However, patients should be informed that the procedure is associated with worse intraoperative and postoperative outcomes. Although the urinary continence rate was not affected by previous prostatitis, neurovascular bundle preservation is technically more difficult. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e767 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sukru Kumsar More articles by this author Feridun Sengor More articles by this author Omer Yuksel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP34-20 MOBILE PHONE APPS FOR THE PREDICTION OF PROSTATE CANCER: A MULTICENTER EXTERNAL VALIDATION AND COMPARISON

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2018MP34-20 MOBILE PHONE APPS FOR THE PREDICTION OF PROSTATE CANCER: A MULTICENTER EXTERNAL VALIDATION AND COMPARISON Riccardo Lombardo, Cosimo De Nunzio, Giorgia Tema, Fabiana Cancrini, Rodrigo Chacon, Eduard Garcia-Cruz, Jordi Huguet, Maria J. Ribal, Antonio Alcaraz, and Andrea Tubaro Riccardo LombardoRiccardo Lombardo More articles by this author , Cosimo De NunzioCosimo De Nunzio More articles by this author , Giorgia TemaGiorgia Tema More articles by this author , Fabiana CancriniFabiana Cancrini More articles by this author , Rodrigo ChaconRodrigo Chacon More articles by this author , Eduard Garcia-CruzEduard Garcia-Cruz More articles by this author , Jordi HuguetJordi Huguet More articles by this author , Maria J. RibalMaria J. Ribal More articles by this author , Antonio AlcarazAntonio Alcaraz More articles by this author , and Andrea TubaroAndrea Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mobile phone apps have been recently introduced for the prediction of prostate cancer (PCa) and high grade PCa. The aim of our study was to analyze the performance of two mobile phone apps, the Rotterdam prostate cancer risk app and the Coral app, in a multicenter cohort of patients undergoing prostate biopsies METHODS A consecutive series of men undergoing prostate biopsies were enrolled in two centers. Indications for prostate biopsy included abnormal PSA level (>4ng/ml) and/or abnormal DRE. Prostate cancer risk and high-grade prostate cancer risk were assessed using the Rotterdam prostate cancer risk app (iOS) and the Coral app (iOS). Both the App includes the following variables: PSA, previous prostate biopsies, DRE and prostate volume; the Coral App also includes race and age. Calibration and discrimination were assessed using calibration plots and ROC analysis. The usability of the Apps were also assessed and compared using the Post-Study System Usability Questionnaire (PSSUQ), developed by IBM, in a group of 50 participants comprising urologists, oncologists, radiotherapist and medical students. RESULTS Overall 1736 patients with a median age of 68 (62/73) years were enrolled. Median PSA was 6.8 (4.8/10.0) ng/ml, median BMI was 27±5 kg/m2 and median prostate volume was 48 (35/68) ml. Overall 663/1736 (37%) presented PCa and out of them 386/663 (58%) presented high-grade PCa. The Rotterdam App out-performed the Coral App in the prediction of prostate cancer (AUC: 0.70 vs 0.631, p=0.001) and of high grade PCa (0.75 vs 0.69, p=0.001) (Fig1). PSSUQ data revealed that both Rotterdam and Coral applications were comparable in terms of usefulness (87% vs 83%, p=0.708), information quality (74% vs 72%, p=0.349), interface quality (79%vs74%, p=0,216) and satisfaction (76% vs 76%, p=0.935), respectively. In terms of preferences, 26/50 (54%) preferred the Rotterdam app while 24/50 (46%) preferred the Coral App. CONCLUSIONS In our experience the Rotterdam App outperformed the Coral App for the prediction of prostate cancer or high-grade cancer diagnosis. Particularly, we confirmed, using the Rotterdam App, that only one out of ten patients with a low Rotterdam score will harbor high grade prostate cancer on biopsy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e445-e446 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Riccardo Lombardo More articles by this author Cosimo De Nunzio More articles by this author Giorgia Tema More articles by this author Fabiana Cancrini More articles by this author Rodrigo Chacon More articles by this author Eduard Garcia-Cruz More articles by this author Jordi Huguet More articles by this author Maria J. Ribal More articles by this author Antonio Alcaraz More articles by this author Andrea Tubaro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate cancer management choices in patients undergoing multiparametric magnetic resonance imaging/ultrasound fusion biopsy compared to systematic biopsy

ObjectivesTo assess management choices in patients who undergo magnetic resonance imaging (MRI)/ultrasound (MRI/US) fusion-guided prostate biopsy compared to patients who undergo systematic biopsy. MethodsWe compared men who underwent MRI/US fusion-guided prostate biopsy to those who underwent systematic 12-core biopsy from 2014 to 2016. Patient demographics and pathologic findings were reviewed. The highest grade group per case was considered for analysis. ResultsFollow-up was available on 133 patients who underwent MRI/US targeted biopsy and 215 patients who underwent systematic biopsy. There was no difference in prebiopsy prostate-specific antigen (PSA) (10.1 ± 10.0 vs. 12.9 ± 20.5, P = 0.11) between the 2 cohorts. Patients in the MRI cohort were more likely to have had a previous prostate biopsy (P<0.0001). Overall, more patients in the MRI cohort choose active surveillance compared to the standard cohort (49.6% vs. 24.2%, P<0.0001), confirmed on multivariate logistic regression model adjusting for age, PSA density, prior biopsy history, race, grade group, and provider (P = 0.013). This finding held true independently for patients with grade groups 1 and 2 tumors (P = 0.02 and P = 0.005, respectively) and in a multivariate logistic regression model adjusting for grade group 1 and 2 tumors (P = 0.0051). In the standard cohort, more patients chose radiation over prostatectomy (47.2% vs. 24.4%, P<0.0001). On multivariate analysis, race was an independent predictor of active surveillance, with African Americans less likely to undergo active surveillance. ConclusionsPatients who undergo MRI/US targeted biopsy are more likely to choose active surveillance over early definitive treatment compared to men diagnosed on systematic biopsy when adjusting for tumor grade, PSA density, prior biopsy history, race, and provider.

Prostate cancer: A valuable tool for prediction of repeat biopsy pathology.

Multiparametric MRI (mpMRI) findings are not always accurate in patients with a previous negative prostate biopsy. Truong et al. have developed a nomogram to identify patients with previous negative prostate biopsy who are at elevated risk of harbouring benign histology and should undergo repeat biopsy.

EO2 - Diagnostic accuracy of MRI-Transrectal Ultrasound Fusion prostate Biopsy in men with previous prostate biopsies: Preliminary results of the FUPROS16 project

EO2 - Diagnostic accuracy of MRI-Transrectal Ultrasound Fusion prostate Biopsy in men with previous prostate biopsies: Preliminary results of the FUPROS16 project

Effects of increasing the PSA cutoff to perform additional biomarker tests before prostate biopsy

BackgroundMulti-step testing might enhance performance of the prostate cancer diagnostic pipeline. Using PSA >1 ng/ml for first-line risk stratification and the Stockholm 3 Model (S3M) blood-test >10% risk of Gleason Score > 7 prostate cancer to inform biopsy decisions has been suggested. We aimed to determine the effects of changing the PSA cutoff to perform reflex testing with S3M and the subsequent S3M cutoff to recommend prostate biopsy while maintaining the sensitivity to detect Gleason Score ≥ 7 prostate cancer.MethodsWe used data from the prospective, population-based, paired, diagnostic Stockholm 3 (STHLM3) study with participants invited by date of birth from the Swedish Population Register during 2012–2014. All participants underwent testing with PSA and S3M (a combination of plasma protein biomarkers [PSA, free PSA, intact PSA, hK2, MSMB, MIC1], genetic polymorphisms, and clinical variables [age, family, history, previous prostate biopsy, prostate exam]). Of 47,688 men in the STHLM3 main study, we used data from 3133 men with S3M >10% and prostate biopsy data. Logistic regression models were used to calculate prostate cancer detection rates and proportion saved biopsies.Results44.2%, 62.5% and 67.9% of the participants had PSA <1, <1.5 and <1.7 ng/ml, respectively. Increasing the PSA cut-off for additional work-up from 1 ng/ml to 1.5 ng/ml would thus save 18.3% of the performed tests, 4.9% of the biopsies and 1.3% (10/765) of Gleason Grade ≥ 7 cancers would be un-detected. By lowering the S3M cutoff to recommend biopsy, sensitivity to high-grade prostate cancer can be restored, to the cost of increasing the number of performed biopsies modestly.ConclusionThe sensitivity to detect prostate cancer can be maintained when using different PSA cutoffs to perform additional testing. Biomarker cut-offs have implications on number of tests and prostate biopsies performed. A PSA cutoff of 1.5 ng/ml to perform additional testing such as the S3M test might be considered.Trial registrationISRCTN84445406.

Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted.

Magnetic resonance imaging (MRI) is being more widely used in the detection of prostate cancer (PCa), particularly after an initial negative biopsy. In this study, we compared 12-core systematic biopsy (SYS), MRI-targeted biopsy (TAR), and the association of systematic and MRI-targeted (SYS+TAR) prostate biopsy in patients with previous biopsy and those who were biopsy-naive to evaluate the differences in terms of cancer detection and clinically significant cancer detection between the three modalities. Overall, 203 consecutive patients with suspicion of PCa were analyzed; 48.2% were biopsy-naive and 51.7% had at least one previous negative prostate biopsy. The median age was 66 years, median prostate-specific antigen (PSA) level was 7.9 ng/mL and median prostate volume was 46 mL. 38.9% had SYS, 19.2% TAR only, and 41.8% had SYS+TAR biopsy. Overall, the PCa detection (PCaDR) was 63%. The SYS+TAR biopsy detected significantly more cancer than SYS and TAR only biopsies (72.9% vs. 56.9% and 53.8% respectively; p=0.03). Detection rate of clinically significant cancer (csPCaDR) was 50.7% overall; 65.8% in the SYS+TAR biopsy vs. 39.2% in the SYS and 48.7% in the TAR groups (p=0.002). In the biopsy-naive group, PCaDR and csPCaDR were significantly higher in the SYS+TAR group than in the SYS and TAR groups (p=0.01). In the repeat biopsy group, PCaDR and csPCaDR were equivalent in the TAR and SYS+TAR groups and higher than in the SYS group (p=0.001). TAR biopsy, when added to SYS biopsy, was associated with a higher detection rate of csPCa in biopsy-naive patients when compared to TAR and SYS only biopsies. In patients after previous negative biopsy, detection rates of csPCa were equivalent for SYS+TAR and TAR only biopsies, but higher than SYS.