Prostate Biopsy In Patients Research Articles

Implementing Change Through an Outpatient Antibiotic Stewardship Program.

We sought to implement a multi-pronged behavioral intervention to reduce and tailor antibiotic use for two common urologic outpatient procedures. This study was a non-blinded intervention study that consisted of a pre-intervention phase (11/2018-1/2019), an intervention phase (1/2020-12/2020) in which a multi-pronged behavioral intervention was implemented, and a post-intervention phase (1/2021-3/2021). We examined antibiotic use for cystoscopy and transrectal prostate biopsy at three separate urologic outpatient clinics. A multi-pronged behavioral intervention consisted of formal physician education, modification of the electronic health order sets, clinic staff education, literature review, development and introduction of patient questionnaires, and individual audit feedback. The primary outcome was 30-day infections. Secondary outcomes were adherence to the recommended antibiotic protocols, questionnaire completion, and Escherichia coli outpatient antibiograms. A total of 2374 patients underwent 3047 cystoscopies and 547 patients underwent 559 prostate biopsies. The proportions of cystoscopy patients receiving antibiotic prophylaxis and prostate biopsy patients receiving augmented antibiotic prophylaxis decreased 33% and 35%, respectively. The odds of post-cystoscopy infection were not different between the pre-intervention and intervention phases and were lower in the post-intervention phase. The odds of post-biopsy infection were not changed between the pre-intervention and intervention or between the pre-intervention and post-intervention phases. Implementing a multi-pronged behavioral intervention reduced and tailored antibiotic use without an increase in 30-day infections. These findings suggest that outpatient antibiotic stewardship and facilitating rapid adoption of guidelines can be accomplished via this approach.

A Transperineal Biopsy of the Prostate Does Not Require Routine Antibiotic Cover.

Introduction A transperineal ultrasound-guided prostate biopsy (TPB) under local anaesthetics (LA) after a prostate MRI scan is the gold standard for performing a prostate biopsy in patients with suspected prostate cancer. It has superseded transrectal ultrasound-guidedprostate biopsy (TRUSB). Historically, TRUSB by definition was performed in a contaminated environment and was routinely covered with antibiotics to reduce the risks of infection. Despite this, the rate of post-biopsy urosepsis has been documented to be as high as 5% in some series. In the transition from TRUSB to the establishment of a TPB under LA service in our unit, we continued to use a single dose of oral antibiotics for all patients attending for biopsy. The aim of this study is to establish whether the use of single-dose antibiotics has any effect on morbidity rates post-TPB. Methods A retrospective analysis of complications was carried out on 326 consecutive patients, who underwent TPB over a six-month period. One cohort of patients were biopsied with no antibiotic cover (n=149, 45.7%) as compared to another cohort who were given a single dose of oral antibiotics (n=177, 54.3%). Those patients in the group receiving antibiotics received either a single dose of co-amoxiclav or a single dose of ciprofloxacin. Patients with indwelling urethral catheters or with a urinary tract infection (UTI) were excluded from the analyses. All patients were followed- up after a multidisciplinary team meeting discussion (MDT) with either a telephone or a face-to-face consultation. Results A total of 324 (99.4%) patients did not report post-procedural complications. Two patients from the antibiotic group presented with infectious complications (1.1%); one patient was admitted with a prostate abscess and required drainage under general anaesthesia, and another was admitted with urosepsis requiring intravenous antibiotics. In the group who did not receive antibiotics, there were no complications reported, which was not significantly different compared to the antibiotic group (p=0.50). Conclusion Our results demonstrate that the routine use of single-dose antibiotics with TPB does not affect morbidity rates. On the basis of this investigation, we have now stopped using routine antibiotic cover for patients undergoing an LA TPB.

Biomarker vs MRI-Enhanced Strategies for Prostate Cancer Screening

Prostate cancer guidelines often recommend obtaining magnetic resonance imaging (MRI) before a biopsy, yet MRI access is limited. To date, no randomized clinical trial has compared the use of novel biomarkers for risk estimation vs MRI-based diagnostic approaches for prostate cancer screening. To evaluate biomarker-based risk estimation (Stockholm3 risk scores or prostate-specific antigen [PSA] levels) with systematic biopsies vs an MRI-enhanced strategy (PSA levels and MRI with systematic and targeted biopsy) for the detection of clinically significant prostate cancer in a screening setting. This open-label randomized clinical trial conducted in Stockholm, Sweden, between April 4, 2018, and December 10, 2020, recruited men aged 50 to 74 years with no history of prostate cancer. Participants underwent blood sampling for PSA and Stockholm3 tests to estimate their risk of clinically significant prostate cancer (Gleason score ≥3 + 4). After the blood tests were performed, participants were randomly assigned in a 2:3 ratio to receive a Stockholm3 test with systematic biopsy (biomarker group) or a PSA test followed by MRI with systematic and targeted biopsy (MRI-enhanced group). Data were analyzed from September 1 to November 5, 2023. In the biomarker group, men with a Stockholm3 risk score of 0.15 or higher underwent systematic biopsies. In the MRI-enhanced group, men with a PSA level of 3 ng/mL or higher had an MRI and those with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3 or higher (range: 1-5, with higher scores indicating a higher likelihood of clinically significant prostate cancer) underwent targeted and systematic biopsies. Primary outcome was detection of clinically significant prostate cancer (Gleason score ≥3 + 4). Secondary outcomes included detection of clinically insignificant cancer (Gleason score ≤6) and the number of biopsy procedures performed. Of 12 743 male participants (median [IQR] age, 61 [55-67] years), 5134 were assigned to the biomarker group and 7609 to the MRI-enhanced group. In the biomarker group, 8.0% of men (413) had Stockholm3 risk scores of 0.15 or higher and were referred for systematic biopsies. In the MRI-enhanced group, 12.2% of men (929) had a PSA level of 3 ng/mL or higher and were referred for MRI with biopsies if they had a PI-RADS score of 3 or higher. Detection rates of clinically significant prostate cancer were comparable between the 2 groups: 2.3% in the biomarker group and 2.5% in the MRI-enhanced group (relative proportion, 0.92; 95% CI, 0.73-1.15). More biopsies were performed in the biomarker group than in the MRI-enhanced group (326 of 5134 [6.3%] vs 338 of 7609 [4.4%]; relative proportion, 1.43 [95% CI, 1.23-1.66]), and more indolent prostate cancers were detected (61 [1.2%] vs 41 [0.5%]; relative proportion, 2.21 [95% CI, 1.49-3.27]). Findings of this randomized clinical trial indicate that combining a Stockholm3 test with systematic biopsies is comparable with MRI-based screening with PSA levels and systematic and targeted biopsies for detection of clinically significant prostate cancer, but this approach resulted in more biopsies as well as detection of a greater number of indolent cancers. In regions where access to MRI is lacking, the Stockholm3 test can aid in selecting patients for systematic prostate biopsy. ClinicalTrials.gov Identifier: NCT03377881.

Phytotherapy Might Have a Role in Reducing Unnecessary Prostate Biopsies: Results from an Exploratory, Randomized Controlled Trial of Two Different Phytotherapeutic Agents.

We aimed to evaluate the impact of two different phytotherapeutic agents on decision making regarding prostate biopsy for patients with higher-than-normal prostate-specific antigen (PSA) levels. From June 2022 to May 2023, all patients attending two urological institutions due to higher-than-normal PSA levels were randomized to receive either oral capsules of Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica (Group A) or Serenoa Repens 320 mg (Group B) for 3 months. At the follow-up visit after 3 months, all patients underwent PSA tests and multiparametric magnetic resonance imaging (mpMRI). In the per-protocol analysis, data from 66 patients in Group A and 76 in Group B were analyzed. Fifty patients in Group A (75.7%) showed a significant reduction in total PSA compared to forty-nine in Group B (64.4%) (p < 0.001). Twenty-eight patients had PI-RADS III or higher in mpMRI: twelve in Group A and fourteen in Group B. Twenty-three patients (34.8%) in Group A and fifty-nine (77.6%) in Group B (p < 0.001) underwent prostate biopsy based on the mpMRI findings and PSA values. Three patients in Group A showed a significant reduction in total PSA values while having positive mpMRI findings (6%) compared with nine in Group B (19.5%) (p < 0.001). On the contrary, 7 patients in Group A did not show significant reduction in total PSA values and had negative mpMRI findings (43%) compared to 22 in Group B (81.4%) (p < 0.001). In conclusion, a three-month course of a combination of Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica seems to be an interesting tool to avoid unnecessary prostate biopsies among men with higher-than-normal PSA levels.

Based on PI-RADS v2.1 combining PHI and ADC values to guide prostate biopsy in patients with PSA 4-20 ng/mL.

The study aimed to investigate the diagnostic accuracy of prostate health index (PHI) and apparent diffusion coefficient (ADC) values in predicting prostate cancer (PCa) and construct a nomogram for the prediction of PCa and clinically significant PCa (CSPCa) in Prostate Imaging-Reporting and Data System (PI-RADS) three lesions cohort. This study prospectively enrolled 301 patients who underwent multiparametric magnetic resonance (mpMRI) and were scheduled for prostate biopsy. The receiver operating characteristic curve (ROC) was performed to estimate the diagnostic accuracy of each predictor. Univariable and multivariable logistic regression analysis was conducted to ascertain hidden risk factors and constructed nomograms in PI-RADS three lesions cohort. In the whole cohort, the area under the ROC curve (AUC) of PHI is relatively high, which is 0.779. As radiographic parameters, the AUC of PI-RADS and ADC values was 0.702 and 0.756, respectively. The utilization of PHI and ADC values either individually or in combination significantly improved the diagnostic accuracy of the basic model. In PI-RADS three lesions cohort, the AUC for PCa was 0.817 in the training cohort and 0.904 in the validation cohort. The AUC for CSPCa was 0.856 in the training cohort and 0.871 in the validation cohort. When applying the nomogram for predicting PCa, 50.0% of biopsies could be saved, supplemented by 6.9% of CSPCa being missed. PHI and ADC values can be used as predictors of CSPCa. The nomogram included PHI, ADC values and other clinical predictors demonstrated an enhanced capability in detecting PCa and CSPCa within PI-RADS three lesions cohort.

Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors.

Current prostate biopsy (PBx) protocol for prostate cancer (PCa) diagnosis is to perform systematic biopsies (SBx) combined with targeted biopsies (TBx) in case of positive MRI (i.e. PI-RADS ≥ 3). To assess the utility of performing SBx in combination with TBx, we determined the added value of SBx brought to the diagnosis of PCa according to their sextant location and MRI target characteristics. In our local prospectively collected database, we conducted a single-center retrospective study including all patients with a suspicion of PCa, who underwent transrectal ultrasound-guided (TRUS) prostate biopsies (PBx) with a prior MRI and a single lesion classified as PI-RADS ≥ 3. We have characterized the SBx according to their location on MRI: same sextant (S-SBx), adjacent sextant (A-SBx), ipsilateral side (I-SBx) and contralateral side (C-SBx). The added value of SBx and TBx was defined as any upgrading to significant PCa (csPCa) (ISUP ≥2). 371 patients were included in the study. The added value of SBx was 10% overall. Regarding the lesion location and the SBx sextant, the added value of SBx was: 5.1% for S-SBx, 5.4% for A-SBx, 4.9% for I-SBx and 1.9% for C-SBx. The overall added value of SBx was 6.8% for PI-RADS 3 lesions, 14% for PI-RADS 4 lesions and 6.7% for PI-RADS 5 lesions (p = 0.063). The added value of SBx for contralateral side was 1.9% (2/103), 3.1% (5/163) and 0% (0/105) for PI-RADS 3, PI-RADS 4 and PI-RADS 5 lesions, respectively (p = 0,4). The added value of SBx was lower when the number of TBx was higher (OR 0.57; CI 95% 0.37-0.85; p = 0.007). Our results suggest that the utility of performing SBx in the contralateral lobe toward the MRI lesion was very low, supporting that they might be avoided.

Development and validation of a novel nomogram predicting clinically significant prostate cancer in biopsy-naive men based on multi-institutional analysis.

Prediction of clinically significant prostate cancer (csPCa) is essential to select biopsy-naive patients for prostate biopsy. This study was to develop and validate a nomogram based on clinicodemographic parameters and exclude csPCa using prostate-specific antigen density (PSAD) stratification. Independent predictors were determined via univariate and multivariate logistic analysis and adopted for developing a predictive nomogram, which was assessed in terms of discrimination, calibration, and net benefit. Different PSAD thresholds were used for deciding immediate biopsies in patients with Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. A total of 932 consecutive patients who underwent ultrasound-guided transperineal cognitive biopsy were enrolled in our study. In the development cohort, age (odds ratio [OR], 1.075; 95% confidence interval [CI], 1.036-1.114), PSAD (OR, 6.003; 95% CI, 2.826-12.751), and PI-RADS (OR, 3.419; 95% CI, 2.453-4.766) were significant predictors for csPCa. On internal and external validation, this nomogram showed high areas under the curve of 0.943, 0.922, and 0.897, and low Brier scores of 0.092, 0.102, and 0.133 and insignificant unreliability tests of 0.713, 0.490, and 0.859, respectively. Decision curve analysis revealed this model could markedly improve clinical net benefit. The probability of excluding csPCa was 98.51% in patients with PI-RADS 3 lesions and PSAD <0.2 ng/ml2 . This novel nomogram including age, PSAD, and PI-RADS could be applied to accurately predict csPCa, and 44.08% of patients with equivocal imaging findings plus PSAD <0.2 ng/ml2 could safely forgo biopsy.

Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study

BackgroundTo evaluate the role of targeted antibiotic prophylaxis (TAP) after rectal and urethral swab cultures compared to empiric antibiotic prophylaxis (EAP) for the prevention of infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx). MethodsWe conducted a prospective comparative study on 141 patients who underwent TRUS-Bx and were allocated in two groups. The first group (n = 71) received EAP with ciprofloxacin and the second (n = 70) received TAP according to rectal and urethral cultures. Post-biopsy infectious complications rates were compared between the two groups. Fluoroquinolone resistance (FQ-R) in the urethral and rectal swabs was recorded. Baseline characteristics were analyzed to assess their relationship with infectious complications and antibiotic resistance. ResultsA total of 8 infectious complications were observed, 7 of them in the EAP group (9.85%) and 1 in the TAP group (1.4%). There was a statistically significant difference in febrile UTIs between the two groups (6 vs 0, P = 0.028). FQ-R rate was 4.3% and 12.9% for rectal and urethral samples, respectively. Recent antibiotic exposure was associated with higher post-biopsy infection rates for EAP group and FQ-R rates for TAP group. ConclusionCombination of rectal and urethral swab cultures for TAP was able to detect FQ-R bacteria carriers and was associated with fewer infectious complications compared to EAP.

Histomic and transcriptomic features of MRI-visible and invisible clinically significant prostate cancers are associated with prognosis.

Magnetic resonance imaging (MRI) is increasingly used to triage patients for prostate biopsy. However, 9% to 24% of clinically significant (cs) prostate cancers (PCas) are not visible in MRI. We aimed to identify histomic and transcriptomic determinants of MRI visibility and their association to metastasis, and PCa-specific death (PCSD). We studied 45 radical prostatectomy-treated patients with csPCa (grade group [GG]2-3), including 30 with MRI-visible and 15 with MRI-invisible lesions, and 18 men without PCa. First, histological composition was quantified. Next, transcriptomic profiling was performed using NanoString technology. MRI visibility-associated differentially expressed genes (DEGs) and Reactome pathways were identified. MRI visibility was classified using publicly available genes in MSK-IMPACT and Decipher, Oncotype DX, and Prolaris. Finally, DEGs and clinical parameters were used to classify metastasis and PCSD in an external cohort, which included 76 patients with metastatic GG2-4 PCa, and 84 baseline-matched controls without progression. Luminal area was lower in MRI-visible than invisible lesions and low luminal area was associated with short metastasis-free and PCa-specific survival. We identified 67 DEGs, eight of which were associated with survival. Cell division, inflammation and transcriptional regulation pathways were upregulated in MRI-visible csPCas. Genes in Decipher, Oncotype DX and MSK-IMPACT performed well in classifying MRI visibility (AUC = 0.86-0.94). DEGs improved classification of metastasis (AUC = 0.69) and PCSD (AUC = 0.68) over clinical parameters. Our data reveals that MRI-visible csPCas harbor more aggressive histomic and transcriptomic features than MRI-invisible csPCas. Thus, targeted biopsy of visible lesions may be sufficient for risk stratification in patients with a positive MRI.

Differentiation of patients with and without prostate cancer using urine 1 H NMR metabolomics.

Prostate cancer (PCa) is one of the most prevalent cancers in men worldwide. For its detection, serum prostate-specific antigen (PSA) screening is commonly used, despite its lack of specificity, high false positive rate, and inability to discriminate indolent from aggressive PCa. Following increases in serum PSA levels, clinicians often conduct prostate biopsies with or without advanced imaging. Nuclear magnetic resonance (NMR)-based metabolomics has proven to be promising for advancing early-detection and elucidation of disease progression, through the discovery and characterization of novel biomarkers. This retrospective study of urine-NMR samples, from prostate biopsy patients with and without PCa, identified several metabolites involved in energy metabolism, amino acid metabolism, and the hippuric acid pathway. Of note, lactate and hippurate-key metabolites involved in cellular proliferation and microbiome effects, respectively-were significantly altered, unveiling widespread metabolomic modifications associated with PCa development. These findings support urine metabolomics profiling as a promising strategy to identify new clinical biomarkers for PCa detection and diagnosis.

372 Is the Mixing of Local Anaesthetic Agents for Perineal Block in TP Prostate Biopsy Patients Advantageous? a Comparative Study of Local Anaesthetic Efficacy

Abstract Aim Traditional mixing of short and long-acting local anaesthetics for perineal blocks for TP Biopsies might risk altering their pH and allow the use of suboptimal dose of the mixed agents. Method This is a prospective study in which we look at 102 patients who have had transperineal prostate biopsies. The patients were divided into 2 groups according to the type of peri-prostatic local anaesthetic i.e. mixed (10mls of 1% lignocaine and 10 mls of 0.5% levobupivacaine) and non-mixed (20mls 0.5% levobupivacaine). Patients were asked to fill a pain score and satisfaction questionnaire after the procedure. Results The two groups were matched in their demographics including age, PSA and prostate volume. The pain threshold was similar in both groups during administration of the perineal block. The difference in pain threshold between the ‘mixed’ vs ‘non-mix’ group was statistically significant during the biopsy sampling i.e., 4(std 2) for the ‘mixed’ and 2(std1) for the ‘non-mix’ group. 84.8% of the ‘mixed’ group vs 97.7% of the ‘non-mix’ group said they would recommend the procedure. The response was the same when asked whether they would repeat the procedure if required (84.4% in ‘mixed’ vs 97.7% in ‘non-mix’). The cancer detection rate had no statistical difference between the 2 groups although core-length’s taken from target lesions were shorter in ‘mixed’ vs ‘non-mixed’ group (mean 7mm vs 9.5mm). Conclusions Our study confirms that using a pure agent gave better pain scores with the same cancer detection rates as compared to mixed agents.

Reliability of Multiparametric Magnetic Resonance Imaging in Patients with a Previous Negative Biopsy: Comparison with Biopsy-Naïve Patients in the Detection of Clinically Significant Prostate Cancer.

Background: Multiparametric magnetic resonance is an established imaging utilized in the diagnostic pathway of prostate cancer. The aim of this study is to evaluate the accuracy and reliability of multiparametric magnetic resonance imaging (mpMRI) in the detection of clinically significant prostate cancer, defined as Gleason Score ≥ 4 + 3 or a maximum cancer core length 6 mm or longer, in patients with a previous negative biopsy. Methods: The study was conducted as a retrospective observational study at the University of Naples "Federico II", Italy. Overall, 389 patients who underwent systematic and target prostate biopsy between January 2019 and July 2020 were involved and were divided into two groups: Group A, which included biopsy-naïve patients; Group B, which included re-biopsy patients. All mpMRI images were obtained using three Tesla instruments and were interpreted according to PIRADS (Prostate Imaging Reporting and Data System) version 2.0. Results: 327 patients were biopsy-naïve, while 62 belonged to the re-biopsy group. Both groups were comparable in terms of age, total PSA (prostate-specific antigen), and number of cores obtained at the biopsy. 2.2%, 8.8%, 36.1%, and 83.4% of, respectively, PIRADS 2, 3, 4, and 5 biopsy-naïve patients reported a clinically significant prostate cancer compared to 0%, 14.3%, 39%, and 66.6% of re-biopsy patients (p < 0.0001-p = 0.040). No difference was reported in terms of post-biopsy complications. Conclusions: mpMRI confirms its role as a reliable diagnostic tool prior to performing prostate biopsy in patients who underwent a previous negative biopsy, reporting a comparable detection rate of clinically significant prostate cancer.

Initial Outcomes of Freehand Transperineal Biopsies Regarding Diagnostic Value and Safety: An Early Experience at King Fahad Specialist Hospital, Buraydah, Saudi Arabia.

Prostate cancer is a common type of cancer in Saudi Arabia with a high incidence rate. Trans-rectal ultrasound guided prostatic biopsy (TRUSBx) has been the standard diagnostic study for prostate cancer since a landmark study in 1989which showed that it is better than digitally directed biopsy sampling of the prostate. As an alternative to TRUSBx, transperineal biopsies (TPBx) have gained popularity as they give a higher accuracy rate and avoid many complications. A new study has been conducted in Riyadh, Saudi Arabia to compare TRUSBx and TPBx showed that TPBx has a significantly higher detection rate of prostate cancer cases compared to TRUSBx (45.1% vs. 29.1%, p=0.003). The aim of this study is to determine the diagnostic value and safety of freehand transperineal prostate biopsy in patients with an elevated prostatic specific antigen (PSA) and/or abnormal digital rectal exam in King Fahad Specialist Hospital KFSH in Buraydah, Qassim region, Saudi Arabia. This is an observational retrospective study of all patients (n=39) who underwent transperineal biopsies at KFSH to assess the diagnostic value and safety of the procedure. The mean age of the patients was 70.3 (SD 10.1) years. The most commonly found diagnosis was adenocarcinoma (61.5%), and incidence of complications was detected in (5.1%) of the patients. We concluded that the freehand technique TPBx has a high accuracy rate in detecting prostatic cancer. However, the learning curve could be a limiting factor in implementing it. Increasing the number of biopsies could positively affect diagnostic accuracy, especially with our low complication rate in this procedure. A low number of biopsies in the older age group can give an accurate result with a low risk of complications. Although template-guided TPBx and robot-guided TPBx are better options, the freehand technique represents a cost-effective and time-saving alternative. However, more studies are needed to compare the outcome of such a technique.

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy.

A negative multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in patients with suspected prostate cancer (PC) results in clinical uncertainty, as the biopsy can be false negative. The clinical challenge is to determine the optimal follow-up and to select patients who will benefit from repeat biopsy. In this study, we evaluated the rate of significant PC (sPC, Gleason score ≥7) and PC detection in patients who received a follow-up mpMRI/ultrasound-guided biopsy for persistent PC suspicion after a negative mpMRI/ultrasound-guided biopsy. We identified 58 patients at our institution that underwent repeat targeted biopsy in case of PI-RADS lesions and systematic saturation biopsy between 2014 and 2022. At the initial biopsy, the median age was 59 years, and the median prostate specific antigen level was 6.7 ng/mL. Repeat biopsy after a median of 18 months detected sPC in 3/58 (5%) patients and Gleason score 6 PC in 11/58 (19%). Among 19 patients with a downgraded PI-RADS score at the follow-up mpMRI, none had sPC. In conclusion, men with an initial negative mpMRI/ultrasound-guided biopsy had a high likelihood of not harboring sPC at repeat biopsy (95%). Due to the small size of the study, further research is recommended.

Avoiding Prostate Biopsies in Patients at Low Risk for Prostate Cancer: A Prospective Evaluation of a PSA-Density-Based Safety Net

Introduction and Objectives: Decision-making to perform prostate biopsy should include individual risk assessment. Patients classified as low risk by the Rotterdam Prostate Cancer Risk Calculator are advised to forego biopsy (PBx). There is concern about missing clinically significant prostate cancer (csPCa). A clear pathway for follow-up is needed. Material and Methods: Data for 111 consecutive patients were collected. Patients were encouraged to adhere to a PSA-density-based safety net after PBx was omitted. Cut off values indicating a re-evaluation were PSA density >0.15 ng/mL/ccm in PBx-naïve patients and >0.2 ng/mL/ccm in men with past-PBx. Primary endpoint was whether men had their PSA taken regularly. Secondary endpoint was whether a new multiparametric MRI was performed when PSA-density increased. Tertiary endpoint was whether biopsy was performed when risk stratification revealed an increased risk. Results: Median follow-up was 12 months (IQR 9–15 months). The primary endpoint was reached by 97.2% (n = 106). The secondary endpoint was reached by 30% (n = 3). The tertiary endpoint was reached by 50% (n = 2). Histopathologic analyses revealed csPCa in none of these cases. Risk stratification did not change (p = 0.187) with the majority of patients (89.2%, n = 99). Conclusion: The concern of missing csPCa when omitting PBx in the risk-stratified pathway may be negated. Changes in risk stratification during follow-up should lead to subsequent PBx. We suggest implementing a safety net based on PSA density and digital rectal examination (DRE).

MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA Daniel Nemirovsky, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Jacob Enders, Michael Rothberg, Antoun Toubaji, Sandeep Gurram, and Peter Pinto Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Jacob EndersJacob Enders More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Antoun ToubajiAntoun Toubaji More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003226.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Signet ring cells (SRC) on pathology are typically associated with gastric carcinoma, but are also rarely seen in other malignancies, including prostate cancer (PCa). Though primary SRC adenocarcinoma of the prostate is a well-described aggressive malignancy, there is a paucity of literature describing the oncologic significance of SRC on prostate biopsy in patients with primary acinar adenocarcinoma. In this study, we aimed to describe the clinicopathologic characteristics and outcomes of these patients. METHODS: A prospectively collected database of patients with PCa was queried for presence of SRC on prostate biopsy. Patients with primary SRC adenocarcinoma were excluded. Demographics, imaging, pathological and treatment data were collected. Patients who received radical prostatectomy (RP) without neoadjuvant therapy were examined for adverse features, including extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymphovascular invasion (LVI), as well as post-RP biochemical recurrence (BCR). RESULTS: Between 2014-2022, 46 patients with SRC on biopsy were found. Clinicopathologic data is displayed in Table 1. Patients had a mean of 2.2 cores with SRC on biopsy, and 40/46 (87.0%) of these cores were GG ≥4. Oncologic outcomes are shown in Table 2. Every lesion containing SRC was MRI-visible, 93.3% of which were PIRADS 4 or 5. Of 14 patients with available whole-mount pathology data after RP, 12/14 (85.7%) had Gleason grade group ≥ 3 disease. 5/14 (35.7%) patients had EPE, 4/14 (28.6%) had SVI, and 3/14 (21.4%) had LVI. 3/14 (21.4%) patients experienced BCR post-RP, with a median time to BCR of 12 months (3-28). CONCLUSIONS: Signet ring cells on biopsy were typically identified in the setting of MRI-visible high-grade acinar adenocarcinoma and frequently associated with adverse features on whole mount pathology. While the biological significance of signet ring features in prostate cancer remains to be elucidated, clinical and pathologic correlates suggest an association with high risk disease and should prompt further study of this entity. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Jacob Enders More articles by this author Michael Rothberg More articles by this author Antoun Toubaji More articles by this author Sandeep Gurram More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of Pelvic Diffusion Weighted MRI Prior to Prostate Biopsy in Patients with elevated tPSA Level for Determination of Malignant Lesions

Efficacy of Pelvic Diffusion Weighted MRI Prior to Prostate Biopsy in Patients with elevated tPSA Level for Determination of Malignant Lesions

MP80-12 ASSOCIATION BETWEEN HIGH PREOPERATIVE SERUM TOTAL TESTOSTERONE LEVELS IN OBESITY PATIENTS AND PSA RECURRENCE AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AMONG JAPANESE POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP80-12 ASSOCIATION BETWEEN HIGH PREOPERATIVE SERUM TOTAL TESTOSTERONE LEVELS IN OBESITY PATIENTS AND PSA RECURRENCE AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AMONG JAPANESE POPULATION Yutaka Horiguchi, Kiichi Hagiwara, Noboru Sakamoto, Fumio Tsukuda, Toshikazu Okaneya, and Shoji Koga Yutaka HoriguchiYutaka Horiguchi More articles by this author , Kiichi HagiwaraKiichi Hagiwara More articles by this author , Noboru SakamotoNoboru Sakamoto More articles by this author , Fumio TsukudaFumio Tsukuda More articles by this author , Toshikazu OkaneyaToshikazu Okaneya More articles by this author , and Shoji KogaShoji Koga More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although a relationship between prostate cancer pathology and prognosis and serum total testosterone (TT) has been studied, previous evidences were contradictory. Also, there are few reports on the relationship between TT and oncologic outcomes after robotic-assisted laparoscopic radical prostatectomy (RARP). While, the influence of a high body mass index (BMI) on prostate cancer risk has been suggested. Therefore, we prospectively investigated the relationship between preoperative TT and postoperative PSA recurrence (BCR) in patients who underwent RARP. METHODS: A total of 1060 prostate biopsies were performed in our hospital between July 2015 and November 2020. Of 666 patients diagnosed with prostate cancer, 238 underwent RARP. The study cohort were 233 patients who had been followed up for more than 6 months after surgery. TT measurements were performed at 6:00 early morning on admission to all patients for prostate biopsy. A BCR was defined as postoperative PSA ≥0.2 ng/mL. RESULTS: The median age, serum PSA level, and TT at diagnosis were 70 (41 - 80) years, 8.56 (3.23 - 113.86) ng/mL, and 4.15 (0.73 - 10.70) ng/mL, respectively. RARP was performed at a mean of 2.5 (1.2 - 6.3) months after biopsy, and the mean postoperative follow-up period was 47 (6 - 86) months. Median TT level 12 months after RARP was 114% of preoperative TT in randomely evaluated 30 patients. BCR was observed in 54 patients (23.2%) at an average of 17 (0 - 65) months after surgery and salvage radiation and/or androgen deprivation therapy were applied. On Cox proportional hazard model multivariate analysis, significant preoperative predictors of BCR were biopsy Grade Group (bGG) ≥4 (Hazard ratio (HR) 3.3, p<0.0001), clinical stage T classification (cT) ≥ 3 (HR 2.3, p=0.003), and PSA density (PSAD) ≥ 0.25 (HR 2.2, p=0.014). When the patients are stratified by BMI ≥ 26.0 (n=57, 24.5% of study cohort, median TT: 3.51 ng/mL), bGG and cT lost their significance; instead, TT ≥ 3.78 ng/mL (HR 3.9, p=0.021) and PSAD ≥ 0.25 (HR 5.0, p=0.035) were significant predictors. When a risk of BCR was classified according to these 2 factors, only 1 of 17 patients (5.8%) in the low-risk (0 factor) group had BCR, whereas 9 of 14 (64.3%) patients in the high-risk (2 factors) group had BCR (Log-rank test, p<0.001). CONCLUSIONS: Preoperative TT was a significant independent factor for predicting BCR after RARP in patients with BMI ≥ 26.0 among Japanese population, indicating its usefulness when considering the treatment options prior to RARP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1156 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yutaka Horiguchi More articles by this author Kiichi Hagiwara More articles by this author Noboru Sakamoto More articles by this author Fumio Tsukuda More articles by this author Toshikazu Okaneya More articles by this author Shoji Koga More articles by this author Expand All Advertisement PDF downloadLoading ...

MP77-10 STAGE AND GRADE MIGRATION OF PROSTATE CANCER DURING THE COVID-19 PANDEMIC

You have accessJournal of UrologyCME1 Apr 2023MP77-10 STAGE AND GRADE MIGRATION OF PROSTATE CANCER DURING THE COVID-19 PANDEMIC Edoardo Beatrici, Muhieddine Labban, Benjamin V. Stone, Dejan K. Filipas, Nicola Frego, Sandeep S. Voleti, Nicolò Maria Buffi, Giovanni Lughezzani, Firas Abdollah, Adam S. Kibel, Alexander P. Cole, and Quoc-Dien Trinh Edoardo BeatriciEdoardo Beatrici More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Benjamin V. StoneBenjamin V. Stone More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Nicola FregoNicola Frego More articles by this author , Sandeep S. VoletiSandeep S. Voleti More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic likely affected the healthcare system’s ability to deliver prostate cancer care services. Herein, we sought to evaluate prostate cancer's stage and grade migration resulting from the COVID-19 pandemic. METHODS: We retrospectively analyzed the National Cancer Database (NCDB) for men with prostate cancer between 2018-2020. We divided our cohort into the “Pre-Pandemic” (2018/2019) and “Pandemic” (2020) periods. Stage and grade of prostate cancer were stratified according to the severity of disease: PSA value (≤20 vs. >20), clinical T stage (cT1-T2 vs. cT3-T4), clinical M stage (cM0 vs. cM1), International Society of Uropathology (ISUP) grade group (ISUP 1-2-3 vs. ISUP 4-5), and D’Amico risk classification (low risk vs. intermediate & high risk). Pearson’s chi-square test was used to assess differences in the distribution of stage and grade across the two periods. We performed multivariable logistic regressions to estimate the effect of the “Pandemic” period on stage and grade distribution adjusting for clinical and socioeconomic covariates. RESULTS: A total of 398,719 men were diagnosed with prostate cancer during the “Pre-pandemic” (70.6%) and “Pandemic” (29.4%) periods (Table 1). On univariable comparisons, an increase in stage/grade across the two periods was demonstrated (all p<0.001). After adjusting for covariates, compared to the “Pre-pandemic”, the “Pandemic” period was associated with increased odds of PSA >20 levels (aOR 1.06; 95% CI 1.03 – 1.08; p-value <0.001), cT3-4 stages (aOR 1.12; 95% CI 1.08 – 1.16; p<0.001), cM1 stage (aOR 1.15; 95% CI 1.12 – 1.18; p<0.001), ISUP grade group 4 or 5 (aOR 1.03; 95% CI 1.01 – 1.05; p=0.003) and D’Amico Intermediate & High risk groups (aOR 1.15; 95% CI 1.13 – 1.18; p<0.001). CONCLUSIONS: The COVID-19 pandemic was associated with significant changes in the distribution of both stage and grade of prostate cancer. Possible explanations for this migration include a better selection of patients for prostate biopsy during the pandemic or changes in prostate cancer screening patterns. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1105 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edoardo Beatrici More articles by this author Muhieddine Labban More articles by this author Benjamin V. Stone More articles by this author Dejan K. Filipas More articles by this author Nicola Frego More articles by this author Sandeep S. Voleti More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Firas Abdollah More articles by this author Adam S. Kibel More articles by this author Alexander P. Cole More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Microbiota of Urine, Glans and Prostate Biopsies in Patients with Prostate Cancer Reveals a Dysbiosis in the Genitourinary System

Prostate cancer (PCa) is the most common malignant neoplasm with the highest worldwide incidence in men aged 50 years and older. Emerging evidence suggests that the microbial dysbiosis may promote chronic inflammation linked to the development of PCa. Therefore, this study aims to compare the microbiota composition and diversity in urine, glans swabs, and prostate biopsies between men with PCa and non-PCa men. Microbial communities profiling was assessed through 16S rRNA sequencing. The results indicated that α-diversity (number and abundance of genera) was lower in prostate and glans, and higher in urine from patients with PCa, compared to non-PCa patients. The different genera of the bacterial community found in urine was significantly different in PCa patients compared to non-PCa patients, but they did not differ in glans and prostate. Moreover, comparing the bacterial communities present in the three different samples, urine and glans show a similar genus composition. Linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed significantly higher levels of the genera Streptococcus, Prevotella, Peptoniphilus, Negativicoccus, Actinomyces, Propionimicrobium, and Facklamia in urine of PCa patients, whereas Methylobacterium/Methylorubrum, Faecalibacterium, and Blautia were more abundant in the non-PCa patients. In glans, the genus Stenotrophomonas was enriched in PCa subjects, while Peptococcus was more abundant in non-PCa subjects. In prostate, Alishewanella, Paracoccus, Klebsiella, and Rothia were the overrepresented genera in the PCa group, while Actinomyces, Parabacteroides, Muribaculaceae sp., and Prevotella were overrepresented in the non-PCa group. These findings provide a strong background for the development of potential biomarkers with clinical interest.