Prostate Biopsy In Patients Research Articles

Is adjuvant amikacin to oral levofloxacine effective for prevention of febrile complications following transrectal prostate biopsy in patients with fluoroquinolone-resistant E. coli in the rectal flora?

Is adjuvant amikacin to oral levofloxacine effective for prevention of febrile complications following transrectal prostate biopsy in patients with fluoroquinolone-resistant E. coli in the rectal flora?

Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients

BackgroundTransrectal (TR) ultrasound guided prostate biopsy and transperineal (TP) ultrasound guided prostate biopsy are the two most commonly used methods to detect prostate cancer, the detection rate of the two biopsy approaches may differ in patients with different clinical characteristics. Here we aimed to compare the prostate cancer detection rate and positive rate of biopsy cores between TR and TP prostate biopsy in patients with different clinical characteristics.MethodsWe retrospectively analyzed and compared the clinical data of 452 patients underwent TR or TP prostate biopsy in our hospital from June 2017 to September 2021. And patients were stratified according to several clinical characteristic (serum PSA level, prostate volume, PSA density, T stage and ISUP grade), cancer detection rate and positive rate of biopsy cores were compared in different stratified groups.ResultsThere was no significant difference in age, PSA level, prostate volume, and PSA density between the TR and TP groups. TR group had a higher overall cancer detection rate and positive rate of biopsy cores than TP group. Further subgroup analysis showed that TR group had a higher cancer detection rate in patients with prostate volumes 30–80 mL, and that the TR group had a higher positive rate of biopsy cores among the patients with T3–T4 stages, while TP group had a higher positive rates of biopsy cores among the patients with T1–T2 stages. There were no significant differences between the TR and TP groups for each subgroup when stratified by PSA level, PSA density and ISUP grade.ConclusionsTR approach may have advantage in patients with prostate volumes 30–80 mL and T3–T4 stages, while TP approach may have advantage in patients with T1–T2 stages.

MRI-Based Radiomics Nomogram for Predicting Prostate Cancer with Gray-Zone Prostate-Specific Antigen Levels to Reduce Unnecessary Biopsies.

The aim of this study was to establish a predictive nomogram for predicting prostate cancer (PCa) in patients with gray-zone prostate-specific antigen (PSA) levels (4-10.0 ng/mL) based on radiomics and other traditional clinical parameters. In all, 274 patients with gray-zone PSA levels were included in this retrospective study. They were randomly divided into training and validation sets (n = 191 and 83, respectively). Data on the clinical risk factors related to PCa with gray-zone PSA levels (such as Prostate Imaging Reporting and Data System, version 2.1 [PI-RADS V2.1] category, age, prostate volume, and serum PSA level) were collected for all patients. Lesion volumes of interest (VOI) from T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) imaging were annotated by two radiologists. The radiomics model, clinical model, and combined prediction model, which was presented on a nomogram by incorporating the radiomics signature and clinical and radiological risk factors for PCa, were developed using logistic regression. The area under the receiver operator characteristic (AUC-ROC) and decision, calibration curve were used to compare the three models for the diagnosis of PCa with gray-zone PSA levels. The predictive nomogram (AUC: 0.953) incorporating the radiomics score and PI-RADS V2.1 category, age, and the radiomics model (AUC: 0.941) afforded much higher diagnostic efficacy than the clinical model (AUC: 0.866). The addition of the rad score could improve the discriminatory performance of the clinical model. The decision curve analysis indicated that the radiomics or combined model could be more beneficial compared to the clinical model for the prediction of PCa. The nomogram showed good agreement for detecting PCa with gray-zone PSA levels between prediction and histopathologic confirmation. The nomogram, which combined the radiomics score and PI-RADS V2.1 category and age, is an effective and non-invasive method for predicting PCa. Furthermore, as well as good calibration and is clinically useful, which could reduce unnecessary prostate biopsies in patients having PCa with gray-zone PSA levels.

Characteristics of prostate biopsy in patients under the dutasteride treatment.

We performed a retrospective study to clarify the characteristics of prostate biopsies in patients treated with dutasteride, a benign prostate hyperplasia treatment drug that inhibits 5α-reductase. We studied the digital clinical data of 677 patients, including 96 cases treated with dutasteride, with suspected localized prostate cancer. All patients underwent transrectal ultrasonography-guided prostate biopsy between 2014 and 2017 in our department. A propensity score matching analysis was performed based on prostate-specific antigen (PSA) (calculated as double the PSA value for the dutasteride group) and age. Ninety-six patients in each of the dutasteride and control groups were assessed and their characteristics were compared. The characteristics of the patients in the dutasteride and control groups were well balanced by matching. There were fewer prostate cancer-positive patients in the dutasteride group. When comparing only the prostate cancer-positive patients in each group, there were significantly more cases of high-grade cancers and abnormal magnetic resonance imaging (MRI) findings in the dutasteride group. In the dutasteride group, abnormal MRI findings and advanced age were significant predictors of high grade cancer. This study shows the characteristics of prostate biopsies in patients treated with dutasteride and indicates that patients on dutasteride with advanced age and abnormal MRI findings should undergo prostate biopsy.

Prostate-specific Antigen Density Cutoff of 0.15 ng/ml/cc to Propose Prostate Biopsies to Patients with Negative Magnetic Resonance Imaging: Efficient Threshold or Legacy of the Past?

BackgroundA prostate-specific antigen density (PSAd) cutoff of 0.15 ng/ml/cc is a commonly recommended threshold to identify patients with negative prostate magnetic resonance imaging (MRI) who should proceed to a prostate biopsy. We were unable to find any study that explicitly examined the properties of this threshold compared with others. ObjectiveTo investigate whether the 0.15 cutoff is justified for selecting patients at risk of harboring high-grade cancer (Gleason score ≥3 + 4) despite negative MRI. Design, setting, and participantsA cohort of 8974 prostate biopsies provided by the Prostate Biopsy Collaborative Group (PBCG) was included in the study. Outcome measurements and statistical analysisLocally weighted scatterplot smoothing was used to investigate whether there was a change in the risk of high-grade cancer around this value. We examined whether the use of this cutoff in patients with negative MRI corresponds to a reasonable threshold probability for a biopsy (defined as a 10% risk of high-grade disease). To do so, we applied the negative likelihood ratio of MRI, calculated from eight studies on prostate MRI, to the risk curve derived from the PBCG. Results and limitationsThere was no discontinuity in the risk of high-grade prostate cancer at a PSAd cutoff of 0.15. This cutoff corresponded to a probability of high-grade disease ranging from 2.6% to 10%, depending on MRI accuracy. Using 10% as threshold probability, the corresponding PSAd cutoff varied between 0.15 and 0.38, with the threshold increasing for greater MRI accuracy. Possible limitations include difference between studies on MRI and the use of ultrasound to measure prostate volume. ConclusionsThe 0.15 cutoff to recommend prostate biopsies in patients with negative MRI is justified only under an extreme scenario of poor MRI properties. We recommend a value of at least ≥0.20. Our results suggest the need for future studies to look at how to best identify patients who need prostate biopsies despite negative MRI, likely by using individualized risk prediction. Patient summaryIn this study, we investigated whether the commonly used prostate-specific antigen density cutoff of 0.15 is justified to identify patients with negative magnetic resonance imaging (MRI) who should proceed to a prostate biopsy. We found that this cutoff is appropriate only in case of very poor MRI quality, and a higher cutoff (≥0.20) should be used for the average MRI.

Correlation of digital rectal examination and serum prostate-specific antigen levels for detection of prostate cancer: Retrospective analysis results from a tertiary care urology center.

The objective of our study was to evaluate the detection rate of prostate cancer by digital rectal examination (DRE) and serum prostate-specific antigen (PSA) levels followed by standard 12-core transrectal ultrasound (TRUS)-guided prostate biopsy. After screening of patients presenting with lower urinary tract symptoms (LUTS) using DRE and serum PSA level, we enrolled patients for TRUS-guided 12-core prostate biopsy. Indications included PSA level ≥4 ng/ml and/or suspicious DRE findings. A retrospective analysis was done to find out the correlation between suspicious rectal examination and various serum PSA levels in detection of cancer prostate. A total of 847 patients were screened for cancer prostate during our study period (May 2012-February 2020). Among them, 823 patients who underwent prostate biopsy were analyzed. Prostate cancer was detected in 330 cases (40.09%). Mean age of patient (years) with and without prostate cancer was 66.25 ± 9.45 and 64.3 ± 8.96 years, respectively. Median value of serum PSA in patients positive for cancer was 33 ± 260 ng/ml compared to patients without cancer, who had a median value of 9 ± 64 ng/ml (P-value of <0.0001). The detection rate of cancer based on suspicious DRE findings irrespective of PSA was 52.18% (251/481), compared to 45.46% (311/684) using a PSA cut-off of ≥4.0 ng/ml alone. Among 330 patients with positive biopsy, 19 (5.75%) had a PSA level <4 ng/ml and they were identified based on suspicious DRE alone. Suspicious DRE was significantly associated with detection of prostate cancer across all PSA levels. Patients with PSA <4 can harbor prostate malignancy and such cases can be detected by use of DRE in screening of all patients with LUTS.

Patient engagement in a mobile health intervention to improve preparedness for prostate biopsy.

We designed and implemented a peri-procedural text message (SMS) program for patients undergoing transrectal prostate biopsy and aimed to evaluate predictors of patient enrollment and engagement with the SMS program. We designed an SMS-based program with 8 messages containing web-based modules with educational content and reminders confirming MRI for fusion biopsy, antibiotic adherence, enema use, and anticoagulation cessation. Data on patient demographics, enrollment, and engagement with modules were collected from June 1, 2018 to February 28, 2021. Engagement was defined as a patient clicking a link delivered via SMS to access modules. We made multivariable models to identify predictors of patient enrollment and engagement. Of the 1,760 prostate biopsies between June 2018 and March 2021, 1,383 (78.6%) were enrolled in SMS, 182 (10.3%) in email, 106 (6.0%) in both, and 240 (13.6%) were not enrolled. Of 1418 patients enrolled, 1,270 (89.6%) engaged with at least one module. African American patients had 50% lower odds of being enrolled (OR = 0.50, 95% CI 0.28-0.96; P = 0.03), but once enrolled there were no differences in engagement. Patients for whom English was not listed as their primary language had 60% lower odds of engagement (OR = 0.40, 95% CI 0.17-1.00, P = .04) and patients who were single or divorced had a 40% lower odds of engagement (OR = 0.60, 95% CI 0.41-0.91, P = 0.01). A cohort of older men undergoing prostate biopsy were able to engage with a text message-based education and reminder program. Future efforts must address barriers to enrollment for Black or African American men and improve accessibility to non-English speaking patients.

Pathological characteristics and predictive factors of prostate biopsy in patients with serum PSA levels between 0 and 4.0 ng/ml.

BackgroundThis study aimed to analyze the pathological characteristics and predictive factors of prostate biopsy in men with PSA levels below 4.0 ng/ml.Patients and methodsWe retrospectively analyzed 158 patients who underwent prostate biopsy with PSA levels below 4.0 ng/ml. Pathological results were statistically analyzed. The logistic regression analysis was used to determine the predictive factors for malignant outcomes. Subgroup analysis was performed on patients who received surgery and the postoperative pathological upgrading was counted.ResultsA total of 143 patients were enrolled. The tumor detection rate was 20.3%. Among these patients, most of them (79.3%) had prostate adenocarcinoma, but rare malignant tumors also accounted for 20.7%. Logistic regression analysis indicated that the only independent predictive factor for a positive prostate biopsy was the PI-RADS score. For prostate adenocarcinoma cases, 95.7% of them were organ localized and 47.8% of cases were clinically significant. Subgroup analysis was performed on 14 patients who received surgical treatment. 28.6% of patients were upgraded to clinically significant prostate cancer, while 64.3% of patients had an upgrade in tumor stage.ConclusionOur study indicated that 20.3% of men with PSA levels between 0 and 4.0 ng/ml were diagnosed with prostate malignancies. Among these patients, most of them (79.3%) were diagnosed with prostate adenocarcinoma, and several uncommon types of malignancies were also detected in 20.7% of patients. The only risk factor for a positive biopsy in patients with a low PSA concentration was the PI-RADS score. It should be emphasized that the invasiveness of PCa patients diagnosed by biopsy may be underestimated as more than half of patients will upgrade their Gleason score or clinical stages after surgery. Thus, clinicians should pay more attention to patients with PSA levels between 0 and 4.0 ng/ml.

The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS

BackgroundIn patients with multiparameter magnetic resonance imaging (mpMRI) low-possibility but highly clinical suspicion of prostate cancer, the biopsy core is unclear. Our study aims to introduce the biopsy density (BD; the ratio of biopsy cores to prostate volume) and investigates the BD-predictive value of prostate cancer and clinically significant prostate cancer (csPCa) in PI-RADS<3 patients.MethodsPatients underwent transperineal template–guided prostate biopsy from 2012 to 2022. The inclusion criteria were PI-RADS<3 with a positive digital rectal examination or persistent PSA abnormalities. BD was defined as the ratio of the biopsy core to the prostate volume. Clinical data were collected, and we grouped the patients according to pathology results. Kruskal–Wallis test and chi-square test were used in measurement and enumeration data, respectively. Logistics regression was used to choose the factor associated with positive biospy and csPCa. The receiver operating characteristic (ROC) curve was used to evaluate the ability to predict csPCa.ResultsA total of 115 patients were included in our study. Biopsy was positive in 14 of 115 and the International Society of Urological Pathology grade groups 2–5 were in 7 of all the PCa patients. The BD was 0.38 (0.24-0.63) needles per milliliter. Binary logistics analysis suggested that PSAD and BD were correlated with positive biopsy. Meanwhile, BD and PSAD were associated with csPCa. The ROC curve illustrated that BD was a good parameter to predict csPCa (AUC=0.80, 95% CI: 0.69-0.91, p<0.05). The biopsy density combined with PSAD increased the prediction of csPCa (AUC=0.90, 95% CI: 0.85-0.97, p<0.05). The cut-off value of the BD was 0.42 according to the Youden index.ConclusionIn PI-RADS<3 patients, BD and PSAD are related to csPCa. A biopsy density of more than 0.42 needles per millimeter can increase the csPCa detection rate, which should be considered as an alternative biopsy method when we perform prostate biopsy in patients with PI-RADS<3.

Comparison of Proclarix, PSA Density and MRI-ERSPC Risk Calculator to Select Patients for Prostate Biopsy after mpMRI.

Simple SummaryThe selection of proper candidates for prostate biopsy after magnetic resonance imaging (MRI) has usually been studied in the overall population with suspected prostate cancer (PCa). However, the performance of these tools can change regarding the Prostate Imaging-Reporting and Data System (PI-RADS) categories. We compared three different tools: PSA density, MRI-ERSPC risk calculator and Proclarix in 567 men with suspected PCa (PSA > 3 ng/mL and/or abnormal rectal examination) in one academic institution. All patients underwent multiple transrectal ultrasound guided biopsies after a multiparametric MRI was performed. We concluded that in the overall population, MRI-ERSPC RC outperformed PSA density and Proclarix, whereas in patients with lesions PI-RADS < 3 Proclarix was better than the other tools. However, no tool guaranteed 100% detection of clinically significant PCa in PI-RADS 4 and 5.Tools to properly select candidates for prostate biopsy after magnetic resonance imaging (MRI) have usually been analyzed in overall populations with suspected prostate cancer (PCa). However, the performance of these tools can change regarding the Prostate Imaging-Reporting and Data System (PI-RADS) categories due to the different incidence of clinically significant PCa (csPCa). The objective of the study was to analyze PSA density (PSAD), MRI-ERSPC risk calculator (RC), and Proclarix to properly select candidates for prostate biopsy regarding PI-RADS categories. We performed a head-to-head analysis of 567 men with suspected PCa, PSA > 3 ng/mL and/or abnormal rectal examination, in whom two to four core transrectal ultrasound (TRUS) guided biopsies to PI-RADS ≥ three lesions and/or 12-core TRUS systematic biopsies were performed after 3-tesla mpMRI between January 2018 and March 2020 in one academic institution. The overall detection of csPCa was 40.9% (6% in PI-RADS < 3, 14.8% in PI-RADS 3, 55.3% in PI-RADS 4, and 88.9% in PI-RADS 5). MRI-ERSPC model exhibited a net benefit over PSAD and Proclarix in the overall population. Proclarix outperformed PSAD and MRI-ERSPC RC in PI-RADS ≤ 3. PSAD outperformed MRI-ESRPC RC and Proclarix in PI-RADS > 3, although none of them exhibited 100% sensitivity for csPCa in this setting. Therefore, tools to properly select candidates for prostate biopsy after MRI must be analyzed regarding the PI-RADS categories. While MRI-ERSPC RC outperformed PSAD and Proclarix in the overall population, Proclarix outperformed in PI-RADS ≤ 3, and no tool guaranteed 100% detection of csPCa in PI-RADS 4 and 5.

Evaluation of periprocedure antibiotics and infection-related hospitalizations after transrectal prostate biopsies

Background: Prostate cancer is the leading cancer diagnosis and the second leading cause of cancer deaths in men. Definitive diagnosis is made by prostate biopsy. This procedure poses a risk of infection and, rarely, sepsis. Studies have found the incidence of symptomatic urinary tract infection (UTI) after biopsy to be 2%–3%, and the rate of infection-related hospitalization (IRH) to be 0.6%–4.1%. An initial review at our facility found the IRH rate to be 3.7%. The primary purpose of this study was to determine the incidence of IRH following prostate biopsy in patients at the Memphis VA Medical Center (VAMC) after initial review and education. Methods: All transrectal prostate biopsies performed at the Memphis VAMC from October 2017 through May 2021 were analyzed. Patients were excluded if they had a spinal cord injury or concomitant procedure. The primary outcome was IRH occurring within 30 days of the procedure. Variables collected included risk factors, antibiotic choice and duration, and details of postprocedural infections. Analyses were performed on a per-procedure basis. Results: Overall, 601 procedures were identified; 13 were excluded, for a total of 588 transrectal prostate biopsies on 533 patients. All patients were given antibiotics. Oral antibiotics alone were provided for 306 procedures (52%) for an average duration of 3 days. A combination of both oral and intramuscular antibiotics were provided for 282 (48%) procedures. The most common oral antibiotics used were cefuroxime (538, 91.4%), ciprofloxacin (17, 2.9%), amoxicillin–clavulanate (16, 2.7%), and sulfamethoxazole–trimethoprim (12, 2%). Intramuscular antibiotics included ceftriaxone (263, 93.3%) and gentamicin (19, 6.7%). An infectious complication occurred in 29 patients (4.9%): 26 (3.4%) were urogenital and 5 (0.8%) required hospitalization. Of the procedures complicated by a postprocedure infection, 22 (75.9%) received an oral antibiotic alone, 21 (95.4%) of which were cefuroxime, and 7 (24.1%) received both an intramuscular and an oral agent. Conclusions: In our initial review, the most common antibiotics used were fluroquinolones, with an average duration of 3 days periprocedure and an IRH rate of 3.7%. These findings were used to reinforce practices compliant with American Urological Association (AUA) guidelines. This follow-up review reveals that the first-line choice changed from fluroquinolones to cephalosporins, with average duration remaining at 3 days. Although the overall infection rate was 4.9%, the IRH rate decreased from 3.7% to 0.8%.Funding: NoneDisclosures: None

MP32-11 FREE-HAND VERSUS GRID-ASSISTED TRANSPERINEAL ULTRASOUND MRI-FUSION PROSTATE BIOPSY: AN INITIAL EXPERIENCE

You have accessJournal of UrologyCME1 May 2022MP32-11 FREE-HAND VERSUS GRID-ASSISTED TRANSPERINEAL ULTRASOUND MRI-FUSION PROSTATE BIOPSY: AN INITIAL EXPERIENCE Jacob Enders, Nicole Varble, Michael Rothberg, Zach Kozel, Sheng Xu, Patrick Gomella, Michael Daneshvar, Reza Seifabadi, Maria Merino, Baris Turkbey, Bradford Wood, and Peter Pinto Jacob EndersJacob Enders More articles by this author , Nicole VarbleNicole Varble More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Zach KozelZach Kozel More articles by this author , Sheng XuSheng Xu More articles by this author , Patrick GomellaPatrick Gomella More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Reza SeifabadiReza Seifabadi More articles by this author , Maria MerinoMaria Merino More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal (TP) prostate biopsy has been shown to reduce rates of bleeding, sepsis, and other infectious complications compared to the traditional transrectal (TR) approach. Recent efforts have focused on using free-hand TP ultrasound (US) rather than TRUS for TP biopsy, with the objective of facilitating prostate biopsies in patients with post-TRUS biopsy urosepsis or in those without a rectum. We sought to compare cancer detection and upgrading rates between free-hand TPUS TP biopsy versus grid-assisted TP biopsy with TRUS. METHODS: Patients with an indication for prostate biopsy were enrolled in an IRB-approved clinical trial at our institution and underwent multiparametric MRI (mpMRI) of the prostate prior to biopsy. Under monitored anesthesia care or deep sedation, patients were placed in the dorsal lithotomy position. Registration of 2D TPUS sweeps with mpMRI was performed and, using the UroNav platform (Invivo/Philips, Gainesville, FL), two biopsy cores per MR-visible target lesion were obtained via the free-hand TPUS TP biopsy and grid-assisted TP biopsy with TRUS guidance techniques. A modified Barzell scheme was then used for systematic TP biopsy. Clinically significant prostate cancer was defined as Gleason grade group 2 or higher. Concordance of pathology of targeted biopsy cores and rates of upgrading between free-hand and grid-assisted TP biopsy techniques were compared. RESULTS: 49 patients have undergone free-hand and grid-assisted TP biopsy at our institution. 33/49 patients (67.3%) with a median PSA of 7.3 ng/mL (IQR: 5.2 – 11.0) were positive for cancer on biopsy. The mean number of cores obtained from targeted lesions per patient was 5.0±2.2 for the grid-assisted technique and 3.8±2.1 with free-hand technique. 40% and 34% of targeted cores were positive on grid-assisted and free-hand TP biopsy, respectively. 17/49 patients (34.7%) had a higher grade cancer on grid-assisted than free-hand biopsy, and in 6 cases this discordance was clinically significant. There were zero infection-related complications following the procedure. CONCLUSIONS: Free-hand TP prostate biopsy with TPUS guidance allows for diagnosis of prostate cancer with comparable rates to the grid assisted TP biopsy technique with TRUS. This may facilitate biopsies in patients who have had prior post-TRUS biopsy urosepsis or in patients without a rectum. Further work is necessary to refine needle placement with the free-hand technique to ensure accurate lesion sampling and validate the technique in a larger patient cohort. Source of Funding: The National Institute of Health (NIH) Medical Research Scholars Program, Foundation for the NIH, NIH Intramural Research Program © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e535 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Enders More articles by this author Nicole Varble More articles by this author Michael Rothberg More articles by this author Zach Kozel More articles by this author Sheng Xu More articles by this author Patrick Gomella More articles by this author Michael Daneshvar More articles by this author Reza Seifabadi More articles by this author Maria Merino More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD39-12 A PROSPECTIVE TRIAL OF MULTIPARAMETRIC MAGNETIC RESONANCE OF THE PROSTATE USE TO AVOID BIOPSIES IN PATIENTS WITH ELEVATED PROSTATE SPECIFIC ANTIGEN AND SURGICAL INDICATION FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022PD39-12 A PROSPECTIVE TRIAL OF MULTIPARAMETRIC MAGNETIC RESONANCE OF THE PROSTATE USE TO AVOID BIOPSIES IN PATIENTS WITH ELEVATED PROSTATE SPECIFIC ANTIGEN AND SURGICAL INDICATION FOR BENIGN PROSTATIC HYPERPLASIA Marcelo Wroclawski, Lucas Takemura, Felipe Gushiken, Breno Amaral, Paulo Kayano, Ronaldo Baroni, Bianca Bianco, Arie Carneiro, and Gustavo Lemos Marcelo WroclawskiMarcelo Wroclawski More articles by this author , Lucas TakemuraLucas Takemura More articles by this author , Felipe GushikenFelipe Gushiken More articles by this author , Breno AmaralBreno Amaral More articles by this author , Paulo KayanoPaulo Kayano More articles by this author , Ronaldo BaroniRonaldo Baroni More articles by this author , Bianca BiancoBianca Bianco More articles by this author , Arie CarneiroArie Carneiro More articles by this author , and Gustavo LemosGustavo Lemos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002597.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with benign prostatic hyperplasia (BPH) may have increased prostate specific antigen (PSA) levels, posing a dilemma as to whether perform a prostate biopsy to rule out a concomitant prostate cancer (PCa) before a surgical procedure. Multiparametric magnetic resonance imaging (mpMRI) has increased the detection of clinically significant PCa and may aid the decision to biopsy patients who are suspicious for PCa. This study aimed to evaluate if mpMRI could safely prescind the prostate biopsy in patients who will undergo a BPH procedure. METHODS: Interim analysis of a prospective study including 84 men with surgical indication due to BPH and concomitantly elevated PSA levels (PSA ≥4 ng/ml, or PSA ≥2 ng/ml if using 5-alpha-reductase inhibitor). All patients underwent 1.5 Tesla mpMRI prior to transrectal ultrasound (TRUS) biopsy. Additional fragments were obtained with the fusion guided technique in cases where mpMRI identified focal lesions. Biopsy histopathological results were used as the standard of reference. Two scenarios were evaluated: scenario 1, considering mpMRI PIRADS 1 and 2 as negative; and scenario 2, considering PIRADS 1, 2 and 3 as negative. Clinically significant PCa was defined as ISUP ≥2. RESULTS: Median age was 72.5 years (53-86), median PSA was 8.06 ng/ml (2.0-39.87) and median prostatic volume was 119.80 cc (30-342). Scenario 1: mpMRI sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for any PCa on biopsy was 65.2%, 68.8%, 44.1%, 84% and 67.8%. For clinically significant PCa, they were 81.8%, 65.7%, 26.4%, 96% and 67.8%, respectively, for the same measures. Scenario 2: mpMRI sensitivity, specificity, PPV, NPV and accuracy for any PCa on biopsy was 39.1%, 91.8%, 64.2%, 80% and 77.3%. For clinically significant PCa, they were 72.7%, 91.7%, 57.1%, 95.7% and 89.2%, respectively, for the same measures. CONCLUSIONS: Prostate mpMRI may prevent unnecessary biopsies in patients with elevated PSA and surgical indication due to BPH, given its high negative predictive value. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e657 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcelo Wroclawski More articles by this author Lucas Takemura More articles by this author Felipe Gushiken More articles by this author Breno Amaral More articles by this author Paulo Kayano More articles by this author Ronaldo Baroni More articles by this author Bianca Bianco More articles by this author Arie Carneiro More articles by this author Gustavo Lemos More articles by this author Expand All Advertisement PDF DownloadLoading ...

Ex Vivo High-Resolution Magic Angle Spinning (HRMAS) 1H NMR Spectroscopy for Early Prostate Cancer Detection

Simple SummaryProstate cancer is the second leading cancer diagnosed in men worldwide. Current diagnostic standards lack sufficient reliability in detecting and characterizing prostate cancer. Due to the cancer’s multifocality, prostate biopsies are associated with high numbers of false negatives. Whereas several studies have already shown the potential of metabolomic information for PCa detection and characterization, in this study, we focused on evaluating its predictive power for future PCa diagnosis. In our study, metabolomic information differed substantially between histobenign patients based on their risk for receiving a future PCa diagnosis, making metabolomic information highly valuable for the individualization of active surveillance strategies.The aim of our study was to assess ex vivo HRMAS (high-resolution magic angle spinning) 1H NMR spectroscopy as a diagnostic tool for early PCa detection by testing whether metabolomic alterations in prostate biopsy samples can predict future PCa diagnosis. In a primary prospective study (04/2006–10/2018), fresh biopsy samples of 351 prostate biopsy patients were NMR spectroscopically analyzed (Bruker 14.1 Tesla, Billerica, MA, USA) and histopathologically evaluated. Three groups of 16 patients were compared: group 1 and 2 represented patients whose NMR scanned biopsy was histobenign, but patients in group 1 were diagnosed with cancer before the end of the study period, whereas patients in group 2 remained histobenign. Group 3 included cancer patients. Single-metabolite concentrations and metabolomic profiles were not only able to separate histobenign and malignant prostate tissue but also to differentiate between samples of histobenign patients who received a PCa diagnosis in the following years and those who remained histobenign. Our results support the hypothesis that metabolomic alterations significantly precede histologically visible changes, making metabolomic information highly beneficial for early PCa detection. Thanks to its predictive power, metabolomic information can be very valuable for the individualization of PCa active surveillance strategies.

MiCheck prostate blood test for aggressive prostate cancer designed for the clinical lab setting.

229 Background: Clinicians want a more accurate diagnostic test to identify patients for prostate biopsy. We have previously described the development of a Luminex based test for aggressive prostate cancer (MiCheck). To facilitate widespread deployment of MiCheck on standard clinical chemistry analysers such as Roche Cobas and Abbott ARCHITECT/Alinity systems, we have performed additional analytical validation and model development using the MiCheck-01 clinical samples. A novel algorithm, termed MiCheck Prostate, was developed to differentiate aggressive prostate cancer (Gleason 3+4 or above) from non-aggressive (GS3+3) or no cancer patients. Methods: Serum protein biomarkers were measured in 317 samples from the MiCheck-01 clinical trial using either Luminex Multiplex kits, Abbott ARCHITECT or Beckmann Coulter systems. Logistic regression models were used to select best analytes, then Monte Carlo cross-validation was applied to avoid overfitting. A final model was selected from the cross-validation models with best test specificity at 95% sensitivity. The MiCheck-01 samples were later all measured on a standard Abbott ARCHITECT system using commercial ARCHITECT IVD tests. The best cross-validated model was developed and the results compared to those obtained from the mixed analyte platforms using ROC curve analysis. Results: The MiCheck Prostate algorithm was developed to maximise discrimination between aggressive prostate cancer and no cancer or non-aggressive cancer. The MiCheck Prostate algorithm reports a percentage risk of aggressive prostate cancer on biopsy. MiCheck Prostate is a logistic regression algorithm that combines three serum protein markers and one clinical factor and was derived using data from the MiCheck-01 trial. The algorithm gave an AUC of 0.82, with a 48% specificity at a 95% sensitivity cutpoint, with a negative predictive value of 94% for GS3+4 and higher cancers. The samples were later re-measured using all ARCHITECT immunoassays. Good correlations of each analyte across different measurement platforms was observed (Pearson’s R &gt; 0.9). The algorithm was revalidated using the new set of analyte values. AUC of 0.82 for the detection of aggressive CaP, and sensitivity of 95%, specificity of 47% were obtained for the best model, showing no statistical difference to the previous best model derived from the mixed platforms. NPV of 94% for GS3+4 or higher cancers was maintained. Conclusions: The MiCheck Prostate test shows high sensitivity, specificity and NPV for the detection of aggressive prostate cancer. It uses analytes widely available on standard clinical chemistry analysers such as Abbott Architect and Roche Cobas, hence is simple to deploy in the laboratory setting. Studies are ongoing to confirm the MiCheck Prostate algorithm performance using additional clinical sample cohorts.

Detection of ISUP ≥2 prostate cancers using multiparametric MRI: prospective multicentre assessment of the non-inferiority of an artificial intelligence system as compared to the PI-RADS V.2.1 score (CHANGE study)

IntroductionProstate multiparametric MRI (mpMRI) has shown good sensitivity in detecting cancers with an International Society of Urological Pathology (ISUP) grade of ≥2. However, it lacks specificity, and its inter-reader reproducibility...

Integration of magnetic resonance imaging into prostate cancer nomograms.

The decision whether to undergo prostate biopsy must be carefully weighed. Nomograms have widely been utilized as risk calculators to improve the identification of prostate cancer by weighing several clinical factors. The recent inclusion of multiparametric magnetic resonance imaging (mpMRI) findings into nomograms has drastically improved their nomogram’s accuracy at identifying clinically significant prostate cancer. Several novel nomograms have incorporated mpMRI to aid in the decision-making process in proceeding with a prostate biopsy in patients who are biopsy-naïve, have a prior negative biopsy, or are on active surveillance. Furthermore, novel nomograms have incorporated mpMRI to aid in treatment planning of definitive therapy. This literature review highlights how the inclusion of mpMRI into prostate cancer nomograms has improved upon their performance, potentially reduce unnecessary procedures, and enhance the individual risk assessment by improving confidence in clinical decision-making by both patients and their care providers.

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

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

Association between the presence of bacteria in prostate tissue and histopathology in biopsies from men not complaining of lower urinary tract symptoms.

To investigate the presence of bacteria in prostate tissue, and relationships between the bacteria and histopathological findings. Samples were collected from prostate biopsy patients with no obvious lower urinary tract symptoms (LUTS). Detection and identification of bacterial species in the prostate tissues were performed with PCR for 16SrDNA and DNA sequencing. Histopathology was also evaluated. LUTS and lower urinary tract function were assessed by questionnaires, uroflowmetry, and ultrasonography. DNA was extracted from 97 prostate biopsies, with 5 bacterial species detected among samples from 7 patients (7.2%). The stroma-to-gland ratio in the prostate tissues from patients with bacteria was lower than in those without bacteria (p < 0.01). Glandular epithelial hyperplasia was also identified in the prostates harboring bacteria. International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QOL), Overactive Bladder Symptom Score (OABSS), maximum flow rate, urine volume by uroflowmetry, and post-voided residual urine were not significantly different when comparing patients with and without bacteria in their prostate samples. The present study demonstrated that 7.2% of men without obvious LUTS had bacteria in their prostate tissues. The presence of such bacteria might induce glandular hyperplasia and contribute to pathological changes in the early stages of benign prostate enlargement before affecting LUTS.

IsoPSA® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study.

We assessed the impact of the IsoPSA® test for prostate cancer risk assessment on provider patient management decisions in a real-world clinical setting. A total of 38 providers, including advanced practice providers, fellowship trained oncologists and general urologists in the Cleveland Clinic health system including both community-based practices and academic locations, enrolled 900 men being evaluated for prostate cancer; 734 met inclusion criteria (age ≥50 years, total serum prostate specific antigen [PSA] ≥4 and <100 ng/ml and no history of prostate cancer) and IsoPSA indication for use. A standard template was used to document biopsy recommendation prior to and after receiving IsoPSA results. The primary outcome was the number of biopsy and magnetic resonance imaging recommendation changes occurring after IsoPSA testing. IsoPSA testing resulted in a 55% (284 vs 638) net reduction in recommendations for prostate biopsy for men with total PSA ≥4 ng/ml. Additionally, a 9% reduction in recommendations for magnetic resonance imaging was observed. There was strong concordance between IsoPSA results and provider recommendations for prostate biopsy, with 87% of patients with an IsoPSA index above the threshold recommended for biopsy and 92% of patients with an IsoPSA index below the threshold not recommended for biopsy. In a real-world clinical setting, providers from diverse training backgrounds and practice settings readily adopted IsoPSA with substantial reductions in the rate of recommended prostate biopsies in patients with elevated PSA values (≥4 ng/ml). There was a high concordance between recommendation for or against prostate biopsy and the IsoPSA result.