Prostate Biopsy In Patients Research Articles

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.

Compаrative study: Efficacy and safety of MRI / ultrasound transperineal vs systematic transrectal prostate biopsy in patients with previous negative TRUS biopsy

Objective The aim of the study was to compare the efficacy and safety of magnetic resonance imaging / ultrasound-targeted transperineal prostate biopsy versus standard transrectal systemic biopsy, in detection of prostate cancer, in patients with evidence of previous negative systematic transrectal ultrasound prostate biopsy. Material and Methods From February 2019 to February 2021 in the Clinic of Endourology and SWL of the Military Medical Academy – Sofia, in 59 patients repeated prostate biopsy was performed after a previous negative systematic transrectal ultrasound-guided biopsy. In 35/59 patients in the group, MRI / ultrasound transperineal prostate biopsy was performed (group A), and in the remaining 24/59 patients a repeat systemic TRUS biopsy was performed (group B). The main indications for repeat prostate biopsy were persistent elevated PSA values, a finding on rectal digital examination, and / or a suspected area of prostate MRI. Results. Preoperative data were comparable in the two groups of patients, with no statistically significant differences. The mean value of PSA in group A was 17.27 ± 14.6 ng / ml, compared to 25.93 ± 24.19 ng / ml in group B, p = 0.264. MRI / ultrasound transperineal prostate biopsy revealed the presence of prostate cancer in 28 patients (80%) of the study group, compared to 8 patients (33.3%) in the group who underwent systematic TRUS biopsy, p = 0.001. The histopathological results of group A revealed the presence of low-grade prostate cancer in 15 patients (42.9%), compared to 13 patients (37.1%) in whom high-grade cancer was detected. The results show a statistically significant difference compared to patients in group B, where 3 patients (12.5%) showed low-grade prostate cancer, and 5 patients (20.8%) had a high-grade malignant process, p = 0.005. There was no statistically significant difference in intra- and postoperative complications in the two groups. Conclusion. Performing MRI / ultrasound targeted biopsy showed significant higher efficacy and identical safety in diagnosing a prostate neoplastic process compared to standard 12-core transrectal systemic biopsy in patients with previous negative systemic TRUS biopsy.

A Germline Variant at 8q24 Contributes to the Serum p2PSA Level in a Chinese Prostate Biopsy Cohort.

IntroductionThe clinical performance of [–2]proPSA (p2PSA) and its derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) has been well evaluated in prostate biopsy patients. However, no study has been performed to evaluate the common genetic determinants that affect serum level of p2PSA.Materials and MethodsHere, we performed a two-stage genome-wide association study (GWAS) on the p2PSA level in Chinese men who underwent a transperineal ultrasound-guided prostate biopsy at Huashan Hospital, Shanghai Cancer Center, and Ruijin Hospital in Shanghai, China. Germline variants significantly associated with the p2PSA level in the first stage (n = 886) were replicated in the second stage (n = 1,128). Multivariate linear regression was used to assess the independent contribution of confirmed single nucleotide polymorphisms (SNPs) and known covariates, such as age, to the level of p2PSA.ResultsA novel non-synonymous SNP, rs72725879, in region 8q24.21 of the PRNCR1 gene was significantly associated with the serum level of p2PSA in this two-stage GWAS (p = 2.28 × 10−9). Participants with homozygous “T” alleles at rs72725879 had higher p2PSA levels compared to allele “C” carriers. This variant was also nominally associated with PCa risk (p-combined = 3.44 × 10−18). The association with serum level of p2PSA was still significant after adjusting for PCa risk and age (p = 0.017).ConclusionsOur study shows that the genetic variants in the 8q24.21 region are associated with the serum level of p2PSA in a large-scale Chinese population. By taking inherited variations between individuals into account, the findings of these genetic variants may help improve the performance of p2PSA in predicting prostate cancer.

A new ASAP Scoring System and Risk Table to predict second prostate biopsy outcomes

IntroductionThis study aimed to discuss the necessity of a second prostate biopsy in patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table to be used as new criteria for a second biopsy.Material and methodsThe study reviewed the data of 2,845 patients; who underwent transrectal ultrasonography-guided prostate biopsy in the period between January 2008 and May 2019. A total of 128 patients with ASAP were included in the study. The tPSA, fPSA, f/tPSA, and PSA-Density levels before the first and second biopsies and changes in the measured levels between the values obtained before the first and the second biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy.ResultsThe mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of prostate cancer patients were significantly higher compared to patients without prostate cancer (p: 0.001). In the ROC curve analysis of ASS-RT, the area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT scores in diagnosing cancer was ≥ 7 with 60.8% sensitivity and 80.5% specificityConclusionsThe cut-off value of 7 determined for the ASS-RT score in this study suggests that patients with ASS-RT scores of ≥7 should undergo a second prostate biopsy. We think that there may be no need for a second biopsy if the ASS-RT score is &lt;7, especially for low-risk patients.

MP26-15 HEAD-TO-HEAD COMPARISON OF PROSTATE CANCER DETECTION RATE AT MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING-TARGETED FUSION BIOPSY BETWEEN HUB AND SPOKE CENTERS

INTRODUCTION AND OBJECTIVE:European guidelines on prostate cancer strongly recommend multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy in patients with clinical suspicion of...

MP43-14 COMPARISON BETWEEN QUINOLONES AND OTHER ANTIBIOTICS IN PREVENTING INFECTIVE COMPLICATIONS IN TRANSRECTAL PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP43)1 Sep 2021MP43-14 COMPARISON BETWEEN QUINOLONES AND OTHER ANTIBIOTICS IN PREVENTING INFECTIVE COMPLICATIONS IN TRANSRECTAL PROSTATE BIOPSY Gabriele Tulone, Vincenzo Serretta, Ettore Dalmasso, Marco Vella, Nino Dispensa, Carlo Pavone, Davide Baiamonte, Piero Mannone, Alberto Abrate, Roberta Aimar, Vincenzo Ficarra, Riccardo Bartoletti, and Alchiede Simonato Gabriele TuloneGabriele Tulone More articles by this author , Vincenzo SerrettaVincenzo Serretta More articles by this author , Ettore DalmassoEttore Dalmasso More articles by this author , Marco VellaMarco Vella More articles by this author , Nino DispensaNino Dispensa More articles by this author , Carlo PavoneCarlo Pavone More articles by this author , Davide BaiamonteDavide Baiamonte More articles by this author , Piero MannonePiero Mannone More articles by this author , Alberto AbrateAlberto Abrate More articles by this author , Roberta AimarRoberta Aimar More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , Riccardo BartolettiRiccardo Bartoletti More articles by this author , and Alchiede SimonatoAlchiede Simonato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002064.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sepsis is one of the most feared complications of prostate biopsy: it’s incidence is 1-3%. Prevention of infection after biopsy procedure consists in prophylactic antibiotic therapy. Quinolones were indicated in European and American guidelines as the first-choice antibiotic prophylaxis up to 2018 European Medicine Agency (EMA) restrictions on their use in patients at risk of aortic aneurysms. Guidelines in prostate biopsies placed quinolones as second-choice antibiotic. The goal of our study was to compare the incidence of infective complications of prostate biopsy adopting different antibiotics. METHODS: A retrospective case-control study including all patients submitted to ultrasound-guided transrectal prostate biopsy before and after the publication of the EMA note (2017 to 2019) was conducted in 3 referral urology institutions (Palermo, Cuneo and Pisa). A standard number of 12 biopsy samples was planned. Biopsy complications (fever, haematuria, haematospermia, rectal bleeding, rectal pain and sepsis) were evaluated in patients undergoing prophylaxis with quinolones (levofloxacin, ciprofloxacin, plurifloxacin), cephalosporins (cefixime, ceftriaxone) and trimethoprim /sulfamethoxazole. The data were compared with the variance analysis (ANOVA). A p value <0.05 was considered significant. RESULTS: Data of 1160 patients were collected. Median age was 70 years (IQR 64-75.6) and median PSA 7.36 ng/ml (IQR 5.38-11). The meadian number of biopsy samples was 12 (range 2-18). Among 448 patients (38.6%) undergoing quinolone prophylaxis, 9.6% reported haematuria, 5.4% haematospermia, 4.2% rectal bleeding and 1.13% fever. Among 606 (52.2%) patients receiving non-quinolone drugs (cephalosporins, trimethoprim /sulfamethoxazole) haematuria was reported in 12.2% patients, haematospermia in 15.4%, rectal bleeding in 9.7% and fever in 3.5%. There was a statistically significant difference in the incidence of the complications described between the two populations examined (p < 0.001 for hematuria, hematospermia and rectal bleeding and p = 0.004 for fever). Incidence was independent from center and operator. CONCLUSIONS: After EMA note in 2018, the European Association Urology guidelines recommended the use of cephalosporins or phosphomycin as the first-choice antibiotic prophylaxis of prostate biopsy in patients at risk of aortic aneurysm. In our study quinolone-based prophylaxis was associated with a lower incidence of complications after prostate biopsy in comparison with other antibiotics. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e787-e787 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tulone More articles by this author Vincenzo Serretta More articles by this author Ettore Dalmasso More articles by this author Marco Vella More articles by this author Nino Dispensa More articles by this author Carlo Pavone More articles by this author Davide Baiamonte More articles by this author Piero Mannone More articles by this author Alberto Abrate More articles by this author Roberta Aimar More articles by this author Vincenzo Ficarra More articles by this author Riccardo Bartoletti More articles by this author Alchiede Simonato More articles by this author Expand All Advertisement Loading ...

Safety of transrectal ultrasound-guided prostate biopsy in patients receiving aspirin: An update meta-analysis including 3373 patients.

Background:The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB).Methods:We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding.Results:Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.09–1.49], P = .002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RR = 1.02, 95%CI [0.91–1.16], P = .71) and hematospermia (RR = 0.93, 95%CI [0.82–1.06], P = .29).Conclusion:Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.

Impact of early hypothalamic-pituitary-gonadal axis maturation on prostate cancer: cross-sectional analysis of a Veterans affairs cohort.

BackgroundIt has been hypothesized that earlier onset of puberty, and thus a more prolonged exposure to high androgen levels, increases risk of prostate cancer development. Our objective was to determine whether earlier age of first shave and height, as surrogates of pubertal onset, were associated with risk of prostate cancer diagnosis.MethodsA prospectively collected outcomes registry of patients presenting for a prostate biopsy at the Charlie Norwood Veterans Affair Medical Center in Augusta, GA between July 1995 and June 2016 was utilized. The associations between age of first shave and height, each, and risks of a positive prostate biopsy, high grade cancer, and high volume disease were evaluated using univariable and multivariable logistic regression analysis, controlling for baseline patient demographic and oncologic characteristics.ResultsOur cohort included 2,456 patients. Biopsies were positive in 1,257 (51.2%) patients, of whom 293 (23.3%) and 407 (32.4%) had high grade and volume disease, respectively. Median age of first shave was 17.0 years (interquartile range 16.0–19.0) and height was 177.7 cm (172.8–182.9). On multivariable analysis, later of age of first shave was significantly associated with increased odds of a positive prostate biopsy (odds ratio for >18 versus <16 years: 5.34, P=0.02) and taller patients had significantly increased odds of high grade cancer (odds ratio for 175–180 versus <175 cm: 7.46, P=0.037).ConclusionsAmongst patients presenting for a prostate biopsy, those with a later age of first shave and taller height have an increased risk of a positive prostate biopsy and high grade prostate cancer, respectively.

Can Prostate-Specific Antigen Density Be an Index to Distinguish Patients Who Can Omit Repeat Prostate Biopsy in Patients with Negative Magnetic Resonance Imaging?

PurposeWe evaluated the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI) in detecting clinically significant prostate cancer (csPCa) according to biopsy setting and prostate-specific antigen density (PSAD) using transperineal template-guided saturation prostate biopsy (TPB) as the reference standard.MethodsA total of 161 patients with biopsy histories and negative pre-biopsy mpMRI (Prostate Imaging Reporting and Data System version 2 scores of less than 3) participated in the study. TPB was performed on the following indications: “prior negative biopsy” in patients with persistent suspicion of prostate cancer (n = 91) or “confirmatory biopsy” in patients who were candidates for active surveillance (n = 70). The csPCa was defined as a Gleason score of 3 + 4 or greater. We calculated the NPV of mpMRI in detecting csPCa according to biopsy history and prostate-specific antigen density (PSAD) and conducted a logistic regression analysis to determine the clinical predicator for the absence of csPCa.ResultsThe detection rate of csPCa was 5.5% in the prior negative biopsy group and 14.3% in the confirmatory biopsy group (P = 0.057). None of the variables in the logistic regression models including PSAD <0.15 ng/mL/cc and prior negative biopsy could predict the absence of csPCa. The NPV of mpMRI in detecting csPCa in patients with a prior negative biopsy worsen from 94.5% to 93.3% when combined with PSAD <0.15 ng/mL/cc.ConclusionPatients with negative mpMRI findings may not omit repeat biopsy even if their prior biopsy histories are negative and PSADs are <0.15 ng/mL/cc.

Diagnostic efficacy and safety of transperineal prostate targeted and systematic biopsy: The preliminary experience of first 100 cases.

Post-biopsy urosepsis is a major concern for patient morbidity and cost. Trasperineal biopsy is reported to have less complications and higher detection rate of clinically significant prostate cancer (csPCa). To determine the diagnostic efficacy and safety of transperineal prostate biopsy in patients with elevated prostatic specific antigen (PSA). A prospective study included men with elevated PSA > 3 ng/ml and previous negative biopsy from January 2018 to April 2019. All patients had multiparametric magnetic resonance imaging (mpMRI) and suspicious lesions reported as Prostate Imaging Reporting and Data System (PIRADS) score version 2. Average twelve systematic and two targeted cores were biopsied under general anaesthesia. Patients received single dose of antibiotic prebiopsy. 100 Consecutive patients having median age 64.0 years and median PSA of 6.1ng/ml were included for mpMRI-US fusion transperineal biopsies. Cancer detection rate was 45% (targeted 38% and systematic 22%) and csPCa were detected in 75.55% (targeted 86.84% and systematic 59.09%). MRI-US fusion targeted biopsies detected 63.88% csPCa in PIRADS 5, 33.33% in PIRADS 4 and 5.88% in PIRADS 3 lesions. PSA > 10 (p = 0.012), PSA density > 0.15 (p = 0.0002), and PIRADS 5 (0.0001) were significantly associated with PCa. Factors like Age (0.0001), initial PSA (0.022) and PSA density (0.006) were significant on univariate analysis while age (0.0001) was significant on multivariate analysis. There was no case of urinary tract infection. Transperineal prostate biopsy is safe and effective in diagnosing csPCa. There is no risk of sepsis and major complications.

P0153 - 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?

P0153 - 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?

P1029 - The development of a dynamic prediction model using MRI predicting Gleason upgrading on prostate biopsy in patients on active surveillance

P1029 - The development of a dynamic prediction model using MRI predicting Gleason upgrading on prostate biopsy in patients on active surveillance

Cognitively targeted transperineal prostate biopsy in patients with previous abdominoperineal excision of the rectum

Introduction: Prostate biopsy is performed using an ultrasound probe placed in the rectum with either a transrectal or, increasingly popular, transperineal approach. This is not possible in patients with abdominoperineal excision of the rectum due to the lack of rectum. In our case series, we present a technique for prostate biopsy in this cohort and our outcomes. Method: The study population consisted of three consecutive patients who presented to our institution between 2018–2019 with an elevated level of prostate-specific antigen, a history of abdominoperineal excision of the rectum and undergone multiparametric magnetic resonance imaging of the prostate at our institution before a biopsy. Transperineal prostate biopsies were performed under general anaesthesia using a curved uniplanar ultrasound transducer with an attached guide to stabilise the needle. Free-hand biopsies were taken using an 18-gauge biopsy needle with an automatic spring-driven device. Multiple biopsy cores were directed to multiparametric magnetic resonance imaging target areas by visual registration. Results: Three men with a median age of 69 years (range 68–75 years) were included in this case series with serum index prostate-specific antigen values between 6.5–14 ng/ml. All three patients had Prostate Imaging Reporting and Data System 5 lesions identified on multiparametric magnetic resonance imaging scans. All three men were diagnosed with clinically significant prostate cancer (&gt;Gleason grade group 2). On average, 13 biopsy cores (range: 12–15) were obtained with a median core length of 9 mm (range: 6–20 mm). All patients were discharged home on the day of the procedure and had none had postoperative complications. Conclusion: The use of multiparametric magnetic resonance imaging and cognitive targeted transperineal biopsy provides an option for diagnosing prostate cancer in this challenging group of patients. Level of evidence: 4

Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

To analyze the clinical characteristics of patients with negative biparametric magnetic resonance imaging (bpMRI) who didn’t need prostate biopsies (PBs). A total of 1,012 male patients who underwent PBs in the First Affiliated Hospital of Nanjing Medical University from March 2018 to November 2019, of 225 had prebiopsy negative bpMRI (defined as Prostate Imaging Reporting and Data System (PI-RADS 2.1) score less than 3). The detection efficiency of clinically significant prostate cancer (CSPCa) was assessed according to age, digital rectal examination (DRE), prostate volume (PV) on bpMRI, prostate-specific antigen (PSA) and PSA density (PSAD). The definition of CSPCa for Gleason score > 6. Univariate and multivariable logistic regression analysis were used to identify predictive factors of absent CSPCa on PBs. Moreover, absent CSPCa contained clinically insignificant prostate cancer (CIPCa) and benign result. The detection rates of present prostate cancer (PCa) and CSPCa were 27.11% and 16.44%, respectively. Patients who were diagnosed as CSPCa had an older age (P < 0.001), suspicious DRE (P < 0.001), a smaller PV (P < 0.001), higher PSA value (P = 0.008) and higher PSAD (P < 0.001) compared to the CIPCa group and benign result group. PSAD < 0.15 ng/ml/cm3 (P = 0.004) and suspicious DRE (P < 0.001) were independent predictors of absent CSPCa on BPs. The negative forecast value of bpMRI for BP detection of CSPCa increased with decreasing PSAD, mainly in patients with naive PB (P < 0.001) but not in prior negative PB patients. 25.33% of the men had the combination of negative bpMRI, PSAD < 0.15 ng/ml/cm3 and PB naive, and none had CSPCa on repeat PBs. The incidence of PB was determined, CSPCa was 1.59%, 0% and 16.67% in patients with negative bpMRI and PSAD < 0.15 ng/ml/cm3, patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and biopsy naive and patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and prior negative PB, separately. We found that a part of patients with negative bpMRI, a younger age, no suspicious DRE and PSAD < 0.15 ng/ml/cm3 may securely avoid PBs. Conversely PB should be considered in patients regardless of negative bpMRI, especially who with a greater age, obviously suspicious DRE, significantly increased PSA value, a significantly small PV on MRI and PSAD > 0.15 ng/ml/cm3.

Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

PurposeTo determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration.Materials and MethodsPatients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume.ResultsA total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3–4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063).ConclusionThe combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.

Impact of early hypothalamic-pituitary-gonadal axis maturation on prostate cancer:Cross-sectional analysis of a Veterans Affairs cohort.

255 Background: Early onset of puberty, resulting in more prolonged exposure to higher androgen levels, has been hypothesized to be a risk factor for more aggressive prostate cancer (PCa) later in life. We sought to determine whether earlier age of first shave and height, as surrogates of pubertal onset, were associated with worsening PCa characteristics. Methods: A prospectively collected registry of patients presenting for a prostate biopsy at the Charlie Norwood Veterans Affairs Medical Center in Augusta, GA between July 1995 and June 2016 was utilized. Age of first shave and height were compared to the risk of cancer on prostate biopsy, high grade cancer (i.e. Gleason score 8 or higher), and high volume disease (i.e. at least 50% of total cores were positive) using univariable and multivariable logistic regression analysis, controlling for patient age, race, prostate specific antigen, percent free prostate specific antigen, clinical stage, prostate volume, body mass index, family history. Statistical significance was set at p &lt; 0.05 and all statistical analyses were performed using R version 3.6.1. Results: Of the 1,176 patients analyzed, 599 (50.9%) had a cancer on prostate biopsy, of which 141 (23.5%) and 194 (32.4%) had high grade and volume disease, respectively. Median age of first shave was 17.0 years (interquartile range 16.0-19.0) and height was 177.8 cm (172.7-182.9). On multivariable analysis, later age of first shave was significantly associated with increased odds of a positive prostate biopsy (odds ratio for &gt; 18 years versus &lt; 16 years: 5.36, p = 0.03) and taller patients had significantly increased odds of high-grade cancer (odds ratio for 175-180 cm versus &lt; 175 cm 7.41, p = 0.038). Conclusions: Among patients presenting for a prostate biopsy, those with a later age of first shave and taller height had an increased risk of a positive prostate biopsy and high-grade PCa, respectively. This suggests that patients with later age of puberty, and thus later testosterone surges, are at increased risk of overall and high-grade PCa. [Table: see text]

Multiparametric MRI prostate PI-RAD scoring in a district general hospital: correlating PI-RADS 3 results with histological findings.

Prostate cancer is the most common male cancer in the UK. In many hospitals, patients are now being referred for a multiparametric (mp) MRI scan of their prostate as part of an evaluation for the presence of prostate cancer, prior to an ultrasound-guided biopsy. Prostate Imaging Reporting and Data System (PI-RADS) score of 3 are defined as "equivocal" for the presence of prostate cancer. Thus, a PI-RADS 3 lesion does not confidently determine whether there is significant prostate disease or not.Our aim is to determine the correlation of PI-RADS 3 prostatic lesions with histology proven, clinically significant cancer. We performed a retrospective review on a cohort of 143 consecutive patients. Each patient underwent a mp-MRI scan of their prostate given a PI-RADS score. PI-RADS 3 lesions were analysed further based on histology and categorised into malignant and non-malignant lesions. Prostate-specific antigen (PSA) results and prostatic volume of PI-RADS 3 lesions were also analysed. We identified 45 patients with PI-RADS 3 lesions out of 143 patients. 32 patients subsequently underwent transrectal/transperineal ultrasound-guided biopsy. 43% of patients were found to have had a malignant prostatic adenocarcinoma on histology. The remaining 56% had non-malignant findings. Of those with malignant disease, there was a higher median PSA and lower mean prostatic volume. The study confirms that a score of PI-RADS 3 does not accurately differentiate between malignant and non-malignant lesions. Further investigations such as ultrasound-guided prostate biopsy and PSA parameters are required to accurately ascertain the nature of a prostate lesion with PI-RADS score 3. An ultrasound-guided prostate biopsy in patients with PI-RADS 3 remains of paramount importance when distinguishing malignant vs non-malignant lesions. Multicentre data of MRI findings with PI-RADS 3 scores is required to yield a sample size large enough to carry out statistical analysis.

The utility of ADC parameters in the diagnosis of clinically significant prostate cancer by 3.0-Tesla diffusion-weighted magnetic resonance imaging.

PurposeThis study has focused on investigating the relationship between the exponential apparent diffusion coefficient (exp-ADC), selective apparent diffusion coefficient (sel-ADC) values, the ADC ratio (ADCr), and prostate cancer aggressiveness with transrectal ultrasound-guided prostate biopsy in patients with prostate cancer.Material and methodsAll patients underwent a multiparametric magnetic resonance imaging (mpMRI) including tri-planar T2-weighted (T2W), dynamic contrast-enhanced (DCE), diffusion-weighted sequences using a 3.0-Tesla MR scanner (Skyra, Siemens Medical Systems, Germany) with a dedicated 18-channel body coil and a spine coil underneath the pelvis, with the patient in the supine position. Exp-ADC, sel-ADC, and ADCr of defined lesions were evaluated using region-of-interest-based measurements. Exp-ADC, sel-ADC, and ADCr were correlated with the Gleason score obtained through transrectal ultrasound-guided biopsy.ResultsPatients were divided into 2 groups. Group I is Gleason score ≥ 3 + 4, group II is Gleason score = 6. Sel-ADC and exp-ADC were statistically significant between 2 groups (0.014 and 0.012, respectively). However, the ADCr difference between nonclinical significant prostate cancer from clinically significant prostate cancer was not significant (p = 0.09).ConclusionsThis study is the first to evaluate exp-ADC and sel-ADC values of prostate carcinoma with ADCr. One limitation of this study might be the limited number of patients. Exp-ADC and sel-ADC values in prostate MRI imaging improved the specificity, accuracy, and area under the curve (AUC) for detecting clinically relevant prostate carcinoma. Adding exp-ADC and sel-ADC values to ADCr can be used to increase the diagnostic accuracy of DWI.

Perineural invasion in prostate needle biopsy: Prognostic value on radical prostatectomy and active surveillance.

The aim of this study was to evaluate the clinical impact of perineural invasion (PNI) in prostate biopsy in patients submitted to radical prostatectomy and on active surveillance (AS). We performed a single center, retrospective, cohort study on patients diagnosed with clinically localized prostate cancer and submitted to radical prostatectomy between January 2010 and December 2016. We evaluated clinical and anatomopathological characteristics from the biopsy and radical prostatectomy specimen and correlated with biochemical recurrence (BCR) using a survival analysis. We also evaluated the impact of PNI in patients with criteria for active surveillance. The cohort analyzed consists of 107 patients, with a mean age of 63.1 years and a mean PSA prior to biopsy of 7.8 ng/ml. In prostate biopsy, 66.4% of the patients had a Gleason score of 6, 30.9% had a Gleason score of 7, and 2.7% had a Gleason score of 8 or higher, with PNI being detected in 57 (53.3%) of the patients. Regarding the anatomopathological characteristics of the surgical specimen, invasion of the seminal vesicles was observed in 6.5%, lymph nodes involvement in 9.3% and positive surgical margins in 27.1% of the cases. During follow-up, BCR was recorded in 24.3% of cases. Clinicopathological features were stratified according to the presence or absence of PNI, with statistical significance in relation to the Gleason Score (p = 0.001), pathologic T stage (p = 0.001), D'Amico risk (p = 0.002) and upstaging of the Gleason score (p = 0.045). The survival analysis revealed a relationship between PNI and BCR (hazard ratio = 2.98; 95% CI: 1.36-6.58; p = 0.007). Regarding the men potentially eligible for AS, the presence of PNI on the biopsy presented a significant relation with Gleason upgrade (p = 0.004) and extraprostatic extension (p = 0.017). The presence of PNI in prostate biopsy is related to adverse anatomopathological factors, being a potential predictor of BCR and have a possible role in the selection of patients for AS.