Prostate Biopsy Results Research Articles

Association of prostate-specific antigen density with prostate cancer mortality after a benign systematic prostate biopsy result.

To assess the association between prostate-specific antigen (PSA) density (PSAD) and prostate cancer mortality after a benign result on systematic transrectal ultrasonography (TRUS)-guided prostate biopsy. This retrospective study used data from the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) collected between 1996 and 2020. We identified men aged 55-71 years randomised to the screening arm with PSA ≥4.0 ng/mL and a benign systematic TRUS-guided biopsy result. The cumulative prostate cancer mortality of men stratified by a PSAD cutoff of 0.15 ng/mL/cm3 was modelled with competing risk functions. The ability of PSAD, PSA, and base variables (age at biopsy, DRE result, socioeconomic status, 5α-reductase inhibitor usage, family history, and Charlson Comorbidity Index (CCI)) to predict prostate cancer death was compared using c-statistics and a likelihood ratio test. After excluding 10 men without PSA data within 2 years of the biopsy and 65 without prostate volume data, 2276 men were eligible for inclusion in the study. A total of 50 men died from prostate cancer and 1028 from other causes during a median (interquartile range) follow-up of 17.4 (13.2-20.9) years. The cumulative prostate cancer mortality of men with PSAD <0.15 ng/mL/cm3 was significantly lower than that of men with PSAD ≥0.15 ng/mL/cm3: 0.5% (95% confidence interval [CI] 0.2%-1.1%) vs 2.0% (95% CI 1.2%-3.1%) at 15 years (Grey's test, P = 0.001). The model consisting of PSAD, PSA and the base variables predicted prostate cancer mortality (c-statistic 0.781) significantly better than either the base variables alone (c-statistic 0.737; likelihood-ratio test, P = 0.003) or the base variables and PSA (c-statistic 0.765; likelihood-ratio test, P = 0.039). Prostate cancer mortality after a benign systematic TRUS-guided biopsy is low. In these patients, PSAD predicts prostate cancer mortality and provides additional value to other clinical variables. PSAD-based stratification can be used to guide follow-up strategy.

Machine Learning-Based Prediction of Prostate Biopsy Necessity Using PSA, MRI, and Hematologic Parameters.

Background: To establish a machine learning (ML) model for predicting prostate biopsy outcomes using prostate-specific antigen (PSA) values, multiparametric magnetic resonance imaging (mpMRI) findings, and hematologic parameters. Methods: The medical records of the patients who had undergone a prostate biopsy were evaluated. Laboratory findings, mpMRI findings, and prostate biopsy results were collected. Patients with benign prostate pathology were classified as Group 1, and those with prostate cancer (PCa) were classified as Group 2. The following ML algorithms were used to create the ML model: ExtraTrees classifier, Light Gradient-Boosting Machine (LGBM) classifier, eXtreme Gradient Boosting (XGB) classifier, Logistic Regression, and Random Forest classifier. Results: A total of 244 male patients who met the inclusion criteria were included in this study. Among them, 171 (71.1%) were categorized in Group 1, and 73 (29.9%) in Group 2. The LGBM classifier model demonstrated the highest performance, achieving an accuracy rate of 81.6% and an AUC-ROC (area under the curve-receiver operating characteristic) of 78.4%, with sensitivity and specificity values of 66.7% and 88.2%, respectively, in predicting prostate biopsy outcomes. Conclusions: Pathological results can be predicted by ML models using PSA values, mpMRI findings, and hematologic parameters prior to a prostate biopsy, potentially reducing unnecessary biopsy procedures.

The initial results of MRI-TRUS fusion prostate biopsy in high volume tertiary center.

Multiparametric magnetic resonance imaging (mpMRI) is a prerequisite for targeted prostate biopsy. The aim of our study was to evaluate the performance and learning curve of the mpMRI-transrectal ultrasound (TRUS) software image fusion (MRI-TRUS fusion) biopsy (BX) process in the first year after its introduction in our urology department. MRI-TRUS fusion BX was performed in 293 patients with at least one Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion. The proportion of patients and lesions with positive histopathologic result for prostate cancer (PCa) was analyzed. The learning curve for MRI-TRUS fusion BX was assessed at institutional and individual level. Positive BX lesions were further analyzed by PIRADS and Gleason scores. The proportion of patients with positive histopathologic results for targeted BX, systematic BX, and combined BX was 53.9%, 47.9%, and 63.5%, respectively. The chi-square test for the proportion of PCa positive patients showed no significant difference between the time-based patient groups at the institutional level and no significant difference between individual urologists. PIRADS score (p < 0.001), total PSA concentration (p = 0.05), prostate volume (p < 0.001) and number of cores per lesion (p = 0.034) were significant predictors of a positive histopathologic result in a lesion-based analysis. Clinically significant PCa (csPCa) was confirmed in 34.7% of the 412 BX lesions and 76.4% of the 187 positive PCa lesions. MRI-TRUS fusion targeted BX significantly improves the overall rate of PCa detection compared with systematic BX alone. No steep learning curve was observed in our urologists. The proportion of lesions with clinically insignificant PCa was low, limiting overdiagnosis of PCa.

Outcomes of Systematic Transrectal Ultrasound-Guided Prostate Biopsy Performed by a Surgical Care Practitioner and Implications for Resource-Poor Countries.

Introduction Prostate cancer remains the most prevalent cancer among men and continues to present a significant public health challenge globally. The disease's growing prevalence has heightened the demand for skilled professionals capable of obtaining histological samples for accurate diagnosis, as tissue biopsy remains the cornerstone for diagnosing prostate cancer. Surgical care practitioners have become integral to the surgical team, and their roles have expanded to include performing biopsies. This paper evaluates the outcomes of transrectal ultrasound-guided (TRUS) prostate biopsies conducted by a surgical care practitioner (SCP) and explores the implications for resource-poor countries. Methods We retrospectively collated data from 218 patients who underwent TRUS prostate systematic biopsy by a surgical care practitioner between 2020 and 2022. We evaluated the prostate-specific antigen (PSA) values, MRI Likert score where available, and histological data and determined diagnostic yield and complication rates. Results The mean age and PSA level of the men were 69.7 years and 61.2 ng/ml, respectively; an average of 12 cores were obtained per biopsy. The cancer detection rate was 128/218 (59%), with a mean Gleason grade of 2.8. From available MRI, Likert 3 was the most common finding, 45/103 (43.6%), and prostate cancer was found in 40%. The mean MRI Likert scores for a positive and negative biopsy were 4 and 3.3, respectively. We recorded three complications (1%), all Clavien-Dindo 1 to 2, with no mortality. Conclusion A well-trained, supported, and supervised surgical care practitioner can safely and effectively perform TRUS systematic prostate biopsies and may improve access to prostate cancer diagnosis in developing countries.

Evaluating the Diagnostic Accuracy of MRI-Derived Prostate-Specific Antigen (PSA) Density in Prostate Cancer Detection and its Association With Tumor Aggressiveness.

Introduction Prostate-specific antigen density (PSAD), calculated by dividing serum PSA levels by prostate volume, offers greater specificity and accuracy than serum PSA alone in detecting prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of PSAD in PCa detection across different PSA levels and its correlation with Gleason scores. Methods This retrospective, single-center study reviewed data from 154 patients with suspected PCa who underwent prostate MRI between July 2021 and July 2023. Among these, 113 met the inclusion criteria, which required MRI-derived prostate volume measurements, serum PSA levels within three months of biopsy, and transperineal prostate biopsy results. PSAD was calculated by dividing serum PSA levels by prostate volume. Statistical analysis was conducted using STATA/SE 18.0 (StataCorp., College Station, TX, USA). Receiver operating characteristic (ROC) curves identified optimal PSAD cutoff values for PCa detection, and the relationship between PSAD and Gleason scores was analyzed. Results Of the 113 patients, 72 (63.72%) were diagnosed with PCa. The overall PSAD cutoff of 0.158 demonstrated a sensitivity of 73.61% and specificity of 92.68%, with an area under the curve (AUC) of 0.83 (95% CI: 0.77-0.90). For patients with PSA levels between 4-10 ng/ml, the optimal PSAD cutoff was 0.155 (sensitivity 65%, specificity 85.19%). For those with PSA levels >10 ng/ml, the cutoff was 0.175 (sensitivity 96.55%, specificity 66.67%). A significant correlation was found between PSAD and Gleason scores (p < 0.001), with higher PSAD values associated with more aggressive cancers. Conclusion PSAD demonstrates strong diagnostic accuracy for PCa and is significantly correlated with Gleason scores, suggesting its potential in assessing tumor aggressiveness and guiding clinical decisions.

Prostate-specific antigen, digital rectal examination, and prostate cancer detection: A study based on more than 7000 transrectal ultrasound-guided prostate biopsies in Ghana

Purpose of the studyThis study aims to determine the role of serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE) in predicting the histological outcomes of prostate biopsies by analyzing a database of over 7000 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsies. MethodsWe conducted a retrospective analysis of men who underwent TRUS-guided prostate biopsies at Korle Bu Teaching Hospital, a tertiary referral center in Accra, Ghana, from July 2005 to December 2022. The biopsies, which included 10 to 12 core samples, were prompted by PSA levels greater than 4.0 ng/mL, abnormal DRE findings, or both. We then correlated histopathology results with PSA and DRE findings. ResultsOut of 7,338 patients who presented for biopsy, 76.3% were between the ages of 60 and 79. Histology reports were available for 5,289 patients, of whom 2,564 (48.5%) were diagnosed with prostate cancer. Cancer detection rates based on PSA levels were as follows: 21.6% for PSA <4 ng/mL, 21.7% for PSA 4-10 ng/mL, 32.7% for PSA 10-20 ng/mL, 53.0% for PSA 20-50 ng/mL, 71.5% for PSA 50-100 ng/mL, and 92.0% for PSA >100 ng/mL. When DRE findings were classified according to the 2016 TNM System (AJCC 8th Edition) as T1, T2, T3, and T4, cancer detection rates were 26.8%, 51.8%, 87.6%, and 95.7%, respectively. The overall cancer detection rate was significantly higher with abnormal DRE findings (64.6% vs. 26.7%, p < 0.001). Additionally, 78.2% of the detected cancers were high-grade (Gleason score of 7 or more). ConclusionThis extensive study of Ghanaian men undergoing TRUS biopsies reveals a high prostate cancer detection rate, with nearly 80% of the detected cancers being high-grade. These findings underscore the importance of PSA and DRE in the early detection of prostate cancer and should be considered in patient counseling and discussions regarding the implementation of prostate cancer screening programs in this population.

Preoperative multidisciplinary team meeting improves the incidence of positive margins in pathological T2 prostate cancer

PurposePositive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) can increase the risk of biochemical recurrence and PCa-specific mortality. We aimed to evaluate the impact of multidisciplinary team meetings (MDTM) on reducing the incidence of PSM following RARP.MethodsWe retrospectively collected the clinical data of consecutive patients undergoing RARP at Hiroshima University between February 2017 and October 2023. The MDTM, comprising a radiologist, uropathologist, and urologist, reviewed the preoperative magnetic resonance imaging (MRI) and prostate biopsy results of each patient before RARP and considered the areas requiring attention during RARP. Surgeons were categorized as experienced or non-experienced based on the number of RARP procedures performed.ResultsIn the pT2 population, the PSM rate was significantly lower in cases evaluated using the MDTM than in those not (11.1% vs. 24.0%; p = 0.0067). Cox regression analysis identified that a PSA level > 7 ng/mL (hazard ratio 2.2799) and nerve-sparing procedures (hazard ratio 2.2619) were independent predictors of increased PSM risk while conducting an MDTM (hazard ratio 0.4773) was an independent predictor of reduced PSM risk in the pT2 population. In the pathological T3 population, there was no significant difference in PSM rates between cases evaluated and not evaluated at an MDTM. In cases evaluated at an MDTM, similar PSM rates were observed regardless of surgeon experience (10.4% for non-experienced and 11.9% for experienced surgeons; p = 0.9999).ConclusionsAn MDTM can improve the PSM rate of pT2 PCa following RARP.

Role of Ultrasound Elastography versus Ultrasound Guided Biopsy in Detection of Cancer Prostate

Abstract Background Prostate cancer detection has evidently evolved through the past years. Ultrasound is already established in PCA diagnosis, with introduction of adjuvant techniques to ultrasonography promoting its capabilities in PCA diagnosis. Elastography technique was introduced for the first time in the 90s, it is an easy procedure with high capabilities in diagnosis and can be at same session with US increasing its specificity. Aim of the Work The aim of this study is to define the effect of US elastography in early detection of cancer prostate. Patients and Methods This study was prospectively carried on 22 male patients having prostatic lesions, (between June 2020 to November 2022), the mean age of all cases was 63.5 years, with a median of PSA of 30.6 ng/mL, a median prostatic volume of 65 mL. This study was performed in the ultrasound unit/ radiology department of the Police Medical Complex at New-Cairo. Patients were referred from the outpatient clinic of the urology department. Results We found that to differentiate between benign and malignant lesions the best stiffness cut-off value would be between 35 and 37 kPa, sensitivity 83.3%, specificity 70%, PPV 76.9% and NPV 77.7% and accuracy 77.2%. Conclusion Elastography is an easy procedure that provides diagnostic extra tool which can be easily done in the same session with the B-mode ultrasound examination and improves its specificity for detection of prostatic cancer. It has proven benefit in differentiating benign form malignant lesions and optimizing the results of prostate biopsies.

Consistency between Gleason score of prostate biopsy and radical prostatectomy: predictors of increased tumour grading

Introduction. Gleason grading is one of the key parameters for determining the prostate cancer (risk group after receiving the results of a prostate biopsy in addition to the level of prostate-specific antigen (PSA). However, an important clinical issue arises from changes in this grading following radical surgery. In some cases, such discrepancies in data can lead to a shift in patient management tactics from radical surgery to active follow-up recommended for patients with low cancer risk.Objective. To assess the consistency of the results of prostate biopsy and radical prostatectomy with an assessment of possible predictors of increased tumor Gleason grading.Materials &amp; methods. Between 2019 and 2021, 193 patients with prostate cancer were selected for treatment at the Medical Centre of Moscow State University. Of these, 139 patients were chosen for the final analysis of Gleason tumour grading consistency after biopsy and radical prostatectomy.Results. The results of prostate biopsy and radical prostatectomy were comparable in 54.7% of patients (n = 76), while the remaining 45.3% (n = 63) showed a change in Gleason gradaing after radical prostatectomy: 29.5% (n = 41) patients showed an increased gradation, and 15.8% (n = 22) — decrease. Most often, the data were consistent for patients with a Gleason score 7: 63.6% for 3 + 4 = 7 and 57.9% for 4 + 3 = 7. The highest percentage of graduation increase was observed for patients from the group 3 + 3 = 6 and amounted to 48%. Cohen's kappa value was 0.351 (p &lt; 0.001), indicating poor consistency between the results of the two studies. The total number of biopsies was associated with an increase in Gleason score after radical prostatectomy (OR = 0.816; 95% CI = 0.680 – 0.978). For example, the odds of Gleason tumour grading decreases by 18.4% when the number of biopsy specimens per unit increasesConclusion. The concordance of Gleason grading of prostate cancer after prostate biopsy and radical prostatectomy remains poor. The only predictor of improved concordance is the biopsy count, thereby reflecting biopsy quality and encouraging clinicians to move away from sextant biopsies to systematic and targeted biopsies. Increasing the consistency of results can provide more accurate staging and classification of patients according to cancer risk, thereby influencing future management.

Trifecta Outcomes After Use of 3-Dimensional Digital Models for Planning of Robotic Prostatectomy

Planning complex operations such as robotic-assisted laparoscopic radical prostatectomy (RALP) requires surgeons to review 2-dimensional magnetic resonance imaging (MRI) scans to understand 3-dimensional (3D) patient anatomy. Three-dimensional digital models for planning RALP may allow better understanding of patient anatomy and may lead to better patient outcomes, although data are currently limited. To determine surgical outcomes after RALP when surgeons reviewed 3D digital models during operative planning. This study was a planned secondary analysis of a multicenter, single-blind, randomized clinical trial conducted at 6 large teaching hospitals in the US. The study was conducted between January 1, 2019, and December 31, 2022, and included patients undergoing RALP. Patients were assessed and recruited at the time of surgical consultation. Final data analysis was conducted between August and December 2023. Patients were randomized to either a control group undergoing usual preoperative planning with prostate biopsy results and multiparametric MRI only or to an intervention group in which imaging and biopsy results were supplemented with a 3D digital model. This model was viewed on the surgeon's mobile phone in 3D format and picture-in-picture on the robotic console screen. The primary outcome measure for the overall study was oncologic outcomes after RALP, measured as prostate-specific antigen (PSA) detectability. Secondary outcomes were sexual function and urinary function, measured with Sexual Health Inventory for Men (SHIM) scores and rates of urinary incontinence, respectively, as well as use of salvage or adjuvant radiation therapy (RT) or androgen deprivation therapy (ADT). Trifecta outcomes were defined as undetectable PSA without RT or ADT, SHIM score categorically the same or greater than preoperatively, and complete continence. Univariate analysis was performed to compare outcomes between groups. This trial included 92 patients undergoing RALP (51 in the control group and 41 in the intervention group). Their mean (SD) age was 62 (7.4) years; 10 patients (10.9%) were Black and 67 (72.8%) were White. At 18 months postsurgery, the intervention group had lower rates of biochemical recurrence (PSA level >0.1 ng/mL, 0 vs 7 [17.9%]; absolute difference, 17.9% [95% CI, 1.8% to 31.8%]; P = .01) and were significantly less likely to undergo adjuvant or salvage RT (1 [3.1%] vs 12 [31.6%]; absolute difference, 28.5% [95% CI, 10.1% to 46.7%]; P = .002) compared with the control group. Sexual function at 18 months postsurgery was significantly better in the intervention group (mean [SD] SHIM score, 16.8 [8.7] vs 9.8 [7.7]; absolute difference, 7.0 [95% CI, 2.6 to 11.4]; P = .002) and urinary function was unchanged (total continence, 22 [78.6%] vs 29 [80.6%]; absolute difference, 2.0% [95% CI, -17.9% to 21.9%]; P = .84) compared with the control group. Trifecta outcomes were achieved for 12 (48.0%) patients in the intervention group and 3 patients (10.0%) in the control group (absolute difference, 38.0% [95% CI, 14.4% to 61.6%]; P = .002). In this secondary analysis of a randomized clinical trial, patients whose surgical planning of RALP involved 3D digital models had better oncologic and functional outcomes. Further work should assess the effect of 3D models in a broader set of patients, physicians, and hospital settings. ClinicalTrials.gov Identifier: NCT03943368.

The predictive impact of hematological inflammatory markers in detecting prostate cancer in patients with PI-RADS 3 lesions on multiparametric magnetic resonance imaging.

The diagnostic accuracy of suspicious lesions that are classified as PI-RADS 3 in multiparametric prostate magnetic-resonance imaging (mpMRI) is controversial. This study aims to assess the predictive capacity of hematological inflammatory markers such as neutrophil-lymphocyte ratio (NLR), pan-immune-inflammation value (PIV), and systemic immune-response index (SIRI) in detecting prostate cancer in PI-RADS 3 lesions. 276 patients who underwent mpMRI and subsequent prostate biopsy after PI-RADS 3 lesion detection were included in the study. According to the biopsy results, the patients were distributed to two groups as prostate cancer (PCa) and no cancer (non-PCa). Data concerning age, PSA, prostate volume, PSA density, PI-RADS 3 lesion size, prostate biopsy results, monocyte counts (109/L), lymphocyte counts (109/L), platelet counts (109/L), neutrophils count (109/L) were recorded from the complete blood count. From these data; PIV value is obtained by monocyte × neutrophil × platelet/lymphocyte, NLR by neutrophil/lymphocyte, and SIRI by monocyte number × NLR. Significant variations in neutrophil, lymphocyte, and monocyte levels between PCa and non-PCa patient groups were detected (p = 0.009, p = 0.001, p = 0.005 respectively, p < 0.05). NLR, PIV, and SIRI exhibited significant differences, with higher values in PCa patients (p = 0.004, p = 0.001, p < 0.001 respectively, p < 0.05). The area under curve of SIRI was 0.729, with a cut-off value of 1.20 and with a sensitivity 57.70%, and a specificity of 68.70%. SIRI outperformed NLR and PIV in detecting PCa in PI-RADS 3 lesions, showcasing its potential as a valuable biomarker. Implementation of this parameter to possible future nomograms has the potential to individualize and risk-stratify the patients in prostate biopsy decision.

Can 3D Multiparametric Ultrasound Imaging Predict Prostate Biopsy Outcome?

ObjectivesTo assess the value of 3D multiparametric ultrasound imaging, combining hemodynamic and tissue stiffness quantifications by machine learning, for the prediction of prostate biopsy outcomes. MethodsAfter signing informed consent, 54 biopsy-naïve patients underwent a 3D dynamic contrast-enhanced ultrasound (DCE-US) recording, a multi-plane 2D shear-wave elastography (SWE) scan with manual sweeping from base to apex of the prostate, and received 12-core systematic biopsies (SBx). 3D maps of 18 hemodynamic parameters were extracted from the 3D DCE-US quantification and a 3D SWE elasticity map was reconstructed based on the multi-plane 2D SWE acquisitions. Subsequently, all the 3D maps were segmented and subdivided into 12 regions corresponding to the SBx locations. Per region, the set of 19 computed parameters was further extended by derivation of eight radiomic features per parameter. Based on this feature set, a multiparametric ultrasound approach was implemented using five different classifiers together with a sequential floating forward selection method and hyperparameter tuning. The classification accuracy with respect to the biopsy reference was assessed by a group-k-fold cross-validation procedure, and the performance was evaluated by the Area Under the Receiver Operating Characteristics Curve (AUC). ResultsOf the 54 patients, 20 were found with clinically significant prostate cancer (csPCa) based on SBx. The 18 hemodynamic parameters showed mean AUC values varying from 0.63 to 0.75, and SWE elasticity showed an AUC of 0.66. The multiparametric approach using radiomic features derived from hemodynamic parameters only produced an AUC of 0.81, while the combination of hemodynamic and tissue-stiffness quantifications yielded a significantly improved AUC of 0.85 for csPCa detection (p-value < 0.05) using the Gradient Boosting classifier. ConclusionsOur results suggest 3D multiparametric ultrasound imaging combining hemodynamic and tissue-stiffness features to represent a promising diagnostic tool for biopsy outcome prediction, aiding in csPCa localization.

The Value of Adding Exosome-Based Prostate Intelliscore to Multiparametric Magnetic Resonance Imaging in Prostate Biopsy: A Retrospective Analysis

Introduction: Currently, there is limited evidence for the relationship of Exosome-based Prostate Intelliscore (EPI) and multiparametric magnetic resonance imaging (mpMRI) in stratifying risk for clinically significant prostate cancer. Using a retrospective cohort study design, we sought to characterize the relationship between these two noninvasive metrics and prostate biopsy outcome. Methods: Data were collected via electronic medical record for all patients who underwent EPI testing from 1 January 2019 to 3 February 2022 and had available medical records at a single mid-western university medical center. Positive test result was defined as &gt;15.6 for EPI, ≥3 PI-RADS score and ≥3 + 4 Gleason Score for biopsy findings. Utility of EPI, mpMRI and combined use was characterized through calculation of sensitivity, specificity, positive predictive value, negative predictive value, and ROC analysis. Results: A total of 226 patients were identified as receiving EPI testing for risk stratification of clinically significant prostate cancer. Sensitivity for EPI was 91%, mpMRI was 90%, and the highest was combined use at 96%. With ROC analysis, AUC for EPI alone was 0.57 (95% CI, 0.47–0.67) and 0.78 (95% CI, 0.70–0.87) for mpMRI alone. With prior positive EPI result, AUC for combined use with mpMRI was 0.80 (95% CI, 0.71–0.89). Further subgroup analysis resulted in increased AUC values of EPI 0.67 (95% CI, 0.48–0.87), mpMRI 0.90 (95% CI, 0.76–1.0), and combined 0.90 (95% CI, 0.75–1.0) in the African American population. Discussion: We observed that the combined use of EPI and mpMRI led to an avoided biopsy in 43% of patients. Using both parameters increased the overall sensitivity and diagnostic accuracy in detecting clinically significant prostate cancer. The best test performance was observed in the African American cohort. Identifying optimal noninvasive tools to assess risk for prostate cancer is crucial to providing accurate and cost-effective care. Future study should utilize a prospective study design to further support the combined use of these metrics.

Patient Preferences for Benefit and Risk Associated With High Intensity Focused Ultrasound for the Ablation of Prostate Tissue in Men With Localized Prostate Cancer

IntroductionFood and Drug Administration must make decisions about emerging high intensity focused ultrasound (HIFU) devices that may lack relevant clinical oncologic data but present with known side effects. This study aims to capture patients’ perspective by quantifying their preferences regarding the available benefit and important side effects associated with HIFU for localized prostate cancer. Materials and methodsPreferences for HIFU outcomes were examined using a discrete choice experiment survey. Participants were asked to choose a preferred treatment option in 9 choice questions. Each included a pair of hypothetical treatment profiles that have similar attributes/outcomes with varying levels. Outcomes included prostate biopsy outcome and treatment-related risks of erectile dysfunction (ED) and urinary incontinence (UI). We calculated the maximum risk of side effect patients were willing to tolerate in exchange for increased benefit. Preferences were further explored via clinical and demographic data. ResultsAbout 223 subjects with a mean age of 64.8 years completed the survey. Respondents were willing to accept a 1.51%-point increase in new ED risk for a 1%-point increase in favorable biopsy outcome. They were also willing to accept a 0.93%-point increase in new UI risk for a 1%-point increase in biopsy outcome. Subjects who perceived their cancer to be more aggressive had higher risk tolerance for UI. Younger men were willing to tolerate less ED risk than older men. Respondents with greater than college level of education had a lower risk tolerance for ED or UI. ConclusionsResults may inform development and regulatory evaluation for future HIFU ablation devices by providing supplemental information from the patient perspective.

The role of urology and radiology in prostate biopsy: current trends and future perspectives.

Prostate biopsy is central to the accurate histological diagnosis of prostate cancer. In current practice, the biopsy procedure can be performed using a transrectal or transperineal route with different technologies available for targeting of lesions within the prostate. Historically, the biopsy procedure was performed solely by urologists, but with the advent of image-guided techniques, the involvement of radiologists in prostate biopsy has become more common. Herein, we discuss the pros, cons and future considerations regarding their ongoing role. A narrative review regarding the current evidence was completed. PubMed and Cochrane central register of controlled trials were search until January 2024. All study types were of consideration if published after 2000 and an English language translation was available. There are no published studies that directly compare outcomes of prostate biopsy when performed by a urologist or radiologist. In all published studies regarding the learning curve for prostate biopsy, the procedure was performed by urologists. These studies suggest that the learning curve for prostate biopsy is between 10 and 50 cases to reach proficiency in terms of prostate cancer detection and complications. It is recognised that many urologists are poorly able to accurately interpret multi parametric (mp)-MRI of theprostate. Collaboration between the specialities is of importance with urology offering the advantage of being involved in prior and future care of the patient while radiology has the advantage of being able to expertly interpret preprocedure MRI. There is no evidence to suggest that prostate biopsy should be solely performed by a specific specialty. The most important factor remains knowledge of the relevant anatomy and sufficient volume of cases to develop and maintain skills.

MRI-based monitoring of prostate cancer after HIFU: Inter-reader agreement and diagnostic performance of the PI-FAB score

PurposeTo investigate inter-reader agreement, and diagnostic performance of the Prostate Imaging after Focal Ablation (PI-FAB) score applied to multiparametric MRI (mpMRI) in patients who underwent focal high-intensity focused ultrasound (HIFU) therapy for localized prostate cancer. MethodsIn this retrospective, IRB-approved, single-center study, 73 men, who underwent focal HIFU treatment and received follow-up mpMRIs with subsequent prostate biopsies, were included. The PI-FAB score was applied to follow-up MRIs at 6, 12, and 36 months post-HIFU by two radiologists with different experience levels. Inter-reader agreement was assessed using Gwet’s AC1, and the diagnostic performance of the PI-FAB score was assessed in relation to histopathologic results of subsequent prostate biopsies for each reader. ResultsPI-FAB scores showed substantial to almost perfect inter-reader agreement (AC1: 0.80–0.95) and demonstrated high specificity (Reader 1: 90–98 %, Reader 2: 87–98 %) and NPVs (Reader 1: 91–100 %, Reader 2: 88–97 %) in ruling out residual or recurrent in-field prostate cancer post-HIFU. Sensitivity (Reader 1: ≥43 %, Reader 2: ≥14 %) and PPVs (Reader 1: ≥33 %, Reader 2: ≥14 %) were mostly relatively lower, with notable disparities between the two readers, indicating the potential influence of radiologist experience. ConclusionsThe PI-FAB score provides a consistent and reliable tool for post-HIFU monitoring of prostate cancer using mpMRI. It demonstrates substantial to almost perfect inter-reader agreement and is particularly effective in excluding in-field residual or recurrent prostate cancer post-HIFU treatment. Its application can potentially enhance post-treatment patient care, emphasizing its value as a non-invasive MRI-based monitoring approach after focal ablative therapy of the prostate.

3T multiparametric MRI’s accuracy in detecting prostate cancer using Prostate Imaging Reporting and Data System (PIRADS) version 2.1 with prostate biopsy as a reference

BackgroundMultiparametric magnetic resonance imaging (MRI) is valuable in detecting prostate cancer due to its high sensitivity to malignant lesions. It is commonly utilized to improve the identification of clinically significant cancers within the prostate. This study aimed to correlate the findings from 3T multiparametric MRI of the prostate using the updated Prostate Imaging Reporting and Data System version 2.1 (PIRADSv2.1) from 2019 with reference to prostate biopsy results. Additionally, PIRADSv2.1 was used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value of the 3T multiparametric MRI of the prostate.Methods and materialsA retrospective study was conducted at a tertiary center, wherein we identified patients who underwent a prostate biopsy between June 2019 and June 2021 and had a corresponding MRI of the prostate performed at the same institution, evaluated with PIRADSv2.1 criteria.ResultsA total of 50 patients were eligible for final analysis. The prevalence of prostate cancer was 69% (95% confidence interval (CI) 54–81%). Receiver operating characteristic (ROC) curves were generated for 3T multiparametric MRI of the prostate using PIRADSv2.1 to diagnose prostate cancer; the area under the ROC curve was 0.81 (95% CI 0.68–0.95, p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the 3T multiparametric prostate MRI using PIRADSv2.1 were 74.0%, 87.0%, 92.9%, and 59.1%, respectively.ConclusionsPIRADSv2.1 exhibited good overall performance in the diagnosis of prostate cancer.

A Case of Primary Adenocarcinoma Mucinous Subtype of the Bladder

A 48-year-old man who presented with asymptomatic gross hematuria in July 202X had been followed up without treatment. In January 202X, he was referred to our department due to the exacerbation of his hematuria. Contrast-enhanced magnetic resonance imaging revealed bladder cancer suggested bilateral seminal vesicle and prostate invasion, and enlarged right internal and external iliac lymph nodes. The pathological diagnosis was mucinous bladder adenocarcinoma. Prostate biopsy results were negative. Upper and lower gastrointestinal examinations were unremarkable. We suspected bladder cancer cT4aN2M0. In March 202X＋1, the patient underwent robotic-assisted laparoscopic total bladder resection, pelvic lymph node dissection, and intracorporeal urinary tract modification (ileal conduit creation). The final diagnosis was primary mucinous adenocarcinoma pT4aN2M0 of the bladder. Given the heightened risk of recurrence, the patient was administered a three-month course of oxaliplatin and capecitabine (XELOX) as adjuvant postoperative chemotherapy. The patient remains free of progression at 8 months postoperatively. Adenocarcinoma of the bladder is an exceedingly rare entity, with no established chemotherapeutic protocols. Primary mucinous adenocarcinoma of the bladder is even more exceptional. Presently, only regimens similar to those for colorectal cancer or adenocarcinoma of unknown primary, including 5-fluorouracil, are considered. In our particular case, we elected to pursue XELOX therapy, aligning with the principles governing the management of colorectal cancer.

Московская программа по гистофьюжн биопсии предстательной железы: результаты опроса практикующих урологов на основании данных мультицентрового исследования.

Introduction. Prostate cancer (PC) is one of the most frequently diagnosed malignant diseases among men. It is necessary to search for new methods of additional visualization. The most promising modern diagnostic method is histoscanning (HS) with the software «True Targeting», which allows you to perform «targeted» prostate biopsy (PB) in real time. We conducted a comparative observational clinical study with anonymous Internet survey implemented based on the SurveyMonkey program. Material and methods. The survey of urology specialists was initiated from the beginning of the «Moscow program for «Histoffusion» biopsies». The survey was composed of 16 questions. Data were obtained and analyzed on the doctor's work experience, experience in performing pancreatic biopsy, hospital, features of the operation, method of choosing anesthesia, patient position and complications in the postoperative period. Results. The division by hospitals showed that transrectal prostate biopsy is performed under the conditions in one day hospital in 80% of cases. Biopsy takes no more than 19 minutes on average. Half of the respondents had experience about 5 years, and only about 15% about 15 years. About 68% of specialists recommend performing MRI with contrast. However, only 22% of patients perform results. About 16% note the impossibility of performing MRI due to contraindications or other difficulties of the healthcare system. The most common complications are hemospermia and hematuria. In 100% of cases, respondents noted the need to prescribe antibiotic therapy. In 64.9% of cases, doctors note the need for a histoscan-guided prostate biopsy, and 82.1% are sure that in the future it is necessary to standardize the method of performing histoscan-guided prostate biopsy. Conclusion. We note the lack of standardization of histoscan-guided prostate biopsy. We suggest that the results of histoscan-guided prostate biopsy can be improved by developing a standardized follow-up as well as an algorithm aimed at optimizing for each patient.

Expect the unexpected: investigating discordant prostate MRI and biopsy results

ObjectivesTo evaluate discrepant radio-pathological outcomes in biopsy-naïve patients undergoing prostate MRI and to provide insights into the underlying causes.Materials and methodsA retrospective analysis was conducted on 2780 biopsy-naïve patients undergoing prostate MRI at a tertiary referral centre between October 2015 and June 2022. Exclusion criteria were biopsy not performed, indeterminate MRI findings (PI-RADS 3), and clinically insignificant PCa (Gleason score 3 + 3). Patients with discrepant findings between MRI and biopsy results were categorised into two groups: MRI-negative/Biopsy-positive and MRI-positive/Biopsy-negative (biopsy-positive defined as Gleason score ≥ 3 + 4). An expert uroradiologist reviewed discrepant cases, retrospectively re-assigning PI-RADS scores, identifying any missed MRI targets, and evaluating the quality of MRI scans. Potential explanations for discrepancies included MRI overcalls (including known pitfalls), benign pathology findings, and biopsy targeting errors.ResultsPatients who did not undergo biopsy (n = 1258) or who had indeterminate MRI findings (n = 204), as well as those with clinically insignificant PCa (n = 216), were excluded, with a total of 1102 patients analysed. Of these, 32/1,102 (3%) were classified as MRI-negative/biopsy-positive and 117/1102 (11%) as MRI-positive/biopsy-negative. In the MRI-negative/Biopsy-positive group, 44% of studies were considered non-diagnostic quality. Upon retrospective image review, target lesions were identified in 28% of cases. In the MRI-positive/Biopsy-negative group, 42% of cases were considered to be MRI overcalls, and 32% had an explanatory benign pathological finding, with biopsy targeting errors accounting for 11% of cases.ConclusionProstate MRI demonstrated a high diagnostic accuracy, with low occurrences of discrepant findings as defined. Common reasons for MRI-positive/Biopsy-negative cases included explanatory benign findings and MRI overcalls.Clinical relevance statementThis study highlights the importance of optimal prostate MRI image quality and expertise in reducing diagnostic errors, improving patient outcomes, and guiding appropriate management decisions in the prostate cancer diagnostic pathway.Key Points• Discrepancies between prostate MRI and biopsy results can occur, with higher numbers of MRI-positive/biopsy-negative relative to MRI-negative/biopsy-positive cases.• MRI-positive/biopsy-negative cases were mostly overcalls or explainable by benign biopsy findings.• In about one-third of MRI-negative/biopsy-positive cases, a target lesion was retrospectively identified.