Effect of [68Ga]Ga-PSMA-11 PET-CT in the diagnosis of prostate cancer in men with equivocal or clinically high-risk non-suspicious findings on multiparametric MRI (PRIMARY2): a multicentre, non-inferiority, phase 3, randomised controlled trial.

To develop and retrospectively validate an artificial intelligence-based decision support system (AI-DSS) for optimising prostate biopsy decisions and improving benefit-to-harm ratios. This retrospective, multicentre, multiscanner study used data from 1022 patients. An AI-DSS integrating PI-RADS scores, automated prostate-specific antigen density (PSAd), and deep-learning imaging risk scores was developed on 770 cases and validated on an independent cohort of 252 men from six UK centres. The AI-DSS performance was benchmarked against the real-world clinical decisions (reference standard) using grade selectivity, biopsy efficiency, and selective biopsy avoidance as outcome measures. Biopsy-proven detection of grade group (GG) ≥ 2 disease was the reference standard. In the validation cohort of 252 patients (mean age, 67.3 years), 137 underwent biopsy and 79 (31%) harboured ≥ GG2 disease. Compared to the reference standard, the AI-DSS at the 31% cancer detection rate (CDR) would have avoided 28 biopsies while missing one ≥ GG2 cancer. This corresponded to a 70% increase in grade selectivity (from 4.6 to 7.8), 79% increase in biopsy efficiency (from 1.4 to 2.5), and a 143% increase in selective biopsy avoidance (from 2.8 to 6.8). At the reduced CDR of 30%, grade selectivity, biopsy efficiency, and selective biopsy avoidance increased by 172%, 236%, and 475%, with four ≥ GG2 cancers missed. An AI-DSS that integrates clinical and advanced imaging data improves the benefit-to-harm ratio of prostate biopsy decisions in a retrospective setting. Future prospective validation as part of real-world clinical workflow is required to enable clinical implementation. Question Current prostate cancer diagnostic pathways result in fewer unnecessary biopsies. Can an AI decision support system (AI-DSS) further improve biopsy efficiency for detecting significant cancer? Findings An AI-DSS avoided 28 biopsies in a 252-patient cohort, increasing grade selectivity, biopsy efficiency, and selective biopsy avoidance by 70%, 79%, and 143%, respectively. Clinical relevance Integrating an AI-DSS into clinical workflows may further reduce unnecessary prostate biopsies and overdiagnosis of indolent disease, thus potentially improving the efficiency of the prostate cancer diagnostic pathway.

Partial gland ablation for radio-recurrent prostate cancer: Short-term oncological and functional outcomes.

Transperineal (TP) prostate biopsy offers reduced infection risk compared to transrectal (TR) methods, but patient discomfort remains a concern, especially under local anesthesia. This study evaluated the discomfort from a TP prostate biopsy under local anesthesia and strategies to decrease pain. This prospective study included 500 consecutive patients undergoing TP prostate biopsy between June 2023 and November 2024. Pre-biopsy magnetic resonance imaging was used to identify target lesions, followed by TP magnetic resonance imaging/ultrasound (ultrasound) fusion biopsy using the Artemis device. A survey questionnaire was administered immediately following the procedure to assess pain scores related to probe insertion, skin infiltration, deep periprostatic block, and overall discomfort, using the Visual Analog Scale (VAS). A total of 450 consecutive patients underwent TP biopsy with local anesthesia, and 50 patients underwent TP biopsy with sedation. No procedures were aborted, and all patients who underwent the procedure under local anesthesia completed the survey. The median overall VAS score was 2 (interquartile range [IQR] 0-3). Ethyl chloride spray and tactile stimulation reduced skin infiltration pain (p = 0.035), while adding sodium bicarbonate reduced deep block pain (p < 0.001). Combined interventions lowered median overall pain from 3 (IQR 1-5) to 1 (IQR 1-3), p < 0.001. Older patients reported less pain (p < 0.001). No association was found between pain and race, prostate size, number of lesions, lesion location, or grade group. The median duration of hematuria was 5 days (IQR 4-8). Two (0.4%) patients in the local anesthesia group developed urinary retention, and two (0.4%) experienced a vasovagal episode. No patients developed sepsis. TP prostate biopsy with local anesthesia is a well-tolerated outpatient procedure when optimized pain control techniques are implemented. Tactile stimulation, ethyl chloride spray, and the use of NaHCO3-buffered lidocaine significantly enhance patient comfort by reducing pain. These strategies enhance patient experience, making TP biopsy a viable outpatient option.

This study aimed to investigate the feasibility of MR diffusion imaging of fresh prostate needle biopsy cores in a 14 Tesla vertical bore NMR system. Biopsies sampled from the index tumor and a presumed tumor-free area of eight prostatectomy specimens underwent diffusion-weighted imaging using conventional pulsed gradient spin echoes (PGSE) and stimulated echo acquisition mode (STEAM) with different gradient separation times between 10 and 400 ms at nominal b values ranging from 0 up to 5000 s/mm2. The apparent diffusion coefficient (ADC) was determined over the b-value range 0-1000 s/mm2. Kurtosis and biexponential models were fitted to measured signals at effective b values within the range 0-2000 and 0-5000 s/mm2, respectively. Moreover, monoexponential models were fitted over the same b-value ranges. After imaging, all biopsies underwent histopathological evaluation. For all diffusion gradient separation times evaluated, the ADC of histopathologically confirmed tumor and normal tissue was not significantly different (p = 0.140 at 10 ms gradient separation time). Irrespective of the investigated tissue type, for an increasing gradient separation time up to 150 ms ADC decreased. For longer times up to 400 ms no further change was evident. For short diffusion gradient separation times, the Akaike information criterion (AIC) favored the biexponential model in almost all voxels, but for longer diffusion gradient separation times, in a majority of voxels the AIC favored the monoexponential model over either the kurtosis or biexponential model. Imaging of fresh prostate biopsies is feasible. At short diffusion times, in agreement with the presence of at least two distinct compartments, the signal decay is well described by a biexponential model. At long diffusion times, the ADC is lower, and a monoexponential model tends to be more appropriate, indicating the presence of exchange between compartments.

Proton pump inhibitor (PPI) use has been associated with increased prostate cancer (PCa) risk in case-control and cohort studies of men with a negative prostate biopsy. We estimated the association of cumulative PPI use with PCa diagnosis and outcomes in a biopsy-naïve cohort of men using provincewide-linked administrative data from Ontario, Canada, including men ≥66 years with no prior PCa diagnosis, biopsy, or treatment and no PPI/H2-blocker prescriptions within the year preceding study inclusion (January 2003-December 2018). The primary outcome was time to PCa diagnosis. Associations were evaluated using univariable/multivariable logistic regression models with complementary log-log-modeling. Median follow-up was 9.2 years (n=559,425), and 30.2% had any PPI use during follow-up. Annual PPI use increased from 2.4% (2003) to 13.8% (2019). Cumulative PPI use was associated with lower PCa diagnosis rates (hazard ratio [HR] for highest user quintile versus non-users: 0.75, 95% confidence interval [CI]: 0.71-0.79). Following adjustment for the frequency of general practitioner visits and PSA tests in the preceding two years, PPI use was no longer associated with PCa diagnosis (HR: 0.99, 95% CI: 0.93-1.05). No association was observed between PPI use and rates of clinically significant or high-grade PCa (HRs: 0.99 and 1.04, respectively). Cumulative PPI use was associated with up to 17% lower rates of a first androgen deprivation therapy prescription or bilateral orchiectomy. Cumulative PPI use was not associated with PCa diagnosis rates, including clinically significant and high-grade PCa. These findings do not support an independent association between PPI use and PCa risk.

Multi-institutional Assessment of Performance Metrics for MRI-targeted Transperineal Prostate Biopsy.

Secondary use of individual-level health data for research is cost-efficient but challenging. In the PCBase Xtend project, we collected PSA values, biopsy reports, MRI results, and chemotherapy data from all 21 regions and private healthcare providers in Sweden. The process required 46 applications over a period of almost 4 years and revealed major variability in IT systems, administrative routines, and costs. The time to data delivery ranged from weeks to years. Early quality checks were essential to correct errors in the data extraction. Despite challenges, >11 million PSA values, 550 000 prostate biopsies, 170 000 MRI results, and >6 million drug administrations could be added to PCBase for use in epidemiological studies of prostate cancer. Better administrative routines, data extraction integrated in IT systems, incentives for data migration, and national support structures are needed to improve access to health data for research.

Several studies have reported contradictory associations between prostate cancer (PCa), tumor grade, and anogenital distances; however, all were based on conventional transrectal ultrasound (TRUS) prostate biopsy. We aimed to investigate the relationship between Anogenital distances (AGDs)/body mass index (BMI)-adjusted AGDs and overall PCa and clinically significant prostate cancer (csPCa) detected by multiparametric magnetic resonance imaging (MRI)/TRUS fusion prostate biopsy. All mp-MRI scans conducted from July 2020 to May 2024 for suspected PCa were reviewed for the study (n = 10,204). Among these, patients who underwent fusion biopsy due to Prostate Imaging-Reporting and Data System (PIRADS) 3/4/5 lesions were included in the study (n = 675). After exclusion criteria (n = 256), the remaining patients were divided into 3 groups. The study group (group-1, study group, n = 153 ) consisted of patients with cancer pathology, while the study subgroup (group-2, n = 80) included patients with csPCA. The control group (group-3, n = 266) comprised patients without cancer. The groups were comparatively analyzed with respect to demographic characteristics, clinical parameters, prostate-specific antigen (PSA)-related variables, mpMRI findings, biopsy characteristics, and pathological outcomes, AGDAnus to Penis (AGDAP), adjusted AGDAP, AGDAnus to scrotum (AGDAS), and adjusted AGDAS. Multivariable logistic regression analyses adjusted for age, prostate volume, PSA-related parameters, and PIRADS score were used to evaluate anogenital distance measures and identify independent predictors of csPCa. The study group exhibited a significantly higher age compared to the control group; nevertheless, no differences were seen between the groups for BMI and metabolic syndrome. As expected, there were significant differences between the study and control group in terms of total PSA, PSA density, DRE findings, and prostate volume. There was no significant difference between the study and control groups in terms of AGDAP, adjusted AGDAP, AGDAS, and adjusted AGDAS. When the csPCa subgroup was selected as the study group, no significant difference was observed between the control group in terms of AGDs and adjusted AGDs. Multivariable logistic regression analysis identified age and PIRADS score as independent predictors of csPCa, while prostate volume showed an inverse association. Although standard AGDAP demonstrated an independent association, other AGD parameters were not significant. While standard AGDAP emerged as an independent predictor, BMI-adjusted AGD measures did not provide independent diagnostic value for csPCa in patients undergoing mpMRI/TRUS fusion biopsy.

Multiparametric magnetic resonance imaging (mpMRI), interpreted using the Prostate Imaging Reporting and Data System (PI-RADS), is increasingly used to improve prostate cancer detection and reduce unnecessary biopsies. However, its diagnostic accuracy compared with histopathological confirmation remains variable across institutions. This study aimed to evaluate the correlation between mpMRI findings and TRUS-guided prostate biopsy results in detecting clinically significant prostate cancer (csPCa) in our patient cohort. This retrospective diagnostic accuracy study included 100 biopsy records (86 unique patients) who underwent mpMRI followed by TRUS-guided biopsy. mpMRI findings were scored using PI-RADS v2, while biopsy histopathology served as the reference standard. Clinically significant prostate cancer (csPCa) was defined as ISUP Grade Group ≥ 2. Diagnostic performance was assessed for two interpretive rules: (1) Baseline rule: PI-RADS ≥ 4 as positive; (2) Combined rule: PIRADS ≥ 4 or PI-RADS = 3 with PSA density (PSAD) > 0.15 ng/mL/mL. Sensitivity, specificity, predictive values, and area under the RoC curve (AUC) were calculated. Hierarchical logistic regression assessed the independent contribution of PSAD and clinical covariates. Malignant cases showed higher PSA (median 10.0 ng/mL vs 7.0 ng/mL) and PSAD (0.32 vs 0.13 ng/mL/mL) and smaller prostate volumes (36.5 mL vs 61.0 mL) compared with benign cases. csPCa detection increased with rising PI-RADS category (3.7% for PI-RADS 3, 56.9 % for PI-RADS 4-5). At the patient level, the Baseline rule achieved sensitivity = 86.7% and specificity = 66.1%, while the Combined rule increased sensitivity to 90.0 % with specificity = 55.4%. The ordinal PI-RADS score demonstrated excellent discrimination (AUC = 0.826, 95% CI 0.713-0.924). In logistic regression, adding PSAD improved model AUC from 0.836 to 0.888 (p < 0.001), and inclusion of age and prostate volume further increased AUC to 0.900 (p = 0.044). within PI-RADS 3 lesions, the optimal PSAD threshold (youden index) was 0.163 ng/mL/mL, yielding 100% sensitivity and 76% specificity. Postbiopsy complications were within expected ranges, with mild hematuria (29%), minor rectal bleeding (23%), and UTI (7%) being most common. mpMRI findings strongly correlated with histopathological outcomes from TRUS-guided biopsy. Incorporating PSA density significantly enhanced the diagnostic accuracy for csPCa, particularly in equivocal PI-RADS 3 cases. Combining mpMRI and PSAD can refine patient selection for biopsy and improve early detection of clinically significant prostate cancer.

Repeat biopsy remains central to active surveillance (AS) because upgrading and tumor burden may change management. This retrospective paired workflow study included 38 men and 47 repeat biopsy sessions (2023-2025), comprising 846 biopsy cores and 871 H&E slides. Whole-slide imaging (WSI) and conventional microscopy were compared after a washout interval. QuPath was used only for pathologist-guided tumorlength and greatest percentage of cancer (GPC) documentation. On the first eligible repeat biopsy, upgrading to ISUP Grade Group (GG) 2 occurred in 7/38 men (18.4%; 95% CI, 7.7- 34.3). No GG3, cribriform morphology, or intraductal carcinoma was identified. Protocol-linked reclassification occurred in 11/38 men (28.9%). Slide-level cancer-detection agreement was 856/871 (98.3%; kappa = 0.91), and raw patient-level agreement for upgrading was 36/38 (94.7%; kappa = 0.80). After adjudication, no upgraded patient remained missed. QuPathsupported measurement was interpretable in 79/101 positive core-level assessments (78.2%), with excellent agreement (ICC = 0.98) and shorter median measurement time (41 s vs 78 s). WSI reproduced management-relevant conventional microscopy outputs in repeat AS biopsies. Its value was organizational and documentary, not autonomous cancer detection or grading.

Prostate-specific antigen (PSA) testing to screen for prostate cancer is controversial. An alternative approach, Stockholm3, combines PSA, plasma protein biomarkers, polygenic risk, and clinical factors into a multivariable risk score. To compare detection of clinically significant prostate cancer (csPC) using PSA and Stockholm3 in a population-based screening with short-term follow-up. Secondary analysis of the baseline round of the prospective STHLM3-MRI (Prostate Cancer Screening Using a Combination of Risk-Prediction, MRI, and Targeted Prostate Biopsies) randomized screening trial in men aged 50 to 74 years who had PSA and Stockholm3 screening. Men with abnormal screening tests (PSA ≥3 ng/mL or Stockholm3 ≥11) were randomly assigned (2:3) to systematic biopsy or magnetic resonance imaging with systematic and targeted biopsies for lesions with a Prostate Imaging Reporting and Data System score of 3 or greater. Cancer diagnosed within 2 years was identified through linkage to the Swedish National Cancer Register; cancer after a negative baseline test was classified as false negative. (ClinicalTrials.gov: NCT03377881). Stockholm region, Sweden, 2018 to 2020. Men aged 50 to 74 years who had PSA and Stockholm3 screening. Prostate-specific antigen and Stockholm3 tests at baseline. Clinically significant prostate cancer (grade group ≥2) within 2 years of baseline. Among 12 670 men, 443 (3.5%) were diagnosed with csPC. Decision curve analysis showed higher net benefit for Stockholm3 versus PSA across a range of decision thresholds for biopsy, indicating fewer unnecessary biopsies and fewer missed csPC cases. Stockholm3 (≥11) had a false-negative rate of 10% (43 of 443) and a false-positive rate of 11% (1289 of 12 227), whereas PSA (≥3 ng/mL) had a false-negative rate of 26% (116 of 443) and a false-positive rate of 10% (1203 of 12 227). Correspondingly, sensitivity was 90% (95% CI, 87% to 93%) for Stockholm3 and 74% (CI, 69% to 78%) for PSA, with similar specificity (89% vs. 90%). Participation was approximately 25% of invited men; follow-up was limited to 2 years; and the cohort was predominantly Swedish or European, which may limit generalizability. In this screening cohort with short-term follow-up, Stockholm3 provided greater clinical net benefit than PSA for detecting csPC, driven by fewer false-negative results, although follow-up was limited to 2 years. Swedish Research Council, Swedish Prostate Cancer Society, Stockholm Region, and the Swedish Cancer Society.

Postoperative dysuria after endoscopic laser enucleation of the prostate (EEP) is common, yet its true incidence, temporal profile, and determinants remain poorly defined. We aimed to characterize the incidence, severity, and predictors of moderate-to-severe dysuria up to 6 months after EEP. In this prospective cohort study, we analyzed 108 patients who underwent EEP using Holmium (standard or Moses®) or pulsed Thulium (RealPulse®) lasers. Dysuria was assessed weekly using a Likert scale and categorized as mild (1-2), moderate (3-7), and severe (8-10). Patients with moderate-to-severe dysuria (score ≥ 3) were grouped for subsequent analyses. Associations were evaluated using Spearman correlation and multivariable logistic regression. Moderate-to-severe dysuria (score ≥ 3) was highly prevalent early after surgery, affecting 75.9% of patients at week 1 and 29.6% at week 4, but declined sharply thereafter (8.3% at 3 months and 0.9% at 6 months). Early dysuria was associated with younger age, diabetes, and clot retention. Between 1 and 3 months, dysuria showed weak associations, with operative and functional variables, including operative time, total energy, enucleation efficiency, bipolar energy use, prior prostate biopsy, and postoperative Qmax. On exploratory multivariate analysis, younger age independently predicted early dysuria (OR 0.90, 95% CI 0.84-0.97, p = 0.007), while prior prostate biopsy predicted dysuria between 1 and 3 months (OR 10.85, 95% CI 1.12-105.15, p = 0.040). Postoperative dysuria after EEP is highly prevalent during the early postoperative period but follows a predominantly self-limited course, with near-complete resolution after 12 weeks. These findings provide a detailed characterization of symptom evolution over time and may help improve postoperative counseling and patient expectations regarding recovery. Exploratory analyses identified associations with younger age and prior prostate biopsy.

Automating standardization of prostate cancer biopsy and histopathology reports with privacy-preserving local large language models.

This study aims to compare the consistency of the Gleason score after radical prostatectomy between cognitive multi-parametric magnetic resonance imaging (mpMRI)-guided transperineal ultrasound–guided transperineal prostate biopsy (TPUS-TPPB), prostate systematic biopsy, and their combined biopsy, and to identify the optimal biopsy approach. This retrospective observational study analyzed 60 patients with prostate cancer who underwent cognitive mpMRI-guided TPUS-TPPB combined with systematic transperineal biopsy in our hospital from August 2021 to May 2023, followed by radical prostatectomy. All patients completed pre-biopsy multiparametric MRI. Using the Gleason score of post-radical prostatectomy specimens as the reference standard, we compared prostate cancer detection rates and Gleason score consistency among targeted biopsy, systematic biopsy, and combined biopsy. The positive detection rate of prostate systematic biopsy was 46.67% (28/60; 95% confidence interval (CI): 33.7%–59.9%), while the detection rate of cognitive mpMRI-guided TPUS-TPPB was 71.67% (43/60; 95% CI: 58.7%–82.1%). After combining both approaches, the detection rate increased to 100.00% (60/60; 95% CI: 94.0%–100.0%). The Gleason score upgrade rate after systematic biopsy was significantly higher than that after combined biopsy (46.67% vs 11.67%; P <.05) and cognitive mpMRI-guided TPUS-TPPB (36.67%; P <.05). There was no significant difference in the Gleason score upgrade rate between combined biopsy and cognitive mpMRI-guided TPUS-TPPB alone (P >.05). Cognitive mpMRI-guided TPUS-TPPB combined with systematic biopsy increases the prostate cancer detection rate and yields Gleason scores that are closer to those of radical prostatectomy specimens. The findings indicate that systematic prostate biopsy retains important complementary value when used alongside targeted biopsy.

Lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 4 or greater on multiparametric MRI (mpMRI) indicate a high likelihood of prostate cancer (PCa), and guidelines recommend a targeted biopsy. We aimed to compare the diagnostic performance of robotic arm-assisted [68Ga]Ga-PSMA-11 PET/CT-guided prostate biopsy (PGPB) with mpMRI-directed cognitive-fusion transrectal ultrasound-guided biopsy (MCFB) in biopsy-naïve men with clinical findings suggestive of PCa. Methods: This prospective, single-center, randomized clinical trial (NCT05137561) enrolled biopsy-naïve men age 50-90 y with elevated levels of prostate-specific antigen (≥4 ng/mL) and abnormal digital rectal examination findings. All participants underwent mpMRI, and those with a PI-RADS score of 4 or greater were randomized into 2 arms. In arm 1, participants underwent PGPB for a [68Ga]Ga-PSMA-avid lesion, and participants in arm 2 underwent MCFB. Participants in arm 1 with PET-negative findings subsequently underwent MCFB, and participants with negative biopsy results underwent PET and PGPB. The primary outcome was the detection of PCa. Secondary outcomes included complication rates and participant-reported pain. Result: Of the 267 participants enrolled, 81.3% (217) had lesions with a PI-RADS score of 4 or greater and were randomized to either PGPB (n = 112) or MCFB (n = 105). PCa was detected in 97.1% of participants (101/104) in arm 1 and 81.0% (85/105) in arm 2 (P < 0.05). PGPB showed higher diagnostic accuracy for PI-RADS 5 lesions (100% vs. 95.1%, P = 0.09). Major complications were observed in arm 2 only (n = 5). Arm 1 had significantly fewer complications (10.8% vs. 51.4%, P < 0.01), a lower median visual analog scale score for pain (3 vs. 5), and shorter procedure times. The core positivity rate was higher in arm 1 (60% ± 20%), despite obtaining fewer cores. Conclusion: [68Ga]Ga-PSMA-11 PCPB demonstrated higher diagnostic performance, fewer complications, and better tolerability compared with MCFB. This approach enables integrated diagnosis and staging, offering a promising alternative for efficient, safe, and accurate evaluation of prostate cancer.

PI-RADS 3 lesions represent a diagnostic "gray zone" in which biopsy decision-making is particularly challenging, with reported clinically significant prostate cancer (csPCa) detection rates ranging from 13% to 50%. This study evaluated the predictive value of the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)-alone and in combination with PSA density (PSAD) and PI-RADS score-for the detection of prostate cancer (PCa) and csPCa, with a specific focus on the PI-RADS 3 subgroup. In this two-center retrospective observational study, 982 patients who underwent prostate biopsy between 2020 and 2025 were included. csPCa was defined as ISUP Grade Group ≥ 2. Univariable and multivariable logistic regression analyzes were performed to identify independent predictors of PCa and csPCa. In the PI-RADS 3 subgroup (n = 251), two predictive models were compared using receiver operating characteristic analysis and the DeLong test: Model 1 (age, free/total PSA ratio, PSAD) and Model 2 (Model 1 + SII + NLR). Of the 982 patients, 188 (19.1%) were diagnosed with PCa and 150 (15.3%) with csPCa. In the overall cohort, NLR ≥ 2.11 was independently associated with csPCa (OR, 15.924; 95% CI, 2.472-102.567; p = 0.004), whereas SII did not retain independent significance. PLR showed an inverse association with PCa, possibly reflecting tumor-related platelet dynamics. In the PI-RADS 3 subgroup, SII ≥ 661.37 (OR, 2.317; p = 0.039) remained an independent predictor of PCa alongside age, free/total PSA ratio, and PSAD ≥ 0.20 (OR, 6.111; p = 0.013), while NLR showed borderline significance. The addition of SII and NLR to the clinical model increased the AUC from 0.795 to 0.816 in the PI-RADS 3 subgroup, although this improvement did not reach statistical significance (p = 0.134). Systemic inflammatory markers-particularly SII and NLR-provide complementary predictive information in the pre-biopsy risk stratification of prostate cancer. SII emerged as an independent predictor of PCa specifically within the PI-RADS 3 gray zone, while NLR independently predicted csPCa in the overall cohort. These routinely available, low-cost parameters may serve as practical adjuncts to PSA derivatives and mpMRI in the individualization of biopsy decisions, particularly for PI-RADS 3 patients.

Magnetic resonance imaging (MR) of the prostate is an important part of the diagnostic pathway for patients with suspected prostate cancer. Current practice in many Irish centres is to perform biparametric MRI (bpMRI) incorporating T2- and diffusion-weighted imaging, and interpret it using the latest version of the American College of Radiology Prostate Imaging Reporting and Data System (PI-RADS), version 2.1. No study has yet reported on the use of bp-MRI and PI-RADS 2.1 in the investigation of prostate cancer investigation in the Irish healthcare setting. We aimed to review one year of practice at our regional tertiary prostate cancer referral centre and compare diagnostic yield with international standards. We identified all patients who had undergone prostate biopsy at our institution in 2023 and extracted pre-biopsy MRI results for each patient, comparing MRI results with biopsy reports. We identified 328 patients in the study period who underwent prostate biopsy and pre-biopsy MRI. 182 of these had a pathological diagnosis of clinically significant prostate cancer (csPCa), defined as Gleason score of 7 or higher. Of these, 167 (92%) had a PI-RADS score of 3 or above, meaning at least equivocal for the presence of csPCA. Cancer detection rates were 31%, 54% and 96% for PI-RADS three, four and five lesions respectively. We demonstrated a sensitivity of 92% and specificity of 49% for detection of csPCa, closely aligned with international datasets. The use and performance of bpMRI and PI-RADS 2.1 at our Irish tertiary urological centre is in line with international datasets. These have a key role in the diagnostic pathway of prostate cancer in Ireland.

Aromatherapy effects on pain and anxiety during transrectal ultrasound-guided prostate biopsy: A randomized controlled trial.

Prostate-specific antigen (PSA)-based prostate cancer (PCa) screening risks overdiagnosis and overtreatment. PCa disproportionately affects Black men, those with a family history (FH) of the disease, and BRCA1/2 gene variant carriers. Risk-adapted approaches are gaining interest but are underexplored. To assess the feasibility of PSA-based Targeted Prostate Health Checks (TPHCs) for men at high PCa risk, compare invitation methods, and assess sociodemographic variations. Prospective feasibility cohort study in four primary care networks (PCNs) in North East London. Men aged 45-69 years from Black ethnic group, or with a positive PCa FH, were identified via primary care records and invited by the PCN to one of two TPHCs: (i) telephone-first (phone consultation followed by hospital-based PSA testing); or (ii) test-first (community-based PSA testing followed by phone consultation). Elevated PSA prompted multiparametric magnetic resonance imaging (mpMRI), and prostate biopsy if malignancy was suspected. Of 2400 invitees, 398 (16.6%) attended. Attendance was higher with the test-first than telephone-first TPHC (22.9% versus 11.2%, P<0.001). Only 51.4% of participants met eligibility criteria owing to inaccurate FH coding, although men who did not meet the eligibility criteria were offered PSA tests. Black men had lower prior PSA testing (55.7% versus 82.5%) and higher deprivation than White men. Elevated PSA occurred in 6.0% of participants (n = 22), with five PCa diagnoses (1.4%). Identification of men at high PCa risk is feasible using age and ethnicity primary care data, but FH coding is unreliable. Test-first invitations improved engagement. Disparities affecting Black men highlight the need for tailored outreach, and better coding of risk factors will facilitate risk-adapted screening.