Prostate Needle Biopsy Research Articles

Association of Obesity with Prostate Cancer at Time of Biopsy: A MultiCentre 10-Year Retrospective Study

Background and Aim: The incidence of Prostate cancer (PCa) is on the rise in Cameroon, making it the most commonly diagnosed cancer amongst men. Factors, such as obesity, smoking, and the consumption of high fat diet have been reported to play a role in the aetiology and progression of cancers in general. However, the exact relationship between obesity and prostate cancer in Africans is still poorly described. The present study aimed to evaluate the association between obesity as measured by the body mass index (BMI) and high-grade prostate cancer in Cameroonians. Methods: This was a retrospective analyses of the clinical records of 300 consecutive men who underwent transrectal ultrasound-guided core needle prostate biopsy between January 2010 and January 2020. Patients were grouped as obese (BMI ≥30kg/m²) and non-obese (BMI <30kg/m²) and binary logistic regression modelling was used to compare the association between obesity and patient characteristics, such as age, digital rectal examination (DRE) findings, prostate specific antigen (PSA) level, prostate volume, PSA density, and Gleason score (GS). Results: The mean age at diagnosis of PCa was 65.46 ± 8.54 years (Range: 34-89 years), the mean BMI was 28.93 ± 4.57 kg/m² (Range: 18.35-42.37 kg/m²), and the median total PSA level was 44.2 ng/ml. In total, 142 men (47.3%) were obese and biopsies detected high-grade prostate cancer in 160 men (63.3%). Obese men were significantly younger and had a higher risk (OR= 2.74, p <0.001) of having high-grade PCa compared to nonobese men. Furthermore, 94 obese men (58.75%) had high-grade PCa. Obese men had higher age-adjusted PSA densities (P<0.001), while there was no statistical difference in DRE findings (OR= 1.06, p= 0.225). Conclusion: This study demonstrated that obesity is associated with a higher risk of high-grade prostate cancer. This risk is more pronounced among younger patients and DRE findings are not influenced by BMI.

Clinically Significant Prostate Cancer in Men With High-Grade Intraepithelial Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation

Purpose: The clinical management of Atypical Small Acinar Proliferation (ASAP) and High-Grade Prostate Intraepithelial Neoplasia (HGPIN) varies significantly. The aim of this study was to characterize the incidence and natural history of ASAP and HGPIN lesions to optimize follow-up strategies. Materials and Methods: A retrospective analysis of patients at a VA Medical Center who underwent a prostate needle biopsy between 1988 and 2017 was performed. The pathological lesions were grouped as ASAP, HGPIN, and ASAP & HGPIN. The primary outcome was the incidence of clinically significant prostate cancer (csPCa) defined as grade group ≥2 prostate cancer. Results: Of 6104 patients screened, 312 patients included having ASAP (n = 70, 1.1%), HGPIN (n = 222, 3.6%), or ASAP & HGPIN (n = 20, 0.3%). Follow-up biopsy was performed in 99.3% of patients. The incidence of prostate cancer in ASAP, HGPIN, or ASAP & HGPIN groups was 46.3%, 37%, and 68.4%, respectively (P = .03). However, the rate of csPCa was similar across the 3 groups (10.1% in ASAP, 10.3% in HGPIN, and 10.5% in ASAP & HGPIN, P = .6). The median time to cancer diagnosis was significantly shorter for patients with ASAP (2.8 years for ASAP, 4.9 years for HGPIN, and 1.5 years for ASAP & HGPIN, P = .001); however, there was no significant difference in time to diagnosis of csPCa between the various groups (P = .7). Conclusion: Both ASAP and HGPIN have a low risk of progression to csPCa. This, coupled with a prolonged time to any cancer diagnosis, suggests that immediate repeat biopsy might not be necessary among these patients.

Audit of Urological Procedures in a Tertiary Health Center

Background: Urology is a branch of medicine that focuses on the surgical and medical diseases of the geni-tourinary system. This area of specialty can be broken down into several subspecialties. The information on the spectrum of urological procedures is sparse in our environment. This study aimed todeterminethe spec-trum of urological procedures at Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Oyo State Nigeria.. The study’s objective was to determine the age and gender distribution, the type and in-dication of the procedures, and the common subspecialty categorization. This may serve as a policy frame-work for healthcare development in the field of urology, including sub-specialization. Methods: The records of patients with urological procedures between July 2013 and June 2022 were re-trieved from the hospital’s Medical Records Department. The information retrieved from case files was ana-lyzed using SPSS version 23. Results: A total of 1,069 urological procedures were done between the years under review. This comprises 998males (93.31%) and 71 females (6.64). The most common in-patient urological procedure was open sim-ple prostatectomy (14.1%, 151 patients), while the most common outpatient urological procedure was pros-tatic needle biopsy (32.74%; 350). Urethrocystocopy accounted for 7.48% (80). Suspected prostate cancer was the most common indication for these procedures (32.74%; 350), while benign prostate enlargement was the most common indication for in-patient procedures. Conclusion: The most common outpatient procedure was prostate biopsy, while the most common in-patient procedure was open simple prostatectomy..

Validation of real-time prostatic biopsies evaluation with fluorescence laser confocal microscopy.

Routine processing of prostate biopsies requires conventional steps that usually take a few days. The aim of this study was to validate the use of fluorescence laser confocal microscopy (FCM) for real-time diagnostics. We prospectively tested images from prostate needle biopsies (75 images were evaluated by FCM and conventional slides). Two pathologists reviewed the images and assessed agreements between FCM versus conventional slides and between pathologists (κ-values). Interpretation was performed on digital images from the VivaScope 2500 confocal microscope (MAVIG GmbH, Munich, Germany; Caliber I.D., Rochester, NY, USA) placed in the urological operating room. Cancerous versus benign tissue was the primary focus, then the application of the grading system. Cancer was diagnosed in 24 conventional slides (on 75 images) in which agreement among pathologists was high for both conventional (κ=0.96) and FMC (κ=0.84). 1/24 (4%) was ISUP/WHO grade group I, 12/24 (50%) II, 8/24 (33%) III, 2/24 (8%) IV and 1/24 (4%) grade V. Near perfect agreement was obtained for grades I, IV and V (κ=0.85). Grade III values achieved a moderate agreement (κ=0.55). The mean time for laser scanning was 9 minutes. For the remaining non-tumor images, agreement was nearly perfect (κ=0.81). We validated the use of FCM for real-time cancer detection in prostate biopsies.

Grade Group accuracy is improved by extensive prostate biopsy sampling, but unrelated to prostatectomy specimen sampling or use of immunohistochemistry.

Assessing the accurate Grade Group of a prostate needle biopsy specimen is essential for choosing the adequate therapeutic modality for prostate cancer patients. However, it is well-known that biopsy Grade Group tends to up- or downgrade significantly at radical prostatectomy. We aimed to investigate the correlation between accuracy and biopsy core number, performed immunohistochemical staining (IHC) or prostatectomy specimen sampling, with the latest also being correlated with higher detection rates of adverse pathological features, e.g., positive surgical margins, higher pathological stage or presence of perineural invasion (PnI status). The study cohort consisted of 315 consecutive patients diagnosed with prostate adenocarcinoma via transrectal ultrasound-guided needle biopsy who later underwent radical prostatectomy. We grouped and compared patients based on Grade Group accuracy, presence of IHC on biopsy, margin status, pathological stage, and PnI status. Inter-observer reproducibility was also calculated. Statistical analyzes included ANOVA, Tukey's multiple comparisons post hoc test, Chi-squared test, and Fleiss kappa statistics. Undergraded cases harboured a significantly lower number of biopsy cores (p < 0.05), than accurately graded cases. Using IHC did not affect grading accuracy significantly, nor did the number of slides from prostatectomy specimens. The mean number of slides was virtually identical when margin status, pathological stage and PnI status of prostatectomy specimens were compared. Inter-observer reproducibility at our institute was calculated as fair (overall kappa = 0.29). Grade Group accuracy is significantly improved by obtaining more cores at biopsy but is unrelated to performed IHC. The extent of sampling prostatectomy specimens, however, did not affect accuracy and failed to significantly improve detection of adverse pathological features.

A brief mind-body intervention to reduce pain and anxiety during prostate needle biopsy: A randomized, controlled trial with two-staged consent.

e17092 Background: Prostate biopsy is among the most common oncologic procedures performed annually. A substantial proportion of patients experience significant morbidity related to biopsy, including pain, anxiety, and discomfort which may discourage follow-up biopsy crucial for identifying progression or discourage enrollment in active surveillance programs that require serial biopsy. Guided meditation significantly reduces pain and anxiety during breast biopsy. We developed a brief mind-body intervention that could easily integrate into general practice for patients during prostate biopsy and compared patient-reported outcomes after biopsy with and without this intervention. Methods: We conducted a clinically-integrated randomized controlled trial (MSK IRB 18-089) of a brief mind-body intervention during prostate biopsy compared to usual care. All adult patients offered biopsy were eligible. Patients randomized to the intervention were offered both a pre-biopsy mind-body exercise and guided mindfulness meditation during biopsy via headphones. The primary outcome of interest was any severe patient-reported pain, anxiety, discomfort, or tolerability on a visual-analog scale (0-10). We compared the proportion of men in each arm reporting a severe score (7-10) on any of the four scales using Fisher’s exact test. The pre-specified clinically relevant improvement justifying integration into clinical practice was 15%. We compared means separately using ANCOVA with randomization stratum (first vs. prior biopsy) as a covariate. Results: 238 patients (119 per arm) enrolled. 102 in the intervention arm and 94 in the usual care arm proceeded to biopsy and completed the questionnaire. A total of 37/94 (39%) and 38/102 (37%) patients in the usual care and the intervention arms, respectively, reported severe scores in any of the four domains, a difference of 2.1% (95% confidence interval -13, 17%, p = 0.8). The upper bound of the confidence interval includes the pre-specified clinically relevant difference. There was no evidence of a difference in mean post-biopsy anxiety (p = 0.3), discomfort (p = 0.09), pain (p = 0.4) or tolerability scores (p = 0.2), Table. Conclusions: There was no difference in patient reported outcomes between a mind-body intervention and usual care for prostate biopsy. Though the upper bound of the 95% confidence interval included the clinically relevant difference in severe scores, the difference in means for each outcome suggests a clinically meaningful benefit for this brief mindfulness intervention is unlikely. [Table: see text]

CONFIDENT-trial protocol: a pragmatic template for clinical implementation of artificial intelligence assistance in pathology

IntroductionArtificial intelligence (AI) has been on the rise in the field of pathology. Despite promising results in retrospective studies, and several CE-IVD certified algorithms on the market, prospective clinical implementation...

ROLE OF EXPRESSION OF P63 AND CALPONIN IN PROSTATIC BIOPSIES

Background: An increased number of mortality and morbidity in elderly men is caused due to prostatic diseases all over the world. An increase in mass screening programmes conducted with the help of Prostate Specic Antigen (PSA) blood test along with Digital rectal examination (DRE) and imaging studies has resulted in an upsurge in the diagnosis of prostatic cancer which is markedly noted in the recent decades. Material And Methods: A total 100 cases of formalin xed parafn embedded histological sections of various prostatic lesions including benign prostatic hyperplasia, prostatic intraepithelial lesion and prostate carcinoma were studied. Out of 100 cases, 55 cases were benign prostatic hyperplasia, 10 cases of prostatic intraepithelial lesion and 35 cases were of prostate adenocarcinoma. All the sections were stained with Hematoxylin and Eosin stain and then immunohistochemical staining of p63 and Calponin was performed on all the cases (gure 6- 12). The parameters used to analyse the expression of both p63 and calponin were - Pattern of staining, Percentage of stained cell, Intensity of staining reaction. Total 100 cases i Results: ncluded in this study, out of which 55 (55%) cases were benign prostatic hyperplasia, 10 (10%) cases of prostatic intraepithelial neoplasia, and 35 (35%) cases were prostatic adenocarcinoma, majority of specimens (78%) were TURP followed by trucut biopsy (20%), Suprapubic prostatectomy (2%). The proportion of Transurethral resection of prostate (TURP) was signicantly higher as compared to the proportion of Trucut biopsy and supra pubic prostatectomy (SPP) (p&lt;.001). Expression of calponin in various prostatic lesion. On analysing expression of proliferation marker calponin, in BPH it was expressed in only 52 cases out of 5 cases (94.5%) and 3 cases (8.6%) were negative. Our study concluded that the proportion of Benign prostatic Conclusion: hyperplasia was signicantly higher as compared to the Prostatic intraepithelial neoplasia and Prostatic adenocarcinoma. Immunohistochemical staining by p63 is diagnostically reliable in identifying basal cells in prostatic needle biopsies and TURP specimens. p63 is a valuable tool with high sensitivity in differentiating BPH from prostatic carcinoma. The decreased or absent stromal staining of calponin which indicates a reactive stroma in malignancy can be used alone or in conjunction with p63 for conrmation of diagnosis of prostatic carcinoma

Evaluation of initial prostate cancer biopsies utilizing 3D open-top light-sheet microscopy for detection of early disease.

Open-top light-sheet (OTLS) microscopy is a technique that allows for high-resolution 3D imaging of tissue specimens and can therefore provide a more detailed assessment of tissue architecture. Given that Gleason grading is based on tissue architecture, we hypothesized that OTLS microscopy would enable us to survey a larger amount of tissue and detect occult prostate cancers in men who had prostate core biopsy specimens initially classified as being benign-appearing who later developed clinically significant prostate cancers. Benign appearing tissue (based on routine pathologic evaluation) from 20 patients who subsequently developed a clinically significant prostate cancer (experimental group) was evaluated with OTLS microscopy and compared to tissue from 20 patients who underwent prostate biopsy and never developed a clinically significant prostate cancer (control group). We compared the incidence of detectable prostate cancer between groups. Baseline clinical characteristics were similar between the experimental and control groups. Three patients (15%) in the control group and one (5%) in the experimental group had suspicious findings on low-resolution OTLS microscopy. Higher resolution OTLS imaging revealed two patients (10%) in the control group had an occult prostate cancer, while no occult cancers were found in the experimental group. In spite of a high pretest probability for the presence of an occult prostate cancer, we did not identify cancer in our experimental group. This may be due to under-sampling at the time of prostate needle biopsy.

Evaluation of Matrix Metalloproteases by Artificial Intelligence Techniques in Negative Biopsies as New Diagnostic Strategy in Prostate Cancer.

Usually, after an abnormal level of serum prostate-specific antigen (PSA) or digital rectal exam, men undergo a prostate needle biopsy. However, the traditional sextant technique misses 15-46% of cancers. At present, there are problems regarding disease diagnosis/prognosis, especially in patients' classification, because the information to be handled is complex and challenging to process. Matrix metalloproteases (MMPs) have high expression by prostate cancer (PCa) compared with benign prostate tissues. To assess the possible contribution to the diagnosis of PCa, we evaluated the expression of several MMPs in prostate tissues before and after PCa diagnosis using machine learning, classifiers, and supervised algorithms. A retrospective study was conducted on 29 patients diagnosed with PCa with previous benign needle biopsies, 45 patients with benign prostatic hyperplasia (BHP), and 18 patients with high-grade prostatic intraepithelial neoplasia (HGPIN). An immunohistochemical study was performed on tissue samples from tumor and non-tumor areas using specific antibodies against MMP -2, 9, 11, and 13, and the tissue inhibitor of MMPs -3 (TIMP-3), and the protein expression by different cell types was analyzed to which several automatic learning techniques have been applied. Compared with BHP or HGPIN specimens, epithelial cells (ECs) and fibroblasts from benign prostate biopsies before the diagnosis of PCa showed a significantly higher expression of MMPs and TIMP-3. Machine learning techniques provide a differentiable classification between these patients, with greater than 95% accuracy, considering ECs, being slightly lower when considering fibroblasts. In addition, evolutionary changes were found in paired tissues from benign biopsy to prostatectomy specimens in the same patient. Thus, ECs from the tumor zone from prostatectomy showed higher expressions of MMPs and TIMP-3 compared to ECs of the corresponding zone from the benign biopsy. Similar differences were found for expressions of MMP-9 and TIMP-3, between fibroblasts from these zones. The classifiers have determined that patients with benign prostate biopsies before the diagnosis of PCa showed a high MMPs/TIMP-3 expression by ECs, so in the zone without future cancer development as in the zone with future tumor, compared with biopsy samples from patients with BPH or HGPIN. Expression of MMP -2, 9, 11, and 13, and TIMP-3 phenotypically define ECs associated with future tumor development. Also, the results suggest that MMPs/TIMPs expression in biopsy tissues may reflect evolutionary changes from prostate benign tissues to PCa. Thus, these findings in combination with other parameters might contribute to improving the suspicion of PCa diagnosis.

MP20-15 VALIDATION OF ARTIFICIAL INTELLIGENCE DIAGNOSTIC SUPPORT SYSTEM FOR PROSTATE NEEDLE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP20-15 VALIDATION OF ARTIFICIAL INTELLIGENCE DIAGNOSTIC SUPPORT SYSTEM FOR PROSTATE NEEDLE BIOPSY Naoto Tokuyama, Akira Saito, Bin Shen, Ryu Muraoka, Takuya Ishida, Takeshi Kashima, Ryo Iseki, Kunihiko Yoshioka, Takashi Arakawa, Masahiko Kuroda, and Yoshio Ohno Naoto TokuyamaNaoto Tokuyama More articles by this author , Akira SaitoAkira Saito More articles by this author , Bin ShenBin Shen More articles by this author , Ryu MuraokaRyu Muraoka More articles by this author , Takuya IshidaTakuya Ishida More articles by this author , Takeshi KashimaTakeshi Kashima More articles by this author , Ryo IsekiRyo Iseki More articles by this author , Kunihiko YoshiokaKunihiko Yoshioka More articles by this author , Takashi ArakawaTakashi Arakawa More articles by this author , Masahiko KurodaMasahiko Kuroda More articles by this author , and Yoshio OhnoYoshio Ohno More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003245.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence rate of prostate cancer has been increasing in Asia. The number of prostate needle biopsies is also increasing for early detection and treatment. However, prostate cancer has some borderline lesions which are difficult to diagnose, that may become the burden on pathologists. Although there were some studies of artificial intelligence (AI) to support prostate cancer pathological diagnosis worldwide, there were few large-scale validations using data from Asian patients. We have developed a simple diagnostic support system that can be used immediately in clinical practice based on Asian data. METHODS: A dataset of 12,230 hematoxylin-eosin stained prostate needle biopsy specimens was converted to digital images by whole slide image scanner, and annotated about cancer sites and Gleason patterns by pathologists. From these data sets, a cancer diagnosis and Gleason score discrimination system was created by deep learning. For the external validation, we obtained other 12,230 data sets from Shin-yurigaoka General Hospital, and confirmed the discrimination accuracy of cancer or non-cancer, and Gleason score based on International society of urological pathology (ISUP) grade. RESULTS: As a result of external validation, a high detection rate of 99.85% was achieved for the sensitivity and 69.62% for specificity by a needle unit. About 1 in 1000 needles was misdiagnosed. Most of these were cancerous ducts smaller than 1 mm or small ducts in the inflammatory background. Aggregating the results based on a patient, the cancer detection rate was 100%. On the other hand, the discrimination rate for ISUP grade was following, ISUP1:58.5%, ISUP2:31.1%, ISUP3:33.6%, ISUP4:25.9%, and ISUP5:81.9%. CONCLUSIONS: The results of the external validation showed that the discrimination of cancerous areas could be diagnosed with high sensitivity, which may prevent the misdiagnosis of cancerous areas and contribute to the reduction of the pathologist's working time. However, the Gleason score was not sufficiently discriminated due to inter-observer variability. Therefore, pathologist's visual inspection was considered essential for Gleason score evaluation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e281 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naoto Tokuyama More articles by this author Akira Saito More articles by this author Bin Shen More articles by this author Ryu Muraoka More articles by this author Takuya Ishida More articles by this author Takeshi Kashima More articles by this author Ryo Iseki More articles by this author Kunihiko Yoshioka More articles by this author Takashi Arakawa More articles by this author Masahiko Kuroda More articles by this author Yoshio Ohno More articles by this author Expand All Advertisement PDF downloadLoading ...

The CONFIDENT-P trial: Clinical implementation of artificial intelligence assistance in prostate cancer pathology.

TPS405 Background: Prostate cancer grading has been subject to variation, putting patients at risk for over- and under-treatment (Flach et al., 2022). As a response, development of artificial intelligence (AI) prostate cancer algorithms has been on the rise in the field of pathology. Despite promising results in retrospective studies, and several FDA-approved and CE-IVD certified algorithms on the market, prospective clinical implementation studies of AI are lacking. Moreover, uptake of digital pathology is currently insufficient due to high implementation costs (Ho et al., 2014). In this trial, we will explore the benefits of an AI-assisted pathology workflow in prostate cancer detection, while maintaining diagnostic safety standards. We will focus on reducing costly immunohistochemistry stains (IHC), which are currently used to aid in the diagnosis of prostate cancer. Methods: CONFIDENT-P is a SPIRIT-AI compliant single-centre, clinical trial, in a fully digital academic pathology laboratory. We will prospectively enroll 80 prostate cancer patients who undergo prostate needle biopsies. The pathology specimens will be pseudo-randomized to be assessed by a pathologist with- or without AI-assistance in a pragmatic (bi-)weekly sequential design, in a 1:1 allocation ratio. Patients are excluded when they are redirected for a second opinion to the UMC Utrecht. In the intervention group, pathologists will assess whole slide images (WSI) of the standard haematoxylin-eosin (HE)-stained sections assisted by the output of a CE-IVD approved prostate cancer detection and grading algorithm. In the control group, pathologists will assess HE WSI according to the current clinical workflow. If no tumour cells are identified or when the pathologist is in doubt, staining by immunohistochemistry (IHC) will be performed. Primary endpoint is the number of saved resources on IHC for detecting tumour cells, since this will clarify tangible cost savings that will help to build the business case for AI. We will compare the proportion of IHC-use in both arms, and calculate adjusted relative risks, using a log-binomial model. The sample size gives at least 80% power to detect a 30% difference in IHC usage, using a one-sided significance level of 5%. Enrolment is set to begin in November 2022. The ethics committee (MREC NedMec) waived the need of official ethical approval, as participants are not subjected to procedures and as they are not required to follow rules. Furthermore, they are not at risk of an inferior diagnosis. Trial registration is therefore applicable nor suitable.

Interobserver reproducibility of cribriform cancer in prostate needle biopsies and validation of International Society of Urological Pathology criteria.

There is strong evidence that cribriform morphology indicates a worse prognosis of prostatic adenocarcinoma. Our aim was to investigate its interobserver reproducibility in prostate needle biopsies. A panel of nine prostate pathology experts from five continents independently reviewed 304 digitised biopsies for cribriform cancer according to recent International Society of Urological Pathology criteria. The biopsies were collected from a series of 702 biopsies that were reviewed by one of the panellists for enrichment of high-grade cancer and potentially cribriform structures. A 2/3 consensus diagnosis of cribriform and noncribriform cancer was reached in 90% (272/304) of the biopsies with a mean kappa value of 0.56 (95% confidence interval 0.52-0.61). The prevalence of consensus cribriform cancers was estimated to 4%, 12%, 21%, and 20% of Gleason scores 7 (3 + 4), 7 (4 + 3), 8, and 9-10, respectively. More than two cribriform structures per level or a largest cribriform mass with ≥9 lumina ora diameter of ≥0.5 mm predicted a consensus diagnosis of cribriform cancer in 88% (70/80), 84% (87/103), and 90% (56/62), respectively, and noncribriform cancer in 3% (2/80), 5% (5/103), and 2% (1/62), respectively (all P < 0.01). Cribriform prostate cancer was seen in a minority of needle biopsies with high-grade cancer. Stringent diagnostic criteria enabled the identification of cribriform patterns and the generation of a large set of consensus cases for standardisation.

The percentage of positive biopsy cores in predicting biochemical recurrence and adverse pathology in prostate cancer patients after radical prostatectomy: a systematic review and meta-analysis

Background: Biochemical recurrence (BCR) occurs in more than one-third of prostate cancer (PCa) patients 10 years after radical prostatectomy. The percentage of positive biopsy cores (PPBC) obtained from prostate needle biopsy is suggested as one of the predictors of BCR. We aim to investigate the role of PPBC in predicting BCR and adverse pathology in PCa patients after RP. Methods: A systematic search was conducted based on PRISMA guidelines from Pubmed, Scopus, and Cochrane Library databases up to July 2022. We screened studies that met our inclusion criteria and NOS (Newcastle-Ottawa Scale) was utilized as the quality assessment tool. The primary outcome was BCR measured as Hazard Ratios (HRs). The secondary outcome was adverse pathology, including positive surgical margin (PSM), Extra-prostatic disease (EPD), and seminal vesicle invasion (SVI). Review Manager®5.4 was used as the statistical analysis tool. Results: A total of 5971 patients were included from eleven eligible studies with overall good quality scores. Eleven studies were included in the qualitative synthesis and five of them were analyzed in the meta-analysis. The pooled analysis demonstrated that higher PPBC has a 2.77 times risk of BCR (OR 2.77 (95% CI: 1.97, 3.9; p&lt;0.00001) after RP. Similarly, it has significant results in SVI (OR 2.61 (95% CI: 1.19, 5.73; p=0.02). However, there were insignificant results in terms of EPD (p=0.17) and PSM (p=0.33). Conclusion: This systematic review and meta-analysis (SRMA) indicate that a high PPBC is strongly correlated with a greater risk of BCR and SVI, but not EPD and PSM in patients following RP.

Histopathological Correlations of Serum Prostate Specific Antigen (PSA) and Tumor Grade among Prostate Cancer Patients in Kano, Nigeria

Context: Prostate cancer is the most common cancer in men of black extraction afflicting mostly the elderly with attendant morbidity and mortality. Prostate specific antigen (PSA) is the most widely used tumor marker for the diagnosis and management of prostate cancer. Patients with raised PSA above 4ng/dl need further evaluation by needle biopsy, and those with cancer are graded using Gleason's score for appropriate prognostication. Aims: The study was aimed at establishing a correlation between PSA level and Gleason's tumor grade among patients with prostate cancer. Settings and Design: This is a prospective study of prostatic needle biopsies and serum PSA of prostate cancer patients over a period of 1 year. Materials and Methods: Venous blood samples for serum PSA were taken and analyzed in the laboratory using an automated in vitro immunoassay analyzer. Patients with raised PSA values (&gt;4 ng/ml) were counseled and consented for trans-rectal needle biopsies and sampled using an 18-gauge biopsy needle; tissue samples were routinely processed and reviewed. Statistical Analysis: Statistical analysis was performed by means of statistical package for social sciences (SPSS) software version 21. Results: The mean age of patients at presentation was 69 years with a range of 50 to 90 years and mean serum PSA of 78.8ng/dl. The dominant Gleason's scores were 7 and 8 with grade group 5 as the most predominant. There was however no significant correlation between serum PSA and tumor grade. Conclusions: Prostatic adenocarcinoma is associated with raised PSA, but tumor grade has no statistical correlation with PSA in patients seen at AKTH, Kano.

A Case of Hemostasis by Transcatheter Arterial Embolization for Upper Rectal Wall Bleeding after a Transrectal Prostate Needle Biopsy

A Case of Hemostasis by Transcatheter Arterial Embolization for Upper Rectal Wall Bleeding after a Transrectal Prostate Needle Biopsy

Effect of constipation on acute urinary retention following transrectal prostate biopsy.

To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guided prostate biopsy (TRUS PB). A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-void residue, age, body mass index, histopathological inflammation, and AUR. The mean age of patients was 64.63±8.31 years, the PSA level was 11.60±16.83 ng/mL, and the prostate volume was 54.66±25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively). Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.

411. Characterization of Antibiotic Prophylaxis Prior to Trans Rectal Ultrasound Guided Prostate Needle Biopsy (TRUS PNB): A 5-Year Nationwide Study among Patients in the United States Veterans Health Administration

Abstract Background Prophylactic antibiotics are used prior to TRUS PNB to reduce risk for infectious complications such as UTI, prostatitis, epididymitis, orchitis, bacteremia and sepsis. Fluoroquinolones have been commonly used for prophylaxis, however, the incidence of post TRUS PNB infections caused by fluoroquinolone resistant Escherichia coli has increased. The purpose of this study was to characterize the prophylaxis agents used nationwide in the Veterans Health Administration (VHA) prior to TRUS PNB. Methods We conducted a review of records of all patients undergoing TRUS PNB in the VHA database from January 1st, 2013 to December 31st, 2018. We collected data about outpatient oral prophylaxis antibiotics, inpatient injectable antibiotics and microbiology results from rectal swabs and urine cultures performed within 90 days prior to the procedure. Results Of 153,055 patients undergoing prostate biopsy between January 1st, 2013 and December 31st, 2018, 27.6% (n=42,319) had urine cultures and 3.9% (n=5,294) had rectal swab cultures done within the 90-day window prior to the procedure. Among these who had urine and rectal swabs culture, 3.0% (n=1,292) and 20.1% (n=1,062) were positive for E. coli, respectively; 40.2% of E. coli isolates recovered from urine and 89.6% recovered from rectal swabs were resistant to fluoroquinolones. Table 1 shows the frequencies and percentages of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure. Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Conclusion Despite the high rate of recovery of fluoroquinolone-resistant E. coli in pre-procedure urine and rectal swabs, oral fluoroquinolones remained the most frequently used prophylactic agents prior to TRUS PNB. This inadequate prophylactic coverage may increase the risk of infectious complications following prostate biopsy. Disclosures Elie Saade, MD, MPH, FIDSA, Janssen: Advisor/Consultant.

A high serum dehydroepiandrosterone concentration is a predictor of candidates for active surveillance in men with serum prostate-specific antigen < 10 ng/mL

BackgroundThere is no consensus on the role of serum dehydroepiandrosterone (DHEA) concentrations in the detection of prostate cancer. This study examined the effectiveness of serum DHEA in predicting candidate patients for active surveillance (AS) prior to prostate biopsy.MethodsA systematic prostate needle biopsy was performed in 203 men with serum PSA levels of < 10 ng/mL to detect prostate cancer. Serum DHEA concentrations were measured with liquid chromatography-tandem mass spectrometry (LC–MS/MS) just before biopsy. Patient’s age, serum prostate-specific antigen (PSA) levels, prostate volume, and serum DHEA concentrations were compared with pathological findings in multivariate analyses.ResultsThe median patient’s age, PSA, serum DHEA concentration and prostate volume were 68 years, 5.5 ng/mL, 1654.7 pg/mL, and 31.2 mL, respectively. In a multivariate analysis, low PSA values, high serum DHEA concentrations, and large prostate volume were significant predictors of the patients with benign prostatic hyperplasia (BPH) or prostate cancer with a Gleason score of ≤ 3 + 4 who are candidate for AS. The DHEA cut-off point for predicting BPH or prostate cancer with a Gleason score of ≤ 3 + 4 was 2188 pg/mL, with a sensitivity, specificity, positive predictive value, and negative predictive value of 33.7%, 96.0%, 98.4%, and 16.9%, respectively.ConclusionThe study indicated that higher serum DHEA concentrations prior to prostate biopsy might predict the patients with BPH or prostate cancer with a Gleason score ≤ 3 + 4 who are candidate for AS, in men with PSA of < 10 ng/mL.

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy.

Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B). We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.