Transition Zone Prostate Research Articles

Prostate cancer lesions in transition zone exhibit a higher propensity for pathological upgrading in radical prostatectomy.

The varying malignancy and lethality of different grades of prostate cancer (PCa) highlight the importance of accurate diagnosis. This study aims to evaluate the upgrading of transition zone (TZ) prostate cancer biopsies and identify factors to improve TZ biopsy accuracy. This retrospective study included 217 patients who underwent laparoscopic radical prostatectomy after 12 + X cores transperineal transrectal ultrasound-magnetic resonance imaging (MRI)-guided targeted prostate biopsy from 2018 to 2021 in our center. Patients with TZ lesions showed a higher incidence of International Society of Urological Pathology (ISUP) grade upgrading from 1 to higher grade compared to peripheral zone lesions (16.9% vs. 5.0%, p = 0.005). Multivariate analysis confirmed TZ lesions as an independent risk factor (OR: 4.594, 97.5% CI: 1.569-15.238, p = 0.008) for upgrading from 1 to higher. Additionally, the number of positive biopsy cores (OR: 0.586, 97.5% CI: 0.336-0.891, p = 0.029) and anterior TZ lesion location (OR: 10.797, 97.5% CI: 1.503-248.727, p = 0.048) were independent factors for the upgrading in TZ patients. This study found that PCa lesions located in the TZ, particularly the anterior TZ, have a higher risk of ISUP grade upgrading. This elevated risk arises from the insufficient distribution of biopsy cores around the TZ lesion. The findings underscore the importance of having an adequate number of biopsy cores around the lesion area to improve the accuracy of ISUP grade assessments.

Diffusion weighted image-guided transitional zone scoring in the detection of transitional zone prostate cancer: comparison with current PI-RADS v2.1 scoring.

To compare the performance of diffusion-weighted imaging-guided transitional zone (TZ) lesion scoring on T2-weighted imaging (DWI-guided TZ scoring) to conventional PI-RADS TZ scoring. Forty patients carried transition zone prostate cancer (TZPCa), and 40 patients had benign prostatic hyperplasia without TZPCa. A lesion-base, one-to-one correlation between the pathologic mapping sheet and the corresponding MR imaging was conducted by consensus between the genitourinary-specialized radiologist and pathologist. DWI-guided TZ scoring was defined as evaluating the DWI/apparent diffusion coefficient (ADC) images first, identifying the suspicious foci, then correlating the foci with the T2-weighted imaging, and finally assigning the PI-RADS score based on PI-RADS v2.1. Three other radiologists independently recorded the PI-RADS v2.1 scoring for TZ and the DWI-guided TZ scoring, with a time interval of 4weeks. When a PI-RADS score of ≥ 3 was considered a positive lesion, the specificity, PPV, NPV and sensitivity between the DWI-guided TZ scoring and conventional PI-RADS TZ scoring were 0.896 vs. 0.542 (p < .001), 0.764 vs. 0.439 (p < .001), 0.853 vs. 0.759 (p = .001), and 0.687 vs. 0.676 (p = .836), respectively. When PI-RADS scores ≥ 4 was considered cancer-positive, the specificity and PPV were also higher when applying DWI-guided TZ scoring (0.986 vs. 0.944, p = .007; 0.943 vs. 0.810, p = .009, respectively); however, the sensitivity and NPV were not statistically different (0.468 vs. 0.468, p = .998; 0.785 vs. 0.776, p = .537, respectively). The interobserver agreement presented as κ-value was higher in DWI-guided TZ scoring (0.584) than in conventional PI-RADS TZ scoring (0.155) (p = .003). DWI-guided TZ scoring improves the interobserver agreement, specificity, and predictive value without impairing the sensitivity.

The Etiology and Pathogenesis of Benign Prostatic Hyperplasia: The Roles of Sex Hormones and Anatomy.

Benign prostatic hyperplasia (BPH) mainly causes lower urinary tract symptoms in ageing men, but its exact etiology and pathogenesis have not been established. The objective of this review was to design an update on the advances of human BPH research. We undertook a literature search for identifying studies of the roles of sex hormones (androgens and estrogens) in the onset and development of human BPH using the Pubmed database. In literature, many studies have indicated that ageing and obesity are the factors for preceding the onset of BPH. No evidence for the role of testosterone (T) or dihydrotestosterone (DHT) is found in BPH initiation. Since BPH exclusively occurs in the transitional zone (TZ) surrounding the urethra, it is postulated that years of exposure to uncharacterized urinary toxins could disrupt the homeostasis of the stroma and/or epithelium of this prostatic zone that are typically occurring in ageing men. After cellular damage and subsequent inflammation generated, the intraprostatic DHT produced mainly from T by 5α-reductase promotes BPH development. Further, estrogens could take part in the nodular proliferation of stromal cells in some BPH patients. The confounding of BPH may attenuate the development of prostate tumor in the TZ. In conclusion, evidence in literature suggests that androgens are not etiological factors for BPH, and intraprostatic DHT along with chronic inflammation are mainly responsible for nodular proliferation of stromal and/or epithelial cells in prostatic TZ. The urinary factors for the etiology of BPH and BPH as a prediction of PCa progression still need further investigation.

Change in prostate tissue gene expression following finasteride or doxazosin administration in the medical therapy for prostatic symptoms (MTOPS) study

Benign prostatic hyperplasia (BPH) may decrease patient quality of life and often leads to acute urinary retention and surgical intervention. While effective treatments are available, many BPH patients do not respond or develop resistance to treatment. To understand molecular determinants of clinical symptom persistence after initiating BPH treatment, we investigated gene expression profiles before and after treatments in the prostate transitional zone of 108 participants in the Medical Therapy of Prostatic Symptoms (MTOPS) Trial. Unsupervised clustering revealed molecular subgroups characterized by expression changes in a large set of genes associated with resistance to finasteride, a 5α-reductase inhibitor. Pathway analyses within this gene cluster found finasteride administration induced changes in fatty acid metabolism, amino acid metabolism, immune response, steroid hormone metabolism, and kinase activity within the transitional zone. We found that patients without this transcriptional response were highly likely to develop clinical progression, which is expected in 13.2% of finasteride-treated patients. Importantly, a patient’s transcriptional response to finasteride was associated with their pre-treatment kinase expression. Further, we identified novel expression signatures of finasteride resistance among the transcriptionally responded patients. These patients showed different gene expression profiles at baseline and increased prostate transitional zone volume compared to the patients who responded to the treatment. Our work suggests molecular mechanisms of clinical resistance to finasteride treatment that could be potentially helpful for personalized BPH treatment as well as new drug development to increase patient drug response.

Correlation of serum interleukin-8 levels and prostate volume to the degree of lower urinary tract symptoms in patients with benign prostate enlargement: a cross-sectional study

BackgroundBenign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS) are pro-inflammatory cytokine interleukin-8 (IL-8)-associated which causes epithelial hyperplasia of the prostate transitional zone. This study aimed to determine the correlation between the levels of IL-8 serum and the prostate volume with the degree of LUTS severity in patients with BPE.MethodsDetermination of the correlation between serum IL-8 levels and prostate volume with the LUTS severity degree was conducted using a cross-sectional approach. The International Prostate Symptom Score was used to measure the LUTS severity degree, the enzyme-linked immunosorbent assay (ELISA) technique was used to measure the serum IL-8 level, and the transabdominal ultrasonography (TAUS) was used to measure the prostate volume. The sample used in this study was 32 patients with BPE grouped by the degree of LUTS severity of the patients. The correlation between variables was then analyzed using the Pearson correlation test.ResultsThe prostate volume was higher in severe LUTS degree (38.19 cc) than in the mild LUTS degree (13.05 cc). The levels of serum IL-8 were higher in the severe LUTS degree (21.65 pg/mL) than in the mild LUTS degree (8.44 pg/m). Both the levels of serum IL-8 and the degree of LUTS did not have a significant correlation with the volume of prostate (p > 0.05). On the other side, the prostate volume and the degree of LUTS severity had a significant positive correlation (p = 0.001, R = 0.913).ConclusionThe prostate volume and the levels of serum IL-8 are higher in the severe LUTS degree. There is a trend of increasing prostate volume with the severity of LUTS symptoms and higher serum IL-8 levels. The severity of prostate enlargement can be assessed by measuring the levels of IL-8 in the serum.

Tale of two zones: investigating the clinical outcomes and research gaps in peripheral and transition zone prostate cancer through a systematic review and meta-analysis

ObjectiveTo assess pathological characteristics, clinical features and outcomes of patients diagnosed with peripheral zone (PZ) and transition zone (TZ) prostate cancer after prostatectomy.Methods and analysisWe systematically reviewed PubMed, EMBASE and...

Spatial transcriptomics identifies candidate stromal drivers of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the nodular proliferation of the prostate transition zone in older men, leading to urinary storage and voiding problems that can be recalcitrant to therapy. Decades ago, John McNeal proposed that BPH originates with the "reawakening" of embryonic inductive activity by adult prostate stroma, which spurs new ductal proliferation and branching morphogenesis. Here, by laser microdissection and transcriptional profiling of the BPH stroma adjacent to hyperplastic branching ducts, we identified secreted factors likely mediating stromal induction of prostate glandular epithelium and coinciding processes. The top stromal factors were insulin-like growth factor 1 (IGF1) and CXC chemokine ligand 13 (CXCL13), which we verified by RNA in situ hybridization to be coexpressed in BPH fibroblasts, along with their cognate receptors (IGF1R and CXCR5) on adjacent epithelium. In contrast, IGF1 but not CXCL13 was expressed in human embryonic prostate stroma. Finally, we demonstrated that IGF1 is necessary for the generation of BPH-1 cell spheroids and patient-derived BPH cell organoids in 3D culture. Our findings partially support historic speculations on the etiology of BPH and provide what we believe to be new molecular targets for rational therapies directed against the underlying processes driving BPH.

IPCa-Net: A CNN-based framework for predicting incidental prostate cancer using multiparametric MRI

Incidental prostate cancer (iPCa) is an early stage of clinically significant prostate cancer (csPCa) and is typically asymptomatic, making it difficult to detect in clinical practice. The objective of this study is to predict iPCa by analyzing prostatic MRIs using deep convolutional neural network (CNN). While CNN-based models in medical image analysis have made significant advancements, the iPCa prediction task presents two challenging problems: subtler differences in MRIs that are imperceptible to human eyes and a lower incidence rate, resulting in a more pronounced sample imbalance compared to routine cancer prediction. To address these two challenges, we propose a new CNN-based framework called iPCa-Net, which is designed to jointly optimize two tasks: prostate transition zone segmentation and iPCa prediction. To evaluate the performance of our model, we construct a prostatic MRI dataset comprising 9536 prostate MRI slices from 448 patients diagnosed with benign prostatic hyperplasia (BPH) at our institution. In our study, the incidence rate of iPCa is 5.13% (23 out of 448) . We compare our model with eight state-of-the-art methods for segmentation task and nine established methods for prediction task respectively using our dataset, and experimental results demonstrate the superior performance of our model. Specifically, in the prostate transition zone segmentation task, our iPCa-Net outperforms the top-performing method by 1.23% with respect to mIoU. In the iPCa prediction task, our iPCa-Net surpasses the top-performing method by 2.06% with respect to F1 score. In conclusion, our iPCa-Net demonstrates superior performance in the early identification of iPCa patients compared to state-of-the-art methods. This advancement holds great significance for appropriate disease management and is highly beneficial for patients.

Comparison of the Utility of PI-RADS 2.1, ADC Values, and Combined Use of Both, for the Diagnosis of Transition Zone Prostate Cancers.

To assess the performance of apparent diffusion coefficient (ADC; values or category) alone, Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) scoring alone, and the two in combination, to diagnose transition zone prostate cancers (PCas). This retrospective study included 222 patients who underwent multiparametric magnetic resonance imaging of the prostate between May 2020 and December 2022 and who had pathologically confirmed PCa or benign prostatic hyperplasia (BPH). Prostate Imaging Reporting and Data System version 2.1 and ADC (values or category) were used in the assessment of suspicious findings identified in the transition zone. The interobserver agreements for region-of-interest measurements were calculated by intraclass correlation coefficients. Logistic regression analyses were used to determine the performance of PI-RADS v2.1 alone and in combination with ADC (values or category) to diagnose PCa. Receiver operating characteristic curve and DeLong test were used to evaluate the diagnostic performance of the quantitative parameters. A total of 152 patients had BPH, and 70 patients had PCa. For BPH versus PCa, the ADC values of PCa (0.64 × 10 -3 ± 0.16 × 10 -3 mm 2 /s) were significantly lower than BPH (1.06 ± 0.18 × 10 -3 mm 2 /s; P < 0.001). The PI-RADS scores for PCa (5 [interquartile range, 5-5]) were significantly higher than BPH (2 [interquartile range, 2-3]; P < 0.001). For all patients who had PI-RADS 1-5, the combined use of ADC (values or category) together with PI-RADS v2.1 did not perform significantly better than the use of PI-RADS v2.1 alone. The receiver operating characteristic of ADC category in combination with PI-RADS v2.1 score, 0.756 (95% confidence interval, 0.646-0.846), was significantly higher than that for PI-RADS 2.1 alone, 0.631 (95% confidence interval, 0.514-0.738), in PI-RADS 3-4 lesions ( P = 0.047). The ADC category can help to improve the diagnostic performance of PI-RADS v2.1 category 3-4 lesions in diagnosing PCa.

Transitional zone prostate cancer: Performance of texture-based machine learning and image-based deep learning.

This study is aimed to explore the performance of texture-based machine learning and image-based deep-learning for enhancing detection of Transitional-zone prostate cancer (TZPCa) in the background of benign prostatic hyperplasia (BPH), using a one-to-one correlation between prostatectomy-based pathologically proven lesion and MRI. Seventy patients confirmed as TZPCa and twenty-nine patients confirmed as BPH without TZPCa by radical prostatectomy. For texture analysis, a radiologist drew the region of interest (ROI) for the pathologically correlated TZPCa and the surrounding BPH on T2WI. Significant features were selected using Least Absolute Shrinkage and Selection Operator (LASSO), trained by 3 types of machine learning algorithms (logistic regression [LR], support vector machine [SVM], and random forest [RF]) and validated by the leave-one-out method. For image-based machine learning, both TZPCa and BPH without TZPCa images were trained using convolutional neural network (CNN) and underwent 10-fold cross validation. Sensitivity, specificity, positive and negative predictive values were presented for each method. The diagnostic performances presented and compared using an ROC curve and AUC value. All the 3 Texture-based machine learning algorithms showed similar AUC (0.854-0.861)among them with generally high specificity (0.710-0.775). The Image-based deep learning showed high sensitivity (0.946) with good AUC (0.802) and moderate specificity (0.643). Texture -based machine learning can be expected to serve as a support tool for diagnosis of human-suspected TZ lesions with high AUC values. Image-based deep learning could serve as a screening tool for detecting suspicious TZ lesions in the context of clinically suspected TZPCa, on the basis of the high sensitivity.

Predicting Positive Repeat Prostate Biopsy Outcomes: Comparison of Machine Learning Approaches to Identify Key Parameters and Optimal Algorithms.

Innovative strategies are necessary to enhance prostate cancer diagnosis whilst reducing unnecessary and invasive repeat biopsies. This study aimed to determine the significant parameters affecting repeat prostate biopsy outcomes and develop an optimal machine learning algorithm for predicting positive repeat prostate biopsy results. We analysed data from 174 men who underwent repeated prostate biopsies between January 2008 and December 2022. Systematic multiple-core, ultrasound-targeted prostate biopsies were performed, each two samples from prostatic transitional zone and peripheral zone were obtained bilaterally. Clinical characteristics were collected, including patients' age, initial prostate volume, prostate-specific antigen (PSA) level, free PSA (fPSA)/PSA ratio, biopsy core numbers, pathological result; The time interval between first and latest prostate biopsy; Latest PSA level, fPSA/PSA ratio, biopsy core numbers; And final pathological diagnosis. Six feature selection methods, namely, variable ranking, correlation matrix, random forest regression, recursive feature elimination, cross-validation and forward selection, were employed to identify key influencing factors for repeat biopsy outcomes. Subsequently, the performance of seven machine learning algorithms, namely, multivariable logistic regression (LR), K-nearest neighbour search (KNN), support vector classification (SVC), decision tree (DT), random forest classifier (RF), naïve Bayes classifier (NBC) and gradient booster tree (GB), was assessed based on accuracy, misclassification, recall, specificity, precision and receiver operating characteristic (ROC) area under the curve (AUC). About 70% of patients were used as the training dataset, meanwhile remaining 30% as validation dataset. 52 were ultimately diagnosed with prostate cancer following the final pathological examination. The remaining 122 patients were negative. Amongst six feature selection methods, the variable ranking emerged as the most effective method for identifying the essential factors influencing repeat biopsy results. Amongst the machine learning algorithms, SVC demonstrated superior accuracy (0.7365), low recall rate (0.2500) and low misclassification rate (0.2093) for both patients with cancer and healthy individuals. Meanwhile, the ROC curve of SVC showed a relatively high AUC (0.6871). We developed an SVC-based machine learning algorithm for predicting positive repeat prostate biopsy results. Our analysis revealed that initial and latest prostate volumes, initial and latest PSA levels, latest fPSA/PSA ratio and age are significant factors for this model.

Primary high-grade urothelial carcinoma of prostate with prostatic hyperplasia: a rare case report and review of the literature

Background Primary urothelial carcinoma in the prostate (UCP) is extremely rare and occurs most frequently in the bladder. There are only dozens of primary cases reported in the literature. Here, we describe a rare case of primary UCP and review the literature. Case presentation A 67-year-old widowed male, was referred to our hospital due to the frequency, and urgency of dysuria. Magnetic resonance imaging (MRI) examination revealed prostate size was about 57 mm × 50 mm × 54 mm, increased prostatic transitional zone, and surrounding of prostatic duct indicate bar isointense T1, short T2, hyperintense DWI, and hyposignal ADC (PI-RADS 3); posterior of peripheral zone indicate patchy isointense T1, short T2, hyperintense DWI, and hyposignal ADC (PI-RADS 5). Subsequently, the patient underwent a transrectal prostate biopsy. Histopathological and immunohistochemical (IHC) assessments showed prostatic high-grade urothelial carcinoma with benign prostatic hyperplasia. Finally, the patient underwent laparoscopic radical prostatectomy. Four months after surgery, CT plain and enhanced scan revealed thickening of the bladder wall. On further workup, cystoscopy revealed lymphoid follicular changes in the cut edge of the radical prostatectomy, and cystoscopic biopsies showed the malignant tumor. Conclusions Prostatic urothelial carcinoma should always be considered if the patient with severe lower urinary tract symptoms or hematuria, PSA, and digital rectal examination without abnormalities, without a personal history of urothelial cancer, but contrast-enhanced MRI showed the lesion located in the prostate. As of right now, radical surgical resections remain the most effective treatment. The effectiveness of neoadjuvant or adjuvant chemotherapy is still controversial.

Morphologic perfusion patterns and PI-RADSv2.1 in transition zone prostate cancer

PurposeTo evaluate morphologic perfusion patterns in transition zone prostate cancer in multiparametric MRI controlled by in-bore MRI-guided prostate biopsy.MethodsTwo experienced radiologists evaluated MRI perfusion patterns in consensus from 321 biopsy cores from the transition zone in 141 patients. Transition zone cancer was present in 77 cores in 36 patients. Single early-phase perfusion images were evaluated separately for the presence of a transition zone prostate cancer (consensus tumor early perfusion). The proposed criteria for the perfusion pattern (asymmetry, signal strength, and homogeneity) were rated in consensus for each biopsy position in the presence of the T2w images including the markers of the biopsy trace. We analyzed receiver operating characteristic curves for the PI-RADSv2.1 score and the proposed perfusion pattern.ResultsA logistic regression model with PI-RADSv2.1 and perfusion patterns in early perfusion imaging improved the model fit significantly compared to a model containing only PI-RADSv2.1 (Likelihood Ratio Test, LR = 14.5, p < .001). The AUC was 0.96 for the multiple regression model compared to 0.92 for the PI-RADSv2.1 alone. The evaluation of homogeneity in single early-enhancement images is not inferior compared to the conventional DCE parameter of PI-RADSv2.1 (AUC 0.84 versus 0.83).ConclusionMorphologic perfusion patterns significantly improve the diagnostic performance of PI-RADSv2.1 in TZ prostate cancer.Graphical abstract

Comparing the Efficacy and Safety of Treatment with Fixed Dose of Tadalafil Monotherapy versus Its Combination with Silodosin in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction

Background Benign prostate hyperplasia (BPH) is a histological diagnosis which is identified by non-malignant hyperplasia of prostatic tissue due to smooth muscle and epithelial cell proliferation in the prostatic transition zone. Aim of the Work To assess the efficacy and safety of fixed-dose of Tadalafil monotherapy versus its combination with Silodosin in treatment of BPH patient and erectile dysfunction (ED) by comparing IPSS score, PVR, Q max and The international Index of Erectile Function (IIEF questionnaire). Methodology This prospective randomized control clinical study was conducted at tertiary care hospital at Ain Shams University hospitals from June 2021 till January 2022 and performed on total 60 men patients which were 45 years old or older with a history of LUTS secondary to BPH of at least 6 months. Results Our study results revealed that there was no statistically significant difference found between the studied groups regarding IPSS and Q-max at baseline while there was statistically significant difference found in IPSS and Q-max at 1 month, 2 months and 3 months, with statistically significant decrease in IPSS and significant increase in Q-max through follow-up from baseline in each group. Conclusion This analysis suggested that the combination-therapy of tadalafil and Silodosin was more effective than tadalafil alone in improving subjective LUTS, but there was no significant improvement in sexual function.

Are T2WI PI-RADS sub-scores of transition zone prostate lesions biased by DWI information? A multi-reader, single-center study

PurposeAccording to PI-RADS v2.1, T2-weighted imaging (T2WI) is the dominant sequence for transition zone (TZ) lesions. This study aimed to assess, whether diffusion-weighted imaging (DWI) information influences the assignment of T2WI scores. MethodOut of 283 prostate MRI examinations with correlated biopsy results, fourty-four patients were selected retrospectively: first, 22 patients with a TZ lesion with T2WI and DWI scores ≥ 4, to represent lesions with unequivocal suspicion on T2WI and DWI. Second, 22 additional patients with TZ lesions of similar T2WI appearance but with corresponding DWI score ≤ 3 were added as control. Four residents and one board-certified radiologist each performed two assessments of the included patients: First, only T2WI was available (T2-only read); second, both T2WI and DWI sequences were available (biparametric read). Lesion scores were assessed using Wilcoxon signed-rank test, inter-reader agreement using weighted kappa and Kendall's W statistics, and sensitivity/specificity using McNemar test. ResultsThe T2WI scores were significantly different between the T2-only and biparametric read for 3 out of 4 residents (p ≤ 0.049) but not for the radiologist. The overall PI-RADS scores derived from the two reading sessions differed considerably for 35/220 cases (all readers pooled). Inter-reader agreement was fair for the T2WI and overall PI-RADS scores (mean kappa 0.27–0.30) and moderate for the DWI scores (mean kappa 0.43). ConclusionsFor inexperienced readers, assessment of T2WI is variable and potentially biased by availability of DWI information, which can lead to changes of overall PI-RADS score and consequently clinical management. Assessment of T2WI should be performed before reviewing DWI to ensure non-biased interpretation of TZ lesions in the dominant sequence.

Case Study of Reducing Pain Scale in Patients Benign Prostate Hyperplasia Post TURP Uses The Murrotal Distraction Relaxation Technique

Introduction : Benign prostatic hyperplasia is a diagnosis that refers to the proliferation of epithelial tissue and smooth muscle in the prostatic transition zone (Reynardi 2021). One of the actions taken to overcome the problem of BPH is TURP (Transuretharl Resection Of the Prostate). Methods: This study used the case study method with 1 patient and 1 case of nursing problems in postoperative TURP patients who experienced acute pain problems. Results: After nursing interventions with relaxation techniques and distraction techniques in Postoperative TURP patients showed that distraction relaxation techniques can reduce pain levels in patients from scale 5 to scale 2 and also the criteria for the results achieved Conclusion: Distraction Relaxation Techniques with Murrotal can reduce pain scale in postoperative patients.

MP76-05 PERI-URETHRAL PROSTATIC CAVITY FORMATION FOLLOWING WATER VAPOR THERMAL THERAPY: AN UNRECOGNIZED COMPLICATION CAUSING PERSISTENT LUTS?

You have accessJournal of UrologyCME1 Apr 2023MP76-05 PERI-URETHRAL PROSTATIC CAVITY FORMATION FOLLOWING WATER VAPOR THERMAL THERAPY: AN UNRECOGNIZED COMPLICATION CAUSING PERSISTENT LUTS? Leo D. Dreyfuss, Kevin Alter, Adithya Balasubramanian, Barry Zisholtz, Kevin C. Zorn, Naeem Bhojani, Dean Elterman, and Bilal Chughtai Leo D. DreyfussLeo D. Dreyfuss More articles by this author , Kevin AlterKevin Alter More articles by this author , Adithya BalasubramanianAdithya Balasubramanian More articles by this author , Barry ZisholtzBarry Zisholtz More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean EltermanDean Elterman More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Water vapor thermal therapy (WVTT) causes tissue necrosis secondary to release of thermal energy within the collagen networks of the prostate transition zone. Some men experience worsening of LUTS following treatment. We report 3 patients with persistent LUTS following WVTT who were found to have anatomic abnormalities in the prostate, ultimately requiring repeat procedures. METHODS: WVTT (Rezum, NxThera, Inc, Maple Grove, MN) was offered to patients with bothersome LUTS and prostate volume less than 80 cc’s. WVTT was performed outpatient at a high-volume academic urology clinic. Patients were treated under local anesthesia with 1-3 sticks in bilateral lateral lobes. Patients underwent trial of void on post-procedure day 1 and were followed at regular intervals with post-operative surveys, post-void residual (PVR), and uroflowmetry. RESULTS: All 3 patients successfully underwent WVTT and passed trial of void with minimal post-void residual. Patient 1 experienced persistent bothersome LUTS despite medical therapy. Urodynamics revealed high pressure with low urinary flow. Cystoscopy revealed urethral cavities filled with debris causing obstruction (Figure 1A). Transurethral unroofing was performed leading to resolution of symptoms. Patient 2 experienced persistent LUTS, slow urinary stream, and elevated PVR’s to 100 mL following procedure. After 5 months of persistent symptoms, they began to experience watery ejaculate. CT Urogram revealed cystic dilation of prostatic urethra with urethral stones requiring cystoscopy and stone removal. Patient 3 experienced LUTS for 2.5 months following WVTT, at which time they developed watery ejaculate. Cystoscopy revealed prostatic urethral diverticulum (Figure 1B) and MRI showed 2.4×2.4×2.5 cm cystic cavity in prostatic transition zone contiguous with prostatic urethra (Figure 1C, D). Photoselective vaporization of the prostate was performed 14 months following index procedure with resolution of symptoms. At last follow up, all patients are voiding well with resolution of LUTS. CONCLUSIONS: WVTT may be associated with atypical tissue necrosis and cavity formation within prostatic transition zone. Patients with worsening or persistent LUTS following WVTT may benefit from further workup to exclude anatomic defects. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1092 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo D. Dreyfuss More articles by this author Kevin Alter More articles by this author Adithya Balasubramanian More articles by this author Barry Zisholtz More articles by this author Kevin C. Zorn More articles by this author Naeem Bhojani More articles by this author Dean Elterman More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF downloadLoading ...

Commentary on "Integrative multiplatform molecular profiling of benign prostatic hyperplasia identifies distinct subtypes".

Commentary on "Integrative multiplatform molecular profiling of benign prostatic hyperplasia identifies distinct subtypes".

Extracapsular extension of transitional zone prostate cancer miss-detected by multiparametric magnetic resonance imaging.

To demonstrate the importance of extracapsular extension (ECE) of transitional zone (TZ) prostate cancer (PCa), examine the causes of its missed detection by Mp-MRI, and develop a new predictive model by integrating multi-level clinical variables. This retrospective study included 304 patients who underwent laparoscopic radical prostatectomy after 12 + X needle transperineal transrectal ultrasound (TRUS)-MRI-guided targeted prostate biopsy from 2018 to 2021 in our center was performed. In this study, the incidence rates of ECE were similar in patients with MRI lesions in the peripheral zone (PZ) and TZ (P = 0.66). However, the missed detection rate was higher in patients with TZ lesions than in those with PZ lesions (P < 0.05). These missed detections result in a higher positive surgical margin rate (P < 0.05). In patients with TZ lesions, detected MP-MRI ECE may have grey areas: the longest diameters of the MRI lesions were 16.5-23.5mm; MRI lesion volumes were 0.63-2.51ml; MRI lesion volume ratios were 2.75-8.86%; PSA were 13.85-23.05ng/ml. LASSO regression was used to construct a clinical prediction model for predicting the risk of ECE in TZ lesions from the perspective of MRI and clinical features, including four variables: the longest diameter of MRI lesions, TZ pseudocapsule invasion, ISUP grading of biopsy pathology, and number of positive biopsy needles. Patients with MRI lesions in the TZ have the same incidence of ECE as those with lesions in the PZ, but a higher missed detection rate.

Effects of dynamic contrast enhancement on transition zone prostate cancer in Prostate Imaging Reporting and Data System Version 2.1.

The aim of the study was to analyse the effects of dynamic contrast enhanced (DCE)-MRI on transitional-zone prostate cancer (tzPCa) and clinically significant transitional-zone prostate cancer (cs-tzPCa) in Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1. The diagnostic efficiencies of T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE in tzPCa and cs-tzPCa were compared using the score of ≥ 4 as the positive threshold and prostate biopsy as the reference standard. A total of 425 prostate cases were included in the study: 203 cases in the tzPCa group, and 146 in the cs-tzPCa group. The three sequence combinations had the similar areas under the curves in diagnosing tzPCa and cs-tzPCa (all P < 0.05). The sensitivity of T2WI + DCE and T2WI + DWI + DCE (84.7% and 85.7% for tzPCa; 88.4% and 89.7% for cs-tzPCa, respectively) in diagnosing tzPCa and cs-tzPCa was significantly greater than that of T2WI + DWI (79.3% for tzPCa; 82.9% for cs-tzPCa). The specificity of T2WI + DWI (86.5% for tzPCa; 74.9% for cs-tzPCa) were significantly greater than those of T2WI + DCE and T2WI + DWI + DCE (68.0% and 68.5% for tzPCa; 59.1% and 59.5% for cs-tzPCa, respectively) (all P > 0.05). The diagnostic efficacies of T2WI + DCE and T2WI + DWI + DCE had no significant differences (all P < 0.05). DCE can improve the sensitivity of diagnosis for tzPCa and cs-tzPCa, and it is useful for small PCa lesion diagnosis.