Ultrasound Prostate Research Articles

PHSPP06 Presentation Time: 3:20 PM: A New Way to Visualize Needles for Ultrasound Prostate Brachytherapy Using Color Doppler and Needle Surface Modifications

<h3>Purpose</h3> Brachytherapy applicator conspicuity during ultrasound (US) imaging can be impaired by bowel gas, tissue interfaces, or when the applicator is far or angled with respect to the ultrasound probe. Without adequate conspicuity, applicators can be inaccurately reconstructed, leading to decreased tumor control or increased normal tissue dose due to a geometrically inaccurate treatment plan. To improve the conspicuity of titanium high-dose rate (HDR) brachytherapy needles under US imaging, the surface of needles can be modified, and color-Doppler can be utilized to highlight the surface patterns. Color-Doppler imaging can produce a twinkling signature, also referred to as a ‘twinkling artifact,' when ultrasound waves reflect from a surface with a rough or patterned structure. The twinkling signature highlights the modified applicator as variegated pixels atop a grayscale B-mode US image, enhancing conspicuity. This research was a preliminary investigation into the types of surface modifications that can produce a twinkling signature, based upon a review of prior literature that has associated surface roughness with twinkling. <h3>Materials and Methods</h3> The surfaces of 17-gauge, 25 cm titanium HDR brachytherapy needles were modified using three methods of surface modification: sandblasting with an 80-grit media, laser-etching of thin grooves, and application of a polymethyl methacrylate (PMMA)-based bone cement. Laser-etches were created on the surface of the needles using a 343 nm femtosecond laser (Pharos, Light Conversion, Lithuania) on a machining system (Photomachining Inc., USA) and were created at variable widths (0.1-1 mm) and depths (10-100 μm) without penetrating the inner lumen of the applicator. Unmodified and modified needles were imaged with a bk3000 (BK Medical, USA) with an E14CL4b transrectal probe and Logiq E9 (General Electric, USA) with a 9L linear-array transducer under B-mode and color-Doppler imaging. Needle conspicuity between needle types was assessed qualitatively in the axial and sagittal planes within a prostate phantom (CIRS, Inc., USA). <h3>Results</h3> Color-Doppler imaging in combination with surface-modified needles produced a twinkling signature with select laser-etched and PMMA-cement surface modifications. The twinkling signature appeared as a color signal atop the applicator, overlaid on grayscale B-mode ultrasound images. The twinkling signature was observed with both transrectal and linear-array ultrasound transducers. Twinkling was observed at laser-etched scribe depths >20 μm and widths >0.1 mm, and it was observed that the magnitude of the twinkling signature was dependent upon the total surface area of the etched region. It was also demonstrated that needles can be laser-etched or coated with PMMA-cement to mark a reference location with respect to the needle tip (2 cm distal). The hand-roughened needles produced a faint twinkling signature with the linear-array transducer and negligible twinkling with the transrectal transducer. Sandblasted and unmodified needles produced a negligible twinkling signature. Generally, the twinkling signature was observed to be transient in nature and dependent on the pressure between the probe and the phantom. Future work is planned to study the mechanisms underlying the color-Doppler signal and to establish an optimal surface modification and signal strength. <h3>Conclusions</h3> Color-Doppler ultrasound combined with brachytherapy applicator surface modifications may be used to enhance applicator conspicuity and aid with applicator placement and digitization. HDR brachytherapy needles may be modified for color-Doppler imaging via laser-etching or coating with a PMMA-based bone cement.

Three-dimensional ultrasound integrating nomogram and the blood flow image for prostate cancer diagnosis and biopsy: A retrospective study.

Prostate cancer (PCa) is the second most common male cancer in the world and based on its high prevalence and overwhelming effect on patients, more precise diagnostic and therapeutic methods are essential research topics. As such, this study aims to evaluate the value of three-dimensional transrectal ultrasound (3D-TRUS) in the detection, diagnosis and biopsy of PCa, and to provide a basis for clinical practice of PCa. Retrospective analysis and comparison of a total of 401 male patients who underwent prostate TRUS in our hospital from 2019 to 2020 were conducted, with all patients having prostate biopsy. Nomogram was used to estimate the probability of different ultrasound signs in diagnosing prostate cancer. The ROC curve was used to estimate the screening and diagnosis rates of 3D-TRUS, MRI and TRUS for prostate cancer. A total of 401 patients were randomly divided into two groups according to different methods of prostate ultrasonography, namely the TRUS group (251 patients) and the 3D-TRUS group (150 patients). Of these cases, 111 patients in 3D-TRUS group underwent MRI scan. The nomogram further determined the value of 3D-TRUS for prostate cancer. The ROC AUC of prostate cancer detected by TRUS, MRI and 3D-TRUS was 0.5580, 0.6216 and 0.6267 respectively. Biopsy complications were lower in 3D-TRUS group than TRUS group, which was statistically significant (P<0.005). The accuracy of 3D-TRUS was higher in diagnosis and biopsy of prostate cancer. Meanwhile, the positive rate of biopsy could be improved under direct visualization of 3D-TRUS, and the complications could be decreased markedly. Therefore, 3D-TRUS was of high clinical value in diagnosis and biopsy of prostate cancer.

Holmium laser enucleation of the prostate in men on active surveillance for prostate cancer with refractory lower urinary tract symptoms secondary to enlarged prostates.

The surgical treatment of men with lower urinary tract symptoms (LUTS) and significantly enlarged symptomatic prostates on active surveillance (AS) for low-risk prostate cancer (PCa) is not well defined. We report our single-institution initial experience with holmium laser enucleation of the prostate (HoLEP) for LUTS in men with low-risk PCa being managed with AS. Men on AS who underwent HoLEP between 2013 and 2019 were identified. Data regarding preoperative cancer workup, prostate-specific antigen (PSA), perioperative outcomes, and voiding parameters were analyzed. Postoperative surveillance for PCa including PSA nadir, prostate magnetic resonance imaging, prostate biopsy (PBx), and PSA at last follow-up were evaluated. Twenty men met the inclusion criteria. Preoperative mean max flow 7.9 ml/s, median postvoid residual 101 cc, and mean transrectal ultrasound prostate size 99 cc. Patients had a median adjusted preoperative PSA of 8.5 (interquartile range[IQR]: 4.8-13.2) ng/ml. Mean resected tissue weight was 65.5 gwith improved postoperative flow rate and significantly decreased residual. A total of 5/20 men had PCa in the specimen (all GleasonGrade Group 1).The median postoperative PSA nadir was 1.2 (IQR: 0.5-1.8) ng/ml at median of 5 months. At the last follow-up (median 18.5 months, IQR: 10.5-37.8), the median postoperative PSA was 1.4 (IQR: 0.63-2.48) ng/ml. Nine men underwent postoperative multiparametric magnetic resonance imaging(mpMRI) with the identification of a new prostate imaging reporting and data system 5 lesion in onepatient who underwent negative fusion biopsy. Five men underwent post-HoLEP PBx with progression in two patients, who both successfully underwent radical prostatectomy. Men on AS for low-risk PCa can safely undergo HoLEP with significantly improved voiding parameters. Postoperative monitoring with PSA, mpMRI, and PBx can detect disease progression requiring definitive treatment. Further research is needed to optimize surveillance strategies and long-term cancer-specific outcomes.

Geographic Variation of Infectious Complications Following Prostate Biopsy in The United States: Results From a Population-Based Cohort of Privately Insured Patients

To elucidate regional trends of infectious complications following transrectal ultrasound prostate biopsy (TRUS-PB) from a national, privately-insured database. Using Market Scan, we identified all men who underwent TRUS-PB from 2010 to 2015. Infectious complications (UTI, prostatitis, sepsis) occurring 30 days after the prostate biopsy from emergency room (ER) visits or hospital admissions constituted the primary outcomes. We analyzed unadjusted and adjusted rates of infectious complications from ER visits and hospital admissions per 100 prostate biopsies by state. Multivariable logistic regression analyses were used to identify patient covariates associated with infectious complications. During the study interval, we identified 193,490 patients who underwent TRUS-PB. The mean age was 57.6 years (SD: 5.0). Over time the unadjusted national rates of infectious complications remained similar from 0.4 ER visits per 100 prostate biopsies in 2010 -0.2 in 2015 (P = 0.83), and 1.2 hospital admissions per 100 prostate biopsies in 2010 to 1.1 in 2015 (P= 0.58). Connecticut had the lowest unadjusted infectious complication rate per 100 biopsies at 0.64, whereas West Virginia had the highest at 2.34. Multivariable analysis revealed higher Elixhauser status and patient age were associated with higher odds of infectious complications (P<0.05). While rates of infectious complications attributable to prostate biopsies remain relatively stable, significant variation exists at the state level regarding this adverse outcome.

Safety and efficacy of MRI-guided transurethral ultrasound ablation for radiorecurrent prostate cancer in the presence of gold fiducial markers.

Safety and efficacy of ultrasound prostate ablation for radiorecurrent prostate cancer (PCa) in the presence of gold fiducial markers has not been previously reported. To evaluate safety, functional, and early-stage oncological outcomes for patients with gold fiducial markers undergoing salvage magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (sTULSA) for radiorecurrent PCa. Data were acquired from an ethics-approved, single-center phase-1 study. Eight patients with 18 total gold fiducial markers inside the planned treatment volume were identified. MRI controls were performed at three and 12 months, followed by PSMA-PET-CT imaging and biopsies at 12 months. A control cohort of 13 patients who underwent sTULSA without markers were also identified for safety profile comparison. Adverse events were reported using the Clavien-Dindo classification, and questionnaires including EPIC-26, IPSS, and IIEF-5 were collected. Of 18 markers, 2 (11%) were directly responsible for poor ultrasound penetration. However, there were no local recurrences at 12 months. PSA, prostate volume, and non-perfused volume all decreased over time. At 12 months, 11/18 (61%) of fiducial markers had disappeared via sloughing. The adverse event profile was similar between both patient cohorts, and when controlled for ablation type, no statistical difference in functional outcomes between the two cohorts was observed. Patients with radiorecurrent PCa with intraprostatic gold fiducial markers can be successfully treated with TULSA. The early-stage efficacy of sTULSA for patients with intraprostatic gold markers is encouraging and the safety profile is unaffected by marker presence.

Long-Term Complications of Open and Robot-Assisted Laparoscopic Radical Prostatectomy in an Afro-Caribbean Population.

BackgroundWith the Afro-Caribbean population increasing in the United States, their complication profiles following open (ORP) and robot-assisted laparoscopic (RALP) radical prostatectomy warrants investigation. The purpose of this pilot study was to evaluate differences in long-term complications between ORP and RALP in Afro-Caribbeans.MethodsA retrospective review of patients undergoing ORP or RALP between April 2010 and August 2019 at an academic medical center and county hospital was conducted. Patients who identified as Afro-Caribbean with complete data were analyzed. Complications were classified using the Clavien-Dindo system. Age, transrectal ultrasound prostate volume, preoperative prostate-specific antigen, Gleason scores, and long-term complications (persisting to at least 18 months postoperatively) were compared between procedures using the Mann-Whitney U test or Fisher’s exact test for statistical significance. Multivariable logistic regression was used to assess the odds of complications.ResultsThis study included 53 Afro-Caribbean patients (mean age±SD; 65.9±6.8 years, 30 ORP, and 23 RALP). Patients treated by RALP were younger and had lower Gleason scores. Patients who were treated by RALP had a lower association to having ≥1 complications compared to those treated by ORP (OR=0.28, 95%CI 0.09-0.89, p=0.024). In addition, >60% of complications had a Clavien-Dindo grade≤II for both procedures. RALP resulted in fewer grade II complications compared to ORP (OR=0.25, 95%CI 0.08-0.81, p=0.046).ConclusionsTreatment of Afro-Caribbeans with RALP allows for fewer complications, especially Clavien-Dindo Grade II complications. While previous investigations show that Black populations experience more complications when treated with ORP or RALP compared to other groups, their complication profile is likely not homogenous when considering their sub-ethnic background and must be investigated to understand optimal interventions for prostate cancer.

MP30-14 ENVIRONMENTAL IMPACT OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyCME1 May 2022MP30-14 ENVIRONMENTAL IMPACT OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Michael Leapman, Cassandra Thiel, Ilyssa Gordon, Adam Nolte, Aaron Perecman, Michael Overcash, and Jodi Sherman Michael LeapmanMichael Leapman More articles by this author , Cassandra ThielCassandra Thiel More articles by this author , Ilyssa GordonIlyssa Gordon More articles by this author , Adam NolteAdam Nolte More articles by this author , Aaron PerecmanAaron Perecman More articles by this author , Michael OvercashMichael Overcash More articles by this author , and Jodi ShermanJodi Sherman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare is a major contributor to global pollution. Reducing the over-use of clinical care is one solution to lowering environmental emissions and improving care value. We aimed to estimate the environmental impact of transrectal ultrasound (TRUS) prostate biopsy, a procedure that is commonly performed in excess of recommended guidelines based on patient age or life-expectancy. METHODS: We performed a cradle-to-grave life cycle assessment (LCA) to estimate environmental emissions associated with a single TRUS biopsy. Data included materials and energy inventory, as well as patient and staff travel across 3 process-steps: a pre-biopsy prostate magnetic resonance imaging (MRI), TRUS biopsy, and pathology laboratory processing. We performed sensitivity analyses to assess contributions from waste, travel, and energy use. The primary endpoint was greenhouse gas (GHG) emissions (CO2 equivalents, CO2e), calculated using LCA tools Ecoinvent (a database of emissions) and the US Environmental Protection Agency’s TRACI 2.1 v1.04 (Tool for Reduction and Assessment of Chemicals and Other Environmental Impacts). We estimated the potential environmental impacts associated with reductions in the annual number of biopsies performed. RESULTS: A single prostate biopsy procedure involving prostate MRI emits an estimated 78.7 kg CO2e. Overall, energy was the largest contributor to CO2 emissions, with an estimated 46.8kg CO2e, 59.5% of the procedural total. Staff travel contributed 20.0kg CO2e (25.4%), followed by supply production (10.2kg CO2e, 13%). Integration of a prostate MRI process step contributed an estimated 42.3kg CO2e, 53.8% of the total emissions. Reduction of prostate biopsy (per 100,000 procedures) would avoid the equivalent of 7.87x106 kg CO2e, the equivalent of 190,778,876 miles driven by an average passenger vehicle. CONCLUSIONS: Although prostate biopsy is a small-scale procedure, it contributes a calculable environmental footprint. Reducing the number of prostate biopsies performed, in line with best clinical practice, would also result in significant reductions in health care pollution. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e483 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Leapman More articles by this author Cassandra Thiel More articles by this author Ilyssa Gordon More articles by this author Adam Nolte More articles by this author Aaron Perecman More articles by this author Michael Overcash More articles by this author Jodi Sherman More articles by this author Expand All Advertisement PDF DownloadLoading ...

V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY

You have accessJournal of UrologyCME1 May 2022V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY Roberto Hugo Martinez Rodriguez, Alberto Robles Samaniego, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Alejandro Garcia Viña, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Alberto Robles SamaniegoAlberto Robles Samaniego More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Alejandro Garcia ViñaAlejandro Garcia Viña More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both prostatic enucleation and adenomectomy can be considered gold treatments for benign prostatic hypertrophy (BPH) of large volume with obstructive clinic. Nowdays trend to minimally invasive surgery and/or the anatomical impossibility for enucleation have motivated the laparoscopic approach to conventional adenomectomy. We present the objective and subjective functional outcomes of our initial series of laparoscopic adenomectomies while surgical steps are shown. METHODS: Surgical tips are shown while functional outcomes are described.We prospectively analyzed patients undergoing extraperitoneal laparoscopic adenomectomy between April - December 2020 for infravesical obstruction due to BPH. We evaluated objective functional outcomes using flowmetry and post-voiding residue and subjective with sexual and quality of life questionnaires (IPSS AND IIEF) before and after surgery. Demographic data on age, weight and height were collected; prostate size estimated by ultrasound; surgical time, intraoperative bleeding, days of hospital stay, subjective pain measured by visual EVA scale, weight and anatomy of the surgical piece, and postoperative complications according to Clavien Dindo gradation.Descriptive analysis is performed. RESULTS: 50 laparoscopic procedures were performed on patients with a mean age of 70 years (range 60-78) and a mean ultrasound prostate size of 120cc (80-180). 19 of these patients were bladder catheter carriers at the time of surgery. Mean surgical time: 90min (80-150);decreased hemoglobin test 1.2gr/dl (0.5-3.8). Postoperative pain was 0/2 according to EVA scale, and mean hospital stay 2 days (1-7). We recorded 5 complications grade 3 Clavien Dindo scale (urinary tract infections) and one grade 2 (tube obstruction). The IPSS questionnaires showed a mean decrease of 19.41 points in the questions referring to voiding symptoms and 3.92 in the quality of life index. Peak flow was increased by >10 ml/sg and no patient had significant post-voiding residue. The IIEF showed an average increase of 4.45 points. CONCLUSIONS: Functional results, objectified through the use of validated questionnaires, support the laparoscopic approach in those selected cases. Laparoscopic adenomectomy represents a reasonable, safe and effective alternative in the treatment of high-volume prostatic hypertrophy with associated voiding clinic. Decreases the rate of transfusions, postoperative analgesic requirement and hospital stay, maintaining a satisfactory functional result. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e112 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Alberto Robles Samaniego More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Alejandro Garcia Viña More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Non-infectious complications following transrectal prostate needle biopsy - Outcomes from over 8000 procedures.

BackgroundProstate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry.MethodsTransrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications.ResultsOf 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02–1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding.ConclusionNon-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy.

A Prospective Multicenter Comparison Study of Risk-adapted Ultrasound-directed and Magnetic Resonance Imaging–directed Diagnostic Pathways for Suspected Prostate Cancer in Biopsy-naïve Men

BackgroundEuropean Association of Urology guidelines recommend a risk-adjusted biopsy strategy for early detection of prostate cancer in biopsy-naïve men. It remains unclear which strategy is most effective. Therefore, we evaluated two risk assessment pathways commonly used in clinical practice. ObjectiveTo compare the diagnostic performance of a risk-based ultrasound (US)-directed pathway (Rotterdam Prostate Cancer Risk Calculator [RPCRC] #3; US volume assessment) and a magnetic resonance imaging (MRI)-directed pathway. Design, setting, and participantsThis was a prospective multicenter study (MR-PROPER) with 1:1 allocation among 21 centers (US arm in 11 centers, MRI arm in ten). Biopsy-naïve men with suspicion of prostate cancer (age ≥50 yr, prostate-specific antigen 3.0–50 ng/ml, ± abnormal digital rectal examination) were included. InterventionBiopsy-naïve men with elevated risk of prostate cancer, determined using RPCRC#3 in the US arm and Prostate Imaging Reporting and Data System scores of 3–5 in the MRI arm, underwent systematic biopsies (US arm) or targeted biopsies (MRI arm). Outcome measurements and statistical analysisThe primary outcome was the proportion of men with grade group (GG) ≥2 cancer. Secondary outcomes were the proportions of biopsies avoided and GG 1 cancers detected. Categorical (nonparametric) data were assessed using the Mann-Whitney U test and χ2 tests. Results and limitationsA total of 1965 men were included in the intention-to-treat population (US arm n = 950, MRI arm n = 1015). The US and MRI pathways detected GG ≥2 cancers equally well (235/950, 25% vs 239/1015, 24%; difference 1.2%, 95% confidence interval [CI] −2.6% to 5.0%; p = 0.5). The US pathway detected more GG 1 cancers than the MRI pathway (121/950, 13% vs 84/1015, 8.3%; difference 4.5%, 95% CI 1.8–7.2%; p < 0.01). The US pathway avoided fewer biopsies than the MRI pathway (403/950, 42% vs 559/1015, 55%; difference −13%, 95% CI −17% to −8.3%; p < 0.01). Among men with elevated risk, more GG ≥2 cancers were detected in the MRI group than in the US group (52% vs 43%; difference 9.2%, 95% CI 3.0–15%; p < 0.01). ConclusionsRisk-adapted US-directed and MRI-directed pathways detected GG ≥2 cancers equally well. The risk-adapted US-directed pathway performs well for prostate cancer diagnosis if prostate MRI capacity and expertise are not available. If prostate MRI availability is sufficient, risk assessment should preferably be performed using MRI, as this avoids more biopsies and detects fewer cases of GG 1 cancer. Patient summaryAmong men with suspected prostate cancer, relevant cancers were equally well detected by risk-based pathways using either ultrasound or magnetic resonance imaging (MRI) to guide biopsy of the prostate. If prostate MRI availability is sufficient, risk assessment should be performed with MRI to reduce unnecessary biopsies and detect fewer irrelevant cancers.

H-ProSeg: Hybrid ultrasound prostate segmentation based on explainability-guided mathematical model

Background and ObjectiveAccurate and robust prostate segmentation in transrectal ultrasound (TRUS) images is of great interest for image-guided prostate interventions and prostate cancer diagnosis. However, it remains a challenging task for various reasons, including a missing or ambiguous boundary between the prostate and surrounding tissues, the presence of shadow artifacts, intra-prostate intensity heterogeneity, and anatomical variations. MethodsHere, we present a hybrid method for prostate segmentation (H-ProSeg) in TRUS images, using a small number of radiologist-defined seed points as the prior points. This method consists of three subnetworks. The first subnetwork uses an improved principal curve-based model to obtain data sequences consisting of seed points and their corresponding projection index. The second subnetwork uses an improved differential evolution-based artificial neural network for training to decrease the model error. The third subnetwork uses the parameters of the artificial neural network to explain the smooth mathematical description of the prostate contour. The performance of the H-ProSeg method was assessed in 55 brachytherapy patients using Dice similarity coefficient (DSC), Jaccard similarity coefficient (Ω), and accuracy (ACC) values. ResultsThe H-ProSeg method achieved excellent segmentation accuracy, with DSC, Ω, and ACC values of 95.8%, 94.3%, and 95.4%, respectively. Meanwhile, the DSC, Ω, and ACC values of the proposed method were as high as 93.3%, 91.9%, and 93%, respectively, due to the influence of Gaussian noise (standard deviation of Gaussian function, σ = 50). Although the σ increased from 10 to 50, the DSC, Ω, and ACC values fluctuated by a maximum of approximately 2.5%, demonstrating the excellent robustness of our method. ConclusionsHere, we present a hybrid method for accurate and robust prostate ultrasound image segmentation. The H-ProSeg method achieved superior performance compared with current state-of-the-art techniques. The knowledge of precise boundaries of the prostate is crucial for the conservation of risk structures. The proposed models have the potential to improve prostate cancer diagnosis and therapeutic outcomes.

Review on Computational Models for Prostate Segmentation from Ultrasound Medical Images

The segmentation method plays an important character to obtain region of interest from Prostate Ultrasound (US) image. Segmentation of the prostate ultrasound image is a tough task, and the challenges significantly differ from one imaging modality to another. The partition tool is utilized to segregate an image into multiple slices for easy evaluation. The design of automatic segmentation is a challenging task to obtain a required portion of the image, due to auditory intervention and artifacts like shadow acquire in prostate US image. This research article reviews the methods so far developed for prostate segmentation using ultrasound images. The main objective of this review work is to contemplate the key similarities and contrasts among the various methods, highlighting their strengths and weaknesses to assist in the choice of an appropriate prostate ultrasound image segmentation methodology. The prime task of the analysts working in the field of image processing and analysis is to build up a technique for effective and better image segmentation. This paper focuses on the different techniques that are broadly used for prostate image segmentation.

Determination of Serum Prostate Specific Antigen Levels Amongst Apparently Healthy Nigerian Males in a University and University Hospital Community in the Federal Capital Territory.

BackgroundProstate cancer is the commonest cancer among men worldwide and serum prostate specific antigen (PSA) has remained the most commonly applied screening test for the disease till date. Current PSA test results guidelines in our population are informed by reference intervals derived from studies from Caucasians and other racial groups. With scanty data on PSA reference values from our local population, this study evaluated the serum PSA levels of apparently healthy Nigerian male subjects in whom prostate cancer and urinary tract infection have been excluded.MethodThis study had participants aged 40 to 70 years, with no lower urinary tract symptoms or other symptoms suggestive of prostate disease recruited from the male staff population of the University of Abuja and University of Abuja Teaching Hospital and the adjoining local community. They were physically examined, had prostate ultrasonography, urine analysis, and blood sample collected for PSA testing. Data collected was analyzed using Statistical Package for Social Science (SPSS) version 24.ResultOf a total of 210 men who participated in the study, 191 eventually met the inclusion criteria. The average age was 52.9 years, ninety seven percent of them had heard of prostate cancer before now. The mean total PSA was 1.46 ng/mL (SD +/−1.55), while the reference interval was .23–5.60 ng/mL. The average prostate size was 41.8 mL (SD+/-20.11), and there was a positive correlation between the PSA and the prostate size (.418) as well as the age of the subjects (.446). There was no significant difference in the mean PSA value for those with or without family history of prostate cancer (P=.979).ConclusionThe reference range of PSA in Nigeria is higher than in other races, hence utilizing a local value in decision making would help to reduce unnecessary invasive procedures.

COMPARISON OF GRADING ACCURACY OF PROSTATE CANCER IN SAMPLES ACQUIRED BY A TARGETED AND SYSTEMIC PROSTATE BIOPSY.

All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading. To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy. We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological report. The undergrading was found in 17,7% (N=11) cases in the non-mpMRI group and in 12,0% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1. In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy.

Effect of urinary retention on the surgical outcome of holmium laser enucleation of the benign prostatic hyperplasia.

To evaluate the effect of urinary retention (UR) on holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms. A retrospective analysis of a prospective cohort of patients who underwent HoLEP between January 2010 and December 2016 was performed. The perioperative factors, including the International Prostate Symptom Score, Overactive Bladder Symptom Score, prostate-specific antigen, urodynamic study results, uroflowmetry results, transrectal ultrasound prostate volume, operative time, morcellation time, enucleation weight, and complications, were evaluated. Postoperative evaluation was performed at 2, 3, and 6 months. Overall, 903 patients were identified. The mean age and follow-up were 68.3 years and 6 months, respectively. Among the patients, 135 (15.0%) patients had a history of acute UR (AUR), and 36 patients (4.0%) had chronic UR (CUR). The mean detrusor pressures at maximum flow were 64.4, 74.3, and 77.7 cmH2O (p<0.001). The mean maximum flow rates (Qmax) were 7.6, 6.6, and 4.8 mL/s (p<0.001). Additionally, the mean bladder outlet obstruction indices were 49.5, 61.1, and 69.4 (p<0.001). The postoperative Qmax improved in all three groups. The mean postvoid residual volumes (PVRs) were 55, 75, and 333 mL preoperatively; 20, 29, and 66 mL at 2 weeks; 16, 23, and 45 mL at 3 months; and 15, 22, and 52 mL at 6 months (p<0.001). Voiding symptoms, PVR, and Qmax of BPH patients with preoperative AUR and CUR significantly improved after Ho-LEP, similar to those without preoperative UR.

Impact of neoadjuvant androgen deprivation therapy on postimplant prostate D90 and prostate volume after low-dose-rate brachytherapy for localized prostate cancer.

Higher quality of postimplant dosimetric evaluation is associated with higher biochemical recurrence-free survival rates after low-dose-rate brachytherapy for localized prostate cancer. Postimplant prostate D90 is a key dosimetric parameter showing the quality of low-dose-rate brachytherapy. In this study, to improve the quality of low-dose-rate brachytherapy for localized prostate cancer, we investigated pre-implant factors affecting the reduction of postimplant prostate D90. A total of 441 patients underwent low-dose-rate brachytherapy monotherapy and 474 patients underwent low-dose-rate brachytherapy with external beam radiation therapy. Logistic regression analysis was carried out to identify predictive factors for postimplant D90 decline. The cut-off value of the D90 decline was set at 170 Gy and 130 Gy in the low-dose-rate brachytherapy monotherapy group and low-dose-rate brachytherapy with external beam radiation therapy group, respectively. On multivariate analysis, neoadjuvant androgen deprivation therapy was identified as an independent predictive factor for the decline of postimplant D90 in both the low-dose-rate brachytherapy monotherapy group (P < 0.001) and low-dose-rate brachytherapy with external beam radiation therapy group (P = 0.003). Prostate volume changes and computed tomography/transrectal ultrasound prostate volume ratio were significantly and negatively correlated with the postimplant D90. The prostate volume changes and computed tomography/transrectal ultrasound prostate volume ratio were significantly higher in patients with neoadjuvant androgen deprivation therapy than those without neoadjuvant androgen deprivation therapy (P < 0.001). Neoadjuvant androgen deprivation therapy decreased postimplant D90 with substantial prostate gland swelling after low-dose-rate brachytherapy. When neoadjuvant androgen deprivation therapy is required to reduce prostate volume for patients with large prostate glands and offer adequate local control for patients with high-risk prostate cancer before low-dose-rate brachytherapy, intraoperative D90 adjustment might be necessary.

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

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

Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study.

Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). The aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome. A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e., age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC. Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59 [IQR 52-74] vs. 99 [IQR 74-125] mL, P=0.008) and a thinner BWT (5[IQR 4.8-5.2] vs. 5.2 [4.7-5.5] mm P=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11 (14%) vs. 33 (52%), P=0.001. On multivariate analysis, IPP<10mm (OR 6.10 [95%CI 2.61-14.20], P=0.001), lower IPSS (OR 0.95 [95% CI 0.89-0.99], P=0.045), smaller TRUS (OR 0.96 [95% CI 0.95-0.97], P=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) P=0.001were the independent predictors of voiding recovery. Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.

Deep Learning-Based Registration of MR and Treatment Planning Ultrasound Images for HDR Prostate Brachytherapy

Propagation of contours from high-quality magnetic resonance (MR) images to treatment planning ultrasound (US) images with severe needle artifacts is a challenging task, which can greatly aid the organ or intraprostatic lesion contouring in high dose rate (HDR) prostate brachytherapy. In this study, a deep learning approach was developed to automatize this registration procedure for HDR brachytherapy practice.With the approval from the institutional review board, the MR and US images with manual prostate contours were collected from our clinical database and processed to construct the deep learning dataset. A deep learning framework based on the weakly-supervised strategy was proposed for the registration of prostate MR images and US images after the needle insertion, which consisted of two segmentation networks and a deformable registration network. Specifically, two 3D V-Net was trained for the prostate segmentation on the MR and US images separately, to generate the weak supervision labels automatically for the registration network training. Besides the image pair, the corresponding prostate probability maps from the segmentation were further fed to the registration network to improve the registration accuracy, and the deformation matrix was the output. A random augmentation method was designed to alleviate the map overfitting problem during the network training. The overlap between the deformed and fixed prostate contours was analyzed to evaluate the registration accuracy.Clinical data from 121, 104 and 63 patient cases were collected and utilized for the MR and US image segmentation networks, and the registration network learning, respectively. The mean DSC, center-of-mass (COM) distance, Hausdorff distance (HD) and averaged symmetric surface distance (ASSD) results for the registration of prostate contours were 0.87 ± 0.05, 1.70 ± 0.89 mm, 7.21 ± 2.07 mm, 1.61 ± 0.64 mm, respectively. By providing the prostate probability map from the segmentation to the registration network, as well as applying the random map augmentation method, the evaluation results of the four metrics were all improved, such as an increase of DSC from 0.83 ± 0.08 to 0.86 ± 0.06 and from 0.86 ± 0.06 to 0.87 ± 0.05, respectively.This study first worked on the deep learning-based registration about the treatment planning US image for HDR prostate brachytherapy. A novel segmentation-based registration framework was proposed for this multi-modality registration problem, which not only largely saved the labor work on the data preparation, but also improved the registration accuracy. The evaluation results showed the potential of this approach in HDR brachytherapy to automatize current clinical procedures.

COMPARING The EFFICACY AND SAFETY OF TREATMENT WITH FIXED DOSE OF TADALAFIL OR TAMSULOSIN AND THEIR COMBINATION THERAPY IN Patients With BENIGN PROSTATIC HYPERPLASIA and Erectile Dysfunction

Abstract Purpose To compare monotherapy with tadalafil or tamsulosin and their combination therapy in men with benign prostatic hyperplasia and erectile dysfunction by comparing IPSS score, prostate volume and Qmax and some other outcomes. Materials and Methods All patients with lower urinary tract symptoms, benign prostatic hyperplasia and any grade of erectile dysfunction were recruited. They were randomly divided into three groups (50 participants in each group): Group A received 5 mg/daily tadalafil; Group B received 0.4 mg/daily tamsulosin; Group C receieved a combination of 0.4 mg/daily tamsulosin and 5 mg/daily tadalafil. Primary outcomes were prostate volume, prostate specific antigen, post-void residual volume, IPSS score, LUTS severity, Qmax, IIEF and erectile dysfunction severity and secondary outcome was complications. Results The mean ± SD of ultrasonographic prostate volume was 61.4 ± 15.1 mL and prostate specific antigen level was 2.4 ± 1.9 ng/dl. Post-void residual level was significantly different before and after the treatment, except for group A. Also, this group had no meaningful difference compared to the other groups in this regard (P &amp;gt; 0.05). There were significant differences between pre- and post-treatment international prostate symptom scores in each group (P &amp;lt; 0.05). Conclusion: Combination of tamsulosin and tadalafil can improve international prostate symptom scores, international index of erectile function questionnaire scores and Qmax in patients with lower urinary tract symptoms and benign prostatic hyperplasia to more degrees than their separate use. This combination is recommended because of its synergistic effects, well toleration and safety Conclusion Combination of tamsulosin and tadalafil can improve international prostate symptom scores, international index of erectile function questionnaire scores and Qmax in patients with lower urinary tract symptoms and benign prostatic hyperplasia to more degrees than their separate use. This combination is recommended because of its synergistic effects, well toleration and safety.