Digital Rectal Examination Results Research Articles

Association of Prostate-Specific Antigen With Age, Digital Rectal Examination, and Lower Urinary Tract Symptoms in the Lebanese Population: A Cross-Sectional Study.

Prostate cancer (PCa) is a leading cause of mortality in men worldwide. Prostate-specific antigen (PSA) testing is a standard method for PCa detection, yet its associationwith age, digital rectal examination (DRE) results, and lower urinary tract symptoms (LUTS) remains understudied, particularly in the Lebanese population. This study aimed to investigate the associationof PSA levels with age, DRE results, and LUTS severity among Lebanese men. A total of 725 men aged 55-70 years were recruited from a men's health campaign at Saint George Hospital University Medical Center in Lebanon. PSA levels, DRE results, andInternational Prostate Symptom Score(IPSS)were assessed. Statistical analysis included Kruskal-Wallis tests and Spearman's rho correlation coefficient. Participants exhibited a significant correlation between age and PSA levels (r = 0.138, p < 0.01). PSA levels varied significantly across age groups (p = 0.029), with higher mean PSA levels observed in older age groups. IPSS status correlated positively with PSA levels (r = 0.23, p < 0.001), indicating higher PSA levels associated with increased LUTS severity. Abnormal DRE findings were significantly associated with elevated PSA levels (p < 0.00), suggesting their potential as an indicator of prostate abnormalities. This study highlights the importance of age-specific reference ranges for PSA levels in the Lebanese population. Elevated PSA levels were associated with older age, increased LUTS severity, and abnormal DRE findings. These findings highlight the significance of integrating PSA testing with clinical assessments for PCa detection and risk stratification in Lebanon.

A Handheld Ultrasound Device Can Predict Constipation with Rectal Fecal Retention in a Palliative Care Setting.

Although handheld ultrasound devices (HUDs) are commonplace, their ability to diagnose fecal retention (FR) remains unclear. This prospective observational study examined HUDs' usefulness in diagnosing FR in patients with constipation in a palliative care setting. Between 10 December 2020 and 30 June 2022, we compared rectal ultrasonographic findings obtained using HUDs with clinical manifestations in 64 males and 70 females (48%, 52%, 68 ± 11 years old) with constipation who had undergone computed tomography (CT). FR was diagnosed using a HUD and compared with CT and digital rectal examination (DRE) results. In total, 42 (31%), 42 (31%), and 41 (31%) patients were diagnosed using HUDs, CT, and DRE, respectively. Thirty-nine (93%) patients in the CT group were also diagnosed with FR using HUDs. A total of 89 of 92 patients with a negative CT diagnosis also had a negative HUD diagnosis. Among the 41 patients in the DRE group, 37 were also diagnosed with FR using HUDs. Among 93 patients with a negative DRE diagnosis, 86 had a negative HUD diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of HUDs for CT were 93%, 97%, 93%, and 97%, respectively. Those of HUDs for DRE were 88%, 94%, 86%, and 95%, respectively. The concordance rates for FR diagnosis were 128/134 for CT and HUDs and 123/134 for DRE and HUDs. HUD was useful for diagnosing FR in this setting. HUDs could provide valuable support for appropriate treatment selection. Developing a constipation treatment algorithm based on rectal ultrasonographic findings is warranted in the future.

Development and validation of an imageless machine-learning algorithm for the initial screening of prostate cancer.

Prostate specific antigen (PSA) testing is a low-cost screening method for prostate cancer (PCa). However, its accuracy is limited. While progress is being made using medical imaging for PCa screening, PSA testing can still be improved as an easily accessible first step in the screening process. We aimed to develop and validate a new model by further personalizing the analysis of PSA with demographic, medical history, lifestyle parameters, and digital rectal examination (DRE) results. Using data from 34,224 patients in the screening arm of the PLCO trial (22,188 for the training set and 12,036 for the validation set), we applied a gradient-boosting model whose features (Model 1) were one PSA value and the personal variables available in the PLCO trial except those that signaled an ex-anteassumption of PCa. A second algorithm (Model 2) included a DRE result. The primary outcome was the occurrence of PCa, while the aggressiveness of PCa was a secondary outcome. ROC analyses were used to compare both models to other initial screening tests. The areas under the curve(AUC) for Model 2 was 0.894 overall and 0.908 for patients with a suspicious DRE, compared to 0.808 for PSA for patients with a suspicious DRE. The AUC for Model 1 was 0.814 compared to 0.821 for PSA. Model 2 predicted 58% more high-risk PCa than PSA ≥4 combined with an abnormal DRE and had a positive predictive value of 74.7% (vs. 50.6%). Personalizing the interpretation of PSA values and DRE results with a gradient-boosting model showed promising results as a potential novel, low-cost method for the initial screening of PCa. The importance of DRE, when included in such a model, was also highlighted.

Development of Machine Learning Algorithm to Predict the Risk of Incontinence After Robot-Assisted Radical Prostatectomy.

Introduction: Predicting postoperative incontinence beforehand is crucial for intensified and personalized rehabilitation after robot-assisted radical prostatectomy. Although nomograms exist, their retrospective limitations highlight artificial intelligence (AI)'s potential. This study seeks to develop a machine learning algorithm using robot-assisted radical prostatectomy (RARP) data to predict postoperative incontinence, advancing personalized care. Materials and Methods: In this propsective observational study, patients with localized prostate cancer undergoing RARP between April 2022 and January 2023 were assessed. Preoperative variables included age, body mass index, prostate-specific antigen (PSA) levels, digital rectal examination (DRE) results, Gleason score, International Society of Urological Pathology grade, and continence and potency questionnaires responses. Intraoperative factors, postoperative outcomes, and pathological variables were recorded. Urinary continence was evaluated using the Expanded Prostate cancer Index Composite questionnaire, and machine learning models (XGBoost, Random Forest, Logistic Regression) were explored to predict incontinence risk. The chosen model's SHAP values elucidated variables impacting predictions. Results: A dataset of 227 patients undergoing RARP was considered for the study. Post-RARP complications were predominantly low grade, and urinary continence rates were 74.2%, 80.7%, and 91.4% at 7, 13, and 90 days after catheter removal, respectively. Employing machine learning, XGBoost proved the most effective in predicting postoperative incontinence risk. Significant variables identified by the algorithm included nerve-sparing approach, age, DRE, and total PSA. The model's threshold of 0.67 categorized patients into high or low risk, offering personalized predictions about the risk of incontinence after surgery. Conclusions: Predicting postoperative incontinence is crucial for tailoring rehabilitation after RARP. Machine learning algorithm, particularly XGBoost, can effectively identify those variables more heavily, impacting the outcome of postoperative continence, allowing to build an AI-driven model addressing the current challenges in post-RARP rehabilitation.

The feasibility of distance to the tumor of biopsy cores to estimate the extracapsular extension

BackgroundTo investigate the predictive capability of a new parameter, the distance between the fibromuscular capsule and the tumor as measured using a prostate biopsy core (referred to as “distance to the tumor” [DTT]), for the presence of extracapsular extension (ECE). Materials and methodsWe analyzed specimens obtained from 246 patients diagnosed with prostate cancer. All patients underwent prebiopsy, prostate magnetic resonance imaging (MRI), and subsequent prostatectomy. DTT measurements were obtained for each prostate biopsy core, and the minimum (min) DTT was extracted. We assessed the relationship between min DTT, MRI-estimated ECE, and pathological ECE, considering factors such as the PI-RADS score and tumor location. ResultsIn this study of 246 patients, the mean age was 65.8 years, and the mean prostate-specific antigen (PSA) level was 18.9 ng/ml. Patients with suspicious lesions in the peripheral zone and pathological ECE displayed higher rates of positive digital rectal examination (DRE), elevated PSA levels, and shorter DTT values in the biopsy cores. DTT demonstrated an accurate estimation of the presence of ECE, similar to MRI findings. Min DTT exhibited higher accuracy for peripheral zone masses, with a cutoff value of 1.0 mm for min DTT predicting ECE (AUC: 0.84, sensitivity: 72.23%, specificity: 77.78%, P < 0.01). Of the 246 patients, 66 had no ECE on MRI; however, 18 of these patients displayed pathological ECE, with 14 having DTT values <1.0 mm. ConclusionsMin DTT, positive DRE results, and a higher Gleason grade were significantly associated with ECE. DTT measurements of <1 mm can provide a more accurate prediction of ECE in the peripheral zone of the prostate than MRI-based assessments.

18F-Fluoroethylcholine PET/CT Radiomic Analysis for Newly Diagnosed Prostate Cancer Patients: A Monocentric Study.

Aim: The aim of this study is to assess whether there are some correlations between radiomics and baseline clinical-biological data of prostate cancer (PC) patients using Fluorine-18 Fluoroethylcholine (18F-FECh) PET/CT. Methods: Digital rectal examination results (DRE), Prostate-Specific Antigen (PSA) serum levels, and bioptical-Gleason Score (GS) were retrospectively collected in newly diagnosed PC patients and considered as outcomes of PC. Thereafter, Volumes of interest (VOI) encompassing the prostate of each patient were drawn to extract conventional and radiomic PET features. Radiomic bivariate models were set up using the most statistically relevant features and then trained/tested with a cross-fold validation test. The best bivariate models were expressed by mean and standard deviation to the normal area under the receiver operating characteristic curves (mAUC, sdAUC). Results: Semiquantitative and radiomic analyses were performed on 67 consecutive patients. tSUVmean and tSkewness were significant DRE predictors at univariate analysis (OR 1.52 [1.01; 2.29], p = 0.047; OR 0.21 [0.07; 0.65], p = 0.007, respectively); moreover, tKurtosis was an independent DRE predictor at multivariate analysis (OR 0.64 [0.42; 0.96], p = 0.03) Among the most relevant bivariate models, szm_2.5D.z.entr + cm.clust.tend was a predictor of PSA levels (mAUC 0.83 ± 0.19); stat.kurt + stat.entropy predicted DRE (mAUC 0.79 ± 0.10); cm.info.corr.1 + szm_2.5D.szhge predicted GS (mAUC 0.78 ± 0.16). Conclusions: tSUVmean, tSkewness, and tKurtosis were predictors of DRE results only, while none of the PET parameters predicted PSA or GS significantly; 18F-FECh PET/CT radiomic models should be tested in larger cohort studies of newly diagnosed PC patients.

Outcomes of active surveillance for clinically localized prostate cancer in a middle eastern tertiary care center.

The aim of our study was to evaluate the outcome of active surveillance (AS) for prostate cancer for a cohort of patients at our institution. A total of 43 patients with low risk prostate cancer were enrolled in an active surveillance pilot program at our institution between 2008 and 2018. Follow up protocols included: periodic prostate specific antigen (PSA), digital rectal examination (DRE), multiparametric MRI, and prostate biopsy at one year. Pertinent parameters were collected, and descriptive statistics were reported along with a subset analysis of patients that dropped out of the protocol to receive active treatment for disease progression. Out of 43 eligible patients, 46.5% had a significant rise in follow up PSA. DRE was initially suspicious in 27.9% of patients, and none had any change in DRE on follow up. Initially, prostate MRIs showed PIRADS 3, 4, and 5 in 14%, 37.2%, and 11.6% respectively, while 23.2% had a negative initial MRI. 14% did not have an MRI. Upon follow up, 18.6% of patients had progression on MRI. Initial biopsies revealed that 86% were classified as WHO group 1, while 14% as WHO group 2. With regards to the follow up biopsies, 11.6% were upgraded. 20.9% of our patients had active treatment; 44.4% due to upgraded biopsy results, 22.2% due to PSA progression, 22.2% due to strong patient preference, and 11.1% due to radiologic progression. For selected men with low risk prostate cancer, AS is a reasonable alternative. The decision for active treatment should be tailored upon changes in PSA, DRE, MRI, and biopsy results.

Analysis of the Effectiveness of Various Types of Conservative Therapy for Chronic Bacterial Prostatitis

Analysis of the Effectiveness of Various Types of Conservative Therapy for Chronic Bacterial Prostatitis

Analysis of the usefulness of magnetic resonance imaging and clinical parameters in the detection of prostate cancer in the first systematic biopsy combined with targeted cognitive biopsy.

IntroductionThe study aimed to assess the suitability of multiparametric magnetic resonance prostate imaging (mpMRI) in combination with clinical parameters [prostate-specific antigen (PSA), digital rectal examination (DRE)] in the identification of men at risk of the presence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa, Gleason Score ≥3+4) in the cognitive fusion with systematic prostate biopsy.Material and methodsWe retrospectively evaluated a population of 215 biopsy – naive patients with a clinical suspicion of prostate cancer. The results of mpMRI, DRE, PSA and biopsy were analyzed. MpMRI of the prostate according to the Prostate Imaging Reporting and Data System (PI-RADS) v.2.0 scheme preceded cognitive fusion and systematic transrectal prostate biopsy. Uni- and multivariable logistic regression analysis (MVA) was used to identify the variables determining the risk of detecting PCa overall and csPCa.ResultsIn MVA, it was established that the combination of variables such as PSA level [odds ratio (OR) 1.195; p = 0.002], PI-RADS ≥3 (OR 7.7; p = 0.002), prostate volume (OR 0.98; p = 0.017) significantly determines the probability of PCa detection in biopsy, while for csPCa it is PSA level (OR 1.14; p = 0.004), DRE (+) (OR 5.75; p <0.001), PI-RADS ≥4 (OR 6.5; p <0.001). Analysis of mpMRI diagnostic value for PI-RADS ≥4 revealed better sensitivity (88.9% vs 82.6%) and better negative predictive value (NPV) (94.5% vs 82.4%) for detection of csPCa than for PCa overall.ConclusionsMpMRI results combining with DRE and PSA parameters help to identify men at high – or low risk of csPCa detection in the first – time biopsy.

A review of current clinical biomarkers for prostate cancer: towards personalised and targeted therapy

AbstractBackground:Prostate cancer is the most commonly diagnosed cancer in men and it is responsible for about 10% of all cancer mortality in Canadian men. The current ‘gold standard’ for the diagnosis of prostate cancer is a prostate biopsy and the decision on when to biopsy a patient with non-suspicious Digital Rectal Examination (DRE) result and total prostate specific antigen (tPSA) of 4–10 ng/ml can be challenging. In order to shift the treatment paradigm of prostate cancer toward more personalised and targeted therapy, there is the need for a clear system that makes its detection binary so as to decrease the rate of inaccurate detections. Therefore in recent years, there have been several investigations into the development of various biomarkers with high sensitivity and specificity for screening, early detection and personalised patient-specific targeted medicine from diagnosis to treatment of the disease.Materials and methods:This paper reports on nine currently available clinical biomarkers used in screening for early detection and diagnosis, to reduce the number of unnecessary biopsies, in risk assessment of aggressive disease and in monitoring treatment response of prostate cancer.Conclusion:Current clinical prostate cancer biomarkers have the potential for a personalised risk assessment of aggressive disease and the risk of developing distant metastatic disease and have been proven to be useful tools to guide clinicians in personalised patient-specific targeted treatment and in the shared decision making between patients and their physicians regarding prostate biopsy and treatment. Using biomarkers to select patients with a significant probability of aggressive prostate cancer would potentially avoid premature death from the disease, while at the same time would safely preclude patients who do not require unnecessary invasive intervention.

Effect of Antibiotic on Men with Raised Prostatic-Specific Antigen (4-10 ng/ml)

Background: The managing of raised Prostate-Specific Antigen (PSA) in a range of 4 to 10 ng/ml is still controversial among urologists. In addition to prostatic cancer, benign prostatic hyperplasia, and prostatitis is established to increase PSA. PSA reduction after antibiotic therapy might detect those patients in whom biopsy can be avoided or postponed. Objectives: To evaluate the effectiveness of a 6 weeks levofloxacin course on the serum total PSA level and PSA density (PSAD) in patients with PSA 4 -10 ng/ml and ordinary digital rectal examination and ultrasonography results. Materials and Methods: The study conducted at Al-Ramadi Teaching Hospital from February 2016 to December 2019. A total of 177 men with benign prostatic hyperplasia or lower urinary tract symptoms were with a normal digital rectal examination, chronic prostatitis (Expressed prostatic secretion was done before treatment), total PSA 4-10 ng/ml, and ultrasonography findings that did not reveal a hypoechoic lesion in the prostate will be included in this study. Serum PSA and PSAD were measured before, and after treatment with a 6 weeks course of levofloxacin. Results: The age of our 177 men was ranged from 40-80 years with a mean age of 56.52 years ± 7.253. The mean prostatic size was 49.5 ± 28.5 g (range, 23-150 g). In 89 (50.2%) patients of the 177 men, total PSA has normalized to less than 4 ng/ml after antibiotics treatment. In 56 patients of 89 men had a high level of PSAD. PSAD was normalized (less than 0.15 ng/ml/cm3) after treatment in 49 patients of the 56 patients. A significant reduction in total PSA and PSAD after treatment (p <0.05).

PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium.

We performed this study to investigate the diagnostic performance of prostate-specific antigen density (PSAD) in a multicenter cohort of the Chinese Prostate Cancer Consortium. Outpatients with prostate-specific antigen (PSA) levels ≥4.0 ng ml−1 regardless of digital rectal examination (DRE) results or PSA levels <4.0 ng ml−1 and abnormal DRE results were included from 18 large referral hospitals in China. The diagnostic performance of PSAD and the sensitivity and specificity for the diagnosis of prostate cancer (PCa) and high-grade prostate cancer (HGPCa) at different cutoff values were evaluated. A total of 5220 patients were included in the study, and 2014 (38.6%) of them were diagnosed with PCa. In patients with PSA levels ranging from 4.0 to 10.0 ng ml−1, PSAD was associated with PCa and HGPCa in both univariate (odds ratio [OR] = 45.15, P < 0.0001 and OR = 25.38, P < 0.0001, respectively) and multivariate analyses (OR = 52.55, P < 0.0001 and OR = 26.05, P < 0.0001, respectively). The areas under the receiver operating characteristic curves (AUCs) of PSAD in predicting PCa and HGPCa were 0.627 and 0.630, respectively. With the PSAD cutoff of 0.10 ng ml−2, we obtained a sensitivity of 88.7% for PCa, and nearly all (89.9%) HGPCa cases could be detected and biopsies could be avoided in 20.2% of the patients (359/1776 cases). Among these patients who avoided biopsies, only 30 cases had HGPCa. We recommend 0.10 ng ml−2 as the proper cutoff value of PSAD, which will obtain a sensitivity of nearly 90% for both PCa and HGPCa. The results of this study should be validated in prospective, population-based multicenter studies.

Biomarkers That Differentiate Benign Prostatic Hyperplasia from Prostate Cancer: A Literature Review.

Prediction of prostate cancer in primary care is typically based upon serum total prostate-specific antigen (tPSA) and digital rectal examination results. However, these tests lack sensitivity and specificity, leading to over-diagnosis of disease and unnecessary, invasive biopsies. Therefore, there is a clinical need for diagnostic tests that can differentiate between benign conditions and early-stage malignant disease in the prostate. In this review, we evaluate research papers published from 2009 to 2019 reporting biomarkers that identified or differentiated benign prostatic hyperplasia (BPH) from prostate cancer. Our review identifies hundreds of potential biomarkers in urine, serum, tissue, and semen proposed as useful targets for differentiating between prostate cancer and BPH patients. However, it is still not apparent which of these candidate biomarkers are most useful, and many will not progress beyond the discovery stage unless they are properly validated for clinical practice. We conclude that this validation will come through the use of multivariate panels which can assess the value of biomarker candidates in combination with clinical parameters as part of a risk prediction calculator. Implementation of such a model will help clinicians stratify patients with prostate cancer symptoms in primary care, with tangible benefits for both the patient and the health service.

MP74-11 FEASIBILITY AND RELIABILITY OF TELEPHONE FOLLOW-UP AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (MP74)1 Apr 2020MP74-11 FEASIBILITY AND RELIABILITY OF TELEPHONE FOLLOW-UP AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER Matteo Balzarro*, Emanuele Rubilotta, Marilena Gubbiotti, Alberto Diminutto, Simone Francavilla, Chiara Lonati, Antonio Benito Porcaro, Mariaangela Cerruto, Michele Di Nauta, Ester Illiano, Vito Mancini, Luigi Cormio, Elisabetta Costantini, Giuseppe Carrieri, and Alessandro Antonelli Matteo Balzarro*Matteo Balzarro* More articles by this author , Emanuele RubilottaEmanuele Rubilotta More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Alberto DiminuttoAlberto Diminutto More articles by this author , Simone FrancavillaSimone Francavilla More articles by this author , Chiara LonatiChiara Lonati More articles by this author , Antonio Benito PorcaroAntonio Benito Porcaro More articles by this author , Mariaangela CerrutoMariaangela Cerruto More articles by this author , Michele Di NautaMichele Di Nauta More articles by this author , Ester IllianoEster Illiano More articles by this author , Vito ManciniVito Mancini More articles by this author , Luigi CormioLuigi Cormio More articles by this author , Elisabetta CostantiniElisabetta Costantini More articles by this author , Giuseppe CarrieriGiuseppe Carrieri More articles by this author , and Alessandro AntonelliAlessandro Antonelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000960.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the feasibility and reliability of telephone follow-up after radical prostatectomy (RP) for prostate cancer (PC). METHODS: This is a multicenter prospective observational study (January 2017- ongoing). Patients received telephone call 7-10 days before the office evaluation. During the telephone call clinical history and last available PSA were assessed. During office evaluation a urologist performed digital rectal examination (DRE) and was blind to PSA level, a second urologist assessed the PSA and the reported DRE. Correlation between PSA and DRE was performed. Patients were stratified according to PSA levels as follow: Group 1 PSA < 0.2 ng/ml. Group 2 PSA > 0.2 ng/ml. Patients were stratified also according to surgical margin specimen and pT stages. Agreement evaluation was performed. Telephone follow-up satisfaction was assessed by VAS scale. RESULTS: All patients with PSA < 0.2 ng/ml had negative DRE with agreement of 100%. Pts with PSA > 0.2 ng/ml had a positive DRE in 3/34, all pts with PSA <4 ng/ml. The concordance between DRE and PSA in non-biochemical recurrence patients was 100% (461/461), while the concordance between DRE and PSA in biochemical recurrence patients was 8.8% (3/34). Surgical margin specimen and pT stages did not influenced DRE results (Table 1). The patient management between telephone follow-up and in clinic evaluation did not change in all cases with PSA <0.2, while in case of biochemical recurrence could change in 8.8%. Satisfaction rate was high (82%). Stratification of patients according with DRE and PSA levels is reported in table 2. CONCLUSIONS: Telephone follow-up was feasible and reliable in the management of males without biochemical recurrence after RP. While, in case of biochemical recurrence an office evaluation is advisable. Telephone follow-up had high patients’ satisfaction rate. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1135-e1136 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Balzarro* More articles by this author Emanuele Rubilotta More articles by this author Marilena Gubbiotti More articles by this author Alberto Diminutto More articles by this author Simone Francavilla More articles by this author Chiara Lonati More articles by this author Antonio Benito Porcaro More articles by this author Mariaangela Cerruto More articles by this author Michele Di Nauta More articles by this author Ester Illiano More articles by this author Vito Mancini More articles by this author Luigi Cormio More articles by this author Elisabetta Costantini More articles by this author Giuseppe Carrieri More articles by this author Alessandro Antonelli More articles by this author Expand All Advertisement PDF downloadLoading ...

Transrectal ultrasound-guided prostate biopsy versus combined magnetic resonance imaging-ultrasound fusion and systematic biopsy for prostate cancer detection in routine clinical practice

PurposeThe goal of this study was to retrospectively compare systematic ultrasound-guided prostate biopsy (US-PB) and multiparametric magnetic resonance imaging-ultrasound fusion prostate biopsy (MRI-PB) in men undergoing primary or repeated biopsies.MethodsA population of 2,200 patients with a prostate-specific antigen (PSA) level >4.0 ng/ dL and/or an abnormal rectal examination was divided into two groups. All patients underwent US-PB (n=1,021) or MRI-PB (n=1,179) between April 2015 and April 2019. Population demographics, including age, PSA level, digital rectal examination results, prostate volume, number of previous negative biopsies, Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) score, and biopsy results, were acquired and compared with respect to these variables. Univariate regression analysis of the risk factors for a higher Gleason score (GS) was performed.ResultsThe cancer detection rate (CDR) was 23.8% (243 of 1,021) in the US-PB group and 31.3% (399 of 1,179) in the MRI-PB group. Of those, 225 patients (22.0%) in the US-PB group and 374 patients (31.7%) in the MRI-PB group had clinically significant prostate cancer (csPCa). The patients with csPCa in the MRI-PB group included 10 (40%), 50 (62.5%), 184 (94.8%), and 32 (94.1%) patients with PI-RADS V2 scores of 2, 3, 4, and 5, respectively. Of the patients with csPCa, 155 (91.7%) in the US-PB group were diagnosed on the basis of the primary biopsy, compared to 308 (94.4%) in the MRI-PB group. We found the PI-RADS V2 score to be the best predictor of a higher GS.ConclusionMRI-PB showed a high CDR for csPCa. MRI-PB could be a reasonable approach in patients with high PI-RADS V2 scores at primary biopsy.

Роль совмещенной МРТ-УЗИ прицельной биопсии предстательной железы в диагностике рака предстательной железы

To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI. The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate. There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason more or equal 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason more or equal 4 + 3) compared to SB (p=0.025). MRF-TB allows to detect more significant PCa (Gleason more or equal 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.

Роль совмещенной МРТ-УЗИ прицельной биопсии предстательной железы в диагностике рака предстательной железы

To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI.The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate.There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason more or equal 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason more or equal 4 + 3) compared to SB (p=0.025).MRF-TB allows to detect more significant PCa (Gleason more or equal 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.

Factors affecting the diagnosis of prostate cancer through 12 quadrant guided prostate biopsy

Purpose Investigate the factors affecting the efficacy of the widely used 12-quadrant prostate biopsy for the diagnosis of prostate cancer. Methods The data of 1846 male patients between 45 and 75 years of age was evaluated. The patients were subdivided into groups according to age, blood prostate-specific antigen (PSA) levels prostate volume (PV), digital rectal examination (DRE) findings, and pathology results. The tumour detection rates in the 12-quadrant biopsies were compared with PV, PSA levels, and DRE results of the grouped patients. Results The tumour detection rate decreased with increasing PV in patients 45–75 years of age and with a PSA level ≤ 14.5. No decrease was detected in patients 45–60 years of age or those aged 61–75 years with a PSA ≤ 6.99 and suspicious DRE findings. A decrease in the tumour detection rate with increasing PV was observed in the other three subgroups of patients in this age group, who had a PSA ≤ 6.99, and normal DRE findings but a PV ≤ 40, PV 41–80, or PV ≥ 81. Conclusions Even though there is no statistically significant relationship between PV and the prostate cancer detection rate in patients 45–60 years of age, the cancer detection rate decreased with increasing PV in three of the four subgroups of patients between the ages of 61 and 75 years. Our study results have demonstrated that an individualised approach can play an important role in the diagnosis and treatment of prostate cancer.

Stromal androgen receptor expression in prostate cancer in relation to clinicopathological parameters

Background Prostate cancer (PCa) is one of the most commonly diagnosed male tumors all over the world. Most studies have concentrated upon the established role of epithelial androgen receptor (AR) expression in PCa, but the role of stromal AR expression is still not completely understood. Aim To assess immunohistochemical expression of stromal AR and investigate its relation to the PCa grade (according to the new contemporary advances in Gleason score/grading system) and other clinicopathological parameters. Materials and methods This is a retrospective study performed on 65 cases of PCa. All cases were immunohistochemically stained for AR to assess its stromal expression using the Allred score applied for estrogen receptor (ER) and progesterone receptor (PR) in the breast. The results were recorded for statistical analysis. Results Stromal AR was significantly related to the percentage of PCa in the specimen (P=0.003), tumor grade (P=0.001), perineural invasion (P=0.041), and cancer stage (P=0.001). On the contrary, stromal AR expression showed statistically insignificant relation with patients’ age (P=0.231), diabetes mellitus status (P=0.073), preoperative prostate-specific antigen level (P=0.202), digital rectal examination result (P=0.421), weight of the prostate (P=0.083), tumor size (P=0.209), and lymph node metastasis (P=0.411). Moreover, using Spearman’s correlation, there was a highly statistically significant correlation between stromal AR score and both Gleason grade/score (P Conclusion AR expression in prostatic cancer stroma may have protective value against cancer progression.

Developing a Chinese PI-RADS v2-based nomogram for predicting clinically significant prostate cancer in patients with a prior negative biopsy

Objective: To develop a nomogram based on prostate imaging reporting and data system version 2 (PI-RADS v2) to predict clinically significant prostate cancer in patients with a prior negative prostate biopsy. Methods: The clinical and pathological data of 231 patients who underwent repeat prostate biopsy and multiparametric MRI (mpMRI) were reviewed. Based on PI-RADS v2, the mpMRI results were assigned as PI-RADS grade from 0 to 2. A Logistic regression nomogram for predicting the probabilities of clinically significant prostate cancer were constructed. The performances of the nomogram were assessed using area under the receiver operating characteristic (ROC) curve, calibrations and decision curve analysis. Results: Of the total 231 repeat prostate biopsy patients, clinically significant prostate cancer was detected in 59 cases(25.5%). In multivariate Logistic regression analysis, age, prostate specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) and mpMRI results were significant independent predictors of the diagnosis of clinically significant prostate cancer (P<0.05). The nomogram with super predictive accuracy were constructed (AUC=0.927, P<0.001), and exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of threshold probabilities . Conclusions: PI-RADS v2 combined with age, PSA, PV and DRE can predict the probability of clinically significant prostate cancer in patients with negative initial biopsies. The nomogram generated may help the decision-making process in patients with prior benign histology before the performance of repeat biopsy.