Serum Prostate Research Articles

IsoPSA® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study.

We assessed the impact of the IsoPSA® test for prostate cancer risk assessment on provider patient management decisions in a real-world clinical setting. A total of 38 providers, including advanced practice providers, fellowship trained oncologists and general urologists in the Cleveland Clinic health system including both community-based practices and academic locations, enrolled 900 men being evaluated for prostate cancer; 734 met inclusion criteria (age ≥50 years, total serum prostate specific antigen [PSA] ≥4 and <100 ng/ml and no history of prostate cancer) and IsoPSA indication for use. A standard template was used to document biopsy recommendation prior to and after receiving IsoPSA results. The primary outcome was the number of biopsy and magnetic resonance imaging recommendation changes occurring after IsoPSA testing. IsoPSA testing resulted in a 55% (284 vs 638) net reduction in recommendations for prostate biopsy for men with total PSA ≥4 ng/ml. Additionally, a 9% reduction in recommendations for magnetic resonance imaging was observed. There was strong concordance between IsoPSA results and provider recommendations for prostate biopsy, with 87% of patients with an IsoPSA index above the threshold recommended for biopsy and 92% of patients with an IsoPSA index below the threshold not recommended for biopsy. In a real-world clinical setting, providers from diverse training backgrounds and practice settings readily adopted IsoPSA with substantial reductions in the rate of recommended prostate biopsies in patients with elevated PSA values (≥4 ng/ml). There was a high concordance between recommendation for or against prostate biopsy and the IsoPSA result.

Prostatic Malakoplakia Presenting as PI-RADS Score 5 Lesion Which was Down-Scored after Treatment: A Case Report and Review Literatures

Background: Malakoplakia is a rare, granulomatous disorder that is typically triggered by infections in immunocompromised patients and most commonly affects the bladder. Herein, we report the seventy-fourth case of prostatic malakoplakia in the world literatures and the first case reported in Thailand. The paper will also be the first to compare the multiparametric (mp) magnetic resonance imaging (MRI) of malakoplakia before and after treatment, for differentiating the combined concurrence of malakoplakia and prostatic adenocarcinoma. Case Report: A case of prostatic malakoplakia in a 70-year-old Thai man with a history of recurrent urinary tract infections who presented with acute urinary retention and prostatitis. An mpMRI study showed a Prostate Imaging- Reporting and Data System (PI-RADS) 5 lesion. His serum prostate specific antigen level (PSA) had risen to be 47.53 ng/mL. All findings strongly indicated prostate cancer. The patient underwent MRI-TRUS (Transrectal ultrasound) fusion-guided prostate biopsy and pathology slides revealed, microscopically, macrophages known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. He underwent transurethral resection of the prostate combined with antibiotic therapy. There was no longer any evidence of the PI-RADS 5 lesion by mpMRI six months after the treatment. Conclusion: We reported that prostatic malakoplakia can present as prostatitis and a PI-RADS score 5 lesions. This awareness can prevent misdiagnosis and overtreatment of such a rare but benign condition. Combined surgical excision and antibiotic courses were effective in the treatment, and the importance of long-term follow-up of the patient is emphasized. Keywords: Malakoplakia; Michaelis-Gutmann bodies; Prostate; Multiparametric magnetic resonance imaging

Synergistic Effect of Docetaxel Plus Saponin Fraction of Vitex doniana on Prostate Specific Antigen and p53 in Nitrsobis (2-oxopropyl) Amine-induced Prostate Toxicity

Aim: This study investigated the synergistic effect of docetaxel plus saponin fraction of Vitex doniana on prostate specific antigen and p53 in nitrsobis (2-oxopropyl) amine-induced prostate toxicity in Wistar rat.&#x0D; Methodology: Twenty-four (24) male Wistar rats with elevated serum prostate specific antigen level were selected from a group of sixty (60) rats pretreated with subcutaneous Nitrosobis (2-oxopropyl) amine 5 mg/kg daily for 4 weeks. The selected 24 male Wistar rats were then grouped into 6 groups of four (4) rats each. Group 1 was given 1ml normal saline daily from day 1-28. Groups 2, 3, 4, 5, and 6 further received subcutaneous nitrosobis (2-oxopropyl) amine 5 mg/kg daily from day 1-28. In addition, groups 3, 4, 5, and 6 were given weekly intravenous docetaxel 8 mg/kg on day 15 and 22. In addition to docetaxel, groups 4, 5, and 6 were further treated with oral saponin at 250 mg/kg, 500 mg/kg, and 750 mg/kg, respectively, daily, from day 15-28. Immunoenzymometric assay method was used for analysis of blood sample for prostate specific antigen. The prostate tissues were subjected to immuno study using the ImmunoCruz Staining System (Lab Vision Corporation, Fremont, CA, USA). The quantitative evaluation of p53 was done by calculating the percentages of p53-immunostained nuclei (labeling index).&#x0D; Results: Significant increase in prostate specific antigen and p53 expression were observed in group 2 (treated with Nitrsobis (2-oxopropyl) amine alone) when compared with group 1 (control). Dose dependent decrease in prostate specific antigen and p53 expression were observed in groups 4, 5, and 6, treated with docetaxel 8 mg/kg plus 250 mg/kg, 500 mg/kg, and 750 mg/kg of saponin respectively.&#x0D; Conclusion: Docetaxel plus Saponin fraction of Vitex doniana significantly reduced the serum prostate specific antigen concentration and p53 expression in a dose dependent manner, with the group treated with 750 mg/kg showing the highest decrease in the parameters tested.

Clinical Effects of Jiawei Danggui Beimu Kushen Pills in the Treatment of Prostate Cancer and Their Influence on the Expression of Serum Prostate Specific Antigen.

Objective To observe the clinical effects of Jiawei Danggui Beimu Kushen pills in treating prostate cancer and their influence on the expression of serum prostate specific antigen. Methods A total of 234 prostate cancer patients were selected and randomly divided into observation group and control group, with 117 cases in each group. The control group was given oral bicalutamide tablets, while the observation group was treated with Jiawei Danggui Beimu Kushen pills on the basis of the control group. The treatment efficacy, IPSS score, TCM syndrome score, VAS score, quality-of-life score, and immune function of the two groups were compared before and after treatment. The serum PSA and f-PSA levels of patients before treatment and after 30 days, 90 days, and 180 days of treatment in the two groups were compared. The five-year cumulative survival rate and the incidence of adverse reactions were compared between the two groups. Results After treatment, the total effective rate of the observation group was 88.03% (103/117), which was higher than that of the control group 69.23% (81/117); the difference was statistically significant (P < 0.05). After treatment, the IPSS score, TCM syndrome score, and VAS score of the two groups were reduced, and those in the observation group were lower than those in the control group; the difference was statistically significant (P < 0.05). After treatment, the quality-of-life scores of the two groups increased, and the observation group was higher than the control group; the difference was statistically significant (P < 0.05). Before treatment, there was no significant difference in serum PSA levels and f-PSA levels when comparing between the two groups of patients (P > 0.05). With the increase of treatment time, the two index levels of the two groups were gradually decreased. After 180 days of treatment, the two index levels of the two groups of patients were significantly lower than those before treatment, and the two index levels of the observation group were significantly lower than those of the control group; the difference was statistically significant (P < 0.05). After treatment, the levels of IgM and IgA in the two groups were decreased, and the level of IgG was increased. The difference between the two groups in the levels of each index before and after treatment was statistically significant (P < 0.05), and the difference between the two groups in the levels of each index after treatment was also statistically significant (P < 0.05). The five-year cumulative survival rate of the observation group was 69.23%, and the five-year cumulative survival rate of the control group was 46.15% (P < 0.05). There was no statistically significant difference between the two groups in the incidence of dizziness, fatigue, and gastrointestinal reactions (P > 0.05), but the difference in the incidence of dysuria as well as dysuria and hematuria was statistically significant (P < 0.05). Conclusion Jiawei Danggui Beimu Kushen pills are effective in treating prostate cancer, which can effectively reduce the patients' IPSS score and TCM syndrome scores, relieve the pain, and improve the quality of life of patients. They also have a potential role in regulating serum PSA levels, clearing tumor lesions, reducing postoperative complications, and improving related symptoms.

Modern principles of diagnosis and treatment of patients with neuroendocrine carcinoma of the prostate

Background. Prostate cancer (PCa) is well-known as the 2nd leading cause of death from malignant neoplasms among the males from developed countries. One of the variants of the disease - neuroendocrine carcinoma of the prostate (NECP) -manifests itself as the form of castration-resistant PCa. Distinctive manifestations of NECP include a low level of serum prostate specific antigen (PSA), a high potential rate of metastasis, and resistance to hormone replacement therapy. There are very few medical publications on the possibilities of diagnosis and therapy of this type of tumor.The objective of the study is to review the current foundations of pathogenesis, methods of diagnosis and treatment of patients with NECP.Materials and methods. The data of modern medical literature from the PubMed/Crossref archives, from the Elsevier and Scopus databases for 1991-2020 were studied. The materials on the epidemiology and pathogenesis of NECP, as well as the methods of diagnosis and treatment of patients with this pathology are summarized. A comparative analysis of the levels of neuroendocrine markers in castration-resistant and localized forms of PCa was carried out. The schemes of combination therapy of NECP with the use of somatostatin analogs are considered.Results. The detection rate of NECP is reduced due to the blurred clinical picture and morphological characteristics similar to poorly differentiated carcinoma. The basis for the diagnosis of NECP is the determination of the levels of neuronal markers - chromogranin A, neuron-specific enolase, and a number of potentially mitogenic hormones, including PTHrP, NT, serotonin, bombesin, calcitonin, and thyroid-stimulating hormone. The worst prognosis was observed in patients with initially high levels of chromogranin A, which emphasizes the high significance of this indicator for monitoring NECP. The drug of choice in the treatment of patients with this pathology is the somatostatin analogue octreotide-depot, the use of which in combination with hormone replacement therapy leads to stabilization of PCa in 50 % of cases. During therapy with an analogue of somatostatin alone or in cases of tumor progression against the background of chemotherapy, a decrease in PSA level is noted in 50-60 % of cases, and PSA level stabilization - in 41.7-53.3 %.Conclusion. We founded an insufficient number of randomized clinical trials of NECP, therefore, the prognosis of the development of this pathology remains completely unclear. The use of somatostatin analogues, along with targeted therapy, is the main choice of therapy for NECP, but requires further study in the program of randomized trials. If a positive result is obtained, it will be possible to use somatostatin analogs more widely to improve the quality and increase the life expectancy of patients with NECP.

Study on Estimation of Serum Prostate Specific Antigen Level and Prostate Volume with Trans-Abdominal Ultrasonography Finding in Benign Prostate Hypertrophy at Tertiary Care Hospital : A Cross Sectional Descriptive Study

Introduction: The periurethral and transition zones of the prostatic gland develop benign prostatic hyperplasia and represent an inevitable phenomenon for the ageing male population. Prostatic specific antigen, is a serine protease, level rises in the blood if the barrier between thelining epithelium and the blood stream is damaged. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised. Prostate volume also increases according to age, which can be estimated by trans-abdominal ultrasonography.&#x0D; Objective: The aim of the study is to estimate the PSA level in blood and its relationship with prostate volume in benign prostatic hyperplasia patients.&#x0D; Methodology: It is a descriptive cross-sectional study which was carried out between a periods of 1st April 2018 to 31st March 2019 at Birat Medical College Teaching Hospital. All the patients diagnosed with benign prostate hyperplasia at the department of urology were included in the study. Blood samples of patients were analyzed for Prostate specific antigen level estimation by chemiluminescence immunosorbent assay. Prostatic volume of the patients was measured by Transabdominal ultrasound technique. Data were entered and analyzed in Microsoft Excel.&#x0D; Results: A total of 68 patients were diagnosed with benign prostate hyperplasia. The mean age of the patients was 61.8±12.3 years. The maximum number 23 of patients with BPH was there in age group 51-60. The maximum no of patients 38 were having their PSA level between the range of 4.0-10.0 ng/ml. The maximum no of patients 28 was having Prostate volume in the range of 40-60 gm. The maximum number of patients 31 was having diabetes mellitus as a co-morbid association. The maximum mean PSA level and prostate volume in the patients were observed in age group &gt;80 years,which was 20.1±8.6 ng/ml and &gt;80 gm respectively.&#x0D; Conclusion: The prostate specific antigen level and prostate volume both increase in advance age group of patients suffering with benign prostate hyperplasia.

Pumpkin seed oil (Cucurbita pepo) versus tamsulosin for benign prostatic hyperplasia symptom relief: a single-blind randomized clinical trial

BackgroundBenign prostatic hyperplasia (BPH) is very common in aging men. We aimed to compare the effects of tamsulosin and pumpkin (Cucurbita pepo) seed oil on BPH symptoms.MethodsThis single-blind randomized clinical trial included patients with BPH aged ≥ 50 years referred to the Urology Clinic of Shahid Beheshti Hospital, Hamadan, Iran, from August 23, 2019 to February 19, 2020. Patients were randomized into two groups. One group received 0.4 mg tamsulosin every night at bedtime and the other received 360 mg pumpkin seed oil twice a day. Patients’ age, weight, height, and body mass index (BMI) were recorded. The International Prostate Symptom Score (IPSS) was filled out by the patients at baseline and then 1 month and 3 months after the initiation of treatment. The BPH-associated quality of life (QoL), serum prostate-specific antigen, prostate and postvoid residual volume, and maximum urine flow were also assessed at baseline and 3 months later. Drug side effects were also noted.ResultsOf the 73 patients included in this study with a mean age of 63.59 ± 7.04 years, 34 were in the tamsulosin group and 39 in the pupkin seed oil group. Patients were comparable with respect to age, weight, height, BMI, and baseline principal variables in both groups. Also, there was no significant difference between groups in terms of principal variables at any time point. However, there was a significant decrease in IPSS and a significant improvement in QoL in both groups. Although the decrease in IPSS from baseline to 1 month and 3 months was significantly higher in the tamsulosin group compared to the pumpkin group (P = 0.048 and P = 0.020, respectively), the decrease in IPSS from 1 to 3 months was similar (P = 0.728). None of the patients in the pumpkin group experienced drug side effects, while dizziness (5.9%), headache (2.9%), retrograde ejaculation (2.9%), and erythema with pruritus occurred in the tamsulosin group.ConclusionsPumpkin (Cucurbita pepo) seed oil relieved BPH symptoms with no side effects, but was not as effective as tamsulosin. Further studies are required to confirm the role of pumpkin seed oil as an option for the treatment of BPH symptoms.Trial registration Iranian Registry of Clinical Trials, IRCT20120215009014N340. Registered 19.02.2020. Retrospectively registered, https://en.irct.ir/trial/45335.

The Role of Pentraxin-3, Fetuin-A and Sirtuin-7 in the Diagnosis of Prostate Cancer.

Prostate canceris the most commonly diagnosed type of cancer and one of the leading causes of cancer-related death in men.Numerous efforts have been made to improve existing diagnostic methods and develop a new biomarker to identify patients with prostate cancer. In line with current literature, we preferred new serum-based biochemical markers as Pentraxin-3, Fetuin-A and Sirtuin-7 in the present study. A total of 174 patients aged 42-76 years were included in the study. Patients with prostate cancer (n=38) were enrolled as Group 1 and patients with benign prostatic hyperplasia (n=136) as Group 2. The serum levels of Pentraxin-3, Fetuin-A and Sirtuin-7 levels were compared between the groups. The mean age of the patients was 61.9±7.6 years (p= .001). The mean serum Prostate Specific Antigen levels 32.0±59.6 (2.6-336) ng/mL and 10.0±11.3 (2.5-77.4) ng/mL in Group 1 and 2, respectively (p= .029). The mean serum levels of Pentraxin-3 and Fetuin-Ain Group 1 were statistically significantlydifferent from Group 2(3.3±4.4 ng/mL vs 1.8±2.4 ng/mL, p= .002 and 466.8±11.0 µg/mL vs 513.3±11.0 µg/mL,p= .041,respectively). There was no significant difference between Group 1 and 2 according to serum levels of Sirtuin-7 (12.7±8.2 ng/mL vs 12.7±12.4 ng/mL respectively, p= .145). Pentraxin-3, Fetuin-A and Sirtuin-7 may be effective in the diagnosis of prostate cancerin light of the current literature.In this study, it was found that Pentraxin-3 and Fetuin-A were significantly different in the diagnosis of prostate cancer.Larger-scale prospective studies are needed to determine the importance of Pentraxin-3 and Fetuin-A in the diagnosis of prostate cancer.

499 A Retrospective Audit on Detection Rate of Clinically Significant Cancer Among MP-MRI Targeted Biopsy – A Single Centre Experience

Abstract Men with high serum prostate specific antigen (PSA) typically undergo standard transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) during which 10 to 12 cores are obtained. TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric MRI (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. According to the renowned PROMIS study, for clinically significant cancer, MP-MRI was more sensitive and less specific than TRUS-biopsy. In this study, we performed a single centre, retrospective audit on the detection rate of clinically significant cancer among MP-MRI targeted biopsy and compare it with the standard TRUS biopsy. Clinically significant cancer is defined as Gleason score ³ 4 +3 or a maximum cancer core length 6mm or longer. Besides, we also compare the rate of clinically significant cancer in MP-MRI targeted biopsy against the PROMIS study. Through this audit, we found that in 2019, there is a 54% (60 out of 112 patients) of clinically significant cancer in MP-MRI biopsy and 41% (26 out of 64 patients) of clinically significant cancer among standard TRUS biopsy. Comparing it with the PROMIS study in which clinically significant cancer was detected in 38% in the MP-MRI targeted biopsy group and 26% in the standard-biopsy group, the adjusted difference in our study (13%) is similar to PROMIS study which is 12%. In conclusion, our study reaffirms that MP-MRI targeted biopsy reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.

Prognostic role of 11C-choline PET/CT scan in patients with metastatic castrate resistant prostate cancer undergoing primary docetaxel chemotherapy.

We sought to assess the prognostic utility of 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with metastatic castrate resistant prostate cancer (mCRPC) undergoing primary docetaxel chemotherapy. We performed a single institution retrospective analysis of 77 mCRPC patients who were treated with 6 cycles of docetaxel chemotherapy, and who also underwent 11C-choline PET/CT scans at baseline (before chemotherapy), mid-course (after 3 cycles), and posttherapy (after 6 cycles). We evaluated treatment response based on percent change in blood pool-corrected maximum standardized uptake value (SUVmax) of the target lesion on PET/CT, as well as percent change in serum prostate specific antigen (PSA). Logistic regression analysis was used to identify factors associated with complete treatment response. Progression free survival (PFS) analysis was performed using log-rank test and shown on Kaplan-Meier plot. Percent change in blood pool-corrected SUVmax on mid-course scan was a significant predictor of complete response (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, p = .0003), whereas percent change in PSA was not (OR: 0.99, 95% CI: 0.99-1.01, p = .6025). 57 of 77 patients (74%) achieved ≥20% reduction in blood pool-corrected SUVmax on mid-course; these patients were 3.6 times more likely to achieve complete response after full 6 cycles of docetaxel chemotherapy, compared to patients with <20% reduction in blood pool-corrected SUVmax (OR: 3.56, 95% CI: 1.04-16.52, p = .0420). Median PFS in the complete response group was 35.1 months (95% CI: 26.0-52.7 months), compared to 9.4 months (95% CI: 6.9-13.0 months) in the incomplete response group (p = .0005). Our study showed that mid-course and posttherapy 11C-choline PET/CT evaluation for mCRPC patients undergoing primary docetaxel chemotherapy can predict full course treatment response and PFS, respectively. 11C-choline PET/CT imaging may provide valuable prognostic information to guide treatment choices for patients with mCRPC.

Prostatic alterations associated to early weaning and its relation with cocoa powder supplementation. Experimental study in adult wistar rats.

ABSTRACTEarly weaning can predispose the offspring to greater risk of developing chronic diseases in adulthood. It is believed that the consumption of functional foods is able to prevent these effects. The aim of this study is to evaluate the effects of maternal and postnatal cocoa powder supplementation on body mass, metabolism, and morphology of the prostate of early weaned Wistar rats. The animals were divided into four experimental groups according to lactation time (21 or 18 days, n=6, each) as follows: control group (C), cocoa control group (CCa), early weaning group (EW), and cocoa early weaning group (EWCa). The animals were euthanized at 90 days of age. Serum biochemical analysis and prostate histomorphometric evaluation were performed. The animals supplemented with cocoa powder were heavier than their respective controls (p <0.05), although with no difference in food intake among the groups. Likewise, these same groups showed a reduction in the serum glucose in relation to C and EW groups (p <0.0001). With respect to the prostate, there was no difference in smooth muscle and lumen area densities, while the EW group had a lower epithelial height and a higher percentage of mast cells than the C group (p <0.05). On the other hand, the EWCa group managed to reverse these parameters, leveling with the controls. Early weaning resulted in hyperglycemia and important morphological changes in the prostate. In contrast, dietary supplementation with cocoa powder attenuated these effects on the metabolism and prostatic histoarchitecture, proving to be a good nutritional treatment strategy.

Current Trends in Prostate Cancer Etiology, Pathogenesis and Diagnostics

Abstract Prostate cancer (PCa) remains the second most commonly diagnosed cancer in men, with an estimated 1.1 million diagnoses worldwide in 2012, accounting for 15% of all cancers diagnosed. In many cases, successful treatment of prostate cancer is difficult due to late detection and rate of metastasis. Importantly, the tumours of many patients with prostate cancer become refractory to androgen therapy and progress to metastatic castration-resistant disease. An effective treatment course of prostate cancer patients requires predictive biomarkers in metastatic castration-resistant prostate cancer that support individual treatment. Different risk classification tools have been developed to distinguish patients with early PCa according to the prognosis, including the D’Amico classification system, the Cancer of the Prostate Risk Assessment score, and the National Comprehensive Cancer Network risk groups classification. Unfortunately, there is still no single, universal, cheap, non-invasive, early prostate cancer diagnostic tool, as serum prostate specific antigen (PSA) has not approved expectations and is not implemented in standardised prostate cancer screening. The aim of this review was to provide current state of art knowledge of prostate cancer screening, diagnosis, staging and future perspectives and directions.

Study of serum prostate specific antigen levels in patients with prostate lesions

In order to see a relationship between histopathology and PSA levels, group of 100 men were studied which included obtaining there Histopathological diagnosis and serum PSA levels before surgical intervention. We found that most common pathology encountered in prostate specimen is BPH. Most of disease of prostate occur in the age group of 61-70 years. With increasing PSA levels the possibility of malignancy increases. But Poorly differentiated tumor may not correlate with PSA level because the tumor cells may not produce PSA as they have lost differentiation.

Development of a highly sensitive digital PCR assay to quantify long non-coding RNA MYU in urine samples which exhibited great potential as an alternative diagnostic biomarker for prostate cancer.

BackgroundThe diagnostic methods of prostate cancer (PCa) present major drawbacks in that serum prostate specific antigen (PSA) testing lacks specificity for PCa and prostate needle biopsy is a painful and highly invasive procedure for patients. Thus, new alternative screening methods which are specific and non-invasive both in the early detection and in the clinical definitive diagnosis of PCa are in urgent need. Long non-coding RNA MYU has been shown to promote PCa cell proliferation and migration, and is significantly upregulated both at the cellular and tumor tissue level. Therefore, long non-coding RNA MYU may be a new potential diagnostic biomarker for PCa.MethodsIn the present study, we successfully developed a highly sensitive digital PCR assay to detect long non-coding RNA in clinical urine samples. dPCR was carried out using Qx200 ddPCR EvaGreen Supermix (Bio-Rad) according to the manufacturer’s instructions.ResultsOur results indicated that the digital PCR assay showed better linearity, repeatability, and reproducibility when compared with real-time quantitative PCR. In addition, we identified the normalized MYU level and used the digital PCR assay to measure it in 100 clinical urine samples. Our study showed that the normalized MYU level is a promising diagnostic biomarker for predicting and evaluating the malignancy of PCa.ConclusionsOur findings presented a non-invasive liquid biopsy method to detect an alternative diagnostic parameter which can assist the diagnosis of PCa in clinical practice.

Multiparametric Magnetic Resonance Imaging, 68Ga Prostate-Specific Membrane Antigen Positron Emission Tomography-Computed Tomography, and Respective Quantitative Parameters in Detection and Localization of Clinically Significant Prostate Cancer in Intermediate- and High-Risk Group Patients: An Indian Demographic Study.

Objectives:The objective of this study was to evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and 68Ga prostate-specific membrane antigen positron emission tomography–computed tomography (PSMA PET-CT) and respective quantitative parameters (Ktrans – influx rate contrast, Kep – efflux rate constant, ADC – apparent diffusion coefficient, and SUVmax ratio – prostate SUVmax to background SUVmax ratio) in detection and localization of clinically significant prostate cancer (CSPCa) in D’Amico intermediate- and high-risk group patients (prostate-specific antigen [PSA] >10 ng/ml).Methodology:The study included thirty-three consecutive adult men with serum prostate specific antigen >10ng/ml, and systematic 12 core prostate biopsy proven prostate cancer. All the 33 patients, were evaluated with mpMRI, and 68Ga PSMA PET-CT. The biopsy specimens and imaging were evaluated for 12 sectors per prostate by a predetermined scheme.Results:MpMRI Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score ≥3 showed higher sensitivity than 68Ga PSMA PET-CT (96.3% vs. 82.4%), with similar specificity (54.5% vs. 54.5%) (n = 33 patients, 396 sectors). Combined use of MRI and 68Ga PSMA PET-CT in parallel increased sensitivity (99.5%) and NPV (98.7%) for detection of CSPCa and combined use of MRI and 68Ga PSMA PET-CT in series increased specificity (71.8%) and PPV (71.5%) (n = 33 patients, 396 sectors). ADC showed a strong negative correlation with Gleason score (r = −0.77), and the highest discriminative ability for detection and localization of CSPCa (area under curve [AUC]: 0.91), followed by Ktrans (r = 0.74; AUC: 0.89), PI-RADS (0.73; 0.86), SUVmax ratio (0.49; 0.74), and Kep (0.24; 0.66).Conclusion:MpMRI PI-RADS v2 score and 68Ga PSMA PET-CT (individually as well as in combination) are reliable tool for detection and localization of CSPCa. Quantitative MRI and 68Ga PSMA PET-CT parameters have potential to predict Gleason score and detect CSPCa.

Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making.

PurposeThe purpose of this study is to explore the value of combining bpMRI and clinical indicators in the diagnosis of clinically significant prostate cancer (csPCa), and developing a prediction model and Nomogram to guide clinical decision-making.MethodsWe retrospectively analyzed 530 patients who underwent prostate biopsy due to elevated serum prostate specific antigen (PSA) levels and/or suspicious digital rectal examination (DRE). Enrolled patients were randomly assigned to the training group (n = 371, 70%) and validation group (n = 159, 30%). All patients underwent prostate bpMRI examination, and T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences were collected before biopsy and were scored, which were respectively named T2WI score and DWI score according to Prostate Imaging Reporting and Data System version 2 (PI-RADS v.2) scoring protocol, and then PI-RADS scoring was performed. We defined a new bpMRI-based parameter named Total score (Total score = T2WI score + DWI score). PI-RADS score and Total score were separately included in the multivariate analysis of the training group to determine independent predictors for csPCa and establish prediction models. Then, prediction models and clinical indicators were compared by analyzing the area under the curve (AUC) and decision curves. A Nomogram for predicting csPCa was established using data from the training group.ResultsIn the training group, 160 (43.1%) patients had prostate cancer (PCa), including 128 (34.5%) with csPCa. Multivariate regression analysis showed that the PI-RADS score, Total score, f/tPSA, and PSA density (PSAD) were independent predictors of csPCa. The prediction model that was defined by Total score, f/tPSA, and PSAD had the highest discriminatory power of csPCa (AUC = 0.931), and the diagnostic sensitivity and specificity were 85.1% and 87.5%, respectively. Decision curve analysis (DCA) showed that the prediction model achieved an optimal overall net benefit in both the training group and the validation group. In addition, the Nomogram predicted csPCa revealed good estimation when compared with clinical indicators.ConclusionThe prediction model and Nomogram based on bpMRI and clinical indicators exhibit a satisfactory predictive value and improved risk stratification for csPCa, which could be used for clinical biopsy decision-making.

Genetic Aberrations of DNA Repair Pathways in Prostate Cancer: Translation to the Clinic.

Prostate cancer (PC) is the second most common cancer in men worldwide. Due to the large-scale sequencing efforts, there is currently a better understanding of the genomic landscape of PC. The identification of defects in DNA repair genes has led to clinical studies that provide a strong rationale for developing poly (ADP-ribose) polymerase (PARP) inhibitors and DNA-damaging agents in this molecularly defined subset of patients. The identification of molecularly defined subgroups of patients has also other clinical implications; for example, we now know that carriers of breast cancer 2 (BRCA2) pathogenic sequence variants (PSVs) have increased levels of serum prostate specific antigen (PSA) at diagnosis, increased proportion of high Gleason tumors, elevated rates of nodal and distant metastases, and high recurrence rate; BRCA2 PSVs confer lower overall survival (OS). Distinct tumor PSV, methylation, and expression patterns have been identified in BRCA2 compared with non-BRCA2 mutant prostate tumors. Several DNA damage response and repair (DDR)-targeting agents are currently being evaluated either as single agents or in combination in patients with PC. In this review article, we highlight the biology and clinical implications of deleterious inherited or acquired DNA repair pathway aberrations in PC and offer an overview of new agents being developed for the treatment of PC.

PD17-08 IMPACT OF SERIAL PROSTATE MULTIPARAMETRIC MRI ON TREATMENT FREE SURVIVAL IN MEN ON ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD17)1 Sep 2021PD17-08 IMPACT OF SERIAL PROSTATE MULTIPARAMETRIC MRI ON TREATMENT FREE SURVIVAL IN MEN ON ACTIVE SURVEILLANCE Joshua Harvey, Andrew Gusev, Jeffrey Twum-Ampofo, Alberto Pieretti, Florian Rumpf, Alice Yu, Keyan Salari, Douglas Dahl, and Adam Feldman Joshua HarveyJoshua Harvey More articles by this author , Andrew GusevAndrew Gusev More articles by this author , Jeffrey Twum-AmpofoJeffrey Twum-Ampofo More articles by this author , Alberto PierettiAlberto Pieretti More articles by this author , Florian RumpfFlorian Rumpf More articles by this author , Alice YuAlice Yu More articles by this author , Keyan SalariKeyan Salari More articles by this author , Douglas DahlDouglas Dahl More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001999.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate multiparametric magnetic resonance imaging (mpMRI) is increasingly utilized in the risk stratification of men with prostate cancer (PCa). During Active Surveillance (AS) men often receive multiple mpMRIs, yet how the findings impact their cancer outcomes is not well described. We investigated our AS cohort to assess the outcomes of men who underwent at least two prostate mpMRIs during AS METHODS: We reviewed our institutional database of 1252 men enrolled in AS for localized PCa from 1996-2016. We identified 205 men who underwent at least two prostate mpMRIs during AS. MRIs without a reported Prostate Imaging Reporting and Data System (PIRADS) version 2.0 score were excluded. Radiologic progression was defined as new lesion (PIRADS ≥ 3) on a previously negative MRI or increase in PIRADS score of a previous lesion. Multivariate logistic regression was used to evaluate if PIRADS score from serial MRI was a predictor of progression to treatment on AS. Covariates adjusted for included age, NCCN risk group, PSA density, and PIRADS score on initial MRI. A Cox proportional hazards model with PIRADS scores as time-dependent variables was used to evaluate the impact of each PIRADS score during AS on patient treatment free survival (TFS). Survival analyses were conducted using the Kaplan-Meier method. RESULTS: Median values for the cohort of 205 men were as follows: number of MRIs meeting criteria: 2 (range 2-3); follow up time: 5.1 years (IQR 3.7-7.7); time between MRIs: 2 years (IQR 1.5-2.8). On MRI 1, 10% of patients had PIRADS 3 lesions, 19% PIRADS 4, 6% PIRADS 5, while 65% were negative. On repeat MRI, 62% of PIRADS scores did not change, while 27% increased and 11% decreased. Compared to lesions that remained the same, PIRADS increase was an independent predictor of progression to treatment (OR 9.0, 95% CI 3.8-21.4, p<0.001). PIRADS decrease was not a significant predictor of outcomes, yet a negative result on repeat MRI was an independent predictor of reduced progression to treatment (OR 0.16, 95% CI 0.07-0.37, p<0.001). Overall, men with negative MRIs on AS experienced prolonged TFS compared to those with PIRADS 5 lesions, with 85% vs 48% remaining on surveillance at 5 years, respectively. CONCLUSIONS: While a majority of men did not experience PIRADS score change on serial prostate mpMRI, radiologic progression was an independent predictor of increased AS failure and progression to treatment. Men with serial negative MRIs on AS have significantly prolonged TFS and may be candidates for an increased interval between surveillance MRI and biopsy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e287-e288 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Harvey More articles by this author Andrew Gusev More articles by this author Jeffrey Twum-Ampofo More articles by this author Alberto Pieretti More articles by this author Florian Rumpf More articles by this author Alice Yu More articles by this author Keyan Salari More articles by this author Douglas Dahl More articles by this author Adam Feldman More articles by this author Expand All Advertisement Loading ...

MP02-16 EFFECT OF ROUTINELY PREOPERATIVE URETHRAL DILATION TO PREVENT URETHRAL STRICTURE AFTER TRANSURETHRAL RESECTION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-16 EFFECT OF ROUTINELY PREOPERATIVE URETHRAL DILATION TO PREVENT URETHRAL STRICTURE AFTER TRANSURETHRAL RESECTION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA Yeong Uk Kim, Jae Young Choi, Young Hwii Ko, Phil Hyun Song, Ki Hak Moon, and Hee Chang Jung Yeong Uk KimYeong Uk Kim More articles by this author , Jae Young ChoiJae Young Choi More articles by this author , Young Hwii KoYoung Hwii Ko More articles by this author , Phil Hyun SongPhil Hyun Song More articles by this author , Ki Hak MoonKi Hak Moon More articles by this author , and Hee Chang JungHee Chang Jung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture is one of the postoperative complications after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) and urethral dilation is simple and effective procedure to treat urethral stricture. However, there are no studies that have evaluated the relationship between preoperative urethral dilation and the incidence of post-TURP urethral stricture. Thus, we retrospectively investigated the effect of routinely urethral dilation just before surgery on preventing urethral stricture after TURP. METHODS: From January 2010 to December 2018, a total of 651 patients who underwent TURP for BPH was included in this study. We divided into two groups: Group A (295 patients, routinely urethral dilation before TURP) and B (356 patients, control group). We used a 26Fr resectoscope sheath, 30-degree telescope, and bipolar resectoscope. Urethral dilation was performed immediately before insertion of resectoscope sheath and 28Fr dilator was used. Urethral stricture after TURP was assessed by cystoscopy. Each patient was evaluated at 1 month, 3 months, and 6 months after TURP. The effect of urethral dilation was assessed based on International Prostate Symptom Score (IPSS), peak urine flow rate, voiding volume, and post-void residual urine. RESULTS: There were no significant differences of clinical variables, such as prostate volume, serum prostate specific antigen (PSA), age, operation time, and duration of catheterization between two groups (p >0.05). However, peak urine flow rate was significantly different between group A and B (19.87±9.12 vs 16.18±9.79, p=0.047). The incidence of urethral stricture after TURP was 4.06% (12/295) and 8.71% (31/356) in group A and B, respectively (p=0.032). CONCLUSIONS: This study demonstrated that the preoperative urethral dilation decreased the incidence of urethral stricture after TURP. We suggested that the routinely preoperative urethral dilation is simple and effective way to prevent urethral stricture after TURP for BPH. Source of Funding: No source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e18-e18 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yeong Uk Kim More articles by this author Jae Young Choi More articles by this author Young Hwii Ko More articles by this author Phil Hyun Song More articles by this author Ki Hak Moon More articles by this author Hee Chang Jung More articles by this author Expand All Advertisement Loading ...

Clinical value of transrectal ultrasound-guided puncture biopsy combined with serum prostate specific antigen level in prostate cancer.

article: Clinical value of transrectal ultrasound-guided puncture biopsy combined with serum prostate specific antigen level in prostate cancer - Panminerva Medica 2021 Sep 06 - Minerva Medica - Journals