Subsequent Biopsy Research Articles

Core needle biopsy for the diagnosis of primary soft tissue lesions: Accuracy and diagnostic challenges.

Core needle biopsy (CNB) and fine needle aspiration (FNA) are currently the most common biopsy methods for investigation of soft tissue lesions. Selection of the method to be used depends on a number of factors including diagnostic accuracy, local expertise with the techniques and the need for ancillary testing. We investigated the diagnostic accuracy of CNB and factors influencing the selection of CNB or FNA. An electronic search of the surgical pathology records for all core needle biopsies of soft tissue lesions with subsequent incisional biopsies or excisions between January 1, 2015 and December 31, 2021 was performed. Searches of the literature for publications documenting diagnostic accuracy of core biopsy and FNA were performed using the Pub Med literature data base. The electronic search yielded 177 CNBs with appropriate follow-up. Six cases were non-diagnostic. The remaining 171 cases showed an accuracy of 90% for separation of benign from malignant with two false-positive and 17 false-negative diagnoses. The literature search revealed 11 series of CNBs with a diagnostic accuracy of 74% to 97%. The literature search revealed 20 series of FNAs with an accuracy of 84.8% to 100% for separation of benign from malignant. Core needle biopsy is a highly accurate diagnostic technique with an accuracy of 90% for separation of benign from malignant lesions. The percentage of non-diagnostic cases is low (3.4%). No significant biopsy related complications were seen in this study.

A Case of Lamotrigine-Induced Inflammatory Myositis

We describe a 21-year-old woman with bipolar disorder who started taking lamotrigine 2 months ago who presented with fever and weakness. Physical examination revealed an erythematous rash over the right thenar eminence, as well as proximal muscle weakness in bilateral upper and lower extremities. Magnetic resonance imaging of the lower extremities showed patchy bilateral enhancing myositis. Right quadriceps muscle biopsy revealed inflammatory myopathy. Subsequent bone marrow biopsy demonstrated hemophagocytic lymphohistiocytosis. The patient started a prednisone taper for suspected inflammatory myositis and achieved full remission. This is one of the first descriptions of lamotrigine inducing an autoimmune response presenting as an inflammatory myositis.

Marked Hypoleptinemia precedes Overt Fat Loss in Immune Checkpoint Inhibitor-induced Acquired Generalized Lipodystrophy

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> The development of immune checkpoint inhibitors (ICIs) targeting cancer cells that evade immune T-cell regulation has revolutionized the treatment of metastatic carcinomas. Unfortunately, secondary endocrinopathies associated with ICI use, including adrenal insufficiency, primary hypothyroidism, autoimmune diabetes, and rarely hypoparathyroidism, are increasing. Lipodystrophy, presumably due to autoimmune destruction of adipocytes, leading to metabolic complications is a less well recognized adverse effect of ICI therapy. <h3>Objective/Purpose</h3> To report the clinical features and evolution of Acquired Generalized Lipodystrophy (AGL) in a patient on ICI therapy. <h3>Methods</h3> Case Report: A 66-year-old woman with metastatic lung adenocarcinoma was started on combination chemo/immunotherapy with programmed cell death-1 (PD-1) inhibitor- pembrolizumab after surgical resection of cerebellar mass and radiation. She had good tumor response but developed primary hypothyroidism and secondary adrenal insufficiency approximately ten months after initiation of ICI. <h3>Results</h3> Approximately 15 months following the treatment, she developed new-onset insulin requiring diabetes mellitus but without autoantibodies associated with type 1 diabetes. At that time, she was also noted to have hypertriglyceridemia (436 mg/dL), and elevated liver enzymes (3-4 X ULN), and a subsequent liver biopsy revealed severe macrovesicular steatosis. Her BMI was 30 kg/m2 and she had mild loss of buccal fat. Skin fold thickness measurements over the trunk and limbs were in the normal range. However, she had an undetectable serum leptin level and whole body fluorodeoxyglucose (FDG)- positron emission tomography (PET) scan, obtained for cancer surveillance, showed mild diffuse FDG activity throughout the subcutaneous tissues. She was advised low fat diet and started on insulin therapy. Over the next three months, she lost about 20 kg weight with generalized loss of subcutaneous fat from face, trunk, and extremities. Pioglitazone was started but discontinued after 4 weeks due to pedal edema and no effect on fat loss. Despite generalized lipodystrophy, she has maintained good glucose control on moderate dose insulin therapy (0.6 â€" 0.8 units/kg) and with normalization of liver enzymes and serum triglycerides. <h3>Conclusions</h3> ICI therapy can be associated with AGL, and the diagnosis must be considered in patients who develop metabolic complications such as diabetes, dyslipidemia, or steatohepatitis. Interestingly, metabolic abnormalities may precede overt fat loss. Hypoleptinemia and diffuse FDG uptake of subcutaneous tissue suggest subclinical panniculitis and adipocyte dysfunction even before clinically evident lipodystrophy.

Performance of HPV E4 and p16INK4a biomarkers in predicting regression of cervical intraepithelial neoplasia grade 2 (CIN2): protocol for a historical cohort study

IntroductionCervical intraepithelial neoplasia grade 2 (CIN2) represents a spectrum of lesions with variable progression and regression. Pathological diagnosis of CIN2 is subjective and poorly reproducible. Accurate diagnosis and identification of...

Case Report: Giant Cell Arteritis presenting with 6th Nerve Palsy without Ischemic Optic Neuropathy

Purpose: Giant cell arteritis (GCA) can be a difficult condition to identify in the early stages especially in the absence of the pathognomonic arteritic anterior ischemic optic neuropathy. Optometrists serve an important role in correctly triaging and initiating appropriate work-up and treatment for this emergent condition. This case report and review serves as a refresher of the systemic and ocular signs and symptoms of GCA. Background: GCA is a systemic autoimmune condition characterized by granulomatous inflammation of medium and large arteries in patients over 50. The most well-known constellation of signs and symptoms include new onset headache, jaw claudication, scalp tenderness, temporal artery abnormality with painless vision loss secondary to arteritic anterior ischemic optic neuropathy. However, it is important to be aware of alternate presenting signs and symptoms including pain anywhere in the distribution of the external carotid (occipital, neck, tongue, throat, ear) and signs of large vessel GCA (arm/limb claudication, chest/back pain, Raynaud’s phenomenon) and Polymyalgia Rheumatica (PMR) (bilateral hip/shoulder pain and morning stiffness). Case Report: An 86-year-old Caucasian female presents for a referred exam regarding new onset diplopia with concurrent occipital headache, neck pain and sore throat originally dismissed as symptoms of her other systemic health conditions. ESR, CRP and platelets were elevated on serology and subsequent temporal artery biopsy was positive for GCA. Oral steroids were initiated, and she was lost to follow up after her ocular symptoms resolved. Conclusion: GCA can present with a large range of manifestations, and many are nonspecific and easily attributable to other causes especially when it deviates from the classic constellation of new onset headache, jaw claudication, scalp tenderness and temporal artery abnormality with painless vision loss. Optometrists as primary eye care providers may be the first point of contact and need to be cognizant of the broader set of manifestations to minimize delays in diagnosis and treatment of this life and vision threatening condition. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/case-report-giant-cell-arteritis-presenting-with-6th-nerve-palsy-without-ischemic-optic-neuropathy) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Abstract 1184: Early-stage lung cancer detection via circulating microbial DNA biomarkers and machine learning classification

Abstract Introduction: Human tissues, including tumors, are extensively colonized by taxonomically diverse microbes. Intra-tumoral microbial activity and events of cellular turnover and trafficking contribute to shedding of microbial nucleic acids into the blood stream. Here we characterized microbial signatures (mbDNA) present in primary-tumor tissue and in the blood of patients affected with different cancer types, with particular focus on lung cancer, and we demonstrated the discriminatory power of such microbial signatures for the identification and classification of lung cancer versus other cancer types. We further validated our findings using plasma-derived cell-free microbial DNA (cf-mbDNA) to discriminate between lung cancer and cancer-free control samples. Methods: We examined The Cancer Genome Atlas (TCGA) compendium of treatment-naïve, whole genome and transcriptomic sequencing datasets to extrapolate genetic signatures of microbial origin associated with 33 different tumor types collected from 10,481 patients, which included non-neoplastic tumor-adjacent tissue and blood samples. 7.2% of TCGA sequencing reads were classified as non-human, of which 35.2% could be taxonomically classified using a reference database containing 59,974 total microbial genomes. These taxonomically assigned data sets were then used to train machine learning models (using a 70/30 train/test split for all cancers) to discriminate between and within types and stages of cancer. Results: We demonstrated that mbDNA signatures from whole blood can be used to accurately classify the tissue of origin of 20 unique cancer types, including lung adenocarcinoma and lung squamous cell carcinoma. For lung adenocarcinoma we reported high discrimination between paired tumor tissue and normal-adjacent tissue (Avg. {AUROC,AUPR}={0.85,0.95}) and between primary tumor tissue and all-other cancer types (Avg. {AUROC,AUPR}={0.96,0.69}, n=32 cancer-types). We also demonstrated the high performance of blood-derived mbDNA when discriminating among TCGA cancer types: Avg. {AUROC,AUPR}={0.97,0.80}. Subsequent liquid biopsy results using plasma-derived cf-mbDNA offer compelling evidence that cf-mbDNA signatures can robustly discriminate adenocarcinoma lung-cancer samples from non-cancer controls. Conclusion: mbDNA holds considerable promise as a truly orthogonal means of detecting and classifying lung cancer independently from host genomic alternations. Using only mbDNA signatures we have demonstrated robust discrimination between cancer-free controls and lung cancer samples and have provided early evidence of the applicability of this approach to liquid biopsy. Our present efforts analyzing plasma cf-mbDNA with an expanded sample cohort will serve to fully validate this new class of liquid biopsy biomarkers for lung cancer detection. Citation Format: Gregory D. Sepich-Poore, Serena Fraraccio, Stephen Wandro, Rob Knight, Sandrine Miller-Montgomery, Eddie Adams. Early-stage lung cancer detection via circulating microbial DNA biomarkers and machine learning classification [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1184.

Cyto-histo correlation and false-negative urine: Before and after the Paris system for reporting urinary cytology.

The impact of implementing the Paris system (TPS) on the rate of discrepant cases in the negative for high-grade urothelial carcinoma (NHGUC) category that had a subsequent diagnosis of high-grade urothelial carcinoma (HGUC) on histology is not well studied. We adopted TPS in May 2019. We searched discrepant cases with negative urine cytology 2017-2019 in our cyto-histo correlation database. The urine cytology and follow-up biopsy/resection were reviewed by a cytopathologist who also did Genitourinary (GU) Pathology subspecialty sign-out. Voided urine and instrumented urine were included in this study. There were total of 70 discrepant cases with negative cytology interpretation but HGUC on the subsequent biopsy or resected specimen. Following the TPS criteria, the rate of discrepant negative cytology cases increased from 6 cases between January 2017 and May 2019 to 64 cases after May 2019 when we adopted TPS. There were 2 discrepant negative cases in 2017, 3 cases in 2018, and 65 cases in 2019. Out of 65 cases in 2019, 64 cases were identified after May 2019. Additional 55 urine cytology slides were reviewed according to the TPS criteria, of which, the diagnoses remained unchanged in 45 (82%) cases and 10 (19%) cases were reassigned to either atypical or suspicious categories. The discrepancy was noted more on the instrumented urine and the upper tract urine. However, the false-negative rate rose faster in voided urine and lower tract urine. The risk of HGUC with the category of NHGUC was 0.03% in 2017, 0.05% in 2018, and 1.06% in 2019 at our institution. The increase in false-negative rate could not be attributed to a single cytopathologist. After adopting TPS for reporting urine cytology, there was an increase in HGUC from negative urine cytology which was subsequently confirmed on histology as cases of HGUC. The quality control of negative urines could be important monitoring the process when implementing TPS.

Axillary surgery after neoadjuvant chemotherapy in breast cancer patients downstaging from cN+ to ycN0.

e12580 Background: Axillary lymph node dissection is a redundant method of surgical treatment and axillary staging for a large number of patients receiving neoadjuvant therapy with positive lymph nodes before NCT. Methods: The study included 212 patients with breast cancer (cT1-3N1M0) who received treatment at the breast tumors department of the N.N. Petrov NMRC of Oncology from 2019 to 2021 All patients included in the study had the cN1 initial status of the axillary lymph nodes. All patients underwent neoadjuvant systemic therapy and subsequent sentinel lymph node biopsy (SLNB). In patients with pathomorphologically proven metastatic lymph nodes (cN1) even at the initial diagnosis, lymph node marking was performed before the start of NCT and targeted axillary lymph node dissection after the completion of neoadjuvant systemic therapy. In the same patients, after SLNB and targeted axillary lymph node dissection, a complete (standard) axillary lymph node dissection was performed to determine the false-negative rate and the oncological safety of the procedure. Results: The identification rate of only one sentinel lymph node was 21% (40 out of 193 patients), two sentinel lymph nodes - 30% (58 out of 193 patients), more than 3 - 49% (95 out of 193 patients). When only 1 sentinel lymph node was found, the false-negative rate of SLNB was 20.0% (4 of 20) (95% CI, 5.7 to 43.7). When two sentinel lymph nodes were found, the false-negative rate of SLNB was 20.0% (6 of 30) (95% CI, 7.7 to 38.6). When three sentinel lymph nodes were found, the false negative rate of SLNB was 4.7% (2 of 43) (95% CI, 0 to 15.8). Among 45 patients who had a microseed with the iodine-125 radioisotope installed before the start of treatment, the frequency of identifying a marked node was 100%. In 19 patients, tumor cells were found in the lymph nodes. The false-negative rate of targeted axillary dissection in combination with SLNB was 5.3% (1 of 19) (95% CI, 0 to 26.0). Conclusions: Targeted axillary dissection and sentinel lymph nodes biopsy, provided that 3 SLNs are removed, are reliable methods for identifying patients in whom systemic therapy is guaranteed to achieve complete response of regional lymph nodes (ypN0), thereby relieving patients of the need to perform a crippling complete axillary lymph node dissection. Clinical trial information: 3/198.

Phase Ib/IIa trial of CEND‐1 in combination with neoadjuvant FOLFIRINOX-based therapies in pancreatic, colorectal, and appendiceal cancers (CENDIFOX).

TPS4195 Background: The efficacy of chemotherapy is often compromised due to poor penetration of drugs in solid tumors. The tumor microenvironment, which is characterized by dense extracellular matrix‐rich stroma that creates a physical barrier to penetration of anti‐cancer drugs, is especially pronounced in Pancreatic Ductal Adenocarcinoma (PDAC) and in peritoneal metastases from Colorectal/Appendiceal Adenocarcinoma. CEND‐1 is a tumor‐penetrating peptide (scientifically also known as iRGD) that has preclinically demonstrated to enhance the tumor penetration of chemotherapy agents through binding and activation of alphav-integrins and neuropilin‐1 (NRP-1). The 2-step mechanism leads to a higher delivery and concentration of chemotherapeutics selectively in the tumor, while sparing normal tissue. Hence CEND-1 therapy has the potential to improve the efficacy of anti‐cancer therapies and reduce side effects through increased tumor access, specificity, and sensitivity. We hypothesize that CEND‐1 may become a powerful adjuvant that safely enhances standard anti‐neoplastic therapy in the neoadjuvant setting for the above populations. Methods: A safety lead-in 6-9 patients (Phase Ib) will be followed by an open label, single arm, parallel (3 cohorts) Phase IIa study. A total of 50 patients (20 PDAC, 15 colorectal/appendiceal with peritoneal metastases, 15 oligometastatic colorectal) will be enrolled. A starting CEND-1 dose of 3.2 mg/kg in combination with the standard doses of FOLFIRINOX (+/- Panitumumab if RAS/RAF wild type) will be used for the safety lead-in. CEND-1 dose will be lowered for Phase IIa if &gt; 1/6 patients experienced DLTs. Participants enrolled will receive standard doses of FOLFIRINOX q2w +/- Panitumumab q2w 6mg/kg IV q2w (14-day cycles) for Cycles 1-3. After a subsequent research biopsy, the CEND-1 + chemotherapy combo will be continued at RP2D q2w for cycles 4-6, followed by CEND-1 +/- Panitumumab ̃72h prior to resection. Assessment of tumor response using RECIST v1.1 will be done every 3 cycles. Up to 10 patients may receive Panitumumab. Eligible Pts are untreated, newly diagnosed, resectable/borderline resectable PDAC or colorectal/appendiceal adenocarcinoma with peritoneal metastases or oligometastases eligible for cytoreductive surgery, as determined by multidisciplinary evaluation. Inclusion criteria also include ECOG PS 0-1, adequate organ function, measurable or evaluable disease. Primary objectives are safety and biological activity of CEND‐1. Secondary objectives include ORR, R0 resection rate, DFS, OS. Exploratory objectives include pathologic response, tissue immune response, EGFR expression, tumor tissue-to-plasma concentration of Panitumumab pre and post CEND-1 treatment. Enrollment to the CENDIFOX trial is currently ongoing. Clinical trial information: NCT05121038.

Diffuse Bone Marrow Involvement of Multiple Myeloma on [18F]PSMA-1007 PET/CT

A 71-year-old man presented with chronic anemia (hemoglobin 7.3 g/dL). Further serum analyses showed elevated prostate-specific antigen (13 ng/mL), suggestive of prostate cancer. However, ultrasound-guided transrectal sextant biopsy did not find any evidence of prostate cancer. In order to improve guidance of intended repeated biopsy, [ 18 F]prostate-specific membrane antigen (PSMA) 1007 PET/CT was performed, which showed a solitary lesion with strong PSMA expression in the left peripheral zone in the prostate gland. Surprisingly, also a diffuse bone marrow involvement with predominantly osteolytic lesions was observed. This massive osseous tumor burden was clearly discordant to the only relatively mild elevated prostate-specific antigen. The subsequent bone biopsy revealed multiple myeloma. This case does not only highlight a possible pitfall on PSMA PET/CT, but also raises the question on how far PSMA ligands may offer diagnostic and therapeutic potential in multiple myeloma.

Quantitative water T2 relaxometry in the early detection of neuromuscular diseases: a retrospective biopsy-controlled analysis

ObjectivesTo assess quantitative water T2 relaxometry for the early detection of neuromuscular diseases (NMDs) in comparison to standard qualitative MR imaging in a clinical setting.MethodsThis retrospective study included 83 patients with suspected NMD who underwent multiparametric MRI at 3 T with a subsequent muscle biopsy between 2015 and 2019. Qualitative T1-weighted and T2-TIRM images were graded by two neuroradiologists to be either pathological or normal. Mean and median water T2 relaxation times (water T2) were obtained from manually drawn volumes of interests in biopsied muscle from multi-echo sequence. Histopathologic pattern of corresponding muscle biopsies was used as a reference.ResultsIn 34 patients, the T1-weighted images showed clear pathological alternations indicating late-stage fatty infiltration in NMDs. In the remaining 49 patients without late-stage changes, T2-TIRM grading achieved a sensitivity of 56.4%, and mean and median water T2 a sensitivity of 87.2% and 97.4% to detect early-stage NMDs. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.682, 0.715, and 0.803 for T2-TIRM, mean water T2, and median water T2, respectively. Median water T2 ranged between 36 and 42 ms depending on histopathologic pattern.ConclusionsQuantitative water T2 relaxometry had a significantly higher sensitivity in detecting muscle abnormalities than subjective grading of T2-TIRM, prior to late-stage fatty infiltration signal alternations in T1-weighted images. Normal-appearing T2-TIRM does not rule out early-stage NMDs. Our findings suggest considering water T2 relaxometry complementary to T2-TIRM for early detection of NMDs in clinical diagnostic routine.Key Points• Quantitative water T2 relaxometry is more sensitive than subjective assessment of fat-suppressed T2-weighted images for the early detection of neuromuscular diseases, prior to late-stage fatty infiltration signal alternations in T1-weighted images.• Normal-appearing muscles in fat-suppressed T2-weighted images do not rule out early-stage neuromuscular diseases.• Quantitative water T2 relaxometry should be considered complementary to subjectively rated fat-suppressed T2-weighted images in clinical practice.

Impact of enema prep on the false-negative rate of a PI-RADS 1 MRI of the prostate for clinically significant prostate cancer.

To investigate whether use of an enema prep reduces the false-negative (FN) rate of PI-RADS 1 MRI of the prostate for clinically significant prostate cancer (csPCa). 1108 consecutive patients with a PI-RADS 1 MRI performed 01/2016-09/2021 were retrospectively collected. Patient charts were examined for subsequent systematic prostate biopsy performed within 1 year if positive or anytime thereafter if negative. Patients without biopsy were excluded. Use of an enema prep 1-2h before MRI, which was implemented in 03/2019, was recorded. FN rate of MRI for detection of csPCa, defined as Gleason score ≥ 7, using systematic biopsy was assessed per patient and compared between those with and without an enema prep. Χ2 test and logistic regression were performed. 255 patients (median age 64, IQR 58-69) with median PSA 5.6 (IQR 4.2-8.1), PI-RADS 1 MRI, and subsequent biopsy were included in the analysis. 66 patients (26%) had an enema prep and 189 patients (74%) did not. 7 (11%) patients with and 21 (11%) patients without enema prep had a FN biopsy. There was no significant association between enema prep and FN biopsy (OR 0.95, 95% CI 0.38-2.35, p = 0.91). Use of an enema prep prior to prostate MRI did not decrease the FN rate of PI-RADS 1 MRI of the prostate for clinically significant prostate cancer.

Prevalence and clinical significance of portal inflammation, portal plasma cells, interface hepatitis and biliary injury in liver biopsies from patients with non-alcoholic steatohepatitis

The significance of portal tract histological changes in non-alcoholic fatty liver disease (NAFLD) remains unclear. In 2019, CymaBay Therapeutics halted clinical trials of seladelpar (a PPARδ agonist) because initial end-of-treatment liver biopsies of patients with non-alcoholic steatohepatitis (NASH) showed concerning features of portal inflammation with plasma cells, interface hepatitis and focal bile duct abnormalities. Adjudication concluded that these findings were present in the initial, as well as the subsequent biopsies. Thus, this study's aim was to determine the prevalence and clinical significance of portal inflammation, portal plasma cells, interface hepatitis and features of bile duct damage in liver biopsies of adult patients with NAFLD. The pathology database was searched for cases of NAFLD, including steatosis alone and NASH, from January 2016 to October 2020. Liver biopsies were selected from age and sex matched adult patients with diagnoses of steatosis alone (n=10), NASH fibrosis stage 1 (n=10), stage 2 (n=10), stage 3 (n=10), and stage 4 (n=10). There were 24 males and 26 females with a mean age of 48 years (range 20-79). Exclusion criteria included age <18 years, daily alcohol intake >14 drinks per week, elevation of alkaline phosphatase level, comorbid chronic liver disease, or liver biopsy performed as part of a clinical trial for NASH. Control liver biopsies were selected from age and sex matched persons without significant steatosis and normal liver biochemical tests (n=10). Histological parameters were evaluated in 10 portal tracts or 10 septal areas in each liver biopsy. Portal inflammation and interface hepatitis were graded on a scale of 0-4. Portal plasma cells and bile duct damage were scored from 0-3. Ductular proliferation was assessed by CK7 immunostain and graded from 0-4. NASH biopsies with advanced fibrosis (stage 3 and 4) showed portal inflammatory infiltrates (score 2-3) with readily identifiable plasma cells (score 2), and mild to moderate interface hepatitis (score 2-3). All cases and controls showed focal, mild cholangiocyte changes, characterised by cytoplasmic vacuolation, segmental loss of nuclei, nuclear disarray and apoptosis. NASH patients with advanced fibrosis had frequent and diffuse cholangiocyte changes, along with focal lymphocytic cholangitis and moderate to marked ductular reaction (score 3-4). Histopathological features of advanced NASH frequently include increased portal inflammation with plasma cells, interface hepatitis, cholangiocyte injury and prominent ductular reaction.

MP43-07 NEGATIVE PROSTATE MRI AS A PREDICTOR OF DISEASE STABILITY IN PATIENTS ON ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 May 2022MP43-07 NEGATIVE PROSTATE MRI AS A PREDICTOR OF DISEASE STABILITY IN PATIENTS ON ACTIVE SURVEILLANCE Jacob Enders, Michael Rothberg, Zach Kozel, Michael Daneshvar, Luke O'Connor, Alex Wang, Cheyenne Williams, Nitin Yerram, Sandeep Gurram, Maria Merino, Baris Turkbey, Bradford Wood, and Peter Pinto Jacob EndersJacob Enders More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Zach KozelZach Kozel More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Luke O'ConnorLuke O'Connor More articles by this author , Alex WangAlex Wang More articles by this author , Cheyenne WilliamsCheyenne Williams More articles by this author , Nitin YerramNitin Yerram More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Maria MerinoMaria Merino More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) for prostate cancer (PCa) increasingly relies on regularly scheduled imaging with multiparametric MRI (mpMRI) and subsequent prostate biopsy. However, MRI scans are costly and time-consuming, and transrectal biopsies can cause significant patient morbidity due to infection. As such, patients may benefit from avoiding biopsy when the results are unlikely to change clinical management. We sought to identify patients in our AS cohort undergoing annual mpMRI and subsequent MRI-US fusion systematic and targeted biopsy who had no lesions detected on MRI and examine rates and risk factors for disease upgrading. METHODS: A prospectively maintained retrospective database of patients with biopsy-proven PCa on AS at our institution was queried to find patients with no distinct lesion on surveillance mpMRI who underwent subsequent MRI-US fusion biopsy from 2007 to 2019. Patient demographics and information from prostate mpMRI and biopsy were collected, with clinically significant prostate cancer (csPCa) defined as Gleason grade group 2 or higher. A logistic regression model was constructed to examine risk factors for upgrading to csPCa at biopsy using JMP v16.0 (SAS Institute, NC). RESULTS: 466 patients on AS with at least one surveillance mpMRI were identified. Patients underwent an median of 4 MRIs across a median duration on AS of 3.4 years. The median age was 65.0 years (IQR: 60 – 69), median PSA was 5.4 ng/mL (IQR: 3.3 – 7.8), and median PSA density was 0.086 ng/mL/cc (IQR: 0.057 – 0.113). 120/466 (25.7%) patients had at least one surveillance mpMRI showing no distinct lesions in the prostate. Of these, 73/120 (60.8%) patients underwent at least one subsequent biopsy. Across 95 biopsy sessions in these 73 patients, 33/95 (34.7%) showed equal-grade and 47/95 (49.5%) showed lower-grade cancers compared to previous pathology. 10/95 (10.5%) biopsies in 9/73 (12.4%) patients showed upgrading to csPCa. A multivariate logistic regression model showed increased PSA density was a significant predictor of upgrading to csPCa at biopsy (OR: 4.2 for increase of 0.100 ng/mL/cc, 95% CI: 1.5-11.9, p <0.01). CONCLUSIONS: Negative mpMRI while on AS for prostate cancer resulted in equal grading or downgrading in the vast majority of patients undergoing subsequent biopsy. Patients with a negative mpMRI were more likely to be upgraded to csPCa with increasing PSA density. Thus, patients with a negative mpMRI, especially in the setting of a low PSA density, may be able to defer biopsy given the low likelihood for disease upgrading. Source of Funding: The National Institute of Health (NIH) Medical Research Scholars Program, Foundation for the NIH, NIH Intramural Research Program © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e743 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Enders More articles by this author Michael Rothberg More articles by this author Zach Kozel More articles by this author Michael Daneshvar More articles by this author Luke O'Connor More articles by this author Alex Wang More articles by this author Cheyenne Williams More articles by this author Nitin Yerram More articles by this author Sandeep Gurram More articles by this author Maria Merino More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD40-07 CLINICAL DECISION ALGORITHM USING RESTRICTION SPECTRUM IMAGING AND BIOMARKERS TO PREDICT UPGRADING IN ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 May 2022PD40-07 CLINICAL DECISION ALGORITHM USING RESTRICTION SPECTRUM IMAGING AND BIOMARKERS TO PREDICT UPGRADING IN ACTIVE SURVEILLANCE Stefan Eng, Benjamin Basasie, Alfonso Lam, John Semmes, Dean Troyer, Geoffrey Clarke, Abhijit Sunnapwar, Robin Leach, Teresa Johnson-Pais, Lori Sokoll, Daniel Chan, Jeffrey Tosoian, Javed Siddiqui, Arul Chinnaiyan, Paul Boutros, and Michael Liss Stefan EngStefan Eng More articles by this author , Benjamin BasasieBenjamin Basasie More articles by this author , Alfonso LamAlfonso Lam More articles by this author , John SemmesJohn Semmes More articles by this author , Dean TroyerDean Troyer More articles by this author , Geoffrey ClarkeGeoffrey Clarke More articles by this author , Abhijit SunnapwarAbhijit Sunnapwar More articles by this author , Robin LeachRobin Leach More articles by this author , Teresa Johnson-PaisTeresa Johnson-Pais More articles by this author , Lori SokollLori Sokoll More articles by this author , Daniel ChanDaniel Chan More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Javed SiddiquiJaved Siddiqui More articles by this author , Arul ChinnaiyanArul Chinnaiyan More articles by this author , Paul BoutrosPaul Boutros More articles by this author , and Michael LissMichael Liss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002601.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the relative value and optimal combination of radiologic and molecular biomarkers to predict prostate cancer progression in men on active surveillance. METHODS: We prospectively enrolled 123 men with prostate cancer on active surveillance who were undergoing repeat biopsy to obtain an MRI and non-invasive biomarkers that predict the risk of upgrading. Subjects underwent a prostate multiparametric MRI and a short duration, diffusion-weighted enhanced MRI called restriction spectrum imaging (RSI) to generate a restricted signal map (RSM) along with evaluation of 30 features (14 clinico-epidemiologic features, 9 molecular biomarkers and 7 radiologic-associated features). Our primary outcome was upgrading to higher grade disease on subsequent active surveillance prostate biopsy. Statistical analysis evaluated AUROC and AUPRC, and improvements in these. Using the data, we then devised a clinical decision algorithm to best predict upgrading using the tested biomarkers. RESULTS: RSM (RSI-MRI biomarker) was the most accurate single biomarker in predicting upgrading at the subsequent active surveillance biopsy (AUROC=0.84; 95%CI: 0.71-0.96). RSI improved a baseline clinical model that included MRI PIRADSv2 scores from an AUROC of 0.74 (95%CI 0.69-0.80) to 0.84 (95% CI 0.79–0.89). The best non-imaging biomarker was the prostate volume corrected Prostate Health Index (PHI) density (AUROC=0.68; 95%CI: 0.53-0.82). Combining these with age as a clinical decision tree to perform or not perform a biopsy using cross validated statistics we reach an AUC of the model at 0.8 (SD 0.18). CONCLUSIONS: Enhancement of diffusion-weighted imaging using RSI in addition to standard PIRADSv2 scoring, PHI, and age provides improvement to the predictive ability of MRI to detect upgrading in active surveillance. A combination of multiple biomarkers in a clinical decision tree improves prediction of groups at high risk for future upgrading. Source of Funding: Department of Defense © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e686 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefan Eng More articles by this author Benjamin Basasie More articles by this author Alfonso Lam More articles by this author John Semmes More articles by this author Dean Troyer More articles by this author Geoffrey Clarke More articles by this author Abhijit Sunnapwar More articles by this author Robin Leach More articles by this author Teresa Johnson-Pais More articles by this author Lori Sokoll More articles by this author Daniel Chan More articles by this author Jeffrey Tosoian More articles by this author Javed Siddiqui More articles by this author Arul Chinnaiyan More articles by this author Paul Boutros More articles by this author Michael Liss More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD03-01 MRI AS FIRST INVESTIGATION IN MEN WITH ELEVATED PSA. POPULATION-BASED COHORT STUDY

You have accessJournal of UrologyCME1 May 2022PD03-01 MRI AS FIRST INVESTIGATION IN MEN WITH ELEVATED PSA. POPULATION-BASED COHORT STUDY David Robinsson, Hans Garmo, Delshad Nasrollah, Tiago Bonde Miranda, and Pär Stattin David RobinssonDavid Robinsson More articles by this author , Hans GarmoHans Garmo More articles by this author , Delshad NasrollahDelshad Nasrollah More articles by this author , Tiago Bonde MirandaTiago Bonde Miranda More articles by this author , and Pär StattinPär Stattin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002518.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In randomized controlled trials of men with elevated PSA, MRI before prostate biopsy resulted in fewer insignificant cancers defined as Gleason Score ≤6 while the detection of significant cancers defined as Gleason Score ≥7 increased. The aim of this study was assessed if these results from RCT’s can be reproduced in clinical practice including all men with elevated PSA in a region. METHODS: Data on all PSA values between 2010-2020 and all prostate biopsies performed in 2005-2020 and use of MRI were collected for all men in the region of Jönköping. These data were linked to The National Prostate Cancer Register. Before 1 January 2020 only select cases underwent MRI whereas after that, there was unlimited access to MRI in this region. Results for all men who underwent biopsy 2016-2019 when prior use of MRI was low was compared to all men who underwent biopsy in 2020 when usage of MRI was high. Outcome was number of men who underwent prostate biopsy, benign or malignant pathology report, and distribution of Gleason score. RESULTS: First investigation in men with elevated PSA was 66 MRIs in 2016 and 681 MRIs in 2020. Out of these 681 MRIs, 317 were performed on men who had undergone at least one previous biopsy set with negative result before MRI, their risk of cancer was 9 % on biopsy after MRI. In contrast, 51 % of biopsy naive men who underwent an MRI had cancer on subsequent biopsy. The number of men who performed a biopsy as first investigation was 630 in 2016 and 190 in 2020. The median PSA was 8.5 ng/mL in 2016-2019 vs 8.0 in 2020. In 2020, 499 biopsies were performed vs an average of 598 in 2016-2019. The number of biopsies without cancer was 167 for 2020 vs an average of 216 in 2016-2019. There was no difference in the number of significant tumors between 2020 and 2016-2019, 267 in 2020 vs an average of 256 in 2016-2019. In contrast, there was a decrease from an average of 126 insignificant cancers per year in 2016-2019 vs. 65 in 2020, (figure). CONCLUSIONS: When MRI became available without any limitations in our region, the number of prostate biopsy sessions decreased by 20%, the numbers of significant tumors remained the same, and the number of insignificant cancers decreased by 48%. Source of Funding: Stiftelsen fonden klinisk cancerforskning i Jönköping © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e41 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Robinsson More articles by this author Hans Garmo More articles by this author Delshad Nasrollah More articles by this author Tiago Bonde Miranda More articles by this author Pär Stattin More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP43-15 A 5-YEAR PROSPECTIVE STUDY OF AFRICAN AMERICAN MEN ON PROSTATE CANCER ACTIVE SURVEILLANCE: DOES RACE PREDICT UPGRADING?

You have accessJournal of UrologyCME1 May 2022MP43-15 A 5-YEAR PROSPECTIVE STUDY OF AFRICAN AMERICAN MEN ON PROSTATE CANCER ACTIVE SURVEILLANCE: DOES RACE PREDICT UPGRADING? Joshua Pincus, Jacob W. Greenberg, Christopher Koller, Jonathan Silberstein, and L. Spencer Krane Joshua PincusJoshua Pincus More articles by this author , Jacob W. GreenbergJacob W. Greenberg More articles by this author , Christopher KollerChristopher Koller More articles by this author , Jonathan SilbersteinJonathan Silberstein More articles by this author , and L. Spencer KraneL. Spencer Krane More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is a widely accepted management option for patients with very low and low risk prostate cancer (PCa) to minimize side effects of treatment without compromise of disease mortality. However, most large single institution studies are underrepresented for men from African American (AA) heritage. In this large prospective cohort we hypothesized that race was not associated with Gleason upgrading (GU) for patients electing AS. METHODS: All patients who elected AS for PCa at the Southeast Louisiana Veterans Health Care System are entered into a prospectively managed observational database. Patients were divided into groups based on self-reported race. GU was defined as an increase in WHO grade group (GG) on subsequent biopsy over GG 1. All tests were two sided using a significance of 0.05. RESULTS: 228 men were enrolled in the study, including 154 AA and 74 CA men, with a median follow-up of 5 years from the initiation of AS. At the time of diagnostic biopsy, there was no significant difference with respect to age, family history of PCa, smoking status, PSA, PSA density, prostate volume, or number of positive cores (all P values > 0.05). AA race was not predictive of GU on Cox multivariate analysis (Table 1), with a hazard ratio (HR) of 1.02 and 95% CI of 0.65 - 1.61 (P = 0.92). Number of positive cores was correlated with GU (HR = 1.32, CI 1.17-1.48, P < 0.0001). On Kaplan-Meier analysis (Figure 1), the 2.5-year GU-Free survival probability was 71% for AA (CI 63% - 78%) and 72% for CA (CI 63% - 83%). At 5 years, AA GU-free survival probability was 48% (CI 40% - 58%) versus 58% for CA (CI 46% - 72%). Risk of GU was similar between races (p=0.35) at both 2.5 and 5 years with 47% of all patients remaining on AS or without local curative therapy. CONCLUSIONS: AS is a safe treatment option for low and very low risk PCa, regardless of race. AA and CA men did not have any significant difference in GU in our cohort with five-year follow up. Importantly, our study is conducted in an equal access setting and includes a large prospective cohort of AA patients on AS for PCa. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e747 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Pincus More articles by this author Jacob W. Greenberg More articles by this author Christopher Koller More articles by this author Jonathan Silberstein More articles by this author L. Spencer Krane More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD11-04 THE LIMITED UTILITY OF PROSTATE HEALTH INDEX IN AFRICAN AMERICAN MEN WITH A PSA 4-10

You have accessJournal of UrologyCME1 May 2022PD11-04 THE LIMITED UTILITY OF PROSTATE HEALTH INDEX IN AFRICAN AMERICAN MEN WITH A PSA 4-10 Kostantinos Morris, Judd Moul, and Srinath Kotamarti Kostantinos MorrisKostantinos Morris More articles by this author , Judd MoulJudd Moul More articles by this author , and Srinath KotamartiSrinath Kotamarti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate Health Index (PHI) is a blood test approved for men being evaluated for prostate cancer (PCa) with a prostate specific antigen (PSA) in the “gray zone” of 4-10 ng/ml. As such, in the largest examination of PHI in African American (AA) men, we sought to assess PHI utility in the pre-biopsy work-up of this demographic, who notably were minimally represented in the original validation studies. METHODS: AA men in the Duke Health System with a PSA of 4-10 ng/mL, a PHI score, and subsequent prostate biopsy between 2016-2020 were identified. Established PHI cutoffs were utilized to stratify patients (Table 1). Multivariable logistical regressions were performed to assess possible predictors of cancer detection with the lowest PHI cutoff serving as reference. Clinically significant cancer (CSC) was defined as Gleason ≥7. RESULTS: A total of 1,131 AA men underwent PHI testing, and 236 met final inclusion criteria. Average age was 61.2 years. Mean PSA and PHI for the entire cohort were 6.5 ng/ml (SD 1.7) and 48.5 (SD 21.6), respectively. Detection rate at biopsy was 64.0% (n=151) for any PCa, ranging from 48.0% for PHI 0-26.9 to 84.1% for PHI ≥55 (Table 1). For CSC, overall detection rate was 44.5% (n=105), ranging from 24.0% for PHI 0-26.9 to 66.7% for PHI ≥55 (Table 1). On multivariable analysis, PHI ≥55 cutoff was the only PHI category associated with identification of all PCa (OR 5.66, p <0.01) and CSC (OR 6.15, p <0.01) (Table 2). CONCLUSIONS: Two-thirds of patients in the highest PHI category (≥ 55) were found to have CSC. This cutoff was the only stratification significantly associated with PCa detection. However, alarmingly, all established PHI cutoffs featured high rates of PCa and CSC. While elevated PHI in AA men with equivocal PSA should be regarded with heightened suspicion, our findings also highlight the difficulty in identifying patients at low risk who may benefit from a less fastidious approach. Likely, the current established stratification for PHI needs to be re-evaluated for the high-risk cohort of AA men. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e190 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kostantinos Morris More articles by this author Judd Moul More articles by this author Srinath Kotamarti More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP53-12 HOW DO PSA-BASED MARKERS PREDICT CLINICALLY SIGNIFICANT PROSTATE CANCER (CSPCA) ON PROSTATE BIOPSY INDEPENDENT OF PROSTATE SIZE

You have accessJournal of UrologyCME1 May 2022MP53-12 HOW DO PSA-BASED MARKERS PREDICT CLINICALLY SIGNIFICANT PROSTATE CANCER (CSPCA) ON PROSTATE BIOPSY INDEPENDENT OF PROSTATE SIZE Max Kuster, Michelle Ou, Jacob Gaines, Eric Macdonald, and Simon Hall Max KusterMax Kuster More articles by this author , Michelle OuMichelle Ou More articles by this author , Jacob GainesJacob Gaines More articles by this author , Eric MacdonaldEric Macdonald More articles by this author , and Simon HallSimon Hall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both PSA density (PSAD) and PSA based makers (4k and PHI) are used to guide prostate biopsy decisions. In this study we examined the correlation between percent free PSA (%fPSA) and PSAD, as well as their potential combined use in determining csPCa risk. METHODS: We identified 331 patients from an IRB-approved prostate MRI database without a prior diagnosis of prostate cancer, who had an mpMRI, %fPSA and PSAD at the time of imaging, and a subsequent prostate biopsy within 1.5 years. The relationship between %fPSA and PSAD was analyzed using Pearson correlation. Logistic regression and ROC curves were used to test the diagnostic ability of %fPSA, PSAD, and %fPSA + PSAD. Detection rates of csPCa, defined as Gleason grade (GG) group ≥2, were compared among cohorts. RESULTS: The Pearson correlation coefficient for %fPSA and PSAD was -.349 (p < .001). ROC analysis predicting csPCa yielded an AUC of .712 for PSAD, .638 for %fPSA, and .718 for the combined PSAD+%fPSA model. We noted that there were “outliers” in terms of low %fPSA and low PSAD and vice versa. As such, we analyzed low risk (Cohort 1: %fPSA>20 and PSAD <0.15, N=54) and high risk (Cohort 2: %fPSA<10 and PSAD>0.15, N=79) groups against the restrictive associated “outlier” groups (Cohort 3: %fPSA>20 & PSAD>0.15, N=14 and Cohort 4: %fPSA<10 & PSAD<0.15, N=7). The low-risk cohort showed a csPCa rate of 25.9% while the high-risk cohort showed a rate of 74.7%, a significantly higher rate (p < .001). Cohort 3 showed a significantly higher csPCa rate and average GG group (78.6% and 2.64) than Cohort 1 (25.9% and 1.04, both p < .001). There were no significant differences in csPCa between the two low-%fPSA cohorts (2 and 4), the two high-PSAD cohorts (2 and 3), the two low-PSAD cohorts (1 and 4), or the two outlier cohorts (3 and 4). CONCLUSIONS: This analysis notes an inverse correlation between PSAD and %fPSA and may explain the ability of PSA-based markers utilizing %fPSA to predict cancer risk independent of prostate size. The higher AUC of PSAD compared with %fPSA and the negligible change in diagnostic efficacy when adding %fPSA to a PSAD-based model suggest that PSAD is a more powerful metric than %fPSA for the prediction of csPCa. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e899 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Kuster More articles by this author Michelle Ou More articles by this author Jacob Gaines More articles by this author Eric Macdonald More articles by this author Simon Hall More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD17-05 CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH PIRADS 5 LESIONS AND NEGATIVE BIOPSIES

You have accessJournal of UrologyCME1 May 2022PD17-05 CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH PIRADS 5 LESIONS AND NEGATIVE BIOPSIES Eric Li, Mohammad Siddiqui, Jonathan Aguiar, Brandon Ansbro, Parth Shah, Moataz Soliman, Jordan Rich, Jasmine Lin, Johan Alfaro Carballo, Mary Kate Keeter, Quan Mai, Edward Schaeffer, and Ashley Ross Eric LiEric Li More articles by this author , Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Parth ShahParth Shah More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Jordan RichJordan Rich More articles by this author , Jasmine LinJasmine Lin More articles by this author , Johan Alfaro CarballoJohan Alfaro Carballo More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002555.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Best evidence supports use of mpMRI prior to initial diagnosis of prostate cancer. PIRADS 5 lesions typically have a 80-90% concordance with diagnosis of clinically significant disease. Here we investigate the characteristics and outcomes of patients with PIRADS 5 lesions and subsequent negative biopsies. METHODS: We queried our institutional database for men without an established diagnosis of prostate cancer for whom MRI targeted biopsy was performed after demonstration of a PIRADS 5 lesion from March 2018-present. T test, chi-squared test, and logistic regression were performed. RESULTS: 2,206 men underwent MRI for suspicion of prostate cancer, with PIRADS 5 lesions detected in 268 patients. 257 of these men underwent prostate biopsy (13 with transperineal biopsy) with a positivity rate of 93.8%. Men with PIRADS 5 lesions and negative biopsies (n=16) were more likely to be African American (25% vs 13.3%, p<0.001), younger (61.4 vs 66.3, p=0.03), have larger prostates (80.3 g vs 48.4 g, p<0.001), and have lower prostate health index (PHI, 44.3 vs. 78.2, p=0.04). There was no significant difference in anterior lesions, prostate inflammation, PSA, or PSA density. Of men with negative prostate biopsies, 1 patient was subsequently diagnosed with prostate cancer, and 2 patients had bladder outlet procedures with negative pathology. 2 patients with negative biopsies previously received BCG for non-muscle invasive bladder cancer and were subsequently found to have inflammation on prostate biopsy. CONCLUSIONS: Men with PIRADS 5 lesions and negative prostate biopsies tend to be African American, younger, have larger prostates, and have lower PHI compared to patients with positive prostate biopsies. Additional investigation is needed to determine lesion location is a risk factor for undersampling that may benefit from transperineal prostate biopsy, as well as the role of inflammation in determining how to follow these patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e337 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Li More articles by this author Mohammad Siddiqui More articles by this author Jonathan Aguiar More articles by this author Brandon Ansbro More articles by this author Parth Shah More articles by this author Moataz Soliman More articles by this author Jordan Rich More articles by this author Jasmine Lin More articles by this author Johan Alfaro Carballo More articles by this author Mary Kate Keeter More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF DownloadLoading ...