Suspicion Of Prostate Cancer Research Articles

Relationship between lower urinary tract symptoms (LUTS) and prostate cancer: A persistent myth

Background:The presence of lower urinary tract symptoms (LUTS) is described as an early symptom of prostate cancer in some patient guidelines; however, a statistical association has never been established.Methods:This study was conducted using a prospective electronic database at a single tertiary institution between January 2015 and November 2017. LUTS were assessed using the International Prostate Symptom Score (IPSS), and prostate cancer was graded according to the International Society of UroPathologists (ISUP) grading system. The association between IPSS and Grade Group was tested using parametric one-way analysis of variance (ANOVA) with post hoc analysis using Tukey’s honestly significant difference (Tukey’s HSD).Results:A total of 611 men attended the One-Stop Prostate Clinic (OSPC) and IPSSs were available for 557 men. Overall, 46% had mild LUTS (IPSS: 1–7), 38% had moderate LUTS (IPSS: 8–19) and 16% had severe LUTS (IPSS: 20–35). Almost 85% proceeded to have transrectal ultrasound (TRUS) prostate biopsies, and clinically significant prostate cancer (CSPC) was detected in 37% with mild LUTS, 35% with moderate LUTS and 42% with severe LUTS. Correlation between histopathology and IPSSs was assessed in all 78.8% of men who had IPSS data available and underwent prostate biopsies.Conclusion:This large series did not establish any correlation between LUTS and prostate cancer in men undergoing investigation for the suspicion of prostate cancer.Level of evidence:Not applicable

A Light, 3D UNet-based Architecture for Fully Automatic Segmentation of Prostate Lesions from T2-MRI Images.

Prostate magnetic resonance imaging (MRI) has been recently integrated into the pathway of diagnosis of prostate cancer (PCa). However, the lack of an optimal contrast-to-noise ratio hinders automatic recognition of suspicious lesions, thus developing a solution for proper delimitation of the tumour and its separation from the healthy parenchyma, which is of primordial importance. As a solution to this unmet medical need, we aimed to develop a decision support system based on artificial intelligence, which automatically segments the prostate and any suspect area from the 3D MRI images. We assessed retrospective data from all patients diagnosed with PCa by MRI-US fusion prostate biopsy, who underwent prostate MRI in our department due to a clinical or biochemical suspicion of PCa (n=33). All examinations were performed using a 1.5 Tesla MRI scanner. All images were reviewed by two radiologists, who performed manual segmentation of the prostate and all lesions. A total of 145 augmented datasets were generated. The performance of our fully automated end-to-end segmentation model based on a 3D UNet architecture and trained in two learning scenarios (on 14 or 28 patient datasets) was evaluated by two loss functions. Our model had an accuracy of over 90% for automatic segmentation of prostate and PCa nodules, as compared to manual segmentation. We have shown low complexity networks, UNet architecture with less than five layers, as feasible and to show good performance for automatic 3D MRI image segmentation. A larger training dataset could further improve the results. Therefore, herein, we propose a less complex network, a slim 3D UNet with superior performance, being faster than the original five-layer UNet architecture.

(233) Treatment of Benign Prostatic Hyperplasia. How to Preseve the Ejaculatory Function with the Transperineal Laser Ablation of the Prostate

Abstract Introduction Benign prostatic hyperplasia (BPH) can be the cause of Lower urinary tract symptomps (LUTS). Endoscopic treatments like the trans-urethral resection of the prostate (TURP) is still the gold standard technique to treat this condition. This technique often leads to sexual dysfunction as retrograde ejaculation. Objective The objective of the study was to evaluate the safety and the efficacy of this new technique. The transperineal laser ablation of the prostate (TPLA) is a new minimal invasive technique used to treat BPH that reduces the prostate volume preserving the ejaculatory function. Methods This is a prospective study done in accordance with the Declaration of Helsinki. 168 patients (pts) (age 60.5 ± 10.5 years) with LUTS and BPH were enrolled. Mean prostate volume was 71.5 ± 25.5 m (from 30 to 100 grams). Inclusions criteria were: Peak urinary flow (Q max): ≤15 mL/sec, International Prostatic Symptoms Score (IPSS) >19, Postvoid residual (PVR): > 100 mL. Exclusion criteria were: catheterized pts, history of neurodegenerative disease, positive urinary culture, prostate volume > 100 grams, Clinical suspicion of prostate cancer (Abnormal digital rectal examination, PSA levels). The procedure was performed under local anaesthesia (Periprostatic nerve block) plus sedation. Under US guidance, up to four 21G applicators with a length of 15 cm were inserted into the prostate tissue. Each treatment was performed with diode lasers operating at 980 nm with 1800 joules per lobe at a power of 5 watts. The primary endpoint was the reduction of prostate volume (misured at 6 months follow-up) and preservation of the ejaculation in the treated pts. Secondary endpoints included operating time, ablation time, energy used, hospitalization time, catheterization time and International Prostate Symptom Score (IPSS) variation, quality of life (QoL), Q max and PVR. Results All procedures have been successful from a technical point of view. The average operating time was (38 ± 6.5 min) and the average ablation time was (12.4 ± 2.8 min). The average energy used was (11.622 ± 4350.5 J), the average hospital stay was (1.7 ± 0.2 days) and the average catheterization time was (6.1 ± 4.0 days.) At 6 months, IPSS improved from (22.5±2.1 points) to (12.3±1.8 points) (P < 0.001). QoL was improved from (4.8±0.2) to (1.8. ± 0.3) (P < 0.05) and Q max was improved from (4.6 ± 3.1 mL/s) to (12.8 ±2.6 mL/s) (P < 0.001). Moreover, PVR was improved from (120±59.3 ml) to (46.7±27.9ml) (P<0.001); the average prostate volume at 6 months improved from (71.5 ± 25.5 grams) to (48.8 ± 21.8 grams) (P < 0.05). 130 out of 150 sexually active subjects (86.6%) maintained ejaculation following treatment at 6 months. 44 subjects (26,5%) needed recatheterization for acute urinary retention. Perineal pain was reported in 5 subjects, urethrorrhagia in 8 subjects. Conclusions TPLA is a safe, feasible and promising procedure for the treatment of LUTS in BPH. This procedure induces coagulative necrosis in the treated tissue, reducing the prostate volume while preserving the ejaculatory function Disclosure No

Prostate imaging-reporting and data system version 2 in combination with clinical parameters for prostate cancer detection: a single center experience.

The diagnostic performance of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) has been challenged due to its lower diagnostic accuracy and higher false-positive rates for prostate cancer detection. This study aimed to analyze the diagnostic performance of PI-RADS v2 in combination with clinical parameters in patients with suspected prostate cancer. A total of 424 men with suspicion of prostate cancer were retrospectively analyzed. Logistic regression analyses were performed to identify predictors of clinically significant prostate cancer defined as a Gleason score of 3 + 4 or greater. The prediction performance was compared with prostate specific antigen (PSA), free/total PSA ratio (f/t PSA), PSA density (PSAD), PI-RADS v2 alone, and PI-RADS v2 plus PSAD using receiver operating characteristics (ROCs). In total, 231 out of 424 cases (54.48%) were pathologically diagnosed as prostate cancer. The percentage of clinically significant prostate cancer was higher in patients with PI-RADS v2 score of 4 or greater compared to PI-RADS v2 score of less than 4 (90.86% vs. 55.88%, P < 0.001). Age, PSA level, f/t PSA, PSAD, and PI-RADS v2 were significant independent predictors of clinically significant prostate cancer. The ROC area under the curve of PI-RADS v2 plus PSAD (0.952) was larger compared with PSA (0.845), f/t PSA (0.719), PSAD (0.920), and PI-RADS v2 alone (0.885). PI-RADS v2 in combination with PSAD may help detect clinically significant prostate cancer and provide benefit in making the decision to biopsy men at suspicion of prostate cancer.

Reliability of prostate imaging reporting and data system version 2.1 for excluding clinically significant prostate cancer using a 1.5 tesla scanner

IntroductionMultiparametric magnetic resonance imaging (mpMRI) of the prostate gland is now the recommended initial investigation of choice for the detection of Prostate cancer (PCa). It effectively identifies patients who require prostate biopsies due to the risk of clinically significant PCa. It helps patients with clinically insignificant PCa avoid the invasive biopsies and possible accompanying complications. Large clinical trials have investigated the accuracy of mpMRI in detecting PCa. We performed a local review to examine the reliability of omitting tissue sampling in men with a negative (PIRADS 2 (P2) or less) mpMRI in the primary diagnostic setting.MethodsThis was a retrospective study of patients with clinical suspicion of PCa within a 2-year period. Patients had a mpMRI prior to having trans-perineal prostate gland biopsies. Clinically significant disease was defined as Gleason 7 and above. The descriptive data was analysed using contingency table methods. A p-value less than 0.05 was statistically significant.ResultsOut of 700 patients 90 had an mpMRI score of PIRADS 2. Seventy-seven (85.5%) of these patients had a negative biopsy, 9(10%) showed Gleason 6, 4 patients showed Gleason 7 or above. 78 patients with PIRADS 2 had a PSA density of < 0.15, none of which had a clinically significant biopsy result. The negative predictive value of mpMRI from this study is 95%.ConclusionOur results are in line with negative predictive values demonstrated in the current literature. This local study, likely applicable to other district general hospitals, shows that mpMRI is a safe and reliable initial investigation to aid decisions on which patients require biopsies.

Is there more than meets the eye in PSMA imaging in prostate cancer with PET/MRI? Looking closer at uptake time, correlation with PSA and Gleason score

BackgroundIn patients with increasing PSA and suspicion for prostate cancer, but previous negative biopsies, PET/MRI is used to test for tumours and target potential following biopsy. We aimed to determine different PSMA PET timing effects on signal kinetics and test its correlation with the patients’ PSA and Gleason scores (GS).MethodsA total of 100 patients were examined for 900 s using PET/MRI approximately 1–2 h p.i. depending on the tracer used (68Ga-PSMA-11, 18F-PSMA-1007 or 18F-rhPSMA7). The scans were reconstructed in static and dynamic mode (6 equal frames capturing “late” PSMA dynamics). TACs were computed for detected lesions as well as linear regression plots against time for static (SUV) and dynamic (SUV, SUL, and percent injected dose per gram) parameters. All computed trends were tested for correlation with PSA and GS.ResultsStatic and dynamic scans allowed unchanged lesion detection despite the difference in statistics. For all tracers, the lesions in the pelvic lymph nodes and bones had a mostly negative activity concentration trend (78% and 68%, resp.), while a mostly positive, stronger trend was found for the lesions in the prostate and prostatic fossa following RPE (84% and 83%, resp.). In case of 68Ga-PSMA-11, a strong negative (Rmin = − 0.62, Rmax = − 0.73) correlation was found between the dynamic parameters and the PSA. 18F-PSMA-1007 dynamic data showed no correlation with PSA, while for 18F-rhPSMA7 dynamic data, it was consistently low positive (Rmin = 0.29, Rmax = 0.33). All tracers showed only moderate correlation against GS (Rmin = 0.41, Rmax = 0.48). The static parameters showed weak correlation with PSA (Rmin = 0.24, Rmax = 0.36) and no correlation with GS.Conclusion“Late” dynamic PSMA data provided additional insight into the PSMA kinetics. While a stable moderate correlation was found between the PSMA kinetics in pelvic lesions and GS, a significantly variable correlation with the PSA values was shown depending on the radiotracer used, the highest being consistently for 68Ga-PSMA-11. We reason that with such late dynamics, the PSMA kinetics are relatively stable and imaging could even take place at earlier time points as is now in the clinical routine.

MP09-10 PROSTATE IMAGING-REPORTING AND DATA SYSTEM VERSION 2 IN COMBINATION WITH CLINICAL PARAMETERS FOR PROSTATE CANCER DETECTION

You have accessJournal of UrologyCME1 Apr 2023MP09-10 PROSTATE IMAGING-REPORTING AND DATA SYSTEM VERSION 2 IN COMBINATION WITH CLINICAL PARAMETERS FOR PROSTATE CANCER DETECTION Lei Wang, Yi Luo, Tongzu Liu, Ming Deng, Hiroaki Wakimoto, and Xing Huang Lei WangLei Wang More articles by this author , Yi LuoYi Luo More articles by this author , Tongzu LiuTongzu Liu More articles by this author , Ming DengMing Deng More articles by this author , Hiroaki WakimotoHiroaki Wakimoto More articles by this author , and Xing HuangXing Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The purpose of this study was to analyze the diagnostic performance of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) in combination with clinical parameters in patients with suspected prostate cancer (PCa). METHODS: A total of 424 men with suspicion of PCa were retrospectively analyzed, who underwent multiparametric magnetic resonance imaging (mpMRI) evaluated with PI-RADS v2 prior to transperineal ultrasound guided systematic biopsy. Clinical parameters including age, prostate volume, prostate specific antigen (PSA), free/total PSA ratio (f/t PSA), PSA density (PSAD) and PI-RADS v2 score were investigated. Logistic regression analyses were performed to identify predictors of clinically significant PCa defined as a Gleason score of 3 + 4 or greater. The prediction performance was compared with PSA level, f/t PSA, PSAD, PI-RADS v2 alone, and PI-RADS v2 plus PSAD using receiver operating characteristics (ROCs). RESULTS: In total, 231 out of 424 cases (54.48%) were pathologically diagnosed as PCa. The percentage of clinically significant PCa was higher in patients with PI-RADS v2 score of 4 or greater compared to PI-RADS v2 score of less than 4 (90.86% vs. 55.88%, p < 0.001). Age, PSA level, f/t PSA, PSAD, and PI-RADS v2 were significant independent predictors of clinically significant PCa (Figure 1). The ROC area under the curve of PI-RADS v2 plus PSAD (0.952) was larger compared with PSA (0.845), f/t PSA (0.719), PSAD (0.920), and PI-RADS v2 alone (0.885) (Table 1, Figure 2). CONCLUSIONS: PI-RADS v2 in combination with PSAD may help detect clinically significant PCa and provide benefit in making the decision to biopsy men at suspicion of PCa. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e108 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lei Wang More articles by this author Yi Luo More articles by this author Tongzu Liu More articles by this author Ming Deng More articles by this author Hiroaki Wakimoto More articles by this author Xing Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-08 PROSPECTIVE EVALUATION OF RADICAL PROSTATECTOMY WITHOUT PRIOR BIOPSY BASED ON PSA, DRE, MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND PROSTATE-SPECIFIC MEMBRANE ANTIGEN POSITRON EMISSION TOMOGRAPHY

You have accessJournal of UrologyCME1 Apr 2023MP61-08 PROSPECTIVE EVALUATION OF RADICAL PROSTATECTOMY WITHOUT PRIOR BIOPSY BASED ON PSA, DRE, MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND PROSTATE-SPECIFIC MEMBRANE ANTIGEN POSITRON EMISSION TOMOGRAPHY Michael Chaloupka, Maria Apfelbeck, Magnus Idzikowski, and Christian G Stief Michael ChaloupkaMichael Chaloupka More articles by this author , Maria ApfelbeckMaria Apfelbeck More articles by this author , Magnus IdzikowskiMagnus Idzikowski More articles by this author , and Christian G StiefChristian G Stief More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Modern imaging techniques are able to predict advanced prostate cancer with very high level of probability. This raises the question of omitting prostate biopsy as prerequisite for therapy. Here, we present a prospective study of patients undergoing radical prostatectomy without prior biopsy, based on DRE, PSA, PSMA-PET and mpMRI. METHODS: Inclusion criteria were suspicious DRE and PSA value≥10 ng/ml, high suspicion of prostate cancer on mpMRI (PI-RADS 4/5) and high suspicion of prostate cancer on PSMA-PET imaging (CT or MRI). Between March 2019-August 2022, 27 patients were included into the study (Group 1). After filing for an amendment that allowed to omit PSMA-PET imaging, six more patients were included (Group 2). Outside of the study, radical prostatectomy without prior biopsy was performed in carefully selected cases, who did not meet the inclusion criteria. (n=17, group 3). Approved by the university clinic ethics committee (#19-693). RESULTS: Group 1: In histology, 7/27 patients had ISUP 2, 10/27 had ISUP 3, 5/27 had ISUP 4 and 5/27 had ISUP 5. 1/27 patients had local tumor stage of pT2a, 9/27 had pT2c, 9/27 had pT3a and 8/27 had pT3b. Group 2: In histology, 3/6 patients had ISUP grade 2, 1/6 had ISUP grade 3, 2/6 had ISUP grade 5. 1/6 patients had local tumor stage pT2a, 2/6 had pT2c and 3/6 had pT3b. Group 3: All patients had abornmal PSA level+DRE. Median PSA was 7.06 ng/ml (IQR: 5.9 - 8.5). Suspicion of prostate cancer based on abnormal mpMRI in 15/17 patients and abnormal PSMA-PET imaging in 15/17 patients. 13/17 had suspicion of prostate cancer in both modalities. In histology, 4/17 patients had ISUP 1, 9/17 had ISUP grade 2, 3/17 patients had ISUP 3 and 1/17 had ISUP 5. 3/17 patients had local tumor stage of pT2a, 12/17 had pT2c and 2/17 had pT3b. Group 1+2 showed a significantly higher rate of locally advanced prostate cancer compared to Group 3 (pT3a/pT3b: 60.6% vs. 11.8%, p<0.001). Group 1+2 showed a significantly higher rate of aggressive prostate cancer compared to group 3 (ISUP grade>2: 66.7% vs. 23.5%, p<0.001). CONCLUSIONS: In this prospective study approved by the ethics committee, it was shown that radical prostatectomy without prior biopsy can be done finding significant cancer in every single patient. Applying the strict inclusion criteria, histology showed a very high rate of locally advanced prostate cancer. More studies are needed to further improve the inclusion criteria for radical prostatectomy without prior biopsy. Source of Funding: - © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e855 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Chaloupka More articles by this author Maria Apfelbeck More articles by this author Magnus Idzikowski More articles by this author Christian G Stief More articles by this author Expand All Advertisement PDF downloadLoading ...

Total Prostate Specific Antigen in Prostate Cancer Screening in Hyperglycemic Individuals.

In this study, it was aimed to investigate the reliability of total prostate-specific antigen (t-PSA) in prostate cancer screening in hyperglycemic (≥126 mg/dL) individuals. This research was planned as a cross-sectional retrospective study. Three hundred eleven cases which underwent biopsy with the suspicion of prostate cancer in the hospital were included in the study. Prostate cancer risk groups were categorized as low, intermediate and high. Those with fasting blood glucose (FBG) levels lower than 126 mg/dL were considered as the normoglycemia group. It was determined that the t-PSA measurement was higher in the patient group with cancer (P < .001). It was determined that the median t-PSA levels of the intermediate and high cancer groups were higher than the low cancer group (P < .001 and P=.001, respectively). t-PSA was found to be associated with increased cancer risk in cases with FBG <126. However, an increase in t-PSA values in cases with FBG ≥126 was not associated with increased prostate cancer. There is no relationship between FBG measurement and t-PSA measurement (rs=0.05, P=.446). In addition, it was determined that the t-PSA measurements of patients with FBG ≥126 and FBG<126 did not differ (P=.962). As a contribution to literature, we found that the t-PSA test lost its sensitivity in cases with plasma glucose levels above normal. Loss of sensitivity may result in underdiagnosis in prostate cancer and this, in turn, results in diagnosis of the cancer at a later stage. In the future, it may be necessary to adopt a different approach in prostate cancer screening in hyperglycemic cases.

MP44-16 NON-INFECTIOUS ADVERSE EVENTS OF TRANSPERINEAL PROSTATE BIOPSIES PERFORMED UNDER LOCAL ANESTHESIA IN AN OUTPATIENT SETTING: RESULTS FROM THE NORAPP STUDY

You have accessJournal of UrologyCME1 Apr 2023MP44-16 NON-INFECTIOUS ADVERSE EVENTS OF TRANSPERINEAL PROSTATE BIOPSIES PERFORMED UNDER LOCAL ANESTHESIA IN AN OUTPATIENT SETTING: RESULTS FROM THE NORAPP STUDY Maciej Jacewicz, Erik Rud, and Eduard Baco Maciej JacewiczMaciej Jacewicz More articles by this author , Erik RudErik Rud More articles by this author , and Eduard BacoEduard Baco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of our study was to examine the feasibility and adverse events of transperineal prostate biopsies (TPBx) performed under local anesthesia (LA) in an outpatient setting. METHODS: Patients with suspicion of prostate cancer were included in this randomized clinical trial. Primary endpoint was examining the role of antibiotic prophylaxis in TPBx. Secondary endpoints were pain during and after the procedure (VAS), hematuria, hematospermia and acute urinary retention (AUR). Patients with a high risk of infection were excluded. Free-hand MRI-TRUS fusion TPBx, using the Koelis Trinity device, were performed in an outpatient setting under LA. 40 ml of 1% Lidocaine and 4 ml Sodium Bicarbonate was injected in the perineal skin, under the prostatic apex, in levator ani bilaterally and along the path of the needle under TRUS guidance. Target biopsies were performed in patients with PIRADS ≥3 on MRI, systematic biopsies were performed in biopsy naïve and MRI negative patients. VAS was reported immediately after biopsy, followup regarding non-infectious adverse events was after 2 weeks and 2 months. Correlation was analyzed using Pearson coefficient. RESULTS: We included 402 patients. Median age was 69 years (IQR 63-74, range: 38-86), PSA 7.0 ng/ml (IQR 4.5-11) and prostate volume (PV) 40 ml (IQR 27-58). Median number of cores was 8 (IQR 6-10). Response rate to the questionnaire was 100% (401/402). Median VAS during the placement of LA was 1 (IQR: 1-2, range 0-8) and VAS during biopsy 1 (IQR:1-2, range: 0-8). Additional LA was required by 10% (40/401). There was a weak correlation between age and VAS during placement of LA (r: -0.293, p: <0.001), age and VAS during biopsy (r: -0.243 p:<0.001) and number of cores and VAS during biopsy (r:0.137, p=0.006). There was no correlation between VAS and PV. Median post-procedural VAS was 0 (IQR: 0-0, range 0-5), 2% (9/401) used analgesics after the procedure. Hematuria was present in 64% (258/401), median duration was 3 days (IQR:2-7, range 1-35). There was a weak correlation between number of cores and hematuria (r:0.180, p:<0.001. Hematospermia was present in 54% (197/366) of patients, median duration was 14 days (IQR:7-21, range 1-49). AUR occurred in two patients (0.5%, 95% CI:0.1-1.8). One suffered a clot retention resolved by single time catheterization, the other was treated with a permanent catheter for a week. CONCLUSIONS: Transperineal prostate biopsies under LA can safely be performed in an outpatient setting with limited discomfort to the patient and few non-infectious adverse events. Source of Funding: Oslo University Hospital © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e618 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maciej Jacewicz More articles by this author Erik Rud More articles by this author Eduard Baco More articles by this author Expand All Advertisement PDF downloadLoading ...

PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP

PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP

PD38-08 AVOIDING UNNECESSARY TARGETED PROSTATE BIOPSIES USING MACHINE LEARNING

You have accessJournal of UrologyCME1 Apr 2023PD38-08 AVOIDING UNNECESSARY TARGETED PROSTATE BIOPSIES USING MACHINE LEARNING Roxana Esmaili, Ghazal Khajir, Michael Leapman, Preston Sprenkle, Darryl Martin, and John Onofrey Roxana EsmailiRoxana Esmaili More articles by this author , Ghazal KhajirGhazal Khajir More articles by this author , Michael LeapmanMichael Leapman More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , Darryl MartinDarryl Martin More articles by this author , and John OnofreyJohn Onofrey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI)-targeted transrectal ultrasound (TRUS) guided needle biopsy is the current gold standard for diagnosing prostate cancer in patients with suspicion for prostate cancer. This leads to a frequent needle biopsy to determine the presence of clinically significant prostate cancer (csPCa) with a high rate of invasive overdiagnosis in patients with non-aggressive cancer. Supervised machine learning (ML) algorithms provide a mathematical framework to make predictions about csPCa in order to make personalized decisions to perform a biopsy or not and avoid unnecessary targeted needle biopsies. METHODS: From January 2016 to February 2020, 1099 patients underwent multiparametric MRI before TRUS fusion biopsy. We included PI-RADS score (version 2), gland volume, lesion region of interest volume before biopsy, PSA value, PSA density, and patient age at the time of biopsy as input variables to calculate the probability of csPCa for each lesion for each patient before biopsy using different ML classification algorithms: logistic regression (LR); random forest (RF); naïve Bayes (NB); and nearest neighbor (NN). Gleason Grade Group ≥2 was used as a reference for the presence of csPCa. Ten-fold cross-validation stratified over patients validated the ML approaches and compared to univariate models. RESULTS: Area under the receiver operating characteristic curves (AUC) and net reduction curves show that multivariate LR (AUC 81.3%) outperformed RF (AUC 79.2%), NN (AUC 71.8%) and NB (AUC 78.3%) and outperformed standard univariate LR using PSA density (AUC 71.4%) and PI-RADS (AUC 73.9%). The algorithms were evaluated at a point on the ROC curve for high sensitivity. Using the multivariate LR model, 636 (41.38%) targeted biopsies could have been avoided while missing only 90 (5.86%) csPCa, which is reasonable with a threshold probability of 25% and a net benefit of 0.21. CONCLUSIONS: Our findings suggest that multivariate ML models using clinical data can be used to avoid unnecessary targeted biopsy cores among patients with suspicion of prostate cancer undergoing prostate biopsy. Source of Funding: JAO supported by NIH R42 CA224888. DTM supported by DoD W81XWH-19-PCRP-IDA. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e996 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roxana Esmaili More articles by this author Ghazal Khajir More articles by this author Michael Leapman More articles by this author Preston Sprenkle More articles by this author Darryl Martin More articles by this author John Onofrey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP40-09 EXTERNAL VALIDATION OF A MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING VOLUMETRIC MODEL TO PREDICT THE UTILITY OF SYSTEMATIC BIOPSIES AT THE TIME OF TARGETED BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP40-09 EXTERNAL VALIDATION OF A MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING VOLUMETRIC MODEL TO PREDICT THE UTILITY OF SYSTEMATIC BIOPSIES AT THE TIME OF TARGETED BIOPSY Antonella Ninivaggi, Ugo Falagario, Francesco Guzzi, Vito Mancini, Carlo Bettocchi, Gian Maria Busetto, Luigi Cormio, and Giuseppe Carrieri Antonella NinivaggiAntonella Ninivaggi More articles by this author , Ugo FalagarioUgo Falagario More articles by this author , Francesco GuzziFrancesco Guzzi More articles by this author , Vito ManciniVito Mancini More articles by this author , Carlo BettocchiCarlo Bettocchi More articles by this author , Gian Maria BusettoGian Maria Busetto More articles by this author , Luigi CormioLuigi Cormio More articles by this author , and Giuseppe CarrieriGiuseppe Carrieri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this study we aimed to externally validate a nomogram based on MRI volumetric parameters and clinical information for deciding when SBx (Standard Biopsy) should be performed in addition to TBx (Target Biopsy)in men with suspicious prostate MRI. METHODS: We retrospectevely analysed a prospectevely mantained databes of 496 biopsy naïve men undergoing prostate biopsy with a pre-biopsy multiparametric Magnetic Resonance Imaging (mpMRI) at two institutions. Prostate MRI was performed according to PI-RADS recommendations including T1-wighted (T1WI) and T2-weighted images (T2WI), diffusion weighted images (DWI) with apparent diffusion coefficient (ADC) maps, and dyamic contrast enhances images (DCEI). Men with PIRADSsv 2.1 score of 3-5 were included. All patients underwent MRI-Ultrasound Fusion biopsy of each MRI-suspicious lesion and a fourteen-systematic biopsy according to our protocol. Lesion volume percentage was computed as the ratio of cancer volume on MRI divided the whole prostate volume. Outcomes of this study were non-clinically significant PCa (ncsPCa) (Gleason Grade Group 1) and clinically significant PCa (csPCa) (Gleason Grade Group >1). The model was evaluated with AUC (Area Under the Curve) decision curve analyses and a systematic analysis of model derived probability cut-offs in terms of number of ncsPCa diagnosis avoidance and number of csPCa diagnosed. RESULTS: The nomogram includes age, PSA value, prostate volume, PIRADSsv2.1 score, MRI-suspicion lesion volume percentage, and lesion location. The AUC was 0.73. Using different nomogram cut-offs (from 5% to 30%), 19-58% of men would avoided SBx while missing 0-10% of csPCA and avoiding detection of 6-31% of ncsPCa. These results are similar to those found in the multi-insitutional external validation study based on IMPROD trial (n=122) and MULTI-IMPROD trial (n=262). Decision Curve Analysis (DCA) shows that this nomogram increases the overall net clinical benefit when threshold probability is above 10%. CONCLUSIONS: The present study supports the potential utility of a model based on MRI volumetrics for the selection of men with a clinical suspicion of prostate cancer who would benefit of SBx in addition to TBx. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e548 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonella Ninivaggi More articles by this author Ugo Falagario More articles by this author Francesco Guzzi More articles by this author Vito Mancini More articles by this author Carlo Bettocchi More articles by this author Gian Maria Busetto More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Expand All Advertisement PDF downloadLoading ...

MP55-05 BASELINE 4K SCORE PREDICTS PROGRESSION ON ACTIVE SURVEILLANCE IN PROSTATE CANCER INDEPENDENTLY OF CLINICAL INFORMATION AND PIRADS SCORE

You have accessJournal of UrologyCME1 Apr 2023MP55-05 BASELINE 4K SCORE PREDICTS PROGRESSION ON ACTIVE SURVEILLANCE IN PROSTATE CANCER INDEPENDENTLY OF CLINICAL INFORMATION AND PIRADS SCORE Helen Hougen, Isildinha M. Reis, Nachiketh S. Prakash, Ruben Blachman-Braun, Jessica Delgado, Chad R. Ritch, Bruno Nahar, Mark L. Gonzalgo, Dipen J. Parekh, Radka Stoyanova, Sandra M. Gaston, Oleksandr Kryvenko, Brandon Mahal, Matthew Abromowitz, Alan Dal Pra, Alan Pollack, and Sanoj Punnen Helen HougenHelen Hougen More articles by this author , Isildinha M. ReisIsildinha M. Reis More articles by this author , Nachiketh S. PrakashNachiketh S. Prakash More articles by this author , Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Jessica DelgadoJessica Delgado More articles by this author , Chad R. RitchChad R. Ritch More articles by this author , Bruno NaharBruno Nahar More articles by this author , Mark L. GonzalgoMark L. Gonzalgo More articles by this author , Dipen J. ParekhDipen J. Parekh More articles by this author , Radka StoyanovaRadka Stoyanova More articles by this author , Sandra M. GastonSandra M. Gaston More articles by this author , Oleksandr KryvenkoOleksandr Kryvenko More articles by this author , Brandon MahalBrandon Mahal More articles by this author , Matthew AbromowitzMatthew Abromowitz More articles by this author , Alan Dal PraAlan Dal Pra More articles by this author , Alan PollackAlan Pollack More articles by this author , and Sanoj PunnenSanoj Punnen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the preferred management in low and select intermediate risk prostate cancer patients. Currently, the 4Kscore identifies men with grade group 2+ disease in men with clinical suspicion of prostate cancer but little is known about its utility in men undergoing AS. In this study, we assessed the 4Kscore’s ability to predict tumor progression on men enrolled in a prospective active surveillance protocol. METHODS: We enrolled patients with biopsy-confirmed very low to intermediate risk prostate cancer who elected for AS and obtained prostate MRI, 4Kscore, and targeted +/- systematic biopsy within 1 year of diagnosis and then yearly for 3 years. The 4Kscore was categorized as low (=<20%) and high (=>20%) risk. We estimated cumulative incidence rates of progression over time by the Kaplan-Meier method and used multivariable Cox analyses to assess the association between the 4Kscore and progression while adjusting for NCCN risk at diagnosis, age, PSA density and baseline PIRADS score. RESULTS: The 4Kscore was collected in 166 men at the time of confirmatory biopsy. Over half the patients had a PIRADS 4 or 5 lesions and 4K score of over 20% at baseline. A total of 79 (47.6%) patients progressed during the study period, with 26.5%, 13.3%, 5.4%, and 2.4% progressing at the baseline, 12-month, 24- month, and 36-month visit, respectively. Patients who progressed had higher baseline 4Kscore compared with patients who did not progress (31% IQR 15-59 vs. 14% IQR 8-35, p<0.001; Figure 1a). Patients with a 4Kscore above 20% had higher cumulative incidence of progression by 36 months compared with patients with 4Kscores less than 20% (72.5% [95% CI 60.9-83.1%] vs. 41.0% [95% CI: 28.6-56.3%], p=0.0001, Figure 1b). In a multivariable Cox analysis, 4Kscore above 20% was an independent predictor of progression (HR 1.73, 95% CI: 1.03, 2.88, p=0.037), after adjusting for age, NCCN risk, PSA density and PIRADS score. CONCLUSIONS: Patients with a 4Kscore above 20% have a higher likelihood of progression despite their NCCN risk and MRI findings. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e764 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Helen Hougen More articles by this author Isildinha M. Reis More articles by this author Nachiketh S. Prakash More articles by this author Ruben Blachman-Braun More articles by this author Jessica Delgado More articles by this author Chad R. Ritch More articles by this author Bruno Nahar More articles by this author Mark L. Gonzalgo More articles by this author Dipen J. Parekh More articles by this author Radka Stoyanova More articles by this author Sandra M. Gaston More articles by this author Oleksandr Kryvenko More articles by this author Brandon Mahal More articles by this author Matthew Abromowitz More articles by this author Alan Dal Pra More articles by this author Alan Pollack More articles by this author Sanoj Punnen More articles by this author Expand All Advertisement PDF downloadLoading ...

Synchronous bladder and prostate cancer specimens obtained from radical cystoprostatectomy: A single‑center retrospective analysis.

The aim of the present study was to analyze incidence, histopathological features and clinical outcomes of patients undergoing radical cystoprostatectomy (RCP) for bladder cancer, in which incidental prostate cancer (PCa) was found. How these types of cancer impacted the patients' management and whether prostate-sparing cystectomy could be an option for these patients was determined. The current study retrospectively analyzed the data of a cohort of patients from 'Umberto I' Hospital of Nocera Inferiore who underwent RCP for bladder transitional cell carcinoma. Patients with a preoperative diagnosis or clinical suspicion of PCa were excluded. Patients affected by incidental PCa in the RCP specimens were identified, and then their demographic, histopathological and clinical outcome data were collected. Overall, it was revealed that of the 303 patients undergoing RCP for bladder cancer, 69 (22.7%) had incidental PCa, with a median age of 71.6 (age range, 54-89 years). In total, 23 (33.33%) of the 69 patients with incidental PCa were considered to have clinically significant prostate disease. In conclusion, it was relatively common to identify incidental PCa in RCP specimens but no preoperative predictive factors were identified that were able to determine 'non-aggressive' PCa status. Therefore, the present results demonstrate the need for a careful and complete prostate removal during RCP. Nevertheless, since organ-sparing surgeries are widely performed in young population, due to the impossibility of predicting aggressive prostate cancer, these patients require close monitoring through lifelong PSA surveillance, particularly focusing on the possible relapse of PCa after RCP.

Radical Prostatectomy without Prior Biopsy in Patients with High Suspicion of Prostate Cancer Based on Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen Positron Emission Tomography: A Prospective Cohort Study

Modern risk stratification of prostate cancer (PCa) allows for prediction of advanced disease with a high level of certainty. We aimed to evaluate a prospective series of patients undergoing radical prostatectomy without prior biopsy based solely on clinical criteria and imaging results. The patients were divided into three groups. Group 1 included 27 patients with: (i) suspicious digital rectal examination, (ii) PSA ≥ 10 ng/mL, (iii) PI-RADS 4/5 on mpMRI, and (iv) high suspicion of PCa on PSMA-PET. Group 2 included six patients who fulfilled criteria i, ii, and iii but did not undergo PSMA-PET imaging. Group 3 included 17 patients with at least one clinical (i or ii) and one imaging (iii or iv) criterion. All of the patients were diagnosed with PCa. Comparison of Group 1 and 2 versus Group 3 showed a significantly higher ratio of locally advanced PCa for Groups 1 and 2 compared to Group 3 (60.6% versus 11.8%, p = 0.005, respectively). Similarly, these patients displayed a significantly higher ratio of aggressive PCa (ISUP grade > 2: 66.7% versus 23.5%, p = 0.027, respectively) and tumor infiltration (median tumor infiltration: 32.5% vs. 15%, p = 0.001, respectively) in the final specimen compared to Group 3. In conclusion, we have shown that radical prostatectomy without prior biopsy is safe in terms of the diagnosis of clinically significant PCa when proper preoperative risk stratification involving mpMRI and PSMA-PET imaging is applied.

ReIMAGINE Prostate Cancer Risk: A prospective cohort study in men with a suspicion of prostate cancer who are referred onto an MRI-based diagnostic pathway with donation of tissue, blood, urine and imaging for biomarker analyses

ReIMAGINE Prostate Cancer Risk: A prospective cohort study in men with a suspicion of prostate cancer who are referred onto an MRI-based diagnostic pathway with donation of tissue, blood, urine and imaging for biomarker analyses

Prospective comparison of PSMA PET/CT vs. mpMRI in patients with a high suspicion of prostate cancer and previously negative biopsy: Preliminary data from PROSPET-BX trial

Prospective comparison of PSMA PET/CT vs. mpMRI in patients with a high suspicion of prostate cancer and previously negative biopsy: Preliminary data from PROSPET-BX trial

Diagnostic performance of high-resolution micro-ultrasound targeted biopsy for detection of clinically significant prostate cancer among naïve patients with a negative multiparametric MRI and a persistently high suspicion of prostate cancer

Diagnostic performance of high-resolution micro-ultrasound targeted biopsy for detection of clinically significant prostate cancer among naïve patients with a negative multiparametric MRI and a persistently high suspicion of prostate cancer

Monoparametric high-resolution diffusion weighted MRI as a possible first step in an MRI-directed diagnostic pathway for men with suspicion of prostate cancer.

To explore if a high-resolution diffusion weighted MRI sequence (DWI-only) could be used as a first step in an MRI-directed diagnostic pathway. Prospective single center study that between December 2017 and August 2018 included 129 consecutive patients with suspicion of prostate cancer into a PI-RADS-based MRI-directed diagnostic pathway. All patients had multiparametric MRI (mpMRI). Based on only the transversal high-resolution DWI images two consultant radiologists prospectively categorized the findings as positive, equivocal, or negative for clinically significant cancer. The radiologists then interpreted the mpMRI and assigned a PI-RADS score. A third independent reader retrospectively categorized the DWI-only exams without access to the mpMRI. The interpretations of DWI-only were compared to the PI-RADS classification from mpMRI and the histopathology from the biopsies. Non-biopsied patients were followed in a safety net monitoring for 56 months. Based on DWI-only, 29 (22.5%) of the exams were categorized as negative, 38 (29.5%) as equivocal and 62 (48.1%) as positive. Of the 56 patients with PI-RADS 4-5 at mpMRI, 55 were also categorized as positive at DWI-only. All patients diagnosed with clinically significant cancer were identified using DWI-only. 56 months of safety net monitoring did not reveal any clinically significant cancers among patients with exams categorized as negative or equivocal. There was high inter-reader agreement on positive findings, but less agreement on negative and equivocal findings. In this concept study, the monoparametric DWI-only identified all patients with clinically significant cancer in a mpMRI-directed diagnostic pathway.