Total Number Of Cores Research Articles

Ultrasound-MRI Fusion Prostate Biopsy: Experience from a Cancer Center in the Midwest

Abstract Introduction/Objective Majority of literature with few exceptions suggests ultrasound-magnetic resonance imaging (MRI) fusion biopsy of prostate to be superior in diagnosing cancer compared to systematic transrectal ultrasonographic (TRUS) biopsy. However, it is highly dependent on the expertise of the person performing the biopsy and comes at a higher cost. The purpose of this study is a to evaluate the effectiveness of ultrasound-MRI fusion prostate biopsy at our institution. Methods/Case Report All prostate biopsies received at our institution from January to December 2022 were included. Data such as patient age, presence of region of interest (ROI) biopsy, presence of cancer in any core, presence of cancer in ROI core, total number of cores with cancer, highest Gleason score in ROI core, and highest Gleason score in other cores were collected. Results (if a Case Study enter NA) A total of 448 consecutive cases were identified. Of these 214 (47.8%) were transrectal ultrasonographic and 234 (52.2%) were ultrasound-MRI fusion biopsies. Mean age of patients with TRUS biopsy was 64.3±8.6 years and mean age of patients with MRI-guided biopsy was 65.4±6.9 years, a statistically comparable population (p-value 0.001). Among TRUS cases, 133 (62.1%) had tumor. Among ultrasound-MRI fusion cases, 169 (72.2%) had tumor. Among ultrasound-MRI fusion cases with tumor, 31 had cancer only in ROI core, 55 had cancer only in other cores and 83 had cancer in ROI core as well as at least one additional non-ROI core. Among 83 cases with tumor in ROI as well as non-ROI cores, 12 had higher Gleason score in ROI core, 18 had higher Gleason score in non-ROI core and in 53 cases the Gleason score in ROI core and highest Gleason score in any of the other positive cores were equal. Conclusion In our experience ultrasound-MRI fusion biopsy improves cancer detection; however, it does not improve the rate of detection of higher-grade cancer.

PD39-10 THE ASSOCIATION BETWEEN PSA DENSITY AND THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PIRADS SCORES IN MEN WITH POSITIVE MPMRI. WHEN PSA DENSITY CAN HELP AVOIDING PROSTATE BIOPSY?

PD39-10 THE ASSOCIATION BETWEEN PSA DENSITY AND THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PIRADS SCORES IN MEN WITH POSITIVE MPMRI. WHEN PSA DENSITY CAN HELP AVOIDING PROSTATE BIOPSY?

Presence of cells in the polyaneuploid cancer cell (PACC) state predicts the risk of recurrence in prostate cancer.

The nonproliferating polyaneuploid cancer cell (PACC) state is associated with therapeutic resistance in cancer. A subset of cancer cells enters the PACC state by polyploidization and acts as cancer stem cells by undergoing depolyploidization and repopulating the tumor cell population after the therapeutic stress is relieved. Our aim was to systematically assess the presence and importance of this entity in men who underwent radical prostatectomy with curative intent to treat their presumed localized prostate cancer (PCa). Men with National Comprehensive Cancer Network intermediate- or high-risk PCa who underwent radical prostatectomy l from 2007 to 2015 and who did not receive neoadjuvant treatment were included. From the cohort of 2159 patients, the analysis focused on a subcohort of 209 patientsand 38 cases. Prostate tissue microarrays (TMAs) were prepared from formalin-fixed, paraffin-embedded blocks of the radical prostatectomy specimens. A total of 2807 tissue samples of matched normal/benign and cancer were arrayed in nineTMA blocks. The presence of PACCs and the number of PACCs on each core were noted. The total number of cells in the PACC state and the total number of cores with PACCs were significantly correlated with increasing Gleason score (p = 0.0004) and increasing Cancer of the Prostate Risk Assessment Postsurgical(CAPRA-S) (p = 0.004), but no other variables. In univariate proportional hazards models of metastasis-free survival, year of surgery, Gleason score (9-10 vs. 7-8), pathology stage, CAPRA-S, total PACCs, and cores positive for PACCs were all statistically significant. The multivariable models with PACCs that gave the best fit included CAPRA-S. Adding either total PACCs or cores positive for PACCs to CAPRA-S both significantly improved model fit compared to CAPRA-S alone. Our findings show that the number of PACCs and the number of cores positive for PACCs are statistically significant prognostic factors for metastasis-free survival, after adjusting for CAPRA-S, in a case-cohort of intermediate- or high-risk men who underwent radical prostatectomy. In addition, despite the small number of men with complete data to evaluate time to metastatic castration-resistant PCa (mCRPC), the total number of PACCs was a statistically significant predictor of mCRPC in univariate analysisand suggested a prognostic effect even after adjusting for CAPRA-S.

The modified International Society of Urological Pathology system improves concordance between biopsy and prostatectomy tumour grade.

To assess the concordance between biopsy and radical prostatectomy (RP) specimens using the 2005 Gleason score (GS) and the International Society of Urological Pathology (ISUP) 2014/World Health Organization 2016 modified system, accounting for the introduction of transperineal biopsy and pre-biopsy multiparametric magnetic resonance imaging (mpMRI). Between 2002 and 2019, we identified 2431 patients with paired biopsy and RP histopathology from a prospectively recorded and maintained prostate cancer database. Biopsy specimens were graded according to the 2005 GS or ISUP 2014 modified system, according to the year of diagnosis. Multivariable logistic regression analysis was conducted to retrospectively assess the impact of prostate-specific antigen (PSA), PSA density, age, pre-biopsy mpMRI, and biopsy method, on the rate of upgraded disease. The kappa coefficient was used to establish the degree of change in concordance between groups. Overall, 24% of patients had upgraded disease and 8% of patients had downgraded disease when using the modified ISUP 2014 criteria. Agreement in the updated ISUP 2014 cohort was 68%, compared with 55% in the 2005 GS group, which was validated by a kappa coefficient that was good (k = 0.5 ± 0.4) and poor (k = 0.3 ± 0.1), respectively. In multivariable models, a change in grading system independently improved overall disease concordance (P = 0.02), and there were no other co-segregated patient or pathological factors such as PSA, total number of cores, maximum cancer length, biopsy route or the use of mpMRI that impacted this finding. The 2014 ISUP modifed system improves overall concordance between biopsy and surgical specimens, and thus allows more accurate prognostication and management in high-grade disease, independent of more extensive prostate sampling and the use of mpMRI.

Evaluation of four pre-operative models for prediction of biochemical recurrence after radical prostatectomy in localised prostate cancer.

Biochemical recurrence (BCR) can be seen in the early or late period after radical prostatectomy (RP). Various models have been developed to predict BCR. In our study, we evaluated the accuracy of four pre-operative models (GP score, PRIX, D'Amico risk classification, CAPRA) in predicting BCR after RP in Turkish patients. Age, preoperative total prostate-specific antigen (PSA) values, clinical stages, total number of cores taken in biopsy, number of positive cores, preoperative biopsy Gleason score (GS), follow-up time and presence of BCR after RP were recorded. BCR was defined as a total PSA value >0.2ng/dL twice consecutively after RP. Classifications or scoring was performed according to pre-operative models. The 1-, 3- and 5-year BCR-free rates of the patients were determined for each model. Also, the accuracy of four predictive models for predicting 1-, 3- and 5-year BCR was evaluated. For all pre-operative models there was a statistically significant difference between risk groups in BCR-free rates at 1-, 3- and 5-year after RP (P<.001). The Harrell's concordance index for 1-year BCR predictions was 0.802, 0.831, 0.773 and 0.745 for the GP score, PRIX, CAPRA and D'Amico, respectively. For 3-year BCR predictions, it was 0.798, 0.791, 0.723 and 0.714 for the GP score, PRIX, CAPRA and D'Amico and respectively. Finally, The Harrell's concordance index for 5-year BCR predictions was 0.778, 0.771, 0.702 and 0.693 for the GP score, PRIX, CAPRA and D'Amico, respectively. In the prediction of BCR, the accuracy of GP scoring and PRIX seems slightly higher than CAPRA and D'Amico risk classification. Surely our results should be supported by head to head comparisons within other larger cohorts.

Safety and side effects of transperineal prostate biopsy without antibiotic prophylaxis

Study aimsTo investigate safety and side effects of transperineal prostate biopsy without antibiotic prophylaxis. Secondary aim was to identify whether the number of cores influenced the occurrence of complications. Patients and methodsA cohort of 184 patients undergoing perineal prostate biopsy without antibiotic prophylaxis from 2015 to 2017 was analyzed retrospectively. On average, 41 cores were taken via two perineal skin punctures. Demographic and clinical data were obtained from patients´ electronic medical records. Binary logistic regression was performed to identify predictors for complications with the following covariates: age, prostate specific antigen (PSA), prostate volume, Prostate Imaging Reporting and Data System score, history of prostatitis, therapeutic anticoagulation, risk factors for urinary tract infection, surgery duration, and the number of biopsy cores. Furthermore, we calculated chi-squared tests with post hoc analyses for differences in the occurrence of complications between quartiles of the above-mentioned parameters. ResultsThe overall complication rate was 10.8% (20/185). Out of 20, 19 (95 %) complications were ≤ grade 2 according to the Clavien-Dindo classification. There were two cases of afebrile urinary tract infection, and no patient developed fever or sepsis. Acute urinary retention was reported in 10 patients (5.4 %). The total number of cores was not associated to infectious complications or acute urinary retention rates. ConclusionsTransperineal prostate biopsy without antibiotic prophylaxis is a safe procedure. Neither postoperative fever nor sepsis occurred. An increased number of cores through two skin punctures was not associated with more complications.

Performance Comparisons on Parallel Optimization of Atmospheric and Ocean Numerical Circulation Models Using KISTI Supercomputer Nurion System

The characteristics of the 5th Supercomputer Nurion Knights Landing (KNL) system of the Korea Institute of Science and Technology Information (KISTI) were analyzed by developing ultra-high resolution atmospheric and ocean numerical circulation models. These models include the Weather Research and Forecasting System (WRF), Regional Ocean Modeling System (ROMS), and Unstructured Grid Finite Volume Community Ocean Model (FVCOM). Ideal and real-case experiments were simulated for each model according to the number of parallelized cores used for comparing performances. Identical experiments were performed on a general multicore system (Skylake and a general cluster system) for a performance comparison with the Nurion KNL system. Although the KNL system has more than twice as many cores per node as the Skylake system, the KNL system demonstrated 1/3 of the performance rate of the Skylake system. However, the performance rate of the Nurion KNL system was approximately 43% for all experiments. Reducing the number of cores per node in the KNL system by half (36 cores) is the most efficient method when the total number of cores is less than 256 cores, while it is more economical to use all cores when using more than 256 cores. In all experiments, the performance was continuously improved even for a maximum core experiment (1024 cores), thereby indicating that the KNL system can effectively simulate ultra-high resolution numerical circulation models.

MP20-17 NEGATIVE AND EQUIVOCAL PREBIOPSY MULTIPARAMETRIC PROSTATE MAGNETIC RESONANCE IMAGING

INTRODUCTION AND OBJECTIVE: Pre-biopsy multiparametric MRI (mp-MRI) are widely performed to indicate the presence or absence of prostate cancer these days. Patients and clinicians often consider deferring a biopsy if the MRI is normal. Our objective was to study the possibility to avoid a prostate biopsy with normal and equivocal mp-MRI and to look for factors which may indicate a clinically significant cancer (csCa). METHODS: Histology outcome of 265 transrectal ultrasound prostate biopsy (TRUS-PB) specimens was evaluated and compared with the pre-biopsy mp-MRI Prostate Imaging Reporting and Data System (PI-RADS) scores 1, 2, 3 and reported normal MRIs. The data were collected retrospectively for 12 months from August 2017. Total number of cancer (Gleason Score (GS) ≥ 3+3), percentage of csCa (defined as GS ≥3+4), maximum cancer core length (MCCL) and the number of positive cores against total cores were studied. Digital rectal examination (DRE) findings and prostate specific antigen density (PSAD) were also evaluated to see the relationship to csCa. RESULTS: Only five of the studied MRIs reported as PI-RADS 1 and none of them showed cancer on biopsy. In total, 21/109 (19.3%) of PI-RADS 2, 8/67 (11.9%) of reported normal MRI and 20/84 (23.8%) of PI-RADS 3 lesions showed cancer. On further study, 9.2%, 9% and 11.9% of them were found to be csCa respectively. In other words, 8.8% (16/181) of csCa were observed with negative MRIs (PI-RADS 1, 2 and normal MRI) at a negative predictive value of 92.2%. Seventy-five (27.3%) patients didn’t have prostate biopsies following their MRI and 73.3% (51/75) of them had benign prostate on DRE. Among those who underwent biopsies, 24.1% of cases resulted in a cancer diagnosis when the prostate felt suspicious, whereas only 14.4% of cancer found when prostate felt benign (p=0.044). Mean PSAD among the benign, GS 3+3 and csCa was 0.14, 0.16 and 0.27 ng/ml/ml respectively (p<0.001). A positive correlation was observed with percentage cancer, MCCL and the number of positive cores in the biopsy specimen against PSAD (p<0.001). The average percentage of cancer in the biopsy specimen for csCa and GS 3+3 was 20.1% and 3.2% respectively. MCCL and percentage of positive cores from the total number of cores were higher in csCa when compared to GS 3+3 (6.5 mm Vs 2.5 mm and 37.9% Vs 12% respectively). These findings suggest a higher volume of cancer with high PSAD and in higher GS. CONCLUSIONS: Since our study has demonstrated 9.8% of csCa with normal and equivocal prebiopsy mp-MRI findings, patients must be warned about this possibility if a biopsy is avoided based on such MRI findings alone. Source of Funding: None.

MP81-01 DIAGNOSTIC PERFORMANCE OF FUSION (US/MRI GUIDED) PROSTATE BIOPSY: COMPARISON BETWEEN ELASTIC VERSUS RIGID FUSION SYSTEM

You have accessJournal of UrologyProstate Cancer: Detection & Screening VIII (MP81)1 Apr 2020MP81-01 DIAGNOSTIC PERFORMANCE OF FUSION (US/MRI GUIDED) PROSTATE BIOPSY: COMPARISON BETWEEN ELASTIC VERSUS RIGID FUSION SYSTEM Mariaconsiglia Ferriero*, Cristian Fiori, Alfredo Bove, Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Aldo Brassetti, Francesco Porpiglia, Sabrina Decillis, Enrico Checcucci, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Mariaconsiglia Ferriero*Mariaconsiglia Ferriero* More articles by this author , Cristian FioriCristian Fiori More articles by this author , Alfredo BoveAlfredo Bove More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Sabrina DecillisSabrina Decillis More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000973.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many software for US/MRI guided prostate biopsy (PB), available for elastic or rigid fusion technology, have been developed in the last years. Most of data in literature reported diagnostic performance of fusion PB compared to systematic biopsy. However, there are few data comparing diagnostic accuracy of different systems based on fusion software. We assessed diagnostic performance of elastic (EF) versus rigid fusion (RF) PB. METHODS: A total of 615 fusion PB were prospectively collected from 2 different centres. Overall, 359 PB were performed using a RF system and 265 using a EF software. All procedures were performed transrectally by an expert urologist. The two groups were compared for the main clinical features. Detection rate (DR) for any prostate cancer (PCa) and clinically significant (cs) PCa were compared and stratified for PIRADS Score. Chi square and Fisher test were used to compare categorical variables and Student T test for continuous variables. RESULTS: The two cohorts were homogeneous for the main clinical variables, except for rate of previous biopsy (p=0.044) and number of total cores taken (p<0.001 (Table 1). At a per patient analysis, DR of EFPB was higher than that obtained with RFPB (71.3% vs 59.3%, respectively, p=0.002), while detection rate of csPCa was comparable between the two groups (46.8% and 52.1%, respectively p=0.76). At a per core evaluation, DR of any PCa cancer and csPCa was comparable between the two cohorts (all p>0.164). (Table 2) After stratifying for PIRADS Score, DR of any PCa was higher in the EFPB group only for PIRADS 4 (77% vs 63%, p=0.007). Concerning csPCa, DR was comparable between the two cohorts for every PIRADS score. (Table 3). CONCLUSIONS: Fusion PB guarantee high diagnostic accuracy for csPCa, regardless the fusion technology. Prospective randomized study are needed to confirm these data. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1235-e1235 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mariaconsiglia Ferriero* More articles by this author Cristian Fiori More articles by this author Alfredo Bove More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Francesco Porpiglia More articles by this author Sabrina Decillis More articles by this author Enrico Checcucci More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

Fluctuations in gross volume increment estimated by the Lithuanian National Forest Inventory compared with annual variations in single tree increment

There are significant inter-annual fluctuations of growing stock volume changes of living trees estimated by the Lithuanian National Forest Inventory (NFI). In the current study, we compared two sources of information on forest productivity: conventional NFI data and dendrochronological data based on tree cores collected in parallel with the measurements of the fourth Lithuanian NFI cycle during 2013–2017 on the same permanent plots (total number of cores was 4967). The main finding is that the dendrochronological basal area increment data confirmed the depression of gross stand volume increment around 2006–2007 (based on Lithuanian NFI measurements in 2008–2009), followed by a steep increase during 2008–2011 (NFI from 2010–2013). The findings explain the differences between projected growing stock volume change, which have been used for forest reference level estimation according to land use, land-use change and forestry sector regulation, and the one recently provided in National Greenhouse Gas Inventory Reports.&#x0D; Key words: Growing stock volume change, basal area increment, forest reference level, greenhouse gas reporting

MP76-18 NATURAL LANGUAGE PROCESSING ALLOWS FOR ACCURATE AND AUTOMATED EXTRACTION OF DATA FROM PROSTATE BIOPSY PATHOLOGY REPORTS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-18 NATURAL LANGUAGE PROCESSING ALLOWS FOR ACCURATE AND AUTOMATED EXTRACTION OF DATA FROM PROSTATE BIOPSY PATHOLOGY REPORTS Gregory Joice, Brant Chee, Natasha Gupta, and Michael Johnson Gregory JoiceGregory Joice More articles by this author , Brant CheeBrant Chee More articles by this author , Natasha GuptaNatasha Gupta More articles by this author , and Michael JohnsonMichael Johnson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Evaluation of prostate biopsy data is a critical aspect of prostate cancer research. Non-standardized formats and syntax in pathology reports make large-scale analyses challenging. Additionally, significant manpower and cost are needed to manually review electronic medical records. Natural language processing (NLP) allows for rapid and automated extraction of important data, but it is unclear how this compares to manual data extraction in accuracy and recall. METHODS We randomly selected 1,000 systematic prostate biopsy reports from men diagnosed with prostate cancer at our institution. All pathology reports were annotated for Gleason score, anatomical location, total number of cores, cancerous cores, percent cancer per core, and benign pathology. We utilized these annotations to train and develop the NLP engine to identify these variables from de novo pathology reports. Next, two independent reviewers annotated an additional 150 prostate biopsy reports to use as a validation set. We evaluated inter-reviewer reliably by utilizing Cohen's kappa statistic. The NLP engine performance was assessed by calculating the precision, recall, and F1 score. RESULTS Inter-reviewer reliability was good between the two reviewers with kappa of 0.84. Overall, the NLP engine had excellent performance with an aggregate precision of 0.978, recall of 0.998, and F1 statistic of 0.987 (Table). NLP performed best at identifying benign cores (F1 = 0.997), percent cancer per core (F1 = 0.993), and Gleason score (F1 = 0.991). The most challenging variables were location (F1 = 0.984), total cores (F1 = 0.982), and cancerous cores (F1 = 0.978) but all still demonstrated excellent overall precision and recall. CONCLUSIONS There is good inter-reviewer reliability for manual data extraction from prostate biopsy pathology reports. We developed an NLP engine that can efficiently extract important data from biopsy reports with excellent precision and recall. NLP can be utilized to review and extract data from medical records to assist in performing large-scale population based analyses. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1025-e1026 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Gregory Joice More articles by this author Brant Chee More articles by this author Natasha Gupta More articles by this author Michael Johnson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Which factors allow to anticipate the diagnosis of prostate cancer in pin patients? a study on 546 patients

To analyze which factors allow to assess the risk of finding a prostate cancer (PCa) at repeated biopsies in patients with diagnosis of prostatic intraepithelial neoplasia (PIN). At our institute all patients with a diagnosis of PIN undergo a 6-monthly control biopsy until the achievement of a benign histology or up to a maximum of 4 consecutive biopsies. For this study a retrospective review of clinical and bioptic data of patients with a diagnosis of isolated PIN (i.e. without associated atypical small acinar proliferation or small cancer foci) was carried out. The correlation between these features and the probability to find PCa at the first re-biopsy or at a further re-biopsy was independently analyzed. The data of 546 patients subjected to a median number of 3 biopsies, (mean: 10.8 and 12.9 cores at initial biopsy and at first re-biopsy, respectively), and with a mean “bioptic” follow-up time of 14.8 months, were analyzed. PCa was found in 174 cases (31.8%): for 116 of them it took place at the first re-biopsy, with a mean latency of 7.8 months from PIN diagnosis, whereas for 58 at a further re-biopsy, with a mean latency of 21.6 months. The risk of diagnosing PCa at the first re-biopsy was statistically correlated with the PSA value--for which a cut-off value of 7 ng/mL was identified--and with an anomalous rectal prostatic examination at the time of the initial biopsy. Differently, the risk of diagnosing PCa after the first re-biopsy correlated with the number of cores positive for PIN at the initial biopsy--for which a cut-off of 4 was identified--and to the ratio between these and the total number of cores, defined as PIN density--for which a cut-off of 50% was determined. DISCUSSION AND CONCLUSIONS. It is possible to suggest a tailored protocol of controls in patients with a diagnosis of PIN on the basis of the data available at the initial biopsy: a) high PSA value and/or an anomalous prostatic rectal examination: the diagnosis of PCa is probably just unacknowledged by the initial sampling and it is advisable to carry out an early re-biopsy; b) number of cores with PIN equal to or higher than 4 and/or PIN density equal to or higher than 50%: a true transition from PIN to PCa is likely to happen with time and it is advisable to carry out a delayed re-biopsy; c) no risk factors: just clinical and PSA monitoring to establish the indication to re-biopsy.

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature.

Only a few papers in the literature aimed to evaluate biopsy core lengths. Additionally, studies evaluated the core length with different approaches. We aimed to determine whether prostate cancer (PCa) detection is affected from core lengths according to three different approaches in a large standard cohort and compare our cut-off values with the published cut-offs. We retrospectively analyzed 1,523 initial consecutive transrectal ultrasound-guided 12-core prostate biopsies. Biopsies were evaluated with respect to total core length (total length of each patients' core) average core length (total core length divided by total number of cores in each patient), and mean core length (mean length of all cores pooled), and compared our cut-off values with the published cut-offs. The prostate volumes were categorized into four groups (<30, 30-59.99, 60-119.99, ≥120 cm3) and PCa detection rates in these categories were examined. PCa was found in 41.5% patients. There was no difference between benign and malignant mean core lengths of the pooled cores (p>0.05). Total core length and average core length were not significantly associated with PCa in multivariate logistic regression analyses (p>0.05). The core lengths (mean, average and total core lengths) increased (p<0.001) and PCa rates decreased (p<0.001) steadily with increasing prostate volume categories. PCa percentages decreased in all categories above the utilized cut-offs for mean (p>0.05), average (p<0.05), and total core lengths (p>0.05). There was no difference between mean core lengths of benign and malignant cores. Total core length and average core length were not significantly associated with PCa. Contrary to the cut-offs used for mean and average core lengths in the published studies, PCa rates decrease as these core lengths increase. Larger studies are necessary for the determination and acceptance of accurate cut-offs.

MP77-19 TIMING OF CONFIRMATORY BIOPSIES INFLUENCES ELIGIBILITY FOR ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2017MP77-19 TIMING OF CONFIRMATORY BIOPSIES INFLUENCES ELIGIBILITY FOR ACTIVE SURVEILLANCE Jessica Armstrong, Peter Haddock, Scott Wiener, Ilene Staff, Joseph Cusano, and Joseph Wagner Jessica ArmstrongJessica Armstrong More articles by this author , Peter HaddockPeter Haddock More articles by this author , Scott WienerScott Wiener More articles by this author , Ilene StaffIlene Staff More articles by this author , Joseph CusanoJoseph Cusano More articles by this author , and Joseph WagnerJoseph Wagner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2127AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While serial biopsies are a key component of most active surveillance (AS) programs, surveillance protocols differ as to when the first surveillance biopsy should be performed. Some protocols mandate a confirmatory biopsy while in others, the first surveillance biopsy is performed at 1 year. In the present study we sought to determine differential impact of obtaining the first surveillance biopsy either within 6 months or at 9-15 months after diagnosis. METHODS We retrospectively identified patients who enrolled in a prostate cancer active surveillance (AS) program during 2004-2015 and underwent a biopsy either ≤6 months or between 9-15 months after their initial diagnostic biopsy. Eligibility for enrollment in AS was defined according to MSK criteria (biopsy Gleason: ≤6; biopsy T stage: cT1c or cT2a, diagnostic PSA <10, % positive for each core ≤50%, ≤3 positive cores, or if number of total cores >12, then number of positive cores ≤25% of the total cores). We compared MSK-defined eligibility for AS in patients who received a second biopsy at either ≤6 or 9-15 months after their initial diagnostic biopsy. RESULTS A total of 115 patients on AS were identified within the study period. 62 (53.9) and 53 (46.1%) of patients underwent a second biopsy at ≤6 or 9-15 months after their initial diagnostic biopsy, respectively (table). Age, number of biopsy cores and positive cores, serum PSA, and eligibility for AS by MSK criteria were similar between groups. 56(90.3%) and 42 (79.2%) of patients initially met MSK AS criteria. Of these, those rebiopsied at 9-15 months appear more apt to be reclassified as ineligible than patients rebiopsied at ≤6 months (42.9 v. 25.0%, p=0.082). Patients biopsied at ≤6 months had more cores taken at the second biopsy (15(IQR 12-16) vs. 12 (12-12), p<.001) CONCLUSIONS Surveillance protocols differ as to when the first surveillance biopsy is performed. In patients initially meeting AS inclusion criteria, a delay in confirmatory biopsy may be associated with a higher rate (42.9% v 25.0%) of AS ineligibility. Just as important, 25% of patients immediately learn they do not meet AS criteria. These findings may be due to disease progression rather than under sampling, as patients who were biopsied at ≤6 months had more biopsies performed. These data may be helpful in patient counseling prior to AS enrollment. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1029 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jessica Armstrong More articles by this author Peter Haddock More articles by this author Scott Wiener More articles by this author Ilene Staff More articles by this author Joseph Cusano More articles by this author Joseph Wagner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes of men who underwent treatment for prostate cancer from a prospective follow up of a racially diverse, multi-institutional active surveillance cohort.

e536 Background: Active surveillance (AS) is an increasingly accepted alternative to treatment for low-grade prostate cancer (PCa). However, it remains unclear what factors may predict which patients will upgrade to a higher grade cancer. We sought to analyze the characteristics at time of diagnosis and outcomes of those men in our racially diverse AS cohort who underwent treatment for PCa. Methods: Men from our AS database were analyzed. Inclusion criteria was PSA &lt; 20 ng/mL, Gleason Score ≤ 7, and clinical stage ≤ T2a. Men who elected active treatment for their PCa at diagnosis or refused subsequent imaging and biopsy were excluded from this cohort. Univariate analysis was done to compare the clinical variables of the treatment group with the entire cohort. Results: We identified 56 men who were treated for PCa from the 308 men currently enrolled in our AS cohort. All 56 men in the treatment group had low risk PCa at diagnosis and initiation of AS. At diagnosis, the treatment group was not significantly different in comparison with our entire cohort with respect to age, BMI, family history of PCa, PSA at diagnosis, prior negative biopsy, TRUS volume, PSAD, smoking status and clinical staging. However the eventual treatment group did differ at diagnosis with respect to greater linear length of cancer per core (p &lt; 0.01), greater % involvement of disease (p = 0.03), and greater number of total cores at time of diagnosis (p = 0.04). The men in this group underwent treatment for PCa for the following reasons: 36 for Gleason Score upgrading, 5 due to increased volume of disease, 6 due to rising PSA, 1 due to MRI findings, 1 due to rising PSA on Avodart and 7 elected treatment despite no significant changes in disease. 31 of the men had RARPs, 17 XRT, 4 had XRT + ADT, 3 had Brachytherapy, and 1 with XRT + salvage RP. Conclusions: Within our prospectively enrolled racially diverse AS cohort, the patients who underwent treatment for PCa had clinical factors that differed in comparison to the whole cohort. Further prospective study is needed to determine how these factors may ultimately impact long term outcomes.

Minimizing Delay in Network Function Virtualization with Shared Pipelines

Pipelines are widely used to increase throughput in multi-core chips by parallelizing packet processing while relying on virtualization. Typically, each packet type is served by a dedicated pipeline with several cores, each implementing a network service. However, with the increase in the number of packet types and their number of required services, there are not enough cores for pipelines. In this paper, we study pipeline sharing , such that a single pipeline can be used to serve several packet types. Pipeline sharing decreases the needed total number of cores, but typically increases pipeline lengths and therefore packet delays. We consider two novel optimization problems of allocating cores between different packet types such that the average or the worst-case delay is minimized. We study the two problems and suggest optimal algorithms that apply under different assumptions on the input. We also present greedy algorithms for the general case. Last, we examine our solutions on synthetic examples as well as on real-life applications and demonstrate that they often achieve close-to-optimal delays.

Pathologic upgrading on confirmatory biopsy in a racially diverse group of men on active surveillance for prostate cancer.

142 Background: To evaluate the clinical variables associated with upgrading at confirmatory biopsy among a racially-diverse group of men with prostate cancer (PCa) who elect Active Surveillance (AS). Methods: Following IRB approval, of the more than 260 men from our multi-institutional prospective AS database we identified 140 that had undergone at least 1 confirmatory biopsy since their initial diagnosis. Patients whose diagnosis was made on TURP, had any Gleason 4 on their initial biopsy or whose initial and confirmatory biopsy were more than 2 years apart were excluded. The analysis cohort included 121 men who had Gleason Score ≤ 6, clinical stage ≤ T2a and PSA ≤ 20 ng/mL. Disease upgrading on confirmatory biopsy was Gleason score ≥ 7. Multiple variables were examined as univariate and MV predictors of upgrading. Results: We identified 121 men who fit inclusion criteria, 55 (45%) African Americans (AA) and 66 non-AA (55%) with a median follow-up of 22 months. The median age was 66, median number of biopsy cores taken at diagnostic biopsy was 12 and median time interval between diagnostic and confirmatory biopsy was 12 months. On confirmatory biopsy, no evidence of disease was noted for 51 (42%) men (26 AA, 25 non-AA), 48 (40%) men (18, AA, 30 non-AA) had findings consistent with their initial biopsy and 22 men (11 AA, 11 non-AA) experienced upgrading at repeat biopsy. Of the 22 (18%) men who were upgraded, 18 (8 AA, 10 non-AA) upgraded to a Gleason score of 7, 3 (2 AA, 1 non-AA) were upgraded to a Gleason score of 8 and 1 (AA) had a Gleason score of 9. In univariate analysis AA race was associated with a greater number of positive cores (p = 0.04) and greater total prostate volume (p = 0.03) at confirmatory biopsy. Multivariate analysis was performed and none of the clinical variables examined (race, age, BMI, PSA, volume, PSAD, number of positive cores, total number of cores, percentage of positive cores, time between biopsies) were associated with upgrading on repeat biopsy. Conclusions: Our findings suggest that race is not associated with an increased risk of upgrading at confirmatory biopsy. AA with low-risk PCa are reasonable candidates for inclusion in most AS protocols and should not be excluded based on race alone.

Probability modeling of the number of positive cores in a prostate cancer biopsy session, with applications.

Among men, prostate cancer (CaP) is the most common newly diagnosed cancer and the second leading cause of death from cancer. A major issue of very large scale is avoiding both over-treatment and under-treatment of CaP cases. The central challenge is deciding clinical significance or insignificance when the CaP biopsy results are positive but only marginally so. A related concern is deciding how to increase the number of biopsy cores for larger prostates. As a foundation for improved choice of number of cores and improved interpretation of biopsy results, we develop a probability model for the number of positive cores found in a biopsy, given the total number of cores, the volumes of the tumor nodules, and - very importantly - the prostate volume. Also, three applications are carried out: guidelines for the number of cores as a function of prostate volume, decision rules for insignificant versus significant CaP using number of positive cores, and, using prior distributions on total tumor size, Bayesian posterior probabilities for insignificant CaP and posterior median CaP. The model-based results have generality of application, take prostate volume into account, and provide attractive tradeoffs of specificity versus sensitivity. Copyright © 2015 John Wiley & Sons, Ltd.

A Longitudinal Study of Predictors of Sexual Dysfunction in Men on Active Surveillance for Prostate Cancer.

AimThe aim of this study was to examine the relationship between sexual dysfunction, repeat biopsies and other demographic and clinical factors in men on active surveillance (AS).MethodsPatient-reported outcomes (PROs) measures were administered at enrollment and every 6 months to assess quality of life (QOL), psychosocial and urological health outcomes. Using mixed-effects models, we examined the impact of repeat biopsies, total number of cores taken, anxiety, age, and comorbidity on sexual function over the first 24 months of enrolling in AS.Main Outcome MeasuresPROs included the Expanded Prostate Cancer Index Composite-26 (EPIC-26) Sexual Function (SF) subscale, the American Urological Association-Symptom Index (AUA-SI), and the Memorial Anxiety Scale for Prostate Cancer (MAX-PC).ResultsAt enrollment (n = 195), mean age was 66.5 ± 6.8 with a mean EPIC-26 SF score of 61.4 ± 30.4. EPIC-26 SF scores steadily decreased to 53.9 ± 30.7 at 24 months (P < 0.01). MAX-PC scores also progressively decreased over time (P = 0.03). Factors associated with lower EPIC-26 scores over time included age, unemployed status, diabetes, coronary artery disease, and hypertension (all P < 0.05). Higher prostate-specific antigen (PSA) was associated with a more rapid decline in EPIC-26 SF over time (P = 0.03). In multivariable analysis, age, diabetes, and PSA × time interaction remained significant predictors of diminished sexual function. Anxiety, number of biopsies, and total cores taken did not predict sexual dysfunction or change over time in our cohort.ConclusionsMen on AS experienced a gradual decline in sexual function during the first 24 months of enrollment. Older age, PSA × time, and diabetes were all independent predictors of diminished sexual function over time. Anxiety, AUA-SI, the number of cores and the number of biopsies were not predictors of reduced sexual function in men in AS.

PD34-01 MR-US FUSION BIOPSY VS. TRUS SATURATION PROSTATE BIOPSY IN ACTIVE SURVEILLANCE

INTRODUCTION AND OBJECTIVES: MR-US fusion biopsy (MR-US-FB) represents a potentially useful tool to assess for PCa progression in patients on active surveillance (AS). It is unknown whether MR-US-FB is superior to TRUS saturation biopsy to accurately characterize disease reclassification. We analyzed our initial experience with MR-US-FB compared with TRUS saturation biopsy in patients on AS. METHODS: 90 patients undergoing surveillance biopsy were analyzed. 35 patients with previously diagnosed PCa on active surveillance underwent MR-US-FB (UroNav, Invivo) with standard 12-core TRUS biopsy in same procedure from 7/2014-10/2014. Patients first had multiparametric prostate MRI (3T without endorectal coil) and target lesions of interest (LOI) for biopsy were marked. Median number of LOI/ patient was 2. Median number of cores per LOI was 3. These patients were compared to a cohort of 55 patients from 2011-2013 undergoing saturation ( 20 cores) TRUS biopsy as part of an active surveillance protocol. RESULTS: Overall, there was no difference between groups in cancer detection or reclassification (p>0.05). Results summarized in table below. The mean total number of cores was higher with saturation biopsy vs. MR-US-FB (20 1.5 vs. 18 5.4, p<.001). Number of previous biopsies was higher in the MR fusion group: (2.0 1.3 vs. 1.4 0.6, p1⁄40.02). Median PSA was 4.3 (IQR 3-6) in the MR fusion group vs. 5.6 (IQR 3.5-7.5) in the saturation biopsy group (p1⁄40.07.). Multivariable analysis of age, PSA, number of previous biopsies, biopsy type (MR vs. saturation), or total number of cores taken demonstrated no significant relationship with PCa diagnosis. 7/35 of MR biopsies showed PCa in both target and standard cores. Of these, 2 had no difference in Gl grade, 4 had higher Gl grade in the standard cores, and only 1 had higher Gl grade in target core. 16/35 patients had PCa present in standard cores only (2 of these were Gl 7). One patient had PCa in only targeted cores, and one patient had only target cores taken. CONCLUSIONS: There was no difference in rates of cancer detection, risk group reclassification, or reclassification by Gleason score upgrading between MR-US-FB and TRUS saturation biopsy in patients on AS. The majority of patients undergoing MR-US-FB had no Gleason upgrading when comparing cancer in standard TRUS cores to cores taken from target lesions.