12-core Transrectal Biopsy Research Articles

Efficacy of additional periprostatic apex nerve block on pain in each of 12 transrectal prostate core biopsies: a retrospective study

BackgroundWe identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB).MethodsThis retrospective study collected data from 312 patients who underwent transrectal prostate biopsies between January 2019 and August 2020. Patients were stratified into two groups according to the site of local anesthesia (base vs. base and apex PNB), with each block achieved with 2.5 cm3 of 2% lidocaine. Pain scores were assessed using the visual analog scale at the following time points: probe insertion, PNB at base, PNB at apex, each of the 12 core biopsy sites, and 15 min after biopsy. The results were analyzed using a linear mixed model.ResultsThe average pain scores were significantly higher in the base-only PNB group than were those in the base and apex PNB group (3.88 vs 2.82, p < 0.001). In the base-only PNB group, the pain scores increased from base to apex (p < 0.001), and the pain at each site also gradually increased as the biopsy proceeded (p < 0.001). In contrast, in the base and apex PNB group, there was minor change in pain scores throughout the procedure.ConclusionsThe pain scores varied at each site during the prostate biopsy. The provision of a base and apex PNB provided greater pain relief than does base-only PNB during prostate biopsy.

Prospective study of diagnostic accuracy in the detection of high-grade prostate cancer in biopsy-naïve patients with clinical suspicion of prostate cancer who underwent the Select MDx test.

This study aimed to externally validate the diagnostic accuracy of the Select MDx test for Significant prostate cancer (Sig PCa) (ISUP > 1), in a contemporaneous, prospective, multicenter cohort with a prostate-specific antigen (PSA) between 3 and 10 ng/ml and a non-suspicious digital rectal examination. For all enrolled patients, the Select Mdx test, the risk calculator ERSPC3 + DRE, and a prostatic magnetic resonance imaging (MRI) were carried out. Subsequently, a systematic 12-core trans-rectal biopsy and a targeted biopsy, in the case of a prostate imaging-reporting and data system (PIRADS) > 2 lesion (max three lesions), were performed. To assess the accuracy of the Select MDx test in the detection of clinically Sig PCa, the test sensitivity was evaluated. Secondary objectives were specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC). A direct comparison with the ERSPC + DRE risk calculator and MRI were also performed. We also studied the predictive ability to diagnose Sig PCa from the combination of the Select MDx test with MRI using clinical decision-curve analysis. There were 163 patients enrolled after meeting the inclusion criteria and study protocol. The Select MDx test showed a sensitivity of 76.9% (95% CI, 63.2-87.5), 49.6% specificity (95% CI, 39.9-59.2), 82.09% (95% CI, 70.8-90.4) NPV, and 41.67% (95% CI, 31.7-52.2) PPV for the diagnosis of Sig PCa. COR analysis was also performed, which showed an AUC of 0.63 (95% CI, 0.56-0.71). There were no differences in the accuracy of Select MDx, ERSPC + DRE, or MRI. The combination of Select MDX + MRI showed the highest impact in the decision-curve analysis, with an NPV of 93%. Our study showed a worse performance for the SelectMdx test than previously reported, within a cohort of patients with a PSA 3-10 ng/ml and a normal DRE, with results similar to those from ERSPC + DRE RC and MRI, but with an improvement in the usual PSA pathway. A combination of the Select Mdx test and MRI could improve accuracy, but studies specifically evaluating this scenario with a cost-effective analysis are needed.

мпМРТ/ТРУЗИ фьюжн, сатурационная, стандартная и когнитивная трансректальная биопсии простаты: Что? Кому? Когда?

The aim of this literature review was to demonstrate the pluses and minuses of each kind of biopsy, which can be helpful for preparing an algorithm and determining the indications and contraindications for each prostate biopsy (PB). Prostate biopsy is the main method of diagnosing prostate cancer (PC), and it remains relevant even in spite of the appearance of a number of new diagnostic tests and methods. Transrectal 12-core biopsy without pre-biopsy mpMRI remains a routine sampling of prostate material. But with the appearance of a great variety of PB and their introduction into practice, there arises the need to compare these methods with each other. At present, all available studies dealing with the informativity of some biopsy method or another, were conducted in different time periods and cannot reliably reflect their informativity for making a comparison. In our opinion, further research into this problem is required and research works should study the informativity of various kinds of biopsy depending on visualization of a pathological site for suspected prostate cancer, in TRUS and its location coincidence in mpMRI, in Pi-RADSv2.1 classification. Key words: prostate biopsy, prostate cancer, transrectal ultrasound

Clinical and biochemical markers of visceral adipose tissue activity: Body mass index, visceral adiposity index, leptin, adiponectin, and matrix metalloproteinase-3. Correlation with Gleason patterns 4 and 5 at prostate biopsy.

Context:The correlation between aggressive prostate cancer and obesity mainly based on body mass index (BMI) and pathology after surgery remains controversial.Aims:The aim of the study was to correlate BMI, visceral adiposity index (VAI), and the plasmatic levels of leptin, adiponectin, and matrix metalloproteinase-3 (MMP-3), and biomarkers of adipose tissue function, with the detection of Gleason patterns 4 and 5 at biopsy.Subjects and Methods:Consecutive patients with prostate cancer at 12-core transrectal biopsy were enrolled. BMI, waist circumference (WC), blood samples to evaluate the plasmatic levels of triglycerides (TG) and high-density lipoproteins (HDL), adiponectin, leptin, and MMP-3 were obtained immediately before biopsy. The VAI was calculated according to the formula: WC/(39.68 + [1.88 × BMI]) × TG/1.03 × 1.31/HDL.Results:One hundred and forty-nine patients were entered. The median PSA, BMI, and VAI were 10.0 ng/ml, 27.6 kg/m2, and 4.6, respectively. Gleason patterns 4 or 5 were detected in 68 (45.6%) patients; in 15 (41.7%), 31 (44.9%), and 22 (50.0%) among normal weight, overweight, and obese patients, respectively (P = 0.55). The statistical analysis did not show any significant correlation between BMI, VAI, the plasmatic levels of leptin, adiponectin, MMP-3, and the detection of Gleason patterns 4 and 5 at biopsy. A statistically significant association emerged with older age (P = 0.017) and higher PSA values (P = 0.02).Conclusion:We did not find any association between BMI, VAI, the plasmatic levels of adiponectin, leptin, and MMP-3 and the detection of Gleason patterns 4 and 5 at prostate biopsy.

The prostate cancer detection rates of CEUS-targeted versus MRI-targeted versus systematic TRUS-guided biopsies in biopsy-na\xefve men: a prospective, comparative clinical trial using the same patients

BackgroundThe current standard for Prostate Cancer (PCa) detection in biopsy-naïve men consists of 10–12 systematic biopsies under ultrasound guidance. This approach leads to underdiagnosis and undergrading of significant PCa while insignificant PCa may be overdiagnosed. The recent developments in MRI and Contrast Enhanced Ultrasound (CEUS) imaging have sparked an increasing interest in PCa imaging with the ultimate goal of replacing these “blind” systematic biopsies with reliable imaging-based targeted biopsies.Methods/designIn this trial, we evaluate and compare the PCa detection rates of multiparametric (mp)MRI-targeted biopsies, CEUS-targeted biopsies and systematic biopsies under ultrasound guidance in the same patients. After informed consent, 299 biopsy-naïve men will undergo mpMRI scanning and CEUS imaging 1 week prior to the prostate biopsy procedure. During the biopsy procedure, a systematic transrectal 12-core biopsy will be performed by one operator blinded for the imaging results and targeted biopsy procedure. Subsequently a maximum of 4 CEUS-targeted biopsies and/or 4 mpMRI-targeted biopsies of predefined locations determined by an expert CEUS reader using quantification techniques and an expert radiologist, respectively, will be taken by a second operator using an MRI-US fusion device. The primary outcome is the detection rate of PCa (all grades) and clinically significant PCa (defined as Gleason score ≥7) compared between the three biopsy protocols.DiscussionThis trial compares the detection rate of (clinically significant) PCa, between both traditional systematic biopsies and targeted biopsies based on predefined regions of interest identified by two promising imaging technologies. It follows published recommendations on study design for the evaluation of imaging guided prostate biopsy techniques, minimizing bias and allowing data pooling. It is the first trial to combine mpMRI imaging and advanced CEUS imaging with quantification.Trial registrationThe Dutch Central Committee on Research Involving Human Subjects registration number NL52851.018.15, registered on 3 Nov 2015. Clinicaltrials.gov database registration number NCT02831920, retrospectively registered on 5 July 2016.

Confirmatory biopsy for the assessment of prostate cancer in men considering active surveillance: reference centre experience.

ObjectivesTo evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy.Subjects and methodsThe cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy.ResultsAfter confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found.ConclusionIn our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance.

Detection of Significant Prostate Cancer According to Anatomical Areas of Sampling Cores Obtained with Transrectal Systematic 12-Core Biopsy

Background: To analyze the diagnostic performance of 12-core biopsy in detecting significant prostate cancer (PCa). Patients and Methods: This study included 206 PCa patients who underwent transrectal 12-core biopsy followed by radical prostatectomy. Radical prostatectomy specimens were anatomically divided into 12 areas according to the sampling cores, and the existence of significant cancer, defined by a tumor volume > 0.5 ml, was investigated. The detection rate of significant cancer in each area was calculated as follows: the number of positive core biopsies/the number of areas containing significant cancer × 100. Results: The overall detection rate of significant cancer in all areas was 53.6%. The detection rate was significantly higher in the standard sextant cores than in the additional 6 cores in patients with prostate-specific antigen ≥ 10 ng/ml, clinical stage ≥ T2, or biopsy Gleason score ≥ 7, but not in those with prostate-specific antigen < 10 ng/ml, clinical stage T1c, or biopsy Gleason score ≤ 6. Conclusions: Approximately half of the significant cancers were not accurately detected, and the detection rates in biopsy cores other than the sextant cores appeared to be significantly lower in PCa patients with aggressive features.

Clinicopathological implications of single positive core prostate cancer in a 12-core transrectal biopsy scheme

To explore the clinicopathological implications of single positive core prostate cancer. A total of 45 patients with transrectal ultrasound (TRUS)-guided prostate biopsy were diagnosed with single positive core prostate cancer and subsequently underwent radical prostatectomy (RP). Their clinicopathological parameters were examined to identify the factors for disease upgrading or upstaging. On final pathology, only 31.1% patients had unilateral prostate cancer. And 37.8% patients experienced Gleason score upgrading, 66.7% patients had upstaging and 31.1% were found positive surgical margins. On multivariable analyses, the percentage of positive cores was an independent predictor of stage upgrading and perineural invasion at RP pathology. Age, prostate volume and preoperative prostate-specific antigen/prostate-specific antigen density (PSA/PSAD) had no significant effect on underestimated tumor burden. Most single positive core prostate cancer diagnosed by 12-core biopsy may be underestimated. The percentage of positive cores is an independent predictor of underestimated prostate cancer. Currently we have no instruments for accurately identifying microfocal or unilateral prostate cancer.

Diagnostic usefulness of the cytological study of the transport buffer in transrectal prostate core biopsies

BackgroundTo evaluate the diagnostic usefulness of the cytological study of the transport buffer in the diagnosis of prostate adenocarcinoma in transrectal core biopsies. MethodsA total of 256 consecutively biopsied patients have been included in the analysis, 100 of them diagnosed of prostate adenocarcinoma. The procedure included the cytological analysis of the transport buffer and conventional histology. Cytological evaluation was performed in a blind way by the same pathologist. ResultsOverall sensitivity, specificity, and positive and negative predictive values to detect malignancy in the cytological slides were 54%, 98%, 94% and 76%, respectively. When restricting the analysis to cases with Gleason score higher than 8, sensitivity and negative predictive value increased to 85% and 97%, respectively. Similarly, when the analysis focused exclusively to cases with more than 5mm of cancer in the biopsy, sensitivity and positive predictive value increased to 66% and 96%, respectively. ConclusionsThis study shows that whilst specificity was maintained in 98%, sensitivity, and positive and negative predictive values significantly improved in high grade and high volume adenocarcinomas. Our findings confirm that the cytological study of the transport buffer may complement the histology in the diagnosis of prostate adenocarcinoma.

Utilidad diagnóstica del estudio citológico del tampón de transporte en biopsias por punción prostática transrectal

BackgroundTo evaluate the diagnostic usefulness of the cytological study of the transport buffer in the diagnosis of prostate adenocarcinoma in transrectal core biopsies. MethodsA total of 256 consecutively biopsied patients have been included in the analysis, 100 of them diagnosed of prostate adenocarcinoma. The procedure included the cytological analysis of the transport buffer and conventional histology. Cytological evaluation was performed in a blind way by the same pathologist. ResultsOverall sensitivity, specificity, and positive and negative predictive values to detect malignancy in the cytological slides were 54%, 98%, 94% and 76%, respectively. When restricted the analysis to cases with Gleason score higher than 8, sensitivity and negative predictive value increased to 85% and 97%, respectively. Similarly, when the analysis focused exclusively to cases with more than 5mm of cancer in the biopsy, sensitivity and positive predictive value increased to 66% and 96%, respectively. ConclusionsThis study shows that whilst specificity was maintained in 98%, sensitivity, and positive and negative predictive values significantly improved in high grade and high volume adenocarcinomas. Our findings confirm that the cytological study of the transport buffer may complement the histology in the diagnosis of prostate adenocarcinoma.

High Diagnostic Ability of Multiparametric Magnetic Resonance Imaging to Detect Anterior Prostate Cancer Missed by Transrectal 12-Core Biopsy

We clarified the diagnostic ability of multiparametric magnetic resonance imaging to reveal anterior cancer missed by transrectal 12-core prostate biopsy based on the results of 3-dimensional 26-core prostate biopsy, which is a combination of transrectal 12-core and transperineal 14-core biopsies. The study population consisted of 324 patients who prospectively underwent prebiopsy multiparametric magnetic resonance imaging and then 3-dimensional 26-core prostate biopsy at a single institution. We defined transrectal 12-core negative cancer as cancer detected by transperineal 14-core but not transrectal 12-core prostate biopsy. We focused on cancer in the anterior region. Any findings suspicious for malignancy in the region anterior to the urethra on multiparametric magnetic resonance imaging were defined as an anterior lesion on imaging. Significant cancer was defined as a biopsy Gleason score of 4 + 3 or greater, a greater than 20% positive core and/or a maximum cancer length of 5 mm or greater. Associations between an anterior lesion on imaging and transrectal 12-core negative cancer were investigated. The overall cancer detection rate on 3-dimensional 26-core prostate biopsy was 39% (128 of 324 cases), of which 28% (36 of 128) were transrectal 12-core negative cancers. An anterior lesion on prebiopsy multiparametric magnetic resonance imaging was identified in 20% of men overall (65 of 324). Of men with and without an anterior lesion on imaging 40% (26 of 65) and 3.8% (10 of 259), respectively, had transrectal 12-core negative cancer. Significant transrectal 12-core negative cancer was observed in 0.4% (1 of 259 men) without an anterior lesion on imaging. Prebiopsy multiparametric magnetic resonance imaging revealed an anterior lesion in 92% of cases (11 of 12) of significant transrectal 12-core negative cancer. Prebiopsy multiparametric magnetic resonance imaging has the potential to efficiently select men who could advantageously undergo anterior samplings, in addition to transrectal 12-core prostate biopsy.

Diagnostic performance of initial transperineal 14-core prostate biopsy to detect significant cancer

To investigate cancers missed by extended transperineal (TP) 14-core biopsy (TP14PBx) and examined its diagnostic performance. We evaluated 744 men with prostate-specific antigen (PSA) levels in the range 2.5-20 ng/mL or abnormal digital rectal examination underwent three-dimensional 26-core prostate biopsy (3D26PBx), a combination of TP14PBx and transrectal 12-core biopsy (TR12PBx), at initial biopsy. Of 269 patients diagnosed with cancer, 127 subsequently underwent radical prostatectomy (RP). Cancers were grouped into TP-positive cancers (detected through TP14PBx) and TP-negative cancers (those not detected through TP14PBx but detected through TR12PBx). Clinicopathological characteristics and cancer locations of TP-negative cancers were evaluated. For cancer location analysis, the prostate was divided into apex, midprostate, and base regions. Thirty-seven (14 %) TP-negative cancers were found in 269 biopsy-positive cancers. Median number of positive cores in TP-negative cancers was significantly lower than that in TP-positive cancers (1 vs. 5, p < 0.001). TP-negative cancers had biopsy Gleason score (GS) of 7 or less in 87 % of cases and had significantly lower biopsy GS than those of TP-positive cancers (p = 0.028). Of 20 TP-negative cancers treated with RP, 70 % (14/20) were insignificant cancers (GS <4+3, volume <0.5 cc, and organ-confined disease). Of all significant cancers treated with RP, 6 % (6/99) were missed by TP14PBx. TP-negative cancers treated with RP were located more frequently in the apex than in the base (85 vs. 20 %, p < 0.001). Initial TP14PBx provides sufficient detectability of significant cancers despite a small risk of missing cancers located in the prostate apex.

Contrast Enhanced Transrectal Ultrasound for the Detection of Prostate Cancer: A Randomized, Double-Blind Trial of Dutasteride Pretreatment

The identification of clinically significant disease is crucial for optimal treatment of prostate cancer. Selective detection of prostate cancer with increased microvessel density is possible with contrast enhanced ultrasound. Preliminary studies suggest that pretreatment with a 5α-reductase inhibitor may improve the efficiency of contrast enhanced ultrasound targeted biopsy. This study was designed to quantify prostate cancer detection with contrast enhanced ultrasound with or without short-term pretreatment with dutasteride. In this randomized, double-blind, placebo controlled trial of oral dutasteride pretreatment, contrast enhanced ultrasound findings were graded and used to direct targeted biopsy (up to 6 cores per prostate). A blinded 12-core systematic biopsy was subsequently performed on every subject based on standard medial and lateral sampling of each sextant. Of 311 subjects who underwent randomization, 272 completed participation. Positive biopsies were obtained in 276 of 3,264 (8.5%) systematic cores and 203 of 1,237 (16.4%) targeted cores (OR 2.1, 95% CI 1.7-2.6, p <0.001). ROC analysis for the detection of all prostate cancers demonstrated an increase in diagnostic accuracy from pre-contrast imaging to contrast enhanced ultrasound (A(z) 0.60 vs 0.64, p = 0.005). For the detection of high grade cancer (Gleason score 7 or greater) ROC analysis demonstrated improved accuracy for pre-contrast imaging (A(z) 0.74) and contrast enhanced ultrasound (A(z) 0.80, p = 0.0005). For the detection of high grade cancer with greater than 50% biopsy core involvement, excellent accuracy was demonstrated with pre-contrast and contrast enhanced ultrasound, A(z) 0.83 and 0.90, respectively (p = 0.001). Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97). Contrast enhanced ultrasound targeted biopsy provides a significant benefit for the detection of high grade/high volume prostate cancer.

Targeted Antimicrobial Prophylaxis Using Rectal Swab Cultures in Men Undergoing Transrectal Ultrasound Guided Prostate Biopsy is Associated With Reduced Incidence of Postoperative Infectious Complications and Cost of Care

We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results. From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record. A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication. Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.

FDG-PET/CTが診断の一助となった原発性精嚢癌の1例

We reported a case of primary seminal vesicle cancer, detected by FDG-PET/CT. A 65-year-old man with constipation and appetite loss was admitted to our hospital. An ultrasound examination revealed evidence of bilateral hydronephrosis. He was diagnosed as acute post renal failure, and nephrostomy was done. CT and MRI showed a solid mass in the area of seminal vesicle. He underwent transrectal core biopsy, which histologically showed poorly differentiated adenocarcinoma. Immunohistochemistry showed the tumor to be CA125 positive, CEA positive and CK7 positive but PSA negative. FDG-PET/CT revealed an increased uptake of FDG only in the area of seminal vesicle. Serum CA125 was elevated and PSA stayed within normal limit. Primaly rectal carcinoma was ruled out by colonoscopy. The result of transperineal prostate biopsy was negative. We diagnosed him as suffering from primary seminal vesicle carcinoma. Anti-androgen blockade and radiotherapy to whole pelvis were performed, and serum CA125 level was improved. But, 6 months later serum CA125 re-elevated and 19 months later multiple liver metastases were noted. The patient received two cycles of docetaxel and cisplatin chemotherapy, however he developed pulmonaly embolism and rectal bleeding by tumor invasion and he died of his disease 22 months after the diagnosis.

Characteristics and clinical significance of prostate cancers missed by initial transrectal 12‐core biopsy

• To characterize prostate cancers missed by initial transrectal 12-core biopsy. • Between 2002 and 2008, 715 men with prostate-specific antigen levels in the range 2.5-20 ng/mL or abnormal digital rectal examination underwent three-dimensional 26-core prostate biopsy (i.e. a combination of transrectal 12-core biopsy and transperineal 14-core biopsy) on initial examination. • Of the 257 patients diagnosed with cancer, 120 patients subsequently underwent radical prostatectomy. • Cancers were grouped into TR12-negative cancers (i.e. not detected through transrectal 12-core biopsy but detected through transperineal 14-core biopsy) and TR12-positive (i.e. detected through transrectal 12-core biopsy) cancers. • Clinicopathological characteristics of the TR12-negative and TR12-positive cancers were evaluated. • TR12-negative cancers comprised 21% of the three-dimensional 26-core biopsy-detected cancers. • The frequency of cancers with a biopsy Gleason score ≤ 6 and that of cancers with a biopsy primary Gleason grade ≤ 3 was higher in TR12-negative cancers, at 58% and 83%, respectively, than in TR12-positive cancers, at 25% (P < 0.001) and 53% (P < 0.001), respectively. • The median number of positive cores in TR12-negative cancers was two out of 26. • TR12-negative cancers were more frequently located anteriorly than posteriorly. • The incidence of the TR12-negative cancers was not associated significantly with any clinical variable. • Many of the cancers missed by initial transrectal 12-core biopsy are probably low-grade and low-volume diseases, although initial transrectal 12-core biopsy has a small but definite risk of missing anterior significant cancers.

195 NEGATIVE RESULT IN UNILATERAL 13-CORE BIOPSY CAN PREDICT THE ABSENCE OF SIGNIFICANT CANCER ON THE IPSILATERAL LOBE WITH A HIGH ACCURACY. IMPLICATIONS FOR HEMIABLATIVE FOCAL THERAPY

INTRODUCTION AND OBJECTIVES: Multiple studies have revealed that it is difficult to predict the presence of purely unilateral prostate cancer for the purpose of hemiablative focal therapy. However, the contralateral untreated lobe in the prostate exposed to this type of therapy does not have to be a lobe without cancer, but could also be a lobe without significant cancer (SC). The aim of this study is to evaluate the ability of extended 26-core prostate biopsy (3D26PBx: a combination of transrectal 12-core biopsy and transperineal 14-core biopsy) to predict the lobe without SC for the purpose of hemiablative focal therapy. METHODS: We studied 165 patients in whom prostate cancer was diagnosed by 3D26PBx and who underwent radical prostatectomy (RP) without neoadjuvant treatment between 2002 and 2009. RP specimens were divided into right and left lobes, and a total of 330 lobes were analyzed. Pathological specimens were evaluated according to the 2005 ISUP consensus. Considering an upward Gleason score (GS) shift after the 2005 consensus, significant cancer was defined as extraprostatic extension and/or a tumor volume of 0.50 cc or greater and/or GS of 4 3 or greater. We believed that the lobe without SC identified possible areas in which the prostate gland could be preserved without treatment. Whether clinical and pathological variables could be used to predict the lobe without SC was also investigated. RESULTS: The median PSA was 6.6 ng/mL. Biopsy GS were / 6, 3 4, 4 3 and 8 / in 35, 47, 37 and 46 patients, respectively. In the entire cohort, 6.7% of the cases (22/330) revealed the presence of the lobe without cancer while 34% (111/330) revealed the lobe without SC. The positive predictive value (PPV) and negative predictive value (NPV) of unilateral negative biopsy for the lobe without cancer were 22% (19/85) and 99% (242/245) in 3D26PBx, respectively. The PPV/NPV/sensitivity/specificity of unilateral negative biopsy for the lobe without SC were 85/77/56/94% in 3D26PBx, respectively. In the cohort of biopsy negative side, standard clinical variables including prostate-specific antigen, prostate volume, digital rectal examination findings and age were not significantly associated with the lobe without SC. CONCLUSIONS: With PPV of 85%, 3D26PBx predicted the lobe without SC. If follow-up treatment of the contralateral untreated lobe was appropriately performed, hemiablative focal therapy may be a reasonable option in patients with a cancer negative side, as detected by 3D26PBx, and with suspected organ-confined disease.

Single Positive Core Prostate Cancer in a 12-Core Transrectal Biopsy Scheme: Clinicopathological Implications Compared with Multifocal Counterpart

PurposeThe incidence of single positive core prostate cancer at the time of biopsy appears to be increasing in the prostate-specific antigen (PSA) era. To determine the clinical implication of this disease, we analyzed surgical and pathological characteristics in comparison with multiple positive core disease.Materials and MethodsAmong 108 consecutive patients who underwent robotic radical prostatectomy following a diagnosis of prostate cancer based on a 12-core transrectal biopsy performed by the same method in a single institute, outcomes from 26 patients (Group 1) diagnosed on the basis of a single positive biopsy core and from 82 patients (Group 2) with multiple positive biopsy cores were analyzed.ResultsThe preoperative PSA value, Gleason score, prostate volume, and D'Amico's risk classification of each group were similar. The proportion of intermediate+highrisk patients was 69.2% in Group 1 and 77.9% in Group 2 (p=0.22). Total operative time and blood loss were similar. Based on prostatectomy specimens, only 3 patients (11.5%) in Group 1 met the criteria for an indolent tumor (7.31% in Group 2). Although similarities were observed during preoperative clinical staging (p=0.13), the final pathologic stage was significantly higher in Group 2 (p=0.001). The positive-margin rate was also higher in Group 2 (11.5% vs. 31.7%, p=0.043). Despite similarity in upstaging after prostatectomy in each group (p=0.86), upgrading occurred more frequently in Group 1 (p=0.014, 42.5% vs. 19.5%). No clinical parameters were valuable in predicting upgrading.ConclusionsMost single positive core prostate cancer diagnoses in 12-core biopsy were clinically significant with similar risk stratification to multiple positive core prostate cancers. Although the positive-margin rate was lower than in multiple positive core disease, an increase in Gleason score after radical prostatectomy occurred more frequently.

Simple and effective local anesthesia for transperineal extended prostate biopsy: Application to three‐dimensional 26‐core biopsy

We developed a local anesthetic procedure for three-dimensional 26-core prostate biopsy (3D26PBx), a combination of transperineal 14-core biopsy (TP14PBx) and transrectal 12-core biopsy (TR12PBx). At first, a periapical triangle, confined by the levator ani, the rhabdosphincter and the external anal sphincter muscle, was made visible by transrectal ultrasound. After administration of 1 mL of 1%-lidocaine into the midline perineal skin 1.5 cm above the anus, we inserted a spinal needle toward the periapical triangle for injection of 1.5-2.0 mL of 1%-lidocaine and performed the TP14PBx. After administration of the periprostatic nerve block with 10 mL of 1%-lidocaine, we performed the TR12PBx. The efficacy of the procedure was evaluated prospectively in 45 consecutive men undergoing the 3D26PBx. The 3D26PBx was completed with just local anesthesia in all patients. The pain levels, assessed by an 11-point visual analog scale, were not different between the TP14PBx and the TR12PBx.

Low stroma androgen receptor level in normal and tumor prostate tissue is related to poor outcome in prostate cancer patients

The role of androgen receptors (ARs) in the prostate tumor cell environment is largely unknown. AR immunostaining was evaluated in relation to stroma morphology, expression of AR co-activator ARA55, tumor characteristics and clinical outcome in normal and prostate cancer (PCa) tissue obtained at transurethral resection in men treated with expectancy, and in diagnostic transrectal core biopsies in men treated with surgical castration. Stroma composition was studied by Masson-trichrome and desmin staining. Levels of AR and ARA55 mRNA were quantified by laser micro-dissection and RT-PCR. The percentage of cells with positive nuclear AR immunostaining in the tumor and normal stroma was inversely related to Gleason score, tumor size, tumor stage, metastasis, response to castration therapy, and cancer-specific survival. The AR staining in the normal stroma provided independent prognostic information in Cox multiple linear regression analysis. Loss of stroma AR staining was linked to low expression of ARA55 in stroma smooth muscle cells, and in tumors also to gradual disappearance of this cell type. PCa aggressiveness and efficacy of castration therapy are related to AR levels in the tumor stroma and importantly to AR levels in the surrounding normal prostate tissue stroma. .