Transrectal Ultrasound Prostate Research Articles

An artificial intelligence model based on transrectal ultrasound images of biopsy needle tract tissues to differentiate prostate cancer.

We aimed to develop an artificial intelligence (AI) model based on transrectal ultrasonography (TRUS) images of biopsy needle tract (BNT) tissues for predicting prostate cancer (PCa) and to compare the PCa diagnostic performance of the radiologist model and clinical model. A total of 1696 2D prostate TRUS images were involved from 142 patients between July 2021 and May 2022. The ResNet50 network model was utilized to train classification models with different input methods: original image (Whole model), BNT (Needle model), and combined image [Feature Pyramid Networks (FPN) model]. The training set, validation set, and test set were randomly assigned, then randomized 5-fold cross-validation between the training set and validation set was performed. The diagnostic effectiveness of AI models and image combination was accessed by an independent testing set. Then, the optimal AI model and image combination were selected to compare the diagnostic efficacy with that of senior radiologists and the clinical model. In the test set, the area under the curve, specificity, and sensitivity of the FPN model were 0.934, 0.966, and 0.829, respectively; the diagnostic efficacy was improved compared with the Whole and Needle models, with statistically significant differences (P < 0.05), and was better than that of senior radiologists (area under the curve: 0.667). The FPN model detected more PCa compared with senior physicians (82.9% vs. 55.8%), with a 61.3% decrease in the false-positive rate and a 23.2% increase in overall accuracy (0.887 vs. 0.655). The proposed FPN model can offer a new method for prostate tissue classification, improve the diagnostic performance, and may be a helpful tool to guide prostate biopsy.

Impact of Relative Volume Difference Between Magnetic Resonance Imaging and Three-dimensional Transrectal Ultrasound Segmentation on Clinically Significant Prostate Cancer Detection in Fusion Magnetic Resonance Imaging–targeted Biopsy

BackgroundSegmentation of three-dimensional (3D) transrectal ultrasound (TRUS) images is known to be challenging, and the clinician often lacks a reliable and easy-to-use indicator to assess its accuracy during the fusion magnetic resonance imaging (MRI)-targeted prostate biopsy procedure. ObjectiveTo assess the effect of the relative volume difference between 3D-TRUS and MRI segmentation on the outcome of a targeted biopsy. Design, setting, and participantsAll adult males who underwent an MRI-targeted prostate biopsy for clinically suspected prostate cancer between February 2012 and July 2021 were consecutively included. InterventionAll patients underwent a fusion MRI-targeted prostate biopsy with a Koelis device. Outcome measurements and statistical analysisThree-dimensional TRUS and MRI prostate volumes were calculated using 3D prostate models issued from the segmentations. The primary outcome was the relative segmentation volume difference (SVD) between transrectal ultrasound and MRI divided by the MRI volume (SVD = MRI volume − TRUS volume/MRI volume) and its correlation with clinically significant prostate cancer (eg, International Society of Urological Pathology [ISUP] ≥2) positiveness on targeted biopsy cores. Results and limitationsOverall, 1721 patients underwent a targeted biopsy resulting in a total of 5593 targeted cores. The median relative SVD was significantly lower in patients diagnosed with clinically significant prostate cancer than in those with ISUP 0–1: (6.7% [interquartile range {IQR} –2.7, 13.6] vs 8.0% [IQR 3.3, 16.4], p < 0.01). A multivariate regression analysis showed that a relative SVD of >10% of the MRI volume was associated with a lower detection rate of clinically significant prostate cancer (odds ratio = 0.74 [95% confidence interval: 0.55–0.98]; p = 0.038). ConclusionsA relative SVD of >10% of the MRI segmented volume was associated with a lower detection rate of clinically significant prostate cancer on targeted biopsy cores. The relative SVD can be used as a per-procedure quality indicator of 3D-TRUS segmentation. Patient summaryA discrepancy of ≥10% between segmented magnetic resonance imaging and transrectal ultrasound volume is associated with a reduced ability to detect significant prostate cancer on targeted biopsy cores.

A mathematical and neural network-based hybrid technique for detecting the prostate contour from medical image data

Extraction of prostate contour on transrectal ultrasound (TRUS) is significant in prostate cancer diagnosis. With the low-contrast images of TRUS and the existence of imaging artifacts, detecting the prostate accurately from TRUS images becomes more and more difficult. In this paper, we present four strategies to achieve improved segmentation precision on difficult images. First, to achieve the data sequence, we adopt a variant of the principal curve-based algorithm, where a small part of prior point information is utilized as the approximate initialization. Secondly, we devise an evolution neural network to assist in finding the optimal neural network. Thirdly, we train the fractional-order-based neural network using data sequence as input, thereby decreasing the model error and increasing the precision of results during training. Finally, a smooth and explainable mathematical function of organ boundary is represented by the parameters of a fractional-order-based neural network. The performance of our method was evaluated on two clinical datasets with 1,338 TRUS prostate images using Accuracy (ACC), Dice similarity coefficient (DSC), and Jaccard similarity coefficient (OMG). Results show that our model 1) achieves better performance than the state-of-the-art segmentation models; the corresponding ACC, DSC, and OMG of our method are 95.3 ± 2.2 %, 95.9 ± 2.3 %, and 94.9 ± 2.4 %, respectively, and 2) detects unseen or vague regions satisfactorily.

Increased prostate volume on transrectal ultrasound and magnetic resonance imaging are potential risk factors for acute urinary retention following transperineal prostate biopsy.

308 Background: Prostate biopsy is one of the most frequently performed procedures in urology. Recently, there has been a nationwide shift towards offering transperineal (TP) biopsies due to a reduced rate of infectious complications compared to the transrectal (TR) route. While infection may be reduced, TP biopsy is not without complication, most notably, acute urinary retention (AUR). Estimates vary as to the true rate of AUR following TP biopsy. Further, some studies have reported higher rates of AUR following TP biopsy than TR. Here we report the rate of AUR following TP biopsy at a single academic institute and relate it to risk factors for developing AUR. Methods: Retrospective case-control study. All biopsies performed with TR ultrasound (TRUS) guidance using TP technique under general anesthesia in dorsal lithotomy with a grid template. TRUS volumes were recorded during the procedure, and MRI volumes were calculated by a trained radiologist pre-biopsy. Charts of men undergoing TP biopsy from 2012 to present were reviewed. AUR was defined as patients who reported inability to urinate within 72 hours post-biopsy and underwent thorough evaluation including PVR and relevant H&amp;P and required catheter placement. Independent samples t-test was run to relate AUR to risk factors pre/post-biopsy. Results: A total of 767 TP biopsies were completed in the study window, but not all had TRUS/MRI data. Total rate of AUR was 5.48% (N=42/767). Risk factors for AUR were increased TRUS (p=0.009, [6.49, 42.30]) and MRI prostate volumes (p=0.027, [2.90, 43.13]). Age, number of cores taken, and number of previous biopsies were not associated with AUR. Conclusions: While data is scant, the rate of AUR at our institution is consistent with current estimates in the literature. There is a growing body of evidence that the rate of AUR post-TP biopsy is higher than TR, but more investigation is needed. There is also a gap in the literature on risk factors predicting AUR after TP biopsy, however our findings are relatively consistent with the few studies currently published. Urologists must recognize patients presenting for TP biopsy with large volume prostates and consider altering management to prevent AUR. [Table: see text]

Prostate cancer risk assessment by the primary care physician and urologist: transabdominal- versus transrectal ultrasound prostate volume-based use of the Rotterdam Prostate Cancer Risk Calculator.

Our objective was to assess the accuracy of transabdominal ultrasound (TAUS) measured prostate volume in the primary care setting with transrectal ultrasound (TRUS) measured prostate volume by the urologist as the reference test. Furthermore, our objective was to assess whether risk-stratification using TAUS prostate volume by the primary care physician could reduce unnecessary referrals to the urologist. Men in two Dutch primary care offices with a prostate cancer (PCa) screening request received a digital rectal examination (DRE), prostate specific-antigen (PSA), and TAUS prostate volume measurement by the general practitioner, followed by Rotterdam Prostate Cancer Risk Calculator (RPCRC) risk assessment. The examination was repeated by a urologist using TRUS. A prostate biopsy was performed in case of a RPCRC positive biopsy advice. A non-inferiority analysis was performed comparing TAUS and TRUS prostate volume differences. A risk-based referral strategy using TAUS and the RPCRC in the primary care setting was compared with the standard referral strategy based on PSA (≥3 ng/mL) and DRE. A total of 105 men were included with a median PSA of 1.9 ng/mL. The mean prostate volumes measured by TAUS and TRUS were 55 and 45 mL, respectively. The mean overestimation of the prostate volume by TAUS as compared to the reference test was 9.9 mL (95% CI: 5.9-13.8). According to Dutch standard practice, 41 out of 105 (39%) men would have been referred to the urologist. Stratification in primary care based on the RPCRC using TAUS prostate volume would have avoided 29 out of the 41 (71%) referrals, at the expense of non-referral of 5 out of 11 (45%) men with a biopsy indication, according to the urologist. RPCRC-based risk stratification in primary care using TAUS prostate volume measurement is feasible and may prevent unnecessary referrals to the urologist and reduce costs. The accuracy of the risk assessment with TAUS might be improved by sufficient training and centralization to achieve a higher volume of consultations in primary care facilities.

H-ProMed: Ultrasound image segmentation based on the evolutionary neural network and an improved principal curve

The purpose of this work is to develop a method for accurate and robust prostate segmentation in transrectal ultrasound (TRUS) images. These images are difficult to segment due to missing/ambiguous boundary between the prostate and neighboring structures, the presence of shadow artifacts, as well as the large variability in prostate shapes. This paper develops a novel hybrid method for TRUS prostate segmentation by combining an improved principal curve-based method with an evolutionary neural network; the former for achieving the data sequences while and the latter for improving the smoothness of the prostate contour. Both qualitative and quantitative experimental results showed that our proposed method achieved superior segmentation accuracy and robustness as compared to state-of-the-art methods. The average Dice similarity coefficient (DSC), Jaccard similarity coefficient (Ω), and accuracy (ACC) of prostate contours against ground-truths were 96.8%, 95.7%, and 96.4%, and the DSC of around 92% and 95% for other deep learning and hybrid methods, respectively.

MP43-06 COMPARING MRI/US FUSION TO STANDARD PROSTATE BIOPSY IN DETERMINING GRADE RECLASSIFICATION AT CONFIRMATORY BIOPSY IN A MULTI-INSTITUTIONAL ACTIVE SURVEILLANCE COHORT: A PENNSYLVANIA UROLOGY REGIONAL COLLABORATIVE (PURC) ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP43-06 COMPARING MRI/US FUSION TO STANDARD PROSTATE BIOPSY IN DETERMINING GRADE RECLASSIFICATION AT CONFIRMATORY BIOPSY IN A MULTI-INSTITUTIONAL ACTIVE SURVEILLANCE COHORT: A PENNSYLVANIA UROLOGY REGIONAL COLLABORATIVE (PURC) ANALYSIS David Strauss, Rohit Reddy, Matthew Loecher, Kaynaat Syed, John Danella, Serge Ginzburg, Laurence Belkoff, Jeffrey Tomaszewski, Edouard Trabulsi, Eric Singer, Bruce Jacobs, Jay Raman, Thomas Guzzo, Robert Uzzo, and Adam Reese David StraussDavid Strauss More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Matthew LoecherMatthew Loecher More articles by this author , Kaynaat SyedKaynaat Syed More articles by this author , John DanellaJohn Danella More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Laurence BelkoffLaurence Belkoff More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Eric SingerEric Singer More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Jay RamanJay Raman More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Adam ReeseAdam Reese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) has emerged as the optimal management of low-risk prostate cancer (CaP) patients, and relies on an accurate confirmatory biopsy to stratify disease risk. The literature is conflicting regarding whether multiparametric (mp) MRI/fusion biopsy improves detection of clinically significant cancers compared to standard 12-core trans rectal ultrasound (TRUS) at time of confirmatory AS biopsy. We aimed to analyze a prospectively maintained multi-institutional AS database with the intent to compare clinically significant reclassification rates between biopsy groups at confirmatory biopsy. METHODS: The Pennsylvania Urological Regional Collaborative (PURC) database, a prospectively maintained consortium CaP database, was retrospectively queried for all low-risk CaP men on AS. Patients were categorized by modality of confirmatory biopsy (either standard 12 core TRUS prostate biopsy or mpMRI targeted/ultrasound fusion prostate biopsy). The primary outcome of interest was grade group reclassification at the time of confirmatory biopsy. RESULTS: The study cohort included 469 low risk men on AS, with 339 (72%) undergoing standard 12-core TRUS confirmatory biopsy and 130 (28%) undergoing fusion confirmatory biopsy. There were no differences between groups at index biopsy, regarding demographic or disease characteristics. (Table 1) Clinically significant grade reclassification, defined as GG2 or greater, was seen on 42% (54) of mpMRI biopsies vs. only 22% (74) of standard biopsies (p < 0.001) (Table 2). CONCLUSIONS: The use of mp-MRI for AS confirmatory biopsy, compared to standard 12-core TRUS biopsy, improved the detection of clinically significant cancer. These findings suggest the value of MRI/US fusion biopsy to appropriately identify higher risk men on AS who may benefit from definitive treatment. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e742 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Strauss More articles by this author Rohit Reddy More articles by this author Matthew Loecher More articles by this author Kaynaat Syed More articles by this author John Danella More articles by this author Serge Ginzburg More articles by this author Laurence Belkoff More articles by this author Jeffrey Tomaszewski More articles by this author Edouard Trabulsi More articles by this author Eric Singer More articles by this author Bruce Jacobs More articles by this author Jay Raman More articles by this author Thomas Guzzo More articles by this author Robert Uzzo More articles by this author Adam Reese More articles by this author Expand All Advertisement PDF DownloadLoading ...

Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study.

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing. Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer. Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019. Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS. Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software. Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion ( p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer ( p <0.05). Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.

PREDICTION OF HYPOECHOIC LESIONS ON ULTRASOUND OF PROSTATE CANCER BASED ON PSA INTERVAL AND GLEASON GROUP

Objective: To evaluate hypoechoic lesion in transrectal ultrasonography of prostate (TRUS-P) predictive value on prostate cancer based on PSA Interval and Gleason Group. Material &amp; Methods: An observational analytic study with a cross-sectional design take place from January 2015 to December 2018 analyzing patients who had undergone TRUS-P Biopsy at Hasan Sadikin Hospital. Patients are divided into several subgroups according to different PSA levels. A p-value &lt; 0.05 was considered statistically significant. PPV, NPV, and Youden’s index were all indexes reflecting the performance of a diagnostic test. Results: There were 35 cases (49.3%) with a visible hypoechoic lesion in TRUS and 36 cases (41.7%) without a visible hypoechoic lesion. In our study, 23.9% of the patients with hypoechoic lesions were diagnosed with prostate cancer on TRUSP-Biopsy. The results of the analysis with Youden’s index show that PSA at intervals of 10-20 is the best predictor of diagnostic values. Then we analyzed the overall detection rate based on PSA interval. Patients with PSA &gt; 20 ng/ml, hypoechoic lesions were significantly associated with Gleason Group. Conclusion: We concluded in our study that the hypoechoic lesion in transurethral ultrasonography of prostate could improve the predictive efficacy for diagnosing prostate cancer.&#x0D;

Erectile dysfunction and micturition disorders in patients with metabolic syndrome

Introduction. The aetiology and pathogenesis of lower urinary tract symptoms, chronic pelvic pain syndrome, and erectile dysfunction are not fully understood. Metabolic syndrome (MS) is an independent factor in these disorders. Purpose of the study. To determine the significance of metabolic syndrome in the development and course of dysuria, chronic pelvic pain syndrome and erectile dysfunction. Materials and methods. The study involved 115 men aged 40 - 60 years. Patients are divided into two groups based on the presence or absence of proven metabolic syndrome. The age of patients in the main group (n = 86) was 52.0 ± 3.5 years. A control group (n = 29) — men without metabolic syndrome at the age of 50.5 ± 2.4 years. Patients were questioned using questionnaires IPSS (International System for the Summary Assessment of Diseases of the Prostate), ICEF-5 (International Index of Erectile Function). An objective (physical) examination was performed. Laboratory diagnostics included the determination of the following indicators: total testosterone, albumin, SHBG (sex hormonebinding globulin), the level of free testosterone was calculated based on the three previous indicators, LH (luteinizing hormone), insulin, glucose, glycosylated haemoglobin, lipid profile. All patients underwent uroflowmetry, bladder ultrasound for determination of residual urine volume, prostate TRUS (transrectal ultrasound) with Doppler blood flow. The significance of the differences was determined by the nonparametric Mann-Whitney test; the differences were considered statistically significant if the probability was greater than 95%. Results. Patients with MS had statistically significant more pronounced symptoms on the IPSS scale and a lower QoL index. According to uroflowmetry, the maximum flow rates in the study group were significantly lower than the control. There was an increase in the duration of urination in patients with MS. Patients with MS presented more pronounced complaints of erectile dysfunction according to the IIEF5 scale in comparison with the control group of observation. The data obtained make it possible to associate MS with the risk of developing lower urinary tract symptoms and urgency in men. Conclusion. Metabolic syndrome acts as an independent factor in erectile dysfunction and hypogonadism, which leads to urinary disorders.

Relationship between Prostate Volume and International Prostate Symptom Score (IPSS) Degree of Tamed Prostate Enlargement on Transabdominal Ultrasonography (TAUS) and Transrectal Ultrasonography (TRUS) Examination

A B S T R A C TIntroduction: IPSS is the gold standard in measuring clinical symptoms of BPH. 1Prostate volume has been said to have a close relationship with the development ofBPH. 9 The aim of this study was to determine the relationship between prostate volumeas measured by transabdominal ultrasonography (TAUS) and transrectal (TRUS) to thedegree of IPSS. Methods: An analytic observational study with a cross sectional designwas carried out on 303 BPH patients at the General Hospital of Kariadi Hospital,Semarang. The data obtained from the TAUS, TRUS and IPSS prostate volume wereobtained from medical records for the period 2015 - 2020. The data were then analyzedby using the chi square test. Results: Patients with BPH have a TAUS prostate volumein classification I of 0 people 0%, classification II of 16 people (5.3%), classification IIIof 96 people (31.7%), classification IV of 102 people (33.7%) and classification V of 89people (29.4%). While TRUS in classification I was 0% (0 people), classification II was11 people (3.6%), classification III was 92 people (30.4%), classification IV was 110people (36.3%) and classification V of 90 people (29.7%). IPSS obtained severe IPSSdegrees, namely 192 people (63.4%), moderate degrees of 111 people (36.6%), and milddegrees 0% (0 people). The results of the Chi Square test obtained a p-value of 0.000(p &lt;0.05), indicating that there was a significant relationship between prostate volume,whether examined by transabdominal or transrectal ultrasound, and the degree ofIPSS. The correlation coefficient r = 0.925 indicates a very strong relationship betweenprostate volume as measured by both transabdominal and transrectal ultrasound withthe degree of IPSS, a positive result shows that the increase in prostate volume, thedegree of IPSS will also increase. Conclusion: There is a significant relationshipbetween prostate volume as measured by both TAUS and TRUS and the degree of IPSS.

The efficiency of prostate-specific antigen density measurement using three different methods on the prediction of biochemical recurrence

Background The aim of this study was to evaluate the efficiency of prostate-specific antigen (PSA) density (PSAD) calculated through prostate volume (PV) obtained via transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) and actual prostate weight (PW) methods obtained via pathological evaluation on the prediction of biochemical recurrence (BCR) in the follow-ups of patients who had undergone radical prostatectomy (RP). Methods A total of 335 clinically localized prostate cancer (PCa) patients who had received open RP between January 2015 and December 2018 were enrolled in the study. Pre and postoperative demographic data, clinical and pathological findings and BCR conditions were recorded. The PSAD was calculated using information obtained through preoperative TRUS examinations, MRI, and collected pathological specimens after RP by dividing the maximum preoperative PSA value and PV/PW. Results In a mean follow-up duration of 20.2 ± 8.5 months, recurrence was observed in 52 patients (24.4%) and progression was observed in 8 (3.8%) patients. The TRUS-PSAD, MRI-PSAD, and PW-PSAD values were statistically significantly higher in BCR patients compared to non-BCR patients. The International Society of Urologic Pathologists (ISUP) grade 5 and pT3b as a pathological stage were detected as independent variables in the prediction of BCR formation. Actual PW had a high prediction value compared to other PSAD measurements at <40 g prostate weights, but it had a low prediction value in prostates with an actual PW >60 g. Conclusions In this study, it was stated that PSAD acquired through different imaging methods does not affect the usability of PSAD in BCR prediction in clinical practice. The ISUP grade 5 and pT3b stage PCa were detected as independent markers in BCR prediction after RP.

Holmium Laser Enucleation of Prostate Within 6 Weeks of Transrectal Ultrasound Guided Prostate Biopsy is Safe and Effective

To evaluate the safety and efficacy of performing Holmium laser enucleation of the prostate (HoLEP) for the treatment of bladder outlet obstruction secondary to an enlarged prostate within 6-weeks of a transrectal ultrasound (TRUS) guided prostate biopsy. We performed a retrospective review of patients who underwent a HoLEP at our institution, excluding any patients with a confounding urologic history and compared patients who underwent a TRUS-guided 6- or 12-core prostate biopsy, and then underwent a HoLEP within 6 weeks (study group) with all other patients (control group). Our primary outcomes were enucleation efficiency (EE) and perioperative complication rate. Our secondary outcomes included postoperative drop in hemoglobin, duration of catheterization, length of hospital stay, voiding metrics at 1 and 6 months and rate of incidental prostate cancer diagnosed on histopathological examination of prostate specimens after HoLEP. To test for differences between the study and control groups, we performed independent sample t-test (2-tailed) and chi-square tests for quantitative and qualitative variables, respectively. P values of < 0.05 were considered statistically significant. 552 patients met inclusion criteria and 84 patients underwent prostate biopsy within a period of 45 days prior to HoLEP. Enucleation efficiency was higher in the study group (P=0.00). There was no significant difference between the 2 groups regarding perioperative complications, postoperative voiding outcomes, or rate of incidental prostate cancer detection. TRUS prostate biopsy performed within 6 weeks of HoLEP does not negatively impact operative difficulty or treatment outcome.

'One Stop Prostate Clinic': prospective analysis of 1000 men attending a public same-day prostate cancer assessment and/or diagnostic clinic.

This study reported the outcomes of the first 1000 men to attend the One Stop Prostate Clinic, a consultant-led same-day prostate cancer assessment and diagnostic clinic at a tertiary public hospital. Prospective audit of demographic and clinical data between August 2011 and November 2017 was conducted for same-day urological assessment and/or trans-rectal ultrasound (TRUS)-guided prostate biopsies with peri-prostatic infiltration local anaesthetic (PILA) and antibiotic prophylaxis. A total of 466 (47%) rural and 534 (53%) metropolitan men attended. Rural mean (range) age was 63 years (38-86) and 65 years (37-89) for metro men (P = 0.006). Rural median (range) prostate specific antigen (PSA) level was 6.7 g/mL (0.2-450) and 7.3 ng/mL (0.5-860) for metro men (P = 0.011). Twenty-five men (2.5%) refused/could not tolerate TRUS-guided biopsy using PILA. One hundred and fifty-one (15%) men had multi-parametric magnetic resonance imaging prior to TRUS biopsy and 876 (88%) men had prostate biopsies, with a new cancer diagnostic rate of 51% (443 men). Clinically significant prostate cancer was detected in 339 (34%) men. The overall infective complication rate requiring hospital admission rose from 1.4% to 2.9% after the prophylactic antibiotic regimen changed from six doses of 500 mg ciprofloxacin to a single dose of 500 mg (P = 0.398). This is the largest single institution prospective TRUS prostate biopsy series in Australasia. Biopsies using PILA were well tolerated with low complication rates and diagnosed a high rate of clinically significant prostate cancer. The 'One Stop' pathway generates efficiencies with combined assessment and diagnostic process, lessens demand on outpatient clinic appointments and reduces travel time and costs for rural men.

Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer

Introduction: Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. Methods: Prospective study was done in 66 males of age &gt;40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA &gt;4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. Results: Twenty-three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. Conclusion: TRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.

Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer

Introduction Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings.&#x0D; MethodsProspective study was done in 66 males of age &gt;40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA &gt;4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings.&#x0D; ResultsTwenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%.&#x0D; ConclusionTRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.

The Value of Prostate-Specific Antigen-Related Indexes and Imaging Screening in the Diagnosis of Prostate Cancer.

ObjectiveThe aim of this study was to explore the value of the prostate-specific antigen (PSA) levels, the ratio of free PSA to total PSA (fPSA/TPSA), the PSA density (PSAD), digital rectal examination (DRE), transrectal prostate ultrasound (TRUS), and multiparameter MRI (MP-MRI) in the differential diagnosis of benign prostatic hyperplasia (BPH) and prostate cancer (PCa).MethodsFrom February 2016 to September 2019, data from 620 patients who underwent systematic transrectal ultrasound-guided prostate biopsy (STURS-PB) in our hospital were retrospectively collected, including the PSA levels, the fPSA/TPSA ratio, the PSAD, DRE, TRUS, MP-MRI, prostate volume, and other clinical data.ResultsAmong the 620 patients, 249 patients were in the PCa group, and 371 patients in the BPH group. The positive puncture rate was 40.16%. The positive predictive values of DRE, TRUS, mpMRI, and TPSA levels for PCa were 39.91%, 39.38%, 64.14%, and 41.57%, respectively; the sensitivity of these parameters was 37.35%, 51.41%, 74.69%, and 57.43%, respectively; and the specificity of these parameters was 62.26%, 46.90%, 71.97%, and 45.82%, respectively. When the TPSA concentration was in the range of 4–20 ng/mL, the positive puncture rate of STURS-PB was 23.18%, with a high rate of misdiagnosis. When the TPSA concentration was in the range of 4–20 ng/mL, the fPSA/TPSA ratio was 0.15, the PSAD was 0.16, the comprehensive evaluation of PCa was optimal (the sensitivity of these parameters was 88.85% and 84.09%, respectively; the specificity was 80.17% and 67.29%, respectively; the positive predictive value was 57.41% and 51.39%, respectively). When the TPSA concentration >4 ng/mL, the fPSA/TPSA ratio ≤0.15 and the PSAD ≥0.16, the sensitivity, specificity, and correctness index of the PCa and BPH diagnosis were 80.54%, 82.75%, and 67.07%, respectively.ConclusionWhen using DRE, TRUS, and MP-MRI to screen for PCa, MP-MRI has a relatively high sensitivity and specificity. Using these three thresholds (TPSA >4 ng/mL combined with an fPSA/TPSA ratio ≤0.15 and a PSAD ≥0.16) is significantly better than using TPSA levels alone for the differential diagnosis of PCa and BPH.

Label-driven magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) registration using weakly supervised learning for MRI-guided prostate radiotherapy

Registration and fusion of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) of the prostate can provide guidance for prostate brachytherapy. However, accurate registration remains a challenging task due to the lack of ground truth regarding voxel-level spatial correspondence, limited field of view, low contrast-to-noise ratio, and signal-to-noise ratio in TRUS. In this study, we proposed a fully automated deep learning approach based on a weakly supervised method to address these issues. We employed deep learning techniques to combine image segmentation and registration, including affine and nonrigid registration, to perform an automated deformable MRI-TRUS registration. To start with, we trained two separate fully convolutional neural networks (CNNs) to perform a pixel-wise prediction for MRI and TRUS prostate segmentation. Then, to provide the initialization of the registration, a 2D CNN was used to register MRI-TRUS prostate images using an affine registration. After that, a 3D UNET-like network was applied for nonrigid registration. For both the affine and nonrigid registration, pairs of MRI-TRUS labels were concatenated and fed into the neural networks for training. Due to the unavailability of ground-truth voxel-level correspondences and the lack of accurate intensity-based image similarity measures, we propose to use prostate label-derived volume overlaps and surface agreements as an optimization objective function for weakly supervised network training. Specifically, we proposed a hybrid loss function that integrated a Dice loss, a surface-based loss, and a bending energy regularization loss for the nonrigid registration. The Dice and surface-based losses were used to encourage the alignment of the prostate label between the MRI and the TRUS. The bending energy regularization loss was used to achieve a smooth deformation field. Thirty-six sets of patient data were used to test our registration method. The image registration results showed that the deformed MR image aligned well with the TRUS image, as judged by corresponding cysts and calcifications in the prostate. The quantitative results showed that our method produced a mean target registration error (TRE) of 2.53 ± 1.39 mm and a mean Dice loss of 0.91 ± 0.02. The mean surface distance (MSD) and Hausdorff distance (HD) between the registered MR prostate shape and TRUS prostate shape were 0.88 and 4.41 mm, respectively. This work presents a deep learning-based, weakly supervised network for accurate MRI-TRUS image registration. Our proposed method has achieved promising registration performance in terms of Dice loss, TRE, MSD, and HD.

Automatic prostate segmentation using deep learning on clinically diverse 3D transrectal ultrasound images.

Needle-based procedures for diagnosing and treating prostate cancer, such as biopsy and brachytherapy, have incorporated three-dimensional (3D) transrectal ultrasound (TRUS) imaging to improve needle guidance. Using these images effectively typically requires the physician to manually segment the prostate to define the margins used for accurate registration, targeting, and other guidance techniques. However, manual prostate segmentation is a time-consuming and difficult intraoperative process, often occurring while the patient is under sedation (biopsy) or anesthetic (brachytherapy). Minimizing procedure time with a 3D TRUS prostate segmentation method could provide physicians with a quick and accurate prostate segmentation, and allow for an efficient workflow with improved patient throughput to enable faster patient access to care. The purpose of this study was to develop a supervised deep learning-based method to segment the prostate in 3D TRUS images from different facilities, generated using multiple acquisition methods and commercial ultrasound machine models to create a generalizable algorithm for needle-based prostate cancer procedures. Our proposed method for 3D segmentation involved prediction on two-dimensional (2D) slices sampled radially around the approximate central axis of the prostate, followed by reconstruction into a 3D surface. A 2D U-Net was modified, trained, and validated using images from 84 end-fire and 122 side-fire 3D TRUS images acquired during clinical biopsies and brachytherapy procedures. Modifications to the expansion section of the standard U-Net included the addition of 50% dropouts and the use of transpose convolutions instead of standard upsampling followed by convolution to reduce overfitting and improve performance, respectively. Manual contours provided the annotations needed for the training, validation, and testing datasets, with the testing dataset consisting of 20 end-fire and 20 side-fire unseen 3D TRUS images. Since predicting with 2D images has the potential to lose spatial and structural information, comparisons to 3D reconstruction and optimized 3D networks including 3D V-Net, Dense V-Net, and High-resolution 3D-Net were performed following an investigation into different loss functions. An extended selection of absolute and signed error metrics were computed, including pixel map comparisons [dice similarity coefficient (DSC), recall, and precision], volume percent differences (VPD), mean surface distance (MSD), and Hausdorff distance (HD), to assess 3D segmentation accuracy. Overall, our proposed reconstructed modified U-Net performed with a median [first quartile, third quartile] absolute DSC, recall, precision, VPD, MSD, and HD of 94.1 [92.6, 94.9]%, 96.0 [93.1, 98.5]%, 93.2 [88.8, 95.4]%, 5.78 [2.49, 11.50]%, 0.89 [0.73, 1.09]mm, and 2.89 [2.37, 4.35]mm, respectively. When compared to the best-performing optimized 3D network (i.e., 3D V-Net with a Dice plus cross-entropy loss function), our proposed method performed with a significant improvement across nearly all metrics. A computation time <0.7s per prostate was observed, which is a sufficiently short segmentation time for intraoperative implementation. Our proposed algorithm was able to provide a fast and accurate 3D segmentation across variable 3D TRUS prostate images, enabling a generalizable intraoperative solution for needle-based prostate cancer procedures. This method has the potential to decrease procedure times, supporting the increasing interest in needle-based 3D TRUS approaches.

Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia.

Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.