Transrectal Ultrasound-guided Biopsy Research Articles

A Prospective Comparison of Transrectal Standard, Cognitive, Transperineal Fusion, and Mapping Prostate Biopsy for Cancer Detection.

Purpose: The aim of this research was to compare the clinically significant prostate cancer (csPCa) detection rate (International Society of Urological Pathology [ISUP] ≥2) for the four biopsy methods: transrectal ultrasound-guided biopsy (TRUS-GB), cognitive transrectal biopsy (COG-TB), fusion transperineal biopsy (FUS-TB), and transperineal template mapping biopsy (TPMB). Materials and Methods: The inclusion criteria were as follows: prostate-specific antigen (PSA) >2 ng/mL, and/or positive digital rectal examination (DRE), and/or suspicious lesion on transrectal ultrasound (TRUS) and Prostate Imaging Reporting and Data System (Pi-RADS) v2.1 ≥ 3 score. In total, 102 patients were enrolled in the study. Biopsies were performed by two urologists. In a single procedure, the first urologist performed a FUS-TB and TPMB followed by second urologist who performed TRUS-GB and COG-TB. All specimens were obtained within a single procedure. Results: The csPCa detection rate and overall cancer detection rate (CDR) per patient were comparable among the respective biopsy methods (p > 0.05). Compared with other biopsy methods, a lower clinically insignificant prostate cancer (cisPCa) was detected using COG-TB (p = 0.004). The positive cores percentage ratio (p < 0.001) as well as positive cores containing csPCa percentage ratio (p < 0.001) significantly increased for the targeted biopsy methods. The median maximum cancer core length (MCCL; p = 0.52) as well the median for the MCCL of csPCa (p = 0.47) did not differ significantly among the respective biopsy methods. Concordance of the Gleason scores between biopsy and postprostatectomy pathology did not differ significantly among biopsy methods (p = 0.87). For TRUS-GB, FUS-TB, and TPMB, the common predictive factors for csPCa were positive DRE, suspicious lesion on ultrasound and Pi-RADS 5. As for COG-TB, the only predictor was Pi-RADS 5. Conclusion: The targeted methods did not show an increase in detection of csPCa and overall CDR over systematic ones in patients with Pi-RADS ≥3. A lower cisPCa was detected using COG-TB in comparison with the other methods. The sampling efficiency increased for the targeted biopsy methods, which used only a proportion of positive cores and cores containing csPCa. There was no statistical difference in histology concordance among the biopsies. One common predictive factor of increased csPCa detection for all biopsy methods was Pi-RADS 5.

Racial differences in the utilization of MRI-guided biopsy before prostate cancer diagnosis.

5093 Background: Most low-risk prostate cancer (PCa) patients undergo active surveillance (AS). Compared with Whites, Blacks are more likely to opt for AS and suffer a higher risk of cancer progression while on AS. A primary concern of AS is the likelihood of missing clinically significant cancer. Transrectal ultrasound-guided biopsy is the most common method for diagnosing and grading PCa; however, this method often misses anterior PCa. Magnetic resonance imaging (MRI) allows clinicians to identify better and detect PCa; however, current guidelines on MRI-guided biopsy (MRI-GB) are inconsistent. This population-based study aimed to examine the utilization of MRI-GB 6 months before PCA diagnosis over time by race in the US. Methods: We used SEER-Medicare data to identify men diagnosed with PCa between January 1, 2012, to December 31, 2017, and excluded patients missing the date of diagnosis, being diagnosed at death, enrolled in HMO, or having no continuous A and B coverage six months before diagnosis. We used the CPT codes to identify prostate biopsy and MRI use. Multivariable logistic regression was used to evaluate racial disparity in MRI use six months before PCa. The model included covariates age, race, SEER region, marital status, state buy-in for Medicare (a poverty indicator), education, income, Charlson comorbidity index, and procedure (MRI) year. Results: Among 38,612 eligible men, MRI use six months before PCa diagnosis increased from 2012 to 2017 (3.2% to 24.3% among Whites, 1.8% to 14.2% among Blacks). Compared with Whites, Blacks were 38% less likely to receive pre-diagnosis MRI (OR=0.62, 95% CI 0.52-0.74). Besides race, having state buy-in for Medicare (OR=0.44; 95% CI 0.30-0.65) and geographic regions (Central vs. West OR=0.40; 95% CI 0.34-0.45) were strong predictors of lower utilization of MRI. Conclusions: The gap in the utilization of MRI may exacerbate racial disparities in PCa. Future studies are needed to identify potential barriers to adopting MRI for PCa workups.

Standard 12-Core Transrectal Ultrasound-Guided Prostate Biopsy, a Useful Tool in Screening for Prostate Cancer: A Prospective Study in Uyo, Akwa Ibom State, Nigeria

Introduction: Guided prostate biopsy is still relevant in confirming the diagnosis of suspected prostate cancer. Objective: This study evaluated the role of Transrectal Ultrasound (TRUS) guided biopsy along with histopathological evaluation in the detection of prostate cancer on the basis of abnormal digital rectal examination (DRE) findings and elevated prostate specific antigen levels (PSA). Participants and Methods: This prospective study was undertaken among consenting men aged 40 years and above screened for prostate cancer at the University of Uyo Teaching Hospital using targeted, stepwise protocol including DRE, PSA and standard 12-core transrectal ultrasound guided biopsy technique. Biopsy samples were sent for histopathological evaluation. Findings were documented, analyzed and presented in tables and figures. Results: Among 437 participants, abnormal DRE findings, elevated PSA level above 4.0 ng/ml and abnormal TRUS findings were 17.2%, 21.1%, and 17.3% respectively. Of 44 participants who had prostate biopsies with histopathologic assessment, benign prostatic diseases were 24 cases (54.5%), slightly outnumbering malignant prostatic diseases seen in 20 (45.5%).The prostate cancer detection and prevalence rates were 45.5% and 4.6% respectively. Prostatic adenocarcinoma (45.5%), nodular hyperplasia (45.5%), basal cell hyperplasia (6.8%) and high grade prostatic intraepithelial neoplasia (2.2%) were identified histologic subtypes. Nodular hyperplasia was commonly associated with chronic prostatitis (80.0%). A significant association between DRE findings, outline of prostate, and tumour subtype was ascertained. Conclusion: Targeted screening protocol encompassing TRUS guided 12- core biopsy is a final arbiter in the diagnosis of prostate cancer and has a fairly high prostate cancer detection rate of 45.5%.

Value of transrectal ultrasound-guided biopsy in endoscopy negative biopsy patients with rectal lesions

ObjectiveTo evaluate the value of transrectal ultrasound (TRUS) guided biopsy in endoscopy negative biopsy patients with rectal lesions.Methods150 endoscopy negative biopsy result rectal lesions adopted the transrectal ultrasound-guided biopsy. Based on whether the patients received contrast-enhanced ultrasound examination or not before the biopsies, all enrolled cases were divided into TRUS guided group and contrast-enhanced TRUS (CE-TRUS) guided group, and the safety and diagnostic performances were analyzed retrospectively.ResultsWe obtained adequate specimens in the majority of cases (98.7%,148/150); There were no complications identified in our study. 126 patients received contrast-enhanced TRUS examination before biopsy to evaluate vascular perfusion and necrosis. The sensitivity, specificity, PPV, NPV, and overall accuracy of all biopsies were 89.1%, 100%,100%, 70.4%, and 91.3% respectively; The sensitivity, specificity, PPV, NPV, and accuracy for TRUS-guided biopsy and CE-TRUS guided biopsy were 73.7%, 100%,100%, 50%,79.2% and 92.1%,100%,100%,75%,93.6% separately; The increase in correct diagnoses was significant (p < 0.05) between TRUS guided biopsy and CE-TRUS guided biopsy.ConclusionTRUS-guided biopsy is a reliable procedure that can be augmented by endoscopic biopsy techniques if the biopsy yields negative results. CE-TRUS might assist in the location of the biopsy and decrease sampling errors.

EFFICACY OF TOPICAL DILTIAZEM COMBINED WITH LOCAL XYLOCAINE TO DECREASE THE PAIN DURING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

Transrectal Ultrasound Guided Biopsy (TRUS) has been the gold standard in the detection of prostate cancer. The cancer detection rate is higher in biopsy protocols taking more core needles. The periprostatic nerve block (PPNB) has become most widely accepted form of anaesthesia for performing TRUS biopsy*1, but PPNB does not reduce the pain during the insertion of rectal ultrasound probe. The act of probe insertion was described as most uncomfortable in a randomized trial of pain perception during TRUS guided biopsy.*2 Calcium channel blockers like diltiazem cream acts by blocking the slow calcium channel located in the anal sphincter bro muscular cell membranes to achieve smooth muscle relaxation, and hence reduce the resting anal sphincter pressure

A Matched-pair Analysis Comparing Systematic Prostate Biopsy by Conventional Transrectal Ultrasound-guidance Versus Software-based Predefined 3D-Guidance

To compare software-based three-dimensional-guided systematic prostate biopsy (3D-GSB) with conventional transrectal ultrasound-guided systematic biopsy (TGSB) regarding prostate cancer (PCa) detection rates (CDR). In total, 956 patients (200 TGSB patients and 756 3D-GSB patients) without prior positive biopsies and with a prostate-specific antigen value ≤20ng/ml were eligible for analysis. TGSB and 3D-GSB cases were matched in a 1:1 ratio using propensity score matching with age, prostate-specific antigen, prostate volume, previous biopsy status, and suspicious palpatory finding as confounders. 3D-GSB was conducted with the semi-robotic prostate fusion-biopsy system Artemis. For each patient in both groups, SB was conducted in a similar pattern with 12 cores. All cores in 3D-GSB were automatically planned and mapped on a 3D-model as well as on the real-time transrectal ultrasound imaging. Primary end points were the clinically significant (cs) and overall CDR. Secondary end point was the cancer-positive core rate. After matching, the csCDR was not significantly different between the 3D-GSB and the TGSB groups (33.3% vs28.8%, P=.385). Overall CDR was significantly higher for 3D-GSB compared to TGSB (55.6% vs39.9%, P=.002). 3D-GSB detected significantly more non-significant PCa than TGSB (22.2% vs11.1%, P=.004). In patients with PCa, the number of cancer-positive SB cores was significantly higher by TGSB (42% vs25%, P<.001). 3D-GSB was associated with a higher CDR than TGSB. However, no significant difference was shown in detection of csPCa between both techniques. Therefore, currently, 3D-GSB does not appear to add value to conventional TGSB.

MP15-04 PRESENCE OF HPV IN PROSTATE TISSUE FROM PATIENTS SUBMITTED TO PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP15-04 PRESENCE OF HPV IN PROSTATE TISSUE FROM PATIENTS SUBMITTED TO PROSTATE BIOPSY Nalisson Pereira, Emerson Martins, Mateus Quintela, Arthur Cunha, and Jaques Waisberg Nalisson PereiraNalisson Pereira More articles by this author , Emerson MartinsEmerson Martins More articles by this author , Mateus QuintelaMateus Quintela More articles by this author , Arthur CunhaArthur Cunha More articles by this author , and Jaques WaisbergJaques Waisberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PCa) is the second most common cancer among men. Environmental and hereditary factors are assumed to play crucial roles in prostate carcinogenesis. In addition, increasing epidemiological evidence, along with molecular research, suggests that viral infection would be a potential cofactor for the development of PCa. Recently, it has been estimated that virus infection represents approximately 10% of the worldwide cancer burden. HPV, one of the most important oncogenic viruses. Based on the genomic sequence of L1, the gene encoding the main capsid protein, more than 200 types of HPV have been identified and characterized, with at least 14 high-risk types which may cause cancer. The aim of this study was to evaluate the presence of HPV in prostate tissue in patients undergoing transrectal ultrasound-guided prostate biopsy and its possible relationship with prostate cancer. METHODS: 157 prostate tissue samples were obtained from patients undergoing screening for PCa by transrectal ultrasound guided biopsy, collected at IOM (Instituto de Oncologia e Mastologia de Macapá, Amapá, Brazil) from December 2018 to January 2021. One fragment was placed in a microcentrifuge tube with 1mL of RNAlater. After collection, the vials were stored at -20C until being processed. Total DNA extraction was performed in the Microbiology and Immunology Laboratory of the Federal University of Amapá (UNIFAP). The Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR) method was used for HPV detection. The analysis to investigate the relationship between the presence of HPV and cancer was the extension of Fisher's exact test and the alpha significance level equal to 5% was applied. RESULTS: 157 patients, 95 (60.5%) with PCa, 55 (35.0%) without cancer, and 7 (4.5%) as inconclusive (ASAP). The presence of HPV was 7/95 =(7.4%) in patients with cancer, and 2/55 =(3.6%) in those without evidence of cancer or inconclusive diagnosis ASAP. The inferential results revealed that the presence of HPV was not related to the diagnosis of cancer when the ASAP diagnosis was considered in the analysis (p=0.663) and, also when the ASAP diagnosis was not included (p=0.487). CONCLUSIONS: There was no L1 gene expression and significant levels of HPV L1 in prostate tissue. These findings suggest no oncogenic activity of HPV in PCa. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nalisson Pereira More articles by this author Emerson Martins More articles by this author Mateus Quintela More articles by this author Arthur Cunha More articles by this author Jaques Waisberg More articles by this author Expand All Advertisement PDF downloadLoading ...

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer. Reply.

No AccessJournal of UrologyReply to Letters to the Editor16 Mar 2023A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer. Reply. Kai Zhang, Jeremy Teoh, Pilar Laguna, Chi-Fai Ng, and Jean de la Rosette Kai ZhangKai Zhang Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China More articles by this author , Jeremy TeohJeremy Teoh S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author , Pilar LagunaPilar Laguna Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author , Chi-Fai NgChi-Fai Ng S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author , and Jean de la RosetteJean de la Rosette Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003405AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer. Reply.." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . A multicenter, randomized, single-blind, 2-arm intervention study evaluating the adverse events and quality of life after irreversible electroporation for the ablation of localized low-intermediate risk prostate cancer. J Urol.2023; 209(2):347-353. Link, Google Scholar 2. . Focal therapy in prostate cancer-report from a consensus panel. J Endourol. 2010; 24(5):775-780. Crossref, Medline, Google Scholar 3. . Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol.2015; 68(3):438-450. Crossref, Medline, Google Scholar 4. . Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol.2020; 17(1):41-61. Crossref, Medline, Google Scholar 5. . Transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy combined with standard template improves prostate cancer detection. J Urol.2022; 207(1):86-94. Link, Google Scholar 6. . Schema and cancer detection rates for transperineal prostate biopsy templates: a review. Ther Adv Urol.2022; 14:175628722211050. Crossref, Google Scholar 7. . EAU—EANM—ESTRO—ESUR—ISUP—SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol.2021; 79(2):243-262. Crossref, Medline, Google Scholar 8. . Effect of focal vs extended irreversible electroporation for the ablation of localized low- or intermediate-risk prostate cancer on early oncological control: a randomized clinical trial. JAMA Surg.2023. doi: 10.1001/jamasurg.2022.7516. Crossref, Google Scholar 9. . An updated systematic review on focal therapy in localized prostate cancer: what has changed over the past 5 years?Eur Urol.2022; 81(1):5-33. Crossref, Medline, Google Scholar 10. . Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy. World J Urol.2018; 36(9):1383-1389. Crossref, Medline, Google Scholar Submitted February 26, 2023; accepted March 2, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kai Zhang Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China More articles by this author Jeremy Teoh S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author Pilar Laguna Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author Chi-Fai Ng S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author Jean de la Rosette Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author Expand All Submitted February 26, 2023; accepted March 2, 2023; published 000. Advertisement PDF downloadLoading ...

Impact of changing PI-RADS cutoff on prostate cancer detection by MRI cognitive fusion biopsy in biopsy-naïve patients

BackgroundMulti-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3–5 and PI-RADS 4–5 as a threshold for targeted prostatic biopsy.MethodsThis is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3–4 versus PI-RADS 4–5 lesion by mpMRI for prostate cancer detection in biopsy-naive men.ResultsThe overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3–5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4–5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively).ConclusionsLimiting the TBs to PI-RADS 4–5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors.

Cone Beam Computed Tomography Radiomics for Prostate Cancer: Favourable vs. Unfavourable Prognosis Prediction

Silently asymptomatic at an early stage and often painless, requiring only active surveillance, Prostate Cancer (PCa) is traditionally diagnosed by a Digital Rectal Examination (DRE) and a Prostate Specific Antigen (PSA) blood test. A histological examination, searching for pattern irregularities on the prostate glandular tissue, is performed to quantify the aggressiveness of PCa. The assigned Gleason Score (GS), usually combined with Transrectal Ultrasound Guided Biopsy (TRUS), allows the stratification of patients according to their risk group. Intermediate-risk patients may have a favourable (GS = 3 + 4) or unfavourable (GS = 4 + 3) prognosis. This borderline is critical for defining treatments and possible outcomes, while External Beam Radiotherapy (EBRT) is a curative option for localised and locally advanced disease and as a palliative option for metastatic low-volume disease; active surveillance or watchful waiting can also be an option for patients with a favourable prognosis. With radiomics, quantifying phenotypic characteristics in medical imaging is now possible. In the EBRT workflow, there are several imaging modalities, such as Magnetic Ressonance Imaging (MRI), Computed Tomography (CT), Positron Emission Tomography (PET), Ultrasound and Cone Beam Computed Tomography (CBCT). Most radiomic PCa studies focused on MRI and addressed tumour staging, GS, PSA or Biochemical Recurrence (BCR). This study intends to use CBCT radiomics to distinguish between favourable and unfavourable cases, with the potential of evaluating an ongoing treatment. Seven of the most used feature selection methods, combined with 14 different classifiers, were evaluated in a total of 98 pipelines. From those, six stood out with Area Under the Receiver Operating Characteristic (AUROC) values ≥ 0.79. To the best of our knowledge, this is the first work to evaluate a PCa favourable vs. unfavourable prognosis model based on CBCT radiomics.

Effect of constipation on acute urinary retention following transrectal prostate biopsy.

To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guided prostate biopsy (TRUS PB). A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-void residue, age, body mass index, histopathological inflammation, and AUR. The mean age of patients was 64.63±8.31 years, the PSA level was 11.60±16.83 ng/mL, and the prostate volume was 54.66±25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively). Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.

Combination of Urinary MiR-501 and MiR-335 With Current Clinical Diagnostic Parameters as Potential Predictive Factors of Prostate Biopsy Outcome.

The detection of prostate cancer (PCa) is currently based on prostate-specific antigen (PSA) quantification as an initial screening followed by ultrasound-guided transrectal biopsy. However, the high rate of false-negative biopsies often leads to inappropriate treatment. Therefore, new molecular biomarkers, such as urine microRNAs (miRNAs), are a possible way to redefine PCa diagnostics. Urine samples of 356 patients undergoing prostate biopsy (256 cases with confirmed prostate cancer, 100 cases with negative prostate biopsy) at the Masaryk Memorial Cancer Institute (Czech Republic) and additional 36 control subjects (healthy controls, benign prostatic hyperplasia - BPH) were divided into the discovery and validation cohorts and analyzed. In the discovery phase, small RNA sequencing was performed using the QIAseq miRNA Library Kit and the NextSeq 500 platform. Identified miRNA candidates were validated by the RT-qPCR method in the independent validation phase. Using the small RNA sequencing method, we identified 12 urine miRNAs significantly dysregulated between PCa patients and controls. Furthermore, independent validation showed the ability of miR-501-3p and the quantitative miR-335:miR-501 ratio to distinguish between PCa patients and patients with negative prostate biopsy. The subsequent combination of the miR-335:miR-501 ratio with PSA and total prostate volume (TPV) using logistic regression exceeded the analytical accuracy of standalone parameters [area under curve (AUC)=0.75, positive predictive value (PPV)=0.85, negative predictive value (NPV)=0.51)] and discriminated patients according to biopsy outcome. Combination of miR-335:miR-501 ratio with PSA and total prostate volume was able to identify patients with negative prostate biopsy and could potentially streamline decision making for biopsy indication.

Comparison of Transrectal Prostate Digital and Ultrasound-Guided Core Biopsies in 400 Men in a Low-and-Middle Income Country

Comparison of Transrectal Prostate Digital and Ultrasound-Guided Core Biopsies in 400 Men in a Low-and-Middle Income Country

Abstract C088: Biological and neighborhood-level social determinants of prostate disease aggressiveness among Black and White men undergoing prostate biopsy

Abstract Introduction and study purpose: Prostate cancer (PCa) is the leading type of newly diagnosed cancer and second leading cause of cancer death in American men. Significant racial differences in PCa incidence and mortality have been long-reported in the U.S., with Black men demonstrating a disproportionately higher burden of disease compared to White men. Though some studies conducted in equal access health care settings have revealed equivalent PCa characteristics at diagnosis and comparable PCa outcomes for White and Black men. Identification of early predictors of prostate disease aggressiveness is essential to avoid over-treatment of clinically favorably disease that is unlikely to progress. This study examines the independent and joint roles of biological and social determinants of health (SDOHs) in predicting prostate disease aggressiveness in a racially diverse cohort of men undergoing biopsy for suspicion of PCa. Methodology: A retrospective cohort study was conducted at the University Hospitals Seidman Cancer Center in Cleveland, Ohio for the period January 1, 2005-May 2022. A retrospective chart review was conducted to identify eligible men, including White and Black men undergoing transrectal ultrasound-guided biopsy whose biopsy results included the following 3 groups: (i) negative biopsy with a history of 1+ negative biopsy (-ies) and no history of prostate cancer; (ii) biopsy-detected PCa of Gleason sum 6; and (iii) biopsy-detected PCa with metastases at initial cancer detection. Detailed clinical and biological specimen data were abstracted during retrospective chart review, and quantitative proteomics analysis of biopsy tissues is ongoing, using mass spectrometry, at the Pacific Northwest National Laboratory (PNNL). Multi-level modeling will be conducted to predict prostate disease aggressiveness as a function of protein biomarker candidates in combination with census block group-level SDOHs. Results: This study has achieved its initial goal of assembling a study cohort of 300 eligible men with available biopsy tissue, necessary clinical information, and full street address for assigning census regions. To date, proteomics data have been generated on the first 60 men (“Discovery cohort”) and SDOHs metrics have been linked to the first 180 men. Proteomic profiles and SDOH data will be examined jointly with SDOHs to predict patient clinical phenotype (i.e., metastatic, biopsy Gleason 6, biopsy negative). Conclusions: Identifying new markers of cancer aggressiveness within and across race has the potential to tailor disease management, and identify patients who are likely to benefit from earlier, timely treatment interventions, which will ultimately improve prostate cancer outcomes and quality of life. Predictive modeling that jointly considers biological determinants of cancer disparities in conjunction with neighborhood-level social factors have the potential to elucidate who can be safely spared repeat biopsies, as well as how to optimize cancer care. Citation Format: Jennifer Cullen, Tao Liu, Karin Rodland, Ranjini Ghosh, Anood Alfamy, Julia Payne, Kirsten Eom, Sweta Balaji, Nicole Diaz, Holly Hartman, Annie Liang Zhang, Daniel Spratt, Jonathan Shoag, Erika Trapl, Lee Ponsky, Gregory MacLennan. Biological and neighborhood-level social determinants of prostate disease aggressiveness among Black and White men undergoing prostate biopsy [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C088.

Correlation of multiparametric MRI (PIRADS grading) and apparent diffusion coefficient values in prostate tumor with Gleason score

Background: Multiparametric magnetic resonance imaging (mpMRI) of prostate is the radiological investigation of choice for the evaluation of prostatic tumors. Aims and Objectives: The aim of the present study was to evaluate the efficacy of mpMRI using PIRADS 2.1 grading and apparent diffusion coefficient (ADC) values as a non-invasive investigation in the detection of prostatic tumors and to correlate PIRADS grade and ADC values with Gleason score of prostate cancer (prostate Ca). Materials and Methods: Fifty patients above the age of 50 years presenting with signs and symptoms of prostate Ca were enrolled for the study. All patients were subjected to the mpMRI including ADC values and then all underwent transrectal ultrasound-guided biopsies. The post-biopsy Gleason score was correlated with PIRADS grading and ADC values followed by statistical correlation. Results: There was a positive linear association between PIRADS score and serum prostate-specific antigen levels (+0.433) and inverse relationship between mean tumor ADC values and Gleason score with correlation coefficient of −0.846 (P&lt;0.001). There was a positive linear association between the PI-RADS score and Gleason score (correlation coefficient of +0.739 with P&lt;0.001). In addition, the positive predictive value of mpMRI was 78.79%, while the negative predictive value was 84.34%. Conclusion: Our study concludes that mpMRI with PIRADS grading including ADC values assists in targeting the appropriate biopsy site for better characterization of the prostate Ca as it correlates well with the Gleason score.

The impact of prostate biopsy on erectile and ejaculatory function: A prospective study.

To evaluate the impact on erectile and ejaculatory function following transrectal ultrasound-guided biopsies of the prostate (TRUS-Bx) in sexually active men. Monocentric prospective study from May 2021 to January 2022 of consecutive patients with suspected prostate cancer [elevated prostate specific antigen (PSA) level and/or abnormal digital rectal examination] undergoing TRUS-Bx. The 15-item version of the International Index of Erectile Function (IIEF-15), Premature Ejaculation Diagnostic Tool (PDET) and short form of Male Sexual Health Questionnaire (MSHQ-EjD Short Form) were assessed before, one and three months after TRUS-Bx. The primary endpoint was to evaluate the risk of temporary post-biopsy erectile and/or ejaculatory dysfunctions. The statistical significance was set as p value < 0.05. A total of 276 consecutive patients were included in the study. The median age, PSA and biopsy cores were 65 years (IQR 59-69), 7 ng/ml (IQR 5-9.7) and 16 (IQR 12-16), respectively. We compared the IIEF subdomains before TRUS-Bx vs. one or three months: the erectile function (EF) decreased after one month (p<0.001) but recovered after three months (p=0.833); the Orgasmic Function (OF), the Sexual Desire (SD), the Intercourse Satisfaction (IS), the Overall Satisfaction (OS), and Total IIEF decreased significantly after both one and three months compared to pre-biopsy values (p < 0.05). As for ejaculatory function (EjF), PDET, MSHQ-EjD Short Form 1, 2, 3 and MSHQ-EjD Short Form 4 scores decreased significantly after one month (p < 0.001), but they returned to pre-biopsy values after 3 months: p = 0.538, p = 0.071 and p = 0.098, respectively. Our study proved that EF, assessed through IIEF- 15, and ejaculatory function, assessed through PDET and MSHQ-EjD Short Form, were negatively affected by TRUS-Bx one month after the procedure and recovered after three months. Interestingly, the other IIEF-15 subdomains (OF, SD, IS, OS and Total) resulted as significantly reduced also after 3 months: this issue highlights the importance of carefully considering the indication to TRUS-Bx.

DCE-MRI and DWI can differentiate benign from malignant prostate tumors when serum PSA is ≥10 ng/ml.

This study investigated the diagnostic utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) parameters for distinguishing between benign and malignant prostate tumors when serum prostate-specific antigen (PSA) level is ≥10 ng/ml. Patients with prostate cancer (PCa) and benign prostatic hyperplasia (BPH) with serum PSA ≥10 ng/ml before treatment were recruited. Transrectal ultrasound-guided biopsy or surgery was performed for tumor classification and patients were stratified accordingly into PCa and BPH groups. Patients underwent DCE-MRI and DWI scanning and the transfer constant (Ktrans), rate constant (Kep), fractional volume of the extravascular extracellular space, plasma volume (Vp), and Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) score were determined. The apparent diffusion coefficient (ADC) was calculated from DWI. The diagnostic performance of these parameters was assessed by receiver operating characteristic (ROC) curve analysis, and those showing a significant difference between the PCa and BPH groups were combined into a multivariate logistic regression model for PCa diagnosis. Spearman's correlation was used to analyze the relationship between Gleason score and imaging parameters. The study enrolled 65 patients including 32 with PCa and 33 with BPH. Ktrans (P=0.006), Kep (P=0.001), and Vp (P=0.009) from DCE-MRI and ADC (P<0.001) from DWI could distinguish between the 2 groups when PSA was ≥10 ng/ml. PI-RADS score (area under the ROC curve [AUC]=0.705), Ktrans (AUC=0.700), Kep (AUC=0.737), Vp (AUC=0.688), and ADC (AUC=0.999) showed high diagnostic performance for discriminating PCa from BPH. A combined model based on PI-RADS score, Ktrans, Kep, Vp, and ADC had a higher AUC (1.000), with a sensitivity of 0.998 and specificity of 0.999. Imaging markers showed no significant correlation with Gleason score in PCa. DCE-MRI and DWI parameters can distinguish between benign and malignant prostate tumors in patients with serum PSA ≥10 ng/ml.

Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia: Experience from a single institution in Malaysia

BackgroundFreehand transperineal prostate biopsy (TPPBx) using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer (PCa). It only requires the same equipment used for transrectal ultrasound-guided (TRUS) biopsy. Our study is the first in Malaysia to report this experience and its outcomes. We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia (LA). MethodsInstitutional review board approval was obtained from National Medical Research Register (NMRR ID-21-02052-VIL). We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022. Records were reviewed for patients’ characteristics, prostate volume, prostate-specific antigen (PSA) results, biopsy results and pain tolerability. Data was analyzed to determine PCa and clinically significant prostate cancer (csPCa) detection rate. LA was achieved using perineal skin infiltration and a periprostatic nerve block. The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide. The principles of the Ginsburg protocol were followed. Pain tolerability was assessed using a visual analog scale. ResultsA total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA. The mean age was 67.3 years, the median PSA was 14.2 ng/mL, and the median PSA density (PSAD) was 0.33 ng/mL/cc. The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc (area under the curve [AUC], 0.792; sensitivity, 87.5%; specificity, 69.2%). PCa was detected in 24 patients (43.6%), of whom 16 (29.1%) had csPCa. The median pain scores during LA infiltration and biopsy were four and two, respectively, which were significant different (P < 0.05). TPPBx exhibited an infection rate of zero. ConclusionThe PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series. The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.

Advantageous Detection of Significant Prostate Cancer Using a Low-Field, Office-Based MRI System.

Background Methods to diagnose prostate cancer (PCa), a highly prevalent disease, remain inadequate in terms of accuracy, cost, and logistical constraints for both patients and providers. Early and accurate detection of PCa is crucial to patient management, most notably in increasing quality of life and lowering cost burdens when considering the associated treatment and follow-up pathways. This article aims to discuss the impact to care pathways for nine patients whose PCa was detected by a novel Food and Drug Administration-cleared low-field magnetic resonance imager (MRI) for transperineal PCa interventions but was missed by standard-of-care systematic transrectal ultrasound (TRUS). Methodology From December 2020 to March 2022, 41 men with elevated prostate-specific antigen (PSA) levels, positive digital rectal exam findings, and Prostate Imaging Reporting & Data System scores of three or higher were enrolled.Patients first underwent targeted transperineal biopsy guided by a low-field MRI (MRIgTBx) and co-registered with T2-weighted images from a pre-procedural 3-T MRI with suspicious lesions annotated by a board-certified radiologist. Following this procedure, patients underwent standard-of-care systematic transrectal ultrasound-guided biopsy (TRUSgSBx). The entire procedure was supervised by a board-certified urologist. Results Of the 41 enrolled patients, both MRIgTBx and TRUSgSBx biopsies detected PCa in 20 patients. MRIgTBx detected PCa in an additional nine patients that were missed by TRUSgSBx. Five of the nine patients elected to pursue immediate treatment. Patients with suspected PCa and a negative biopsy return to the clinic every three to six months for PSA tests, with additional biopsies performed every year for cases with increasing PSA levels. Conclusions Early detection of PCa in nine of the 41 patients using a novel MRIgTBx method has allowed for change management resulting in an improved quality of life and cost saving for those who opted for immediate treatment. Early intervention in cases where the standard-of-care TRUSgSBx treatment was falsely negative ultimately led to a decrease in additional screening procedures, biopsies, associated tests, and an improved pathway for patient management.