Transrectal Ultrasound Prostate Volume Research Articles

Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial.

The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) (p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. The HoLEP procedure significantly improves patients' urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.

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.

MP38-02 THE IMPACT OF GENOMIC BIOMARKERS ON A VALIDATED CLINICAL RISK PREDICTION MODEL FOR UPGRADING/UPSTAGING AMONG MEN WITH LOW-RISK PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP38-02 THE IMPACT OF GENOMIC BIOMARKERS ON A VALIDATED CLINICAL RISK PREDICTION MODEL FOR UPGRADING/UPSTAGING AMONG MEN WITH LOW-RISK PROSTATE CANCER Avery Braun, June Chan, John Neuhaus, Janet Cowan, Stacey Kenfield, Erin Van Blarigan, Imelda Tenggara, Jeanette Broering, Jeff Simko, Matthew Cooperberg, and Peter Carroll Avery BraunAvery Braun More articles by this author , June ChanJune Chan More articles by this author , John NeuhausJohn Neuhaus More articles by this author , Janet CowanJanet Cowan More articles by this author , Stacey KenfieldStacey Kenfield More articles by this author , Erin Van BlariganErin Van Blarigan More articles by this author , Imelda TenggaraImelda Tenggara More articles by this author , Jeanette BroeringJeanette Broering More articles by this author , Jeff SimkoJeff Simko More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The challenge of distinguishing indolent from aggressive tumors in clinically low-risk patients may complicate decision-making for men on active surveillance. Genomic classifiers (GCs) may improve clinical risk stratification by predicting the risk of upgrading or upstaging (UG/US) in this setting. We assessed the impact of GCs on UG/US risk prediction added to a rich clinical model to better guide disease management for low-risk patients. METHODS: We used multivariate logistic regression with backward stepwise regression to eliminate non-predictive variables and compute AUC (area under the receiver operating characteristic curve) to develop a prediction model for UG/US in 864 men who were potential candidates for AS. Participants had low risk, low volume prostate cancer (cT1-2, PSA<15ng/ml, GG1 or low volume GG2 defined as <33% core involvement). The model was validated in an independent cohort of 2,267 men with similar risk characteristics. We then tested predictive ability for 9 additional models, each containing the base variables plus 1 GC (OncoType Dx Genomic Prostate Score, Decipher score, and 7 selected Decipher GRID scores) for the development cohort. RESULTS: Among 864 patients in the development cohort, 450 (52%) experienced US/UG. The prediction model included five diagnostic variables that were significantly associated with risk of UG/US: diagnostic grade group (OR 5.83, 95% CI 3.73-9.10), prostate specific antigen (PSA) per 1 ng/ml (OR 1.10, 95% CI 1.01-1.20), percent positive cores (OR 1.01, 95% CI 1.01-1.02), TRUS prostate volume in ccs (OR 0.98, 95% CI 0.97-0.99), and age in years (OR 1.05, 95% CI 1.02-1.07). The pooled AUC was 0.72 for 10 iterations of the prediction model. When the addition of each GC was applied to this model, Genomic Prostate Score was the only one independently associated with risk of UG/US (OR 1.42, 95%CI 0.02-0.07, p=0.02). The pooled AUC for this model was 0.71, indicating comparable predictive performance to the risk prediction model. CONCLUSIONS: The addition of GCs to a validated rich model incorporating detailed clinical variables, when applied to men with low-risk PCa did not substantially improve prediction of UG/US. Our findings suggest that widespread use of biomarkers to guide management or intensity of follow up may not be supported in men with low-risk, low-volume disease pursuing AS. However, GCs may be valuable in those with higher risk disease. Source of Funding: DOD TIA #(W81XWH-13-2-0074) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e523 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author June Chan More articles by this author John Neuhaus More articles by this author Janet Cowan More articles by this author Stacey Kenfield More articles by this author Erin Van Blarigan More articles by this author Imelda Tenggara More articles by this author Jeanette Broering More articles by this author Jeff Simko More articles by this author Matthew Cooperberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

Comparison of 68Ga-PSMA PET/CT and mp-MRI in regard to local staging for prostate cancer with histopathological results: A retrospective study.

Imaging modalities are used to diagnose and clinical grading of clinically significant prostate cancer. In this study, 68Ga-PSMA PET/CT (PSMA) and multiparametric prostate MRI (mp-MRI) were compared in regard to locating intraprostatic tumor and locoregional staging. After ethics committee approval, a total of 49 patients with prostate cancer who had mp-MRI and PSMA before radical prostatectomy were included. Preoperative and postoperative PSA, transrectal ultrasound-guided prostate biopsy (TRUS-Bx) ISUP grade, radical prostatectomy ISUP grade, body mass index (BMI), TRUS prostate volume, mp-MRI tumor mapping, PSMAtumor mapping, pathologic tumor mapping, extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node invasion (LNI), and bladder neck invasion (BNI)were retrospectively evaluated. Index tumor was located by uroradiologist, nuclear medicine specialist, and uropathologist on a 12-sector prostate pathology map and compared with each other in terms of accuracy and locoregional clinical staging. Mean age of the patients was 66.18 ± 6.67 years and the mean of preoperative PSA results was 21.11 ± 32.56 ng/ml. Nearly half of the patients' (44.9%) pathology was reported as ISUP grade 4 and 5% and 18.4% of patients were surgical margin positive. According to the pathological findings, 362 out of 588 sectors were tumor-positive, 174 out of 362 sectors were tumor-positive in mp-MRI, and 175 out of 362 sectors were tumor-positive in PSMA. Both PSMA and mp-MRI were comparable (p = 0.823) and accurate to detect the location of the intraprostatic index tumor (AUC = 0.66 vs. 0.69 respectively, p = 0.82). The sensitivity and the specificity of the PSMA and mp-MRI for localizing intraprostatic index tumors were 42.5% versus 49.5% and 90.7% versus 88.6% respectively. mp-MRI was more accurate than PSMA in terms of EPE (AUC = 0.8 vs. AUC = 0.57 respectively, p = 0.027) and both methods were comparable in terms of SVI (AUC = 0.75 vs. AUC = 0.75, p = 0.886) and BNI (AUC = 0.51 vs. AUC = 0.59, p = 0.597). PSMA and mp-MRI were comparable in terms of LNI (AUC = 0.76 vs. AUC = 0.64, p = 0.39). mp-MRI should be considered for its high accuracy in the diagnosis of EPE, especially before decision-making for nerve-sparing surgery in high-risk patients. Both imaging modalities were accurate for localizing intraprostatic index tumor. PSMA is accurate for detecting LNI.

Long-Term Complications of Open and Robot-Assisted Laparoscopic Radical Prostatectomy in an Afro-Caribbean Population.

BackgroundWith the Afro-Caribbean population increasing in the United States, their complication profiles following open (ORP) and robot-assisted laparoscopic (RALP) radical prostatectomy warrants investigation. The purpose of this pilot study was to evaluate differences in long-term complications between ORP and RALP in Afro-Caribbeans.MethodsA retrospective review of patients undergoing ORP or RALP between April 2010 and August 2019 at an academic medical center and county hospital was conducted. Patients who identified as Afro-Caribbean with complete data were analyzed. Complications were classified using the Clavien-Dindo system. Age, transrectal ultrasound prostate volume, preoperative prostate-specific antigen, Gleason scores, and long-term complications (persisting to at least 18 months postoperatively) were compared between procedures using the Mann-Whitney U test or Fisher’s exact test for statistical significance. Multivariable logistic regression was used to assess the odds of complications.ResultsThis study included 53 Afro-Caribbean patients (mean age±SD; 65.9±6.8 years, 30 ORP, and 23 RALP). Patients treated by RALP were younger and had lower Gleason scores. Patients who were treated by RALP had a lower association to having ≥1 complications compared to those treated by ORP (OR=0.28, 95%CI 0.09-0.89, p=0.024). In addition, >60% of complications had a Clavien-Dindo grade≤II for both procedures. RALP resulted in fewer grade II complications compared to ORP (OR=0.25, 95%CI 0.08-0.81, p=0.046).ConclusionsTreatment of Afro-Caribbeans with RALP allows for fewer complications, especially Clavien-Dindo Grade II complications. While previous investigations show that Black populations experience more complications when treated with ORP or RALP compared to other groups, their complication profile is likely not homogenous when considering their sub-ethnic background and must be investigated to understand optimal interventions for prostate cancer.

Non-infectious complications following transrectal prostate needle biopsy - Outcomes from over 8000 procedures.

BackgroundProstate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry.MethodsTransrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications.ResultsOf 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02–1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding.ConclusionNon-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy.

Effect of urinary retention on the surgical outcome of holmium laser enucleation of the benign prostatic hyperplasia.

To evaluate the effect of urinary retention (UR) on holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms. A retrospective analysis of a prospective cohort of patients who underwent HoLEP between January 2010 and December 2016 was performed. The perioperative factors, including the International Prostate Symptom Score, Overactive Bladder Symptom Score, prostate-specific antigen, urodynamic study results, uroflowmetry results, transrectal ultrasound prostate volume, operative time, morcellation time, enucleation weight, and complications, were evaluated. Postoperative evaluation was performed at 2, 3, and 6 months. Overall, 903 patients were identified. The mean age and follow-up were 68.3 years and 6 months, respectively. Among the patients, 135 (15.0%) patients had a history of acute UR (AUR), and 36 patients (4.0%) had chronic UR (CUR). The mean detrusor pressures at maximum flow were 64.4, 74.3, and 77.7 cmH2O (p<0.001). The mean maximum flow rates (Qmax) were 7.6, 6.6, and 4.8 mL/s (p<0.001). Additionally, the mean bladder outlet obstruction indices were 49.5, 61.1, and 69.4 (p<0.001). The postoperative Qmax improved in all three groups. The mean postvoid residual volumes (PVRs) were 55, 75, and 333 mL preoperatively; 20, 29, and 66 mL at 2 weeks; 16, 23, and 45 mL at 3 months; and 15, 22, and 52 mL at 6 months (p<0.001). Voiding symptoms, PVR, and Qmax of BPH patients with preoperative AUR and CUR significantly improved after Ho-LEP, similar to those without preoperative UR.

1014 Assessment of Prostate Gland Volume Estimations Using MRI And TRUS Compared to Radical Prostatectomy Specimens

Abstract Introduction The prostate volume is an essential criterion to calculate prostate specific antigen density (PSAD). When selecting patients for active surveillance (AS), in newly diagnosed low risk prostate cancer group or continuing AS in previously diagnosed cancer prostate, PSAD plays a major role. Estimation of the volume using digital rectal exam or PSA are inaccurate. This study aims to conduct a retrospective review to evaluate the accuracy of prostatic volume estimates in patients who had TRUS and MRI scans, comparing the obtained volumes to the reference standard which is the actual volume of radical prostatectomy specimen. Method Data was collected retrospectively for all patients who had robotic assisted radical prostatectomy (RRP) at the Royal Stoke Hospital between October 2015 and October 2018. Clinical information of TRUS and MRI prostate volumes were extracted from PACS and prostate specimen volume was collected from the histopathology report of RRP specimen. Results Pathological specimen prostate volume showed a positive relationship between MRI and TRUS prostate volume with a correlation efficient of 0.71 for MRI vs RRP specimen volume and 0.81 for TRUS vs RRP specimen volume. Mean TRUS volume underestimated prostate volume by 7.33cc and mean MRI volume underestimated prostate volume by 0.02cc Conclusions Although the study showed positive correlation between measuring prostate volume using MRI and TRUS as compared to RRP specimens, MRI showed a greater accuracy as compared to TRUS. We conclude that using MRI prostate volume gives more precise prostate volume estimate aiding appropriate therapeutic planning of patients with prostate cancer.

MP01-14 XPEEDA TM HOLMIUM LASER VAPORESECTION VS GREENLIGHT XPS TM VAPORIZATION OF THE PROSTATE: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-14 XPEEDATM HOLMIUM LASER VAPORESECTION VS GREENLIGHT XPSTM VAPORIZATION OF THE PROSTATE: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL Hazem Elmansy, Waleed Shabana, Abdulrahman Ahmad, Fabiola Oquendo, Amr Hodhod, Loay Abbas, Ryan Kelly, Shalyn Littlefield, Ahmed Kotb, and Walid Shahrour Hazem ElmansyHazem Elmansy More articles by this author , Waleed ShabanaWaleed Shabana More articles by this author , Abdulrahman AhmadAbdulrahman Ahmad More articles by this author , Fabiola OquendoFabiola Oquendo More articles by this author , Amr HodhodAmr Hodhod More articles by this author , Loay AbbasLoay Abbas More articles by this author , Ryan KellyRyan Kelly More articles by this author , Shalyn LittlefieldShalyn Littlefield More articles by this author , Ahmed KotbAhmed Kotb More articles by this author , and Walid ShahrourWalid Shahrour More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare the safety and efficacy of Holmium Laser XpeedaTM Vaporesection and GreenLight XPSTM Vaporization of the Prostate in patients with prostate glands ≤80 g METHODS: Eighty-six men with benign prostatic hyperplasia (BPH) and prostate glands ≤80 g scheduled for laser prostatectomy were included in this prospective randomized trial. Outcome measures including IPSS, QoL, flow rate, PVR, IIEF-15, ICIQ-SF, PSA, catheterization time, and TRUS prostate volume changes were collected and compared. Perioperative complications were also recorded. Patients were offered a trial of void (TOV) 3 hours after their procedures. All patients were discharged home on the same day and were followed up at 1, 3, and 6 months. RESULTS: There were no significant differences in preoperative baseline data between the two surgical groups. Successful same day TOV was noted in 72.2% and 72% of the XpeedaTM and GreenLight XPSTM patients, respectively p=0.98. The laser energy used was significantly lower in XpeedaTM group p=0.002. There were no significant differences in functional and sexual outcomes between both groups at 6 months. Operative parameters and postoperative outcomes are shown in Table 1. CONCLUSIONS: Holmium Laser Xpeeda™ Vaporesection and GreenLight XPSTM Vaporization are safe and effective in the treatment of BPH. Same-day discharge with early trial of void is a feasible option. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e6-e6 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hazem Elmansy More articles by this author Waleed Shabana More articles by this author Abdulrahman Ahmad More articles by this author Fabiola Oquendo More articles by this author Amr Hodhod More articles by this author Loay Abbas More articles by this author Ryan Kelly More articles by this author Shalyn Littlefield More articles by this author Ahmed Kotb More articles by this author Walid Shahrour More articles by this author Expand All Advertisement Loading ...

Enhancement of prostate cancer diagnosis by machine learning techniques: an algorithm development and validation study.

To investigate the value of machine learning(ML) in enhancing prostate cancer(PCa) diagnosis. Consecutive systematic prostate biopsies performed from Jan 2003-June 2017 were used as the training cohort, and prospective biopsies performed from July 2017-November 2019 were used as validation cohort. Men were included if PSA was 0.4-50 ng/mL, and information of digital rectal examination (DRE), Transrectal ultrasound(TRUS) prostate volume, TRUS abnormality were known. Clinically significant PCa(csPCa) was defined as Gleason 3 + 4 or above cancers. Area-under-curve (AUC) of receiver-operating characteristics (ROC) was compared between PSA, PSA density, European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator (ERSPC-RC), and various ML techniques using PSA, DRE and TRUS information. ML techniques used included XGBoost, LightGBM, Catboost, Support vector machine (SVM), Logistic regression (LR), and Random Forest (RF), where cost sensitive learning was applied. Training and validation cohorts included 3881 and 778 consecutive men, respectively. RF model performed better than other ML techniques and PSA, PSA density and ERSPC-RC for prediction of PCa or csPCa in the validation cohort. In csPCa prediction, AUC of PSA, PSA density, ERSPC-RC and RF was 0.71, 0.80, 0.83 and 0.88 respectively. At 90-95% sensitivity for csPCa, RF model achieved a negative predictive value (NPV) of 97.5-98.0% and avoided 38.3-52.2% unnecessary biopsies. Decision curve analyses (DCA) showed RF model provided net clinical benefit over PSA, PSA density and ERSPC-RC. By using the same clinical parameters, ML techniques performed better than ERSPC-RC or PSA density in csPCa predictions, and could avoid up to 50% unnecessary biopsies.

Rezum water vapour therapy: promising early outcomes from the first UK series.

The management of symptomatic BPH is evolving and there is now an expanding portfolio of minimally invasive surgical therapies (MIST). These provide an attractive option for men looking for meaningful improvement in urinary symptoms whilst avoiding the risks of adverse effects, particularly with regards to maintaining sexual function.

Inter-imaging accuracy of computed tomography, magnetic resonance imaging, and transrectal ultrasound in measuring prostate volume compared to the anatomic prostatic weight.

To evaluate the accuracy of transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) compared to the reference standard of the post-surgical anatomic prostatic weight (APW). A total of 349 patients from two institutions were included. The CT and MRI dimensions, and TRUS-reported prostate volumes (PV) were obtained. The prolate ellipsoid formula was used to calculate PV. Cross-sectional measurements were evaluated and compared to the reported post-surgical pathology measurements and calculated pathology volume (path PV). A basic statistical analysis was performed using the Pearson correlation, Bland-Altman analysis, and Passing-Bablok regression. A total of 198 patients were included in the MRI group, 118 in the CT group, 295 in the TRUS group, and 51 in the all-inclusive common cohort. The MRI PV demonstrated a good to excellent correlation with the APW (r=0.79). The CT PV demonstrated a good correlation with APW (r=0.78). The TRUS PV showed a correlation with APW (r=0.67). The correlations identified in each individual group held true in the common cohort as well. The path PV showed an excellent correlation with APW (r=0.87), followed by MRI PV (r=0.81), then CT PV (r=0.73), and lastly TRUS PV (r=0.71). MRI and CT are equally effective in assessing the PV, and they can be readily utilized to guide the benign prostatic hyperplasia (BPH) management without repeating in-office TRUS. This is not only cost-effective, but also eliminates patient anxiety and discomfort.

Transrectal Ultrasound Prostate Volume Correlation with Serum Prostate Specific Antigen Level in Patients with Prostatic Enlargement in Portharcourt

Transrectal Ultrasound Prostate Volume Correlation with Serum Prostate Specific Antigen Level in Patients with Prostatic Enlargement in Portharcourt

Comparison of Holmium Laser Enucleation and Plasmakinetic Resection of Prostate: A Randomized Trial with 72-Month Follow-Up.

To evaluate the long-term and flexible cystourethroscopy results of holmium laser enucleation of the prostate (HoLEP) and to compare them with those of plasmakinetic resection of the prostate (PKRP). In the long-term follow-up, variables, including the international prostatic symptomatic score, quality of life scores, maximum flow rate (Qmax), and international index of erectile function (IIEF), and the adverse events, including the need for retreatment, were specifically assessed. One hundred twenty-two HoLEP and 119 PKRP of the initial 280 patients included in this study were available, with 10 deceased and 29 lost to follow-up. We found that none of the assessable patients required reoperation for recurrent benign prostatic enlargement (BPE) in the HoLEP group, whereas two required reoperation in the PKRP group. There were no significant differences in most variables between the two groups in the long-term results. But in terms of Qmax, transrectal ultrasound prostate volume, prostate specific antigen (PSA) level, IIEF-5 score, and long-term posttrial follow-up of flexible cystourethroscopy, the HoLEP group showed better results. The long-term follow-up data of this randomized trial confirm that HoLEP and PKRP are both effective and durable surgical interventions for the treatment of lower urinary tract symptoms due to BPE. Given the clinically relevant advantages associated with HoLEP, the alternation of PSA level, sexual function, and urination can be improved.

A New Laser Platform for Holmium Laser Enucleation of the Prostate: Does the Lumenis Pulse 120H Laser Platform Improve Enucleation Efficiency?

To determine whether the recently introduced Lumenis Pulse 120H laser platform, which offers a dual-pedal footswitch and preset energy modes to easily switch among laser settings, facilitates a more efficient process in holmium laser enucleation of the prostate (HoLEP) for surgical treatment of benign prostatic hyperplasia. Patients at a single institution who underwent HoLEP with the new Lumenis Pulse 120H laser platform were matched 1:2 with patients who underwent the procedure with the previously used 100-watt VersaPulse single-pedal laser platform. Matching was performed by using propensity scores calculated by a logistic model that considered preoperative transrectal ultrasound prostate volume and patient age. The primary outcome was enucleation efficiency of each platform, determined by the weight of prostate tissue resected and enucleation time. The McNemar test and a conditional logistic model were used to associate predictors and cases. Twenty-nine patients who underwent HoLEP with the Lumenis Pulse 120H platform were matched with 58 patients who underwent the procedure with the 100-watt platform. We observed statistically significant differences in operating room total time, procedure time, and enucleation time. Other perioperative and postoperative outcomes were comparable between the 2 groups. Enucleation efficiency was similar between the 2 laser platforms (0.89 g per minute in the control group vs 0.84 g per minute in the Lumenis Pulse 120H group). The efficiency of the new Lumenis Pulse 120H laser platform is comparable to the 100-watt VersaPulse laser platform in HoLEP when comparing g of tissue enucleated per minute.

Prostate volume estimations using magnetic resonance imaging and transrectal ultrasound compared to radical prostatectomy specimens.

We sought to evaluate the accuracy of prostate volume estimates in patients who received both a preoperative transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in relation to the referent pathological specimen post-radical prostatectomy. Patients receiving both TRUS and MRI prior to radical prostatectomy at one academic institution were retrospectively analyzed. TRUS and MRI volumes were estimated using the prolate ellipsoid formula. TRUS volumes were collected from sonography reports. MRI volumes were estimated by two blinded raters and the mean of the two was used for analyses. Pathological volume was calculated using a standard fluid displacement method. Three hundred and eighteen (318) patients were included in the analysis. MRI was slightly more accurate than TRUS based on interclass correlation (0.83 vs. 0.74) and absolute risk bias (higher proportion of estimates within 5, 10, and 20 cc of pathological volume). For TRUS, 87 of 298 (29.2%) prostates without median lobes differed by >10 cc of specimen volume and 22 of 298 (7.4%) differed by >20 cc. For MRI, 68 of 298 (22.8%) prostates without median lobes differed by >10 cc of specimen volume, while only 4 of 298 (1.3%) differed by >20 cc. MRI and TRUS prostate volume estimates are consistent with pathological volumes along the prostate size spectrum. MRI demonstrated better correlation with prostatectomy specimen volume in most patients and may be better suited in cases where TRUS and MRI estimates are disparate. Validation of these findings with prospective, standardized ultrasound techniques would be helpful.

Prostate health index (PHI) and prostate-specific antigen (PSA) predictive models for prostate cancer in the Chinese population and the role of digital rectal examination-estimated prostate volume.

To investigate PSA- and PHI (prostate health index)-based models for prediction of prostate cancer (PCa) and the feasibility of using DRE-estimated prostate volume (DRE-PV) in the models. This study included 569 Chinese men with PSA 4-10ng/mL and non-suspicious DRE with transrectal ultrasound (TRUS) 10-core prostate biopsies performed between April 2008 and July 2015. DRE-PV was estimated using 3 pre-defined classes: 25, 40, or 60ml. The performance of PSA-based and PHI-based predictive models including age, DRE-PV, and TRUS prostate volume (TRUS-PV) was analyzed using logistic regression and area under the receiver operating curves (AUC), in both the whole cohort and the screening age group of 55-75. PCa and high-grade PCa (HGPCa) was diagnosed in 10.9% (62/569) and 2.8% (16/569) men, respectively. The performance of DRE-PV-based models was similar to TRUS-PV-based models. In the age group 55-75, the AUCs for PCa of PSA alone, PSA with DRE-PV and age, PHI alone, PHI with DRE-PV and age, and PHI with TRUS-PV and age were 0.54, 0.71, 0.76, 0.78, and 0.78, respectively. The corresponding AUCs for HGPCa were higher (0.60, 0.70, 0.85, 0.83, and 0.83). At 10 and 20% risk threshold for PCa, 38.4 and 55.4% biopsies could be avoided in the PHI-based model, respectively. PHI had better performance over PSA-based models and could reduce unnecessary biopsies. A DRE-assessed PV can replace TRUS-assessed PV in multivariate prediction models to facilitate clinical use.

MP42-10 CAN THE USE OF PRE-OPERATIVE TRANSRECTAL ULTRASOUND PROSTATE VOLUME PREDICT THEATRE OPERATING TIMES FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE SURGERY?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2016MP42-10 CAN THE USE OF PRE-OPERATIVE TRANSRECTAL ULTRASOUND PROSTATE VOLUME PREDICT THEATRE OPERATING TIMES FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE SURGERY? Farooq Khan, M Asad Saleemi, Sanjeev Taneja, Asher Alam, Mohammed Al-Sheikh, Ian Nunney, and Tevita Aho Farooq KhanFarooq Khan More articles by this author , M Asad SaleemiM Asad Saleemi More articles by this author , Sanjeev TanejaSanjeev Taneja More articles by this author , Asher AlamAsher Alam More articles by this author , Mohammed Al-SheikhMohammed Al-Sheikh More articles by this author , Ian NunneyIan Nunney More articles by this author , and Tevita AhoTevita Aho More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.198AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pre-operative transrectal ultrasound (TRUS) volumes ensure sensible sized prostates are tackled during the learning curve of holmium laser enucleation of the prostate (HoLEP) surgery. We believe the use of TRUS volumes can allow the prediction of operative time not only early in a surgeons experience but also for experienced surgeons to plan theatre lists. METHODS 253 HoLEPs were undertaken with a 50 Watt (W) holmium laser (Auriga XL, Boston Scientific Inc., Richard Wolf Piranha Morcellator) by two HoLEP naive surgeons during their learning curve and subsequently. All patients underwent a TRUS volume pre-operatively (B-K Hawk 2102). Accurate enucleation time and total operating room (OR) time for a given TRUS volume were plotted against TRUS volume to use as a predictive tool to enhance operating list scheduling. RESULTS Statistical analysis; SAS statistical software v9.3. To determine any linear relationship with TRUS volume linear regression and correlation analysis was performed, reporting both the coefficient of regression and Pearsons correlation coefficient. Complete data was available for 249 cases, 4 patients did not have a TRUS volume. Mean prostate volume 62.8cc, mean patient age of 70.1 and a mean PSA of 3.91ng/ml were noted. Mean enucleated weight of 43.3g (95% CI 39.34,47.29) was achieved. Mean enucleation rate across all prostate sizes was 0.60g/min and with BNI cases excluded this reached 0.68 g/min (95% CI 0.61,0.75) with a mean morcellation rate of 3.58 g/min (95% CI 3.30,3.87). A more efficient rate of enucleation with larger prostates was noted. There was a high correlation between TRUS volume and grams/min enucleated (r=0.6019, 95% CI 0.4772,0.7028) and a significant coefficient of regression (p<0.0001) suggesting a fairly strong linear relationship that was matched by total OR times versus TRUS volume (Pearsons correlation 0.6235, 95% CI 0.5418,0.6935, coefficient of regression p<0.0001). Enucleation, morcellation and OR times all had a strong linear relationship with TRUS volume on plots. CONCLUSIONS The use of pre-operative TRUS volume assessment is encouraged in those setting up a HoLEP service. In established units it provides a guide to operative time required for a given prostate size optimizing theatre utilization. We recommend the regular use of this simple tool for this purpose. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e572-e573 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Farooq Khan More articles by this author M Asad Saleemi More articles by this author Sanjeev Taneja More articles by this author Asher Alam More articles by this author Mohammed Al-Sheikh More articles by this author Ian Nunney More articles by this author Tevita Aho More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...