Underwent Prostate Biopsy Research Articles

PD41-11 UPDATE FROM THE PEDAL TRIAL: A PROSPECTIVE SINGLE ARM PAIRED COMPARISON OF ABILITY TO DIAGNOSE AND LOCATE PROSTATE CANCER BETWEEN MULTIPARAMETRIC MRI AND 18F-PSMA-PET/CT

You have accessJournal of UrologyCME1 May 2022PD41-11 UPDATE FROM THE PEDAL TRIAL: A PROSPECTIVE SINGLE ARM PAIRED COMPARISON OF ABILITY TO DIAGNOSE AND LOCATE PROSTATE CANCER BETWEEN MULTIPARAMETRIC MRI AND 18F-PSMA-PET/CT Vy Tran, Thomas Sutherland, Kim Taubman, Su-Faye Lee, Daniel Lenaghan, Niall Corcoran, Nathan Lawrentschuk, Henry Woo, Lisa Tarlinton, Tim Spelman, Lauren Thomas, Russell Booth, Elisa Perry, Justin Hegarty, and Lih-Ming Wong Vy TranVy Tran More articles by this author , Thomas SutherlandThomas Sutherland More articles by this author , Kim TaubmanKim Taubman More articles by this author , Su-Faye LeeSu-Faye Lee More articles by this author , Daniel LenaghanDaniel Lenaghan More articles by this author , Niall CorcoranNiall Corcoran More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , Henry WooHenry Woo More articles by this author , Lisa TarlintonLisa Tarlinton More articles by this author , Tim SpelmanTim Spelman More articles by this author , Lauren ThomasLauren Thomas More articles by this author , Russell BoothRussell Booth More articles by this author , Elisa PerryElisa Perry More articles by this author , Justin HegartyJustin Hegarty More articles by this author , and Lih-Ming WongLih-Ming Wong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002602.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate the accuracy of 18F-DCFPyl prostate specific membrane antigen (PSMA)-PET/CT to detect and localize prostate lesions compared to multiparametric MRI (mpMRI) prostate in men with suspected prostate cancer. METHODS: This is a prospective single arm paired comparison of ability to diagnose and locate prostate cancer between mpMRI and 18F-DCFPyL-PSMA PET/CT. Detection and localisation of suspicious prostate lesions were compared between mpMRI, PET/CT and fused PET/MR images. Radiological findings were correlated with histological findings following a targeted prostate biopsy. RESULTS: One hundred and thirty-nine men who completed both imaging arms were analysed. The median age was 58 years and median prostate specific antigen (PSA) level 6.3ng/ml. Prostate mpMRI detected 70 index lesions (PIRADS≥3), compared to 72 index lesions on PET/CT (SUVmax ≥7.0). Fifty four index lesions were detected on both mpMRI and PET/CT, with 16 lesions identified by PET/CT alone. Prostate cancer was detected in 59 of 92 men (64.1%) who underwent prostate biopsy. In 43 men with clinically significant prostate cancer (Grade group ≥2), 35 lesions (81.4%) were visualized on both imaging arms. PET/CT visualized 4 (9.3%) clinically significant lesions that were undetected by mpMRI, and identified 21 patients with metastatic disease. One clinically significant lesion was detected by mpMRI alone. CONCLUSIONS: 18F-DCFPyl PSMA-PET/CT appears to detect lesions seen on mpMRI prostate, as well as identify additional clinically significant prostate lesions. The ability of PSMA-PET/CT to diagnose metastatic disease also saves the need for further staging following diagnosis. These early results provide promising evidence for a fully-powered trial to follow. Source of Funding: Cyclotek Aust Pty Ltd, General Electrical Healthcare and philanthropic grants © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e693 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vy Tran More articles by this author Thomas Sutherland More articles by this author Kim Taubman More articles by this author Su-Faye Lee More articles by this author Daniel Lenaghan More articles by this author Niall Corcoran More articles by this author Nathan Lawrentschuk More articles by this author Henry Woo More articles by this author Lisa Tarlinton More articles by this author Tim Spelman More articles by this author Lauren Thomas More articles by this author Russell Booth More articles by this author Elisa Perry More articles by this author Justin Hegarty More articles by this author Lih-Ming Wong More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD57-07 FACTORS PREDICTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN PIRADS 4 LESIONS

You have accessJournal of UrologyCME1 May 2022PD57-07 FACTORS PREDICTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN PIRADS 4 LESIONS Mohammad Siddiqui, Jasmine Lin, Jonathan Aguiar, Brandon Ansbro, Moataz Soliman, Jordan Rich, Johan Alfaro, Mary-Kate Keeter, Quan Mai, Edward Schaeffer, and Ashley Ross Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jasmine LinJasmine Lin More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Jordan RichJordan Rich More articles by this author , Johan AlfaroJohan Alfaro More articles by this author , Mary-Kate KeeterMary-Kate Keeter More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002637.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The PIRADS 4 lesions are commonly biopsied, however many are benign. Here, we sought to investigate factors that may help better risk stratify the PIRADS-4 lesions and predict the presence of clinically significant cancer (defined as Gleason Grade Group (GG) ≥ 2). METHODS: We queried the electronic medical record for patients diagnosed with PIRADS 4 lesions beginning in March 2018 with the focus on patients with total PSA 2-20ng/mL. We compared the clinical characteristics such as Age, African American race, PSA, prostate health index (PHI), and PSA Density (PSAD) of patients with and without clinically significant prostate cancer on biopsy. Statistics were performed using t-test, chi-squared analysis, and logistical regressions with significance defined as p<0.05. RESULTS: From March 2018 to present, 3553 men presented to urology with suspicion of prostate cancer and 1640 (46%) underwent prostate MRI. 571 (35%) of men were identified to have the PIRADS 4 lesion as their highest PIRADS lesion (Table 1). 556 (97%) men with PIRADS 4 lesions underwent prostate needle biopsy. Clinically significant cancer was detected in 288 (52%) of this population (206 (37%) men had negative biopsies, while GG1 was found in 61 (11%)). Predictors of identifying clinically significant prostate cancer on biopsy on multivariable analysis included African American race (OR 3.76, 95% CI 1.86-7.59), PSAD >0.15 (OR 3.01, 95% CI 1.5-5.74) and higher PHI (PHI>36 (OR 3.42, CI 1.58-7.4), PHI≥ 55(OR 10.5, 95% CI 4.07-25.1)). CONCLUSIONS: Consistent with literature, 37% of PIRADS 4 lesions are benign in our series. Our results suggest that men of AA race, or those with PSAD> 0.15, or PHI >36 and PIRADS 4 lesions should undergo prostate biopsy. Men with PSAD < 0.1 and PHI scores in the lowest quartile were least likely to have clinically significant prostate cancer on biopsy of PIRADS 4 lesions. Source of Funding: UROLOGY CARE FOUNDATION RESIDENCY RESEARCH AWARD © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e962 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Siddiqui More articles by this author Jasmine Lin More articles by this author Jonathan Aguiar More articles by this author Brandon Ansbro More articles by this author Moataz Soliman More articles by this author Jordan Rich More articles by this author Johan Alfaro More articles by this author Mary-Kate Keeter More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP53-16 THE TRENDS OF COMPLICATION RATES AND THE ROLE OF AZTREONAM AS A PROPHYLACTIC ANTIBIOTIC AFTER PROSTATE BIOPSY

You have accessJournal of UrologyCME1 May 2022MP53-16 THE TRENDS OF COMPLICATION RATES AND THE ROLE OF AZTREONAM AS A PROPHYLACTIC ANTIBIOTIC AFTER PROSTATE BIOPSY Sung Jin Kim, Han Kyu Chae, Wook Nam, Kim Han Gwun, and Park Jong Yeon Sung Jin KimSung Jin Kim More articles by this author , Han Kyu ChaeHan Kyu Chae More articles by this author , Wook NamWook Nam More articles by this author , Kim Han GwunKim Han Gwun More articles by this author , and Park Jong YeonPark Jong Yeon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An increase in the rate of complications after prostate biopsy due to an increase in antibiotic-resistant bacteria is a global problem. We report the safety of aztreonam as a prophylactic antibiotic in patients undergoing prostate biopsies. METHODS: Clinical data were obtained from 3,638 patients who underwent PB at our hospital from 1997 to 2019. We investigated the complication rates according to group of antibiotic regimens (Figure 1). To analyse the incidence of complications according to the type of antibiotic prescribed, patients who experienced procedure-related complications within 2 weeks of the PB and were treated in the ER or in an outpatient setting were categorised as Cx1 (complication1). Other definition of complication outcomes are described in Figure 2. RESULTS: The clinical cohort in this study included 2,638 patients; 1,457 of these were administered oral quinolone and IV aztreonam. The rate of complications was significantly lower in patients who received oral quinolone and IV aztreonam than in those who received oral quinolone only (p=0.004). Two (0.1%) patients experienced febrile complications. The rate of Cx4 was significantly lower in the clinical cohort in 2018 and 2019 than in 2007, 2010, and 2011 (p<0.01). The rate of Cx5 did not differ by year in the clinical cohort. The rate of Cx4 was significantly lower in the clinical cohort in 2018 and 2019 than in 2007, 2010, and 2011 (p<0.01). The rate of Cx5 did not differ by year in the clinical cohort. CONCLUSIONS: The rates of complications, hospitalisations, and ER visits did not increase among these patients. Oral quinolone combined with intravenous aztreonam reduced the rate of febrile complications compared to quinolone only and is safe for use after a prostate biopsy. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e901 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sung Jin Kim More articles by this author Han Kyu Chae More articles by this author Wook Nam More articles by this author Kim Han Gwun More articles by this author Park Jong Yeon More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP16-13 CAN WE USE THE PROSTATE HEALTH INDEX TO AVOID A PROSTATE BIOPSY IN AFRICAN AMERICAN MEN?

You have accessJournal of UrologyCME1 May 2022MP16-13 CAN WE USE THE PROSTATE HEALTH INDEX TO AVOID A PROSTATE BIOPSY IN AFRICAN AMERICAN MEN? Kostantinos Morris, Srinath Kotamarti, and Judd Moul Kostantinos MorrisKostantinos Morris More articles by this author , Srinath KotamartiSrinath Kotamarti More articles by this author , and Judd MoulJudd Moul More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002549.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: African American (AA) race is a well-known risk factor for prostate cancer (PCa). However, the aggressive push to maximize detection of clinically significant cancer (CSC) is inevitably prone to high rates of over-biopsy. Prostate Health Index (PHI) is a Food and Drug Administration-approved tool to aid in the diagnosis of PCa in men with PSA 4-10 ng/ml. We sought to assess the effectiveness of PHI to avoid a prostate biopsy in AA men with an equivocal PSA. METHODS: Within the Duke Health System, AA men undergoing prostate biopsy with a PSA 4-10 ng/ml and PHI scores from 2016-2020 were identified. The cohort was analyzed for a PHI score cutoff for which 10% or less of men would be identified with CSC, defined as Gleason score ≥7. Representative 95% confidence intervals (CI) were calculated along with cancer detection rates. ROC curves for all PCa and CSC at biopsy were used to identify the area under the curve (AUC) and the diagnostic value of the proposed cutoff point. RESULTS: A total of 236 AA men with an average age of 61.2 years met inclusion criteria out of the 1,131 men who had PHI testing during the study period. Mean PHI and PSA for the entire cohort were 48.5 (SD 21.6) and 6.5 ng/ml (SD 1.7), respectively. Using the established lowest PHI cutoff of 27 led to six of 25 (24.0%) men diagnosed with CSC and 12 of 25 (48%) diagnosed with all PCa. Below a proposed PHI level of 23, one of 12 men were diagnosed with CSC (8.3% [CI: 0.002 – 0.385]) and two of 12 men were diagnosed with any PCa (16.7% [CI: 0.021 – 0.484]). Overall, PHI showed an AUC for all PCa and CSC of 0.705 (0.636 – 0.774) and 0.688 (0.621 – 0.755), respectively. PHI cut point of 23 was associated with a 98.7% sensitivity for all PCa and 99.0% for CSC, at a cost of specificities of 11.8% and 8.4%, respectively. Using this cut point 11 negative biopsies could be avoided, equating to 4.7% of the cohort. CONCLUSIONS: The currently accepted lowest PHI cut point leads to an excessively high rate of PCa in this cohort of AA men. Alternatively, men with a PHI below a proposed cutoff of 23 had optimally low rates of cancer detection and excellent sensitivity to minimize false negative biopsies. While our cohort is the largest reported of AA men undergoing PHI, further validation is needed to confirm these findings. Though generally at higher risk, AA men with an equivocal PSA and a PHI below 23 should be considered candidates to avoid a prostate biopsy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e280 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kostantinos Morris More articles by this author Srinath Kotamarti More articles by this author Judd Moul More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD17-05 CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH PIRADS 5 LESIONS AND NEGATIVE BIOPSIES

You have accessJournal of UrologyCME1 May 2022PD17-05 CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH PIRADS 5 LESIONS AND NEGATIVE BIOPSIES Eric Li, Mohammad Siddiqui, Jonathan Aguiar, Brandon Ansbro, Parth Shah, Moataz Soliman, Jordan Rich, Jasmine Lin, Johan Alfaro Carballo, Mary Kate Keeter, Quan Mai, Edward Schaeffer, and Ashley Ross Eric LiEric Li More articles by this author , Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Parth ShahParth Shah More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Jordan RichJordan Rich More articles by this author , Jasmine LinJasmine Lin More articles by this author , Johan Alfaro CarballoJohan Alfaro Carballo More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002555.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Best evidence supports use of mpMRI prior to initial diagnosis of prostate cancer. PIRADS 5 lesions typically have a 80-90% concordance with diagnosis of clinically significant disease. Here we investigate the characteristics and outcomes of patients with PIRADS 5 lesions and subsequent negative biopsies. METHODS: We queried our institutional database for men without an established diagnosis of prostate cancer for whom MRI targeted biopsy was performed after demonstration of a PIRADS 5 lesion from March 2018-present. T test, chi-squared test, and logistic regression were performed. RESULTS: 2,206 men underwent MRI for suspicion of prostate cancer, with PIRADS 5 lesions detected in 268 patients. 257 of these men underwent prostate biopsy (13 with transperineal biopsy) with a positivity rate of 93.8%. Men with PIRADS 5 lesions and negative biopsies (n=16) were more likely to be African American (25% vs 13.3%, p<0.001), younger (61.4 vs 66.3, p=0.03), have larger prostates (80.3 g vs 48.4 g, p<0.001), and have lower prostate health index (PHI, 44.3 vs. 78.2, p=0.04). There was no significant difference in anterior lesions, prostate inflammation, PSA, or PSA density. Of men with negative prostate biopsies, 1 patient was subsequently diagnosed with prostate cancer, and 2 patients had bladder outlet procedures with negative pathology. 2 patients with negative biopsies previously received BCG for non-muscle invasive bladder cancer and were subsequently found to have inflammation on prostate biopsy. CONCLUSIONS: Men with PIRADS 5 lesions and negative prostate biopsies tend to be African American, younger, have larger prostates, and have lower PHI compared to patients with positive prostate biopsies. Additional investigation is needed to determine lesion location is a risk factor for undersampling that may benefit from transperineal prostate biopsy, as well as the role of inflammation in determining how to follow these patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e337 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Li More articles by this author Mohammad Siddiqui More articles by this author Jonathan Aguiar More articles by this author Brandon Ansbro More articles by this author Parth Shah More articles by this author Moataz Soliman More articles by this author Jordan Rich More articles by this author Jasmine Lin More articles by this author Johan Alfaro Carballo More articles by this author Mary Kate Keeter More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD41-02 DIAGNOSIS OF PROSTATE CANCER IN MEN TREATED WITH 5-ALPHA-REDUCATES INHIBITORS WITH MULTIPARAMETRIC MRI: RESULTS OF A MULTICENTER INTERNATIONAL COLLABORATION

PD41-02 DIAGNOSIS OF PROSTATE CANCER IN MEN TREATED WITH 5-ALPHA-REDUCATES INHIBITORS WITH MULTIPARAMETRIC MRI: RESULTS OF A MULTICENTER INTERNATIONAL COLLABORATION

Fosfomycin in antibiotic prophylaxis of infectious complications after biopsy of the prostate

Introduction. Biopsy of prostate is a routine urologic procedure. More than 1 million biopsies are performed worldwide annually. The frequency of infectious-inflammatory complications remain high, despite the recommended antibiotic prophylaxis schemes.Aim. The evaluation of effectiveness and safety of combined antimicrobial prophylaxis: Fosfomycin and Fluoroquinolones of 3rd generation.Materials and methods. 80 patients underwent prostate biopsy in our study and were divided into 2 groups: the first group of 40 patients received routine prophylaxis: Levofloxacin 500 mg 6 hours before the biopsy and 500 mg per day during 4 days after biopsy. The second group of 40 patients, along with standard prophylaxis as in the first group, additionally after biopsy received Fosfomycin 3 gr single-shot.Results and discussion. In the first group, infectious and inflammatory complications occurred in 8 patients (20%). 12.5% of patients from the first group were hospitalized for paranteral antibiotic therapy. The average length of stay in hospital was 3.4 ± 1.45 days. In all cases, in the first group of patients, E. coli was detected, in 70% of cases fluoroquinolone-resistant strain of the bacterium was received. In the second group of patients now hospitalization was required. One patient out of forty (2.5%) from this group showed signs of urinary tract infection, which was not accompanied by an increase of body temperature, as well as changes in blood and urine tests.Conclusion. Our results show good effectiveness and safety of fosfomicin for antibiotic prophylaxis for transrectal prostate biopsy.

Mean Platelet Volume Enhances the Diagnostic Specificity of PSA for Prostate Cancer.

Mean platelet volume (MPV) is an indicator of platelet activation and has been proposed as a diagnostic marker for several kinds of cancers. We investigated the value of MPV as a diagnostic marker for prostate cancer (PCa) and examined whether MPV in combination with prostate-specific antigen (PSA) could increase the sensitivity or specificity of PSA for PCa diagnosis. For this study, 107 pathologically confirmed PCa and 177 non-PCa patients who underwent prostate biopsy were retrospectively studied. Clinical data and pre-biopsy hematological parameters were collected. The above parameters were compared between PCa and non-PCa patients. The correlation between MPV and clinical characteristics was analyzed. Receiver operating characteristic (ROC) analysis was used to explore the diagnostic value of MPV for PCa. Among all parameters analyzed, the difference was only found in MPV, platelet distribution width (PDW), and PSA between PCa and non-PCa patients. MPV was significantly decreased and PDW increased in PCa than that of non-PCa among men. ROC analysis identified MPV ≤ 9.05 fl as a cut-off value for potential PCa with area under the ROC curve (AUC) = 0.783, 95% CI = 0.733–0.833, sensitivity = 0.746, and specificity = 0.708. AUC and the sensitivity of MPV were comparable with total PSA (TPSA) or free PSA (FPSA). However, the specificity of MPV was larger than that of TPSA (0.461) or FPSA (0.561). Furthermore, MPV combined with TPSA or FPSA further enhanced the specificity of TPSA (0.844) or FPSA (0.927), but PDW did not. These findings suggested that MPV could have a predictive value for the diagnosis of PCa. MPV in combination with TPSA or FPSA could enhance the specificity of PSA and may reduce the rate of unnecessary biopsy for patients with high levels of PSA.

Do prostate-specific antigen parameters have a similar role in predicting prostate cancer regardless of serum testosterone levels in men with gray-zone prostate-specific antigen levels?

BackgroundTo evaluate whether various prostate-specific antigen (PSA) parameters have a similar diagnostic value in predicting prostate cancer (PCa) in men with gray-zone PSA levels (4.0–10.0 ng/mL) depending on different serum testosterone levels.MethodsWe retrospectively reviewed the data of 635 men with gray-zone PSA levels who underwent prostate biopsy between January 2015 and December 2019. The study cohort was divided into two groups according to serum testosterone levels: normal (≥300 ng/dL) and low (<300 ng/dL) testosterone. Using the area under the receiver-operating characteristic curve (AUC), we analyzed the diagnostic accuracy of PSA parameters (total PSA, free PSA, free-to-total PSA ratio, testosterone-to-PSA ratio, and PSA density) in predicting PCa and compared the results between the two groups.ResultsThe median age was 68 (range, 40–88) years, and 76.1% (483 of 635) of the men had low testosterone levels. The PCa incidence was higher in the low testosterone group than in the normal testosterone group (45.5% vs. 35.5%, P=0.030). The AUC of free-to-total PSA ratio for predicting PCa showed no difference between the normal and low testosterone groups (AUC 0.616 vs. 0.684, P=0.257). Moreover, total PSA, testosterone-to-PSA ratio, and PSA density showed similar performance in predicting PCa between the two groups.ConclusionsThe analyzed PSA parameters showed a similar diagnostic value in predicting PCa regardless of testosterone levels in men with gray-zone PSA levels.

Individualised non-contrast MRI-based risk estimation and shared decision-making in men with a suspicion of prostate cancer: protocol for multicentre randomised controlled trial (multi-IMPROD V.2.0)

IntroductionEuropean Association of Urology and UK National Institute for Health and Care Excellence guidelines recommend that all men with suspicions of prostate cancer should undergo prebiopsy contrast enhanced, that is,...

A preliminary study on the diagnostic value of PSADR, DPC and TSRP in the distinction of prostatitis and prostate cancer

BackgroundThe purpose of this study was to investigate the ability of differential diagnosis of prostate specific antigen decline rate (PSADR) per week, degree of prostatic collapse (DPC) and tissue signal rate of prostate (TSRP) between prostatitis and prostate cancer.MethodsThe clinical data of 92 patients [prostate specific antigen (PSA) > 10 ng/mL] who underwent prostate biopsy in the Department of Urology, the Second Affiliated Hospital of Xi ’an Jiaotong University from May 2017 to April 2020 were reviewed retrospectively. They were divided into two groups, prostatitis group (n = 42) and prostate cancer (PCa) group (n = 50), according to pathological results. Parameters, like patient characteristics, PSADR, DPC, TSRP and infectious indicators, were compared and analyzed by t test or non-parametric test to identify if there were significant differences. The thresholds of parameters were determined by the receiver operating characteristic curve (ROC), and the data were analyzed to investigate the diagnostic value in distinguishing of prostatitis and prostate cancer.ResultsThere were statistical differences in age, PSADR, DPC, TSRP, neutrophil percentage in serum, white blood cell (WBC) in urine and prostate volume between prostatitis group and PCa group (P < 0.001, < 0.001, = 0.001, 0.001, 0.024, 0.014, < 0.001 respectively). There was no statistical difference in serum WBC count, serum neutrophil count, monocyte percentage and urine bacterial count between two groups (P = 0.089, 0.087, 0.248, 0.119, respectively). Determined by ROC curve, when the thresholds of PSADR per week as 3.175 ng/mL/week, DPC as 1.113, TSRP as 2.708 were cutoffs of distinguishing prostatitis and prostate cancer. When combining these three indexes to diagnose, the accuracy rate of diagnosis of prostatitis was 78.85%, the accuracy rate of diagnosis of prostate cancer was 97.50%. Univariate analysis suggested that PSADR, DPC and TSRP played an important role in differentiating prostate cancer from prostatitis (P < 0.05), multivariate analysis suggested PSADR > 3.175 might be good indicators when distinguishing prostate disease with prostatitis (OR = 14.305, 95%CI = 3.779 ~ 54.147), while DPC > 1.113 and TSRP > 2.708 might be associated with a higher risk of prostate cancer (OR = 0.151, 95%CI = 0.039 ~ 0.588; OR = 0.012, 95%CI = 0.005 ~ 0.524, respectively).ConclusionThe combination of PSADR per week, DPC, and TSRP might be helpful to distinguish prostate cancer and prostatitis, and can reduce unnecessary invasive and histological procedure.

CUT-OFF VALUES OF PROSTATE SPECIFIC ANTIGEN DENSITY– AN EFFECTIVE SCREENING MARKER BEFORE PROSTATE BIOPSY

OBJECTIVE: To determine cut-off values for prostate specific antigen density (PSAD) in diagnosing prostate carcinoma in symptomatic patients. METHODS: This cross sectional, observational study conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from June 2020 to May 2021. Symptomatic patients (309) having prostatic enlargement on ultrasound were selected through consecutive sampling. All the patients underwent prostate biopsy for histopathological diagnosis. Prostate specific antigen density was calculated and compared between different age groups and different diseases. ROC curve was constructed and area under the curve was calculated to find out cut-off values value for PSAD. Sensitivity, specificity and accuracy were calculated at the cut-off values. RESULTS: Among 309 patients of median age was 68 years (IQR 43 – 75). There was a significant difference of PSAD in different age groups (p&lt;0.001) and diseases like prostate carcinoma, benign prostatic hyperplasia and other prostatic disorders. PSAD had AUC of 0.878 at cut-off value of 0.135 ng/ml where sensitivity was 100%. A higher cut-off 0.20 ng/ml was suggested in younger age group as compared to the old age group where cut-off was found 0.135. CONCLUSION: Using PSAD as part of evaluation profile for prostate lesion, number of unnecessary biopsies can be significantly decreased. PSAD cut-off to aid in decision of invasive prostate biopsy is suggested to be 0.135 ng/ml with close biochemical follow up afterwards.

The Effect of Different Types of Prostate Biopsy Techniques on Post-Biopsy Infectious Complications.

The aim of our study was to compare infectious complication rates between different prostate biopsy techniques with various number of biopsy cores. In this retrospective study, all patients from 2 hospitals who underwent prostate biopsy between 2012 and 2019 were identified. Cohorts with different types of prostate biopsies were compiled within these hospitals. Primary outcome measure was any registered infectious complication within 7 days post-biopsy. Secondary outcomes were infectious complications within 30 days, hospitalization and bacteremia. To compare the risk of infection following different prostate biopsy techniques, data was fitted into a logistic regression model adjusting for potential confounders. In total, 4,233 prostate biopsies in 3,707 patients were included. After systematic transrectal ultrasound-guided prostate biopsy (TRUSPB; 12±1.4 biopsy cores), 4.0% (2,607) of all patients had infectious complications within 7 days post-biopsy. Transperineal magnetic resonance imaging (MRI)-ultrasound fusion guided prostate biopsy (16±3.7 biopsy cores) was associated with significantly lower infection rates than systematic TRUSPB (adjusted OR: 0.29 [0.09-0.73] 95% confidence interval [CI]). Transrectal targeted MRI-ultrasound fusion guided prostate biopsy (3.1±0.8 biopsy cores) and transrectal targeted in-bore MRI guided prostate biopsy (2.8±0.8 biopsy cores) also showed fewer infectious complications than systematic TRUSPB (adjusted OR: 0.41 [0.12-1.12] 95% CI and 0.68 [0.37-1.20] 95% CI, respectively). Transperineal prostate biopsy, or transrectal prostate biopsy with reduced number of biopsy cores, could lower the risk of infectious complications.

Development and validation of a multi-parameter nomogram for predicting prostate cancer: a retrospective analysis from Handan Central Hospital in China.

BackgroundTo explore the possible predicting factors related to prostate cancer and develop a validated nomogram for predicting the probability of patients with prostate cancer.MethodClinical data of 697 patients who underwent prostate biopsy in Handan Central Hospital from January 2014 to January 2020 were retrospectively collected. Cases were randomized into two groups: 80% (548 cases) as the development group, and 20% (149 cases) as the validation group. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for prostate cancer. The nomogram prediction model was generated using the finalized independent risk factors. Decision curve analysis (DCA) and the area under receiver operating characteristics curve (ROC) of both development group and validation group were calculated and compared to validate the accuracy and efficiency of the nomogram prediction model. Clinical utility curve (CUC) helped to decide the desired cut-off value for the prediction model. The established nomogram with Prostate Cancer Prevention Trial Derived Cancer Risk Calculator (PCPT-CRC) and other domestic prediction models using the entire study population were compared.ResultsThe independent risk factors determined through univariate and multivariate logistic regression analyses were: age, tPSA, fPSA, PV, DRE, TRUS and BMI. Nomogram prediction model was developed with the cut-off value of 0.31. The AUC of development group and validation group were 0.856 and 0.797 respectively. DCA exhibits consistent observations with the findings. Through validating our prediction model as well as other three domestic prediction models based on the entire study population of 697 cases, our prediction model demonstrated significantly higher predictive value than all the other models.ConclusionThe nomogram for predicting prostate cancer can facilitate more accurate evaluation of the probability of having prostate cancer, and provide better ground for prostate biopsy.

Predicting the diagnosis of prostate cancer with a scoring system based on novel biomarkers

ObjectiveTo predict prostate cancer using novel biomarker ratios and create a predictive scoring system.Materials and methodsData of a total of 703 patients who consulted Urology Department of Selayang Hospital between January 2013 and December 2017 and underwent prostate biopsy were screened retrospectively. Prostate specific antigen (PSA) levels, prostate volumes (PV), neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR), Prostate specific antigen density (PSAD) and histopathology were evaluated.ResultsAges ranged from 43 to 89 years, divided into 2 groups as per biopsy results; positive for prostate cancer (n = 290, 41.3%) and negative for malignancy (n = 413; 58.7%). Intergroup comparative evaluations were performed. Independent variables with p < 0.001 in the univariate analysis were age, DRE, PV, NLR, PSAD. A scoring system was modelled using NLR < 0.9, PSAD > 0.4, Age > 70 and DRE. A score of 2 or more predicted prostate cancer with a Sensitivity of 83.8% and Specificity of 86.4%.ConclusionsNLR is shown to be good predictor for prostate cancer its usage in this scoring system affords more disease specificity as compared to PSA alone.

Construction and Validation of a Clinical Predictive Nomogram for Improving the Cancer Detection of Prostate Naive Biopsy Based on Chinese Multicenter Clinical Data.

ObjectivesProstate biopsy is a common approach for the diagnosis of prostate cancer (PCa) in patients with suspicious PCa. In order to increase the detection rate of prostate naive biopsy, we constructed two effective nomograms for predicting the diagnosis of PCa and clinically significant PCa (csPCa) prior to biopsy.Materials and MethodsThe data of 1,428 patients who underwent prostate biopsy in three Chinese medical centers from January 2018 to June 2021 were used to conduct this retrospective study. The KD cohort, which consisted of 701 patients, was used for model construction and internal validation; the DF cohort, which consisted of 385 patients, and the ZD cohort, which consisted of 342 patients, were used for external validation. Independent predictors were selected by univariate and multivariate binary logistic regression analysis and adopted for establishing the predictive nomogram. The apparent performance of the model was evaluated via internal validation and geographically external validation. For assessing the clinical utility of our model, decision curve analysis was also performed.ResultsThe results of univariate and multivariate logistic regression analysis showed prostate-specific antigen density (PSAD) (P<0.001, OR:2.102, 95%CI:1.687-2.620) and prostate imaging-reporting and data system (PI-RADS) grade (P<0.001, OR:4.528, 95%CI:2.752-7.453) were independent predictors of PCa before biopsy. Therefore, a nomogram composed of PSAD and PI-RADS grade was constructed. Internal validation in the developed cohort showed that the nomogram had good discrimination (AUC=0.804), and the calibration curve indicated that the predicted incidence was consistent with the observed incidence of PCa; the brier score was 0.172. External validation was performed in the DF and ZD cohorts. The AUC values were 0.884 and 0.882, in the DF and ZD cohorts, respectively. Calibration curves elucidated greatly predicted the accuracy of PCa in the two validation cohorts; the brier scores were 0.129 in the DF cohort and 0.131 in the ZD cohort. Decision curve analysis showed that our model can add net benefits for patients. A separated predicted model for csPCa was also established and validated. The apparent performance of our nomogram for PCa was also assessed in three different PSA groups, and the results were as good as we expected.ConclusionsIn this study, we put forward two simple and convenient clinical predictive models comprised of PSAD and PI-RADS grade with excellent reproducibility and generalizability. They provide a novel calculator for the prediction of the diagnosis of an individual patient with suspicious PCa.

Clinical Utility of Germline Genetic Testing in Japanese Men Undergoing Prostate Biopsy.

BackgroundMultiple common variants and also rare variants in monogenic risk genes such as BRCA2 and HOXB13 have been reported to be associated with risk of prostate cancer (PCa); however, the clinical setting in which germline genetic testing could be used for PCa diagnosis remains obscure. Herein, we tested the clinical utility of a 16 common variant–based polygenic risk score (PRS) that has been developed previously for Japanese men and also evaluated the frequency of PCa-associated rare variants in a prospective cohort of Japanese men undergoing prostate biopsy.MethodsA total of 1336 patients undergoing first prostate biopsy were included. PRS was calculated based on the genotype of 16 common variants, and sequencing of 8 prostate cancer–associated genes was performed by multiplex polymerase chain reaction based target sequencing. PRS was combined with clinical factors in logistic regression models to assess whether addition of PRS improves the prediction of biopsy positivity.ResultsThe top PRS decile was associated with an odds ratio of 4.10 (95% confidence interval = 2.46 to 6.86) with reference to the patients at average risk, and the estimated lifetime absolute risk approached 20%. Among the patients with prostate specific antigen 2-10 ng/mL who had prebiopsy magnetic resonance imaging, high PRS had an equivalent impact on biopsy positivity as a positive magnetic resonance imaging finding. Rare variants were detected in 19 (2.37%) and 7 (1.31%) patients with positive and negative biopsies, respectively, with BRCA2 variants being the most prevalent. There was no association between PRS and high-risk rare variants.ConclusionsGermline genetic testing could be clinically useful in both pre- and post-PSA screening settings.

To Evaluate the Corelation between Age and Gleason Score in Patients with Prostate Cancer- A Tertiary Care Hospital Based Study

Objective: The aim of this study is to evaluate the corelation between age and Gleason score in patients with prostate cancer. Materials and Methods: From January 2009 to December 2021, 268 Asian Pakistani men who underwent prostate biopsy and were diagnosed with Prostate Adenocarcinoma have been included in this study, The age of patients ranged from 40 years to 94 years. The indications for biopsy were suspicious digital rectal examination and abnormally high PSA. The procedure was performed either transurethrally, transperineally or transrectally, Results: A total of 268 patients were diagnosed with Prostate Adenocarcinoma, the age range was from 40 to 94 years. The median age was found as 68 years with an interquartile range of 15 years. The median Gleason score was found as 8 with an interquartile range of 7 scores. A negative weak corelation was found between the age of the patients at the time of diagnosis and the Gleason score (r= -0.013, p=0.832). Conclusion: Though there are many studies that support the existence of corelation between increasing age and Gleason Score, our study, like a couple of others, showed no association between the two and a weak positive corelation. Our conclusion of the study is that while studying the relationship between the two, other variables like PSA, DRE findings and TNM classification of the tumor are also important. Hence, more work needs to be done in this regard.

Firmicutes in Gut Microbiota Correlate with Blood Testosterone Levels in Elderly Men.

PurposeIn males, testosterone levels have been implicated in various diseases. Recently, the influence of gut microbial-derived compounds on host metabolism has become evident, and it has been suggested that some gut bacteria may be involved in testosterone metabolism. In the present study, we examined the relationship between testosterone levels and gut microbiota in elderly Japanese men.Materials and MethodsWe collected samples from Japanese male subjects suspected of having prostate cancer and underwent prostate biopsies and excluded patients with positive biopsies to avoid the effect of prostate cancer on the gut microbiota. In total, 54 Japanese males with negative biopsy results were included in our study. The gut microbiota was analyzed by 16S rRNA gene sequencing of bacterial DNA extracted from rectal swabs. Gut microbiota compositions were compared between the two groups according to the level of serum testosterone (above or below 3.5 ng/mL).ResultsThe median age of the cohort was 71 years, and the quartile range was 67 to 73 years. We observed no significant difference in alpha or beta diversity, but some bacteria belonging to the phylum Firmicutes (Clostridiales, Turicibacter, and Gemella) were increased in the high testosterone group. Serum testosterone levels positively correlated with the relative amount of Firmicutes (rS=0.3323, p=0.0141), and the amount of Firmicutes affected serum testosterone levels independent of host factors (age, body mass index, triglyceride, and total cholesterol; β=0.770, p=0.0396).ConclusionsSome intestinal bacteria belonging to the phylum Firmicutes were associated with testosterone levels in elderly males. Therefore, the gut microbiota could affect testosterone metabolism in elderly males.

Integration of magnetic resonance imaging into prostate cancer nomograms.

The decision whether to undergo prostate biopsy must be carefully weighed. Nomograms have widely been utilized as risk calculators to improve the identification of prostate cancer by weighing several clinical factors. The recent inclusion of multiparametric magnetic resonance imaging (mpMRI) findings into nomograms has drastically improved their nomogram’s accuracy at identifying clinically significant prostate cancer. Several novel nomograms have incorporated mpMRI to aid in the decision-making process in proceeding with a prostate biopsy in patients who are biopsy-naïve, have a prior negative biopsy, or are on active surveillance. Furthermore, novel nomograms have incorporated mpMRI to aid in treatment planning of definitive therapy. This literature review highlights how the inclusion of mpMRI into prostate cancer nomograms has improved upon their performance, potentially reduce unnecessary procedures, and enhance the individual risk assessment by improving confidence in clinical decision-making by both patients and their care providers.