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Grivas N, Dell'Oglio P, De Groote R, Turri F, Mamoulakis C, Larcher A. Re: Vinayak G. Wagaskar, Ankur Mittal, Stanislaw Sobotka, et al. Hood Technique for Robotic Radical Prostatectomy-Preserving Periurethral Anatomical Structures in the Space of Retzius and Sparing the Pouch of Douglas, Enabling Early Return of Continence Without Compromising Surgical Margin Rates. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.09.044. Eur Urol 2021; 79:e152-e153. [PMID: 33648790 DOI: 10.1016/j.eururo.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Nikolaos Grivas
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Ruben De Groote
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Filippo Turri
- ORSI Academy, Melle, Belgium; Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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1452
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Cheng X, Xu J, Chen Y, Liu Z, Sun G, Yang L, Yao J, Zeng H, Song B. Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI? Front Oncol 2021; 11:643051. [PMID: 33718240 PMCID: PMC7952882 DOI: 10.3389/fonc.2021.643051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration. Materials and Methods Patients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume. Results A total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3–4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063). Conclusion The combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.
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Affiliation(s)
- Xueqing Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinshun Xu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yuntian Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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1453
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Apfelbeck M, Pfitzinger P, Bischoff R, Rath L, Buchner A, Mumm JN, Schlenker B, Stief CG, Chaloupka M, Clevert DA. Predictive clinical features for negative histopathology of MRI/Ultrasound-fusion-guided prostate biopsy in patients with high likelihood of cancer at prostate MRI: Analysis from a urologic outpatient clinic1. Clin Hemorheol Microcirc 2021; 76:503-511. [PMID: 33337358 DOI: 10.3233/ch-209225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate clinical features associated with benign histopathology of Prostate Imaging Reporting and Data System (PI-RADS) category 4 and 5 lesions. MATERIALS AND METHODS Between March 2015 and November 2020, 1161 patients underwent mpMRI/Ultrasound-fusion-guided prostate biopsy (FBx) and concurrent 12-core systematic prostate biopsy (SBx) at the Department of Urology of the Ludwig-Maximilians-University of Munich, Germany. 848/ 1161 (73%) patients presented with either PI-RADS 4 or 5 index lesion and were retrospectively evaluated. Multivariate analysis was performed to evaluate clinical parameters associated with a negative outcome of PI-RADS 4 or 5 category lesions after FBx. Area under the receiver operating characteristics (ROC) curve (AUC) was conducted using ROC-analysis. RESULTS 676/848 (79.7%) patients with either PI-RADS 4 or 5 index lesion were diagnosed with prostate cancer (PCa) by FBx and 172/848 (20.3%) patients had a negative biopsy (including the concurrent systematic prostate biopsy), respectively. Prostate volume (P-Vol) (OR 0.99, 95% CI = 0.98-1.00, p = 0.038), pre-biopsy-status (OR 0.48, 95% CI = 0.29-0.79, p = 0.004) and localization of the lesion in the transitional zone (OR 0.28, 95% CI = 0.13-0.60, p = 0.001) were independent risk factors for a negative outcome of FBx. Age (OR 1.09, 95% CI = 1.05-1.13, p < 0.001) and PSA density (PSAD) (OR 75.92, 95% CI = 1.03-5584.61, p = 0.048) increased the risk for PCa diagnosis after FBx. The multivariate logistic regression model combining all clinical characteristics achieved an AUC of 0.802 (95% CI = 0.765-0.835; p < 0.001) with a sensitivity and specificity of 66% and 85%. CONCLUSION Lesions with high or highly likelihood of PCa on multiparametric magnetic resonance imaging (mpMRI) but subsequent negative prostate biopsy occur in a small amount of patients. Localization of the lesion in the transitional zone, prostate volume and prebiopsy were shown to be predictors for benign histopathology of category 4 or 5 lesions on mpMRI. Integration of these features into daily clinical routine could be used for risk-stratification of these patients after negative biopsy of PI-RADS 4 or 5 index lesions.
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Affiliation(s)
- Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Paulo Pfitzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Robert Bischoff
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lukas Rath
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jan-Niklas Mumm
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
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1454
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Re: Jean F.P. Lestingi, Giuliano B. Guglielmetti, Quoc-Dien Trinh, et al. Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.11.040: Time for a Change? Clinically Meaningful Reasons Why We Will Continue Performing Extended Pelvic Lymph Node Dissection in Selected Patients with Prostate Cancer. Eur Urol 2021; 79:e154-e156. [PMID: 33637367 DOI: 10.1016/j.eururo.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
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1455
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Froehner M, Koch R, Graefen M. Re: Nicolas Mottet, Roderick C.N. van den Bergh, Erik Briers, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2021;79:243-62: Comorbidity Measurement in Patients with Prostate Cancer. Eur Urol 2021; 79:e138. [PMID: 33612374 DOI: 10.1016/j.eururo.2021.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | - Rainer Koch
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Markus Graefen
- Martini Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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1456
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Optimized Identification of High-Grade Prostate Cancer by Combining Different PSA Molecular Forms and PSA Density in a Deep Learning Model. Diagnostics (Basel) 2021; 11:diagnostics11020335. [PMID: 33670632 PMCID: PMC7922417 DOI: 10.3390/diagnostics11020335] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 01/21/2023] Open
Abstract
After skin cancer, prostate cancer (PC) is the most common cancer among men. The gold standard for PC diagnosis is based on the PSA (prostate-specific antigen) test. Based on this preliminary screening, the physician decides whether to proceed with further tests, typically prostate biopsy, to confirm cancer and evaluate its aggressiveness. Nevertheless, the specificity of the PSA test is suboptimal and, as a result, about 75% of men who undergo a prostate biopsy do not have cancer even if they have elevated PSA levels. Overdiagnosis leads to unnecessary overtreatment of prostate cancer with undesirable side effects, such as incontinence, erectile dysfunction, infections, and pain. Here, we used artificial neuronal networks to develop models that can diagnose PC efficiently. The model receives as an input a panel of 4 clinical variables (total PSA, free PSA, p2PSA, and PSA density) plus age. The output of the model is an estimate of the Gleason score of the patient. After training on a dataset of 190 samples and optimization of the variables, the model achieved values of sensitivity as high as 86% and 89% specificity. The efficiency of the method can be improved even further by training the model on larger datasets.
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1457
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van den Bergh RCN, O'Hanlon S, Cornford P, Mottet N. Reply to Michael Froehner, Rainer Koch, and Markus Graefen's Letter to the Editor re: Nicolas Mottet, Roderick C.N. van den Bergh, Erik Briers, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2021;79:243-62. Comorbidity Measurement in Patients with Prostate Cancer. Eur Urol 2021; 79:e139-e140. [PMID: 33608157 DOI: 10.1016/j.eururo.2021.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 01/14/2023]
Affiliation(s)
| | - Shane O'Hanlon
- Department of Elderly Care, St Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France.
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1458
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Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study. J Clin Med 2021; 10:jcm10040661. [PMID: 33572174 PMCID: PMC7914654 DOI: 10.3390/jcm10040661] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: no study has compared outcomes of same day discharge (SDD) versus inpatient robot-assisted radical prostatectomy (RARP) in homogenous cohorts. Our aim was to compare perioperative outcomes and urinary continence recovery between SDD and inpatient RARP in contemporary, comparable patients. (2) Methods: we included consecutive patients undergoing RARP between 2018 and 2020 (n = 376). Only patients eligible for SDD (no oral anticoagulant, distance home-hospital <150 km) and having >6-month follow-up were included (n = 180). All patients underwent RARP with or without lymph node dissection. Comparisons were performed between SDD (n = 42) and inpatient RARP (n = 138). Primary outcomes were 90-day complication and readmission rates and continence rates at 1 and 6 months. (3) Results: median patient age was 66.7 years. Median duration of surgery and blood loss was 134 min and 200 mL, respectively. Lymph node dissection and nerve-sparing procedures were performed in 76.7% and 82.2% of cases, respectively. Median follow-up was 19.5 months. No difference was seen regarding patient features, peri-operative outcomes, and pathology parameters between both groups. The proportion of SDD RARP was stable over time (23.5%). The 90-day unplanned visits, readmission and complication rates were 9.5%, 7.1%, and 19.0% in SDD patients versus 14.5% (p = 0.407), 10.1% (p = 0.560), 28.3% (p = 0.234) for inpatient RARP, respectively. Trends favoring SDD were not statistically significant. Continence rates at 1-(p = 0.589) and 6-months (p = 0.674) were comparable between SDD and inpatient RARP. The main limitation was the lack of randomization. (4) Conclusions: this multi-surgeon comparative study confirms the safety of routine SDD RARP in terms of perioperative and functional outcomes. Trends favoring SDD in terms of complications, emergency visits and readmission have to be confirmed.
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1459
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Luining WI, Meijer D, Dahele MR, Vis AN, Oprea-Lager DE. Nuclear Imaging for Bone Metastases in Prostate Cancer: The Emergence of Modern Techniques Using Novel Radiotracers. Diagnostics (Basel) 2021; 11:diagnostics11010117. [PMID: 33450817 PMCID: PMC7828280 DOI: 10.3390/diagnostics11010117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
Accurate staging of prostate cancer (PCa) at initial diagnosis and at biochemical recurrence is important to determine prognosis and the optimal treatment strategy. To date, treatment of metastatic PCa has mostly been based on the results of conventional imaging with abdominopelvic computed tomography (CT) and bone scintigraphy. However, these investigations have limited sensitivity and specificity which impairs their ability to accurately identify and quantify the true extent of active disease. Modern imaging modalities, such as those based on the detection of radioactively labeled tracers with combined positron emission tomography/computed tomography (PET/CT) scanning have been developed specifically for the detection of PCa. Novel radiotracers include 18F-sodium fluoride (NaF), 11C-/18F-fluorocholine (FCH), 18F-fluordihydrotestosterone (FDHT), 68Gallium and 18F-radiolabeled prostate-specific membrane antigen (e.g., 68Ga-PSMA-11, 18F-DCFPyL). PET/CT with these tracers outperforms conventional imaging. As a result of this, although their impact on outcome needs to be better defined in appropriate clinical trials, techniques like prostate-specific membrane antigen (PSMA) PET/CT have been rapidly adopted into clinical practice for (re)staging PCa. This review focuses on nuclear imaging for PCa bone metastases, summarizing the literature on conventional imaging (focusing on CT and bone scintigraphy—magnetic resonance imaging is not addressed in this review), highlighting the prognostic importance of high and low volume metastatic disease which serves as a driver for the development of better imaging techniques, and finally discussing modern nuclear imaging with novel radiotracers.
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Affiliation(s)
- Wietske I. Luining
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands; (D.M.); (A.N.V.)
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands;
- Correspondence: ; Tel.: +31-20-4443289; Fax: +31-20-4446031
| | - Dennie Meijer
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands; (D.M.); (A.N.V.)
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands;
| | - Max R. Dahele
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - André N. Vis
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands; (D.M.); (A.N.V.)
| | - Daniela E. Oprea-Lager
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands;
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1460
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Manini C, López JI. Insights into Urological Cancer. Cancers (Basel) 2021; 13:E204. [PMID: 33429960 PMCID: PMC7827315 DOI: 10.3390/cancers13020204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
The year the Covid-19 pandemic appeared has been quite prolific in urological cancer research, and the collection of articles, perspectives, and reviews on renal, prostate, and urinary tract tumors merged in this Urological Cancer 2020 issue is just a representative sample of this assertion [...].
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Affiliation(s)
- Claudia Manini
- Department of Pathology, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - José I. López
- Department of Pathology, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain
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1461
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Gandaglia G, Leni R, Fossati N, Cucchiara V, Montorsi F, Briganti A. Prostate-specific Membrane Antigen Imaging in Clinical Guidelines: European Association of Urology, National Comprehensive Cancer Network, and Beyond. Eur Urol Focus 2021; 7:245-249. [PMID: 33423971 DOI: 10.1016/j.euf.2020.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/15/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022]
Abstract
Prostate-specific membrane antigen (PSMA) imaging is characterized by superior accuracy compared to conventional imaging for identification of nodal and distant metastases in prostate cancer. The majority of international clinical guidelines recommend PSMA positron emission tomography/computed tomography for patients experiencing biochemical recurrence, even at low prostate-specific antigen values, to identify candidates for salvage therapies. However, its use in for primary staging is still not recommended.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Riccardo Leni
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vito Cucchiara
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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1462
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Bura V, Caglic I, Snoj Z, Sushentsev N, Berghe AS, Priest AN, Barrett T. MRI features of the normal prostatic peripheral zone: the relationship between age and signal heterogeneity on T2WI, DWI, and DCE sequences. Eur Radiol 2021; 31:4908-4917. [PMID: 33398421 PMCID: PMC8213603 DOI: 10.1007/s00330-020-07545-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/30/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
Objectives To assess the multiparametric MRI (mpMRI) appearances of normal peripheral zone (PZ) across age groups in a biopsy-naïve population, where prostate cancer (PCa) was subsequently excluded, and propose a scoring system for background PZ changes. Methods This retrospective study included 175 consecutive biopsy-naïve patients (40–74 years) referred with a suspicion of PCa, but with subsequent negative investigations. Patients were grouped by age into categories ≤ 54, 55–59, 60–64, and ≥ 65 years. MpMRI sequences (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC], and dynamic contrast-enhanced imaging [DCE]) were independently evaluated by two uro-radiologists on a proposed 4-point grading scale for background change on each sequence, wherein score 1 mirrored PIRADS-1 change and score 4 represented diffuse background change. Peripheral zone T2WI signal intensity and ADC values were also analyzed for trends relating to age. Results There was a negative correlation between age and assigned background PZ scores for each mpMRI sequence: T2WI: r = − 0.52, DWI: r = − 0.49, DCE: r = − 0.45, p < 0.001. Patients aged ≤ 54 years had mean scores of 3.0 (T2WI), 2.7 (DWI), and 3.1 (DCE), whilst patients ≥ 65 years had significantly lower mean scores of 1.7, 1.4, and 1.9, respectively. There was moderate inter-reader agreement for all scores (range κ = 0.43–0.58). Statistically significant positive correlations were found for age versus normalized T2WI signal intensity (r = 0.2, p = 0.009) and age versus ADC values (r = 0.33, p = 0.001). Conclusion The normal PZ in younger patients (≤ 54 years) demonstrates significantly lower T2WI signal intensity, lower ADC values, and diffuse enhancement on DCE, which may hinder diagnostic interpretation in these patients. The proposed standardized PZ background scoring system may help convey the potential for diagnostic uncertainty to clinicians. Key Points • Significant, positive correlations were found between increasing age and higher normalized T2-weighted signal intensity and mean ADC values of the prostatic peripheral zone. • Younger men exhibit lower T2-weighted imaging signal intensity, lower ADC values, and diffuse enhancement on dynamic contrast-enhanced imaging, which may hinder MRI interpretation. • A scoring system is proposed which aims towards a standardized assessment of the normal background PZ. This may help convey the potential for diagnostic uncertainty to clinicians. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07545-7.
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Affiliation(s)
- Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Cluj, Romania
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ziga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alexandra S Berghe
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Cluj, Romania.,Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK.
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1463
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Yoshida S, Matsushima H, Fujii Y. Classification of oligometastatic prostate cancer with additional consideration for hormone sensitivity. World J Urol 2021; 40:871-873. [PMID: 33386949 DOI: 10.1007/s00345-020-03570-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/12/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | | | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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1464
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Wang S, Su W, Zhong C, Yang T, Chen W, Chen G, Liu Z, Wu K, Zhong W, Li B, Mao X, Lu J. An Eight-CircRNA Assessment Model for Predicting Biochemical Recurrence in Prostate Cancer. Front Cell Dev Biol 2020; 8:599494. [PMID: 33363156 PMCID: PMC7758402 DOI: 10.3389/fcell.2020.599494] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Prostate cancer (PCa) is a high morbidity malignancy in males, and biochemical recurrence (BCR) may appear after the surgery. Our study is designed to build up a risk score model using circular RNA sequencing data for PCa. The dataset is from the GEO database, using a cohort of 144 patients in Canada. We removed the low abundance circRNAs (FPKM < 1) and obtained 546 circRNAs for the next step. BCR-related circRNAs were selected by Logistic regression using the “survival” and “survminer” R package. Least absolute shrinkage and selector operation (LASSO) regression with 10-fold cross-validation and penalty was used to construct a risk score model by “glmnet” R software package. In total, eight circRNAs (including circ_30029, circ_117300, circ_176436, circ_112897, circ_112897, circ_178252, circ_115617, circ_14736, and circ_17720) were involved in our risk score model. Further, we employed differentially expressed mRNAs between high and low risk score groups. The following Gene Ontology (GO) analysis were visualized by Omicshare Online tools. As per the GO analysis results, tumor immune microenvironment related pathways are significantly enriched. “CIBERSORT” and “ESTIMATE” R package were used to detect tumor-infiltrating immune cells and compare the level of microenvironment scores between high and low risk score groups. What’s more, we verified two of eight circRNA’s (circ_14736 and circ_17720) circular characteristics and tested their biological function with qPCR and CCK8 in vitro. circ_14736 and circ_17720 were detected in exosomes of PCa patients’ plasma. This is the first bioinformatics study to establish a prognosis model for prostate cancer using circRNA. These circRNAs were associated with CD8+ T cell activities and may serve as a circRNA-based liquid biopsy panel for disease prognosis.
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Affiliation(s)
- Shuo Wang
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wei Su
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chuanfan Zhong
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Taowei Yang
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wenbin Chen
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Guo Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zezhen Liu
- Guangdong Key Laboratory of Urology, Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangzhou, China
| | - Kaihui Wu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Weibo Zhong
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Bingkun Li
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiangming Mao
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Jianming Lu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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1465
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Tsirkas K, Zygogianni A, Kougioumtzopoulou A, Kouloulias V, Liakouli Z, Papatsoris A, Georgakopoulos J, Antypas C, Armpillia C, Dellis A. A-blockers for the management of lower urinary tract symptoms in patients with prostate cancer treated with external beam radiotherapy: a randomized controlled study. World J Urol 2020; 39:1805-1813. [PMID: 32776244 DOI: 10.1007/s00345-020-03398-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This is a prospective study aiming to assess the efficacy of α-blockers in treating radiotherapy-induced symptoms of the lower urinary tract and its possible prophylactic role on acute urinary retention (AUR) in patients undergoing radical external beam radiotherapy (EBRT) for localized prostate cancer (PCa). METHODS Overall, 108 patients with localized PCa were recruited and randomly assigned in to two groups; 54 patients of Group 1 received tamsulosin 0.4 mg once daily with the initiation of EBRT and for 6 months and 54 patients of Group 2 served as the control group. All patients received radical EBRT and had post-void volume (Vres) assessment. The International Prostate Symptom Score (IPSS) questionnaire and evaluation of episodes of AUR were performed after the end of radiotherapy, at 3 and at 6 months. RESULTS The incidence of AUR was significantly (p = 0.027) lower in group 1 compared to group 2. No independent predictive factors for AUR were identified in regression analysis. The IPSS changes in univariate and multivariate analysis at 3 months showed significant correlation with α-blockers only, while at 6 months showed significant correlation with Vres assessments (at 3 and 6 months) and with α-blockers. Side effects due to medication were mild and none of the patients discontinued the treatment. CONCLUSIONS The selective use of α-blocker appears to prevent AUR in EBRT-treated patients. Although the administration of α-blockers might relieve patient-reported symptoms, there are no established independent predictive factors to distinguish patients who may benefit.
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Affiliation(s)
- Kimon Tsirkas
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Zygogianni
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Kougioumtzopoulou
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece.
| | - Vasileios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Zoi Liakouli
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Georgakopoulos
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Christos Antypas
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Armpillia
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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