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Liu G, Zhu Y, Yao Z, Jiang Y, Wu B, Bai S. Development and validation of a predictive model for determining clinically significant prostate cancer in men with negative magnetic resonance imaging after transrectal ultrasound-guided prostate biopsy. Prostate 2021; 81:983-991. [PMID: 34254330 DOI: 10.1002/pros.24193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/12/2021] [Accepted: 06/29/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The interpretation of negative magnetic resonance imaging (MRI) screening results for clinically significant prostate cancer (csPCa) (International Society of Urological Pathology grade ≥group 2) is debatable and poses a clinical dilemma for urologists. No nomograms have been developed to predict csPCa in such populations. In this study, we aimed to develop and validate a model for predicting the probability of csPCa in men with negative MRI (PI-RADS score 1-2) results after transrectal ultrasound-guided systematic prostate biopsy. METHODS The development cohort consisted of 728 patients with negative MRI results who underwent subsequent prostate biopsy at our center between January 1, 2014 and December 31, 2017. The patients' clinicopathologic data were recorded. The Lasso regression was used for data dimension reduction and feature selection, then multivariable binary logistic regression was used to build a predictive model with regression coefficients. The model was validated in an independent cohort of 334 consecutive patients from January 1, 2018 and June 30, 2020. The performance of the predictive model was assessed with respect to discrimination, calibration, and decision curve analysis. RESULTS The predictors incorporated in this model included age, history of previous negative prostate biopsy, prostate specific antigen density (PSAD), and lower urinary tract symptoms, with PSAD being the strongest predictor. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.816-0.933) and good calibration (unreliability test, p = .540). Decision curve analysis demonstrated that the model was clinically useful. CONCLUSION This study presents a good nomogram that can aid pre-biopsy risk stratification for the detection of csPCa, and that may help inform biopsy decisions in patients with negative MRI results.
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Affiliation(s)
- Gang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuze Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zichuan Yao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunzhong Jiang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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202
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Wenzel M, Welte MN, Theissen LH, Wittler C, Hoeh B, Humke C, Preisser F, Würnschimmel C, Tilki D, Graefen M, Roos FC, Becker A, Karakiewicz PI, Chun FKH, Kluth LA, Mandel P. Comparison of Complication Rates with Antibiotic Prophylaxis with Cefpodoxime Versus Fluoroquinolones After Transrectal Prostate Biopsy. Eur Urol Focus 2021; 7:980-986. [PMID: 33358884 DOI: 10.1016/j.euf.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/06/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND After recommended restriction of the use of fluoroquinolones, the optimal antibiotic prophylaxis for transrectal prostate biopsy is still under debate. OBJECTIVE To test the effectiveness of cefpodoxime as oral antibiotic prophylaxis for transrectal prostate biopsies and the complication rates relative to fluoroquinolones. DESIGN, SETTING, AND PARTICIPANTS Antibiotic prophylaxis for transrectal prostate biopsies at the Department of Urology at University Hospital Frankfurt was fluoroquinolones for 342 consecutive patients in January 2018 and December 2019 and cefpodoxime for 100 patients from January 2020 to July 2020. Data were prospectively evaluated and retrospectively analyzed. Patients were followed up according to clinical routine at 6 wk after biopsy at the earliest. Patients without follow-up (n = 98) and those receiving antibiotic prophylaxis other than cefpodoxime or fluoroquinolones (n = 15) were excluded. INTERVENTION Use of cefpodoxime or fluoroquinolones as antibiotic prophylaxis for transrectal prostate biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression models were used to predict biopsy-related complications according to antibiotic prophylaxis. RESULTS AND LIMITATIONS Of 442 patients, 100 (22.6%) received cefpodoxime as antibiotic prophylaxis. Patient baseline and biopsy characteristics were comparable between the cefpodoxime and fluoroquinolone groups. Moreover, there were no differences in the number of prior prostate biopsies or the proportions of systematic vs. fusion biopsies (p > 0.05). There were no differences between the groups in infectious complications such as epididymitis and prostatitis after biopsy. Infectious complication rates were very low, at 2.0% in the cefpodoxime and0.9%fluoroquinolone group. Moreover, there were no differences between the groups in patient-reported complications, such as gross hematuria occurring at more than 5 d after biopsy, hematospermia, or rectal bleeding. In multivariable analyses, after adjustment for patient and prostate biopsy characteristics, cefpodoxime was not associated with higher complication rates than fluoroquinolones (p > 0.05). CONCLUSIONS Complications after transrectal prostate biopsies are rare and cefpodoxime might be a sufficient choice as oral antibiotic prophylaxis and noninferior compared to fluoroquinolones. PATIENT SUMMARY Cefpodoxime might be a sufficient choice as an easily applicable oral antibiotic prophylaxis for transrectal prostate biopsy. The safety profile of cefpodoxime is comparable to the safety profile of fluoroquinolones.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.
| | - Maria N Welte
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Lena H Theissen
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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203
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Morokuma F, Sadashima E, Chikamatsu S, Nakamura T, Hayakawa Y, Tokuda N. Use of increasing the number of biopsy cores in proportion to prostate size on prostate cancer diagnosis. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820949370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study aimed to determine the value of changing the number of biopsy cores in proportion to the size of the prostate in patients who had initial transperineal prostate biopsies. Materials and methods: This study included 470 patients who underwent an initial transperineal prostate biopsy. The number of biopsy cores was changed according to the value of the product of the vertical and horizontal diameters of the largest horizontal section of the prostate on transrectal ultrasonography (TRUS). Biopsies were classified into five groups: 12 cores, 14 cores, 18 cores, 20 cores, and 24 cores. Predictive factors for positive biopsy were studied with logistic regression analyses. Results: Variables that were significantly associated with positive biopsy were age, prostate-specific antigen density (PSAD), prostate volume (Pvol), and number of biopsy cores in univariate analysis. Age, PSAD, and Pvol were independent predictors in multivariate analysis. There was no significant difference in the number of biopsy cores, and it was not an independent predictor. Conclusions: Changing the number of biopsy cores according to the area of the largest horizontal section of the prostate on TRUS had no significant impact in detecting prostate cancer. However, further research is required to confirm this conclusion. Level of evidence: Level 2b.
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Affiliation(s)
| | - Eiji Sadashima
- Life Science Research Institute, Saga-Ken Medical Center Koseikan, Japan
| | | | | | | | - Noriaki Tokuda
- Department of Urology, Saga-Ken Medical Center Koseikan, Japan
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204
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Xu B, Li G, Kong C, Chen M, Hu B, Jiang Q, Li N, Zhou L. A multicenter retrospective study on evaluation of predicative factors for positive biopsy of prostate cancer in real-world setting. Curr Med Res Opin 2021; 37:1617-1625. [PMID: 34192993 DOI: 10.1080/03007995.2021.1949270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to evaluate the predictors for positive biopsy in prostate cancer (PCa) patients and develop a risk-stratification score model for positive biopsy rate in patients with prostate specific antigen (PSA) in the gray zone. METHODS In this retrospective, multicenter, real-world study, Chinese patients receiving prostate biopsy for the first time were included. The study evaluated the positive biopsy rate, predictors for positive biopsy and a risk prediction model for PSA 4-10 ng/mL PCa was developed. The univariate and multivariate logistic regression analyses were used to identify the risk factors. RESULTS A total of 2426 patients were included in the study. The biopsy positive rate was 47.57%, 25.77%, and 60.57% among overall patients, total PSA (t-PSA) 4-10 ng/mL patients, and PSA > 10 ng/mL patients respectively. Elderly age 60-74, ≥75, multi parametric magnetic resonance imaging (MP-MRI), pre-operative PSA > 10 and PSA density (PSAD) significantly increased the positive rate in overall population, and elderly age, MP-MRI, positive digital rectal examination and f-PSA were significant predictors for positive biopsy in PSA 4-10 ng/mL population. A risk prediction model for positive biopsy rate in patients with PSA in the gray zone was developed. Area under curve (AUC) was associated with low accuracy for all the variables used such as tPSA (0.53), PSAD (0.57), frequency of puncture (0.53) and MP-MRI (0.64) in prediction of biopsy positive rate. CONCLUSION Our study evaluated the significant predicative factors for positive biopsy and the PCa risk prediction model developed might help Clinicians to avoid unnecessary biopsy in patients with PSA in gray zone.
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Affiliation(s)
- Ben Xu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chuize Kong
- Department of Urology, First hospital of China Medical University, Shenyang, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bin Hu
- Department of Urology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ningchen Li
- Department of Urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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205
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Ferraro DA, Becker AS, Kranzbühler B, Mebert I, Baltensperger A, Zeimpekis KG, Grünig H, Messerli M, Rupp NJ, Rueschoff JH, Mortezavi A, Donati OF, Sapienza MT, Eberli D, Burger IA. Diagnostic performance of 68Ga-PSMA-11 PET/MRI-guided biopsy in patients with suspected prostate cancer: a prospective single-center study. Eur J Nucl Med Mol Imaging 2021; 48:3315-3324. [PMID: 33620559 PMCID: PMC8426229 DOI: 10.1007/s00259-021-05261-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/11/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Ultrasound-guided biopsy (US biopsy) with 10-12 cores has a suboptimal sensitivity for clinically significant prostate cancer (sigPCa). If US biopsy is negative, magnetic resonance imaging (MRI)-guided biopsy is recommended, despite a low specificity for lesions with score 3-5 on Prostate Imaging Reporting and Data System (PIRADS). Screening and biopsy guidance using an imaging modality with high accuracy could reduce the number of unnecessary biopsies, reducing side effects. The aim of this study was to assess the performance of positron emission tomography/MRI with 68Ga-labeled prostate-specific membrane antigen (PSMA-PET/MRI) to detect and localize primary sigPCa (ISUP grade group 3 and/or cancer core length ≥ 6 mm) and guide biopsy. METHODS Prospective, open-label, single-center, non-randomized, diagnostic accuracy study including patients with suspected PCa by elevation of prostate-specific antigen (PSA) level and a suspicious lesion (PIRADS ≥3) on multiparametric MRI (mpMRI). Forty-two patients underwent PSMA-PET/MRI followed by both PSMA-PET/MRI-guided and section-based saturation template biopsy between May 2017 and February 2019. Primary outcome was the accuracy of PSMA-PET/MRI for biopsy guidance using section-based saturation template biopsy as the reference standard. RESULTS SigPCa was found in 62% of the patients. Patient-based sensitivity, specificity, negative and positive predictive value, and accuracy for sigPCa were 96%, 81%, 93%, 89%, and 90%, respectively. One patient had PSMA-negative sigPCa. Eight of nine false-positive lesions corresponded to cancer on prostatectomy and one in six false-negative lesions was negative on prostatectomy. CONCLUSION PSMA-PET/MRI has a high accuracy for detecting sigPCa and is a promising tool to select patients with suspicion of PCa for biopsy. TRIAL REGISTRATION This trial was retrospectively registered under the name "Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) Guided Biopsy in Men with Elevated PSA" (NCT03187990) on 06/15/2017 ( https://clinicaltrials.gov/ct2/show/NCT03187990 ).
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Affiliation(s)
- Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anton S Becker
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Iliana Mebert
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Anka Baltensperger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Konstantinos G Zeimpekis
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hannes Grünig
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan H Rueschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Olivio F Donati
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcelo T Sapienza
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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206
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Eyrich NW, Morgan TM, Tosoian JJ. Biomarkers for detection of clinically significant prostate cancer: contemporary clinical data and future directions. Transl Androl Urol 2021; 10:3091-3103. [PMID: 34430413 PMCID: PMC8350244 DOI: 10.21037/tau-20-1151] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
Use of serum prostate-specific antigen (PSA) testing for early detection of prostate cancer appears to reduce cancer-specific mortality. Due to the limited specificity of PSA for clinically significant [Grade Group (GG) ≥2] cancer, however, screening carries substantial risks, including frequent unnecessary prostate biopsies and overdetection of non-aggressive cancers. To that end, serum and urine biomarkers with improved specificity for GG ≥2 cancer have been proposed for clinical use following PSA. In the current article, we present clinical validation data for five such biomarkers: PHI, 4Kscore, SelectMDx, ExoDx, and MPS. For all studies, we specify the study population (overall biopsy referral vs. pre-specified PSA ranges), previous biopsy status (biopsy-naïve vs. previous negative biopsy), and the proportion of subjects diagnosed with GG ≥2 cancer. Outcomes include test performance characteristics: sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Published data were used to compute the number of unnecessary biopsies avoided and number of GG ≥2 cancers missed if the biomarker had been used clinically to select for prostate biopsy. The evidence review is preceded by a primer on these and other clinically-relevant summary statistics.
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Affiliation(s)
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey J Tosoian
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
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207
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Manceau C, Fromont G, Beauval JB, Barret E, Brureau L, Créhange G, Dariane C, Fiard G, Gauthé M, Mathieu R, Renard-Penna R, Roubaud G, Ruffion A, Sargos P, Rouprêt M, Ploussard G. Biomarker in Active Surveillance for Prostate Cancer: A Systematic Review. Cancers (Basel) 2021; 13:4251. [PMID: 34503059 PMCID: PMC8428218 DOI: 10.3390/cancers13174251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022] Open
Abstract
Active surveillance (AS) in prostate cancer (PCa) represents a curative alternative for men with localised low-risk PCa. Continuous improvement of AS patient's selection and surveillance modalities aims at reducing misclassification, simplifying modalities of surveillance and decreasing need for invasive procedures such repeated biopsies. Biomarkers represent interesting tools to evaluate PCa diagnosis and prognosis, of which many are readily available or under evaluation. The aim of this review is to investigate the biomarker performance for AS selection and patient outcome prediction. Blood, urinary and tissue biomarkers were studied and a brief description of use was proposed along with a summary of major findings. Biomarkers represent promising tools which could be part of a more tailored risk AS strategy aiming to offer personalized medicine and to individualize the treatment and monitoring of each patient. The usefulness of biomarkers has mainly been suggested for AS selection, whereas few studies have investigated their role during the monitoring phase. Randomized prospective studies dealing with imaging are needed as well as larger prospective studies with long-term follow-up and strong oncologic endpoints.
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Affiliation(s)
- Cécile Manceau
- Department of Urology, CHU-IUC Toulouse, F-31000 Toulouse, France
| | - Gaëlle Fromont
- Department of Pathology, CHRU Tours, F-37000 Tours, France;
| | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, F-31130 Quint Fonsegrives, France; (J.-B.B.); (G.P.)
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, F-75014 Paris, France;
| | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)–UMR_S 1085, F-97110 Pointe-à-Pitre, France;
| | - Gilles Créhange
- Department of Radiation Oncology, Curie Institute, F-75005 Paris, France;
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris–Paris University–U1151 Inserm-INEM, Necker, F-75015 Paris, France;
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France;
| | - Mathieu Gauthé
- AP-HP Health Economics Research Unit, INSERM-UMR1153, F-75004 Paris, France;
| | - Romain Mathieu
- Department of Urology, CHU Rennes, F-35033 Rennes, France;
| | - Raphaële Renard-Penna
- Department of Radiology, Sorbonne University, AP-HP, Pitie-Salpetriere Hospital, F-75013 Paris, France;
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, F-33000 Bordeaux, France;
| | - Alain Ruffion
- Service d’Urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69002 Lyon, France;
- Equipe 2–Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY)–Faculté de Médecine Lyon Sud–Université Lyon 1, F-69002 Lyon, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France;
| | - Morgan Rouprêt
- Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, F-75013 Paris, France;
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, F-31130 Quint Fonsegrives, France; (J.-B.B.); (G.P.)
- Institut Universitaire du Cancer Oncopole, F-31000 Toulouse, France
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208
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Fichtinger G, Mousavi P, Ungi T, Fenster A, Abolmaesumi P, Kronreif G, Ruiz-Alzola J, Ndoye A, Diao B, Kikinis R. Design of an Ultrasound-Navigated Prostate Cancer Biopsy System for Nationwide Implementation in Senegal. J Imaging 2021; 7:154. [PMID: 34460790 PMCID: PMC8404908 DOI: 10.3390/jimaging7080154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 12/05/2022] Open
Abstract
This paper presents the design of NaviPBx, an ultrasound-navigated prostate cancer biopsy system. NaviPBx is designed to support an affordable and sustainable national healthcare program in Senegal. It uses spatiotemporal navigation and multiparametric transrectal ultrasound to guide biopsies. NaviPBx integrates concepts and methods that have been independently validated previously in clinical feasibility studies and deploys them together in a practical prostate cancer biopsy system. NaviPBx is based entirely on free open-source software and will be shared as a free open-source program with no restriction on its use. NaviPBx is set to be deployed and sustained nationwide through the Senegalese Military Health Service. This paper reports on the results of the design process of NaviPBx. Our approach concentrates on "frugal technology", intended to be affordable for low-middle income (LMIC) countries. Our project promises the wide-scale application of prostate biopsy and will foster time-efficient development and programmatic implementation of ultrasound-guided diagnostic and therapeutic interventions in Senegal and beyond.
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Affiliation(s)
- Gabor Fichtinger
- School of Computing, Queen’s University, Kingston, ON K7L 2N8, Canada; (P.M.); (T.U.)
| | - Parvin Mousavi
- School of Computing, Queen’s University, Kingston, ON K7L 2N8, Canada; (P.M.); (T.U.)
| | - Tamas Ungi
- School of Computing, Queen’s University, Kingston, ON K7L 2N8, Canada; (P.M.); (T.U.)
| | - Aaron Fenster
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5B7, Canada;
| | - Purang Abolmaesumi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria;
| | - Juan Ruiz-Alzola
- Departamento de Señales y Comunicaciones, University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain;
| | - Alain Ndoye
- Department of Urology, Hôpital Aristide Le Dantec, Cheikh Anta Diop University, Dakar 10700, Senegal; (A.N.); (B.D.)
| | - Babacar Diao
- Department of Urology, Hôpital Aristide Le Dantec, Cheikh Anta Diop University, Dakar 10700, Senegal; (A.N.); (B.D.)
- Department of Urology, Ouakam Military Hospital, Dakar BP 5321, Senegal
| | - Ron Kikinis
- Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02115, USA;
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209
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Utsumi T, Endo T, Sugizaki Y, Mori T, Somoto T, Kato S, Oka R, Yano M, Kamiya N, Suzuki H. Risk assessment of multi-factorial complications after transrectal ultrasound-guided prostate biopsy: a single institutional retrospective cohort study. Int J Clin Oncol 2021; 26:2295-2302. [PMID: 34405316 DOI: 10.1007/s10147-021-02010-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transrectal ultrasound-guided prostate biopsy (TRUSPB) is widely used to diagnose prostate cancer (PCa). The aim of this study was to evaluate the risk of multi-factorial complications (febrile genitourinary tract infection (GUTI), rectal bleeding, and urinary retention) after TRUSPB. METHODS N = 2053 patients were Japanese patients undergoing transrectal or transperineal TRUSPB for suspicious of PCa. To assess risk of febrile GUTI adequately, the patients were divided into four groups: low-risk patients before starting a rectal culture, low-risk patients after starting a rectal culture, high-risk patients, and patients undergoing transperineal TRUSPB. Furthermore, to identify risk of rectal bleeding and urinary retention, patients were divided into transrectal and transperineal group. RESULTS Febrile GUTI significantly decreased owing to risk classification. The frequency of rectal bleeding was 1.43% (transrectal: 25/1742), while it did not happen in transperineal group. The patients with rectal bleeding had a significantly lower body mass index (BMI) (P < 0.01). The frequency of urinary retention was 5.57% (transrectal: 97/1742), while it did not happen in transperineal group. The patients with urinary retention had a significantly higher prostate-specific antigen (PSA) (P = 0.01) in transrectal group. CONCLUSIONS Risk classification, rectal swab culture, and selected antimicrobial prophylaxis for transrectal TRUSPB were extremely effective to reduce the risk of febrile GUTI. Furthermore, lower BMI and higher PSA were novel clinical predictors for rectal bleeding and urinary retention, respectively. When urologists perform transrectal TRUSPB to their patients, they can correctly understand and explain each complication risk to their patients based on these novel risk factors.
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Affiliation(s)
- Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan.
| | - Takumi Endo
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Yuka Sugizaki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Takamichi Mori
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Takatoshi Somoto
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Seiji Kato
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Ryo Oka
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Masashi Yano
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
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Zheng Y, Bai F, Zhang N, Wu H. Analysis of Voiding Impairment after Prostate Biopsy and the Effect of Doxazosin Treatment: Outcomes from a Regional Cancer Center. Urol Int 2021; 106:97-102. [PMID: 34404051 DOI: 10.1159/000517534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the association of transrectal ultrasound (TRUS)-guided prostate biopsy with voiding impairment and the efficacy of doxazosin treatment. METHODS A prospective observational study including 200 male patients undergoing TRUS-guided prostate biopsy was performed between May 2020 and December 2020. One hundred patients underwent biopsy with doxazosin (doxazosin group). The remaining 100 patients underwent biopsy without doxazosin (control group). All patients were questioned regarding post-biopsy voiding difficulty and acute urinary retention. The International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), and residual urine volume were recorded before biopsy and at 7 and 30 days after biopsy. RESULTS There were no significant differences in baseline parameters between the two groups. The rate of post-biopsy voiding difficulty in the doxazosin group was significantly lower than that in the control group. Compared with baseline values, doxazosin treatment significantly improved IPSS, quality of life scores, and Qmax after biopsy (p < 0.05). The baseline values of IPSS and prostate size may be risk factors for post-biopsy voiding difficulty. CONCLUSION TRUS-guided prostate biopsy causes transient voiding impairments, which may be improved by doxazosin treatment.
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Affiliation(s)
- Yi Zheng
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fuding Bai
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nan Zhang
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huifeng Wu
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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211
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Koseoglu H, Celebi A, Galamiyeva G, Dalay N, Ozkardes H, Buyru N. No Tumor Suppressor Role for LKB1 in Prostate Cancer. DNA Cell Biol 2021; 40:1222-1229. [PMID: 34370601 DOI: 10.1089/dna.2021.0274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To elucidate the pathogenesis of prostate diseases, following in silico analysis, the LKB1 gene was selected for further investigation. The LKB1 gene has been associated with poor prognosis and is frequently mutated in different types of cancers. In this study, 50 benign prostatic hyperplasia (BPH) and 57 prostate cancer (PCa) tissues, including matched normal tissue for the patients, were analyzed by qRT-PCR and DNA sequencing for LKB1 expression and the mutation profile, respectively. Expression of LKB1 was increased in 60.7% of the PCa tissues compared with noncancerous tissue samples (p ≤ 0.001). However, LKB1 expression was lower when compared with normal tissues in BPH (p = 0.920). Four coding sequence alterations were detected in BPH. Three silent mutations were located in codons 9, 32, and 275 and a missense mutation was observed in codon 384. Six alterations were identified in the intronic regions of the LKB1 gene in both PCa and BPH. Five mutations were observed in both patient groups. A new alteration in intron 6 was observed in a patient with PCa. The LKB1 gene may be associated with benign transformations rather than the tumors in prostate pathogenesis when its expression and mutation status are considered. However, the mechanism of LKB1 in PCa needs further studies.
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Affiliation(s)
- Hikmet Koseoglu
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Asuman Celebi
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gunay Galamiyeva
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nejat Dalay
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hakan Ozkardes
- Department of Urology, Medical Faculty, Baskent University, Istanbul, Turkey
| | - Nur Buyru
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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212
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Kuss K, Adarkwah CC, Becker M, Donner‐Banzhoff N, Schloessler K. Delivering the unexpected-Information needs for PSA screening from Men's perspective: A qualitative study. Health Expect 2021; 24:1403-1412. [PMID: 34097797 PMCID: PMC8369103 DOI: 10.1111/hex.13275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Making decisions about PSA screening tests is challenging, as it requires both knowledge of the possible benefits and harms of screening and an individual assessment of the patient's values. Our research explores how much and what information men perceive to be necessary with regard to screening for prostate cancer. OBJECTIVE To explore men's information and associated needs for decision making in PSA testing. DESIGN Qualitative interview study. SETTING AND PARTICIPANTS We interviewed 32 men (aged 55-69) about their decision making on PSA screening following counselling with a Decision Aid at their GP's or urologist's practice in Germany. MAIN OUTCOME MEASURES Men's expressed needs for decision making in PSA testing. METHODS All interviews were transcribed verbatim and analysed by framework analysis. RESULTS Comprehensive pre-screening counselling is needed. For the men in our study, information about test (in)accuracy, the benefit-harm balance and consequences of the test were relevant and surprising. Additional needs were for interpretation support, a take-home summary and time for deliberation. For several men, their physician's attitude was of interest. After being well-informed, most men felt empowered to make a preference-based decision on their own. DISCUSSION Men were surprised by what they learned, especially regarding the accuracy and possible harms of screening. There is large variation in the breadth and depth of information needed, and some controversy regarding the consequences of testing. CONCLUSION AND PATIENT CONTRIBUTION A core set of information should be offered before men make their first PSA screening decision. Information about biopsy and associated side-effects could follow in a short form, with details only on request. Knowledge about a high rate of false-positive test results beforehand might help men handle a suspicious test result.
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Affiliation(s)
- Katrin Kuss
- Department of General Practice/Family MedicinePhilipps‐University MarburgMarburgGermany
| | - Charles Christian Adarkwah
- Department of General Practice/Family MedicinePhilipps‐University MarburgMarburgGermany
- CAPHRI School for Public Health and Primary CareDepartment of Health Services Research, Maastricht UniversityMaastrichtThe Netherlands
| | - Miriam Becker
- Department of General Practice/Family MedicinePhilipps‐University MarburgMarburgGermany
| | | | - Kathrin Schloessler
- Department of General Practice/Family MedicinePhilipps‐University MarburgMarburgGermany
- Department of General Practice/Family MedicineRuhr University BochumBochumGermany
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Benli E, Yuce A, Cirakoglu A, Yazici I, Kadim N, Nalbant I. Effect of targeted prophylaxis with rectal swab on complications after prostate biopsy: prospective randomized study. Ir J Med Sci 2021; 191:1147-1152. [PMID: 34304346 DOI: 10.1007/s11845-021-02723-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND For diagnosis of prostate cancer, prostate biopsy accompanied by TRUS is the current method applied today. AIM The aim of this study was to compare targeted antibiotic prophylaxis, chosen according to rectal swab results before the procedure, with routinely administered prophylaxis and to investigate the effect on infective complications. METHODS The study included 140 patients with 12-quadrant prostate biopsy accompanied by TRUS in our hospital from 2018 to 2020. The first group had antibiotherapy prophylaxis administered according to the results of rectal swabs before the procedure. The second group had routine ciprofloxacin prophylaxis administered. Patients were followed prospectively for 1 month after the procedure. RESULTS When the mean age, systemic diseases and distribution in both groups are examined, there was no significant difference observed. Fever (> 38.5 °C) was observed in 3 patients in the rectal swab group (4.3%), while it was identified in 10 people in the control group (14.1%) (p = 0.047). Major complications were observed in 3 people in the rectal swab group (4.3%) and in 7 people in the control group (9.9%) (p = 0.012). CONCLUSIONS The results of the study identified that routine administration of targeted antibiotic prophylaxis may be more effective in preventing infective complications compared to standard prophylaxis. Targeted prophylaxis is recommended for risky patients in the guidelines. However, the lack of difference between the groups in terms of age and comorbidities supports the need to administer targeted prophylaxis not just to risky patients but as well as routine practice.
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Affiliation(s)
- Erdal Benli
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ahmet Yuce
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey.
| | - Abdullah Cirakoglu
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ibrahim Yazici
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Nurullah Kadim
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ismail Nalbant
- Department of Urology Etlik, Lokman Hekim Hospital, Ankara, Turkey
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214
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Meehan J, Gray M, Martínez-Pérez C, Kay C, McLaren D, Turnbull AK. Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine. J Pers Med 2021; 11:jpm11070664. [PMID: 34357131 PMCID: PMC8306523 DOI: 10.3390/jpm11070664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/24/2022] Open
Abstract
Worldwide, prostate cancer (PC) is the second-most-frequently diagnosed male cancer and the fifth-most-common cause of all cancer-related deaths. Suspicion of PC in a patient is largely based upon clinical signs and the use of prostate-specific antigen (PSA) levels. Although PSA levels have been criticised for a lack of specificity, leading to PC over-diagnosis, it is still the most commonly used biomarker in PC management. Unfortunately, PC is extremely heterogeneous, and it can be difficult to stratify patients whose tumours are unlikely to progress from those that are aggressive and require treatment intensification. Although PC-specific biomarker research has previously focused on disease diagnosis, there is an unmet clinical need for novel prognostic, predictive and treatment response biomarkers that can be used to provide a precision medicine approach to PC management. In particular, the identification of biomarkers at the time of screening/diagnosis that can provide an indication of disease aggressiveness is perhaps the greatest current unmet clinical need in PC management. Largely through advances in genomic and proteomic techniques, exciting pre-clinical and clinical research is continuing to identify potential tissue, blood and urine-based PC-specific biomarkers that may in the future supplement or replace current standard practices. In this review, we describe how PC-specific biomarker research is progressing, including the evolution of PSA-based tests and those novel assays that have gained clinical approval. We also describe alternative diagnostic biomarkers to PSA, in addition to biomarkers that can predict PC aggressiveness and biomarkers that can predict response to certain therapies. We believe that novel biomarker research has the potential to make significant improvements to the clinical management of this disease in the near future.
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Affiliation(s)
- James Meehan
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Correspondence:
| | - Mark Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, UK;
| | - Carlos Martínez-Pérez
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Charlene Kay
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Duncan McLaren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh EH4 2XU, UK;
| | - Arran K. Turnbull
- Translational Oncology Research Group, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; (C.M.-P.); (C.K.); (A.K.T.)
- Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
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El-Achkar A, Al-Mousawy M, Abou Heidar N, Moukaddem H, Hussein H, Mouallem N, El-Hajj A, Bulbul M. Magnetic resonance imaging /ultrasonography fusion transperineal prostate biopsy for prostate cancer: Initial experience at a Middle Eastern tertiary medical centre. Arab J Urol 2021; 19:454-459. [PMID: 34881061 PMCID: PMC8648043 DOI: 10.1080/2090598x.2021.1926727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To report on the outcomes of magnetic resonance imaging (MRI)/ultrasonography (US)-fusion transperineal prostate (TP) biopsy at a tertiary medical centre in the Middle East including detection rate of clinically significant prostate cancer (csPCa), complications, and tolerability of the procedure. Patients and methods: Between May 2019 and June 2020, 98 MRI/US-fusion TP biopsies were performed in the US suite using light sedation. All patients had pre-biopsy 3-T multiparametric MRI. Data on patient characteristics, PCa detection rate and complication rates were collected retrospectively. A Gleason score ≥3 + 4 was defined as csPCa. RESULTS There were 98 patients, with a mean (SD) age of 65 (9.1) years, and a median (SD) prostate-specific antigen level prior to biopsy of 7.53 (12.97) ng/mL and prostate volume of 51 (31.1) mL. PCa was detected in 54 (55%) patients, with csPCa detected in 43 (44%). A total of 124 Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 lesions were targeted. Grade Group ≥2 PCa was found in 35.5% of the targeted lesions. Random biopsies detected one csPCa Gleason score 3 + 4 in one patient with a negative target. None of the patients had post-biopsy haematuria or retention. Only one patient developed acute prostatitis requiring in-patient intravenous antibiotics. CONCLUSIONS MRI/US-fusion TP biopsy has an adequate detection rate of csPCa with minimal complications and low infection rates after biopsy. This is one of the first TP biopsy series in the Middle East paving the way for wider adoption in the region. ABBREVIATIONS AS: active surveillance; AUR: acute urinary retention; GG: Grade Group; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; TP: transperineal; US: ultrasonography; TRUS: transrectal Ultrasound guided.
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Affiliation(s)
- Adnan El-Achkar
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Mouhammad Al-Mousawy
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Nassib Abou Heidar
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Hisham Moukaddem
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Hero Hussein
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Nadim Mouallem
- American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut, Lebanon
| | - Albert El-Hajj
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
| | - Muhammad Bulbul
- American University of Beirut Medical Center, Department of Surgery, Division of Urology, Beirut, Lebanon
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216
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Kang SK, Mali RD, Prabhu V, Ferket BS, Loeb S. Active Surveillance Strategies for Low-Grade Prostate Cancer: Comparative Benefits and Cost-effectiveness. Radiology 2021; 300:594-604. [PMID: 34254851 DOI: 10.1148/radiol.2021204321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Active surveillance (AS) is the recommended treatment option for low-risk prostate cancer (PC). Surveillance varies in MRI, frequency of follow-up, and the Prostate Imaging Reporting and Data System (PI-RADS) score that would repeat biopsy. Purpose To compare the effectiveness and cost-effectiveness of AS strategies for low-risk PC with versus without MRI. Materials and Methods This study developed a mathematical model to evaluate the cost-effectiveness of surveillance strategies in a simulation of men with a diagnosis of low-risk PC. The following strategies were compared: watchful waiting, prostate-specific antigen (PSA) and annual biopsy without MRI, and PSA testing and MRI with varied PI-RADS thresholds for biopsy. MRI strategies differed regarding scheduling and use of PI-RADS score of at least 3, or a PI-RADS score of at least 4 to indicate the need for biopsy. Life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated by using microsimulation. Sensitivity analysis was used to assess the impact of varying parameter values on results. Results For the base case of 60-year-old men, all strategies incorporating prostate MRI extended QALYs and life-years compared with watchful waiting and non-MRI strategies. Annual MRI strategies yielded 16.19 QALYs, annual biopsy with no MRI yielded 16.14 QALYs, and watchful waiting yielded 15.94 QALYs. Annual MRI with PI-RADS score of at least 3 or of at least 4 as the biopsy threshold and annual MRI with biopsy even after MRI with negative findings offered similar QALYs and the same unadjusted life expectancy: 23.05 life-years. However, a PI-RADS score of at least 4 yielded 42% fewer lifetime biopsies. With a cost-effectiveness threshold of $100 000 per QALY, annual MRI with biopsy for lesions with PI-RADS scores of 4 or greater was most cost-effective (incremental cost-effectiveness ratio, $67 221 per QALY). Age, treatment type, risk of initial grade misclassification, and quality-of-life impact of procedural complications affected results. Conclusion The use of active surveillance (AS) with biopsy decisions guided by findings from annual MRI reduces the number of biopsies while preserving life expectancy and quality of life. Biopsy in lesions with PI-RADS scores of 4 or greater is likely the most cost-effective AS strategy for men with low-risk prostate cancer who are younger than 70 years. © RSNA, 2021 Online supplemental material is available for this article. An earlier incorrect version appeared online. This article was corrected on July 13, 2021.
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Affiliation(s)
- Stella K Kang
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Rahul D Mali
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Vinay Prabhu
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Bart S Ferket
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Stacy Loeb
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
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217
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van der Slot MA, Boerma MO, Koster K, van Gorp A, Kolderman SE, Wolters T. The value of MRI in the detection of prostate cancer in a peripheral center. Urologia 2021; 89:70-74. [PMID: 34219558 DOI: 10.1177/03915603211028553] [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
INTRODUCTION This study evaluated the value of pre-biopsy MRI and target biopsy in detection of significant prostate cancer in a peripheral center. METHODS A retrospective study included all patients of whom a MRI of the prostate was performed before biopsy, initial and repeated biopsy, between June 2016 and May 2017. Patients underwent transrectal ultrasound guided 8-12 cores prostate biopsy and cognitive fusion target biopsy was performed if a suspicious lesion was seen on MRI. The prostate cancer detection was compared between the MRI cognitive target biopsy and standard random biopsy. RESULTS In a total of 265 patients a MRI was performed of whom 115 underwent prostate biopsy, 96 patients underwent MRI before initial biopsies and 19 patients had previous negative biopsies. In the initial biopsy group 83 MRI's were abnormal and only 7 (8.4%) target biopsies had an additional value in detecting or upstaging prostate cancer. Prostate cancer was found in 4 of 13 (30.8%) normal MRI's. In the prior negative biopsy group, 4 of 18 abnormal MRI's had an additional value in upstaging or detecting prostate cancer. CONCLUSION In this study the pre-biopsy MRI had a limited additional value compared to standard biopsy in detecting or upstaging prostate cancer.
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Affiliation(s)
| | - Michiel O Boerma
- Department of Urology, Deventer Hospital, Deventer, The Netherlands
| | - Kenneth Koster
- Department of Radiology, Deventer Hospital, Deventer, The Netherlands
| | | | | | - Tineke Wolters
- Department of Urology, Deventer Hospital, Deventer, The Netherlands
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Bajpai RR, Razdan S, Sanchez-Gonzalez MA, Razdan S. Minimizing transrectal prostate biopsy-related infections; A prospective randomized trial of povidone-iodine intrarectal cleaning versus formalin needle disinfection. Indian J Urol 2021; 37:254-260. [PMID: 34465955 PMCID: PMC8388331 DOI: 10.4103/iju.iju_34_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Transrectal prostate biopsies are associated with post biopsy infection and sepsis. We compared the efficacy of povidone-iodine rectal disinfection versus formalin needle disinfection in preventing post biopsy infection among patients undergoing transrectal ultrasound-guided prostate biopsy. METHODS Patients scheduled to undergo ultrasound-guided transrectal prostate biopsy (n = 621) over 20 months were randomized into 2 groups to receive either povidone-iodine intrarectal disinfection or formalin disinfection of needle after each core. These were compared to assess which methodology better prevented postprocedure infection. Statistical analysis were used to identify independent factors promoting infections. RESULTS Two hundred and ninety-eight patients from povidone-iodine intrarectal disinfection were compared with 300 from formalin needle disinfection group. Formalin needle disinfection was associated with significantly more infections (P = 0.02). Escherichia coli was the dominant pathogen, with >50% of cases being quinolone resistant. Type of disinfection (P = 0.002), BMI (P = 0.001), chronic prostatitis (P = 0.002), and diabetes mellitus (P = 0.01) were independent predictors of infections. BMI at 28.95 kg/m2 provided the best predictive cut-off point for infections, irrespective of method of disinfection. Area under the curve for all these parameters together was 0.91. CONCLUSIONS We conclude that along with oral cephalosporin prophylaxis, povidone-iodine intrarectal disinfection is a superior to formalin needle disinfection alone in preventing post biopsy infection. Patients with BMI >28.95 kg/m2 should be considered at a higher risk for infections.
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Affiliation(s)
- Rajesh Raj Bajpai
- Department of Urology, Larkin Community Hospital, South Miami, Florida, USA
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | | | - Sanjay Razdan
- Department of Urology, International Robotic Prostatectomy Institute, Doral, Florida, USA
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Fiorella D, Marenco JL, Mascarós JM, Borque-Fernando Á, Esteban LM, Calatrava A, Pastor B, López-Guerrero JA, Rubio-Briones J. Role of PCA3 and SelectMDx in the optimization of active surveillance in prostate cancer. Actas Urol Esp 2021; 45:439-446. [PMID: 34148844 DOI: 10.1016/j.acuroe.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION & OBJECTIVES A not negligible percentage of patients included in active surveillance (AS) for low and very low risk prostate cancer (PCa) are reclassified in the confirmatory biopsy or have disease progression during follow-up. Our aim is to evaluate the role of PCA3 and SelectMDx, in an individual and combined way, in the prediction of pathological progression (PP) in a standard AS program. MATERIALS & METHODS Prospective and observational study comprised of 86 patients enrolled in an AS program from 2009 to 2019, with results for PCA3 and SelectMDx previous to PCa diagnosis or during their confirmatory period. Univariate and multivariate analysis were performed to correlate PCA3 and SelectMDx scores as well as clinical and pathological variables with PP-free survival (PPFS). The most reliable cut-offs for both biomarkers in the context of AS were defined. RESULTS SelectMDx showed statistically significant differences related to PPFS (HR 1.035, 95%CI: 1.012-1.057) (p = 0.002) with a C-index of 0.670 (95%CI: 0.529-0.810) and AUC of 0.714 (95%CI: 0.603-0.825) at 5 years. In our series, the most reliable cut-off point for SelectMDx was 5, with a sensitivity and specificity for PP of 69.8% and 67.4%, respectively. Same figure for PCA3 was 65, with a sensitivity and specificity for PP of 51.16% and 74.42%, respectively. The combination of both biomarkers did not improve the prediction of PP, C-index 0.630 (95%CI: 0.455-0.805). CONCLUSIONS In the context of low or very low risk PCa, SelectMDx > 5 predicted 5 years PP free survival with a moderate discrimination ability outperforming PCA3. The combination of both tests did not improved outcomes.
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Affiliation(s)
- D Fiorella
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - J L Marenco
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - J M Mascarós
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - Á Borque-Fernando
- Departamento de Urología, IIS-Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L M Esteban
- Departamento de Matemáticas Aplicadas, Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, La Almuniade Doña Godina, Zaragoza, Spain
| | - A Calatrava
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, Spain
| | - B Pastor
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, Spain
| | - J A López-Guerrero
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, Spain; IVO-CIPF Joint Research Unit of Cancer, Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain; Departamento de Patología, Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - J Rubio-Briones
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain.
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Forsvall A, Jönsson H, Wagenius M, Bratt O, Linder A. Rate and characteristics of infection after transrectal prostate biopsy: a retrospective observational study. Scand J Urol 2021; 55:317-323. [PMID: 34096449 DOI: 10.1080/21681805.2021.1933169] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of infection after transrectal prostate biopsy (TRbx). Secondary objectives were to describe infection characteristics, antibiotic resistance patterns, ICD-10 coding, and costs. METHODS TRbx carried out at the hospitals of Ängelholm and Helsingborg, Scania, Sweden, between October 2017 and March 2019, were identified based on the NOMESCO Classification of Surgical Procedures code for TRbx, TKE00. All patients received per oral antibiotic prophylaxis, usually 750 mg ciprofloxacin at biopsy. Other preventative measures were not used. Medical care within 30 days of the biopsy was evaluated through a manual retrospective medical chart review. Data on patient and infection characteristics were collected. The costs of infections causing hospitalization were estimated. RESULTS After 36 (5.4%) of 670 biopsies, the patient developed post-biopsy infection within 30 days after TRbx. Twenty-six patients (3.9%) required hospitalization for an average of 6 days, at an estimated direct cost of USD 9174 (EUR 8031) per patient. Nine patients (1.3%) had a complicated infection leading to intensive care, multiple hospitalizations or emergency department visits. The inpatient care episodes for the 26 hospitalized patients were categorized with 15 different ICD-codes. In 6 episodes no ICD-code related to infection was used. CONCLUSIONS In this study, we found an infection rate of 5.4% after TRbx; 3.9% of the patients were hospitalized for a post-TRbx infection and 1.3% had complicated infections. A specific ICD code for post-TRbx infections would facilitate evaluation and monitoring of this common, costly, and sometimes serious complication.
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Affiliation(s)
- Andreas Forsvall
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Hannah Jönsson
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Wagenius
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Linder
- Division of Clinical Sciences,Department of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
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Crump RT, Remmers S, Van Hemelrijck M, Helleman J, Nieboer D, Roobol MJ, Venderbos LDF, Trock B, Ehdaie B, Carroll P, Filson C, Logothetis C, Morgan T, Klotz L, Pickles T, Hyndman E, Moore C, Gnanapragasam V, Van Hemelrijck M, Dasgupta P, Bangma C, Roobol M, Villers A, Robert G, Semjonow A, Rannikko A, Valdagni R, Perry A, Hugosson J, Rubio-Briones J, Bjartell A, Hefermehl L, Shiong LL, Frydenberg M, Sugimoto M, Chung BH, van der Kwast T, Hulsen T, de Jonge C, van Hooft P, Kattan M, Xinge J, Muir K, Lophatananon A, Fahey M, Steyerberg E, Nieboer D, Zhang L, Steyerberg E, Nieboer D, Beckmann K, Denton B, Hayen A, Boutros P, Guo W, Benfante N, Cowan J, Patil D, Park L, Ferrante S, Mamedov A, LaPointe V, Crump T, Stavrinides V, Kimberly-Duffell J, Santaolalla A, Nieboer D, Olivier J, France B, Rancati T, Ahlgren H, Mascarós J, Löfgren A, Lehmann K, Lin CH, Cusick T, Hirama H, Lee KS, Jenster G, Auvinen A, Bjartell A, Haider M, van Bochove K, Buzza M, Kouspou M, Paich K, Bangma C, Roobol M, Helleman J. Using the Movember Foundation's GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function-a retrospective study in low-risk prostate cancer patients. Transl Androl Urol 2021; 10:2719-2727. [PMID: 34295757 PMCID: PMC8261406 DOI: 10.21037/tau-20-1255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Active surveillance (AS) for low-risk prostate cancer (PCa) is intended to overcome potential side-effects of definitive treatment. Frequent prostate biopsies during AS may, however, impact erectile (EF) and urinary function (UF). The objective of this study was to test the influence of prostate biopsies on patient-reported EF and UF using multicenter data from the largest to-date AS-database. METHODS In this retrospective study, data analyses were performed using the Movember GAP3 database (v3.2), containing data from 21,169 AS participants from 27 AS-cohorts worldwide. Participants were included in the study if they had at least one follow-up prostate biopsy and completed at least one patient reported outcome measure (PROM) related to EF [Sexual Health Inventory for Men (SHIM)/five item International Index of Erectile Function (IIEF-5)] or UF [International Prostate Symptom Score (IPSS)] during follow-up. The longitudinal effect of the number of biopsies on either SHIM/IIEF-5 or IPSS were analyzed using linear mixed models to adjust for clustering at patient-level. Analyses were stratified by center; covariates included age and Gleason Grade group at diagnosis, and time on AS. RESULTS A total of 696 participants completed the SHIM/IIEF-5 3,175 times, with a median follow-up of 36 months [interquartile range (IQR) 20-55 months]. A total of 845 participants completed the IPSS 4,061 times, with a median follow-up of 35 months (IQR 19-56 months). The intraclass correlation (ICC) was 0.74 for the SHIM/IIEF-5 and 0.68 for the IPSS, indicating substantial differences between participants' PROMs. Limited heterogeneity between cohorts in the estimated effect of the number of biopsies on either PROM were observed. A significant association was observed between the number of biopsies and the SHIM/IIEF-5 score, but not for the IPSS score. Every biopsy was associated with a decrease in the SHIM/IIEF-5 score of an average 0.67 (95% CI, 0.47-0.88) points. CONCLUSIONS Repeated prostate biopsy as part of an AS protocol for men with low-risk PCa does not have a significant association with self-reported UF but does impact self-reported sexual function. Further research is, however, needed to understand whether the effect on sexual function implies a negative clinical impact on their quality of life and is meaningful from a patient's perspective. In the meantime, clinicians and patients should anticipate a potential decline in erectile function and hence consider incorporating the risk of this harm into their discussion about opting for AS and also when deciding on the stringency of follow-up biopsy schedules with long-term AS.
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Affiliation(s)
| | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mieke Van Hemelrijck
- King’s College London, Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), London, UK
| | - Jozien Helleman
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Ellis SD, Hwang S, Morrow E, Kimminau KS, Goonan K, Petty L, Ellerbeck E, Thrasher JB. Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists. BMC Cancer 2021; 21:649. [PMID: 34058998 PMCID: PMC8165996 DOI: 10.1186/s12885-021-08386-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists' recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. METHODS We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention. RESULTS Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient's ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. CONCLUSIONS Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.
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Affiliation(s)
- Shellie D. Ellis
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS USA
| | - Soohyun Hwang
- Department of Health Policy and Management, School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7411 USA
| | - Emily Morrow
- Department of Sociology, University of Kansas, Kansas City, KS USA
| | - Kim S. Kimminau
- Department of Family Medicine, School of Medicine, University of Kansas, Kansas City, KS USA
| | - Kelly Goonan
- Independent Researcher/Consultant/Scientific Writer, Greensboro, NC USA
| | - Laurie Petty
- Department of Sociology, University of Kansas, Kansas City, KS USA
| | - Edward Ellerbeck
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS USA
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Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Comparison of biparametric versus multiparametric prostate MRI for the detection of extracapsular extension and seminal vesicle invasion in biopsy naïve patients. Eur J Radiol 2021; 141:109804. [PMID: 34062473 DOI: 10.1016/j.ejrad.2021.109804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare biparametric MRI (bpMRI) with multiparametric MRI (mpMRI) staging accuracy in assessing extracapsular extension (ECE) and seminal vesicle invasion (SVI). METHOD Biopsy-naïve patients undergoing 3 T-MRI before radical prostatectomy for clinically significant prostate cancer were included in this single-centre retrospective study. Two uroradiologists separately evaluated bpMRI and mpMRI for presence of ECE and SVI using a 5-point Likert scale (1: ECE/SVI highly unlikely, 5: ECE/SVI highly likely). RESULTS 110 men of median age 63 years and PSA 8.5 ng/mL were included. ECE and SVI was confirmed histologically in 71/110 (64.5 %) and 18/110 (16.4 %) patients, respectively. Sensitivity and specificity of bpMRI versus mpMRI for predicting ECE was 59.1 % and 87.2 % versus 66.2 % and 84.6 %, respectively. For SVI detection, the sensitivity and specificity for bpMRI versus mpMRI was 66.7 % and 92.4 % versus 83.3 % and 97.8 %, respectively. At an optimal cut-off Likert score ≥3 for ECE prediction, mpMRI area under the receiver operating curve (AUC) was 0.80 (95 % confidence interval (CI) 0.72-0.87) versus 0.78 (95 % CI 0.69-0.86) for bpMRI (p = 0.52) and for SVI, mpMRI AUC was 0.91 (95 % CI 0.84-0.96) versus 0.86 (95 % CI 0.78-0.92) for bpMRI (p = 0.02), respectively. Inter-reader agreement for both ECE and SVI prediction was substantial, with a marginally higher k-value for mpMRI (k range, 0.67-0.75) than bpMRI (k range, 0.65-0.69). CONCLUSIONS Diagnostic performance of bpMRI and mpMRI was comparable for detection of ECE, however, mpMRI with contrast was superior for SVI detection and improved the inter-reader agreement.
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Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nimish Shah
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK.
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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Saidova AA, Potashnikova DM, Tvorogova AV, Paklina OV, Veliev EI, Knyshinsky GV, Setdikova GR, Rotin DL, Maly IV, Hofmann WA, Vorobjev IA. Myosin 1C isoform A is a novel candidate diagnostic marker for prostate cancer. PLoS One 2021; 16:e0251961. [PMID: 34019593 PMCID: PMC8139512 DOI: 10.1371/journal.pone.0251961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/06/2021] [Indexed: 12/26/2022] Open
Abstract
Early diagnosis of prostate cancer is a challenging issue due to the lack of specific markers. Therefore, a sensitive diagnostic marker that is expressed or upregulated exclusively in prostate cancer cells would facilitate diagnostic procedures and ensure a better outcome. We evaluated the expression of myosin 1C isoform A in 5 prostate cell lines, 41 prostate cancer cases, and 11 benign hyperplasias. We analyzed the expression of 12 surface molecules on prostate cancer cells by flow cytometry and analyzed whether high or low myosin 1C isoform A expression could be attributed to a distinct phenotype of prostate cancer cells. Median myosin 1C isoform A expression in prostate cancer samples and cancer cell lines was 2 orders of magnitude higher than in benign prostate hyperplasia. Based on isoform A expression, we could also distinguish clinical stage 2 from clinical stage 3. Among cell lines, PC-3 cells with the highest myosin 1C isoform A level had diminished numbers of CD10/CD13-positive cells and increased numbers of CD29 (integrin β1), CD38, CD54 (ICAM1) positive cells. The surface phenotype of clinical samples was similar to prostate cancer cell lines with high isoform A expression and could be described as CD10-/CD13- with heterogeneous expression of other markers. Both for cell lines and cancer specimens we observed the strong correlation of high myosin 1C isoform A mRNA expression and elevated levels of CD29 and CD54, suggesting a more adhesive phenotype for cells with high isoform A expression. Compared to normal tissue, prostate cancer samples had also reduced numbers of CD24- and CD38-positive cells. Our data suggest that a high level of myosin 1C isoform A is a specific marker both for prostate cancer cells and prostate cancer cell lines. High expression of isoform A is associated with less activated (CD24/CD38 low) and more adhesive (CD29/CD54 high) surface phenotype compared to benign prostate tissue.
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Affiliation(s)
- Aleena A. Saidova
- School of Biology, Cell Biology and Histology Department, M.V. Lomonosov Moscow State University, Moscow, Russia
- * E-mail:
| | - Daria M. Potashnikova
- School of Biology, Cell Biology and Histology Department, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Anna V. Tvorogova
- A.N. Belozersky Institute of Physico-Chemical Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Oxana V. Paklina
- Pathoanatomy Department, S.P. Botkin Clinical Hospital, Moscow, Russia
| | | | | | | | - Daniil L. Rotin
- Pathoanatomy Department, S.P. Botkin Clinical Hospital, Moscow, Russia
| | - Ivan V. Maly
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Wilma A. Hofmann
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Ivan A. Vorobjev
- School of Biology, Cell Biology and Histology Department, M.V. Lomonosov Moscow State University, Moscow, Russia
- A.N. Belozersky Institute of Physico-Chemical Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
- Department of Biology, School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
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225
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Rajwa P, Pradere B, Quhal F, Mori K, Laukhtina E, Huebner NA, D'Andrea D, Krzywon A, Shim SR, Baltzer PA, Renard-Penna R, Leapman MS, Shariat SF, Ploussard G. Reliability of Serial Prostate Magnetic Resonance Imaging to Detect Prostate Cancer Progression During Active Surveillance: A Systematic Review and Meta-analysis. Eur Urol 2021; 80:549-563. [PMID: 34020828 DOI: 10.1016/j.eururo.2021.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Although magnetic resonance imaging (MRI) is broadly implemented into active surveillance (AS) protocols, data on the reliability of serial MRI in order to help guide follow-up biopsy are inconclusive. OBJECTIVE To assess the diagnostic estimates of serial prostate MRI for prostate cancer (PCa) progression during AS. EVIDENCE ACQUISITION We systematically searched PubMed, Scopus, and Web of Science databases to select studies analyzing the association between changes on serial prostate MRI and PCa progression during AS. We included studies that provided data for MRI progression, which allowed us to calculate diagnostic estimates. We compared Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) accuracy with institution-specific definitions. EVIDENCE SYNTHESIS We included 15 studies with 2240 patients. Six used PRECISE criteria and nine institution-specific definitions of MRI progression. The pooled PCa progression rate, which included histological progression to Gleason grade ≥2, was 27%. The pooled sensitivity and specificity were 0.59 (95% confidence interval [CI] 0.44-0.73) and 0.75 (95% CI 0.66-0.84) respectively. There was significant heterogeneity between included studies. Depending on PCa progression prevalence, the pooled negative predictive value for serial prostate MRI ranged from 0.81 (95% CI 0.73-0.88) to 0.88 (95% CI 0.83-0.93) and the pooled positive predictive value ranged from 0.37 (95% CI 0.24-0.54) to 0.50 (95% CI 0.36-0.66). There were no significant differences in the pooled sensitivity (p = 0.37) and specificity (p = 0.74) of PRECISE and institution-specific schemes. CONCLUSIONS Serial MRI still should not be considered a sole factor for excluding PCa progression during AS, and changes on MRI are not accurate enough to indicate PCa progression. There was a nonsignificant trend toward improved diagnostic estimates of PRECISE recommendations. These findings highlight the need to further define the optimal triggers and timing of biopsy during AS, as well as the need for optimizing the quality, interpretation, and reporting of serial prostate MRI. PATIENT SUMMARY Our study suggests that serial prostate magnetic resonance imaging (MRI) alone in patients on active surveillance is not accurate enough to reliably rule out or rule in prostate cancer progression. Other clinical factors and biomarkers along with serial MRI are required to safely tailor the intensity of follow-up biopsies.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nicolai A Huebner
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphaële Renard-Penna
- Department of Radiology, Pitié-Salpétrière Hospital, Paris-Sorbonne University, Paris, France
| | | | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Forsvall A, Fisher J, Cardoso JFP, Wagenius M, Tverring J, Nilson B, Dahlin A, Bratt O, Linder A, Mohanty T. Evaluation of the Forsvall biopsy needle in an ex vivo model of transrectal prostate biopsy - a novel needle design with the objective to reduce the risk of post-biopsy infection. Scand J Urol 2021; 55:227-234. [PMID: 33999753 DOI: 10.1080/21681805.2021.1921023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transrectal prostate biopsy (TRbx) transfers colonic bacteria into prostatic tissue, potentially causing infectious complications, including sepsis. Our objective was to determine whether biopsy needle shape, surface properties and sampling mechanism affect the number of bacteria transferred through the colon wall, and evaluate a novel needle with improved properties. METHODS The standard Tru-Cut biopsy needle used today was evaluated for mechanisms of bacterial transfer in a pilot study. A novel Tru-Cut needle (Forsvall needle prototype) was developed. TRbx was simulated using human colons ex-vivo. Four subtypes of the prototype needle were compared with a standard Tru-Cut needle (BARD 18 G). Prototype and standard needles were used to puncture 4 different colon specimens in 10 randomized sites per colon. Needles were submerged into culture media to capture translocated bacteria. The media was cultured on blood agar and then the total amount of transferred bacteria was calculated for each needle. The primary outcome measure was the percent reduction of bacteria translocated by the prototype needles relative to the standard needle. Secondary outcome measures were the effects of tip design and coating on the percent reduction of translocated bacteria. RESULTS Prototype needles reduced the number of translocated bacteria by, on average, 96.0% (95% confidence interval 93.0-97.7%; p < 0.001) relative to the standard needle. This percent reduction was not significantly affected by prototype needle tip style or surface coating. CONCLUSIONS The Forsvall needle significantly reduces colonic bacterial translocation, suggesting that it could reduce infectious complications in prostate biopsy. A clinical trial has been initiated.
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Affiliation(s)
- Andreas Forsvall
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Jane Fisher
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
| | | | - Magnus Wagenius
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Jonas Tverring
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Bo Nilson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden.,Clinical Microbiology, Lund, Sweden
| | - Andreas Dahlin
- Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
| | - Tirthankar Mohanty
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
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227
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Forsvall A, Fisher J, Wagenius M, Broman C, Korkocic D, Bratt O, Linder A. Prostate biopsy quality and patient experience with the novel Forsvall biopsy needle - a randomized controlled non-inferiority trial. Scand J Urol 2021; 55:235-241. [PMID: 33999764 DOI: 10.1080/21681805.2021.1921024] [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: 12/24/2022]
Abstract
BACKGROUND Transrectal prostate biopsy (TRbx) carries an increasing risk of infection. The Forsvall Needle Prototype (FNP) is a novel biopsy needle that reduces bacterial load brought across the rectum and may therefore reduce infection risk. The objective of this study was to compare biopsy length, quality and patient experience for the FNP Version 2 (FNP2) versus a standard Tru-Cut needle. METHODS We conducted a randomized, parallel-group, non-inferiority trial with twenty consecutive patients eligible for TRbx. Participants were randomized to undergo TRbx using either FNP2 or a standard Tru-Cut needle. The primary outcome was difference in mean biopsy lengths measured by the pathologist. FNP2 biopsy lengths ≤1.35 mm of the standard needle length were considered non-inferior. Secondary outcomes were biopsy length in the needle chamber and immediately after removal, biopsy quality, biopsy fragmentation, patient discomfort/pain, and complications (immediate and after 14 and 30 days). RESULTS Mean pathologist-measured FNP2 biopsy length was non-inferior compared to the standard Tru-Cut needle (0.02 mm longer, 95%CI-0.73 to 0.76 mm). Biopsy length in the needle chamber and immediately after removal were also non-inferior. Biopsy quality and patient discomfort were not significantly different for the FNP2 and the standard Tru-Cut needle. Biopsy fragmentation was more common in the FNP2 group. CONCLUSIONS The FNP2 biopsy needle is non-inferior to the Tru-Cut needle in terms of biopsy length and not significantly different in terms of biopsy quality and patient experience. Future studies will evaluate the Forsvall needle design's effect on post-biopsy infection risk.
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Affiliation(s)
- Andreas Forsvall
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Jane Fisher
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
| | - Magnus Wagenius
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Christian Broman
- Department of Pathology, Helsingborg Hospital, Helsingborg, Sweden
| | - Dejan Korkocic
- Department of Pathology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
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228
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Getaneh AM, Heijnsdijk EA, de Koning HJ. Cost-effectiveness of multiparametric magnetic resonance imaging and MRI-guided biopsy in a population-based prostate cancer screening setting using a micro-simulation model. Cancer Med 2021; 10:4046-4053. [PMID: 33991077 PMCID: PMC8209626 DOI: 10.1002/cam4.3932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The introduction of multiparametric magnetic resonance imaging (mpMRI) and MRI-guided biopsy has improved the diagnosis of prostate cancer. However, it remains uncertain whether it is cost-effective, especially in a population-based screening strategy. METHODS We used a micro-simulation model to assess the cost-effectiveness of an MRI-based prostate cancer screening in comparison to the classical prostate-specific antigen (PSA) screening, at a population level. The test sensitivity parameters for the mpMRI and MRI-guided biopsy, grade misclassification rates, utility estimates, and the unit costs of different interventions were obtained from literature. We assumed the same screening attendance rate and biopsy compliance rate for both strategies. A probabilistic sensitivity analysis, consisting of 1000 model runs, was performed to estimate a mean incremental cost-effectiveness ratio (ICER) and assess uncertainty. A €20,000 willingness-to-pay (WTP) threshold per quality-adjusted life year (QALY) gained, and a discounting rate of 3.5% was considered in the analysis. RESULTS The MRI-based screening improved the life-years (LY) and QALYs gained by 3.5 and 3, respectively, in comparison to the classical screening pathway. Based on the probabilistic sensitivity analyses, the MRI screening pathway leads to total discounted mean incremental costs of €15,413 (95% confidence interval (CI) of €14,556-€16,272) compared to the classical screening pathway. The corresponding discounted mean incremental QALYs gained was 1.36 (95% CI of 1.31-1.40), resulting in a mean ICER of €11,355 per QALY gained. At a WTP threshold of €20,000, the MRI screening pathway has about 84% chance to be more cost-effective than the classical screening pathway. CONCLUSIONS For triennial screening from age 55-64, incorporation of mpMRI as a reflex test after a positive PSA test result with a subsequent MRI-guided biopsy has a high probability to be more cost-effective as compared with the classical prostate cancer screening pathway.
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Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline Am Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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229
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Qu M, Lian B, Wang Y, Zhang W, Zhu F, Wang T, Yue X, Jia Z, Chen H, Li H, Li J, Gao X. Transperineal Parallel Biopsy of the Prostate: A New Approach of Tissue Sampling for Precision Medicine. Int J Gen Med 2021; 14:1631-1640. [PMID: 33976563 PMCID: PMC8104976 DOI: 10.2147/ijgm.s302105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/30/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Through an observational study to present a new approach for obtaining high-quality samples for the targeted therapy of prostate cancer. Patients and Methods Parallel biopsy, which was defined as collecting the tissue from the same site by two biopsies, was performed on patients with elevated PSA. Each tissue was stained by ink to identify the pathological characteristics, including Gleason score and tumor tissue ratio. Kendall tau-b test and intraclass correlation coefficient test were used to compare the consistency between each paired sample. Then, based on the pathology of the biopsies, high-quality tissues would be selected for sequencing, and PyClone model was used to track the clonal evolution. Results In total, 252 pairs of biopsies were collected. The consistency of Gleason score between each paired biopsy is 0.777 (p<0.01), and the consistency of tumor tissue ratio is 0.853 (p<0.01). With the application of parallel biopsy, on average five nonsynonymous mutations could be identified in patients with castration-resistant prostate cancer. Six out of eight had at least one biology-relevant alteration in patients, guiding further treatment. Meanwhile, clonal evolution was constructed to investigate the progress of tumor. Conclusion Parallel biopsy is a reliable approach to collect high-quality tissue and shows potential application in precision medicine.
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Affiliation(s)
- Min Qu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Bijun Lian
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.,Department of Urology, The 903th PLA Hospital, Hangzhou, People's Republic of China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Wenhui Zhang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Feng Zhu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.,Department of Urology, Tianyou Hospital, Tongji University, Shanghai, People's Republic of China
| | - Tao Wang
- Department of Urology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiaodong Yue
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, People's Republic of China
| | - Zepeng Jia
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Huan Chen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Husheng Li
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jing Li
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.,Center for Translational Medicine, Second Military Medical University, Shanghai, People's Republic of China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
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230
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Emruli VK, Liljedahl L, Axelsson U, Richter C, Theorin L, Bjartell A, Lilja H, Donovan J, Neal D, Hamdy FC, Borrebaeck CA. Identification of a serum biomarker signature associated with metastatic prostate cancer. Proteomics Clin Appl 2021; 15:e2000025. [PMID: 33580906 PMCID: PMC9310707 DOI: 10.1002/prca.202000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Improved early diagnosis and determination of aggressiveness of prostate cancer (PC) is important to select suitable treatment options and to decrease over-treatment. The conventional marker is total prostate specific antigen (PSA) levels in blood, but lacks specificity and ability to accurately discriminate indolent from aggressive disease. EXPERIMENTAL DESIGN In this study, we sought to identify a serum biomarker signature associated with metastatic PC. We measured 157 analytes in 363 serum samples from healthy subjects, patients with non-metastatic PC and patients with metastatic PC, using a recombinant antibody microarray. RESULTS A signature consisting of 69 proteins differentiating metastatic PC patients from healthy controls was identified. CONCLUSIONS AND CLINICAL RELEVANCE The clinical value of this biomarker signature requires validation in larger independent patient cohorts before providing a new prospect for detection of metastatic PC.
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Affiliation(s)
- Venera Kuci Emruli
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Leena Liljedahl
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Ulrika Axelsson
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Corinna Richter
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Lisa Theorin
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jenny Donovan
- Bristol Medical School, University of Bristol, Bristol, UK
| | - David Neal
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C. Hamdy
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Carl A.K. Borrebaeck
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
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231
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Fiorella D, Marenco J, Mascarós J, Borque-Fernando A, Esteban L, Calatrava A, Pastor B, López-Guerrero J, Rubio-Briones J. Role of PCA3 and SelectMDx in the optimization of active surveillance in prostate cancer. Actas Urol Esp 2021. [PMID: 33926745 DOI: 10.1016/j.acuro.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES A not negligible percentage of patients included in active surveillance (AS) for low and very low risk prostate cancer (PCa) are reclassified in the confirmatory biopsy or have disease progression during follow-up. Our aim is to evaluate the role of PCA3 and SelectMDx, in an individual and combined way, in the prediction of pathological progression (PP) in a standard AS program. MATERIALS AND METHODS Prospective and observational study comprised of 86 patients enrolled in an AS program from 2009 to 2019, with results for PCA3 and SelectMDx previous to PCa diagnosis or during their confirmatory period. Univariate and multivariate analysis were performed to correlate PCA3 and SelectMDx scores as well as clinical and pathological variables with PP-free survival (PPFS). The most reliable cut-offs for both biomarkers in the context of AS were defined. RESULTS SelectMDx showed statistically significant differences related to PPFS (HR: 1.035; 95%CI: 1.012-1.057) (P=.002) with a C-index of 0.670 (95%CI: 0.529-0.810) and AUC of 0.714 (95%CI: 0.603-0.825) at 5years. In our series, the most reliable cut-off point for SelectMDx was 5, with a sensitivity and specificity for PP of 69.8% and 67.4%, respectively. Same figure for PCA3 was 65, with a sensitivity and specificity for PP of 51.16% and 74.42%, respectively. The combination of both biomarkers did not improve the prediction of PP, C-index 0.630 (95%CI: 0.455-0.805). CONCLUSIONS In the context of low or very low risk PCa, SelectMDx >5 predicted 5years PP free survival with a moderate discrimination ability outperforming PCA3. The combination of both tests did not improved outcomes.
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232
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Wallström J, Geterud K, Kohestani K, Maier SE, Månsson M, Pihl CG, Socratous A, Arnsrud Godtman R, Hellström M, Hugosson J. Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Göteborg prostate cancer screening 2 trial. Eur Radiol 2021; 31:8692-8702. [PMID: 33890152 PMCID: PMC8523442 DOI: 10.1007/s00330-021-07907-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022]
Abstract
Objectives The PIRADS Steering Committee has called for “higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up,” however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3–5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4–18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3–18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84–0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01–1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives. Key Points • In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI. • In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07907-9.
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Affiliation(s)
- Jonas Wallström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden. .,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Kjell Geterud
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kimia Kohestani
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephan E Maier
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Gustaf Pihl
- Department of Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Socratous
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna Stråket 11B, 413 45, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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233
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Pye H, Singh S, Norris JM, Carmona Echeverria LM, Stavrinides V, Grey A, Dinneen E, Pilavachi E, Clemente J, Heavey S, Stopka-Farooqui U, Simpson BS, Bonet-Carne E, Patel D, Barker P, Burling K, Stevens N, Ng T, Panagiotaki E, Hawkes D, Alexander DC, Rodriguez-Justo M, Haider A, Freeman A, Kirkham A, Atkinson D, Allen C, Shaw G, Beeston T, Brizmohun Appayya M, Latifoltojar A, Johnston EW, Emberton M, Moore CM, Ahmed HU, Punwani S, Whitaker HC. Evaluation of PSA and PSA Density in a Multiparametric Magnetic Resonance Imaging-Directed Diagnostic Pathway for Suspected Prostate Cancer: The INNOVATE Trial. Cancers (Basel) 2021; 13:1985. [PMID: 33924255 PMCID: PMC8074769 DOI: 10.3390/cancers13081985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: To assess the clinical outcomes of mpMRI before biopsy and evaluate the space remaining for novel biomarkers. Methods: The INNOVATE study was set up to evaluate the validity of novel fluidic biomarkers in men with suspected prostate cancer who undergo pre-biopsy mpMRI. We report the characteristics of this clinical cohort, the distribution of clinical serum biomarkers, PSA and PSA density (PSAD), and compare the mpMRI Likert scoring system to the Prostate Imaging-Reporting and Data System v2.1 (PI-RADS) in men undergoing biopsy. Results: 340 men underwent mpMRI to evaluate suspected prostate cancer. 193/340 (57%) men had subsequent MRI-targeted prostate biopsy. Clinically significant prostate cancer (csigPCa), i.e., overall Gleason ≥ 3 + 4 of any length OR maximum cancer core length (MCCL) ≥4 mm of any grade including any 3 + 3, was found in 96/195 (49%) of biopsied patients. Median PSA (and PSAD) was 4.7 (0.20), 8.0 (0.17), and 9.7 (0.31) ng/mL (ng/mL/mL) in mpMRI scored Likert 3,4,5 respectively for men with csigPCa on biopsy. The space for novel biomarkers was shown to be within the group of men with mpMRI scored Likert3 (178/340) and 4 (70/350), in whom an additional of 40% (70/178) men with mpMRI-scored Likert3, and 37% (26/70) Likert4 could have been spared biopsy. PSAD is already considered clinically in this cohort to risk stratify patients for biopsy, despite this 67% (55/82) of men with mpMRI-scored Likert3, and 55% (36/65) Likert4, who underwent prostate biopsy had a PSAD below a clinical threshold of 0.15 (or 0.12 for men aged <50 years). Different thresholds of PSA and PSAD were assessed in mpMRI-scored Likert4 to predict csigPCa on biopsy, to achieve false negative levels of ≤5% the proportion of patients whom who test as above the threshold were unsuitably high at 86 and 92% of patients for PSAD and PSA respectively. When PSA was re tested in a sub cohort of men repeated PSAD showed its poor reproducibility with 43% (41/95) of patients being reclassified. After PI-RADS rescoring of the biopsied lesions, 66% (54/82) of the Likert3 lesions received a different PI-RADS score. Conclusions: The addition of simple biochemical and radiological markers (Likert and PSAD) facilitate the streamlining of the mpMRI-diagnostic pathway for suspected prostate cancer but there remains scope for improvement, in the introduction of novel biomarkers for risk assessment in Likert3 and 4 patients, future application of novel biomarkers tested in a Likert cohort would also require re-optimization around Likert3/PI-RADS2, as well as reproducibility testing.
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Affiliation(s)
- Hayley Pye
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Saurabh Singh
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Joseph M. Norris
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Lina M. Carmona Echeverria
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Alistair Grey
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
- Department of Urology, Barts Health, NHS Foundation Trust, London EC1A 7BE, UK
| | - Eoin Dinneen
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
- Department of Urology, Barts Health, NHS Foundation Trust, London EC1A 7BE, UK
| | - Elly Pilavachi
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Joey Clemente
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Susan Heavey
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Urszula Stopka-Farooqui
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Benjamin S. Simpson
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
| | - Elisenda Bonet-Carne
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK; (E.B.-C.); (E.P.); (D.C.A.)
| | - Dominic Patel
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Peter Barker
- Department of Clinical Biochemistry, Addenbrookes Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK; (P.B.); (K.B.)
| | - Keith Burling
- Department of Clinical Biochemistry, Addenbrookes Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK; (P.B.); (K.B.)
| | - Nicola Stevens
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Tony Ng
- Molecular Oncology Group, University College London, London WC1E 6BT, UK;
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK; (E.B.-C.); (E.P.); (D.C.A.)
| | - David Hawkes
- Department of Medical Physics and Bioengineering, University College London, London WC1E 6BT, UK;
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK; (E.B.-C.); (E.P.); (D.C.A.)
| | - Manuel Rodriguez-Justo
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Aiman Haider
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (D.P.); (M.R.-J.); (A.H.); (A.F.)
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - David Atkinson
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Greg Shaw
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
- Department of Urology, Barts Health, NHS Foundation Trust, London EC1A 7BE, UK
| | - Teresita Beeston
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
| | - Mrishta Brizmohun Appayya
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
| | - Arash Latifoltojar
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Edward W. Johnston
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.G.); (E.D.); (G.S.)
| | - Hashim U. Ahmed
- Imperial Urology, Imperial College Healthcare NHS Trust, London W2 1NY, UK;
- Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.S.); (E.P.); (J.C.); (N.S.); (D.A.); (T.B.); (M.B.A.); (A.L.); (E.W.J.); (S.P.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London WC1H 8NJ, UK; (A.K.); (C.A.)
| | - Hayley C. Whitaker
- Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (J.M.N.); (L.M.C.E.); (V.S.); (S.H.); (U.S.-F.); (B.S.S.); (M.E.); (C.M.M.); (H.C.W.)
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Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study. Eur Urol Oncol 2021; 5:176-186. [PMID: 33846112 DOI: 10.1016/j.euo.2021.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/21/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa. OBJECTIVE To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC). DESIGN, SETTING, AND PARTICIPANTS Men with MRI-visible prostate lesions underwent combined TBx plus SBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score. RESULTS AND LIMITATIONS Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (7.5% vs 8%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%). CONCLUSIONS While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%). PATIENT SUMMARY Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.
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Efesoy O, Saylam B, Tek M, Bozlu M, Akbay E. Is there any priority between the alpha blockers on voiding functions after transrectal ultrasound guided prostate biopsy? Turk J Urol 2021; 47:137-143. [PMID: 33819444 DOI: 10.5152/tud.2021.20509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer. Major and minor complications may develop at varying rates after prostate biopsies, one of which is voiding impairment. This study aimed to evaluate whether all alpha1-blockers were effective in preventing voiding impairment after a transrectal ultrasound-guided prostate biopsy and if so, was one superior to the others. MATERIAL AND METHODS This study included 240 patients who underwent a transrectal ultrasound-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 40 received 10 mg alfuzosin, 40 received 4 mg doxazosin, 40 received 8 mg silodosin, 40 received 0.4 mg tamsulosin, and 40 received 5 mg terazosin beginning on the day before the biopsy and for the following 30 days. The international prostate symptom score (IPSS), maximal flow rate, and post-void residual urine were recorded in all the patients before the procedure and on post-biopsy days 7 and 30. All he patients were followed up and questioned about voiding difficulty and acute urinary retention after the procedure. RESULTS In all the alpha1-blocker groups, the IPSS and post-void residuals were statistically significantly lower, and the maximal flow rate was statistically significantly greater on post-biopsy days 7 and 30 compared with the baseline values (p<0.05). No patient in any of the alpha1-blocker groups developed acute urinary retention after the biopsy. CONCLUSION To prevent voiding impairment and deterioration in the quality of life after a prostate biopsy, preemptive therapy with alpha1-blockers may have a protective role, especially in patients with large prostate volumes.
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Affiliation(s)
- Ozan Efesoy
- Department of Urology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Barış Saylam
- Department of Urology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mesut Tek
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Murat Bozlu
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Erdem Akbay
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
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236
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Yao HH, Ball K, Bazo A, Terry TR, Walton TJ. Effect of transperineal template prostate biopsy on perioperative and functional outcomes following robotic-assisted radical prostatectomy. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211002704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study aimed to determine the effect of template transperineal (TTP) compared to transrectal (TR) biopsy on surgical and functional outcomes after robotic-assisted radical prostatectomy (RARP). Methods: From 2014 to 2018, 280 patients underwent RARP by a single surgeon. Of these, 184 had TR, and 96 had TTP biopsy. Primary outcomes were continence and erectile function recovery (EFR) rates up to 24 months postoperatively. Secondary outcomes comprised positive margin rates and markers of a difficult operation, including operative time, estimated blood loss (EBL), urethral preservation quality and ability to perform planned nerve-sparing surgery. Results: The median age was greater in the TTP group (64 vs. 62 years, p=0.028). The proportions of men with preoperative erectile dysfunction and men undergoing nerve-sparing surgery were not different between groups. Operative time, EBL, urethral preservation quality, proportion of men undergoing intended nerve-sparing procedure, positive margin rates and continence recovery rates were not different among the groups. At 24 months, men in the TR group had a higher EFR rate on univariate analysis ( p=0.036), and multivariate analysis ( p=0.03). Conclusion: TTP biopsy was not associated with markers of a more difficult RARP or worse oncological and continence recovery outcomes but did appear to impact upon long-term rates of EFR. Level of evidence: Level 4.
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Affiliation(s)
- Henry H Yao
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
- Eastern Health Clinical School, Monash University, Australia
| | - Kathryn Ball
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| | - Alvaro Bazo
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| | - Timothy R Terry
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| | - Thomas J Walton
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
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Prospective Validation of Pentraxin-3 as a Novel Serum Biomarker to Predict the Risk of Prostate Cancer in Patients Scheduled for Prostate Biopsy. Cancers (Basel) 2021; 13:cancers13071611. [PMID: 33807333 PMCID: PMC8036446 DOI: 10.3390/cancers13071611] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To test and internally validate serum Pentraxin-3 (PTX3) levels as a potential PCa biomarker to predict prostate biopsy (PBx) results. MATERIALS AND METHODS Serum PSA and serum PTX3 were prospectively assessed in patients scheduled for PBx at our Institution due to increased serum PSA levels or abnormal digital rectal examination. Uni- and multivariable logistic regression analysis, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA), were used to test the accuracy of serum PTX3 in predicting anyPCa and clinically significant PCa (csPCa) defined as Gleason Grade (GG) ≥ 2. RESULTS Among the 455 eligible patients, PCa was detected in 49% and csPCa in 25%. During univariate analysis, PTX3 outperformed other variables in predicting both anyPCa and csPCa. The addition of PTX3 to multivariable models based on standard clinical variables, significantly increased each model's predictive accuracy for anyPCa (AUC from 0.73 to 0.82; p < 0.001) and csPCa (AUC from 0.79 to 0.83; p < 0.001). At DCA, PTX3, and PTX3, density showed higher net benefit than PSA and PSA density and increased the net benefit of multivariable models in deciding when to perform PBx. CONCLUSIONS Serum PTX3 levels might be of clinical utility in predicting prostate biopsy results. Should our findings be confirmed, this novel reflex test could be used to reduce the number and burden of unnecessary prostate biopsies.
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238
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Kato D, Ozawa K, Takeuchi S, Kawase M, Kawase K, Nakai C, Takai M, Iinuma K, Nakane K, Kato H, Matsuo M, Suzui N, Miyazaki T, Koie T. The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2021; 28:1294-1301. [PMID: 33809967 PMCID: PMC8025823 DOI: 10.3390/curroncol28020123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.
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Affiliation(s)
- Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Kaori Ozawa
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan; (K.O.); (S.T.)
| | - Shinichi Takeuchi
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan; (K.O.); (S.T.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Chie Nakai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
| | - Hiroki Kato
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Natsuko Suzui
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Tatsuhiko Miyazaki
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.K.); (M.M.); (N.S.); (T.M.)
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (D.K.); (M.K.); (K.K.); (C.N.); (M.T.); (K.I.); (K.N.)
- Correspondence:
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John JB, MacCormick A, MacDonagh R, Speakman MJ, Vennam R, Burns-Cox N. Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820987661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.
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Affiliation(s)
- Joseph B John
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, UK
| | | | | | | | - Ramesh Vennam
- Department of Urology, Somerset NHS Foundation Trust, UK
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Bagguley D, Ong S, Buteau JP, Koschel S, Dhiantravan N, Hofman MS, Emmett L, Murphy DG, Lawrentschuk N. Role of PSMA PET/CT imaging in the diagnosis, staging and restaging of prostate cancer. Future Oncol 2021; 17:2225-2241. [PMID: 33724868 DOI: 10.2217/fon-2020-1293] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) PET/CT is a novel imaging technique for the detection and staging of either primary or recurrent prostate cancer. Early studies demonstrated its improved sensitivity and specificity over and in combination with other currently employed imaging techniques, such as multiparametric MRI, bone scan, PET and CT. However, the lack of strength and confidence in these studies has meant incorporation of PSMA PET/CT into clinical guidelines and practice has been limited to date. In response, a number of high-quality prospective studies have recently emerged and reflect exciting results seen in preceding publications. Here we recount some of the key earlier publications, report results from the latest studies and look to the future discussing some of the eagerly awaited ongoing clinical trials.
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Affiliation(s)
- Dominic Bagguley
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, 3121, Australia
| | - Sean Ong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, 3121, Australia
| | - James P Buteau
- Molecular Imaging & Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Sam Koschel
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Nattakorn Dhiantravan
- Molecular Imaging & Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Michael S Hofman
- Molecular Imaging & Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, 3000, Australia
| | - Louise Emmett
- St Vincent's Hospital Nuclear Medicine & PET Department, Darlinghurst, 2010, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, 3000, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, 3121, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, 3000, Australia.,Department of Urology, Royal Melbourne Hospital, Parkville, 3000, Australia.,Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, 3084, Australia
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He X, Xiong H, Zhang H, Liu X, Zhou J, Guo D. Value of MRI texture analysis for predicting new Gleason grade group. Br J Radiol 2021; 94:20210005. [PMID: 33684304 DOI: 10.1259/bjr.20210005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To explore the potential value of multiparametric magnetic resonance imaging (mpMRI) texture analysis (TA) to predict new Gleason Grade Group (GGG). METHODS Fifty-eight lesions of fifty patients who underwent mpMRI scanning, including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) prior to trans-rectal ultrasound (TRUS)-guided core prostate biopsy, were retrospectively enrolled. TA parameters were obtained by the postprocessing software, and each lesion was assigned to its corresponding GGG. TA parameters derived from T2WI and DWI were statistically analyzed in detail. RESULTS Energy, inertia, and correlation derived from apparent diffusion coefficient (ADC) maps and T2WI had a statistically significant difference among the five groups. Kurtosis, energy, inertia, correlation on ADC maps and Energy, inertia on T2WI were moderately related to the GGG trend. ADC-energy and T2-energy were significant independent predictors of the GGG trend. ADC-energy, T2WI-energy, and T2WI-correlation had a statistically significant difference between GGG1 and GGG2-5. ADC-energy were significant independent predictors of the GGG1. ADC-energy, T2WI-energy, and T2WI-correlation showed satisfactory diagnostic efficiency of GGG1 (area under the curve (AUC) 84.6, 74.3, and 83.5%, respectively), and ADC-energy showed excellent sensitivity and specificity (88.9 and 95.1%, respectively). CONCLUSION TA parameters ADC-energy and T2-energy played an important role in predicting GGG trend. Both ADC-energy and T2-correlation produced a high diagnostic power of GGG1, and ADC-energy was perfect predictors of GGG1. ADVANCES IN KNOWLEDGE TA parameters were innovatively used to predict new GGG trend, and the predictive factors of GGG1 were screen out.
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Affiliation(s)
- Xiaojing He
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Xiong
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiping Zhang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinjie Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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242
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Tay JYI, McGrath S, Perera M, Anderson P. Chronic bacterial prostatitis leading to intrascrotal abscess after transperineal prostate biopsy. BMJ Case Rep 2021; 14:14/3/e239277. [PMID: 33653844 PMCID: PMC7929809 DOI: 10.1136/bcr-2020-239277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transperineal biopsy is becoming more commonly used, driven by improved detection rates, better complication profile and increasing application of prostate MRI leading to guided biopsy. However, it can still lead to complications such as urinary retention, postoperative pain and erectile dysfunction. There is also a potential for adverse events such as severe infection, abscess and fistula. This article describes a case of an intrascrotal abscess post-transperineal biopsy, which required an orchidectomy.
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Affiliation(s)
- Jia Ying Isaac Tay
- General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Marlon Perera
- Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Paul Anderson
- Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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243
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Walker CH, Marchetti KA, Singhal U, Morgan TM. Active surveillance for prostate cancer: selection criteria, guidelines, and outcomes. World J Urol 2021; 40:35-42. [PMID: 33655428 DOI: 10.1007/s00345-021-03622-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/30/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) has been widely adopted for the management of men with low-risk prostate cancer. However, there is still a lack of consensus surrounding the optimal approach for monitoring men in AS protocols. While conservative management aims to reduce the burden of invasive testing without compromising oncological safety, inadequate assessment can result in misclassification and unintended over- or undertreatment, leading to increased patient morbidity, cost, and undue risk. No universally accepted AS protocol exists, although numerous strategies have been developed in an attempt to optimize the management of clinically localized disease. Variability in selection criteria, reclassification, triggers for definitive treatment, and follow-up exists between guidelines and institutions for AS. In this review, we summarize the landscape of AS by providing an overview of the existing AS protocols, guidelines, and their published outcomes. METHODS A comprehensive electronic search was performed to identify representative studies and guidelines pertaining to AS selection criteria and outcomes. CONCLUSION While AS is a safe and increasingly utilized treatment modality for lower-risk forms of PCa, ongoing research is needed to optimize patient selection as well as surveillance protocols along with improved implementation across practices. Further, assessment of companion risk assessment tools, such as mpMRI and tissue-based biomarkers, is also needed and will require rigorous prospective study.
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Affiliation(s)
- Colton H Walker
- Department of Urology, University of Michigan Health System, University of Michigan, 1500 E Medical Center Drive, 7308 CCC, Ann Arbor, MI, 48109, USA
| | - Kathryn A Marchetti
- Department of Urology, University of Michigan Health System, University of Michigan, 1500 E Medical Center Drive, 7308 CCC, Ann Arbor, MI, 48109, USA
| | - Udit Singhal
- Department of Urology, University of Michigan Health System, University of Michigan, 1500 E Medical Center Drive, 7308 CCC, Ann Arbor, MI, 48109, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan Health System, University of Michigan, 1500 E Medical Center Drive, 7308 CCC, Ann Arbor, MI, 48109, USA. .,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA.
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244
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Liang L, Zhi X, Sun Y, Li H, Wang J, Xu J, Guo J. A Nomogram Based on a Multiparametric Ultrasound Radiomics Model for Discrimination Between Malignant and Benign Prostate Lesions. Front Oncol 2021; 11:610785. [PMID: 33738255 PMCID: PMC7962672 DOI: 10.3389/fonc.2021.610785] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives To evaluate the potential of a clinical-based model, a multiparametric ultrasound-based radiomics model, and a clinical-radiomics combined model for predicting prostate cancer (PCa). Methods A total of 112 patients with prostate lesions were included in this retrospective study. Among them, 58 patients had no prostate cancer detected by biopsy and 54 patients had prostate cancer. Clinical risk factors related to PCa (age, prostate volume, serum PSA, etc.) were collected in all patients. Prior to surgery, patients received transrectal ultrasound (TRUS), shear-wave elastography (SWE) and TRUS-guided prostate biopsy. We used the five-fold cross-validation method to verify the results of training and validation sets of different models. The images were manually delineated and registered. All modes of ultrasound radiomics were retrieved. Machine learning used the pathology of “12+X” biopsy as a reference to draw the benign and malignant regions of interest (ROI) through the application of LASSO regression. Three models were developed to predict the PCa: a clinical model, a multiparametric ultrasound-based radiomics model and a clinical-radiomics combined model. The diagnostic performance and clinical net benefit of each model were compared by receiver operating characteristic curve (ROC) analysis and decision curve. Results The multiparametric ultrasound radiomics reached area under the curve (AUC) of 0.85 for predicting PCa, meanwhile, AUC of B-mode radiomics and SWE radiomics were 0.74 and 0.80, respectively. Additionally, the clinical-radiomics combined model (AUC: 0.90) achieved greater predictive efficacy than the radiomics model (AUC: 0.85) and clinical model (AUC: 0.84). The decision curve analysis also showed that the combined model had higher net benefits in a wide range of high risk threshold than either the radiomics model or the clinical model. Conclusions Clinical-radiomics combined model can improve the accuracy of PCa predictions both in terms of diagnostic performance and clinical net benefit, compared with evaluating only clinical risk factors or radiomics score associated with PCa.
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Affiliation(s)
- Lei Liang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Xin Zhi
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Ya Sun
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Huarong Li
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Jiajun Wang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, China
| | - Jun Guo
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
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245
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The Value of Prostate-specific Antigen Density for Prostate Imaging-Reporting and Data System 3 Lesions on Multiparametric Magnetic Resonance Imaging: A Strategy to Avoid Unnecessary Prostate Biopsies. Eur Urol Focus 2021; 7:325-331. [PMID: 31839564 DOI: 10.1016/j.euf.2019.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) has excellent sensitivity in detecting significant prostate cancer (sPC). Nevertheless, uncertainty exists regarding the management of Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. OBJECTIVE To investigate whether PI-RADS 3 lesions in combination with clinical parameters, especially prostate-specific antigen density (PSAD), can be used to exclude sPC. DESIGN, SETTING, AND PARTICIPANTS A total of 455 consecutive biopsy-naïve men underwent MRI-guided transperineal prostate fusion biopsy at our department between 2017 and 2018. We identified 101 patients who had exclusively one or more PI-RADS 3 lesions on mpMRI. sPC was defined as intermediate- and high-risk PC (according to the D'Amico risk classification). OUTCOME MEASURES AND STATISTICAL ANALYSIS Univariate logistic regression analysis was performed to test different clinical factors as predictors of sPC in men with PI-RADS 3 lesions. The probability of sPC prediction was calculated for different PSAD thresholds. RESULTS AND LIMITATIONS Among patients with PI-RADS 3 lesions, PSAD was a significant predictor of sPC (p = 0.005). For a PI-RADS score of 3 the probability of excluding sPC was 85% (86/101), which increased to 98% (42/43) when combined with PSAD <0.1 ng/ml/ml. CONCLUSIONS Inclusion of PSAD < 0.1 ng/ml/ml in the strategy for biopsy-naïve patients with equivocal mpMRI findings would allow a reduction in prostate biopsies in 43% (43/101) of cases at the cost of missing a very small number (2%, 1/43) of intermediate-risk PCs. PATIENT SUMMARY At high-volume tertiary care centers with significant experience in prostate multiparametric magnetic resonance imaging, immediate biopsies could be safely omitted for men with lesions with a Prostate Imaging-Reporting and Data System score of 3 and prostate-specific antigen density of PSAD < 0.1 ng/ml/ml. Any decision to omit an immediate biopsy should be associated with close monitoring.
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246
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Wang Y, De Leon AC, Perera R, Abenojar E, Gopalakrishnan R, Basilion JP, Wang X, Exner AA. Molecular imaging of orthotopic prostate cancer with nanobubble ultrasound contrast agents targeted to PSMA. Sci Rep 2021; 11:4726. [PMID: 33633232 PMCID: PMC7907080 DOI: 10.1038/s41598-021-84072-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Ultrasound imaging is routinely used to guide prostate biopsies, yet delineation of tumors within the prostate gland is extremely challenging, even with microbubble (MB) contrast. A more effective ultrasound protocol is needed that can effectively localize malignancies for targeted biopsy or aid in patient selection and treatment planning for organ-sparing focal therapy. This study focused on evaluating the application of a novel nanobubble ultrasound contrast agent targeted to the prostate specific membrane antigen (PSMA-targeted NBs) in ultrasound imaging of prostate cancer (PCa) in vivo using a clinically relevant orthotopic tumor model in nude mice. Our results demonstrated that PSMA-targeted NBs had increased extravasation and retention in PSMA-expressing orthotopic mouse tumors. These processes are reflected in significantly different time intensity curve (TIC) and several kinetic parameters for targeted versus non-targeted NBs or LUMASON MBs. These, may in turn, lead to improved image-based detection and diagnosis of PCa in the future.
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Affiliation(s)
- Yu Wang
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA
- Department of Ultrasound, Peking University People's Hospital, Beijing, 100044, China
| | - Al Christopher De Leon
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA
| | - Reshani Perera
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA
| | - Eric Abenojar
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA
| | - Ramamurthy Gopalakrishnan
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA
| | - James P Basilion
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, 11100 Euclid Ave, Wearn Building B49, Cleveland, OH, 44106, USA
| | - Xinning Wang
- Department of Biomedical Engineering, Case Western Reserve University, 11100 Euclid Ave, Wearn Building B49, Cleveland, OH, 44106, USA.
| | - Agata A Exner
- Department of Radiology, Case Western Reserve University, 10900 Euclid Avenue, BRB 330, Cleveland, OH, 44106, USA.
- Department of Biomedical Engineering, Case Western Reserve University, 11100 Euclid Ave, Wearn Building B49, Cleveland, OH, 44106, USA.
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247
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Kohestani K, Månsson M, Arnsrud Godtman R, Stranne J, Wallström J, Carlsson S, Hellström M, Hugosson J. The GÖTEBORG prostate cancer screening 2 trial: a prospective, randomised, population-based prostate cancer screening trial with prostate-specific antigen testing followed by magnetic resonance imaging of the prostate. Scand J Urol 2021; 55:116-124. [PMID: 33612068 PMCID: PMC8376217 DOI: 10.1080/21681805.2021.1881612] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: To describe the study design of the GÖTEBORG prostate cancer screening (PC) 2 (Göteborg-2), a prospective, randomised, population-based trial of PC screening. This trial evaluates whether prostate-specific antigen (PSA) testing followed by 3 Tesla prostate magnetic resonance imaging (MRI) and targeted biopsy can reduce overdiagnosis, while maintaining the detection of clinically significant cancer, compared to PSA-screening and systematic biopsy. Materials and methods: A random sample of men 50–60 years in the Göteborg area, Sweden, identified from the Total Population Register, were randomised to either a screening or control group (CG). Participants in the screening group (SG) were further randomised into one of three arms: (1) PSA-test; if PSA ≥ 3 ng/mL, then MRI and systematic biopsy, plus targeted biopsy to suspicious lesions as per Prostate Imaging – Reporting and Data System, version 2 (PI-RADSv2) 3–5; (2) PSA-test; if PSA ≥ 3 ng/mL, then MRI, and targeted biopsy only if PI-RADSv2 3–5; (3) identical to Arm 2, except lower PSA-cut-off ≥1.8 ng/mL. The primary outcome is the detection rate of clinically insignificant PC (defined as Gleason Score 3 + 3 [Grade Group 1]) comparing all men with PSA ≥ 3 ng/mL in Arm 1 vs. Arm 2 + 3. Results: Randomisation and enrolment started in September 2015. Accrual has hitherto resulted in 38,770 men randomised to the SG. The participation rate is 50%. Invitation to the first screening round was completed in June 2020. Conclusions: The Göteborg-2 trial will provide new knowledge about the performance of prostate MRI in a screening setting.
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Affiliation(s)
- Kimia Kohestani
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Wallström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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248
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Alidjanov JF, Cai T, Bartoletti R, Bonkat G, Bruyère F, Köves B, Kulchavenya E, Medina-Polo J, Naber K, Perepanova T, Pilatz A, Tandogdu Z, Bjerklund Johansen TE, Wagenlehner FM. The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010-2019. World J Urol 2021; 39:3423-3432. [PMID: 33615393 PMCID: PMC8510929 DOI: 10.1007/s00345-021-03614-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate and report the complications, and to analyse antimicrobial stewardship aspects following prostate biopsies (P-Bx) based on the data from a 9-year global study. METHODS The primary outcome was to compare complications after P-Bx between patients of two cohorts: 2010-2014 and 2016-2019. Primary outcomes included symptoms of lower and severe/systemic urinary tract infection (LUTIS and SUTIS, respectively), and positive urine culture. Readmission to hospital after P-Bx, need for additional antimicrobial therapy, consumption of different antimicrobial agents for prophylaxis and therapy were evaluated. Students t test and chi-square test were used for comparative analyses. RESULTS Outcome data were available for 1615 men. Fluoroquinolones-based prophylaxis rate increased from 72.0% in 2010-2014 to 78.6% in 2015-2019. Overall rates of complications increased from 6 to 11.7% including an increase in symptomatic complications from 4.7 to 10.2%, mainly due to an increase in LUTIS. Rates of patients seeking additional medical help in primary care after P-Bx increased from 7.4 to 14.4%; cases requiring post P-Bx antibiotic treatment increased from 6.1 to 9.7%, most of which received fluoroquinolones. Transperineal P-Bx was significantly associated with LUTIS. Following transrectal P-Bx, 2.8% developed febrile infections and 4.0% required hospitalisation. Two men (0.12%) died after transrectal P-Bx due to sepsis. CONCLUSIONS The rates of complications after P-Bx tended to increase in time, as well as rates of patients seeking additional medical help in the post-P-Bx period. To reduce the risk of infectious complications and to comply with the principles of antibiotic stewardship, clinicians should switch to the transperineal biopsy route.
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Affiliation(s)
- Jakhongir F Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | | | - Gernot Bonkat
- Department of Urology, Alta Uro AG, Basel, Switzerland
| | - Franck Bruyère
- Urologie, CHU Bretonneau, Tours, France
- Université François Rabelais de Tours, PRES Centre Val de Loire, Tours, France
| | - Béla Köves
- Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary
| | - Ekaterina Kulchavenya
- Urogenital Department, Novosibirsk Research TB Institute, Koves Str 1. 1204, Budapest, 630040, Novosibirsk, Russian Federation
| | - José Medina-Polo
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Kurt Naber
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Tamara Perepanova
- Department of Urinary Tract Infections and Clinical Pharmacology N.A, Lopatkin Scientific Research Institute of Urology and Interventional Radiology, Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals, London, UK
| | - Truls E Bjerklund Johansen
- Department of Urology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany.
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249
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Zhong W, Cen J, Chen Y, Chen W, Luo J, Chen X. A rare rhabdomyolysis appears after transrectal ultrasound guided prostate biopsy. Asian J Urol 2021; 8:137-139. [PMID: 33569281 PMCID: PMC7859365 DOI: 10.1016/j.ajur.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/16/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
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250
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Akyüz O, Kılıç B, Gündoğan S, Ergün M, Bodakçı MN, Çoban S, Tefekli AH, Çam K. The Effectiveness of Caudal Block with Low Doses of Dexmedetomidine and Pethidine in Transrectal Prostate Biopsy: Preliminary Results. J INVEST SURG 2021; 35:511-516. [PMID: 33550855 DOI: 10.1080/08941939.2021.1880671] [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: 10/22/2022]
Abstract
PURPOSE To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. MATERIAL AND METHODS A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. RESULTS The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. CONCLUSION The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention.
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Affiliation(s)
- Osman Akyüz
- Medicine Hospital Department of Urology, Atlas University, İstanbul, Turkey
| | - Bahriye Kılıç
- Medicine Hospital Department of Anaesthesiology and Reanimation, Atlas University, İstanbul, Turkey
| | - Sertan Gündoğan
- Department of Anaesthesiology and Reanimation, Esencan Hospital, İstanbul, Turkey
| | - Müslüm Ergün
- Medicine Hospital Department of Urology, Atlas University, İstanbul, Turkey
| | | | - Soner Çoban
- Department of Urology, Yuksek Ihtisas Research and Educational Hospital, Bursa, Turkey
| | | | - Kamil Çam
- Medical Faculty Department of Urology, Marmara University, İstanbul, Turkey
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