The role of PSA density in the MRI pathway for prostate cancer diagnostics

Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.

Is the Ellipsoid Formula Reliable in Prostate MRI?

Our study seeks to study the accuracy of the ellipsoidal formula in prostate MRI of different sizes and to establish the limits of its use. The study included 31 patients with a well-visualized, intact prostatic capsule, excluding malignantly transformed prostates, as well as treated prostates, in which the contrast between the prostatic capsule and parenchyma is reduced. Each patient's prostatic volume was recalculated according to the ellipsoidal formula, and then it was compared with the prostatic volume calculated by the segmentation method. The two calculated volumes were similar, in some cases almost identical, with a slight tendency to underestimate prostate volume below 100cm3, in total in 18 cases, on average by 7.6% (+/-6%), overestimation of those with a volume over 100cm3, a total of 13 cases, on average by 3.2% (+/-2.5%), and of all, in 4 cases the difference between the two formulas was below 1%. There was no statistical difference between the two variables, Student's t-test p-value=0.039. With a precision of 92% (+/-6%), the ellipsoidal formula can be considered accurate when it is correctly performed, but if we take into account the importance that PSA density is starting to have in diagnosis, treatment and follow-up, the calculation of a secondary value through the segmentation method or high-precision software can be motivated when the ellipsoidal formula returns a value close to a threshold.