|
1
|
Bologna E, Licari LC, Franco A, Ditonno F, Manfredi C, De Nunzio C, Antonelli A, De Sio M, Leonardo C, Simone G, Cherullo EE, Autorino R. Incidental Prostate Cancer in Patients Treated for Benign Prostatic Hyperplasia: Analysis from a Contemporary National Dataset. Diagnostics (Basel) 2024; 14:677. [PMID: 38611590 PMCID: PMC11011333 DOI: 10.3390/diagnostics14070677] [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: 02/22/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Prostate Cancer (PCa) may be incidentally diagnosed during the microscopic evaluation of resected tissue from BPH surgeries, characterizing the clinical condition known as incidental PCa (iPCa). This study aims to assess the prevalence of iPCa following BPH surgery to evaluate the associated surgical procedures and to scrutinize preoperative and postoperative management. (2) Methods: A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing patient records compiled between 2011 and 2021. International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify the population and outcomes. Our primary objective was to assess the prevalence of iPCa, categorized by the type of procedures, and to evaluate the subsequent treatment strategies. The secondary aim was to assess the impact of prostate biopsy (PB) and prostate MRI on iPCa detection. (3) Results: The overall cohort, accounting for 231,626 patients who underwent BPH surgery, exhibited a 2.2% prevalence rate of iPCa. The highest rate was observed for TURP (2.32%), while the lowest was recorded for RASP (1.18%). Preoperative MRI and PB demonstrated opposing trends over the years. Of the 5090 patients identified with iPCa, nearly 68% did not receive active treatment. The most common treatments were RT and ADT; 34.6% underwent RT, 31.75% received ADT, and 21.75% were treated with RT+ADT. RP was administered to approximately 9% of patients undergoing endoscopic procedures. Multivariate logistic regression analysis revealed age and openSP as additional risk factors for iPCa. Conversely, PB and MRI before surgery were linked to a decreased risk. (4) Conclusions: The contemporary prevalence of iPCa after BPH surgery is <3%. The increase in the use of prostate MRI mirrors a decline in the PB biopsy prior to BPH surgery but without resulting in an increased detection rate of iPCa. In contemporary routine clinical practice, iPCa is mostly managed in a different way when compared to biopsy-detected PCa.
Collapse
Affiliation(s)
- Eugenio Bologna
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (E.B.); (L.C.L.)
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| | - Leslie Claire Licari
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (E.B.); (L.C.L.)
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37129 Verona, Italy;
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37129 Verona, Italy;
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Costantino Leonardo
- Department of Urology, “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (C.L.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (C.L.); (G.S.)
| | - Edward E. Cherullo
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| | - Riccardo Autorino
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| |
Collapse
|
|
2
|
Titze U, Titze B, Hansen T, Barth PJ, Ali FA, Schneider F, Benndorf M, Sievert KD. Ex Vivo Fluorescence Confocal Microscopy of MRI-Guided Targeted Prostate Biopsies for Rapid Detection of Clinically Significant Carcinomas-A Feasibility Study. Cancers (Basel) 2024; 16:873. [PMID: 38473235 DOI: 10.3390/cancers16050873] [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: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND MRI-guided prostate biopsies from visible tumor-specific lesions (TBx) can be used to diagnose clinically significant carcinomas (csPCa) requiring treatment more selectively than conventional systematic biopsies (SBx). Ex vivo fluorescence confocal microscopy (FCM) is a novel technique that can be used to examine TBx prior to conventional histologic workup. METHODS TBx from 150 patients were examined with FCM on the day of collection. Preliminary findings were reported within 2 h of collection. The results were statistically compared with the final histology. RESULTS 27/40 (68%) of the csPCa were already recognized in the intraday FCM in accordance with the results of conventional histology. Even non-significant carcinomas (cisPCa) of the intermediate and high-risk groups (serum prostate-specific antigen (PSA) > 10 or 20 ng/mL) according to conventional risk stratifications were reliably detectable. In contrast, small foci of cisPCa were often not detected or were difficult to distinguish from reactive changes. CONCLUSION The rapid reporting of preliminary FCM findings helps to reduce the psychological stress on patients, and can improve the clinical management of csPCa. Additional SBx can be avoided in individual cases, leading to lower rates of complications and scarring in the future surgical area. Additional staging examinations can be arranged without losing time. FCM represents a promising basis for future AI-based diagnostic algorithms.
Collapse
Affiliation(s)
- Ulf Titze
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Barbara Titze
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Torsten Hansen
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
- MVZ for Histology, Cytology and Molecular Diagnostics Trier GmbH, 54296 Trier, Germany
| | - Peter J Barth
- Gerhard-Domagk-Institute of Pathology, Münster University Hospital, University of Münster, 48149 Münster, Germany
| | - Furat Abd Ali
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Fried Schneider
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Matthias Benndorf
- Department of Diagnostic and Interventional Radiology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Karl-Dietrich Sievert
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| |
Collapse
|
|
3
|
Sievert KD, Hansen T, Titze B, Schulz B, Omran A, Brockkötter L, Gunnemann A, Titze U. Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics. Diagnostics (Basel) 2022; 12:diagnostics12051146. [PMID: 35626301 PMCID: PMC9140526 DOI: 10.3390/diagnostics12051146] [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: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.
Collapse
Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Ahmad Omran
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Lukas Brockkötter
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
| |
Collapse
|
|
4
|
Titze U, Hansen T, Brochhausen C, Titze B, Schulz B, Gunnemann A, Rocco B, Sievert KD. Diagnostic Performance of Ex Vivo Fluorescence Confocal Microscopy in the Assessment of Diagnostic Biopsies of the Prostate. Cancers (Basel) 2021; 13:cancers13225685. [PMID: 34830839 PMCID: PMC8616222 DOI: 10.3390/cancers13225685] [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: 10/09/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. In this study, we compare intraoperative diagnoses from the real-time application of FCM in pre-therapeutic prostate biopsies with the final diagnoses from conventional histology. We found FCM to be an effective tool for the timely assessment of prostate biopsies enabling reliable real-time diagnosis of prostate cancer in patients requiring therapy. Abstract Background: Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumors in dermatological specimens. Methods: We compare intraoperative diagnoses of the real-time application of FCM in pre-therapeutic prostate biopsies (35 patients, total number of biopsy specimens: n = 438) with the findings of conventional histology. Results: Prostate carcinoma was reliably diagnosed in all patients. Depending on scan quality and experience of the examiner, smaller lesions of well differentiated carcinoma (ISUP1) could not be consistently differentiated from reactive changes. Furthermore, in some cases there was difficulty to distinguish ISUP grade 2 from ISUP grade 1 tumors. ISUP grades 3–5 were reliably detected in FCM. Conclusions: Despite some limitations, FCM seems to be an effective tool for the timely assessment of prostate biopsies enabling reliable diagnosis of prostate cancer in patients requiring therapy.
Collapse
Affiliation(s)
- Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Christoph Brochhausen
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany;
- Central Biobank Regensburg, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (A.G.); (K.-D.S.)
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (A.G.); (K.-D.S.)
| |
Collapse
|
|
5
|
Rocco B, Sighinolfi MC, Sandri M, Spandri V, Cimadamore A, Volavsek M, Mazzucchelli R, Lopez-Beltran A, Eissa A, Bertoni L, Azzoni P, Reggiani Bonetti L, Maiorana A, Puliatti S, Micali S, Paterlini M, Iseppi A, Rocco F, Pellacani G, Chester J, Bianchi G, Montironi R. Digital Biopsy with Fluorescence Confocal Microscope for Effective Real-time Diagnosis of Prostate Cancer: A Prospective, Comparative Study. Eur Urol Oncol 2020; 4:784-791. [PMID: 32952095 DOI: 10.1016/j.euo.2020.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A microscopic analysis of tissue is the gold standard for cancer detection. Hematoxylin-eosin (HE) for the reporting of prostate biopsy (PB) is conventionally based on fixation, processing, acquisition of glass slides, and analysis with an analog microscope by a local pathologist. Digitalization and real-time remote access to images could enhance the reporting process, and form the basis of artificial intelligence and machine learning. Fluorescence confocal microscopy (FCM), a novel optical technology, enables immediate digital image acquisition in an almost HE-like resolution without requiring conventional processing. OBJECTIVE The aim of this study is to assess the diagnostic ability of FCM for prostate cancer (PCa) identification and grading from PB. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, comparative study evaluating FCM and HE for prostate tissue interpretation. PBs were performed (March to June 2019) at a single coordinating unit on consecutive patients with clinical and laboratory indications for assessment. FCM digital images (n = 427) were acquired immediately from PBs (from 54 patients) and stored; corresponding glass slides (n = 427) undergoing the conventional HE processing were digitalized and stored as well. A panel of four international pathologists with diverse background participated in the study and was asked to evaluate all images. The pathologists had no FCM expertise and were blinded to clinical data, HE interpretation, and each other's evaluation. All images, FCM and corresponding HE, were assessed for the presence or absence of cancer tissue and cancer grading, when appropriate. Reporting was gathered via a dedicated web platform. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint is to evaluate the ability of FCM to identify cancer tissue in PB cores (per-slice analysis). FCM outcomes are interpreted by agreement level with HE (K value). Additionally, either FCM or HE outcomes are assessed with interobserver agreement for cancer detection (presence vs absence of cancer) and for the discrimination between International Society of Urologic Pathologists (ISUP) grade = 1 and ISUP grade > 1 (secondary endpoint). RESULTS AND LIMITATIONS Overall, 854 images were evaluated from each pathologist. PCa detection of FCM was almost perfectly aligned with HE final reports (95.1% of correct diagnosis with FCM, κ = 0.84). Inter-rater agreement between pathologists was almost perfect for both HE and FCM for PCa detection (0.98 for HE, κ = 0.95; 0.95 for FCM, κ = 0.86); for cancer grade attribution, only a moderate agreement was reached for both HE and FCM (HE, κ = 0.47; FCM, κ = 0.49). CONCLUSIONS FCM provides a microscopic, immediate, and seemingly reliable diagnosis for PCa. The real-time acquisition of digital images-without requiring conventional processing-offers opportunities for immediate sharing and reporting. FCM is a promising tool for improvements in cancer diagnostic pathways. PATIENT SUMMARY Fluorescence confocal microscopy may provide an immediate, microscopic, and apparently reliable diagnosis of prostate cancer on prostate biopsy, overcoming the standard turnaround time of conventional processing and interpretation.
Collapse
Affiliation(s)
- Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Valentina Spandri
- School of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Cimadamore
- Department of Pathology, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Metka Volavsek
- Department of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Roberta Mazzucchelli
- Department of Pathology, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Ahmed Eissa
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy; Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Laura Bertoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Paterlini
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Iseppi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giovanni Pellacani
- Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| |
Collapse
|
|
6
|
Abstract
It is crucial that urologists keep abreast of the latest advances in medical research. This should include an awareness of the role of imaging techniques, collaboration in multidisciplinary teams, adherence to current guidelines, and ongoing documentation of postoperative complications and outcomes. Taken together, these key elements should facilitate optimisation of patient management in routine clinical practice.
Collapse
|