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Esperto F, Cacciatore L, Tedesco F, Raso G, Minore A, Testa A, Ragusa A, Prata F, Alcini A, Salerno A, Flammia GP, Papalia R, Scarpa RM. Prevalence and potential predictors of incidental prostate Cancer in patients undergoing surgery for Benign Prostatic obstruction: a retrospective study in the MRI era. World J Urol 2024; 42:485. [PMID: 39143371 DOI: 10.1007/s00345-024-05171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 07/09/2024] [Indexed: 08/16/2024] Open
Abstract
PURPOSE Despite advancements in prostate multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB), the management of incidental prostate cancer (IPCa) after surgery for benign prostatic obstruction (BPO) remains unclear. The aim of this retrospective study is to determine the prevalence of IPCa in our cohort and identify potential predictors for its occurrence. METHODS We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected. RESULTS Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3%) were found to have IPCa. Of these, 33 patients (44.6%) had undergone previous mpMRI. Among the patients who had mpMRI, 23 had negative mpMRI results for suspected prostate cancer, while 10 had positive mpMRI findings (PIRADS ≥ 3) but no evidence of tumor upon FB. KW analysis indicates that PSAd was statistically associated with higher ISUP score, while at univariable regression analysis negative mpMRI (p = 0.03) was the only potential predictor for IPCa. CONCLUSIONS Among the ISUP groups, PSAd showed a correlation with the tumor, while negative mpMRI was protective against clinically significant PCa. In the era of mpMRI and FB, the IPCa rates found at our center is higher than reported in existing literature and if it were confirmed with further studies, maybe there is a need for expansion in urology guidelines.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy.
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Antonio Minore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Antonio Testa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Antonio Alcini
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Annamaria Salerno
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Gerardo Paolo Flammia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy
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Mac Curtain BM, Temperley HC, Kelly JAO, Ryan J, Qian W, O'Sullivan N, Breen KJ, Mc Carthy CJ, Brennan I, Davis NF. The role of urology and radiology in prostate biopsy: current trends and future perspectives. World J Urol 2024; 42:249. [PMID: 38649544 DOI: 10.1007/s00345-024-04967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Prostate biopsy is central to the accurate histological diagnosis of prostate cancer. In current practice, the biopsy procedure can be performed using a transrectal or transperineal route with different technologies available for targeting of lesions within the prostate. Historically, the biopsy procedure was performed solely by urologists, but with the advent of image-guided techniques, the involvement of radiologists in prostate biopsy has become more common. Herein, we discuss the pros, cons and future considerations regarding their ongoing role. METHODS A narrative review regarding the current evidence was completed. PubMed and Cochrane central register of controlled trials were search until January 2024. All study types were of consideration if published after 2000 and an English language translation was available. RESULTS There are no published studies that directly compare outcomes of prostate biopsy when performed by a urologist or radiologist. In all published studies regarding the learning curve for prostate biopsy, the procedure was performed by urologists. These studies suggest that the learning curve for prostate biopsy is between 10 and 50 cases to reach proficiency in terms of prostate cancer detection and complications. It is recognised that many urologists are poorly able to accurately interpret multi parametric (mp)-MRI of the prostate. Collaboration between the specialities is of importance with urology offering the advantage of being involved in prior and future care of the patient while radiology has the advantage of being able to expertly interpret preprocedure MRI. CONCLUSION There is no evidence to suggest that prostate biopsy should be solely performed by a specific specialty. The most important factor remains knowledge of the relevant anatomy and sufficient volume of cases to develop and maintain skills.
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Affiliation(s)
| | | | - John A O Kelly
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - James Ryan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Wanyang Qian
- Dept of Surgery, St John of God Midland Hospital, Midland, WA, USA
| | | | - Kieran J Breen
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - Colin J Mc Carthy
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Ian Brennan
- Department of Radiology, St James Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
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Haack M, Reisen K, Ghazy A, Stroh K, Frey L, Sparwasser P, Duwe G, Mager R, Haferkamp A, Borgmann H. Understanding tumor localization in multiparametric MRI of the prostate-effectiveness of 3D printed models. Front Surg 2023; 10:1264164. [PMID: 37799119 PMCID: PMC10547869 DOI: 10.3389/fsurg.2023.1264164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Understanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors. Methods and Participants 20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test). Results Overall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [-7.4;41.3] (p < 0.01). Conclusion Urologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.
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Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Katja Reisen
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Ahmed Ghazy
- Department of Cardiovascular Surgery, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Kristina Stroh
- Department of Diagnostic and Interventional Radiology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Lisa Frey
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Bouhadana D, Elbaz S, Di Ioia R, Nguyen AXL, Benea D, Deyirmendjian C, Nguyen DD, Raizenne B, Hardy I, Perotte P, Lagabrielle S, Lee JY, Metcalfe PD, Jaffer R, Bhojani N. Evaluating the perceptions of Canadian urology residents and program directors regarding the current training in genitourinary imaging. Can Urol Assoc J 2023; 17:cuaj.8430. [PMID: 37787594 PMCID: PMC10697708 DOI: 10.5489/cuaj.8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Competency in interpreting genitourinary (GU) imaging is an important skill for urologists; however, no nationally accredited GU imaging curriculum exists for Canadian urology residency training programs. The main objectives of our study were to 1) characterize GU imaging training in Canada; (2) evaluate residents' self-perceived competencies in interpreting GU imaging; (3) explore program directors' (PD) and residents' perceptions regarding the current imaging curriculum and suggestions for future directions. METHODS From November to December 2022, a survey examining current imaging education in residency, perceived resident imaging knowledge, avenues for improvement in imaging education, and the role of point-of-care ultrasound within urology was distributed to all Canadian urology PDs and residents. RESULTS All PDs (13/13) and 40% (72/178) of residents completed the survey. Only two programs had a formal GU imaging curriculum. PDs and residents reported trainees were least comfortable interpreting Doppler ultrasound of renal, gonadal, and penile vessels. PDs reported that residents were most comfortable with non-contrast computed tomography (CT) scans (9.5/10), CT urogram (9.3/10), and retrograde pyelography (9.3/10). All but one PD favored increasing imaging training in their program. PDs highlighted the lack of time in the curriculum (n=3) and lack of educators (n=3) as the primary barriers to increasing imaging training in their program. CONCLUSIONS Most PDs and residents believe there needs to be more imaging training offered at their institution; however, addressing this is challenging due to the limited time in the curriculum and the need for available educators.
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Affiliation(s)
- David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sarah Elbaz
- Faculty of Medicine, Université Laval, Montreal, QC, Canada
| | - Rose Di Ioia
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Diana Benea
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | | | - Brendan Raizenne
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Hardy
- Department of Ophthalmology, Université de Montréal, Montreal, QC, Canada
| | - Paul Perotte
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | | | - Jason Y. Lee
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Rehana Jaffer
- Department of Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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Surveillance Value of Apparent Diffusion Coefficient Maps: Multiparametric MRI in Active Surveillance of Prostate Cancer. Cancers (Basel) 2023; 15:cancers15041128. [PMID: 36831471 PMCID: PMC9953850 DOI: 10.3390/cancers15041128] [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: 12/13/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study aims to establish the value of apparent diffusion coefficient maps and other magnetic resonance sequences for active surveillance of prostate cancer. The study included 530 men with an average age of 66, who were under surveillance for prostate cancer. We have used multiparametric magnetic resonance imaging with subsequent transperineal biopsy (TPB) to verify the imaging findings. RESULTS We have observed a level of agreement of 67.30% between the apparent diffusion coefficient (ADC) maps, other magnetic resonance sequences, and the biopsy results. The sensitivity of the apparent diffusion coefficient is 97.14%, and the specificity is 37.50%. According to our data, apparent diffusion coefficient is the most accurate sequence, followed by diffusion imaging in prostate cancer detection. CONCLUSIONS Based on our findings we advocate that the apparent diffusion coefficient should be included as an essential part of magnetic resonance scanning protocols for prostate cancer in at least bi-parametric settings. The best option will be apparent diffusion coefficient combined with diffusion imaging and T2 sequences. Further large-scale prospective controlled studies are required to define the precise role of multiparametric and bi-parametric magnetic resonance in the active surveillance of prostate cancer.
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