Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy / 亚洲男科学杂志(英文版)

The purpose of this study was to analyze the value of transrectal shear-wave elastography (SWE) in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy (RP). Preoperative clinicopathological variables, multiparametric magnetic resonance imaging (mp-MRI) manifestations, and the maximum elastic value of the prostate (Emax) on SWE were retrospectively collected. The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology, and parameters with statistical significance were selected. The diagnostic performance of various models, including preoperative clinicopathological variables (model 1), preoperative clinicopathological variables + mp-MRI (model 2), and preoperative clinicopathological variables + mp-MRI + SWE (model 3), was evaluated with area under the receiver operator characteristic curve (AUC) analysis. Emax was significantly higher in prostate cancer with extracapsular extension (ECE) or seminal vesicle invasion (SVI) with both P < 0.001. The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa, respectively. Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE (model 2 vs model 1, P = 0.031; model 3 vs model 1, P = 0.002; model 3 vs model 2, P = 0.018) and SVI (model 2 vs model 1, P = 0.147; model 3 vs model 1, P = 0.037; model 3 vs model 2, P = 0.134). SWE is valuable for identifying patients at high risk of adverse pathology.

Influence of prostate cancer seminal vesicle invasion imaging classification on positive surgical margin after laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective:To investigate the effect of different imaging classifications of prostate cancer seminal vesicle invasion on positive surgical margins (PSM) after laparoscopic radical prostatectomy(LRP).Methods:114 patients with pT 3b stage prostate cancer admitted to Peking University Third Hospital from August 2009 to December 2020 were retrospectively analyzed. The age of the patients was (68.2±7.7) years old, the median pre-biopsy PSA was 20.20 (3.45-186.30) ng/ml, and the patients with biopsy Gleason score of ≤7, and ≥8 was 33 and 81 cases, respectively. The median prostate volume was 33.2 (12.1-155.4) ml. According to the imaging of the seminal vesicle invasion of prostate cancer, the patients were divided into the following types: type Ⅰ, the tumor directly invades the seminal vesicle along the vas deferens; type Ⅱa, the tumor invades the basal capsule of the prostate and invades the seminal vesicle; type Ⅱb, the tumor invades the periprostatic fat and retrogradely invades the seminal vesicles; type Ⅲ, solitary lesions in the seminal vesicles that do not continue with the prostate cancer. All patients underwent LRP, and the PSM were recorded as the base, bilateral, posterior, anterior and apical parts of the prostate. The differences in clinicopathological data of patients with different seminal vesicle invasion imaging types were compared, and the independent risk factors of PSM in pT 3b prostate cancer were evaluated by multivariate analysis. Results:The operative time of 114 cases in this group was (229.4±62.2) min, and the blood loss was 100(20-1 800)ml. The postoperative gross pathological Gleason score was ≤7 in 17 cases and ≥8 in 97 cases. In the imaging classification of prostate cancer with seminal vesicle invasion, there were 28 cases (24.6%) of type Ⅰ, 39 cases (34.2%) of type Ⅱa, 47 cases (41.2%) of type Ⅱb, and no type Ⅲ patients. There was no significant difference in age, body mass index, pre-biopsy PSA, prostate volume, and operation time among patients with type Ⅰ, Ⅱa, and Ⅱb seminal vesicle invasion ( P>0.05). There was a statistically significant difference in blood loss among the three types ( P = 0.001), and the difference in the proportion of lymph node metastasis was statistically significant ( P = 0.013). In the classification of prostate cancer seminal vesicle invasion, the PSM rates of type Ⅰ, Ⅱa and Ⅱb were 28.6% (8/28), 38.5% (15/39) and 70.2% (33/39), and the difference was statistically significant ( P=0.001). The PSM rates of type Ⅰ, Ⅱa, and Ⅱb were 21.4% (6/28), 23.1% (9/39), and 34.0% (16/47), respectively. The results of univariate analysis showed that the biopsy Gleason score ( P = 0.063) and the type of seminal vesicle invasion ( P<0.001) entered into multivariate analysis, and the results of multivariate logistic regression analysis showed that the type of seminal vesicle invasion ( P=0.001) was independent risk factor for PSM after LRP. Conclusions:The PSM rate in patients with type Ⅱb seminal vesicle invasion is significantly higher. The higher imaging type of seminal vesicle invasion is the independent risk factor of PSM after LRP.

Value of Gailina nomogram in predicting seminal vesicle invasion in prostate cancer / 中华泌尿外科杂志

Objective To evaluate the accuracy of Gallina nomogram in predicting seminal vesicle invasion (SVI) in prostate cancer.Methods From January 2009 to December 2011,89 patients with prostate carcinoma underwent open retropubic or laparoscopic radical prostatectomy.Complete data of preoperative serum prostate specific antigen (PSA),clinical stage,biopsy Gleason score,percentage of positive biopsy cores,pelvic MRI and pathological report of prostatectomy specimen were collected,and all the patients met the inclusion criteria of Gallina nomogram,2001 Partin tables and 2007 Partin tables.Postoperative pathological results were respectively compared with MRI and the incidence of SVI predicted by the three tools,and the sensitivity,specificity and accuracy of MRI in predicting SVI were calculated.The receiver operating characteristics curves were performed to test the predictive accuracy of SVI of each tool.Results The incidences of organ-confined disease,capsule invasion,SVI and lymph node metastasis were 58.4％,16.9％,22.5％,and 2.2％,respectively.The sensitivity,specificity and accuracy of MRI in predicting SVI was 45.0％ (9/20),71.0％ (49/69) and 65.2％ (58/89),respectively.The area under the curve (AUC) for SVI disease prediction of 2001 Partin tables,2007 Partin tables and Gallina nomogram was 0.712,0.711 and 0.801,respectively.Conclusions The sensitivity of MRI in predicting SVI is poor,the specificity and accuracy are common.All the predictive tools have a reasonable value for SVI (AUC ＞ 0.7),and Gallina nomogram is superior to two versions of Partin tables in predicting SVI.

The Pathological Characteristics of Localized Prostate Cancer, Managed with Radical Prostatectomy / 대한비뇨기과학회지

PURPOSE: Prostate cancer is known as the most common cancer in western men, and their incidences are increasing in oriental men, including Koreans. We made an effort to evaluate the pathological characteristics of this cancer in Koreans. MATERIALS AND METHODS: The medical records of 170 patients with prostate cancer, having undergone a radical retropubic prostatectomy between April 1990 and May 2001 were reviewed. The distributions of preoperative serum PSA levels, preoperative biopsy Gleason scores and clinical stages were evaluated. We analyzed pathological findings, such as the rates of organ confinement, extracapsular extension, seminal vesicle invasion and lymph node involvement. In cases with seminal vesicle invasion, tumor mapping, through microscopic examination of histological sections at multiple levels, were performed to determine the route of invasion. RESULTS: When the patients were stratified according to each preoperative parameter, the largest proportion were found to be in the T1c and T2a clinical stages (40.6%), had Gleason scores between 8 and 10 (34.1%) and serum PSA levels in the range of 4-10ng/ml (32.9%). There were 30.6% of patients with preoperative serum PSA levels greater than 20ng/ml. The rates of organ confinement, extracapsular extension, seminal vesicle invasion and lymph node involvement were 54.7, 17.7, 19.4 and 8.2%, respectively. 75.8% of the seminal vesicle invasions were revealed to be from direct extension of the tumor. CONCLUSIONS: The high incidence of seminal vesicle invasion in Korean prostate cancer patients might be due to the location of the tumors, the aggressiveness of the tumors or racial differences. Considering the reported incidence of seminal vesicle invasion in Japan was 32%, multicentric studies are required to elucidate the cause of the high incidence of seminal vesicle invasion in Asians.

The Usefulness of Endo-rectal Coil MRI in the Staging of Clinically Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the ability of endo-rectal coil MRI (ER-MRI) to predict the local pathological stage of prostate cancer prior to radical prostatectomy and compared the results with those of transrectal ultrasonography (TRUS). MATERIALS AND METHODS: ER-MRI using high field magnets (1.5 Tesla) were performed in 22 patients (mean age 62.8 years, range 51-73) with clinically localized prostate cancer before radical prostatectomy. Of the 22 patients, 17 patients were also assessed by TRUS. The results of the imaging techniques were compared with the post-operative histopathological findings. As one patient with pelvic lymph node metastasis, which was detected on frozen-section examination during surgery, was spared radical prostatectomy, the final evaluation included 21 patients. RESULTS: DSeven of the 21 patients (33%) were found to have extraprostatic extension (EPE), and 5 had seminal vesicle invasion (SVI). The sensitivity and specificity for diagnosing EPE using ER-MRI were 62.5% and 84.6%, respectively, and 16.7% and 100% with TRUS. The sensitivity and specificity for diagnosing SVI were 80.0% and 93.8%, respectively with ER-MRI, and 0% and 92.3% with TRUS. The accuracy of predicting SVI was 90.5% with ER-MRI compared to 70.6% with TRUS. CONCLUSIONS: ER-MRI was significantly better than TRUS for determining the local extent of prostatic cancer and for prediction of SVI in the preoperative staging of clinically localized prostate cancer.