Clinical significance of distally located periurethral calcification in patients with lower urinary tract symptoms of benign prostate hyperplasia / 亚洲男科学杂志(英文版)

This study evaluated the association of periurethral calcification (PUC) with uroflowmetric parameters and symptom severity in male patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). The data were collected from a prospectively maintained database of 1321 men with LUTS of BPH who visited Chonnam National University Hospital (Gwang-ju, Korea) from January 2015 to December 2019. PUC severity and location were evaluated on the midsagittal plane during transrectal ultrasonography. Relationships among age, prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were assessed. Among the 1321 patients in this study, 530 (40.1%) had PUC. Patients with PUC had significantly higher IPSS (mean ± standard deviation [s.d.]: 15.1 ± 8.7 vs 13.1 ± 7.9; P < 0.001) and lower peak flow rate (Qmax; mean ± s.d.: 12.4 ± 6.6 ml s-1 vs 14.7 ± 13.3 ml s-1; P < 0.001), compared with patients who did not have PUC. Analyses according to PUC severity revealed that patients with severe PUC had higher prostate-specific antigen (PSA) level (P = 0.009), higher total IPSS (P < 0.001), lower Qmax (P = 0.002), and smaller prostate volume (P < 0.001), compared with patients who had non-severe (mild or moderate) PUC. Multivariate analysis showed that distal PUC was independently associated with high total IPSS (P = 0.02), voiding symptom score (P = 0.04), and storage symptom score (P = 0.023), and low Qmax (P = 0.015). In conclusion, PUC was significantly associated with worse LUTS parameters in terms of IPSS and Qmax. Furthermore, distally located PUC was independently associated with worse LUTS of BPH in men.

Segmentation of prostate region in magnetic resonance images based on improved V-Net / 生物医学工程学杂志

Magnetic resonance (MR) imaging is an important tool for prostate cancer diagnosis, and accurate segmentation of MR prostate regions by computer-aided diagnostic techniques is important for the diagnosis of prostate cancer. In this paper, we propose an improved end-to-end three-dimensional image segmentation network using a deep learning approach to the traditional V-Net network (V-Net) network in order to provide more accurate image segmentation results. Firstly, we fused the soft attention mechanism into the traditional V-Net's jump connection, and combined short jump connection and small convolutional kernel to further improve the network segmentation accuracy. Then the prostate region was segmented using the Prostate MR Image Segmentation 2012 (PROMISE 12) challenge dataset, and the model was evaluated using the dice similarity coefficient (DSC) and Hausdorff distance (HD). The DSC and HD values of the segmented model could reach 0.903 and 3.912 mm, respectively. The experimental results show that the algorithm in this paper can provide more accurate three-dimensional segmentation results, which can accurately and efficiently segment prostate MR images and provide a reliable basis for clinical diagnosis and treatment.

Guía de práctica clínica para el tamizaje, diagnóstico y tratamiento inicial de cáncer de próstata localizado y localmente avanzado / Clinical practice guideline for the screening, diagnosis and initial treatment of localized and locally advanced prostate cancer

El cáncer de próstata es producto de una proliferación descontrolada de células glandulares, ductales u otras de la glándula prostática. El tipo histológico más frecuente es el adenocarcinoma y se ubican principalmente en la zona periférica de la próstata (1). Así mismo, esta neoplasia se puede clasificar según el estadio clínico en cáncer de próstata localizado, localmente avanzado, y metastásico. Además, el cáncer de próstata localizado puede clasificarse según el riesgo en riesgo bajo, intermedio, o alto (1-4). En el mundo, el cáncer de próstata es la segunda neoplasia maligna más frecuente y una de las principales causas de mortalidad por cáncer en varones. Se diagnostican más de 1,2 millones de casos y las muertes relacionadas a esta neoplasia suelen superar las 350 mil cada año (1). En Perú, se reportó que el cáncer de próstata fue la neoplasia maligna más frecuente y la segunda más letal, independientemente de la edad y género (44,3 casos nuevos por cada 1000 habitantes, y 11,4 fallecimientos por cada 1000 habitantes, respectivamente) en el 2020, tendencia que se mantiene si se toma en cuenta solo a varones (5). En adición, en el Seguro Social de Salud de Perú (EsSalud) se estimó que el cáncer de próstata representó el 3,8% de los años de vida perdidos por muerte prematura causados por tumores malignos en el 2018 (6). Para reducir las cifras de mortalidad causadas por cáncer de próstata y otras neoplasias, en 2012 se implementó el Plan Esperanza, el cual pretende cubrir los servicios de prevención, detección temprana, diagnóstico definitivo, estadiaje, tratamiento y cuidado paliativo (7). Pese a ello, la tendencia de mortalidad por cáncer de próstata en varones mayores de 50 años se ha incrementado entre los años 2009 y 2016 (10,9% vs 21,8%, respectivamente) (8). Además, el manejo del cáncer de próstata se ha vuelto más complejo con el advenimiento de nuevas formas de subclasificación de grupos de riesgo, y nueva evidencia sobre la eficacia y seguridad de las diferentes modalidades de tratamiento inicial para esta neoplasia (3, 4, 9). Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer enunciados basados en evidencia con el fin de gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición. Esta GPC fue realizada por la Dirección de Guías de Práctica Clínica, Farmacovigilancia y Tecnovigilancia del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud.

Comparación del bloqueo periprostático con lidocaina y supositorio de diclofenac y placebo en la biopsia prostática / Comparison of periprostatic block with lidocaine and diclofenac suppository and placebo in prostate biopsy

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)

The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)

Applicability of ARFI elastography in the evaluation of canine prostatic alterations detected by b-mode and Doppler Ultrasonography / [Aplicabilidade da elastografia ARFI na avaliação de alterações prostáticas caninas detectadas pela ultrassonografia modo-B e Doppler]

The aim of this study was to assess the applicability of ARFI elastography for the complementary diagnosis of canine prostatic alterations. Twenty-two healthy dogs and 45 with prostatic alterations were diagnosed by the association of general and specific physical exams. Complete blood count, B-mode and Doppler ultrasound were performed. For the elastography study, tissue homogeneity and deformity were verified using the elastogram, and the shear velocities of the left and right lobes of all prostates were obtained. The change in tissue homogeneity was observed in 62.2% of the animals, while the shear speed was significantly higher in dogs with prostatic alterations, with a cut-off point > 2.35m/s as an indication of change. All animals in both groups were non-deformable. It was concluded that ARFI elastography is capable of providing qualitative and quantitative results that assist in the diagnosis of canine prostatic alterations in a non-invasive way.(AU)

O objetivo deste estudo foi avaliar a aplicabilidade da elastografia ARFI na complementação diagnóstica das alterações prostáticas em cães. Foram avaliados 22 cães saudáveis e 45 com alterações prostáticas, diagnosticadas pela associação de exames físicos geral e específico, hemograma, ultrassonografia modo B e Doppler. No estudo elastográfico, foram verificadas a homogeneidade e a deformidade tecidual, pelo elastograma, e obtidas as velocidades de cisalhamento dos lobos esquerdo e direito de todas as próstatas. A alteração de homogeneidade tecidual foi observada em 62,2% dos animais, enquanto a velocidade de cisalhamento se mostrou significativamente maior em cães com alterações prostáticas, com ponto de corte >2,35m/s como indicativo de alteração. Todos os animais de ambos os grupos se apresentaram não deformáveis. Concluiu-se que a elastografia ARFI é capaz de fornecer resultados qualitativos e quantitativos que auxiliam no diagnóstico das alterações prostáticas caninas de forma não invasiva.(AU)

Prostate volume measurement by multiparametric magnetic resonance and transrectal ultrasound: comparison with surgical specimen weight / Avaliação do volume prostático obtido por ressonância magnética multiparamétrica da próstata e ultrassonografia transretal comparado ao peso da peça cirúrgica

ABSTRACT Objective To assess accuracy of multiparametric magnetic resonance of the prostate to estimate gland volume, comparing the results with transrectal ultrasound and surgical specimen. Methods A retrospective study of 85 patients who underwent multiparametric magnetic resonance and transrectal ultrasound (for fusion image-guided biopsy) before radical prostatectomy. Prostate measurements were obtained from magnetic resonance axial and sagittal T2-weighted images and ultrasound; the prostate volume was determined using the ellipsoid formula. The results were compared with the surgical specimen weight. Maximum interval between multiparametric magnetic resonance imaging, transrectal ultrasound, and prostatectomy was 6 months. Results The prostate volume measured by multiparametric magnetic resonance imaging was 18-157cm3 (mean of 49.9cm3) and by transrectal ultrasound, 22-165cm3 (mean of 54.9cm3); the surgical specimen weight was 20-154g (mean of 48.6g), with no statistical differences. Based on the values obtained from imaging examinations, the prostate volume obtained was very close to the real prostatic weight, and the measures by multiparametric magnetic resonance were slightly more precise. Conclusion Prostate volume measured by multiparametric magnetic resonance imaging and transrectal ultrasound showed similar values, and excellent agreement with real prostate weight of the surgical specimens. Prostate volume measured by magnetic resonance has been increasingly used in the clinical practice, and its value enables appropriate therapeutic planning and control of patients.

RESUMO Objetivo Avaliar a acurácia da ressonância magnética multiparamétrica da próstata para estimativa do volume da glândula, comparando seus resultados com a ultrassonografia transretal e correlacionando com o volume obtido da peça cirúrgica. Métodos Estudo retrospectivo incluindo 85 pacientes submetidos à ressonância magnética e, posteriormente, à ultrassonografia transretal (para orientação de biópsia com fusão de imagens) e, a seguir, à prostatectomia radical. As dimensões prostáticas foram obtidas na ressonância a partir das imagens nos planos axial e sagital em sequências ponderadas em T2 e, assim como na ultrassonografia, o volume foi calculado a partir do método da elipsoide. Os valores foram comparados com o peso prostático pós-cirúrgico. O intervalo máximo entre a ressonância e ultrassonografia e prostatectomia foi de 6 meses. Resultados O volume prostático obtido por ressonância magnética foi de 18 a 157cm3(média de 49,9cm3); pela ultrassonografia transretal, foi de 22 a 165cm3(média de 54,9cm3); e o peso da peça cirúrgica foi de 20 a 154g (média de 48,6g), sem diferenças estatísticas. A partir do valor obtido por esses métodos de imagem, provou-se que o volume prostático obtido aproximou-se bastante do peso real da próstata, com discreta maior precisão das medidas obtidas por ressonância magnética multiparamétrica. Conclusão As medidas do volume prostático adquiridas pela ressonância magnética e pela ultrassonografia transretal são semelhantes entre si, com excelente concordância com os pesos reais das próstatas obtidos das peças cirúrgicas. A avaliação desse dado, a partir da ressonância, método cada vez mais utilizado na prática clínica, permite o adequado planejamento terapêutico e o controle dos pacientes.

Pitfalls en RM de próstata multiparamétrica / Pitfalls in multiparametric prostate MRI

Resumen: La resonancia magnética multiparamétrica (RMmp) de próstata ha tenido un desarrollo importante en los últimos años dado la alta prevalencia del cáncer de próstata y la necesidad de tener información imagenológica concreta para el correcto manejo de los pacientes urológicos. Otras técnicas de imágenes aportan información parcial sobre la morfología de la próstata, pero es la RMmp de próstata la técnica imagenológica que nos entrega mayor información, a través de secuencias morfológicas y funcionales, para detectar lesiones clínicamente significativas y disminuir el número de biopsias, predecir riesgo de agresividad de los tumores, estadificación local y ayudar al urólogo a realizar biopsias dirigidas cognitivas o por fusión RM/US. En este artículo se pretende mostrar casos representativos de errores frecuentes al momento de informar una resonancia magnética de próstata. Damos algunas recomendaciones para evitar estos errores y mejorar los informes radiológicos. Es común al comenzar a realizar informes de RMmp de próstata tener dudas sobre la correcta interpretación de los hallazgos. Ofrecemos a través de este articulo imágenes representativas de los principales errores en la búsqueda de patología neoplásica y algunas sugerencias para evitarlos. Desde el punto de vista académico se pueden dividir en pitfalls de condiciones anatómicas y patologías benignas que pueden simular un tumor. En el caso de pitfalls anatómicos mostramos casos referentes al estroma fibromuscular anterior hipertrófico, cápsula quirúrgica engrosada, plexo venoso peri-prostático, complejo neurovascular y pseudolesión posterior en zona periférica. Dentro de las condiciones benignas se encuentra la hiperplasia prostática benigna, procesos inflamatorios/infecciosos y otras condiciones que pueden simular tumor. Respecto a pitfalls relacionados con la hiperplasia prostática benigna podemos señalar hiperplasia de la zona de transición / central ("moustache-sign"), proliferación estromal en la zona de transición y nódulos adenomatosos ectópicos u extruidos en la zona periférica (ZP). Pitfalls inflamatorios/infecciosos corresponden a casos de prostatitis focal, prostatitis aguda, prostatitis con abscesos y prostatitis granulomatosa. Otros errores frecuentes de dificultad en la interpretación corresponden a casos de calcificaciones y hemorragia.

Abstract: Multiparameter magnetic resonance imaging (RMmp) of the prostate has had an important development in recent years given the high prevalence of prostate cancer and the need to have specific imaging information for the correct management of urological patients. Other imaging techniques provide partial information about the morphology of the prostate, but it is the mp-MRI of the prostate that gives us more information, through morphological and functional sequences, to detect clinically significant lesions and reduce the number of biopsies, predict risk of aggressiveness of the tumors, local staging and help the urologist to perform cognitive biopsies or by MR / US fusion. This article aims to show representative cases of frequent errors when reporting an MRI of the prostate. We give some recommendations to avoid these errors and improve radiological reports. It is common to start making mp-MRI of the prostate reports having doubts about the correct interpretation of the findings. We offer through this article representative images of the main errors in the search for neoplastic pathology and some suggestions to avoid them. From the academic point of view they can be divided into pitfalls of anatomical conditions and benign pathologies that can simulate a tumor. In the case of anatomical pitfalls, we show cases related to the hypertrophic anterior fibromuscular stroma, thickened surgical capsule, peri-prostatic venous plexus, neurovascular complex and posterior pseudo-injury in the peripheral area. Among the benign conditions is benign prostatic hyperplasia, inflammatory / infectious processes and other conditions that can simulate tumor. Regarding pitfalls related to benign prostatic hyperplasia, we can indicate hyperplasia of the transition / central zone ("mustache-sign"), stromal proliferation in the transition zone and ectopic or extruded adenomatous nodules in the peripheral zone. Inflammatory / infectious pitfalls correspond to cases of focal prostatitis, acute prostatitis, prostatitis with abscesses and granulomatous prostatitis. Other frequent errors of difficulty in interpretation correspond to cases of calcifications and hemorrhage.

Impact of PI-RADS v2 on indication of prostate biopsy

ABSTRACT Objectives: To identify the group of patients who could safely avoid prostate biopsy based on the findings of multiparametric prostate resonance imaging (MRmp), parameterized with PI-RADS v2, using prostate biopsy as reference test and to assess the sensitivity and specificity of mpMR in identifying clinically significant prostate cancer using prostate biopsy as a reference test. Patients and Methods: Three hundred and forty two patients with suspected prostate cancer were evaluated with mpMR and prostate biopsy. Agreement between imaging findings and histopathological findings was assessed using the Kappa index. The accuracy of mpMR in relation to biopsy was assessed by calculations of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 342 biopsies were performed. In 201 (61.4%), mpMR had a negative result for cancer, which was confirmed on biopsy in 182 (53%) of the cases, 17 (4.9%) presented non-clinically significant cancer and only 2 (0.5%) clinically significant cancer. 131 (38.3%) patients had a positive biopsy. Clinically significant cancer corresponded to 83 (34.2%), of which 81 (97.5%) had a positive result in mpMR. Considering only the clinically significant cancers the mpMR had a sensitivity of 97.6%, specificity of 76.8%, PPV 57.4% and VPN of 99%. Conclusions: mpMR is a useful tool to safely identify which patients at risk for prostate cancer need to undergo biopsy and has high sensitivity and specificity in identifying clinically significant prostate cancer.

Absceso prostático: revisión de la literatura / Prostatic abscess: literature review

El absceso prostático es una entidad urológica con poca evidencia estadísticamente significativa y pocos estudios que permitan realizar una guía de manejo estandarizada. Se define como la presencia de una o varias colecciones purulentas en la próstata (1), que con un diagnóstico temprano y adecuado manejo médico y/o quirúrgico, tiene una baja morbimortalidad. La presente revisión de tema, reúne los estudios más recientes y sobresalientes en el diagnóstico y manejo de esta patología, de modo que en un futuro se pueda estandarizar el manejo entre los especialistas en esta área.

Prostatic abscess is an urological entity with few statistical significant evidence that allows us to stablish a standardized management guide. It is defined as one or multiple supurative collections in the prostate, which has a low morbidity and mortality with early diagnosis and appropriate management. The next review, group the most important and recent studies in this pathology, so that in the future we could stablish a standardized managent among tthe urologists.

The association between the outcomes of extraperitoneal laparoscopic radical prostatectomy and the anthropometric measurements of the prostate by magnetic resonance imaging

ABSTRACT Introduction and objective To determine the association between the anthropometric measurements by magnetic resonance imaging (MRI) and perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy (ELRP). Materials and Methods From 2008 to June 2016, 86 patients underwent preoperative MRI prior to undergoing ELRP for localized prostate cancer. We analyzed the associations between anthropometric measurements of MRI and the perioperative outcomes of patients who underwent ELRP. Results The mean patient age was 69.61±8.30 years. The medians of operating time and blood loss were 2.30 hours and 725.30ml, respectively. The total post-surgical complication rate was 1.16%. The median hospital stay was 6.50 days. The pathological stages for T2 and T3 were 45.74% and 34.04%, respectively. The rate as positive surgical margins (PSMs) was 18.09% (pT2 and pT3; 6.38% and 9.57%). The angles between pubic bone and prostate gland (angle 1&2), were significantly associated with operative time and hospital stay, respectively (p<0.05). There was no correlation between the pelvimetry and positive surgical margin. Conclusions The findings of the present study suggest that anthropometric measurements of the MRI are related to operative difficulties in ELRP. This study confirmed that MRI planning is the key to preventing complications in ELRP.

Biopsia de próstata transrrectal bajo guía ecográfica y fusión con resonancia magnética: experiencia inicial en pacientes con biopsia previa negativa / Transrectal Prostate Biopsy under Ultrasound Guidance and Magnetic Resonance Fusion: Intial Experience in Patients with Negative Previous Biopsy

Objetivos: Analizar la performance diagnóstica de la punción biopsia prostática (PBP) guiada mediante ecografía con fusión de imágenes de resonancia magnética (RM) para la detección del cáncer de próstata (CP) en pacientes con biopsia previa negativa. Materiales y métodos: Se analizaron todas las PBP transrrectales dirigidas bajo ecografía con fusión de imágenes de RM en pacientes mayores de 40 años de edad con sospecha de CP y biopsia previa randomizada negativa efectuadas durante el período comprendido entre enero de 2015 y enero de 2018. Se calculó la sensibilidad, especificidad, valor predictivo positivo y negativo de dicho procedimiento. Resultados: De un total de 40 pacientes, 25 cumplieron los criterios de inclusión. La PBP transrrectal guiada bajo ecografía con fusión de imágenes de RM presentó una sensibilidad del 90% en la detección de CP clínicamente significativo (CPsig), mostrando una mejoría en la detección del 20% respecto de la biopsia randomizada. Conclusiones: La PBP transrrectal guiada con ecografía y fusión de imágenes de RM mejora la performance en la detección de CPsig en pacientes con biopsia previa negativa(AU)

Objective: To analyze the diagnostic performance of transrectal prostate US (ultrasonography) guided biopsy with magnetic resonance imaging (MRI) fusion in the detection of prostate cancer in patients with negative previous biopsy. Materials and methods: Between January 2015 to January 2018, transrectal prostate biopsies under US guided with MRI fusion were performed in patients older than 40 years with suspicion of prostate cancer and prior negative biopsy. Sensitivity, specificity, positive and negative predictive value of the procedure were analyzed. Results: Out of a total of 40 patients, 25 met the inclusion criteria. Transrectal prostate US guided biopsy with MRI fusion presented a sensitivity of 90%, showing an improvement of 20% in the clinically significant prostate cancer detection compared with randomized biopsy. Conclusions: Transrectal prostate US guided biopsy with MRI fusion showed high performance in the detection of significative prostate cancer in patients with negative previous biopsy(AU)

Predictive role of Trimprob associated with multiparametric MRI in the diagnosis of prostate cancer

ABSTRACT Objectives To evaluate the predictive value of TRIMprob test to detect prostate cancer (PCa) in patients referred to prostate biopsy (PB). Material and Methods Patients with PSA <10ng/mL and rectal exam without findings suggestive of prostate cancer were selected for TRIMprob evaluation. Exam was performed by a single operator through transperineal approach. Patients admitted for the study were submitted to TRIMprob and multiparametric magnetic resonance (mpMRI) and posteriorly to PB. Results In total, 77 patients were included. TRIMprob showed evidences of PCa in 25 (32.5%) and was negative in 52 patients (67.5%). The rate of detection of prostate cancer at biopsy was higher in patients with positive TRIMprob (16/25; 64.0%) than in patients with negative TRIMprob (11/52; 21.1%; p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of TRIMprob were respectively 61.5%, 82.0%, 64.0%, 80.3% and 74.0%. ROC curve showed the following areas under the curve values for TRIMprob, mpMRI and combination of TRIMprob + mpMRI: 0.706; 0.662 and 0.741 respectively. At combined analysis, when both TRIMprob and mpMRI were negative for prostate cancer, accuracy was 96.3% or only 1 in 27 PB was positive (3.7%). Conclusions Trimprob had similar predictive value for PCa in patients submitted to PB as mpMRI. Combined TRIMprob and mpMRI showed higher accuracy than when performed singly.

Prostate cancer detection using multiparametric 3 – tesla MRI and fusion biopsy: preliminary results

ABSTRACT Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.

Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies

ABSTRACT Introduction: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. Materials and Methods: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded. Results: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. Conclusion: Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

Prostate MRI: a national survey of urologist's attitudes and perceptions

ABSTRACT Introduction The use of multi-parametric (MP) MRI to diagnose prostate cancer has been the subject of intense research, with many studies showing positive results. The purpose of our study is to better understand the accessibility, role, and perceived accuracy of MP-MRI in practice by surveying practicing urologists. Materials and Methods Surveys were sent to 7,400 practicing American Urological Association member physicians with a current email address. The survey asked demographic information and addressed access, accuracy, cost, and role of prostate MRI in clinical practice. Results Our survey elicited 276 responses. Respondents felt that limited access and prohibitive cost of MP-MRI limits its use, 72% and 59% respectively. Academic urologists ordered more MP-MRI studies per year than those in private practice (43.3% vs. 21.1%; p<0.001). Urologists who performed more than 30 prostatectomies a year were more likely to feel that an MP-MRI would change their surgical approach (37.5% vs. 19.6%, p-value=0.002). Only 25% of respondents agreed or strongly agreed that MP-MRI should be used in active surveillance. For patients with negative biopsies and elevated PSA, 39% reported MP-MRI to be very useful. Conclusions Our study found that MP-MRI use is most prominent among practitioners who are oncology fellowship-trained, practice at academic centers, and perform more than 30 prostatectomies per year. Limited access and prohibitive cost of MP-MRI may limit its utility in practice. Additionally, study participants perceive a lack of accuracy of MP-MRI, which is contrary to the recent literature.

Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL

ABSTRACT Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

Visually Estimated MRI Targeted Prostate Biopsy Could Improve the Detection of Significant Prostate Cancer in Patients with a PSA Level <10 ng/mL

PURPOSE: To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL. MATERIALS AND METHODS: In total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core). RESULTS: The mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001). CONCLUSION: MRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL.

Community-based research on the benign prostatic hyperplasia prevalence rate in Korean rural area

PURPOSE: We investigated the prevalence rate of benign prostatic hyperplasia (BPH) among Korean males in a rural area through a cross-sectional, community-based epidemiologic survey and analyzed the correlation with epidemiologic factors. MATERIALS AND METHODS: A total of 779 males who lived in Yangpyeong County participated in a prostate examination campaign. Targeting these men, we collected the International Prostate Symptom Score (IPSS), medical history, demographic information, serum prostate-specific antigen, and prostate volume as measured by transrectal ultrasonography. The data for 599 participants were analyzed, excluding 180 men who had a possibility of prostate cancer. BPH was defined as an IPSS of 8 points or higher and a prostate volume of 25 mL or more. RESULTS: The prevalence rate of BPH was 20.0%. The prevalence rate increased with age. There were 2 subjects (4.4%) in the age group of 40-49 years, 18 subjects (10.9%) in the age group of 50-59 years, 44 subjects (22%) in the age group of 60-69 years, and 56 subjects (26.6%) in the age group of over 70 years; this increase with age was statistically significant (p<0.001). In the BPH group, the average IPSS was 14.67+/-5.95, the average prostate volume was 37.04+/-11.71 g, and the average prostate-specific antigen value was 1.56+/-0.88 ng/mL. In the analysis of correlations between the epidemiologic factors and the risk of BPH, smoking was the only statistically significant factor. CONCLUSIONS: The total prevalence rate of BPH in this study was 20.0%, which was a little lower than the rate reported in other cities or rural areas.

Body mass index, waist-to-hip ratio, and metabolic syndrome as predictors of middle-aged men's health

PURPOSE: There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. MATERIALS AND METHODS: A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. RESULTS: By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. CONCLUSIONS: Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.

Hemosepermia after transrectal ultrasound-guided prostatic biopsy: a prospective study

Trans-rectal ultrasound [TRUS] is a safe, cost-effective, radiation-free imaging modality for evaluation of prostate. But unfortunately, hemospermia is known to be associated with TRUS-guided prostate biopsy. The aim of this study is to measure the incidence and risk factors of hemospermia in patients undergoing TRUS. A prospective observational study involving patients undergoing TRUS for suspected prostate cancer has been conducted at AI-Hussein and Sayed Galal Hospitals. Forty patients were included in the study. Most men [90% = 36 patient] undergoing TRUS-guided prostatic biopsy, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 4 [+/- 1.4] weeks. The number of ejaculations before the complete resolution of hemospermia was 6 [+/- 5.6]. None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-guided prostatic biopsy to avoid anxiety and alterations in sexual activity