Prevalence and grade of malignancy differences with respect to the area of involvement in multiparametric resonance imaging of the prostate in the diagnosis of prostate cancer using the PI-RADS version 2 classification.

PURPOSE: The peripheral zone is histologically different from the transitional zone. The aim of this study is to analyze the differences between the prevalence and grade of malignancy of mpMRI-targeted biopsies that involve the TZ with respect to the PZ. METHODS: A cross-sectional study of 597 men evaluated for PC screening between February 2016 and October 2022 was conducted. Exclusion criteria were prior BPH surgery, radiotherapy, 5-alpha-reductase inhibitors treatment, UTI, mixed involvement of PZ-TZ or doubts, and central-zone involvement. Hypothesis contrast test was used to study differences proportions of malignancy (ISUP > 0) and significant (ISUP > 1) and high-grade tumor (ISUP > 3) in PI-RADSv2 > 2-targeted biopsies in PZ with respect to TZ, and logistic regression and hypothesis contrast tests were used to study the influence of the area of exposure as an effect-modifying factor in the diagnosis of malignancy with respect to the PI-RADSv2 classification. RESULTS: 473 patients were selected and 573 lesions biopsied (127 PI-RADS3, 346 PI-RADS4 and 100 PI-RADS5). A significant increase was described in the proportion of malignancy and significant and high-grade tumor in PZ compared to TZ (22.6%, 21.3%, and 8.7%, respectively). Significant increase in proportions and malignancy were described in cores targeted to PZ with respect to TZ, highlight the differences between PZ and TZ for ST (37.3%vs23.7% for PI-RADS4, 69.2%vs27.3% for PI-RADS5, respectively). Statistically significant linear trend was described increasing for malignancy, significant and high-grade tumors with respect to the PI-RADSv2 scores (change > 10%). CONCLUSION: Although the prevalence and grade of malignancy in the TZ is lower than in the PZ, PI-RADS4 and 5-targeted biopsies should not be omitted in this location, but PI-RADS3 could be.

Diagnostic evaluation and incorporation of PSA density and the prostate imaging and data reporting system (PIRADS) version 2 classification in risk-nomograms for prostate cancer.

PURPOSE: The diagnostic approach for prostate cancer still depends on PSA and DRE. OBJECTIVES: to evaluate the diagnostic validity of PSA-Density and PIRADSv2 as diagnostic tests regarding biopsy results, and to design nomograms that include all diagnostic variables for malignancy, significant tumor (ST) and high-grade tumor. METHODS: Cross-sectional study which included men with PSA ≥ 4 ng/ml and/or suspicious DRE, PIRADSv2 ≥ 3 lesions on multiparametric MRI and prostate biopsy. The gold standard test was the maximum ISUP of the targeted biopsy per patient (malignancy: ISUP ≥ 1, ST: ISUP ≥ 2, high-grade tumor: ISUP ≥ 4). Association and logistic regression tests were used and diagnostic validity parameters using PSA-Density and PIRADSv2 classification was analyzed. Nomograms were designed for malignancy, ST, and high-grade tumor using the best model selection procedure from all possible equations. RESULTS: 336 men with median age, PSA and PSA-Density of 67.7 years (IQR:12.6), 6.3 ng/ml (IQR:3.3) and 0.12 ng/ml/cc (IQR:0.10), respectively; 63 index lesions were PIRADS3, 204 PIRADS4, and 69 PIRADS5. 65.8% and 37.8% were malignant and ST, respectively. The significant positive association highlighted between malignancy and ST with age, DRE, PSA-Density and PIRADSv2. PSA-Density and PIRADSv2 ≥ 3 presented the highest sensitivity to detect malignancy, and their combination showed sensitivity nearly 95% (AUC:0.803). Nomograms for malignancy and ST included the variables age, DRE, PSA-Density, and PIRADSv2 with a sensitivity closely 91% (AUC:0.833), and a specificity of almost 85% for ST, exposing risk < 5% for ST when PSA-Density is < 0.15, not suspicious DRE and PIRADS3. CONCLUSION: PSA-Density and PIRADSv2 classification in risk nomograms can provide highly relevant information to increase the accuracy in the diagnosis of PC and ST.

A rare case of penile metastases from small cell prostate cancer / Un caso inusual de metástasis peneanas en el carcinoma prostático de células pequeñas

We present a case of an 83-year-old-male with painless penile nodules several months after he was diagnosed with pure prostatic small cell carcinoma. Penile doppler ultrasound and magnetic resonance imaging demonstrated solid nodules in both corpora cavernosa. Fine-needle aspiration of the nodules with immunohistochemical examination confirmed prostatic small cell carcinoma origin of metastases. Small cell carcinoma of the prostate is a rare disorder accounting for less than 1% of all prostate cancers, the penis being an uncommon site for metastasis. An extremely low number of cases of penile metastases from prostatic small cell carcinoma has been reported to date in the literature

Presentamos un caso de un varón de 83 años con nódulos peneanos indoloros, tras ser diagnosticado meses atrás de carcinoma prostático de células pequeñas puro. La eco-doppler e imagen de resonancia magnética de pene reflejaron nódulos sólidos en ambos cuerpos cavernosos. La aspiración con aguja fina de los nódulos con prueba inmunohistoquímica confirmó el origen metastásico del carcinoma de células pequeñas. El carcinoma prostático de células pequeñas es un trastorno inusual que representa menos del 1% de todos los cánceres prostáticos, siendo el pene un sitio infrecuente de metástasis. Hasta la fecha se ha reportado en la literatura un número de casos extremadamente bajo de metástasis peneanas en el carcinoma de próstata de células pequeñas

A rare case of penile metastases from small cell prostate cancer.

We present a case of an 83-year-old-male with painless penile nodules several months after he was diagnosed with pure prostatic small cell carcinoma. Penile doppler ultrasound and magnetic resonance imaging demonstrated solid nodules in both corpora cavernosa. Fine-needle aspiration of the nodules with immunohistochemical examination confirmed prostatic small cell carcinoma origin of metastases. Small cell carcinoma of the prostate is a rare disorder accounting for less than 1% of all prostate cancers, the penis being an uncommon site for metastasis. An extremely low number of cases of penile metastases from prostatic small cell carcinoma has been reported to date in the literature.

Evaluación del sistema PI-RADSv2 en una cohorte de pacientes sometidos a biopsia prostática por fusión / Evaluation of the PI-RADSv2 classification in a cohort of patients who underwent a prostate fusion biopsy

INTRODUCCIÓN: La biopsia prostática por fusión se describe como superior a la biopsia transrectal sistemática para identificar lesiones sospechosas de carcinoma de próstata. OBJETIVOS: Evaluar la clasificación PIRADS propuesto por la Sociedad Europea de Radiología Urogenital para la detección de cáncer de próstata mediante RNM en una cohorte consecutiva de pacientes con RNM y biopsia guiada por fusión. MATERIAL Y MÉTODOS: Estudio observacional transversal. 87 pacientes con sospecha de cáncer de próstata sometidos a biopsia de próstata transperineal y fusión con RNM en nuestro centro. Describimos tumor significativo como Gleason ≥ 7(3 + 4), y carcinoma de alto riesgo como Gleason ≥ 8. Utilizamos la prueba de Chi-cuadrado para analizar la relación entre cáncer de próstata y PIRADS, así como regresión logística y pruebas de tendencia lineal, comparando las proporciones con medidas de intensidad de asociación. Empleamos el sistema HITACHI Real-Time Virtual Sonography y el software STATA/IC v.14.2 para el análisis estadístico. RESULTADOS: 64,37% pacientes presentaron resultado positivo para malignidad. Media de edad 67,89 años (SD 7,42), de PSA total 9,15 ng/ml (SD 7,85), y de volumen prostático 54,05 cc (SD 22,92). Se biopsiaron 124 lesiones sospechosas en RNM (25% PIRADS III, 57,26% PIRADS IV y 17,74% PIRADS V). 5/31 lesiones PIRADS III, 47/71 PIRADS IV y 18/22 PIRADS V fueron positivas para malignidad, con relación lineal estadísticamente significativa entre PIRADS y malignidad (p < 0,001), razón de prevalencias (RP) 4,10 (IC95% 1,81-9,32) para PIRADS IV, y RP 5,07 (CI95% 2,2211,59) para PIRADS V respecto a PIRADS III. 3,23% lesiones PIRADS III, 32,39% PIRADS IV y 63,64% PIRADS V correspondieron a tumores significativos. Encontramos asociación estadísticamente significativa entre PIRADS y tumores significativos (p < 0,001), RP 10,04 (IC95% 1,42-71,09) para PIRADS IV y RP 19,73 (IC95% 2,80139,18) para PIRADS V respecto a PIRADS III. CONCLUSIÓN: Nuestros resultados muestran que la biopsia de próstata ecodirigida y por fusión utilizando RNM es una técnica segura con excelentes resultados para obtener un diagnóstico preciso de cáncer de próstata, y puede mejorar el diagnóstico de malignidad y de tumores significativos reduciendo el sobrediagnóstico

INTRODUCTION: Prostate Fusion biopsy (MRI + prostate ultrasound) is described in literature as superior to classic random transrectal biopsy in order to identify suspicious lesion. OBJECTIVES: To evaluate the Prostate Imaging Reporting and Data System (PI-RADS) proposed by the European Society of Urogenital Radiology (ESUR) for detection of prostate cancer by multiparametric MRI in a consecutive cohort of patients with MRI and transrectal ultrasound prostate fusion-guided biopsy. MATERIAL AND METHODS: 87 patients with suspected Prostatic Cancer on prostate MRI underwent fusion transperineal prostate biopsy in our Department. 37 patients had at least one prior negative classic prostatic transrectal biopsy. Clinically significant tumor was described as Gleason 7(3+4) or higher. The Chi-square test was used to analyze the relationship between prostate cancer and the different PIRADS stages, as well as logistic regression and linear trend tests, comparing the proportions using measures of association intensity. We use the HITACHI Real-Time Virtual Sonography (HI-RVS) system, and the STATA/IC v.14.2 software for statistical analysis. RESULTS: 64.37% patients had tested positive for malignancy. Median age 67.89 years old. Median PSA 9.15 ng/ml, and average prostate volume was 54.05 cc. 124 suspicious lesions were described in prostate MRI (25% PIRADS III, 57% PIRADS IV and 17% PIRADS V). 5/31 lesions PIRADS III, 47/71 PIRADS IV and 18/22 PIRADS V were positive for malignancy, with a statistically significant linear relationship between PIRADS and malignancy (p < 0.001) - HR 4.10 (CI 95% 1.81 to 9.32) for PIRADS IV and HR 5.07 (CI95% 2.22 to 11.59) for PIRADS V vs. PIRADS III. 3.23% lesions PIRADS III, 32.39% PIRADS IV and 63.64% PIRADS V corresponded to significant tumors. A statistically significant association between PIRADS and significant tumors (p < 0.001) - HR 10.04 (CI95% 1.42 to 71.09) for PIRADS IV and HR 19.73 (CI95% 2.80 to 139.18) for PIRADS V vs PIRADS III was observed -. CONCLUSION: Our results show that transperineal targeted prostate biopsy using multiparametric MRI and transrectal ultrasound fusion is a safe procedure with excellent outcomes to obtain an accurate diagnosis of prostate cancer. Fusion biopsy has the potential to improve the diagnosis of malignancy and clinically significant tumors while reducing overdiagnosis

[Evaluation of the PI-RADSv2 classification in a cohort of patients who underwent a prostate fusion biopsy.] / Evaluación del sistema PI-RADSv2 en una cohorte de pacientes sometidos a biopsia prostática por fusión.

INTRODUCTION: Prostate Fusion biopsy (MRI + prostate ultrasound) is described in literature as superior to classic random transrectal biopsy in order to identify suspicious lesion. OBJECTIVES: To evaluate the Prostate Imaging Reporting and Data System (PI-RADS) proposed by the European Society of Urogenital Radiology (ESUR) for detection of prostate cancer by multiparametric MRI in a consecutive cohort of patients with MRI and transrectal ultrasound prostate fusion-guided biopsy. MATERIAL AND METHODS: 87 patients with suspected Prostatic Cancer on prostate MRI underwent fusion transperineal prostate biopsy in our Department. 37 patients had at least one prior negative classic prostatic transrectal biopsy. Clinically significant tumor was described as Gleason 7(3+4) or higher. The Chi-square test was used to analyze the relationship between prostate cancer and the different PIRADS stages, as well as logistic regression and linear trend tests, comparing the proportions using measures of association intensity. We use the HITACHI Real-Time Virtual Sonography (HI-RVS) system, and the STATA/IC v.14.2 software for statistical analysis. RESULTS: 64.37% patients had tested positive for malignancy. Median age 67.89 years old. Median PSA 9.15 ng/ml, and average prostate volume was 54.05 cc. 124 suspicious lesions were described in prostate MRI (25% PIRADS III, 57% PIRADS IV and 17% PIRADS V). 5/31 lesions PIRADS III, 47/71 PIRADS IV and 18/22 PIRADS V were positive for malignancy, with a statistically significant linear relationship between PIRADS and malignancy (p<0.001) - HR 4.10 (CI 95% 1.81 to 9.32) for PIRADS IV and HR 5.07 (CI95% 2.22 to 11.59) for PIRADS V vs. PIRADS III. 3.23% lesions PIRADS III, 32.39% PIRADS IV and 63.64% PIRADS V corresponded to significant tumors. A statistically significant association between PIRADS and significant tumors (p<0.001) - HR 10.04 (CI95% 1.42 to 71.09) for PIRADS IV and HR 19.73 (CI95% 2.80 to 139.18) for PIRADS V vs PIRADS III was observed -. CONCLUSION: Our results show that transperineal targeted prostate biopsy using multiparametric MRI and transrectal ultrasound fusion is a safe procedure with excellent outcomes to obtain an accurate diagnosis of prostate cancer. Fusion biopsy has the potential to improve the diagnosis of malignancy and clinically significant tumors while reducing overdiagnosis.

INTRODUCCIÓN: La biopsia prostática por fusión se describe como superior a la biopsia transrectal sistemática para identificar lesiones sospechosas de carcinoma de próstata.OBJETIVOS: Evaluar la clasificación PIRADS propuesto por la Sociedad Europea de Radiología Urogenital para la detección de cáncer de próstata mediante RNM en una cohorte consecutiva de pacientes con RNM y biopsia guiada por fusión.MATERIAL Y MÉTODOS: Estudio observacional transversal. 87 pacientes con sospecha de cáncer de próstata sometidos a biopsia de próstata transperineal y fusión con RNM en nuestro centro. Describimos tumor significativo como Gleason ≥7(3+4), y carcinoma de alto riesgo como Gleason ≥8. Utilizamos la prueba de Chi-cuadrado para analizar la relación entre cáncer de próstata y PIRADS, así como regresión logística y pruebas de tendencia lineal, comparando las proporciones con medidas de intensidad de asociación. Empleamos el sistema HITACHI Real-Time Virtual Sonography y el software STATA/IC v.14.2 para el análisis estadístico.RESULTADOS: 64,37% pacientes presentaron resultado positivo para malignidad. Media de edad 67,89 años (SD7,42), de PSA total 9,15 ng/ml (SD7,85), y de volumen prostático 54,05 cc (SD22,92). Se biopsiaron 124 lesiones sospechosas en RNM (25% PIRADS III, 57,26% PIRADS IV y 17,74% PIRADS V). 5/31 lesiones PIRADS III, 47/71 PIRADS IV y 18/22 PIRADS V fueron positivas para malignidad, con relación lineal estadísticamente significativa entre PIRADS y malignidad (p<0,001), razón de prevalencias (RP) 4,10 (IC95% 1,81-9,32) para PIRADS IV, y RP 5,07 (CI95% 2,2211,59) para PIRADS V respecto a PIRADS III. 3,23% lesiones PIRADS III, 32,39% PIRADS IV y 63,64% PIRADS V correspondieron a tumores significativos. Encontramos asociación estadísticamente significativa entre PIRADS y tumores significativos (p<0,001), RP 10,04 (IC95% 1,42-71,09) para PIRADS IV y RP 19,73 (IC95% 2,80139,18) para PIRADS V respecto a PIRADS III.CONCLUSIÓN: Nuestros resultados muestran que la biopsia de próstata ecodirigida y por fusión utilizando RNM es una técnica segura con excelentes resultados para obtener un diagnóstico preciso de cáncer de próstata, y puede mejorar el diagnóstico de malignidad y de tumores significativos reduciendo el sobrediagnóstico.

Bear Paw Sign: Xanthogranulomatous Pyelonephritis.

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis in which the involved areas of the kidneys are destroyed and replaced by foam cells. It usually occurs in immunocompromised middle-aged females with ureteral obstruction or chronic urinary tract infection induced by the formation of renal stones. We herein report the case of a 44-year-old woman, with a history of left kidney staghorn calculi and recurrent urinary tract infections. Abdominal computed tomography showed the 'bear paw' sign, typical appearance of XGP and patient underwent a nephrectomy with uneventful post-operative course.

[Analysis of success predictive factors in the treatment of urinary lithiasis by extracorporeal shock wave lithotripsy. patient optimization: ESWL score.] / Análisis de los factores predictores de éxito en el tratamiento de la litiasis urinaria mediante litotricia extracorpórea por ondas de choque. Optimización de la selección de pacientes: Score LEOC.

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) represents one of the most frequently used methods to treat urinary tract calculi. However, sometimes we do not obtain the fragmentation expected. The aim of this study is to evaluate the parameters that may influence ESWL final results, developing a classification for better patient's selection and outcome optimization. METHODS: 270 patients with renal or ureteral stones were retrospectively reviewed after ESWL treatment, recording both clinical parameters (age, sex, location, laterality, body mass index [BMI]), and CT-Scan parameters (stone size and volume, skin-to-stone distance (SSD), mean and maximal stone density). Cutoff values were determined for each parameter based upon ROC curves, and final score (ESWL score) was calculated based on the number of parameters lower than the cutoff values. RESULTS: Of the 270 patients treated, 186 (68.8%) were considered as ESWL success, without significant differences between success and failure group. Parameters that showed significant difference after multivariate analysis were: size (cut off: 9.3 mm), volume (237.2 mm3), mean density (951 UH), SSD (133 mm) and BMI (26.9 kg/m2). AUC of ROC curve including all of these parameters, was 0.807. Stone free status was 17.6% for score 0, 25% (score 1), 48.8% (score 2), 74.1% (score 3), 86.3% (score 4) and 92.2% for score 5. CONCLUSIONS: Patient classification before ESWL treatment seems to allow us better selection, improving treatment success.

Análisis de los factores predictores de éxito en el tratamiento de la litiasis urinaria mediante litotricia extracorpórea por ondas de choque. Optimización de la selección de pacientes: Score LEOC / Analysis of success predictive factors in the treatment of urinary lithiasis by extracorporeal shock wave lithotripsy. patient optimization: ESWL score

OBJETIVO: La litotricia extracorpórea por ondas de choque (LEOC) representa actualmente una de las opciones más frecuentemente empleadas para tratar la litiasis del tracto urinario. Sin embargo, en algunos casos no se obtiene una fragmentación adecuada tras la misma. El objetivo de este trabajo es evaluar los factores predictores de éxito la litotricia extracorpórea, estableciendo una clasificación para una mejor selección de los pacientes y optimización de los resultados. MÉTODOS: 270 pacientes con litiasis renal y ureteral fueron evaluados retrospectivamente tras el tratamiento con LEOC, registrando tanto las características demográficas (edad, sexo, localización, lateralidad, índice de masa corporal [IMC]), como los parámetros tomográficos (tamaño y volumen litiásicos, distancia piel cálculo [DPC], densidad media y máxima del cálculo).establecieron puntos de corte para cada variable en función del resultado de las curvas ROC, asignando a cada paciente una puntuación final (score LEOC) en función del número de parámetros por debajo del valor del punto de corte establecido. RESULTADOS: De los 270 pacientes tratados, 186 (68.8%) se consideraron éxito del tratamiento. No se registraron diferencias estadísticamente significativas en las características demográficas entre los grupos éxito y fracaso del tratamiento. Las variables que resultaron significativas tras el análisis multivariante fueron: tamaño (punto de corte: 9,3 mm), volumen (237,2 mm3), densidad media (951 UH), DPC (133 mm) e IMC (26,9 kg/m2). El AUC de la curva ROC del score LEOC, que incluye todos estos parámetros, fue de 0,807. La tasa de aclaramiento litiásico (AL) fue de 17,6% (score 0), 25% (score 1), 48,8% (score 2), 74,1% (score 3), 86,3% (score 4) y 92,2% (score 5). CONCLUSIONES: La clasificación de los pacientes previamente al tratamiento mediante LEOC permite una mejor selección de los mismos, pudiendo aumentar el éxito del tratamiento

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) represents one of the most frequently used methods to treat urinary tract calculi. However, sometimes we do not obtain the fragmentation expected. The aim of this study is to evaluate the parameters that may influence ESWL final results, developing a classification for better patient's selection and outcome optimization. METHODS: 270 patients with renal or ureteral stones were retrospectively reviewed after ESWL treatment, recording both clinical parameters (age, sex, location, laterality, body mass index [BMI]), and CT-Scan parameters (stone size and volume, skin-to-stone distance (SSD), mean and maximal stone density). Cutoff values were determined for each parameter based upon ROC curves, and final score (ESWL score) was calculated based on the number of parameters lower than the cutoff values. RESULTS: Of the 270 patients treated, 186 (68.8%) were considered as ESWL success, without significant differences between success and failure group. Parameters that showed significant difference after multivariate analysis were: size (cut off: 9.3 mm), volume (237.2 mm3), mean density (951 UH), SSD (133 mm) and BMI (26.9 kg/m2). AUC of ROC curve including all of these parameters, was 0.807. Stone free status was 17.6% for score 0, 25% (score 1), 48.8% (score 2), 74.1% (score 3), 86.3% (score 4) and 92.2% for score 5. CONCLUSIONS: Patient classification before ESWL treatment seems to allow us better selection, improving treatment success