Should Targeted Biopsy be Performed in Patients Who Have Only Pi-rads 3 Lesions?

Objective: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Patients and Methods: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a software guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Urooncology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. Results: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion- based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG ≥ 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53–0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51–0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15–10.91], p = 0.024). Conclusion: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions (AU)

Factores para predecir los resultados de la litotricia por ondas de choque en pacientes pediátricos y validación externa de un nomograma / Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram

OBJETIVO: Evaluar la exactitud del nomograma de Dogan para predecir la tasa libre de cálculos (LC) tras una única sesión de litotricia extracorpórea por ondas de choque (LEOCH) y evaluar factores predictivos de los resultados de LEOCH en niños. PACIENTES Y MÉTODOS: En el estudio participaron 68 pacientes menores de 18 años que habían sido tratados con LEOCH en nuestro centro terciario desde enero de 2010 hasta diciembre de 2016, por cálculos radiopacos del tracto urinario superior. La media de edad fue de 50 meses (6-207) y la media del período de seguimiento, de 9 meses (4-50). Se excluyeron los pacientes con litiasis cistínica, anomalía renal, derivación urinaria y litiasis múltiples localizadas en diferentes cálices, igual que en el estudio del nomograma original. El estatus LC se evaluó mediante la realización de radiografía simple de abdomen y ecografía urinaria 2 semanas después de cada sesión de LEOCH. Los pacientes que estaban completamente libres de cálculos fueron considerados LC. Se realizaron análisis de regresión logística múltiple para determinar las variables que afectan el estado de LC. El método bootstrap con 1.000 repeticiones se utilizó para la validación externa del nomograma desarrollado por Dogan. RESULTADOS: Las tasas de LC para cada sesión de LEOCH fueron de 54,4% (37/68) para la primera sesión, de 33,3% (7/21) para la segunda y de 55,6% (5/9) para la tercera. En total, la tasa de LC fue del 72,1% (49/68). El análisis de regresión logística múltiple mostró correlaciones positivas y significativas entre la edad y el tamaño del cálculo, y el riesgo de fracaso al tratamiento con LEOCH. El gráfico de calibración externa mostró una validación aceptable respecto al nomograma de Dogan para predecir el fracaso de LEOCH en la primera sesión. CONCLUSIÓN: Nuestro estudio demostró que el nomograma de Dogan se puede utilizar para predecir el estado LC tras una sesión de LEOCH en pacientes pediátricos

OBJECTIVE: To evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. PATIENTS AND METHODS: The study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50 (6-207) months and median follow-up period is 9 (4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography 2 weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1,000 replicates was used for the external validity of a nomogram developed by Dogan. RESULTS: SF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. CONCLUSION: Our study demonstrates that the Dogan nomogram can be used to predict the SF status after one session of SWL in pediatric patients

Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram. / Factores para predecir los resultados de la litotricia por ondas de choque en pacientes pediátricos y validación externa de un nomograma.

OBJECTIVE: To evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. PATIENTS AND METHODS: The study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50 (6-207) months and median follow-up period is 9 (4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography 2 weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1,000 replicates was used for the external validity of a nomogram developed by Dogan. RESULTS: SF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. CONCLUSION: Our study demonstrates that the Dogan nomogram can be used to predict the SF status after one session of SWL in pediatric patients.