Role of contrast-enhanced ultrasound in the differentiation of high- and low-grade urothelial carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the role of contrast-enhanced ultrasound in the differential diagnosis of high- and low-grade urothelial carcinoma.</p><p><b>METHODS</b>The radiological data of 96 patients with urothelial carcinomas who had undergone gray-scale contrast-enhanced ultrasound from August 2010 to April 2011 were analyzed retrospectively. Pathological examination demonstrated that the tumors were high-grade in 55 cases (high-grade group) and low-grade in 41 cases (low-grade group). The dynamic images were analyzed by time-intensity curve, and the arrival time (AT), peak intensity (PI), time to peak (TTP), and washout time (WT) were measured. The enhancement patterns of different urothelial carcinomas were analyzed.</p><p><b>RESULTS</b>Both PI (P=0.005) and WT (P=0.002) were significantly higher in high-grade group than in low-grade group, whereas AT (P=0.374) and TTP (P=0.386) showed no significant difference between these two groups. In the high-grade group, 47 cases (85.5%) were identified as fast wash-in and slow wash-out; in the low-grade group, 35 (85.4%) were identified as fast wash-in and fast wash-out. When the enhancement pattern was used as a diagnostic indicator for differentiating urothelial carcinomas, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 85.5%, 90.2%, 87.5%, 92.2%, and 82.2% for high-grade tumor and 85.4%, 90.9%, 88.5%, 87.5%, and 89.3% for low-grade tumor.</p><p><b>CONCLUSIONS</b>Different grade urothelial carcinomas show different enhancement finding on contrast-enhanced ultrasound. The enhancement pattern can serve as an important diagnostic indicator.</p>

Establishment of a nomogram for predicting positive repeat prostate biopsy in Chinese men / 中华男科学杂志

<p><b>OBJECTIVE</b>To develop a nomogram for predicting the probability of prostate cancer at transrectal ultrasound-guided repeat prostate biopsy in Chinese men.</p><p><b>METHODS</b>We performed repeat biopsy for 170 patients with benign prostate diseases diagnosed on the first biopsy, and analyzed the correlation of positive repeat biopsy with age, prostate volume, PSA, free-to-total PSA (f-PSA/t-PSA), PSA velocity, PSA density, results of digital rectal examination (DRE) and previous histology. We entered the variables stepwise into logistic regression models, and established a nomogram for the risk score on the probability of positive repeat biopsy, whose predictive value was assessed by receiver operating characteristic (ROC) analysis.</p><p><b>RESULTS</b>Prostate cancer was detected in 31.8% of the repeat biopsies (54/170). The most accurate predictive nomogram comprised age, PSA, f-PSA/t-PSA, PSA velocity, prostate volume, DRE and previous prostatic intraepithelial neoplasia (PIN) findings. The nomogram exhibited a high predictive value, with the area under the ROC curve (AUC) of 82.4%, significantly greater than that of the prediction based on PSA density (AUC: 66.9%), prostate volume (AUC: 72.6%), PSA velocity (AUC: 69.6%), f-PSA/t-PSA (AUC: 69.3%), or DRE (AUC: 58.5% ) alone.</p><p><b>CONCLUSION</b>The nomogram is an accurate multi-variable predicting tool to determine the probability of positive repeat prostate biopsy.</p>

Role of transrectal real-time tissue elastography in the diagnosis of prostate cancer.

OBJECTIVE: To investigate the role of transrectal real-time tissue elastography (TRTE) in the diagnosis of prostate cancer (PCa). METHODS: Eighty-four patients with suspected PCa and scheduled for prostate biopsies underwent TRTE, digital rectal examination (DRE), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI). The findings of TRTE were compared with those of other examinations and pathological findings. RESULTS: Of these 84 patients, 36 had benign lesions and 48 had PCa. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 91.7%, 72.2%, 83.3%, 81.5%, and 86.7% for TRTE and 85.4%ì63.9%ì76.2%, 75.9%, and 76.7% for TRUS (P>0.05), while its specificity (72.2%) was significantly higher than that of MRI (44.4%) (P=0.03). The TRTE findings were not significantly correlated with the pathological findings and serum total prostate specific antigen (P>0.05), and the diagnostic sensitivity of TRTE decreased along with the enlargement of prostate. However, the diagnostic specificity of TRTE was higher than MRI for nodules with soft to medium texture (P=0.04).For PCa, the diagnostic sensitivity of TRTE increased when the Gleanson scores of tumors increased (P<0.05). CONCLUSION: TRTE can be used as a diagnostic test to supplement clinical diagnosis of PCa.

Development of a nomogram for predicting positive initial prostate biopsy among Chinese patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To develop a predictive nomogram for predicting the prostate carcinoma among Chinese population.</p><p><b>METHODS</b>Totally 556 Chinese male patients who had undergone an initial prostate biopsy in our hospital from July 2004 to February 2009 were enrolled in this study. Variables including age, volume, prostate specific antigen (PSA) level, and free PSA (f-PSA)/total PSA (t-PSA) were collected. Logistic regression analysis was performed to estimate the relative risk. Regression equation was established for variables via stepwise regression, via which a nomogram for assessing the positive biopsy results was established, and then the predictive value of this nomogram was evaluated using receiver area under curve (ROC) analysis.</p><p><b>RESULTS</b>Of these 556 patients, cancer was detected in 205 patients (36.87%) via biopsies. Univariate analysis showed that age, prostate volume, PSA levels, and f-PSA/t-PSA were the influencing factors of the nomogram. The risk model performed well in an independent sample, with an AUC(ROC) of 0.8767, which was significantly larger than that of the prediction based on age (AUC(ROC) : 0.6397), prostate volume (AUC(ROC) : 0.7255), PSA (AUC(ROC) : 0.7111), or f-PSA/t-PSA (AUC(ROC) : 0.6973) alone.</p><p><b>CONCLUSION</b>A preliminary nomogram with high predictive value for Chinese population was successfully established.</p>

Transrectal ultrasound-guided systematic 12-core biopsy of the prostate improves prostate cancer detection / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate transrectal ultrasound-guided systematic 12-core biopsy of the prostate for the detection and characterization of prostate cancer in different age and prostate specific antigen (PSA) groups.</p><p><b>METHODS</b>Totally 210 patients were divided into four age groups (< or = 59 yr, 60-69 yr, 70-79 yr, and > or = 80 yr) and five PSA groups (0-4 microg/L, 4.1-10 microg/L, 10.1 -20 microg/L, 20.1-50 microg/L, and > 50 microg/L), and underwent transrectal ultrasound-guided systematic 12-core biopsy of the prostate at various sites for detecting prostate cancer. Clinical data and the results of various biopsy schemes were analyzed and compared.</p><p><b>RESULTS</b>Ninety-one cases of prostate cancer were detected among the 210 patients, with a total detection rate of 43.3%, and the percentage was higher with the increase of age and PSA level. Larger and higher-grade tumors were associated with older age and higher PSA level, and higher detection rates were related to laterally directed and apical biopsies. The 12-core biopsy outperformed other biopsy schemes in detecting prostate cancer in patients under 60 years of age and with PSA < 20 microg/L.</p><p><b>CONCLUSION</b>The 12-core biopsy scheme can make up for the inadequacy of sextant biopsy in detecting prostate cancer, and less influenced by the age and PSA level of the patients. Generally larger and higher-grade tumors are associated with older age and higher PSA level.</p>

Diagnostic value of strain index in prostate peripheral zone lesions by real time tissue elastography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the value of strain index (SI) by transrectal real-time tissue elastography (TRTE) for differentiation of the prostate peripheral zone lesions.</p><p><b>METHODS</b>Totally 83 patients with suspected prostate cancer underwent the quantitative analysis by TRTE examination. The SI of total lesions (ASI) and peak elasticity in lesion (PSI) were calculated, and the pathologic findings were compared. Then the values of ASI and PSI in the differential diagnosis of prostate lesions were assessed. The influence of Gleanson scores on SI was evaluated.</p><p><b>RESULTS</b>The area under the Receiver Operating Characteristic curves (or ROC curves) of ASI and PSI were 0.62 (P=0.06) and 0.92 (P=0.00) respectively for the differential diagnosis of prostate peripheral lesions. When a cutoff point of 17.44 was used,PSI had a sensitivity of 74.5% and a specificity of 83.3%. Gleason scores showed no significant difference between PSIü 17.44 group and PSIþ17.44 group ( P>0.05).</p><p><b>CONCLUSION</b>PSI is helpful for the differential diagnosis of prostate peripheral zone lesions.</p>