Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy.

BACKGROUND: The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB. METHODS: Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management. RESULTS: A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4-5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB.Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone.There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%). CONCLUSIONS: This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.

Ureteric Obstruction From Malignant Melanoma in Both Right Double Moiety and Left Single Moiety Ureters.

We report the first documented case of malignant melanoma obstructing ureters of both moieties of a duplex kidney and contralateral single moiety ureter in a 51-year-old male. The patient presented with fever, coryzal symptoms, and liver function test derangement several years after 2 superficial spreading melanomas were excised with clear margins. Ultrasonography demonstrated hydronephroureter in both moieties of a complete right-sided duplex kidney. Retrograde pyelograms showed bilateral hydronephroureter and filling defects in all 3 ureters. Biopsied tumor cells were positive for S100, Melan A, and HMB45. Cutaneous melanoma metastasizing to ureters is a rare phenomenon and can present a diagnostic challenge to clinicians if clinically silent.

Laparoscopic radical prostatectomy: introduction of training during our first 50 cases.

BACKGROUND: The study aims to assess the initial experience of laparoscopic radical prostatectomy (LRP) in a regional centre in Australia which includes Fellowship training during our first 50 cases. METHODS: Data were collected prospectively from our first 50 consecutive patients who underwent LRP for localized prostate cancer between September 2009 and October 2010. All cases were performed or supervised by the primary surgeon. Patient details, operative details, complications, early oncological and functional outcomes were analysed. RESULTS: The median age was 65 (45-76) years and median preoperative prostate-specific antigen was 7.5 (2.5-23) ng/mL, with palpable disease present in 48%. Using D'Amico's risk stratification, 14%, 74% and 12% were in low, intermediate and high-risk categories, respectively. Forty percent of cases were training cases with a median of 5 (2-8) of 10 operative steps performed by the Fellow. There was one open conversion and no rectal injuries. Mean operative time was 288 (175-440) min and with blood transfusion rate of 6%. Mean length of stay was 2.5 (1-6) days. Positive surgical margin rates for pT2 and pT3 disease were 14% and 52%, respectively, although for the last 25 cases they were 7% and 30%, respectively. Continence rate was 86% at 6 months, and 45% and 33% of preoperatively potent patients were potent after bilateral and unilateral nerve preservation at 6 months. CONCLUSION: LRP has been safely introduced in a regional centre with establishment of a Fellowship training programme, with early results comparable with other open, laparoscopic and robotic series.