Background and Objective: Esophageal cancer is the 5th most common gastrointestinal cancer in the United States and has an overall 5 -year survival rate of about 20%. Patients often present with advanced disease, making early detection and initiation of treatment critical to improve long-term survival rates. Surface -enhanced Raman spectroscopy (SERS), a technique that uses frequency shifts of incident light on materials to generate Raman spectra unique to each substrate, is a promising tool for esophageal cancer detection. The objective of this review is to provide an overview of SERS, summarize key advancements made in its utility for esophageal cancer detection, and survey its potential as a noninvasive diagnostic and monitoring tool for esophageal cancer. Methods: Studies on SERS for esophageal cancer application were identified by using the CENTRAL, Web of Science, PubMed, Google Scholar, and PLOS One databases from 2010-2021. Keywords used included: "Raman spectroscopy", "esophageal cancer", "esophageal neoplasms", "surface -enhanced Raman spectroscopy", "SERS", and "nanoparticles". Key Content and Findings: SERS has been employed on urine, blood, and tissue samples to identify patients with esophageal cancer. These spectra revealed multiple differences between cancerous and healthy samples, with spectra patterns suggesting findings such as abnormal DNA/RNA metabolism and abnormal amino acid metabolism in patients with cancer. Machine learning techniques such as principal components analysis and discriminant analysis distinguished between esophageal cancer and healthy patients' Raman spectra with up to 100% sensitivity and 100% specificity. Conclusions: Early detection of esophageal cancer using SERS is a promising technique due to its high diagnostic accuracy and noninvasive sampling technique.

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI (MP74), Moderated Poster 741 May 2024MP74-04 RECTAL POVIDONE-IODINE GEL REDUCES INFECTIOUS COMPLICATIONS FOLLOWING TRANSRECTAL PROSTATE NEEDLE BIOPSY Gary S. Fialk, T. Hunt Batter, and Daniel Nemirovsky Gary S. FialkGary S. Fialk , T. Hunt BatterT. Hunt Batter , and Daniel NemirovskyDaniel Nemirovsky View All Author Informationhttps://doi.org/10.1097/01.JU.0001008632.59099.b9.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have strongly supported the use of an intra-rectal bowel prep of povidone-iodine (topical, enema or suppository) to reduce post transrectal prostate needle biopsy (TRPNB) infections. This prospective study incorporates a 10‰ povidone-iodine (PI) gel at the time of transrectal prostate biopsy as a lubricant and topical antiseptic. The study assessed the incidence of post procedural infections requiring hospitalization for treatment of febrile UTI/sepsis, or treatment of outpatient urinary tract infection. METHODS: An 8-year, 8-month review of consecutive TRPNB procedures performed by 2 urologists, prospectively, in both a community office and facility (Ambulatory Surgery Center and Hospital) setting. A total of 884 procedures were performed. Office patients all had a standard periprostatic nerve block (PPNB). All patients received similar oral fluoroquinolone antibiotic prophylaxis. Patients in the facility had total intravenous anesthesia (TIVA) and no PPNB. In the left lateral decubitus position, patients had a digital rectal exam prostate using the 10‰ povidone- iodine gel to reassess the prostate for abnormalities and to "paint" the anterior rectal wall. This was followed by a generous application of the 10‰ PI gel to the ultrasound transducer tip prior to rectal insertion. A standard TRPNB was performed in the usual fashion securing 12-14 cores (or additional cores if MRI-fusion biopsy performed) as appropriate. RESULTS: A total of 884 consecutive TRPNB procedures were reviewed, 604 performed in the office and 280 performed in the facility. Of the facility procedures, 49 were MRI Fusion TRPNB. Overall, one patient required hospital admission for treatment of a febrile UTI for an incidence of 0.113‰. Five other patients were treated for suspected/documented urinary tract infections (UTI) with antibiotics as outpatients for an incidence of 0.57‰ post-procedural infection rate. Overall infection rate was 0.68‰ (6/884). CONCLUSIONS: By implementing an inexpensive 10% PI gel at the time of TRPNB, we had one patient with a febrile UTI requiring hospitalization out of 884 procedures for an incidence of 0.113‰. Five other patients had outpatient antibiotic treatment for UTI with an incidence of 0.57‰. Total infection incidence is 0.68‰. Routine use of 10‰ PI gel should be adopted to minimize infectious complications following TRPNB. Particularly, in light of the 2023 AUA Guidelines supporting either TR or TP prostate biopsy, the incorporation of intrarectal PI during the TR approach transforms the procedure into one with acceptable risk. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1194 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Gary S. Fialk More articles by this author T. Hunt Batter More articles by this author Daniel Nemirovsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction Multiparametric magnetic resonance imaging (mpMRI) has led to improved diagnosis and risk stratification of prostate cancer. The Prostate Imaging Reporting and Data System (PI-RADS) is a widely-adopted standardized interpretation scheme for prostate mpMRI. Lesions are scored 1-5 based on suspicion for clinically significant prostate (csPCa), defined as Grade Group ≥ 2, with increasing positive predictive value indicated by higher score. Multiple studies have demonstrated the positive predictive value of a PI-RADS 5 lesion for csPCa to cluster around 70-80%. Since nearly 80% of those with PI-RADS 5 lesions harbor clinically significant disease on biopsy, many receive upfront therapy. There is limited understanding of what happens to remaining patients with PI-RADS 5 lesions in whom biopsies reveal less aggressive disease. The purpose of this study is to evaluate the clinical course of those with PI-RADS 5 lesions with Grade Group 1 disease who were placed on Active Surveillance (AS). Methods This analysis was limited to AS patients with GG1 prostate cancer on targeted biopsy of a solitary PI-RADS 5 index lesion performed from 2007 to 2022. Each scan was read by a high-volume genitourinary radiologist (BT or PC). These patients underwent systematic and targeted biopsy by physicians experienced with MRI-fusion biopsies (PP, BW, SG). Repeat biopsies were performed based on clinicopathologic concern for progression (rising PSA, MRI changes) or local AS protocols. For MRIs preceding PI-RADS scoring, an internal Likert suspicion scoring system that has been validated in the literature was used and converted into PI-RADS scores. Beginning in 2015, internal mpMRI readings were reported using PI-RADS v2.0 and in 2019 transitioned to PI-RADS v2.1. Biopsy specimens were reviewed by dedicated genitourinary pathologists. Descriptive statistics were performed. Univariate analyses, including independent samples t-test, chi-squared analysis, and Fisher's exact test, were performed to evaluate for factors associated with disease upgrading. Results 21 patients met inclusion criteria. The mean PSA was 7.9 ng/ml (range 2.4-14.5) (Table 1). At median follow up of 4.3 years, 15/21 (71%) patients progressed to GG≥2 disease, 5 of whom (24% of initial cohort) progressed to GG≥3 (Figure 1). Median time to progression to GG≥2 and GG≥3 was 3.3 years and 4.4 years, respectively. Of the 6 who did not progress, 1 underwent prostatectomy (upgraded to GG2 on final pathology) and 5 were maintained on AS. Of the 16 who progressed to GG≥2, 6/21 (29%) were continued on AS. 5 of these patients remained on AS (median follow-up 3.3 years after progression) and one underwent prostatectomy. Overall, 11 (52%) received definitive therapy. On univariate analysis, only mean maximum cancer core length was associated with progression to radical therapy (4.8 vs 8.0 mm, p=0.048). Conclusions Patients with PI-RADS 5 lesions and GG1 PCa on AS demonstrate a rate of upgrading to GG≥2 of >70% and nearly a quarter were upgraded to GG≥3. Nearly 50% of patients progressed to radical treatment at 4 years. This represents a high rate of upgrading in a short period of time relative to larger AS series, which place pathologic upgrading at 25-50%. Further studies, including longer-term follow-up, will be necessary. Genomic classification of these initially indolent lesions may provide clarity regarding the best management. The question of how our findings should affect practice is important. With half of patients suitable for AS at follow-up, it is reasonable to continue AS as the preferred management. However, there is a higher risk of requiring intervention and these patients should be counseled and monitored accordingly. While focal therapy is not guideline-endorsed for GG1 disease, this may be a population that could benefit.

Introduction The advent of multiparametric magnetic resonance imaging (mpMRI) has helped to localize clinically significant prostate cancer (csPCA). Focal Therapy (FT) has emerged in the mpMRI era, which can treat MRI-visible lesions while avoiding side effects of whole-gland treatment. However, FT remains an investigational treatment option for PCa patients with intermediate-risk disease. Little is known about how many patients on active surveillance (AS) with Gleason grade group (GG) 2 disease retain eligibility for FT over time, or risk factors for loss of eligibility. The objective of this study is to evaluate initial and long-term FT eligibility (FTE) of patients with GG2 disease. Methods A prospectively maintained cohort was retrospectively queried for patients initiated on AS between 2007;and 2020 with GG2 PCa. Patients with biopsy-concordant GG2, unilateral, MRI-visible PIRADS 2-5 lesions amenable to hemiablation were considered FT candidates. Those with PSA>20 ng/mL, >4 MRI lesions, bilateral (BL) MRI-visible/biopsy-concordant lesions, or contralateral GG≥2 PCa or MRI-invisible lesions were excluded. Patients were considered to progress if they developed BL GG≥2 disease or unilateral GG≥3 PCa. Patients without GG progression maintained FTE and those with GG progression maintained FTE if they had unilateral biopsy-concordant/MRI-visible GG≤3, no contralateral GG≥2 disease, and PSA<20 ng/mL. Univariate and multivariate analyses were conducted to compare patients who maintained and lost FTE. Results 252 PCa patients were identified as eligible for FT with an average follow-up of 3.4 years, 83 of whom (33%) had GG2 disease and were FT candidates. 29/83 (35%) lost FT eligibility, 19/83 (23%) with progression to high-risk disease, 6/83 (7.2%) due to development of BL GG≥2 disease, and 4/83 (4.8%) with development of MRI-invisible csPCA. Baseline characteristics are shown in Table 1. Univariate analysis demonstrated that those who lost FTE had smaller prostates than those who maintained it (44.9 mL vs. 56.2mL, respectively, p=0.018). PSA density was similar between the groups. No significant differences were noted in initial imaging and pathologic parameters. No factors significantly associated with loss of FTE were identified on logistic regression (Table 2). Conclusions 33% of the patients on AS had GG2 disease and were initially eligible for FT. 65% of patients with GG2 disease were still eligible for FT after a median follow up of 3.4 years; over one third of these patients lose FTE. This data regarding the loss of a FT therapeutic window could prove useful in counseling GG2 patients considering AS, FT, or radical treatment.

muscle mass. This might be related to urinary incontinence.

You have accessJournal of UrologyCME1 Apr 2023PD38-12 NATURAL HISTORY OF SMALL INDEX LESIONS ON MULTIPARAMETRIC MRI: IMPLICATIONS FOR ACTIVE SURVEILLANCE Anjali Pillai, Zoe Blake, Daniel R. Nemirovsky, Jacob J. Enders, Neil Mendhiratta, Alexander P. Kenigsberg, Michael B. Rothberg, Jibriel Noun, Daniel Nethala, Sandeep Gurram, Bradford J. Wood, Baris Turkbey, and Peter A. Pinto Anjali PillaiAnjali Pillai More articles by this author , Zoe BlakeZoe Blake More articles by this author , Daniel R. NemirovskyDaniel R. Nemirovsky More articles by this author , Jacob J. EndersJacob J. Enders More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Alexander P. KenigsbergAlexander P. Kenigsberg More articles by this author , Michael B. RothbergMichael B. Rothberg More articles by this author , Jibriel NounJibriel Noun More articles by this author , Daniel NethalaDaniel Nethala More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Bradford J. WoodBradford J. Wood More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) has demonstrated utility as an adjunct to active surveillance (AS). However, the optimal time interval between sequential MRIs is not standardized. This aims to analyze index lesion growth rates to potentially inform modern AS imaging practice. METHODS: A prospectively maintained database of patients on AS at our institution was queried for patients with ≥2 mpMRIs with no index lesion or index lesions ≤7 mm, as well as a subset of patients with no index lesion or index lesions ≤5 mm. Both cohorts were limited to patients with paired MRI-targeted biopsy showing benign or Gleason grade group (GG) 1 disease. For MRIs preceding PI-RADS scoring, an internal Likert suspicion scoring system was converted into PI-RADS scores. Imaging intervals were calculated between serial mpMRIs and growth rate was calculated with two-tailed t-tests to assess differences between initial and most recent lesion sizes measured on mpMRI. RESULTS: Between 2003-2021, patients on AS with ≥2 mpMRIs with small index lesions measuring ≤7 mm (n=123) or <5 mm (n=65) were identified (Table 1). Lesions in both the ≤7 mm (p=.015) and ≤5 mm (p=.003) cohorts demonstrated a significant change between first and last mpMRI. For the ≤7 mm cohort, average overall growth rate was 0.44±2.4 mm/year over a mean imaging interval of 1.27±0.09 years. For the ≤5 mm cohort, the average overall growth rate was 0.70±3.05 mm/year over a mean imaging interval of 1.31±0.13 years. There were 11 lesions that grew over 5 mm in the first year after initial mpMRI, however, univariate analysis of age, PSA, PI-RADS, and GG did not identify these variables as significant predictors of growth. The majority of lesions (84.6%) grew <1 mm/year (Figure 1). CONCLUSIONS: Small MRI lesions in patients on AS demonstrate minimal growth between follow up mpMRIs. This may indicate that these lesions can be followed longer surveillance intervals. Further studies are needed to prospectively identify the small subset of lesions that demonstrate more rapid growth. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e998 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anjali Pillai More articles by this author Zoe Blake More articles by this author Daniel R. Nemirovsky More articles by this author Jacob J. Enders More articles by this author Neil Mendhiratta More articles by this author Alexander P. Kenigsberg More articles by this author Michael B. Rothberg More articles by this author Jibriel Noun More articles by this author Daniel Nethala More articles by this author Sandeep Gurram More articles by this author Bradford J. Wood More articles by this author Baris Turkbey More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. This study aims to investigate whether the CBFM pattern containing prostate cancers (PCa) were associated with false negative magnetic resonance imaging (MRI) and determine the association between MRI and histopathological disease burden.Methods: Patients who underwent multiparametric magnetic resonance imaging (mpMRI), combined 12-core transrectal ultrasound (TRUS) guided systematic (SB) and MRI/US fusion-guided biopsy were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores and lesions were categorized as follows: C0 = benign, C1 = PCa with no CBFM pattern, C2 = PCa with CBFM pattern. Correlation between cancer core length (CCL) and measured MRI lesion dimension were assessed using a modified Pearson correlation test for clustered data. Differences between the biopsy core groups were assessed with the Wilcoxon-signed rank test with clustering.Results: Between 2015 and 2022, a total of 131 consecutive patients with CBFM pattern on prostate biopsy and pre-biopsy mpMRI were included. Clinical feature analysis included 1572 systematic biopsy cores (1149 C0, 272 C1, 151 C2) and 736 MRI-targeted biopsy cores (253 C0, 272 C1, 211 C2). Of the 131 patients with confirmed CBFM pathology, targeted biopsy (TBx) alone identified CBFM in 76.3% (100/131) of patients and detected PCa in 97.7% (128/131) patients. SBx biopsy alone detected CBFM in 61.1% (80/131) of patients and PCa in 90.8% (119/131) patients. TBx and SBx had equivalent detection in patients with smaller prostates (p = 0.045). For both PCa lesion groups there was a positive and significant correlation between maximum MRI lesion dimension and CCL (C1 lesions: p < 0.01, C2 lesions: p < 0.001). There was a significant difference in CCL between C1 and C2 lesions for T2 scores of 3 and 5 (p <= 0.01, p <= 0.01, respectively) and PI-RADS 5 lesions (p <= 0.01), with C2 lesions having larger CCL, despite no significant difference in MRI lesion dimension.Conclusions: The extent of disease for CBFM-containing tumors is difficult to capture on mpMRI. When comparing MRI lesions of similar dimensions and PIRADS scores, CBFM-containing tumors appear to have larger cancer yield on biopsy. Proper staging and planning of therapeutic interventions is reliant on accurate mpMRI estimation. Special considerations should be taken for patients with CBFM pattern on prostate biopsy.

This study examined whether race or insurance status influenced the latency between multiparametric MRI-to-biopsy and biopsy-to-prostatectomy. We found that Medicaid insurance was a significant predictor of increased delay between biopsy and surgery (P = .02). Urologists should be aware of the socioeconomic and demographic risk factors that may lead to health disparities.Introduction: Numerous studies have shown that both race and insurance status may affect prostate cancer (PCa) workup and treatment. Preliminary investigations have shown that these factors may be associated with treatment delays, which may indicate inequitable care and increase risk of tumor progression. This investigation aimed to assess whether race and insurance impacted the interval between multiparametric MRI (mpMRI)-to-biopsy, and biopsy-to-prostatectomy.Materials and Methods: A single-institution analysis of 261 patients with recorded race and insurance data was performed using an Institutional Review Board-compliant database with information spanning from 2016 to 2022. Race was self-reported during intake, and insurance status was retrieved from the electronic medical record. Insurance was sub-divided into private, Medicare, and Medicaid. Diagnostic or treatment latency was defined as time between mpMRI-to-biopsy, or biopsy-to-surgery.Results: Stratified by race, there was no difference in either latency period when comparing African American (AA) and white patients. Stratified by insurance status, there was no difference in time from mpMRI-to-biopsy (P = .50), but there was a significantly longer interval from biopsy-to-prostatectomy for patients with Medicaid insurance (P = .02). Patients with Medicaid waited on average 168 days to receive surgery, in contrast to 92 days for private and 87 for Medicare. Notably, 82% of Medicaid patients were AA.Conclusion: Insurance status, which is inherently linked to race and social determinants of health, portended a significantly increased interval between biopsy and surgery. Physicians should be aware of the relationship between insurance status and treatment delay, as well as its potential downstream consequences.

You have accessJournal of UrologyCME1 Apr 2023MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA Daniel Nemirovsky, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Jacob Enders, Michael Rothberg, Antoun Toubaji, Sandeep Gurram, and Peter Pinto Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Jacob EndersJacob Enders More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Antoun ToubajiAntoun Toubaji More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003226.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Signet ring cells (SRC) on pathology are typically associated with gastric carcinoma, but are also rarely seen in other malignancies, including prostate cancer (PCa). Though primary SRC adenocarcinoma of the prostate is a well-described aggressive malignancy, there is a paucity of literature describing the oncologic significance of SRC on prostate biopsy in patients with primary acinar adenocarcinoma. In this study, we aimed to describe the clinicopathologic characteristics and outcomes of these patients. METHODS: A prospectively collected database of patients with PCa was queried for presence of SRC on prostate biopsy. Patients with primary SRC adenocarcinoma were excluded. Demographics, imaging, pathological and treatment data were collected. Patients who received radical prostatectomy (RP) without neoadjuvant therapy were examined for adverse features, including extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymphovascular invasion (LVI), as well as post-RP biochemical recurrence (BCR). RESULTS: Between 2014-2022, 46 patients with SRC on biopsy were found. Clinicopathologic data is displayed in Table 1. Patients had a mean of 2.2 cores with SRC on biopsy, and 40/46 (87.0%) of these cores were GG ≥4. Oncologic outcomes are shown in Table 2. Every lesion containing SRC was MRI-visible, 93.3% of which were PIRADS 4 or 5. Of 14 patients with available whole-mount pathology data after RP, 12/14 (85.7%) had Gleason grade group ≥ 3 disease. 5/14 (35.7%) patients had EPE, 4/14 (28.6%) had SVI, and 3/14 (21.4%) had LVI. 3/14 (21.4%) patients experienced BCR post-RP, with a median time to BCR of 12 months (3-28). CONCLUSIONS: Signet ring cells on biopsy were typically identified in the setting of MRI-visible high-grade acinar adenocarcinoma and frequently associated with adverse features on whole mount pathology. While the biological significance of signet ring features in prostate cancer remains to be elucidated, clinical and pathologic correlates suggest an association with high risk disease and should prompt further study of this entity. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Jacob Enders More articles by this author Michael Rothberg More articles by this author Antoun Toubaji More articles by this author Sandeep Gurram More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP09-02 MULTIPARAMETRIC MRI-BASED RADIOMICS FEATURES OF PROSTATIC ADENOCARCINOMA WITH CRIBRIFORM ARCHITECTURE Zoe Blake, Mason Belue, Daniel Nemirovsky, Stephanie Harmon, Jacob Enders, Alexander Kenigsberg, Neil Mendhiratta, Enis Yilmaz, Yue Lin, Michael Rothberg, Antoun Toubaji, Maria Merino, Sandeep Gurram, Bradford Wood, Peter Choyke, Baris Turkbey, and Peter Pinto Zoe BlakeZoe Blake More articles by this author , Mason BelueMason Belue More articles by this author , Daniel NemirovskyDaniel Nemirovsky More articles by this author , Stephanie HarmonStephanie Harmon More articles by this author , Jacob EndersJacob Enders More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Enis YilmazEnis Yilmaz More articles by this author , Yue LinYue Lin More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Antoun ToubajiAntoun Toubaji More articles by this author , Maria MerinoMaria Merino More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter ChoykePeter Choyke More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. Literature on imaging characteristics of CBFM is sparse and mixed. This study aims to elucidate the multiparametric MRI (mpMRI) features of CBFM-containing cancers on prostate biopsy using radiomics. METHODS: Patients who underwent mpMRI, combined 12-core transrectal ultrasound (TRUS) guided systematic and MRI/US fusion-guided biopsy on a prostate cancer (PCa) clinical trial were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores were scored: C0=benign, C1=PCa with no CBFM pattern, C2=PCa with CBFM pattern. In addition to targeted lesion regions of interest (ROIs), patient-specific 12-core systematic TRUS biopsy sector maps were reconstructed and transposed on mpMRI slices for virtual core ROI creation (Figure 1). Radiomics features from each ROI were extracted using PyRadiomics package in Python. Radiomics and clinical feature analyses were done with Wilcoxon signed-rank test and Akaike Information Criterion. RESULTS: Between 2020-2022, 90 consecutive patients with CBFM pattern on prostate biopsy and paired mpMRI were identified. Radiomics/clinical feature analysis included 1080 transrectal systematic biopsy cores (677 C0, 191 C1, 212 C2) and 272 MRI-targeted biopsy cores (72 C0, 66 C1, 134 C2). On combined biopsy analysis, two DWI radiomics features capturing signal heterogeneity were predictive for CBFM classification (p<.01). On analysis of MRI-targeted biopsy only, overall PIRADS score (p=.037), DWI PIRADS score (p=.017), and target lesion dimension (p=.017) were predictive for CBFM classification (Table 1). CONCLUSIONS: CBFM pattern has visible radiomics features on mpMRI, most notably on DWI. Imaging findings suggestive of CBFM may play a role in risk stratification and patient counseling. Further studies are needed to evaluate these lesions and validate their imageability longitudinally and externally. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e103 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoe Blake More articles by this author Mason Belue More articles by this author Daniel Nemirovsky More articles by this author Stephanie Harmon More articles by this author Jacob Enders More articles by this author Alexander Kenigsberg More articles by this author Neil Mendhiratta More articles by this author Enis Yilmaz More articles by this author Yue Lin More articles by this author Michael Rothberg More articles by this author Antoun Toubaji More articles by this author Maria Merino More articles by this author Sandeep Gurram More articles by this author Bradford Wood More articles by this author Peter Choyke More articles by this author Baris Turkbey More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP38-19 FOCAL THERAPY CANDIDACY: AN EVALUATION OF INITIAL AND CONTINUED ELIGIBILITY FOR FOCAL THERAPY IN AN ACTIVE SURVEILLANCE COHORT Alexander P. Kenigsberg, Daniel Nemirovsky, Neil Mendhiratta, Zoe Blake, Jacob J. Enders, Samuel A. Gold, Michael B. Rothberg, Daniel Nethala, Brad Wood, Baris Turkbey, Sandeep Gurram, and Peter A. Pinto Alexander P. KenigsbergAlexander P. Kenigsberg More articles by this author , Daniel NemirovskyDaniel Nemirovsky More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Zoe BlakeZoe Blake More articles by this author , Jacob J. EndersJacob J. Enders More articles by this author , Samuel A. GoldSamuel A. Gold More articles by this author , Michael B. RothbergMichael B. Rothberg More articles by this author , Daniel NethalaDaniel Nethala More articles by this author , Brad WoodBrad Wood More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal Therapy (FT) for Gleason grade group (GG) 1 prostate cancer (PCa) is controversial, given almost all of these patients are suitable active surveillance (AS) candidates. Little is known about how many AS GG 1 patients retain focal therapy eligibility (FTE) over time. The objective of this study is to evaluate initial and long-term FTE for patients with GG1 disease. METHODS: A prospectively maintained AS cohort was retrospectively queried for patients initiated on AS between 2009 and 2020 with GG1 PCa. Patients with a unilateral, biopsy-concordant, MRI-visible PIRADS or PIRADS-equivalent 2-5 lesions amenable to hemiablation who had a PSA<20, <4 positive systematic biopsy cores were considered FTE. Patients who remained GG1 were considered to have maintained FTE. Those who progressed were reassessed at time of progression for FTE. Patients with ≥GG4 disease, bilateral GG≥2, or MRI-invisible GG≥2 lost FTE. Univariate and multivariate analyses were conducted to evaluate factors associated with FTE. RESULTS: 282 GG1 PCa patients were identified, 164 of whom (58%) were FT candidates, with a mean follow-up of 4.9 years (range 1.0-13.4 years). 81/164 (49%) progressed to GG≥2 or higher on a subsequent biopsy. At the time of PCa upgrading, 36/164 (22%) of the FT candidate cohort lost FTE. Baseline characteristics are shown in Table 1. Patients who lost FTE trended toward increased PSA (6.3 vs 5.3, p=0.062 and MRI lesions (2.6 vs 2.0, p=0.007), and were more likely to have transitional or central zone (TZ/CZ) lesions (30.6% vs 14.1%, p=0.022) relative to those who maintained FTE. On logistic regression (Table 2), the number of MRI lesions and TZ/CZ lesions were associated with FTE loss (p=0.033 and 0.047, respectively). CONCLUSIONS: While approximately half of GG1 FT candidates demonstrate disease progression, almost 80% maintain FTE. Given the demonstrated safety of AS and relatively small number of patients who lose FTE while on surveillance, routine FT for GG1 disease would result in a large number of unnecessary procedures. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e532 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander P. Kenigsberg More articles by this author Daniel Nemirovsky More articles by this author Neil Mendhiratta More articles by this author Zoe Blake More articles by this author Jacob J. Enders More articles by this author Samuel A. Gold More articles by this author Michael B. Rothberg More articles by this author Daniel Nethala More articles by this author Brad Wood More articles by this author Baris Turkbey More articles by this author Sandeep Gurram More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023PD10-12 HISTOPATHOLOGIC AND MRI CORRELATES OF ANTERIOR INDEX LESIONS IN PROSTATE CANCER: IMPLICATIONS FOR POST-SURGICAL ONCOLOGIC OUTCOMES Zoe Blake, Katie Merriman, Daniel Nemirovsky, Jacob Enders, Alexander Kenigsberg, Mason Belue, Enis Yilmaz, Tim Phelps, Neil Mendhiratta, Michael Rothberg, Daniel Nethala, Antoun Toubaji, Maria Merino, Bradford Wood, Sandeep Gurram, Stephanie Harmon, Peter Choyke, Baris Turkbey, and Peter Pinto Zoe BlakeZoe Blake More articles by this author , Katie MerrimanKatie Merriman More articles by this author , Daniel NemirovskyDaniel Nemirovsky More articles by this author , Jacob EndersJacob Enders More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Mason BelueMason Belue More articles by this author , Enis YilmazEnis Yilmaz More articles by this author , Tim PhelpsTim Phelps More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Daniel NethalaDaniel Nethala More articles by this author , Antoun ToubajiAntoun Toubaji More articles by this author , Maria MerinoMaria Merino More articles by this author , Bradford WoodBradford Wood More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Stephanie HarmonStephanie Harmon More articles by this author , Peter ChoykePeter Choyke More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003250.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The influence of anatomic location of prostate cancer (PCa) on biochemical recurrence (BCR) after radical prostatectomy (RP) is an active area of research. Some evidence suggests that anterior lesions are more commonly associated with extra prostatic extension (EPE) due to lack of a distinct capsule in the anterior portion of the prostate, and are more prone to metastasize due to proximity of the Batson venous plexus. We sought to evaluate whether anterior index lesion location is associated with increased rates of EPE, BCR or lymph node invasion (LNI). METHODS: Clinical, imaging, and histopathological data were retrospectively analyzed for patients with PCa who underwent MRI prior to RP between 2008 and 2022. Anterior lesion location, as well as zonal anatomy, was determined by an expert genitourinary radiologist. Correlation with EPE, LNI, and BCR were analyzed using Wilcoxon rank sum and chi-squared tests. BCR-free survival (RFS) was analyzed using Kaplan-Meier (KM) survival curves. RESULTS: 662 RP patients were identified with median follow up of 19 months (IQR 11-35). Anterior lesions were not associated with an increased rate of MRI-detected EPE (p>0.995), pathology-confirmed EPE (p=0.119), LNI (p=0.059), or BCR (p=0.203) (Table 1). A sub-group analysis of anterior lesions by zonal anatomy revealed that transition zone (TZ) lesions were associated with higher rates of MRI-detected EPE than peripheral zone (PZ) lesions (25/144 [19.4%] vs 2/54 [3.7%], p=0.024) but not pathology-confirmed EPE (p=0.392), LNI (p=0.890), or BCR (p=0.525). Differences in RFS were not significant for anterior vs non-anterior lesions overall (p=0.27) or when zonally divided (p=0.11) (Figure 1). CONCLUSIONS: Anterior prostate lesions were not associated with increased rate of EPE, LNI, or difference in RFS, even when sub-stratifying lesions by zone. Thus, anterior vs non-anterior lesion location is unlikely to impact risk stratification or clinical decision making. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e331 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoe Blake More articles by this author Katie Merriman More articles by this author Daniel Nemirovsky More articles by this author Jacob Enders More articles by this author Alexander Kenigsberg More articles by this author Mason Belue More articles by this author Enis Yilmaz More articles by this author Tim Phelps More articles by this author Neil Mendhiratta More articles by this author Michael Rothberg More articles by this author Daniel Nethala More articles by this author Antoun Toubaji More articles by this author Maria Merino More articles by this author Bradford Wood More articles by this author Sandeep Gurram More articles by this author Stephanie Harmon More articles by this author Peter Choyke More articles by this author Baris Turkbey More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To report an initial experience with a novel, "fully" transperineal (TP) prostate fusion biopsy using an unconstrained ultrasound transducer placed on the perineal skin to guide biopsy needles inserted via a TP approach. METHODS Conventional TP prostate biopsies for detection of prostate cancer have been performed with transrectal ultrasound, requiring specialized hardware, imposing limitations on needle trajectory, and contributing to patient discomfort. Seventy-six patients with known or suspected prostate cancer underwent 78 TP biopsy sessions in an academic center between June 2018 and April 2022 and were included in this study. These patients underwent TP prostate fusion biopsy using a grid or freehand device with transrectal ultrasound as well as TP prostate fusion biopsy using TP ultrasound in the same session. Per-session and per-lesion cancer detection rates were compared for conventional and fully TP biopsies using Fisher exact and McNemar's tests. RESULTS After a refinement period in 30 patients, 92 MRI-visible prostate lesions were sampled in 46 subsequent patients, along with repeat biopsies in 2 of the 30 patients from the refinement period. Grade group >= 2 cancer was diagnosed in 24/92 lesions (26%) on conventional TP biopsy (17 lesions with grid, 7 with freehand device), and in 25/92 lesions (27%) on fully TP biopsy (P = 1.00), with a 73/92 (79%) rate of agreement for grade group >= 2 cancer between the two methods. CONCLUSION Fully TP biopsy is feasible and may detect prostate cancer with detection rates comparable to conventional TP biopsy. UROLOGY 181: 76-83, 2023. Published by Elsevier Inc.

You have accessJournal of UrologyCME1 Apr 2023HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER Daniel Nemirovsky, Maksym Pikul, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Peter Pinto, and Gennady Bratslavsky Daniel NemirovskyDaniel Nemirovsky More articles by this author , Maksym PikulMaksym Pikul More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Peter PintoPeter Pinto More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past year, the world has witnessed acts of unprovoked violence and aggression in Ukraine. The AUA issued a strong statement standing against the atrocities and inhumanity of war. Many urologists, both with and without ties to Ukraine, have shown support to the country in various ways. In this light, it is imperative to not only support its citizens, but also to remember the contributions Ukraine has had on our understanding of urology. METHODS: Data was obtained with review of both PubMed and non-PubMed indexed literature, as well as through personal interviews with leading urologists in Ukraine. RESULTS: In the field of genitourinary reconstruction, the first ever use of oral mucosa in urethroplasty was pioneered by Kirill Sapezhko in the late 19th century, while working in Kyiv. Interestingly, Dr. Sapezhko was also the first recorded surgeon to describe a two-stage urethroplasty, using a method now known as the Thiersch-Duplay technique. Ludwik Rydygier, as head of the University of Lviv (then Lemberg), developed an early method for transperineal simple prostatectomy, as well as innovating several techniques for repair of vesicovaginal fistulae in the late 1800s. Yurii Voronoy, while working in Kherson during the early 20th century, revolutionized transplantation by conducting the first recorded renal allotransplant, as well as studying the various stages of immunologic rejection. In the mid-to-late 1900s, urologic oncologists in Kharkiv, including Boris Polonsky, Alexey Pereverzev, and Viktor Karpenko, conducted valuable research describing innovative techniques for IVC thrombectomy. More recently, Ukrainian scientists have made enormous strides in our understanding of urologic carcinogenesis, in large part due to the devastating Chernobyl disaster and related chronic ionizing radiation exposure. These studies have led to better insight into the development of kidney and bladder cancers, including the description of ionizing-radiation induced carcinoma in situ, termed “Chernobyl Cystitis”. CONCLUSIONS: Ukrainian urologists have made significant impacts to the field, with important and novel studies spanning across many urologic subspecialties. As urologists, one of the ways that we can support Ukraine is to highlight their many contributions to the field. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e257 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Maksym Pikul More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Peter Pinto More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

(1) Background: Recent studies report high accuracies when using machine learning (ML) algorithms to classify prostate cancer lesions on publicly available datasets. However, it is unknown if these trained models generalize well to data from different institutions. (2) Methods: This was a retrospective study using multi-parametric Magnetic Resonance Imaging (mpMRI) data from our institution (63 mpMRI lesions) and the ProstateX-2 challenge, a publicly available annotated image set (112 mpMRI lesions). Residual Neural Network (ResNet) algorithms were trained to classify lesions as high-risk (hrPCA) or low-risk/benign. Models were trained on (a) ProstateX-2 data, (b) local institutional data, and (c) combined ProstateX-2 and local data. The models were then tested on (a) ProstateX-2, (b) local and (c) combined ProstateX-2 and local data. (3) Results: Models trained on either local or ProstateX-2 image data had high Area Under the ROC Curve (AUC)s (0.82–0.98) in the classification of hrPCA when tested on their own respective populations. AUCs decreased significantly (0.23–0.50, p < 0.01) when models were tested on image data from the other institution. Models trained on image data from both institutions re-achieved high AUCs (0.83–0.99). (4) Conclusions: Accurate prostate cancer classification models trained on single-institutional image data performed poorly when tested on outside-institutional image data. Heterogeneous multi-institutional training image data will likely be required to achieve broadly applicable mpMRI models.

fi ed by tracking, with 11/83 (13.3%) identi fi ed only on tracking biopsy. Of the 110 total upgrading events between the three repeat tracked biopsy sessions, 41/110 (37.3%) were captured on tracking, with 16/110 (14.5%) discovered solely by tracking. The median number of biopsy cores for systematic, MRI-targeted, and tracked approaches were 12, 4 (IQR: 2-4), and 2 (IQR: 2-4), respectively. CONCLUSIONS: In this series, a signi fi cant portion of upgrading events for patients on AS were uniquely identi fi ed on tracked biopsy and would have otherwise been missed on repeat systematic and MRI-targeted biopsy. Notably, given the low number of additional biopsy cores required for tracking, this approach may be an appropriate and low-risk supplement to standard AS protocols.

31 Background: 4Kscore was developed and validated agnostic to prostate multiparametric MRI (mpMRI) findings, with current clinical paradigms utilizing a value of 7.5% to delineate the potential for high-grade disease. A growing body of evidence suggests improved diagnostic utility when used in conjunction with mpMRI results. Incorporation of mpMRI PIRADS scores may have potential to enhance diagnostic accuracy of 4Kscore, especially for non-definitive lesions. This study aims to examine the optimal 4Kscore threshold in PIRADS 3/4 lesions to maximize test utility and help guide clinical decision-making. Methods: A single-institution review of all patients with recorded 4Kscore, prostate MRI with dominant PIRADS 3/4 lesions, and final biopsy pathology from 2016-2020 was conducted from an IRB-approved database. Clinically significant prostate cancer (csPCa) was defined as Gleason score ≥3+4 on final biopsy. Receiver operating characteristic curves were generated, and the primary data point was chosen to maximize sensitivity and specificity. Results: 88 patients with dominant PIRADS 3 (n = 40) or PIRADS 4 (n = 48) lesions were identified. For patients with PIRADS 3 lesions, area under the curve (AUC) was 0.8083 (p < 0.0039) with optimal 4Kscore threshold to detect csPCa as 18.5% (sensitivity = 70.00%, specificity = 80.00%). Negative predictive value (NPV) at 4Kscore of 18.5% in PIRADS 3 lesions was 0.93. In patients with dominant PIRADS 4 lesions, AUC was 0.7735 (p < 0.002), and optimal threshold to detect csPCa was 21.5% (sensitivity = 70.59%, specificity = 76.67%). NPV at 4Kscore of 21.5% in PIRADS 4 lesions was 0.82. Conclusions: Stratification of mpMRI PIRADS 3/4 lesions suggests that utilization of more permissive 4Kscore thresholds can improve prediction of csPCa without sacrificing NPV, especially for PIRADS 3 lesions. These findings may enhance risk-adapted prostate cancer screening, reduce unnecessary prostate biopsies, and optimize clinical management.

Background: Access to medical cannabis products (MCPs) has rapidly increased though literature on consumer behaviors and attitudes with regards to dermatologic use is limited. Objective: We sought to address the gap of knowledge regarding consumer utilization and perspectives surrounding MCPs for dermatologic indications. Methods: A survey was emailed via SurveyMonkey's platform to adult users of their rewards panel asking about usage patterns and beliefs regarding MCP use to treat dermatologic conditions. Results: 504 of 700 survey invitations sent out were completed (72% response rate). 176% of respondents used an over-the-counter (OTC) cannabis product without dermatologist recommendation to treat a skin condition [most common indications: acne (28.4%) and psoriasis (26.1%)]. Of those' who had seen a dermatologist, 15.3% used an OTC product [most common indications: psoriasis (32%) and rosacea (30%)] and 78% used an MCP which required a Department of Health-approved card per their dermatologist's recommendations [most common indications: acne (68%) and psoriasis (28%)1. 11.8% of respondents were not comfortable seeing a dermatologist who recommended MCPs. Limitations: Limitations include small sample size as well as selection bias. Conclusion: Consumers are interested in and are using MCPs for dermatologic indications, most commonly for inflammatory skin disorders. Targeted education for dermatologists is recommended.