OBJECTIVE Air diplacement plethysmography (ADP) has become increasingly popular to assess body composition in children. The aim of this study was to compare ADP with deuterium dilution and to investigate the effect of using child-specific prediction equations to correct raw body volume from ADP for thoracic gas volume (TGV) and body surface area (BSA). METHODS Thirty-seven healthy Dutch children (17 girls, 20 boys) aged 10-13 years were recruited. Body volume was measured using the Bod Pod. Both adult and child-specific prediction equations were used to correct raw body volume from the Bod Pod for TGV and BSA. Total body water (TBW) was assessed using deuterium dilution. Child-specific densities and hydration fractions of fat-free mass were used to convert body volume and TBW to percentage fat mass (%FM). Correlation and agreement between methods was assessed using linear regression analysis and Bland-Altman plots. RESULTS Despite a high correlation between the Bod Pod and deuterium dilution (R=0.91, p <0.001), a significant difference was found between %FM obtained using the Bod Pod and deuterium dilution (p <0.001), regardless of the equation used to correct raw body volume for TGV and BSA. Bland-Altman plots showed a systematic bias towards a smaller difference between techniques at higher %FM. CONCLUSION Significant differences in %FM were found between both methods. Given the underlying assumptions to translate body volume or TBW to %FM, it is recommended to use a 3- or 4-compartment model when assessing body composition in children.

PURPOSE:Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy.METHODS:A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling.RESULTS:Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI.CONCLUSION:This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.

You have accessJournal of UrologyAdrenal1 Apr 2018MP03-18 LONG TERM OUTCOMES FOR PATIENTS WITH VON HIPPEL LINDAU AND PHEOCHROMOCYTOMA: DEFINING THE BEST CANDIDATES FOR ACTIVE SURVEILLANCE Thomas Sanford, Rashid Siddiqui, Daniel Su, Julie An, and Adam Metwalli Thomas SanfordThomas Sanford More articles by this author , Rashid SiddiquiRashid Siddiqui More articles by this author , Daniel SuDaniel Su More articles by this author , Julie AnJulie An More articles by this author , and Adam MetwalliAdam Metwalli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3061AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with a germline mutation in the Von Hippel-Lindau (VHL) gene have a 7-18% lifetime risk of developing pheochromocytoma. The purpose of this study is to evaluate the oncologic and functional outcomes of patients with VHL associated pheochromocytoma who underwent a period of active surveillance. METHODS Patients were included in the study if they met the following criteria: 1) Confirmed mutation in the Von Hippel Lindau tumor suppressor gene, 2) History of surgery for either pheochromocytoma or paraganglioma, 3) At least 10 years of follow-up at the NIH. The active surveillance cohort consisted of any patients who underwent repeat imaging at the NIH. The surveillance cohort was split into three subsets based on mass size: less than 1 cm, 1-2 cm, and greater than 2cm and the growth rate per year was calculated using the following formula: (size [end of surveillance period]- size [beginning of surveillance period])/ time( years). RESULTS There were 72 patients who met all inclusion criteria from 54 families with median length of follow up of 17 years. There were 38 masses that underwent a period of surveillance in 26 patients. The median age at which surveillance was began was 30 (range 7-61). The median time on surveillance was 4.3 years (range 0.3 -20.1). The median size of mass when starting surveillance was 1.0 cm (range 0.3-2.5 cm) and the median size when the mass was resected was 2.0 (range 0.3-4.5). The median growth rate for all masses was 1mm per year (range -0.23-1.06). The median growth rate for masses under 1.0 cm was 0.3mm per year. The median growth rate for masses between 1.0 and 2.0 cm was 1.2 mm per year. The median growth rate for masses larger than 2.0 cm was 3.2 mm per year (p=0.018). No patients on surveillance developed metastatic disease. CONCLUSIONS Active surveillance is a safe strategy for the management of pheochromocytoma in patients with germline Von Hippel Lindau alterations. Growth rates appear to increase dramatically with increasing size of the tumors. It appears that patients with masses smaller than 2 cm are the optimal candidates for active surveillance. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e30 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Thomas Sanford More articles by this author Rashid Siddiqui More articles by this author Daniel Su More articles by this author Julie An More articles by this author Adam Metwalli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Magnetic Resonance Imaging (MRI) and fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) are recognized approaches for locating paragangliomas. Recently, gallium-68 DOTA-octreotate (DOTATATE) scans have shown promise detecting neuroendocrine tumors missed by FDG-PET and MRI. 13-year-old male with SDH-B mutation presented with symptoms of paraganglioma and elevated catecholamines. MRI did not demonstrate the T2 hyper intense signal typical of paraganglioma and pheochromocytoma; FDG-PET scan did not reveal increased foci of uptake. DOTATATE scan revealed a signal consistent only with residual adrenal tissue. Resection of the right adrenal bed revealed paraganglioma. Following surgery, no further symptoms were reported and biochemical tests normalized.

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2017MP15-10 IMMUNOLOGIC RESPONSE TO A THERAPEUTIC CANCER VACCINE (PANVAC): INITIAL RESULTS FROM A RANDOMIZED PHASE 2 CLINICAL TRIAL Thomas Sanford, Renee Donahue, Caroline Jochems, Rebecca Dolan, Sonia Bellfield, Megan Anderson, Eric Singer, Robert Weiss, Sammy Elsamra, Thomas Jang, Sam Brancato, Daniel Su, Yvonne Wall, James Gulley, Jeffrey Schlom, and Piyush Agarwal Thomas SanfordThomas Sanford , Renee DonahueRenee Donahue , Caroline JochemsCaroline Jochems , Rebecca DolanRebecca Dolan , Sonia BellfieldSonia Bellfield , Megan AndersonMegan Anderson , Eric SingerEric Singer , Robert WeissRobert Weiss , Sammy ElsamraSammy Elsamra , Thomas JangThomas Jang , Sam BrancatoSam Brancato , Daniel SuDaniel Su , Yvonne WallYvonne Wall , James GulleyJames Gulley , Jeffrey SchlomJeffrey Schlom , and Piyush AgarwalPiyush Agarwal View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.495AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients who have recurrences of superficial urothelial carcinoma after BCG have limited therapeutic options. We are conducting a randomized phase II clinical trial in which patients who have recurrence after prior BCG undergo either repeat induction BCG or BCG combined with a cancer vaccine (PANVAC). In this study, we report our analysis of the initial immunologic response for the patients enrolled thus far. METHODS The immunologic responses of all patients enrolled thus far were assessed. Three tumor-specific antigens (Brachyury, CEA, and MUC1) were assessed using an overlapping 15-mer peptide pool spanning the entire length of each of the peptides. HLA was used as a negative control and CEFII was used as a positive control. The tumor associated antigen (TAA) response was evaluated at an early time point (1 month after therapy initiation/1 week after 2nd vaccine administration) and at a later time point (3-4 months after therapy initiation/1 week after 4th vaccine administration). A positive response was defined as antigen levels above 250 (absolute number of cells producing cytokine) after subtracting for background. RESULTS There were a total of 16 patients enrolled thus far: Eight patients were randomized to the BCG-only arm and eight patients were randomized to the BCG+PANVC arm. The median number of BCG instillations prior to enrollment in both groups was 6 (range 5-19). 25% of patients also had intravesical chemotherapy prior to enrollment (2 patient had Mitomycin C, 2 patients had Valrubicin). There was a higher rate of all responses in the BCG+PANVAC (mean TAA value 734) arm than in the BCG alone arm (mean TAA value 434) (p<0.01), and a higher rate of responses attributable to the brachyury antigen (p=0.03). There was also a higher rate of response when CEA and MUC1 were evaluated together. The CD8 response appeared to be greater than the CD4 response for patient in the PANVAC arm but not in the BCG only arm. CONCLUSIONS BCG + PANVAC appears to induce an immunological response that is greater than BCG alone in many patients. The impact of this immunological response on patient outcomes will continue to be assessed as the trial matures. © 2017FiguresReferencesRelatedDetailsCited byMeng M, Gschwend J, Shore N, Grossfeld G, Mostafid H and Black P (2019) Emerging Immunotherapy Options for bacillus Calmette-Guérin Unresponsive Nonmuscle Invasive Bladder CancerJournal of Urology, VOL. 202, NO. 6, (1111-1119), Online publication date: 1-Dec-2019. Volume 197Issue 4SApril 2017Page: e174 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Thomas Sanford More articles by this author Renee Donahue More articles by this author Caroline Jochems More articles by this author Rebecca Dolan More articles by this author Sonia Bellfield More articles by this author Megan Anderson More articles by this author Eric Singer More articles by this author Robert Weiss More articles by this author Sammy Elsamra More articles by this author Thomas Jang More articles by this author Sam Brancato More articles by this author Daniel Su More articles by this author Yvonne Wall More articles by this author James Gulley More articles by this author Jeffrey Schlom More articles by this author Piyush Agarwal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objective: To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic effect on the survival of these patients.Methods: A retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000-2014) was undertaken. Logistic regression to identify predictors of the development of malignant ascites and Kaplan-Meier analysis to estimate survival was done.Results: Overall, 106 consecutive patients with metastatic pRCC were identified; sufficient data were available in 100 patients to enable assessment of ascites. Further, 20% had evidence of malignant ascites. Median age at diagnosis of ascites was 48.0 years (26.1-76.6 years) and median time to development of ascites from initial diagnosis of metastatic disease was 16.0 (0-73.3) months. There was no significant difference in the incidence of ascites between patients with hereditary and sporadic pRCC (P = 0.803) or among patients with different subtypes of pRCC (P = 0.456). Elevated platelet-lymphocyte ratio predicted development of malignant ascites in our cohort (P = 0.009). Median overall survival was shorter for patients who developed ascites [25.0 (10.2-39.8) months] compared with patients who did not develop this complication [42.5 (30.5-54.4) months, P = 0.041].Conclusion: To our knowledge, this is the first systematic evaluation of the incidence, predictors, and prognostic effect of ascites in metastatic pRCC. Malignant ascites is a common manifestation of metastatic pRCC and is associated with a shorter overall survival. An elevated platelet-lymphocyte ratio predicts a higher risk of developing malignant ascites. Published by Elsevier Inc.

Background: The high-spatial resolution of multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer. mpMRI characteristics (extraprostatic extension [EPE], number of lesions, etc.) may predict final pathological findings (positive lymph node [pLN] and pathological ECE [pECE]) and biochemical recurrence (BCR). Tumor contact length (TCL) on MRI, defined as the length of a lesion in contact with the prostatic capsule, is a novel marker with promising early results. We aimed to evaluate TCL as a predictor of +pathological EPE (+pEPE), +pathological LN (+pLN), and BCR in patients undergoing robotic assisted laparoscopic radical prostatectomy.Materials and methods: A review was performed of a prospectively maintained single-institution database of men with prostate cancer who underwent prostate mpMRI followed by robotic-assisted laparoscopic radical prostatectomy without prior therapy from 2007 to 2015. TCL was measured using T2-weighted magnetic resonance images. Logistic and Cox regression analysis were used to assess associations of clinical, imaging, and histopathological variables with pEPE, pLN, and BCR. Receiver operating characteristic curves were used to characterize and compare TCL performance with Partin tables.Results: There were 87/379 (23.0%) +pEPE, 18/384 (4.7%) +pLN, and 33/371 (8.9%) BCR patients. Patients with adverse pathology/ oncologic outcomes had longer TCL compared to those without adverse outcomes (+pEPE: 19.8 vs. 10.1 mm, P < 0.0001, +pLN: 38.0 vs. 11.7 mm, P < 0.0001, and BCR: 19.2 vs. 11.2 mm, P = 0.001). On multivariate analysis, TCL remained a predictor of +pEPE (odds ratio: 1.04, P = 0.001), +pLN (odds ratio: 1.07, P < 0.0001), and BCR (hazard ratio: 1.03, P = 0.02). TCL thresholds for predicting +pEPE and +pLN were 12.5 and 19.7 mm, respectively. TCL alone was found to have good predictive ability for +pEPE and +PLN (pEPE: TCLAUC: 0.71 vs. Partin(AUC): 0.66, P = 0.21; pLN:TCLAUC: 0.77 vs. Partin(AUC): 0.88, P = 0.04).Conclusion: We demonstrate that TCL is an independent predictor of +pEPE, +pLN, and BCR. If validated, this imaging biomarker may facilitate and inform patient counseling and decision-making. Published by Elsevier Inc.

MRI-TRUS fusion biopsy (FBx) has proven efficacy in targeting suspicious areas that are traditionally missed by systematic 12-core biopsy (SBx). Midline prostate lesions are undersampled during SBx, as traditional approaches aim laterally during TRUS biopsy. The aim of our study was to determine the utility of FBx for targeting midline lesions identified on multiparametric MRI (mpMRI).

Purpose: Urologists face a dilemma when a lesion identified on multiparametric magnetic resonance imaging is benign on image guided fusion biopsy. We investigated the detection rate of prostate cancer on repeat fusion biopsy in multiparametric magnetic resonance imaging lesions initially found to be pathologically benign on fusion biopsy.Materials and Methods: We reviewed the records of all patients from 2007 to 2014 who underwent multiparametric magnetic resonance imaging and image guided fusion biopsy. We identified men who underwent rebiopsy of the same discrete lesion after initial fusion biopsy results were benign. Data were documented on a per lesion basis. We manually reviewed UroNav system (Invivo, Gainesville, Florida) needle tracking to verify accurate image registration. Multivariate analysis was used to identify clinical and imaging factors predictive of prostate cancer detection at repeat fusion biopsy.Results: A total of 131 unique lesions were rebiopsied in 90 patients. Of these 131 resampled lesions 21 (16%) showed prostate cancer, which in 13 (61.9%) was Gleason 3 + 3. On multivariate analysis only lesion growth on repeat multiparametric magnetic resonance imaging was significantly associated with prostate cancer detection at repeat biopsy (HR 3.274, 95% CI 1.205-8.896, p = 0.02).Conclusions: Pathologically benign multiparametric magnetic resonance imaging lesions on initial image guided fusion biopsy are rarely found to harbor clinically significant prostate cancer on repeat biopsy. When prostate cancer was identified, most disease was low risk. An increase in lesion diameter was an independent predictor of prostate cancer detection. While these data are retrospective, they may provide some confidence in the reliability of negative initial image guided fusion biopsies despite a positive multiparametric magnetic resonance imaging finding.

INTRODUCTION AND OBJECTIVES: Current prognostic models of metastatic RCC (mRCC) include tumor characteristics (e.g.stage, grade), patient factors (e.g.performance status), and select laboratory values.A comprehensive laboratory-based prognostic panel remains elusive and each laboratory tests relative value remains unknown.To address this challenge, our group has developed a Laboratory-Wide Association Study (LWAS) framework to systematically evaluate laboratory exposures associated with outcome in a national cohort of patients with mRCC.METHODS: We included all patients diagnosed with mRCC (N or M stage >0) between 2002 and 2012 in the VA.We abstracted patient age, sex, BMI, Charlson Score, and receipt of cytoreductive nephrectomy.Overall survival (OS) was determined using the VA Vital Status File.All available serum-based laboratory measures were identified in a period 6 months prior to diagnosis through 1 month after diagnosis.A LWAS analysis was performed as outlined in the figure .RESULTS: We identified 278,902 serum lab values in 2,339 patients.19 factors were associated with worse OS while 17 were associated with improved OS.We validated several known lab values associated with mRCC OS: Hgb (HR 0.82 95%CI 0.81-0.84),Ca (HR 0.98, 95%CI 0.96-0.99),PLT (HR 1.16 95%CI 1.12-1.20),WBC (HR 1.02, 95%CI 1.101-1.03),Alk Phos (HR 1.26, 95%CI 1.24-1.29),Albumin (HR 0.69, 95%CI 0.66-0.71),and TSH (HR 1.07, 95%CI 1.01-1.14).C reactive protein was associated with the greatest hazard of mortality (HR 1.68,.Additional novel associations were also detected.CONCLUSIONS: The LWAS framework is a novel platform to systematically test for associations among lab values and clinical outcomes that can be applied on a broad scale.When applied in a large national integrated health care system with an electronic medical record, LWAS validated many known lab values associated with OS and identified novel lab values that may improve prognostic models for these patients.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2016MP20-16 TRAINING AND SKILLS ASSESSMENT FOR FUSION-GUIDED PROSTATE BIOPSY: DEFINING THE LEARNING CURVE Akhil Muthigi, Arvin George, Daniel Su, Pingkun Yan, Jochen Kruecker, Harish Narayanan, Janice Thai, Meet Kadakia, Michael Kongnyuy, Amogh Iyer, Abhinav Sidana, Amichai Kilchevsky, Thomas Frye, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto Akhil MuthigiAkhil Muthigi More articles by this author , Arvin GeorgeArvin George More articles by this author , Daniel SuDaniel Su More articles by this author , Pingkun YanPingkun Yan More articles by this author , Jochen KrueckerJochen Kruecker More articles by this author , Harish NarayananHarish Narayanan More articles by this author , Janice ThaiJanice Thai More articles by this author , Meet KadakiaMeet Kadakia More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Amogh IyerAmogh Iyer More articles by this author , Abhinav SidanaAbhinav Sidana More articles by this author , Amichai KilchevskyAmichai Kilchevsky More articles by this author , Thomas FryeThomas Frye More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2785AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Advances in multiparametric MRI combined with improved sampling by MR/TRUS fusion-guided prostate biopsy (FBx) have resulted in rapid adoption of this novel technology into the biopsy paradigm. FBx accuracy is dependent on a number of factors and acquired skills that vary by user experience. We aim to define the differences among users with varying levels of experience with a tracked fusion biopsy platform. METHODS 10 users within 5 different experience levels were asked to perform electromagnetically tracked FBx after completion of a standardized didactic and hands-on course. Experience levels included gold standard (>1000 FBx), Expert (50-100 FBx), urologists, radiology residents, and medical students without FBx experience. A prostate phantom model (CIRS Inc.) with 4 gold fiducial targets was segmented on T2 imaging. FBx of each target was performed using rigid registration with the UroNav system (Invivo Corp.) and then with ultrasound (US) only. Mechanical targeting error (MTE) was calculated as distance between the bullseye target and actual core location during FBx; fusion registration error (FRE) was the distance between MR target and transformed core location from the US only biopsy. Time to completion of each task during FBx was recorded. RESULTS Data from the initial trial for each user among experience levels is reported. Mean overall time to completion of FBx by the different experience level subgroups ranged from 13:14 to 37:42 [Figure 1a]. Range of mean MTE, a measure of ability to visualize and biopsy the target, was 0.79 mm-1.42 mm and did not correlate with user level (p=0.893) Mean FRE ranged from 3.03 mm in the gold standard group up to 6.12 mm in the medical student group. FRE demonstrated a linear relationship with user level and was significantly correlated (correlation coefficient 0.935, p<0.001) [Figure 1b]. CONCLUSIONS Fusion-guided biopsy is an acquired skillset with sufficient experience needed to provide an accurate sampling within a reasonable time. Characterization of the learning curve by experience level may help determine a standardized level of proficiency and core competencies for this new procedure, prior to employing it in clinical practice. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e219-e220 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Akhil Muthigi More articles by this author Arvin George More articles by this author Daniel Su More articles by this author Pingkun Yan More articles by this author Jochen Kruecker More articles by this author Harish Narayanan More articles by this author Janice Thai More articles by this author Meet Kadakia More articles by this author Michael Kongnyuy More articles by this author Amogh Iyer More articles by this author Abhinav Sidana More articles by this author Amichai Kilchevsky More articles by this author Thomas Frye More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2016MP53-14 COST EFFECTIVENESS OF MAGNETIC RESONANCE/ULTRASOUND FUSION PROSTATE BIOPSY VS STANDARD OF CARE (TRANSRECTAL ULTRASOUND (TRUS)-GUIDED BIOPSY) Kaitlan Cobb, Amichai Kilchevsky, John Michael DiBianco, Daniel Su, Thomas Frye, Vikram Sabarwal, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto Kaitlan CobbKaitlan Cobb More articles by this author , Amichai KilchevskyAmichai Kilchevsky More articles by this author , John Michael DiBiancoJohn Michael DiBianco More articles by this author , Daniel SuDaniel Su More articles by this author , Thomas FryeThomas Frye More articles by this author , Vikram SabarwalVikram Sabarwal More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.511AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies have shown magnetic resonance imaging / ultrasound (MR/US) fusion prostate biopsies to be to be comparable and superior to standard TRUS-guided biopsy in diagnosing prostate cancer (PCa). MRI of the prostate as a possible initial diagnostic tool has been postulated. We sought to explore the cost-effectiveness of prostate MRI as an initial diagnostic tool as compared to TRUS-guided biopsy. METHODS Using a cost analysis model, the total cost and outcomes for biopsy naïve men presenting with an elevated PSA >4.0 ng/ml was compared. A theoretical cohort was subdivided into those undergoing TRUS prostate biopsy and those undergoing prostate MRI with subsequent MR/US fusion biopsy only if when a target lesion is present. A cancer incidence of 28%, additional 32% non-infectious complication rate cost, 1.73% infectious complication cost, sensitivities and specificities for TRUS-guided biopsy at 53% and 66% respectively, prostate MRI set at 75% and 88% respectively and MR/US fusion biopsy set at 77% and 68% respectively, were based off current literature. Cost of TRUS biopsy, prostate MRI and MR/US fusion biopsy were based of the current AUA recommended CPT and Medicare reimbursement. Added cost for the MR/US fusion cohort included the system cost, determined by the average cost of the commercially available system. RESULTS Using a total cost for 1 patient undergoing TRUS prostate biopsy of $1,410.35, a contrast enhanced prostate MR of $633.36 and MRI fusion biopsy of $2,138.95, TRUS guided biopsy in 100 men would cost $141,035, and would be falsely negative in 13.16 men and falsely positive 24.48 men. The total cost of obtaining initial prostate MRI in 100 men with only patients with target lesion(s) undergoing MR/US fusion biopsy, was determined to be $107,961.69 given that 70.36 men would undergo prostate MRI alone, and 29. 64 men would have a subsequent MR/US fusion biopsy. Within the group of men only undergoing prostate MRI, 7 men would have falsely negative results and 8.64 would have falsely positive results. If MR/US fusion biopsy were performed without the addition of the standard 12-core template, false positivity would occur in 0.521 men, and false negativity in 6.44 men. CONCLUSIONS 100 men with PSA elevation who undergo prostate MRI with MR/US fusion biopsy if indicated, would cost ~25% less than undergoing an initial standard TRUS guided biopsy. Prostate MRI alone would result in fewer biopsies performed, thereby decreasing the cost of diagnosing PCa and reducing biopsy associated complications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e702-e703 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kaitlan Cobb More articles by this author Amichai Kilchevsky More articles by this author John Michael DiBianco More articles by this author Daniel Su More articles by this author Thomas Frye More articles by this author Vikram Sabarwal More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2016PD06-04 MIDLINE PROSTATE LESIONS: FUSION BIOPSY IMPROVES DETECTION OF CLINICALLY SIGNIFICANT CANCER Akhil Muthigi, Arvin George, Michael Kongnyuy, Abhinav Sidana, Nabeel Shakir, Meet Kadakia, Amichai Kilchevsky, Thomas Frye, Daniel Su, Maria Merino, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto Akhil MuthigiAkhil Muthigi More articles by this author , Arvin GeorgeArvin George More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Abhinav SidanaAbhinav Sidana More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Meet KadakiaMeet Kadakia More articles by this author , Amichai KilchevskyAmichai Kilchevsky More articles by this author , Thomas FryeThomas Frye More articles by this author , Daniel SuDaniel Su More articles by this author , Maria MerinoMaria Merino More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2624AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES MRI-TRUS fusion biopsy (FBx) has proven efficacy in targeting suspicious areas that are traditionally missed by standard 12-core biopsy (SBx), such as anterior, distal apical, and subcapsular lesions. Midline lesions may be undersampled with medial biopsy cores during SBx unless large enough to enter the sampling area. The aim of our study was to determine the utility of FBx for targeting midline lesions identified on multiparametric MRI (mpMRI). METHODS A review was performed of a prospectively maintained database of patients undergoing mpMRI followed by FBx and SBx in the same session from 2007-2015. Patients with midline lesions of the prostate in the peripheral and transition zones were identified. Midline location was defined as any lesion crossing the midline on axial imaging and involving both prostatic lobes. Index lesion was defined as the lesion with highest Gleason score on biopsy. Patient demographic, imaging, and histopathologic data were collected. Chi-square and Wilcoxon rank-sum tests were conducted to determine association of patient, MRI, and biopsy pathology characteristics with disease upgrading based on FBx of midline lesions over SBx. RESULTS Out of 1260 patients, we identified 252 midline lesions in 190 patients (mean age 63.2 ± 7.36; median PSA 7.5 ng/dL). Of the 252 midline lesions, 128 (50.8%) had prostate cancer detected by fusion biopsy. In patients with prostate cancer found on biopsy (132/190), a midline target represented the index lesion of the prostate in 65 patients (49.2%). Prostate cancer detection in midline lesions was significantly correlated with upgrading on FBx relative to SBx (p<0.001). Disease risk category upgrading based on FBx of a midline lesion as compared to the highest SBx result occurred in 45/132 patients (34.1%). 41/45 upgrades (91%) were to intermediate (Gleason 7) or high risk (Gleason ≥ 8) cancer. Patients who were upgraded on FBx of midline lesions had significantly smaller MRI prostate volumes (Table 1). CONCLUSIONS MRI-TRUS fusion biopsy allows for targeted sampling of midline lesions missed with standard biopsy alone. Integration of mpMRI and FBx for sampling of midline lesions improves detection of clinically significant prostate cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e175 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Akhil Muthigi More articles by this author Arvin George More articles by this author Michael Kongnyuy More articles by this author Abhinav Sidana More articles by this author Nabeel Shakir More articles by this author Meet Kadakia More articles by this author Amichai Kilchevsky More articles by this author Thomas Frye More articles by this author Daniel Su More articles by this author Maria Merino More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multiparametric MRI (mpMRI) has improved detection and risk stratification of men with newly diagnosed prostate cancer. mpMRI has recently been explored in the setting of biochemical recurrence after external beam radiation therapy and High Dose Rate brachytherapy. However, mpMRI is not routinely performed in the setting of biochemical relapse after Low Dose Rate (LDR) brachytherapy because of concern for seed-induced MRI artifact. Herein, we report the first series of post-LDR brachytherapy mpMRI and confirmatory biopsy in the setting of PSA relapse. All patients who received LDR brachytherapy as a component of therapy and were referred to our institution for mpMRI following PSA relapse were analyzed (2011-present). mpMRI consisted of endorectal coil T2 weighted imaging (T2W), dynamic contrast enhanced (DCE) imaging, and diffusion weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) maps. Lesions were categorized as suspicious by a prostate-dedicated radiologist based on detection in each sequence. Biopsy was performed in patients with no evidence of metastases. Biopsy-proven lesions without unilateral mpMRI findings were considered false negative identifications by mpMRI. Sensitivity (SN) and positive predictive value (PPV) of mpMRI in detecting biopsy-confirmed lesions was determined. 20 patients who developed recurrence post-brachytherapy (Phoenix Criteria: n = 19, rapid PSA rise: n = 1) were included. The mean PSA at the time of mpMRI was 6.42 ng/ml. Pre-implant Gleason score was ≤6 in 12 patients and >6 in 8 patients. The median time from implant to recurrence was 62 months. Prostate biopsy was performed in 17 patients (n = 3 excluded due to metastases). mpMRI detected at least one suspicious prostate lesion in 15/17 patients. A total of 25 lesions were identified (0-4 per patient), 16 of which were confirmed pathologically in 12/17 patients. Pathologic evidence of recurrence was concordant with mpMRI in 12/13 patients. Pathologically confirmed tumors identified by mpMRI were frequently located in the transition zone (TZ, 43.75%) and seminal vesicles (SV, 37.5%). 2/16 of TZ lesions were anterior to the urethra. Two pathologically confirmed SV lesions were not identified by mpMRI. Nine mpMRI defined lesions were benign on biopsy. The overall SN and PPV of detecting pathologically confirmed lesions on any parameter of mpMRI was 70% and 64% respectively. mpMRI detection of local recurrence in the setting of biochemical failure after prostate brachytherapy is feasible, with a high tissue-concordant cancer detection rate. The pattern of local recurrence in the TZ and in the SV post-brachytherapy should be validated in larger series, as it may have implications for treatment planning.

INTRODUCTION:We studied the safety and efficacy of the CyberWand™ lithotripter and how stone density affects the efficacy.METHODS:We retrospectively analyzed the outcomes of percutaneous nephrolithotomy performed using the CyberWand dual frequency ultrasonic lithotripter at our institution between November 2009 and July 2015. A total of 63 procedures were performed on 57 renal units and, thus, we may be considered a low volume center. We assessed the outcomes of each renal unit in terms of the clinically insignificant residual fragment rate, complication rate, operating room time, estimated blood loss and length of hospitalization. We evaluated the effect of HU of the stone (less than 1,000 HU considered soft and greater than 1,000 HU considered hard) on outcome.RESULTS:Our outcomes using the CyberWand lithotripter were comparable to those of other lithotripsy modalities in terms of the complication rate and clinically insignificant residual fragment rate. We achieved clinically insignificant residual fragment status (defined as less than 4 mm residual stone size) in 54% of renal units and the overall complication rate was 24%. There were no appreciable differences between soft stones and hard stones in terms of any outcome parameter including complication rate, clinically insignificant residual fragment rate and operative time.CONCLUSIONS:The CyberWand lithotripter is an acceptable, noninferior modality of percutaneous lithotripsy of renal calculi. The efficacy of the CyberWand lithotripter is not affected by stone density.

Introduction: African-American (AA) men tend to harbor high-risk prostate cancer (PCa) and exhibit worse outcomes when compared to other groups. It has been postulated that AA men may harbor more anterior prostate lesions (APLs) that are undersampled by the standard transrectal ultrasound guided-biopsy (SBx), potentially resulting in greater degree of Gleason score (GS) upgrading at radical prostatectomy. We aimed to evaluate the detection rate of anterior PCa significance of APLs in AA men on multiparametric magnetic resonance imaging (mpMRI) and compare it to a matched cohort of White/Other (W/O) men.Materials and methods: A review of 1,267 men who had an mpMRI with suspicious prostate lesions and who underwent magnetic resonance transrectal ultrasound fusion-guided biopsy (FBx) with concurrent SBx in the same biopsy session was performed. All AA men were matched to a control group of W/O using a 1:1 propensity score-matching algorithm with age, prostate-specific antigen, and prostate volume as matching variables. Logistic regression analysis was used to determine predictors of APLs in AA men.Results: Of the 195 AA men who underwent mpMRI, 93 (47.7%) men had a total of 109 APLs. Prior negative SBx was associated with the presence of APLs in AA men (Odds ratio = 1.81; 95% CI: 1.03-3.20; P = 0.04). On multivariate logistic regression analysis, smaller prostate (P = 0.001) and rising prostate-specific antigen (P = 0.007) were independent predictors of cancer-positive APLs in AA men. Comparative analysis of AA (93/195, 47.7%) vs. W/O (100/194, 52%) showed no difference in the rates of APLs (P = 0.44) or in cancer detection rate within those lesions or the distribution of GS within those cancers (P = 0.63) despite an overall higher cancer detection rate in AA men (AA: 124/195 [63.6%] vs. W/O: 97/194 [50.0%], P = 0.007). In cases where APLs were positive for PCa on FBx, the GS of APL was equal to the highest GS of the entire gland in 82.9% (29/35) and 90.9% (30/33) of the time in AA and W/O men, respectively.Conclusion: Cancer-positive APLs represented the highest risk GS in most cases. AA men with prior negative SBx are twice as likely to harbor a concerning APL. In our cohort, AA and W/O men had comparable rates of APLs on mpMRI. Thus, differences in APLs do not explain the higher risk of AA men for deahth due to PCa. However, targeting of APLs via FBx can clinically improve PCa risk stratification and guide appropriate treatment options. (c) 2016 Published by Elsevier Inc.

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2016MP53-17 CANCER DETECTION ON MRI FUSION BIOPSY IS INDEPENDENT OF PRIOR NEGATIVE BIOPSY HISTORY: A MULTI-INSTITUTIONAL ANALYSIS Abhinav Sidana, Meet Kadakia, Mahir Maruf, Arvin George, Michael Kongnyuy, Akhil Muthigi, Amichai Kilchevsky, Daniel Su, Maria Merino, M. Minhaj Siddiqui, Soroush Rais Bahrami, Ardeshir Rastinehead, Srinivas Vourganti, Thomas Frye, Jennifer Gordetsky, Michele Fascelli, Jeffery Nix, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto Abhinav SidanaAbhinav Sidana More articles by this author , Meet KadakiaMeet Kadakia More articles by this author , Mahir MarufMahir Maruf More articles by this author , Arvin GeorgeArvin George More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Akhil MuthigiAkhil Muthigi More articles by this author , Amichai KilchevskyAmichai Kilchevsky More articles by this author , Daniel SuDaniel Su More articles by this author , Maria MerinoMaria Merino More articles by this author , M. Minhaj SiddiquiM. Minhaj Siddiqui More articles by this author , Soroush Rais BahramiSoroush Rais Bahrami More articles by this author , Ardeshir RastineheadArdeshir Rastinehead More articles by this author , Srinivas VourgantiSrinivas Vourganti More articles by this author , Thomas FryeThomas Frye More articles by this author , Jennifer GordetskyJennifer Gordetsky More articles by this author , Michele FascelliMichele Fascelli More articles by this author , Jeffery NixJeffery Nix More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.514AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with persistently elevated prostate specific antigen (PSA) and prior negative 12-core prostate biopsy (or biopsies) are a diagnostic challenge. Repeat extended sextant biopsy or saturation biopsy in this cohort has been shown to have even lower yield. The aim of our study is to compare the yield of MRI fusion biopsy (FB) to extended sextant biopsy (ESB) in a multi-institutional cohort comprised of patients with prior negative biopsies. METHODS A multi-institutional review was performed on patients with history of one or more prior negative sextant biopsy who underwent multiparametric MRI (mpMRI) followed by FB and ESB in the same session. Imaging protocol was standardized across institutions and mpMRI and pathology was reviewed by respective institutional genitourinary radiologists and pathologists. Gleason score (GS) distribution and risk classifications were recorded. Chi-square and Mann-Whitney U tests were conducted to compare proportions and means respectively. Univariate and multivariate logistic regression was done to identify predictors of cancer detection on ESB and FB. RESULTS 676 patients from 3 institutions were included in the study. Mean age and PSA were 63.5(±7.2) years and 13.3 (±18.1) ng/dL. Median number of prior negative biopsies was 2.0 (1-16). 62 (9.2%) patients had cancer detection only on ESB, 75 (11.1%) had cancer detection only on FB and 177 (26.2%) patients had cancer detection on both FB and ESB. Patients with more than 2 prior negative biopsies had lower cancer detection rate (CDR) on ESB compared to patients with 2 or less negative biopsies (29.9 vs 38.1, p=0.046). The CDR on FB was comparable between two groups (36.9 vs 38.4%, p=0.732). Using multivariate logistic regression, increasing age (p<0.001), PSA (p<0.001), smaller prostate volume (p<0.001), and Afroamerican race (p=0.002), independently predicted cancer detection on ESB. Increasing number of prior negative biopsies (p<0.001) predicted lower odds of CDR on ESB. While increasing age, PSA and smaller prostate volume predicted cancer on FB too, prior negative biopsies and race had no effect. CONCLUSIONS Using a large multi-institutional cohort, we were able to demonstrate decreasing CDR on ESB with increased number of prior biopsies. Yield of FB stayed constant and did not decrease with increased number of prior negative biopsies. Repeat ESB in patients with multiple prior negative biopsies will be hampered by lower yield and FB should be utilized in these patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e704 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Abhinav Sidana More articles by this author Meet Kadakia More articles by this author Mahir Maruf More articles by this author Arvin George More articles by this author Michael Kongnyuy More articles by this author Akhil Muthigi More articles by this author Amichai Kilchevsky More articles by this author Daniel Su More articles by this author Maria Merino More articles by this author M. Minhaj Siddiqui More articles by this author Soroush Rais Bahrami More articles by this author Ardeshir Rastinehead More articles by this author Srinivas Vourganti More articles by this author Thomas Frye More articles by this author Jennifer Gordetsky More articles by this author Michele Fascelli More articles by this author Jeffery Nix More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

61 Background: Multiparametric MRI (MP-MRI) can visualize prostate tumors. MP-MRI characteristics (extraprostatic extension (ECE), tumor volume, etc.) can be predictive of final pathologic findings such as lymph node (LN) involvement, pathological ECE (pECE), and biochemical recurrence (BCR). These are pivotal in the decision-making process regarding treatment. Tumor contact length (TCL) is defined as the length of cancer in contact with the prostatic capsule. We evaluated the ability of MP-MRI determined TCL in predicting pECE, BCR and LN in patients undergoing radical prostatectomy. Methods: All patients who underwent a 3T MP-MRI at the NCI from 2007 to 2015 were retrospectively classed into no ECE, suspicious ECE (sECE) and frank ECE (fECE) based on MP-MRI findings. sECE was defined as tumor with capsular bulge on MRI while fECE was clear capsular obliteration and tumor extension beyond the prostatic capsule. Demographic data was obtained on patients with fECE and sECE on MP-MRI with the presence of pECE, LN, and BCR status following radical prostatectomy from a single surgeon (PP) experience. Chi-Square and Wilcoxon rank sum test were used to compare proportions and continuous variables respectively. Logistic regression was used to determine the predictive ability of TCL. Statistical significance was defined as p-value ≤0.05. Results: Of all 1,260 patients who underwent MP-MRI, we focused on 146 who had sECE (68) or fECE (78) on MP-MRI. Mean age was 60 years and median prostate specific antigen was 11.7 ng/ml. Logistic regression analysis showed that MP-MRI determined TCL was predictive of ECE (p=0.01), LN status (p=0.0001) on final pathology and BCR (p=0.05) during follow up. Patients with pECE had a longer median MP-MRI TCL (2.8 cm) compared to those without pECE (2.4 cm), p=0.04. When analyzed individually, fECE correlated with pECE (p=0.05) while s ECE did not correlate with pECE (p=0.11). Although, not statistically significant, the median MP-MRI TCL for sECE with pECE was still longer than in sECE with no pECE in the sub-group analysis. Conclusions: Longer TCL on MP-MRI can indicate presence of ECE, LN involvement at final pathology as well as predict BCR on follow up.

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2016MP53-15 MULTI-INSTITUTIONAL ASSESSMENT OF MULTIPARAMETRIC MRI AND FUSION BIOPSY OF THE PROSTATE IN A BIOPSY-NAÏVE POPULATION Arvin George, Meet Kadakia, Minhaj Siddiqui, Soroush Rais-Bahrami, Ardeshir Rastinehad, Srinivas Vourganti, Michele Fascelli, Michael Kongnyuy, Akhil Muthigi, Abhinav Sidana, Amichai Kilchevsky, Thomas Frye, Daniel Su, John Thomas, Vidhush Yarlagadda, Vidhush Yarlagadda, Maria Merino, Peter Choyke, Baris Turkbey, Bradford Wood, and Peter Pinto Arvin GeorgeArvin George More articles by this author , Meet KadakiaMeet Kadakia More articles by this author , Minhaj SiddiquiMinhaj Siddiqui More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author , Ardeshir RastinehadArdeshir Rastinehad More articles by this author , Srinivas VourgantiSrinivas Vourganti More articles by this author , Michele FascelliMichele Fascelli More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Akhil MuthigiAkhil Muthigi More articles by this author , Abhinav SidanaAbhinav Sidana More articles by this author , Amichai KilchevskyAmichai Kilchevsky More articles by this author , Thomas FryeThomas Frye More articles by this author , Daniel SuDaniel Su More articles by this author , John ThomasJohn Thomas More articles by this author , Vidhush YarlagaddaVidhush Yarlagadda More articles by this author , Vidhush YarlagaddaVidhush Yarlagadda More articles by this author , Maria MerinoMaria Merino More articles by this author , Peter ChoykePeter Choyke More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.512AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric MRI (mpMRI) and fusion biopsy (FB) have demonstrated proven benefit in patients with a prior negative systematic biopsy (SB) or diagnosis of prostate cancer (CaP). Its value in patients with no prior history of prostate biopsy is less defined. We aim to evaluate mpMRI and FB in a biopsy naive population. METHODS A multi-institutional review was performed on patients with no prior biopsy history who underwent mpMRI followed by FB and SB in the same session. Imaging protocol and image interpretation with the previously validated NIH suspicion scoring system was standardized across institutions. MpMRI and pathology was reviewed by respective institutional genitourinary radiologists and pathologists. CaP risk groupings by Gleason Score (GS) were defined as low (GS 6, low volume GS 3+4=7), intermediate (high volume GS 3+4=7), and high (GS≥4+3). Univariate analysis was performed to compare performance of FB versus SB. RESULTS A total of 395 biopsy naive men were identified from 4 participating institutions. Mean age and PSA were 62.3 years (±8.4) and 7.0ng/ml (±5.8), respectively. Patient characteristics, GS and risk classification distribution for FB and SB are presented in Table 1. Overall cancer detection rate (CDR) was 65.0%. In biopsy naive men, FB detected a greater absolute number of high risk CaP than SB (22.3% vs 20.3%). Additionally, FB detected 18% fewer cases of GS 6 CaP (15.7% vs 19.2%, p=0.1). The CDR for FB alone was 57.2% with only 4 intermediate risk and 1 high risk patient not identified. The addition of SB to FB resulted in the diagnosis of 26 additional cases of low risk disease for each case of high risk CaP detected. The CDR of SB alone was 59.2%, however, 1 intermediate and 4 high risk CaP were missed. The addition of FB to SB alone resulted in only 4.5 additional cases of low risk CaP for each high risk CaP detected. CONCLUSIONS In men with no prior biopsy history, mpMRI and fusion biopsy detects a greater proportion of high risk disease while decreasing the detection of low risk CaP. As urologists explore ways to apply this technology in their practice, additional studies with greater power will be required to validate the potential benefit of mpMRI and FB in the biopsy naive population. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e703 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Arvin George More articles by this author Meet Kadakia More articles by this author Minhaj Siddiqui More articles by this author Soroush Rais-Bahrami More articles by this author Ardeshir Rastinehad More articles by this author Srinivas Vourganti More articles by this author Michele Fascelli More articles by this author Michael Kongnyuy More articles by this author Akhil Muthigi More articles by this author Abhinav Sidana More articles by this author Amichai Kilchevsky More articles by this author Thomas Frye More articles by this author Daniel Su More articles by this author John Thomas More articles by this author Vidhush Yarlagadda More articles by this author Vidhush Yarlagadda More articles by this author Maria Merino More articles by this author Peter Choyke More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...