We analyzed the additional value of systematic biopsy (SB) to MR-Ultrasound fusion biopsy (MRgFbx) for detection of clinically significant prostate cancer (csPCa), as increased sampling may cause increased morbidity. This retrospective study cohort was comprised of 1229 biopsy sessions between July 2016 and May 2020 in men who had a Prostate Imaging-Reporting and Data System (PI-RADSv2) category ≥ 3 lesion on 3 Tesla multiparametric MRI (3TmpMRI) and subsequent combined biopsy (CB; MRgFbx and SB) for suspected prostate cancer (PCa). Cancer detection rates (CDR) were calculated for CB, MRgFbx and SB in the study cohort and sub-cohorts stratified by biopsy history and PI-RADSv2 category. For 927 men with unilateral MR-visible lesions, SB CDR was additionally calculated for contralateral (SBc) and ipsilateral (SBi) subcohorts. On CB, the CDR for csPCa was 54.8

Background/Objectives: This study evaluated metabolites and lipid composition in the calf muscles of Type 2 diabetes mellitus (T2DM) patients and age-matched healthy controls using multi-dimensional MR spectroscopic imaging. We also explored the association between muscle metabolites, lipids, and intra-abdominal fat in T2DM. Methods: Participants included 12 T2DM patients (60.3 ± 8.6 years), 9 age-matched healthy controls (AMHC) (60.9 ± 7.8 years), and 10 young healthy controls (YHC) (28.3 ± 1.8 years). We acquired the 2D MR spectra of calf muscles using an enhanced accelerated 5D echo-planar correlated spectroscopic imaging (EP-COSI) technique and abdominal MRI with breath-hold 6-point Dixon sequence. Results: In YHC, choline levels were lower in the gastrocnemius (GAS) and soleus (SOL) muscles but higher in the tibialis anterior (TA) compared to AMHC. YHC also showed a higher unsaturation index (U.I.) of extramyocellular lipids (EMCL) in TA, intramyocellular lipids (IMCL) in GAS, carnosine in SOL, and taurine and creatine in TA. T2DM patients exhibited higher choline in TA and myo-inositol in SOL than AMHC, while triglyceride fat (TGFR2) levels in TA were lower. Correlation analyses indicated associations between IMCL U.I. and various metabolites in muscles with liver, pancreas, and abdominal fat estimates in T2DM. Conclusions: This study highlights distinct muscle metabolite and lipid composition patterns across YHC, AMHC, and T2DM subjects. Associations between IMCL U.I. and abdominal fat depots underscore the interplay between muscle metabolism and adiposity in T2DM. These findings provide new insights into metabolic changes in T2DM and emphasize the utility of advanced MR spectroscopic imaging in characterizing muscle-lipid interactions.

PURPOSE:We aimed to determine if, using baseline MRI-guided biopsy (MRGB), durability of active surveillance (AS) could be predetermined, follow-up biopsies avoided, and if by incorporating focal therapy (FT), AS extended. MATERIALS AND METHODS:A cohort of 869 men in the University of California, Los Angeles, protocol study of AS (2010-2022) was analyzed. Inclusion criteria were baseline MRGB showing Grade Group (GG) ≤ 2 and ≥ 1 year enrollment. After 2016, FT was offered to men with GG2 and those progressing to GG3. RESULTS:The 869 men accrued 3500 patient-years of follow-up (median follow-up 4.1 years). At baseline, men were GG1 (505), GG2 (174), or "GG0" (190), the latter describing those with prior diagnostic GG1 or 2, but negative baseline MRGB. Overall, progression to ≥ GG3 among the 664 with serial MRGB was 7% for GG0, 19% for GG1, and 34% for GG2. During follow-up, the absence of progression (negative predictive value) was correctly identified by MRI in nearly 95% of men with baseline GG0, 90% of men with GG1, and 70% of men with GG2. FT was performed in 99/393 eligible men (25%); among them, 5-year probability of radical prostatectomy/radiation therapy-free survival was 84% compared with 46% in the no-FT group (P < .01). CONCLUSIONS:Durability of AS may be linked to baseline MRGB. In men starting AS with MRGB and low-risk prostate cancer, subsequent MRI exhibits high negative predictive value, indicating routine follow-up biopsy is avoidable. In some men, FT may allow extension of AS and deferral of surgery or radiation.

We aimed to determine if, using baseline MRI-guided biopsy (MRGB), durability of active surveillance (AS) could be pre-determined, follow-up biopsies avoided, and if by incorporating focal therapy (FT), AS extended. A cohort of 869 men in the UCLA protocol study of AS (2010-2022) was analyzed. Inclusion criteria were baseline MRI-guided biopsy (MRGB) showing Grade Group (GG) ≤ 2 and >1 year enrollment. After 2016, FT was offered to men with GG2 and those progressing to GG3. The 869 men accrued 3500 patient-years of follow-up (median follow-up 4.1 years). At baseline, men were GG1 (505), GG2 (174), and 'GG0' (190), the latter describing those with prior diagnostic GG1 or 2, but negative baseline MRGB. Overall, progression to ≥ GG3 among the 664 with serial MRGB was 7% for GG0, 19% for GG1, and 34% for GG2. During follow-up, absence of progression (negative predictive value, NPV) was correctly identified by MRI in nearly 95% of men with baseline GG0; 90% of men with GG1; and 70% of men with GG2. FT was performed in 99/393 eligible men (25%); among them, five-year probability of RP/RT-free survival was 84% compared to 46% in the no-FT group (p<0.01). Durability of AS may be linked to baseline MRGB. In men starting AS with MRGB and low-risk prostate cancer, subsequent MRI exhibits high NPV, indicating routine follow-up biopsy is avoidable. In some men, FT may allow extension of AS and deferral of surgery or radiation.

PurposePercutaneous ultrasound-guided renal biopsy is essential for diagnosing medical renal disorders in transplant kidneys. A variety of techniques have been advocated. The purpose of this study is to evaluate the safety and efficacy of two different coaxial techniques and biopsy devices.MethodsThis single-center dual-arm, observation study cohort included 1831 consecutive transplant kidney biopsies performed over a 68-month period. Two coaxial techniques were used, distinguished by whether the 17 gauge (G) coaxial needle was advanced into the renal cortex (intracapsular technique; IC) or to the edge of the cortex (extracapsular technique; EC). One of two needle types could be used with either technique: an 18G side-cutting (Bard Max-Core or Mission) or an 18G end-cutting (Biopince Ultra) needle. In all cases, the cortical tangential technique was used to reduce the risk of central artery transgression and unnecessary medullary sampling. Patients were monitored for 30 days post-procedurally and complications were evaluated using the SIR adverse event classification.ResultsOf the 1831 patients included in the study cohort, 13 suffered severe bleeding complications requiring operative intervention. Of these patients, 8 underwent biopsy with side-cutting needle and IC, 2 with side-cutting needle and approach not specified, 2 with end-cutting needle and IC, and 1 with end-cutting needle and EC. There was no statistically significant difference in the risk of bleeding complications between different coaxial techniques and needle types. However, there was a significantly increased chance of inadequate sampling when comparing the side-cutting needle (1.0%) to the end-cutting needle (0.1%).ConclusionsTransplant kidney biopsy performed with two different coaxial techniques and needle types did not show differences in bleeding complications. There is an increased risk of inadequate sampling when using side-cutting relative to end-cutting biopsy devices.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I (MP25)1 May 2024MP25-02 METRICS OF TREATMENT OUTCOME FOLLOWING PARTIAL GLAND ABLATION FOR PROSTATE CANCER: PSA, MRI, OR BIOPSY? Wayne Brisbane, Shannon Richardson, Adam Kinnaird, Lorna Kwan, Samantha Gonzalez, Alan M. Priester, Ely R. Felker, Anthony E. Sisk, Merdie Delfin, and Leonard S. Marks Wayne BrisbaneWayne Brisbane , Shannon RichardsonShannon Richardson , Adam KinnairdAdam Kinnaird , Lorna KwanLorna Kwan , Samantha GonzalezSamantha Gonzalez , Alan M. PriesterAlan M. Priester , Ely R. FelkerEly R. Felker , Anthony E. SiskAnthony E. Sisk , Merdie DelfinMerdie Delfin , and Leonard S. MarksLeonard S. Marks View All Author Informationhttps://doi.org/10.1097/01.JU.0001008692.26556.39.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We tested the hypothesis that changes in MRI or PSA following focal therapy (FT) of prostate cancer (PCa) could replace biopsy in assessment of treatment outcome. METHODS: Subjects were all 309 men with GG2 (69%) or GG3 (31%) PCa who underwent FT from 2016 to 2022 in prospective trials of High Intensity Focused Ultrasound (HIFU; NCT03620786), N=90, or cryotherapy (CRYO; NCT03503643), N=219. PSA & MRI-guided biopsy (MRGB), targeted and systematic, was performed at baseline, 6 and 18 months (Figure 1). Main outcome was presence or absence (+/-) of clinically significant PCa (csPCa; ≥GG2) on follow-up (f/u) MRGB; concordance of biopsy with MRI (+/- lesions) & PSA (decrease by≥50% from baseline) was also determined. RESULTS: 261/309 men completed biopsies at 6 months, and if no csPCa was found, they went on to a 2nd f/u biopsy at 18 mos (N=210). Mean age was 68 yrs (IQR: 63, 72); 77% were White, 5% Black, 18% other/NA. At baseline, MRI lesions (PIRADS 3-5) were present in 236 men; median PSA was 6.6 (IQR 4.7, 9.8). At 6 months after FT, csPCa was absent in 188 (72%) (successful FT) and still present in 73 (28%) (failed FT) (Table 1). Among successes, MRI lesions were no longer present in 147/187 (79%); among failures, lesions were no longer present in 47/65 (72%) (p=0.13) (Table 1). PSA decreased by >50% in most successes (127/190; 67%) and also in most failures (37/68; 54%) (p=0.57). Sensitivity of MRI was 28% and specificity was 79%. Sensitivity of PSA was 46% and specificity 67%. Similar results were seen at 2nd f/u biopsy (Table 1). CRYO and HIFU treatment results were comparable. When change in either MRI or PSA suggested absence of csPCa, the combined sensitivity was 73% and specificity was 75%. CONCLUSIONS: After FT, presence of residual csPCa is best determined by MRGB, rather than by indirect metrics, i.e., PSA or MRI. FT energy appears to have a suppressant effect on the prostate markers independent of the anti-neoplastic effect. Download PPT Source of Funding: This work was supported in part by grants R01CA158627 and R01CA218547 from the National Cancer Institute; grant UL1TR000124 from University of California, Los Angeles (UCLA) Clinical and Translational Science Institute © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e403 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Wayne Brisbane More articles by this author Shannon Richardson More articles by this author Adam Kinnaird More articles by this author Lorna Kwan More articles by this author Samantha Gonzalez More articles by this author Alan M. Priester More articles by this author Ely R. Felker More articles by this author Anthony E. Sisk More articles by this author Merdie Delfin More articles by this author Leonard S. Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

Micro-ultrasound has recently been introduced as a low-cost alternative to multi-parametric MRI for imaging prostate cancer. Early clinical studies have demonstrated promising results; however, robust validation via comparison with whole-mount pathology has yet to be achieved. Due to micro-ultrasound probe design and tissue deformation during scanning, it is difficult to accurately correlate micro-ultrasound imaging planes with ground truth whole-mount pathology slides. In this study, we developed a multi-step methodology to co-register micro-ultrasound and MRI to whole-mount pathology. The three-step process had a registration error of 3.90 ± 0.11 mm and consists of: (1) micro-ultrasound image reconstruction, (2) 3D landmark registration of micro-ultrasound to MRI, and (3) 2D capsule registration of MRI to whole-mount pathology. This process was then used in a preliminary reader study to compare the diagnostic accuracy of micro-ultrasound and MRI in 15 patients who underwent radical prostatectomy for prostate cancer. Micro-ultrasound was found to have equivalent performance to retrospective MRI review for index lesion detection (91.7% vs. 80%), while demonstrating an increased detection of tumor extent (52.5% vs. 36.7%) with similar false positive regions-of-interest (38.3% vs. 40.8%). Prospective MRI review had reduced detection of index lesions (73.3%) and tumor extent (18.9%) but improved false positive regions-of-interest (22.7%) relative to micro-ultrasound and retrospective MRI. Further evaluation is needed with a larger sample size.

AbstractObjectiveThe objective of this study is to compare detection rates of extracapsular extension (ECE) of prostate cancer (PCa) using artificial intelligence (AI)‐generated cancer maps versus MRI and conventional nomograms.Materials and methodsWe retrospectively analysed data from 147 patients who received MRI‐targeted biopsy and subsequent radical prostatectomy between September 2016 and May 2022. AI‐based software cleared by the United States Food and Drug Administration (Unfold AI, Avenda Health) was used to map 3D cancer probability and estimate ECE risk. Conventional ECE predictors including MRI Likert scores, capsular contact length of MRI‐visible lesions, PSMA T stage, Partin tables, and the “PRedicting ExtraCapsular Extension” nomogram were used for comparison.Postsurgical specimens were processed using whole‐mount histopathology sectioning, and a genitourinary pathologist assessed each quadrant for ECE presence. ECE predictors were then evaluated on the patient (Unfold AI versus all comparators) and quadrant level (Unfold AI versus MRI Likert score). Receiver operator characteristic curves were generated and compared using DeLong's test.ResultsUnfold AI had a significantly higher area under the curve (AUC = 0.81) than other predictors for patient‐level ECE prediction. Unfold AI achieved 68% sensitivity, 78% specificity, 71% positive predictive value, and 75% negative predictive value. At the quadrant level, Unfold AI exceeded the AUC of MRI Likert scores for posterior (0.89 versus 0.82, p = 0.003), anterior (0.84 versus 0.80, p = 0.34), and all quadrants (0.89 versus 0.82, p = 0.002). The false negative rate of Unfold AI was lower than MRI in both the anterior (−60%) and posterior prostate (−40%).ConclusionsUnfold AI accurately predicted ECE risk, outperforming conventional methodologies. It notably improved ECE prediction over MRI in posterior quadrants, with the potential to inform nerve‐spare technique and prevent positive margins. By enhancing PCa staging and risk stratification, AI‐based cancer mapping may lead to better oncological and functional outcomes for patients.

Focal therapy of prostate cancer (PCa) is currently of great interest, but a metric of success. other than biopsy, is not yet available. In a patient with a repeatedly negative MRI and negative systematic biopsies, a scan employing the radioisotope 68Ga-PSMA-11 PET/CT identified a PSMA-avid hotspot in the prostate. PSMA-guided biopsy confirmed the diagnosis of a clinically-significant PCa. Following ablation of the lesion with high-intensity focused ultrasound (HIFU), the PSMA-avid lesion disappeared and targeted biopsy confirmed a fibrotic scar with no residual cancer. PSMA imaging may have a role in guiding diagnosis, focal ablation, and follow-up of men with PCa.

You have accessJournal of UrologyCME1 Apr 2023MP73-01 DOES MRI OR PSA PREDICT BIOPSY OUTCOME AFTER FOCAL CRYOTHERAPY FOR PROSTATE CANCER? Wayne Brisbane, Mamdouh Aker, Lorna Kwan, Samantha Gonzalez, Alan Priester, Adam Kinnaird, Merdie Delfin, Ely Felker, Anthony Sisk, and David Kupperman Wayne BrisbaneWayne Brisbane More articles by this author , Mamdouh AkerMamdouh Aker More articles by this author , Lorna KwanLorna Kwan More articles by this author , Samantha GonzalezSamantha Gonzalez More articles by this author , Alan PriesterAlan Priester More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , Ely FelkerEly Felker More articles by this author , Anthony SiskAnthony Sisk More articles by this author , and David KuppermanDavid Kupperman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to determine the value of MRI and serum PSA levels in prediction of targeted biopsy results after partial gland ablation (PGA) of intermediate-risk prostate cancer (PCa) using cryotherapy (CRYO). METHODS: In a prospective, observational trial (NCT03503643), 143 men with unilateral PCa (all >GG2) were enrolled. PSA and MRI-guided biopsy (MRGB) was performed before and after PGA with CRYO. CRYO treatment was a 2-cycle freeze of the affected prostate part using argon gas delivered via transperineal needles under image guidance. Participants underwent MRI/US fusion biopsy at baseline to determine eligibility; at 6 months to determine technical success; and at 18 months. Fusion MRGB in follow-up at 6 and 18 months employed tracking technology (JAMA Open: 31509206). Successful ablation=absence of PCa >GG2 on MRGB. Effects on urinary and sexual function were studied via EPIC-CP. RESULTS: 95% of enrollees (136/143) completed f/u MRGB at 6 mo; 103 had a successful ablation (74%). Of the 103, 71 then had 18-mo f/u MRGB; success rate at 18 mo was 46/71 (65%); among 25 failures at 18 months, PCa was ipsilateral in 8, contralateral in 12, and bilateral in 5. Baseline MRI lesions (PIRADS >3) disappeared post-CRYO in 96/130 men (74%); PCa was found in 22/96 (23%) with no lesion and 11/34 (32%) with lesions (p=NS). In a mult-variate analysis, lesion diameter was the only parameter related to biopsy outcome. PSA levels were similar (p=NS) before and after CRYO in successful and failed treatments (FIGURE), as was PSA density. After CRYO, urinary function changed but little, or improved; overall sexual function decreased in 53/143 (39%), but only 10/143 men reported a severe decrement (>6 point decline). CONCLUSIONS: In the near to intermediate term, PGA with cryotherapy is a safe and moderately effective treatment of intermediate-risk PCa, when outcome is judged by MRGB. Neither PSA nor MRI, at baseline or during follow-up, appear reliable as indicators of post-treatment tissue findings. We postulate the treatment per se alters prostate anatomy and physiology in a manner that obscures a relationship between either test and pathological outcome. Source of Funding: This work was supported in part by the National Cancer Institute (R01CA195505), UCLA CTSI (UL1TR000124), the Jean Perkins Foundation, the Kent Kresa Family Foundation, and the Steven C. Gordon Family Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1034 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wayne Brisbane More articles by this author Mamdouh Aker More articles by this author Lorna Kwan More articles by this author Samantha Gonzalez More articles by this author Alan Priester More articles by this author Adam Kinnaird More articles by this author Merdie Delfin More articles by this author Ely Felker More articles by this author Anthony Sisk More articles by this author David Kupperman More articles by this author Expand All Advertisement PDF downloadLoading ...

Hepatocellular adenomas (HCAs) are a family of liver tumors that are associated with variable prognoses. Since the initial description of these tumors, the classification of HCAs has expanded and now includes eight distinct genotypic subtypes based on molecular analysis findings. These genotypic subtypes have unique derangements in their cellular biologic makeup that determine their clinical course and may allow noninvasive identification of certain subtypes. Multiphasic MRI performed with hepatobiliary contrast agents remains the best method to noninvasively detect, characterize, and monitor HCAs. HCAs are generally hypointense during the hepatobiliary phase; the β-catenin-mutated exon 3 subtype and up to a third of inflammatory HCAs are the exception to this characterization. It is important to understand the appearances of HCAs beyond their depictions at MRI, as these tumors are typically identified with other imaging modalities first. The two most feared related complications are bleeding and malignant transformation to hepatocellular carcinoma, although the risk of these complications depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for HCAs that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs. Thermal ablation and transarterial embolization are potential alternatives to surgical resection. In the acute setting of a ruptured HCA, patients typically undergo transarterial embolization with or without delayed surgical resection. This update on HCAs includes a review of radiologic-pathologic correlations by subtype and imaging modality, related complications, and management recommendations. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Undersampling is desired to reduce scan time but can cause streaking artifacts in stack-of-radial imaging. State-of-the-art deep neural networks such as the U-Net can be trained in a supervised manner to remove streaking artifacts but produce blurred images and loss of image details. Therefore, we developed and trained a 3D generative adversarial network to preserve perceptual image sharpness while removing streaking artifacts. The network used a combination of adversarial loss, L2 loss and structural similarity index loss. We demonstrated the feasibility of the proposed network for removing streaking artifacts and preserving perceptual image sharpness.

Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa).

This study aimed at developing dictionary learning (DL) based compressed sensing (CS) reconstruction for randomly undersampled five-dimensional (5D) MR Spectroscopic Imaging (3D spatial + 2D spectral) data acquired in prostate cancer patients and healthy controls, and test its feasibility at 8x and 12x undersampling factors. Prospectively undersampled 5D echo-planar J-resolved spectroscopic imaging (EP-JRESI) data were acquired in nine prostate cancer (PCa) patients and three healthy males. The 5D EP-JRESI data were reconstructed using DL and compared with gradient sparsity-based Total Variation (TV) and Perona-Malik (PM) methods. A hybrid reconstruction technique, Dictionary Learning-Total Variation (DLTV), was also designed to further improve the quality of reconstructed spectra. The CS reconstruction of prospectively undersampled (8x and 12x) 5D EP-JRESI data acquired in prostate cancer and healthy subjects were performed using DL, DLTV, TV and PM. It is evident that the hybrid DLTV method can unambiguously resolve 2D J-resolved peaks including myo-inositol, citrate, creatine, spermine and choline. Improved reconstruction of the accelerated 5D EP-JRESI data was observed using the hybrid DLTV. Accelerated acquisition of in vivo 5D data with as low as 8.33% samples (12x) corresponds to a total scan time of 14 min as opposed to a fully sampled scan that needs a total duration of 2.4 h (TR = 1.2 s, 32 $${k}_{x}$$ ×16 $${k}_{y}$$ ×8 $${k}_{z}$$ , 512 $${t}_{2}$$ and 64 $${t}_{1}$$ ).

OBJECTIVE:We aimed to investigate if the use of read-out segmented echoplanar imaging with additional two-dimensional navigator correction (Readout Segmentation of Long Variable Echo, RESOLVE) for acquiring prostate diffusion-weighted imaging (DWI) improves image quality, compared to single-shot echoplanar imaging (ss-EPI).METHODS:This single-center prospective study cohort included 162 males with suspected prostate cancer, who underwent 3 Tesla multiparametric MRI (3T-mpMRI). Two abdominal radiologists, blinded to the clinical information, separately reviewed each 3T-mpMRI study to rank geometrical distortion, degree of rectal distention, lesion conspicuity, and anatomic details delineation first on ss-EPI-DWI and later on RESOLVE-DWI using 5-point scales (1 = excellent, 5 = poor). The average of the ranking scores given by two readers was generated and used as the final score.RESULTS:There was good-to-excellent interreader agreement for scoring image quality parameters on both ss-EPI and RESOLVE. Geometrical distortion scores > 3 was seen in 12.3% (20/162) of ss-EPI images, with all having geometrical distortion score <3 on RESOLVE (p < .001). The mean image distortion score was significantly less on RESOLVE than ss-EPI (1.16 vs 1.61, p < .01 regardless of rectal gas, p< .05 when stratified by the degree of rectal distention ). RESOLVE was superior to ss-EPI for lesion conspicuity (mean 1.35 vs 1.53, p< .002) and anatomic delineation (2.60 vs 2.68, p< .001) of prostate on DWI.CONCLUSION:Compared to conventional ss-EPI, the use of RESOLVE for acquisition of prostate DWI resulted in significantly enhanced image quality and reduced geometrical distortion.ADVANCES IN KNOWLEDGE:RESOLVE could be an alternative or replacement of ss-EPI for acquiring prostate DWI with significantly less geometrical distortion and significantly improved lesion conspicuity and anatomic delineation.

193 Background: The local staging of prostate cancer relies on systematic or targeted biopsies and multiparametric magnetic resonance imaging (mpMRI). The role of prostate-specific membrane antigen (PSMA)-targeted PET in the evaluation of intraprostatic cancer foci and T-staging assessment is not well defined. The goal of this analysis was to compare the diagnostic performance of PSMA PET/CT, mpMRI and the combination of the two (PSMA PET/CT+mpMRI) in the detection, intra-prostatic localization and local extension of primary prostate cancer with histopathology as the gold standard.Methods: Patients with intermediate- or high-risk prostate cancer underwent a PSMA PET/CT scan and mpMRI prior to intended radical prostatectomy. Each imaging modality was interpreted by 3 blinded independent readers. A majority rule was applied (2:1). A standardized approach was used to assess presence, location and size of prostate cancer foci within the prostate. The analysis was conducted on a lesion- and segment-level. Whole mount pathology was interpreted by a Genito-Urinary pathologist using the same standardized method described above. Accuracy in determining the location, extra-capsular extension (ECE) and seminal vesicle invasion (SVI) of prostate cancer foci were assessed using receiver operating characteristic (ROC) analysis. A “raw-stringent” and “neighboring” approach were used to define imaging/pathology correlation for the detection of individual prostate cancer foci. Results: The final analysis included 74 patients. Detection rate was 75%, 79% and 82% using the “raw-stringent” approach, 86%, 83% and 87% using the “neighboring” approach for PSMA PET/CT, mpMRI and PSMA PET/CT+mpMRI, respectively. Differences in detection rates between PSMA PET/CT, mpMRI and PSMA PET/CT+mpMRI were not statistically significant. The two imaging modalities performed similarly (AUC = 0.70 vs 0.73, p = 0.09; AUC = 0.77 for the two together) in localizing prostate cancer. ΔAUC between PSMA PET/CT+mpMRI and the two imaging modalities alone was statistically significant (p < 0.001), but not between PSMA PET/CT and mpMRI (p = 0.093). mpMRI performed better than PSMA PET/CT in the T-staging assessment: ECE (AUC = 0.79 vs 0.59, p = 0.002) and SVI (AUC = 0.84 vs 0.63, p = 0.001). Conclusions: PSMA PET/CT and mpMRI have similar diagnostic accuracy in the detection and intra-prostatic localization of prostate cancer foci while mpMRI performs better in the assessment of ECE and SVI. The combination of the two imaging modalities improves performance of the two modalities alone, but this does not reach statistically significant levels on a lesion-level and might not justify changes in the current practices for local staging of prostate cancer.

Background: Systematic prostate biopsies add to the cancer detection rate of targeted biopsies, but the explanation for that increased sensitivity is not yet clear. Objective: To determine and quantify the utility of perilesional biopsies in the detection of clinically significant prostate cancer (csPCa). Design, setting, and participants: Participants were 2048 men with magnetic resonance imaging (MRI) lesions (grades 3-5) who underwent targeted and systematic prostate biopsy via MRI/ultrasound fusion at University of California Los Angeles and Cornell between 2011 and 2019. The study is a retrospective examination of prospectively acquired data. Outcome measurements and statistical analysis: All biopsy cores (30 191), locations of which had been stored digitally in the image-fusion device, were analyzed for tissue pathology and relationship with MRI lesions. A validated Matlab script was used to determine the distance between MRI lesions and cores containing csPCa (3552 cores from 927 men). Significance of distance measurements was determined by multilevel, multivariable logistic regression to account for within patient-biopsy correlation and control for patient characteristics. Results and limitations: Overall, 90% (95% confidence interval [CI] = 89-91) of csPCa cores (3206/3552) were located within a radius of 10 mm from the nearest lesion: 65% (95% CI = 63-67) within the region of interest (ROI) and 26% (95% CI = 24-27) outside the ROI but within the 10-mm ``penumbra.'' The width of the penumbra or concentric band, which enclosed 90% of csPCa, was primarily related to MRI grade of lesion: grade 5, 5 mm; grade 4, 12 mm; grade 3, 16 mm. In 18% (95% CI = 15-20) of patients (166/927), csPCa was diagnosed only by sampling outside the MRI lesion, the yield decreasing with increasing distance. Limitations of MRI interpretation and fusion biopsy performance could affect the utility of these data in individual patients. Conclusions: Perilesional biopsies, that is, samples taken from a band of 10-mm radius outside MRI lesions (the penumbra), contain most cores of csPCa that are not present within the lesion. These data may help increase the performance characteristics of targeted prostate biopsy. Patient summary: We studied the locations of cancer within the prostate in men undergoing magnetic resonance imaging (MRI)-guided biopsy. We found that not all cancers are located within the MRI lesion, but 90% (95% confidence interval = 89-91) of the cancers are within 1 cm of the lesions. Biopsies taken from both within and around MRI lesions provide greater sensitivity for cancer detection than samples taken from the lesion only. (c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

You have accessJournal of UrologyCME1 May 2022MP55-11 PROSTATE CANCER FOCAL THERAPY – LOCATIONS OF POST-ABLATION DISEASE Hemant Chaparala, Anis Davoudi, Alan M. Priester, Adam Kinnaird, David Kuppermann, Ely R. Felker, Anthony E. Sisk, Elizabeth Tran, Merdie K. Delfin, Leonard S. Marks, and Wayne G. Brisbane Hemant ChaparalaHemant Chaparala More articles by this author , Anis DavoudiAnis Davoudi More articles by this author , Alan M. PriesterAlan M. Priester More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , David KuppermannDavid Kuppermann More articles by this author , Ely R. FelkerEly R. Felker More articles by this author , Anthony E. SiskAnthony E. Sisk More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Merdie K. DelfinMerdie K. Delfin More articles by this author , Leonard S. MarksLeonard S. Marks More articles by this author , and Wayne G. BrisbaneWayne G. Brisbane More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy is an option for the treatment of localized clinically significant prostate cancer (csPCa). Post-ablation biopsy is best practice, as there is no reliable alternative metric for success. Currently, it is unclear where csPCa persists post-ablation relative to the target. We hypothesized the majority of post-ablation csPCa would occur at the treatment margins. METHODS: Our cohort included 113 men with csPCa treated with HIFU (N=38) and cryoablation (N=75). All men received a preoperative MRI followed by a targeted and systematic prostate biopsy. Eligible men had MRI visible localized csPCa. Patients underwent either HIFU to the ROI plus >10 mm customized margin or hemigland cryoablation. At six months post-ablation, patients obtained a repeat MRI and biopsy as detailed in Figure 1. A previously validated Matlab code was used to measure the distance from biopsy cores to ablated ROI surface. The primary outcome was the distance of post-ablation csPCa from the ROI surface. RESULTS: Overall, 28% (N=32) of men had csPCa at six months. Of the post-ablation cores containing csPCa (N=95/1622), half occurred within the original ROI (Cryotherapy: 48%, HIFU: 50%, Figure 2). The distribution of csPCa relative to the ROI was similar for HIFU and cryoablation. The median distance from ROI surface to csPCa core was 0.4 cm for cryotherapy and 0.07 cm for HIFU (not statistically significant). CONCLUSIONS: The distribution of post-ablation csPCa relative to targeted ROI was similar for HIFU and Cryotherapy. The majority of persistent cancer is within or close to the target. Optimizing ablation within the target may be the most efficient strategy to improve cancer control in prostate focal therapy. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e941 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hemant Chaparala More articles by this author Anis Davoudi More articles by this author Alan M. Priester More articles by this author Adam Kinnaird More articles by this author David Kuppermann More articles by this author Ely R. Felker More articles by this author Anthony E. Sisk More articles by this author Elizabeth Tran More articles by this author Merdie K. Delfin More articles by this author Leonard S. Marks More articles by this author Wayne G. Brisbane More articles by this author Expand All Advertisement PDF downloadLoading ...