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.

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 ...

AbstractObjectivesThe aim of this study is to evaluate new software (Unfold AI) in the estimation of prostate tumour volume (TV) and prediction of focal therapy outcomes.Subjects/patients and methodsSubjects were 204 men with prostate cancer (PCa) of grade groups 2–4 (GG ≥ 2), who were enrolled in a trial of partial gland cryoablation (PGA) at UCLA from 2017 to 2022. Magnetic resonance imaging (MRI)‐guided biopsy (MRGB) was performed at diagnosis and at 6 and 18 months following PGA. Utilising Unfold AI (FDA‐cleared 2022), which generates a 3D map of GG ≥ 2 PCa margins, we retrospectively estimated TV for each patient. TV was compared against conventional baseline variables as a correlate of a successful primary outcome—defined here as the absence of GG ≥ 2 on follow‐up MRGB at 6 months. Secondary outcomes were MRGB at 18 months and failure‐free survival, that is, lack of metastasis or salvage whole gland therapy. Receiver operating curves and multivariate analysis were used to determine significance.ResultsA successful primary outcome was observed in 77.7% of patients. Significant correlates of a successful ablation were percent pattern 4 and TV; areas under the curve (AUCs) were 0.60 and 0.73, respectively. GG was not a correlate of success (AUC = 0.51). A TV of 1.5 cc provided the optimal combination of sensitivity (55.8%) and specificity (85.7%) at 6 months. TV was also significantly associated with secondary outcomes. In multivariate analysis, TV was the variable most associated with 6‐ and 18‐month biopsy success (adjusted odds ratios [aORs] were 6.1 and 4.2). Utilising TV ≤ 1.5 cc as a PGA criterion would have prevented 72% of failures at the cost of 42% of successes.ConclusionThe AI‐based software Unfold AI estimates TV, which is significantly associated with biopsy outcomes after focal cryoablation. The rate of treatment success is inversely related to TV.

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 May 2024PD50-04 CAN PSMA-TARGETED PROSTATE BIOPSY DETECT CANCER WHEN MRI-GUIDED BIOPSY IS NEGATIVE? Wayne G. Brisbane, Mark T. Topoozian, Jeremie Calais, Merdie K. Delfin, Lorna Kwan, Samantha R. Gonzalez, and Leonard S. Marks Wayne G. BrisbaneWayne G. Brisbane , Mark T. TopoozianMark T. Topoozian , Jeremie CalaisJeremie Calais , Merdie K. DelfinMerdie K. Delfin , Lorna KwanLorna Kwan , Samantha R. GonzalezSamantha R. Gonzalez , and Leonard S. MarksLeonard S. Marks View All Author Informationhttps://doi.org/10.1097/01.JU.0001008620.35181.96.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to determine the value of using PSMA 'hot spots' in the prostate as fusion-biopsy targets in patients where MRI-guided biopsy (MRGB) might have been falsely negative. METHODS: Enrolled in a prospective trial (NCT 05160597) were 38 consecutive men average age 68 y.o. (range 56-84). who, after negative MRGB, remained PCa-suspects because of increased PSA density (PSAD) >0.15 and/or MRI lesion of PIRADS >4. All subjects were treatment-naïve; all had a previous mpMRI; and within a year of PSMA biopsy, all had a negative MRGB (targeted and/or systematic). After screening with a 68Gallium-PSMA scan, 25/38 had an intra-prostatic PSMA focus (Maximum Standardized Uptake Value, SUVmax >3, range 3-30) and underwent targeted biopsy. PSMA-PET positive Lesions were contoured using Profuse software by co-author J.C.; 12 lesions were posterior; 8 anterior; 5 both. Contoured lesions were networked into an Artemis device, and the 25 study patients underwent targeted biopsy of the PSMA-PET hotspot via PET/CT-US fusion (Figure 1). Targeted cores (∼6) were obtained as with MRGB (Sonn, J.Urol.189: 86, 2013). RESULTS: PSMA-targeted fusion biopsy was completed under local anesthesia in all 25 men without incident in an average time of 15 minutes. 10/25 men (40%) were found to harbor csPCa (GGG>2) in or around the hotspot; 12 (48%) were biopsy-negative; and 3 (12%) had GG1 findings. Of the 10 with csPCa, 4 were GG2 and 6 were >GG3; 4 of the 10 PSMA hotspots overlaid MRI lesions, but 6 were de novo. Maximum cancer core length averaged 4.7 mm +/- 2.6 SD. Both SUVmax and the 'Primary Score' (Emmett, J. Nucl. Med, 2022) were correlated with Gleason Grade Group (Figure 2). When SUVmax was >10, 7 of 10 men had csPCa. When SUVmax was <6, none of 9 men had csPCa. Neither PIRADS grade nor PSA density was related to PSMA-guided biopsy result (p=NS). CONCLUSIONS: Diagnosis of csPCa may be made by targeted biopsy of PSMA hotspots in the prostate, when MRGB is negative. Detection rate of PSMA-targeted biopsy is directly related to SUVmax and Primary Score. Download PPTDownload PPT Source of Funding: NCI-RO1CA218547 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1057 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Wayne G. Brisbane More articles by this author Mark T. Topoozian More articles by this author Jeremie Calais More articles by this author Merdie K. Delfin More articles by this author Lorna Kwan More articles by this author Samantha R. Gonzalez More articles by this author Leonard S. Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I (MP25)1 May 2024MP25-08 SOFTWARE TO DETERMINE EXTENT OF TUMOR MARGINS IN FOCAL THERAPY OF PROSTATE CANCER (UNFOLD-AI®) Wayne G. Brisbane, Alan Priester, Mark T. Topoozian, Anissa V. Nguyen, Merdie K. Delfin, Samantha R. Gonzalez, and Leonard S. Marks Wayne G. BrisbaneWayne G. Brisbane , Alan PriesterAlan Priester , Mark T. TopoozianMark T. Topoozian , Anissa V. NguyenAnissa V. Nguyen , Merdie K. DelfinMerdie K. Delfin , Samantha R. GonzalezSamantha R. Gonzalez , and Leonard S. MarksLeonard S. Marks View All Author Informationhttps://doi.org/10.1097/01.JU.0001008692.26556.39.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Margins of prostate cancer (PCa) are poorly defined by MRI, but margins must be treated to ensure a complete ablation. Herein we test a recently FDA-cleared software, Unfold-AI®, to improve the definition of tumor margins and guide focal therapy. METHODS: Unfold-AI®, a PCa margin-prediction software based on artificial intelligence (AI), was described by Priester (Eur.Urol. O.S. vol. 54, page 20-27, 2023). It is derived from biopsy and clinical information of 875 men undergoing 1145 MRI-guided biopsies (13k cores, 128k MR images). The Unfold-AI® output is a patient-specific encapsulation confidence score (ECS) estimating the probability of complete tumor ablation when recommended margins are followed. ECS values from 0 to 1 (Figure 1). are directly related to the probability of focal therapy success.We retrospectively applied Unfold-AI® in 118 treatment-naïve men in a trial of hemi-gland cryotherapy (CRYO) for PCa >GG2 (NCT03503643). Median age was 68 yr (IQR 63-72); 67% were Caucasian, 5% Black, 28% other; PSA 6.8 ng/ml (IQR 4.7-10.3); prostate volume 44cc (IQR 32-56). MRI-guided biopsy (MRGB), targeted + systematic, was performed before and 6 months after CRYO. To determine predictive value, the ECS score and standard PCa variables were compared against the presence or absence of >GG2 in post-CRYO MRGB. ROC analysis was used to assess the significance of the metrics in predicting CRYO outcomes (Table 1). RESULTS: Baseline GG was 66.8% GG2, 28.0% GG3, and 5.2% GG4. Treatment success (no >GG2 on MRGB) was 77.7% and was not related to baseline GG. Univariate ROC analysis (Table 1) showed that max cancer core length, % Gleason pattern 4, and ECS were predictive of success. However, in a multivariate logistic regression, only ECS≥0.7 remained as a predictor of success (aOR 4.7, 1.7-12.9). Sensitivity and specificity for ECS≥0.7 was 70% (61-79) and 68% (51-85), respectively. CONCLUSIONS: In predicting focal therapy success, tumor margins -- as determined here by the ECS of Unfold-AI® --may be more important than other baseline parameters (e.g., GG). Download PPT Source of Funding: NCI-RO1CA218547 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e407 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Wayne G. Brisbane More articles by this author Alan Priester More articles by this author Mark T. Topoozian More articles by this author Anissa V. Nguyen More articles by this author Merdie K. Delfin More articles by this author Samantha R. Gonzalez More articles by this author Leonard S. Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD26)1 May 2024PD26-09 IMPACT OF FOCAL THERAPY ON DEFERRAL OF SURGERY OR RADIATION DURING ACTIVE SURVEILLANCE OF PROSTATE CANCER Shannon Richardson, Samantha Gonzalez, Lorna Kwan, Merdie Delfin, Anissa V. Nguyen, Sara Rodriguez, Wayne Brisbane, and Leonard S. Marks Shannon RichardsonShannon Richardson , Samantha GonzalezSamantha Gonzalez , Lorna KwanLorna Kwan , Merdie DelfinMerdie Delfin , Anissa V. NguyenAnissa V. Nguyen , Sara RodriguezSara Rodriguez , Wayne BrisbaneWayne Brisbane , and Leonard S. MarksLeonard S. Marks View All Author Informationhttps://doi.org/10.1097/01.JU.0001008556.20565.76.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The goal of active surveillance (AS) is to avoid unnecessary treatment, but up to a third of men in AS ultimately progress and undergo surgery (RP) or radiation (RT). We sought to determine if selective use of focal therapy (FT) would permit extension of AS and deferral of RP or RT. METHODS: This study is an analysis of a prospective AS cohort of all 1081 men who enrolled in the UCLA AS program (NCT00949819) during 2010-2022. Inclusion criteria were met by 869: baseline MRI-guided biopsy (MRGB), Grade Group (GG) ≤ 2, and≥1 year follow-up (f/u). Baseline was at first MRGB; 659 had a previous positive TRUS biopsy. F/u was by MRGB (Jayadevan, JAMA Open NW, 2019). When GG2 or GG3 was found (n=401), FT was offered as a path to continue AS. Otherwise RP/RT was offered to all men upgrading to GG3 (n=88), GG4 (23), or GG5 (n=21). FT methods were HIFU (N=26) or Cryotherapy (N=76). Outcomes were RP/RT or progression to ≥ GG3 disease. RESULTS: The 869 men accrued>3,500 person-years of f/u and>1,500 MRGBs over a 12-year period. Mean age was 65 yrs (SD 7.7); 70% were White, 5% Black, 25% other. First MRGB revealed GG0 in 22%, GG1 in 58%, and GG2 in 20%. Median progression-free survival in AS was 5.8 yrs for men with GG2 vs 10.2 for GG0 and 8.7 for GG1 (p<0.01) (Figure 1). Men with GG1 or 2 on first MRGB had a greater rate of progression to ≥ GG3 than men with GG0 (GG1 HR=2.9, 95% CI: 1.4-6.2; GG2 HR=7.1, 95% CI: 3.3-15.4). PSA density was independently associated with progression to ≥ GG3 (ref: ≤ 0.15; HR=1.8, 95% CI: 1.2-2.8). FT was chosen by 102/869 men (12%); 3 chose FT at first MRGB and 99 chose FT after a f/u MRGB at a median of 3.2 yrs from baseline (IQR: 1.5-5.1). Upon FT, 72 were GG2, 21 were GG3, and 2 were GG4. Men who did not receive FT were twice as likely to undergo RP/RT as those who had FT (RR=2.2, 95% CI: 1.3-3.9). The 5-year probability of RP/RT-free survival in the FT group was 0.90 compared to 0.76 in the no-FT cohort (p=0.01). The advantage persisted through 9 yrs of f/u (Figure 2). CONCLUSIONS: Active surveillance can be extended and surgery/radiation deferred by selective use of focal therapy in an AS program. Download PPTDownload 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; and the Alice and David Alkosser Family Trust © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e548 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shannon Richardson More articles by this author Samantha Gonzalez More articles by this author Lorna Kwan More articles by this author Merdie Delfin More articles by this author Anissa V. Nguyen More articles by this author Sara Rodriguez More articles by this author Wayne Brisbane More articles by this author Leonard S. Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

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 ...

You have accessJournal of UrologyCME1 Apr 2023MP55-11 PSMA-GUIDED PROSTATE BIOPSY David Kuppermann, Jeremie Calais, Elizabeth Tran, Samantha Gonzalez, Merdie Delfin, and Leonard Marks David KuppermannDavid Kuppermann More articles by this author , Jeremie CalaisJeremie Calais More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Samantha GonzalezSamantha Gonzalez More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA scanning is a most accurate method for detection of metastatic PCa. PSMA scanning may also reveal intra-prostatic cancer (PCa). Since MRI-guided biopsy (MRGB) may miss 15-20% of clinically-significant csPCa (≥GG2), we postulated that biopsy targeting PSMA foci in the prostate (PSMA-guided biopsy, PSMA-GB) might provide PCa detection in cases where MRGB failed. METHODS: 48 men with negative MRI-guided biopsy (MRGB), but continued suspicion of PCa (increased PSA density), underwent PSMA scanning within 6 months of MRGB. In the 23 with focal PSMA uptake in the prostate, a PSMA-GB was performed using PET/CT images instead of MR images for fusion with ultrasound. 4-8 biopsy cores were taken from each PSMA ‘hot spot’(Figure 1). Method of PSMA-GB was identical to MRGB, but employed US fusion with PET/CT instead of MRI, as detailed in the original case report (PMID: 28607878). Method of Ga-PSMA image acquisition via PET/CT scanning has been reported (PMID: 30920593). Contouring of PSMA foci within the prostate was via Profuse software by co-author J.C. Image fusion and trans-rectal targeted biopsy was via Artemis device (LSM). Detection rate of csPCa by PSMA-GB was primary endpoint. RESULTS: Among the 23 study patients, mean age=67 yrs (Range: 53-81); prostate volume=58.5cc (22.7-109.3); PSA=13.8 ng/ml (4.5- 34.8); PSA density=0.245 ng/ml/cc (0.073- 0.57). At first biopsy (MRGB), PIRADS score = 0-2 in 19 men and >3 in 4. PSMA-GB was successfully completed in all 23. Overall detection rate of csPCa was 15/23 (65.22%): GG2 in 6, GG3 in 6, GG4 in 2, and GG5 in 1. Median SUVmax (standardized uptake value) was 12.5 (5.8-28.7) in men whose PSMA hotspot revealed csPCa vs 5.8 (3.2-10.4) in men with negative PSMA-GB. Of 12 men whose PSMA focus was highly suspicious, i.e., Emmett’s Primary Score of 4 or 5 (PMID: 34373749 ), 11 had csPCa. CONCLUSIONS: Prostate biopsy, which targets PSMA ‘hot spots’ via PET/CT-US fusion, often leads to detection of csPCa missed by MRI-guided biopsy. Source of Funding: Jean Perkins Foundation; NCI-R01 CA 195505; and Department of Nuclear Medicine, UCLA. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e767 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Kuppermann More articles by this author Jeremie Calais More articles by this author Elizabeth Tran More articles by this author Samantha Gonzalez More articles by this author Merdie Delfin More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

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).

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 ...

Introduction: A functional tool to optimize patient selection for magnetic resonance imaging (MRI)-guided prostate biopsy (MRGB) is an unmet clinical need. We sought to develop a prostate cancer risk calculator (PCRC-MRI) that combines MRI and clinical characteristics to aid decision-making for MRGB in North American men. Methods: Two prospective registries containing 2354 consecutive men undergoing MRGB (September 2009 to April 2019) were analyzed. Patients were randomized into five groups, with one group randomly assigned to be the validation cohort against the other four groups as the discovery cohort. The primary outcome was detection of clinically significant prostate cancer (csPCa) defined as Gleason grade group greater than or equal to 2. Variables included age, ethnicity, digital rectal exam (DRE), prior biopsy, prostate-specific antigen (PSA), prostate volume, PSA density, and MRI score. Odds ratios were calculated from multivariate logistic regression comparing two models: one with clinical variables only (clinical) against a second combining clinical variables with MRI data (clinical+MRI). Results: csPCa was present in 942 (40%) of the 2354 men available for study. The positive and negative predictive values for csPCa in the clinical+MRI model were 57% and 89%, respectively. The area under the curve of the clinical+MRI model was superior to the clinical model in discovery (0.843 vs. 0.707, p<0.0001) and validation (0.888 vs. 0.757, p<0.0001) cohorts. Use of PCRC-MRI would have avoided approximately 16 unnecessary biopsies in every 100 men. Of all variables examined, Asian ethnicity was the most protective factor (odds ratio [OR] 0.46 [0.29–0.75]) while MRI score 5 indicated greatest risk (OR15.8 [10.5–23.9]). Conclusions: A risk calculator (PCRC-MRI), based on a large North American cohort, is shown to improve patient selection for MRGB, especially in preventing unnecessary biopsies. This tool is available at https://www.uclahealth.org/urology/prostate-cancer-risk-calculator and may help rationalize biopsy decision-making.

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP22)1 Sep 2021MP22-09 MICRO-ULTRASOUND TO WHOLE MOUNT IMAGE CORRELATION FOR DETECTION AND LOCALIZATION OF PROSTATE CANCER Wayne Brisbane, Jake Pensa, Anthony Sisk, Elizabeth Tran, Alan Priester, Ely Felker, Merdie Delfin, Ada Kinnaird, and Leonard Marks Wayne BrisbaneWayne Brisbane More articles by this author , Jake PensaJake Pensa More articles by this author , Anthony SiskAnthony Sisk More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Alan PriesterAlan Priester More articles by this author , Ely FelkerEly Felker More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , Ada KinnairdAda Kinnaird More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002013.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Micro-Ultrasound (microUS) is an emerging technology for visualization of prostate cancer with 300% improved resolution compared to conventional US. Initial experience using microUS has been promising; but lacks correlation to whole-mount pathology (WMP). Our aim was to evaluate the accuracy of microUS for visualization of prostate cancer. METHODS: Patients were enrolled in a prospective clinical trial comparing microUS and MRI to WMP (IRB#19-001136). Patients with prostate cancer on MRI guided biopsy and undergoing radical prostatectomy, underwent microUS imaging of the prostate. MicroUS images were reviewed and regions of interest (ROI) delineated by a reviewer blinded to MRI and pathology. Pre-biopsy MRI’s were delineated by a GU radiologist. WMP prostate cancer boundaries were delineated by a GU pathologist. Significant cancer was considered ≥3+4 (csPCa). Extent of tumor was measured by dividing prostates into the 12 anatomic segments (Left, Right; Ant., Post.; apex, base and mid). Imaging ROI’s were compared to WMP for accuracy of identifying tumor extent (Figure). Imaging was considered accurate if the ROI and csPCa were in the same anatomic segment(s). RESULTS: Nine patients were enrolled. Median prostate volume was 46 cc. On WMP there were 9 index tumors and 2 secondary tumors. Median index tumor diameter was 2.4 cm (range 1.6–4.2 cm). Three tumors were anterior. Stage was T2 (N=4), T3a (N=2), T3b (N=3). Index tumor grade was 3+4 (N=3), 4+3 (N=4), 4+5 (N=3). All secondary tumors were 3+4 and ≤ 2 cm. MicroUS visualized all index and secondary tumors. MRI visualized 7/9 index tumors, and no secondary tumors. Overall accuracy for microUS was 76% vs. 84% for MRI (Table). CONCLUSIONS: Using WMP as ground truth, microUS compared favorably with MRI in determining presence and extent of index and secondary prostate cancers. The accuracy, simplicity, and potential cost savings of microUS warrant its further evaluation. Source of Funding: PHASE ONE Foundation, Prostate Cancer Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e394-e394 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wayne Brisbane More articles by this author Jake Pensa More articles by this author Anthony Sisk More articles by this author Elizabeth Tran More articles by this author Alan Priester More articles by this author Ely Felker More articles by this author Merdie Delfin More articles by this author Ada Kinnaird More articles by this author Leonard Marks More articles by this author Expand All Advertisement Loading ...

Men diagnosed with low-risk prostate cancer (PC) are increasingly electing active surveillance (AS) as their initial management strategy. While this may reduce the side effects of treatment for prostate cancer, many men on AS eventually convert to active treatment. PC is one of the most heritable cancers, and genetic factors that predispose to aggressive tumors may help distinguish men who are more likely to discontinue AS. To investigate this, we undertook a multi-institutional genome-wide association study (GWAS) of 5,222 PC patients and 1,139 other patients from replication cohorts, all of whom initially elected AS and were followed over time for the potential outcome of conversion from AS to active treatment. In the GWAS we detected 18 variants associated with conversion, 15 of which were not previously associated with PC risk. With a transcriptome-wide association study (TWAS), we found two genes associated with conversion (MAST3, p = 6.9×10-7 and GAB2, p = 2.0×10-6). Moreover, increasing values of a previously validated 269-variant genetic risk score (GRS) for PC was positively associated with conversion (e.g., comparing the highest to the two middle deciles gave a hazard ratio [HR] = 1.13; 95% Confidence Interval [CI]= 0.94-1.36); whereas, decreasing values of a 36-variant GRS for prostate-specific antigen (PSA) levels were positively associated with conversion (e.g., comparing the lowest to the two middle deciles gave a HR = 1.25; 95% CI, 1.04-1.50). These results suggest that germline genetics may help inform and individualize the decision of AS-or the intensity of monitoring on AS-versus treatment for the initial management of patients with low-risk PC.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD17)1 Sep 2021PD17-02 MRI-GUIDED BIOPSY IN ACTIVE SURVEILLANCE OF PROSTATE CANCER Adam Kinnaird, Nitin Yerram, Luke O'Connor, Wayne Brisbane, Vidit Sharma, Ryan Chuang, Rajiv Jayadevan, Michael Ahdoot, Michael Daneshvar, Alan Priester, Merdin Delfin, Elizabeth Tran, Danielle Barsa, Anthony Sisk, Robert Reiter, Ely Felker, Steve Raman, Lorna Kwan, Peter Choyke, Maria Merino, Bradford Wood, Baris Turkbey, Peter Pinto, and Leonard Marks Adam KinnairdAdam Kinnaird More articles by this author , Nitin YerramNitin Yerram More articles by this author , Luke O'ConnorLuke O'Connor More articles by this author , Wayne BrisbaneWayne Brisbane More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Ryan ChuangRyan Chuang More articles by this author , Rajiv JayadevanRajiv Jayadevan More articles by this author , Michael AhdootMichael Ahdoot More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Alan PriesterAlan Priester More articles by this author , Merdin DelfinMerdin Delfin More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Danielle BarsaDanielle Barsa More articles by this author , Anthony SiskAnthony Sisk More articles by this author , Robert ReiterRobert Reiter More articles by this author , Ely FelkerEly Felker More articles by this author , Steve RamanSteve Raman More articles by this author , Lorna KwanLorna Kwan More articles by this author , Peter ChoykePeter Choyke More articles by this author , Maria MerinoMaria Merino More articles by this author , Bradford WoodBradford Wood More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter PintoPeter Pinto More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001999.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The promise of prostate Active Surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. The objective was to determine if prostate biopsy guided by magnetic resonance imaging (MRGB) may improve detection of high-grade cancers during AS. METHODS: From two prospective studies, a sub-cohort of 519 men with low-risk prostate cancer was selected for analysis. All men were diagnosed with Gleason Grade Group 1 (GG1) cancer and underwent confirmatory MRBG (targeted and systematic cores), followed by MRGB surveillance, typically every 12 to 24 months. The primary outcome was tumor upgrading ≥GG3. Secondary outcomes were upgrading ≥GG2 and biopsy type (targeted or systematic) identifying the upgrade. Cox proportional hazard regression was used. RESULTS: After a median follow-up of 4.8 years (IQR 3.1-6.5) after confirmatory MRGB, the primary outcome occurred in 92 men (18%). Upgrading-free probabilities at 2, 5, and 7 years were 0.95, 0.85, and 0.77, respectively. Cancer detected in a targeted core at confirmatory MRBG increased risk of tumor upgrading during AS (HR, 2.7; 95%C.I., 1.2-6.0), while cancer detected by systematic cores did not (Figure 1). In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25%, and both in 47% (p=0.02). Upgrading ≥GG2 occurred in 164 men (37%). In 63 men undergoing prostatectomy, upgrading from MRGB was found in 5 (8%). CONCLUSIONS: In patients undergoing surveillance with MRI-guided and systematic biopsies, cancer detected in biopsies of MRI-visible lesions, but not systematic samples, indicated risk of subsequent upgrading. Source of Funding: This research was supported in part by R01CA218547, R01CA195505, the Intramural Research Program of the National Cancer Institute, the Center for Interventional Oncology, intramural NIH Grants Z1A CL040015, 1ZIDBC011242, and UL1TR000124 from University of California, Los Angeles Clinical and Translational Science Institute © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e284-e285 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Kinnaird More articles by this author Nitin Yerram More articles by this author Luke O'Connor More articles by this author Wayne Brisbane More articles by this author Vidit Sharma More articles by this author Ryan Chuang More articles by this author Rajiv Jayadevan More articles by this author Michael Ahdoot More articles by this author Michael Daneshvar More articles by this author Alan Priester More articles by this author Merdin Delfin More articles by this author Elizabeth Tran More articles by this author Danielle Barsa More articles by this author Anthony Sisk More articles by this author Robert Reiter More articles by this author Ely Felker More articles by this author Steve Raman More articles by this author Lorna Kwan More articles by this author Peter Choyke More articles by this author Maria Merino More articles by this author Bradford Wood More articles by this author Baris Turkbey More articles by this author Peter Pinto More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. Our study was designed to determine the prostate cancer upgrading rate when biopsy guided by magnetic resonance imaging (MRGBx) is used before entry and during AS. MATERIALS AND METHODS:The cohort included 519 men with low- or intermediate-risk prostate cancer who enrolled in prospective studies (NCT00949819 and NCT00102544) between February 2008 and February 2020. Subjects were preliminarily diagnosed with Gleason Grade Group (GG) 1 cancer; AS began when subsequent MRGBx confirmed GG1 or GG2. Participants underwent confirmatory MRGBx (targeted and systematic) followed by surveillance MRGBx approximately every 12 to 24 months. The primary outcome was tumor upgrading to ≥GG3. RESULTS:Upgrading to ≥GG3 was found in 92 men after a median followup of 4.8 years (IQR 3.1-6.5) after confirmatory MRGBx. Upgrade-free probability after 5 years was 0.85 (95% CI 0.81-0.88). Cancer detected in a magnetic resonance imaging lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS (HR 2.8; 95% CI 1.3-6.0), as did presence of GG2 (HR 2.9; 95% CI 1.1-8.2) In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25% and both in 47%. In 63 men undergoing prostatectomy, upgrading from MRGBx was found in only 5 (8%). CONCLUSIONS:When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within a magnetic resonance imaging lesion or when pathology is GG2 than when these features are absent.

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-05 MRI-GUIDED BIOPSY AND THE TRANSFORMATION OF PROSTATE CANCER Wayne Brisbane, Elizabeth Tran, Samantha Gonzalez, Merdie Delfin, Ely Felker, Anthony Sisk, Lorna Kwon, Adam Kinnaird, and Leonard Marks Wayne BrisbaneWayne Brisbane More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Samantha GonzalezSamantha Gonzalez 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 , Lorna KwonLorna Kwon More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-guided prostate biopsy (MRGB) is rapidly replacing ultrasound-guided biopsy (USGB). As a result, a transformation has occurred in prostate cancer (PCa) detection rate (CDR) and grade of cancer detected; management of PCa is likely to change. The contrast of current (MRGB) and previous (USGB) biopsy findings is reported here. METHODS: Study material were data from all men undergoing MRGB at UCLA, 2010-2020; biopsy was part of a protocol-mandated, IRB-approved registry (N=2971 unique patients; first biopsy = 929, prior biopsy= 2042). Comparator data were from 16,172 men undergoing USGB prior to 2014 (Epstein, Eur.Urol., 2016). Further comparison was made between MRGB results obtained early (2010-2015) and late (2016-2020) in the present series. MRGB was by a single operator using MRI/US fusion (Artemis); image interpretation was by experienced MRI radiologists; biopsy sampling was targeted and systematic; biopsy cores were each reported separately by a GU pathologist. MRI grading was by a Likert scale early-on and PIRADS v2 after 2015; the two are closely correlated. Clinically-significant PCa (csPCa) is defined here as >GG2. RESULTS: With advent of MRGB, CDR increased and GG2 tumors became the most common cancer found; with USGB, insignificant tumors were the commonest finding (Fig. 1). Among men undergoing MRGB, CDR of csPCa was directly related to MRI grade (Fig. 2). Aggressive tumors ( >GG4) were found in only 3% of men with MRI grade <2, but in 36% of men with MRI grade 4 and 5. Insignificant tumors (GG <1) were found in 80% of men with MRI grade <2, but only 11% of men with MRI grade of 5. If biopsy were foregone in men with negative MRI, overall CDR of csPCA was 58% but some csPCa (?20%) would have been missed. CDR was similar between early and late MRGB series. CONCLUSIONS: With MRGB, CDR of csPCa has improved dramatically, and Intermediate-risk PCa has become the commonest cancer found. These voluminous data, obtained prospectively, may be useful in patient counseling and may impact consideration of new treatments. Source of Funding: R01CA195505 and R01CA158627 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e853-e853 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wayne Brisbane More articles by this author Elizabeth Tran More articles by this author Samantha Gonzalez 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 Lorna Kwon More articles by this author Adam Kinnaird More articles by this author Leonard Marks More articles by this author Expand All Advertisement Loading ...