Multiparametric magnetic resonance imaging (MRI), with or without prostate biopsy, has become the standard of care for diagnosing clinically significant prostate cancer. Resource capacity limits widespread adoption. Biparametric MRI, which omits the gadolinium contrast sequence, is a shorter and cheaper alternative offering time-saving capacity gains for health systems globally. To assess whether biparametric MRI is noninferior to multiparametric MRI for diagnosis of clinically significant prostate cancer. A prospective, multicenter, within-patient, noninferiority trial of biopsy-naive men from 22 centers (12 countries) with clinical suspicion of prostate cancer (elevated prostate-specific antigen [PSA] level and/or abnormal digital rectal examination findings) from April 2022 to September 2023, with the last follow-up conducted on December 3, 2024. Participants underwent multiparametric MRI, comprising T2-weighted, diffusion-weighted, and dynamic contrast–enhanced (DCE) sequences. Radiologists reported abbreviated biparametric MRI first (T2-weighted and diffusion-weighted), blinded to the DCE sequence. After unblinding, radiologists reported the full multiparametric MRI. Patients underwent a targeted biopsy with or without systematic biopsy if either biparametric MRI or multiparametric MRI was suggestive of clinically significant prostate cancer. The primary outcome was the proportion of men with clinically significant prostate cancer. Secondary outcomes included the proportion of men with clinically insignificant cancer. The noninferiority margin was 5%. Of 555 men recruited, 490 were included for primary outcome analysis. Median age was 65 (IQR, 59-70) years and median PSA level was 5.6 (IQR, 4.4-8.0) ng/mL. The proportion of patients with abnormal digital rectal examination findings was 12.7%. Biparametric MRI was noninferior to multiparametric MRI, detecting clinically significant prostate cancer in 143 of 490 men (29.2%), compared with 145 of 490 men (29.6%) (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points; P = .50). Biparametric MRI detected clinically insignificant cancer in 45 of 490 men (9.2%), compared with 47 of 490 men (9.6%) with the use of multiparametric MRI (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points). Central quality control demonstrated that 99% of scans were of adequate diagnostic quality. In men with suspected prostate cancer, provided image quality is adequate, an abbreviated biparametric MRI scan, with or without targeted biopsy, could become the new standard of care for prostate cancer diagnosis. With approximately 4 million prostate MRIs performed globally annually, adopting biparametric MRI could substantially increase scanner throughput and reduce costs worldwide. ClinicalTrials.gov Identifier: NCT04571840

ObjectivesTo evaluate the interaction of patient age and Prostate Imaging‐Reporting and Data System (PI‐RADS) score in determining the grade of prostate cancer (PCa) identified on magnetic resonance imaging (MRI)‐targeted biopsy in older men.Patients and methodsFrom a prospectively accrued Institutional Review Board‐approved comparative study of MRI‐targeted and systematic biopsy between June 2012 and December 2022, men with at least one PI‐RADS ≥3 lesion on pre‐biopsy MRI and no prior history of PCa were selected. Ordinal and binomial logistic regression analyses were performed.ResultsA total of 2677 men met study criteria. The highest PI‐RADS score was 3 in 1220 men (46%), 4 in 950 men (36%), and 5 in 507 men (19%). The median (interquartile range [IQR]) patient age was 66.7 (60.8–71.8) years, median (IQR) prostate‐specific antigen (PSA) level was 6.1 (4.6–9.0) ng/mL, median (IQR) prostate volume was 48 (34–68) mL, and median (IQR) PSA density was 0.13 (0.08–0.20) ng/mL/mL. Clinically significant (cs)PCa and high‐risk PCa were identified on targeted biopsy in 1264 (47%) and 321 (12%) men, respectively. Prevalence of csPCa and high‐risk PCa were significantly higher in the older age groups. On multivariable analyses, patient age was significantly associated with csPCa but not high‐risk PCa; PI‐RADS score and the interaction of age and PI‐RADS score were significantly associated with high‐risk PCa but not csPCa.ConclusionIn our cohort, the substantial rate of high‐risk PCa on MRI–ultrasound fusion targeted biopsies in older men, and its significant association with MRI findings, supports the value of pre‐biopsy MRI to localise disease that could cause cancer mortality even in older men.

We thank the authors for their review of and comment on our manuscript and we fundamentally agree that these results support the ongoing inclusion of systematic biopsy with targeted biopsy.

OBJECTIVE:To evaluate predictors of contralateral clinically significant prostate cancer (csPCa) in men with biopsy-proven unilateral lesions on magnetic resonance imaging (MRI). METHODS:We retrospectively identified men with no prior diagnosis of PCa with unilateral biopsy-confirmed csPCa within PI-RADS 2-5 lesions within our institutional biopsy database. Multivariate logistic regression was used to identify clinical predictors of contralateral disease. RESULTS:Four hundred ninety men met study inclusion criteria, of which 385 men (78.6%) had no contralateral csPCa and 105 men (21.4%) had contralateral csPCa (Fig. 1). Prior negative biopsy (OR 0.34 [0.14, 0.75], P = .012), prostate-specific antigen density (OR 18.8 [2.77, 249], P = .017), and tumor location in the transverse plane ("Posterior": OR 1.93 [1.02, 3.87], P = .048; "Throughout Transverse Plane": OR 6.56 [2.26, 19.6], P < .001) were significantly associated with contralateral csPCa in multivariate logistic regression models. However, there appear to be no attributes within the MRI-targeted tumor that reliably predict contralateral csPCa (Table 2). CONCLUSION:Approximately 20% of men with unilateral MRI findings and csPCa on targeted biopsy were found to have contralateral csPCa on systematic biopsy (SB). Prior negative biopsy was associated with a decreased odds of contralateral csPCa. Prostate-specific antigen density and tumor in the posterior aspect of or throughout the transverse plane were associated with increased odds of contralateral csPCA. Consideration of these clinical factors may afford an opportunity to only use SB in cases in which the odds of contralateral csPCa are high.

PURPOSE:Balancing surgical margins and functional outcomes is crucial during radical prostatectomy for prostate cancer. Stimulated Raman histology (SRH) is a novel, real-time imaging technique that provides histologic images of fresh, unprocessed, and unstained tissue within minutes, which can be interpreted by either humans or artificial intelligence. MATERIALS AND METHODS:Twenty-two participants underwent robotic-assisted laparoscopic radical prostatectomy (RALP) with intraoperative SRH surgical bed assessment. Surgeons resected and imaged surgical bed tissue using SRH and adjusted treatment accordingly. An SRH convolutional neural network was developed and tested on 10 consecutive participants. The accuracy, sensitivity, and specificity of the surgical team's interpretation were compared with final histopathologic assessment. RESULTS:A total of 121 SRH periprostatic surgical bed tissue (PSBT) assessments were conducted, an average of 5.5 per participant. The accuracy of the surgical team's SRH interpretation of resected PSBT samples was 98%, with 83% sensitivity and 99% specificity. Intraoperative SRH assessment identified 43% of participants with a pathologic positive surgical margin intraoperatively. PSBT assessment using the convolutional neural network demonstrated no overlap in tumor probability prediction between benign and tumor infiltrated samples, with mean 0.30% (IQR, 0.10%-0.43%) and 26% (IQR, 18%-34%, P < .005), respectively. CONCLUSIONS:SRH demonstrates potential as a valuable tool for real-time intraoperative assessment of surgical margins during RALP. This technique may improve nerve-sparing surgery and facilitate decision-making for further resection, reducing the risk of positive surgical margins and minimizing the risk of recurrence. Further studies with larger cohorts and longer follow-up periods are warranted to confirm the benefits of SRH in RALP.

Three-dimensional (3D) printed anatomic models can facilitate presurgical planning by providing surgeons with detailed knowledge of the exact location of pertinent anatomical structures. Although 3D printed anatomic models have been shown to be useful for pre-operative planning, few studies have demonstrated how these models can influence quantitative surgical metrics. To prospectively assess whether patient-specific 3D printed prostate cancer models can improve quantitative surgical metrics in patients undergoing robotic-assisted radical prostatectomy (RARP). Patients with MRI-visible prostate cancer (PI-RADS V2 ≥ 3) scheduled to undergo RARP were prospectively enrolled in our IRB approved study (n = 82). Quantitative surgical metrics included the rate of positive surgical margins (PSMs), operative times, and blood loss. A qualitative Likert scale survey to assess understanding of anatomy and confidence regarding surgical approach was also implemented. The rate of PSMs was lower for the 3D printed model group (8.11

You have accessJournal of UrologyCME1 May 2022MP58-07 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATE BY PI-RADS SCORE AND PSA-DENSITY: A DESCRIPTIVE ANALYSIS Zachary Feuer, Richard Huang, Fang-Ming Deng, James Wysock, William Huang, and Samir Taneja Zachary FeuerZachary Feuer More articles by this author , Richard HuangRichard Huang More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , James WysockJames Wysock More articles by this author , William HuangWilliam Huang More articles by this author , and Samir TanejaSamir Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI has been widely adopted as a risk stratification tool. Previously, PSA and various PSA-associated calculations, including PSA-density (PSAD), were used to estimate the risk of harboring clinically significant prostate cancer (csPCa). Using MRI-based prostate volume measurements (MRI-PV), we aim to describe the cancer detection rate (CDR) for MRI-targeted biopsy MRI-TB, systematic biopsy (SB), and combined biopsy stratified by PSA density and PI-RADS score. METHODS: This study included all men with no prior biopsy and PI-RADS ≥3 pre-biopsy MRI undergoing concurrent SB/MRI-TB between 2/2015-9/2019. Men without concurrent SB and MRI-TB or no MRI-PV were excluded. csPCa was defined as ≥Gleason grade group (GGG) 2. PI-RADS scores were collated into three groups, PI-RADS 1/2 PI-RADS 3 and PI-RADS 4/5. PSAD was calculated using pre-biopsy PSA and MRI-PV. csPCa CDR were calculated for combined, and unique SB and MRI-TB biopsy results. Medians were compared using the Mann-Whitney test. RESULTS: 966 biopsy-naïve men were included. Demographic information is summarized (Table 1). Amongst men with PI-RADS 1/2 MRI, CDR, regardless of PSAD strata was <50%, with the highest CDR amongst men with PSAD >0.20. For men with PI-RADS 3 MRI, CDR was 4.2% amongst men with PSAD <0.05, while CDR was >25% men with PSAD >0.05, with CDR 71.1% amongst men with PSAD >0.20. Men with PI-RADS 4/5 MRI were noted to have CDR >50% regardless of PSAD strata. SB CDR was noted to be higher within the same PSAD strata as compared to MRI-TB. Conversely, within the same PSAD strata, MRI-TB CDR was higher than SB CDR (Table 2). CONCLUSIONS: This study demonstrated increasing CDR with increasing PSAD intervals amongst men, stratified by PI-RADS. SB demonstrated higher CDR amongst men with PI-RADS 1/2 MRI, while MRI-TB demonstrated higher CDR amongst men with PI-RADS 4/5 MRI. Given the large number of biopsy naïve men included, this study may serve as a reference to counsel patients regarding their csPCa risk using only pre-biospy PSA and MRI. Source of Funding: Joseph and Diane Steinberg Charitable Trust © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e993 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Feuer More articles by this author Richard Huang More articles by this author Fang-Ming Deng More articles by this author James Wysock More articles by this author William Huang More articles by this author Samir Taneja More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP58-02 PSA-DENSITY DETERMINES THE NEED FOR SYSTEMATIC BIOPSY IN MEN WITH PI-RADS 4/5 MRI Zachary Feuer, Richard Huang, Fang-Ming Deng, James Wysock, William Huang, and Samir Taneja Zachary FeuerZachary Feuer More articles by this author , Richard HuangRichard Huang More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , James WysockJames Wysock More articles by this author , William HuangWilliam Huang More articles by this author , and Samir TanejaSamir Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-targeted biopsy (MRI-TB) improves cancer detection rate (CDR) of clinically significant prostate cancer (csPCa), while reducing detection of Gleason Grade Group (GGG) 1 in men with PI-RADS ≥3 pre-biopsy MRI. Prior to the adoption of MRI, PSA density (PSAD) was used to risk stratify men. We aim to demonstrate that PSAD stratification helps to identify which men may require systematic biopsy (SB) to improve csPCa CDR. METHODS: All biopsy-naïve men, with PI-RADS ≥3 MRI undergoing concurrent SB and MRI-TB between 2/2015-9/2019 were included. Men were excluded if they had non-concurrent SB/MRI-TB or no reported MRI-based prostate volume. csPCa was defined as ≥GGG2. PI-RADS 4/5 were grouped. CDR were calculated for combined, and unique SB and MRI-TB csPCa, while additive value was determined by subtracting unique SB or MRI-TB CDR from combined CDR. 95% confidence intervals (CI) for CDR were calculated using the Clopper-Pearson exact method. RESULTS: 966 men were included. Median age was 68 years (IQR 66-72), PSA was 6.3 (IQR 4.5-7.4) and PSAD was 0.12 (IQR 0.07-0.18). Results are summarized (Table 1). Amongst men with PI-RADS 3 MRI, CDR were similar for MRI-TB and SB when stratified by PSAD, while combined CDR was improved independent of PSAD strata.For men with PI-RADS 4/5 and PSAD <0.15, CDR for MRI-TB and SB were 80.4% and 66.5%, respectively (p=0.32). Combined CDR was 80.4%, which was improved from SB alone (p=0.001), but not from MRI-TB alone (p=0.39). 13.9% csPCas was uniquely diagnosed on MRI-TB, while no csPCas were uniquely diagnosed on SB.For men with PI-RADS 4/5 and PSAD >0.15, CDR for MRI-TB and SB were 87.5% and 78.5%, respectively (p=0.12). Combined CDR was 90.0%, which was improved from SB alone (p=0.02), but not from MRI-TB alone (p=0.27). 11.5% csPCas were uniquely diagnosed on MRI-TB, while 6.2% csPCas were uniquely diagnosed on SB. CONCLUSIONS: Concurrent MRI-TB and SB improves combined csPCa CDR in men with PI-RADS 3 MRI, while CDR for SB/MRI-TB are similar. Amongst men with PI-RADS 4/5 MRI with PSAD <0.15, no unique csPCa was diagnosed on SB, suggesting that SB may be omitted. For those with PSAD >0.15, MRI-TB and SB contributed unique csPCa diagnoses to combined CDR, suggesting utility of concurrent use. SB may reduce targeting error in small volume prostates, while the value of random sampling is mitigated as size increases. Source of Funding: Joseph and Diane Steinberg Charitable Trust © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e991 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Feuer More articles by this author Richard Huang More articles by this author Fang-Ming Deng More articles by this author James Wysock More articles by this author William Huang More articles by this author Samir Taneja More articles by this author Expand All Advertisement PDF downloadLoading ...

Lorenzo Maria Rovesti*, Riccardo Lombardo, Rome, Italy; Antonio Nacchia, Rionero in Vulture, Italy; Sara Riolo, Antonio Cicione, Beatrice Turchi, Giacomo Gallo, Carmen Gravina, Alessandro Guercio, Jordi Stira, Antonio Franco, Rome, Italy; Ferdinando Di Giacomo, Giuseppe Disabato, Rionero in Vulture, Italy; Giorgio Guarnotta, Elisa Mancini, Olivia Alessandra Voglino, Valeria Baldassarri, Simone D'Annunzio, Cosimo De Nunzio, Andrea Tubaro, Rome, Italy

Purpose: A benign magnetic resonance imaging targeted prostate biopsy in the setting of a PI-RADS (TM) 4/5 abnormality presents a clinical dilemma for future management. We evaluated benign histological features on magnetic resonance imaging targeted prostate biopsy to determine if they predict the likelihood of missed cancer on subsequent biopsy. Materials and methods: Between June 2012 and September 2016, 1,595 men were enrolled in a prospective study of magnetic resonance imaging targeted and systematic biopsy outcomes. We re-reviewed pathology from benign biopsies of PI-RADS 4/5 abnormalities and divided them into 5 groups for comparison to outcomes of clinical followup: inflammation (38%), stroma/glandular hyperplasia (9%), normal prostate tissue (28%), atypical small acinar proliferation/high grade prostatic intraepithelial neoplasia (9%) and cancer in adjacent systematic cores (16%). Results: Of 497 men 88 (18%) with PI-RADS 4/5 abnormality prior to initial biopsy had no cancer on magnetic resonance imaging targeted prostate biopsy. On followup, 45 men underwent repeat magnetic resonance imaging: 12 (27%) had persistent PI-RADS 4/5 abnormalities, 17 (38%) had PI-RADS 2/3, 16 (35%) had PI-RADS 1. On repeat magnetic resonance imaging targeted prostate biopsy, cancer was found in 62.5% of men with PI-RADS 4/5 and 23% of men with PI-RADS 2/3. Histological groups on initial biopsy were not predictive of the likelihood of PI-RADS downgrade on repeat magnetic resonance imaging or cancer detection on repeat biopsy. Conclusions: Among men with no cancer on magnetic resonance imaging targeted prostate biopsy performed for PI-RADS abnormality, downgrade of PI-RADS score is noted in 73% on repeat magnetic resonance imaging. Persistence of PI-RADS 4/5 predicts a higher risk of missed cancer, warranting prompt re-biopsy. While histological findings such as inflammation may underlie some PI-RADS 4/5 abnormalities, initial histology is a poor predictor of cancer likelihood on repeat biopsy.

You have accessJournal of UrologyProstate Cancer: Staging (MP11)1 Sep 2021MP11-02 USE OF THE PI-RADS v2 DEFINED RELATIONSHIP OF AN INDEX LESION AND PROSTATIC CAPSULE IMPROVES THE STAGING ACCURACY OF MRI Zachary Feuer, Ezequiel Becher, Angela Tong, Richard Huang, James S. Wysock, Fang-Ming Deng, William C. Huang, and Samir S. Taneja Zachary FeuerZachary Feuer More articles by this author , Ezequiel BecherEzequiel Becher More articles by this author , Angela TongAngela Tong More articles by this author , Richard HuangRichard Huang More articles by this author , James S. WysockJames S. Wysock More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , William C. HuangWilliam C. Huang More articles by this author , and Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001984.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the increased utilization of pre-biopsy multiparametric magnetic resonance imaging (mpMRI), the use of MRI as a staging tool remains limited. This is because mpMRI lacks sensitivity in detecting extracapsular extension (ECE). We aim to improve staging by assessing a novel MRI lesion/prostatic capsular relationship parameter, based on the standardized PI-RADS v2 report template, to predict the presence of locally advanced prostate cancer in men undergoing RP. METHODS: We identified men who underwent RP after 3-tesla multiparametric MRI (mpMRI) and subsequent concurrent systematic and MRI-targeted prostate biopsy between 2/2015-9/2019. Outcome of interest was ≥pT3a disease. The MRI lesion/prostatic capsular relationship was categorized using a standardized reporting format described in PI-RADS v2. A nomogram was developed including biopsy Gleason grade group (GGG), PSA density, PI-RADS score, and the MRI lesion/prostatic capsular relationship. Receiver operating characteristic curves (ROC) were calculated. RESULTS: 476 men were included in the study. Median age was 65 (IQR 60-70), median PSA was 6.09 (IQR 4.58-9.00). In univariate analysis, men were >5x more likely to harbor ≥pT3a disease if MRI demonstrated PI-RADS 5 lesion, if biopsy detected GGG 4/5, or if the capsular relationship demonstrated irregularity, or ECE (Table 1). Each remained significant predictors in the multivariate regression model. Use of the capsular relationship parameter improved the concordance index for the ROC curve from 0.7201 to 0.7859 (95%CI 0.737-0.822) (Figure 1). CONCLUSIONS: We demonstrate that the MRI lesion/prostatic capsular relationship is a useful parameter in the prediction of locally advanced prostate cancer. Further, the incorporation of this parameter into a clinical nomogram improves the staging accuracy of mpMRI. The predictive model demonstrates more accurate staging as compared to widely used nomograms not inclusive of MRI parameters. Source of Funding: Joseph and Diane Steinberg Charitable Trust © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e177-e178 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Feuer More articles by this author Ezequiel Becher More articles by this author Angela Tong More articles by this author Richard Huang More articles by this author James S. Wysock More articles by this author Fang-Ming Deng More articles by this author William C. Huang More articles by this author Samir S. Taneja More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyProstate Cancer: Staging (MP11)1 Sep 2021MP11-05 FACTORS INFLUENCING UPGRADING BIOPSY AT TIME OF RADICAL PROSTATECTOMY IN MEN UNDERGOING MRI-TARGETED AND SYSTEMATIC PROSTATE BIOPSY Miles P Mannas, Zachary Feuer, Richard Huang, William C Huang, James Wysock, and Samir S Taneja Miles P MannasMiles P Mannas More articles by this author , Zachary FeuerZachary Feuer More articles by this author , Richard HuangRichard Huang More articles by this author , William C HuangWilliam C Huang More articles by this author , James WysockJames Wysock More articles by this author , and Samir S TanejaSamir S Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001984.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI to ultrasound fusion-targeted prostate biopsy (MRF-TB) has led to improved detection of clinically significant prostate cancer (csPCa) and reduced detection of indolent (GGG1) PCa. Though MRF-TB has improved diagnostic accuracy, there remains discordance between GGG on biopsy and radical prostatectomy (RP). We evaluated rates of discordance between MRF-TB, systematic biopsy, and RP, and evaluated clinical factors for prediction of discordance. METHODS: We identified a cohort of 535 men who underwent RP following a combined MRF-TB and SB, between 7/2013 and 8/2020, from an IRB-approved prospectively enrolled database. Men were included regardless of previous biopsy status or if they had been on active surveillance for PCa prior to the final biopsy preceding RP. The rate of PCa, csPCa (GGG≥2), upgrading and downgrading at time of RP, were compared between SB and MRF-TB. Univariate and multivariate analysis were utilized to determine pre-surgical variables predictive of upgrading at RP. RESULTS: Pathologic results at time of RP are shown in Table 1. Biopsy upgrade at RP was observed in 30.2% overall, 22.2% when considering MRF-TB alone, and 42.5% on SB alone (MRF-TB alone versus SB alone p<0.0001). 11.6% of men with GGG≥2 on MRF-TB had upgrade on RP. Downgrade of MRF-TB was observed in 17.6% compared to 18.7% for SB (p=0.1). Baseline characteristics of men with any cancer on MRF-TB, included in multivariate analysis, is presented in Table 2. Of variables tested, only a dominant PIRADS 3 lesion was predictive of upgrade (OR 0.163; 95%CI 0.0299-0.888; p=0.038). CONCLUSIONS: Pathologic upgrade at time of RP is reduced on MRF-TB as compared to SB, but still occurs in approximately 1/5 of men. csPCa on MRF-TB further reduces the likelihood of upgrade. PI-RADS score is additionally predictive of the likelihood of upgrade. Source of Funding: Joseph and Diane Steinberg Charitable Trust © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e179-e179 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miles P Mannas More articles by this author Zachary Feuer More articles by this author Richard Huang More articles by this author William C Huang More articles by this author James Wysock More articles by this author Samir S Taneja More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyProstate Cancer: Staging II (PD57)1 Apr 2020PD57-04 PREDICTING PROSTATECTOMY ADVERSE PATHOLOGY IN THE ERA OF PROSTATE IMAGING: DEVELOPMENT OF A NOMOGRAM INCLUSIVE OF PIRADS SCORE AND MRI STAGING Zachary Feuer*, Ezequiel Becher, Xiaosong Meng, Richard Huang, James Wysock, William C. Huang, Fang-Ming Deng, Andrew B. Rosenkrantz, and Samir Taneja Zachary Feuer*Zachary Feuer* More articles by this author , Ezequiel BecherEzequiel Becher More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Richard HuangRichard Huang More articles by this author , James WysockJames Wysock More articles by this author , William C. HuangWilliam C. Huang More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz More articles by this author , and Samir TanejaSamir Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000967.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nomograms incorporating traditional clinical variables are widely used to guide decisions in men diagnosed with prostate cancer (PCa) considering intervention. In this study, developed a nomogram inclusive of PIRADS score and MRI staging for the prediction of adverse pathology (AP) at radical prostatectomy. METHODS: Clinicopathologic data for 468 men who underwent robotics-assisted RP following prostate MRI/MRI-targeted biopsy (bx) were extracted from an IRB-approved prospective bx database. AP was defined as ≥pT3a disease. 441 men with no prior treatment were included for analysis. Multinomial logistic regression including PIRADS score, biopsy Gleason grade group (BxGGG), imaging-based clinical stage (CS, defined stage 1: PIRADS 1, stage 2: PIRADS 2-5, stage 3: evidence of extraprostatic disease), and pre-bx PSA density was conducted to determine nomogram coefficients. Receiver operating characteristic curve (ROC) determined strength of discrimination and the Hosmer-Lemeshow (H-L) test assessed goodness-of-fit. RESULTS: 441 men underwent RALP. Median age was 65.7 IQR 60.5-70.0), median pre-bx PSA was 6.50 (IQR 4.55-8.98). Distribution of PIRADS 1 & 2, 3, 4, and 5 was 14.1%, 23.1%, 38.6% and 24.3%, respectively. A model for predicting AP was identified including BxGGG, CS, PSAD and PIRADS (p<0.0001, Table 1). CS and BxGGG contributed most to the overall strength of the model (p<0.0001). The ROC of the model demonstrated an area under the curve (AUC) of 0.78 (Figure 1) and demonstrated calibration (H-L p=0.84). The same model, without PIRADS, yielded an AUC of 0.72 (ΔAUC 0.059). CONCLUSIONS: PIRADS score has been previously suggested to improve the diagnostic accuracy of existing nomograms. In this study, we propose use of a predictive nomogram that incorporates PIRADS score, PSAD, bxGGG and a novel MRI-based CS with strong diagnostic accuracy. This nomogram, translatable to an online platform, may be useful in counseling men prior to intervention in the era of prostate MRI. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1194-e1195 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Feuer* More articles by this author Ezequiel Becher More articles by this author Xiaosong Meng More articles by this author Richard Huang More articles by this author James Wysock More articles by this author William C. Huang More articles by this author Fang-Ming Deng More articles by this author Andrew B. Rosenkrantz More articles by this author Samir Taneja More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-11 PI-RADS SCORE PREDICTS EXTRAPROSTATIC EXTENSION AND LYMPH NODE METASTASIS IN MEN UNDERGOING RADICAL PROSTATECTOMY Zachary Feuer*, Ezequiel Becher, Xiaosong Meng, Richard Huang, James Wysock, William C. Huang, Fang-Ming Deng, Andrew B. Rosenkrantz, and Samir Taneja Zachary Feuer*Zachary Feuer* More articles by this author , Ezequiel BecherEzequiel Becher More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Richard HuangRichard Huang More articles by this author , James WysockJames Wysock More articles by this author , William C. HuangWilliam C. Huang More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz More articles by this author , and Samir TanejaSamir Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA recently released an updated policy statement endorsing the use of multiparametric MRI in the diagnosis of prostate cancer (PCa), but stating there was inadequate data to support its use in staging. In this study, we assessed the independent ability of PIRADS score extraprostatic extension (EPE) and the presence of lymph node metastasis (LNM) in men undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). METHODS: Clinicopathologic data from 468 men between 7/2012 and 3/2019 who underwent RALP following prostate MRI were extracted from an IRB-approved prospective biopsy (bx) database. 442 men with pre-operative MRI, reported PI-RADS score, and no prior treatment were included. PI-RADS score was assessed as a predictor of EPE defined as ≥pT3a, or presence of LNM on post-operative pathology using univariate and multivariate analysis (MVA) using logistic regression with odds ratios (OR). RESULTS: Median age was 65.7 at time of RALP (IQR 60.5-70.0) and median pre-bx PSA was 6.50 (IQR 4.55-8.98). In univariate analysis, PI-RADS 4 and 5 regions of interest (ROI) were associated with increased odds of EPE, OR 2.12 (p=0.026) and OR 9.65 (p <0.0001), respectively. There were 21 (4.7%) men with LNM identified at time of RALP. Of these, 14 men had PIRADS 5 ROIs, which was predictive of LNM (OR 9.53, p=0.03). In the MVA, PIRADS 5 ROIs remained a predictor of EPE (OR 3.78, p=0.001). Other factors predictive of EPE included GGG ≥3 on MRI-targeted bx and maximum cancer core length >10mm on bx (Table 2). Only pre-bx PSA >20 ng/mL was associated with LNM (OR 9.05, p=0.002) on MVA. CONCLUSIONS: PI-RADS 4/5 ROIs on prostate MRI independently predict ECE at time of RALP. A PI-RADS 5 ROI is also predictive of LNM, and remains predictive of EPE in MVA. These findings may be used to counsel patients regarding risk of adverse pathology prior to bx or intervention in the era of expanding utilization of pre-bx MRI. Further investigation with a larger cohort of patients with LNM is warranted to characterize the relationship between PI-RADS and LNM. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e949-e950 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Feuer* More articles by this author Ezequiel Becher More articles by this author Xiaosong Meng More articles by this author Richard Huang More articles by this author James Wysock More articles by this author William C. Huang More articles by this author Fang-Ming Deng More articles by this author Andrew B. Rosenkrantz More articles by this author Samir Taneja More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (MP36)1 Apr 2019MP36-08 APPLICATION OF THE PRECISION TRIAL BIOPSY STRATEGY TO A CONTEMPORARY COHORT: HOW MANY CLINICALLY SIGNIFICANT PROSTATE CANCERS ARE MISSED? Xiaosong Meng*, Andrew B. Rosenkrantz, Richard Huang, James S. Wysock, Fang-Ming Deng, William C. Huang, Herbert Lepor, and Samir S. Taneja Xiaosong Meng*Xiaosong Meng* More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz More articles by this author , Richard HuangRichard Huang More articles by this author , James S. WysockJames S. Wysock More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , William C. HuangWilliam C. Huang More articles by this author , Herbert LeporHerbert Lepor More articles by this author , and Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556018.01408.2bAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The PRECISION trial demonstrates the superiority of MRI-targeted prostate bx (TB) over systematic biopsy (SB) in detection of clinically significant prostate cancer (csPCa) and avoidance of indolent disease by only performing TB in men with PI-RADS 3, 4 and 5 lesions on pre-biopsy MRI. In this study, we evaluate our outcomes using a contemporary cohort of men with comparable characteristics as the PRECISION study who underwent combined SB and MRI-US fusion targeted biopsy (MRF-TB) at our institution. METHODS: Between 1/2015 and 9/2018, a total of 1,329 biopsies were performed in 1,136 men after pre-biopsy MRI and outcomes were recorded in an IRB-approved prospective database. Biopsy results, indications, and PI-RADS were queried from those who underwent both MRF-TB and SB using the Artemis/Pro-fuseTM (Eigen, Grass Valley) co-registration system. csPCa was defined as at least one core with Gleason ≥ 3+4 cancer. RESULTS: A total of 450 men (age 64.5 ± 7.9 years, PSA 6.4 ± 3.2ng/mL) who underwent combined MRF-TB and SB met PRECISION study inclusion criteria (No prior biopsy, PSA ≤ 20ng/ml, pre-biopsy MRI with PI-RADS 3,4 or 5 lesions). In our cohort, csPCa was detected in 235/450 (52%) of men with PI-RADS 3, 4 and 5 lesions by MRF-TB. This supports the csPCa detection rate of 55% (95/174) found in PRECISION. If concurrent SB was not performed along with MRF-TB in these men, 46 PCa would be missed, with 18/46 (39%) considered csPCa, equivalent to missing 7% of the csPCa detected in the cohort. The percentage of csPCa missed with avoidance of SB is strongly dependent on PI-RADS (Table 1). CONCLUSIONS: In a cohort of men with comparable clinical characteristics to the PRECISION trial, we found similar csPCa detection among men with PI-RADS 3, 4 and 5 lesions. While avoidance of SB misses few csPCa in men with PI-RADS 4 and 5 lesions, a larger proportion of csPCa (17%) is missed in men with PI-RADS 3 lesions with MRF-TB alone. Further studies are necessary to identify the optimal population in whom SB can be safely avoided. Source of Funding: Joseph and Diane Steinberg Charitable Fund New York, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e517-e517 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xiaosong Meng* More articles by this author Andrew B. Rosenkrantz More articles by this author Richard Huang More articles by this author James S. Wysock More articles by this author Fang-Ming Deng More articles by this author William C. Huang More articles by this author Herbert Lepor More articles by this author Samir S. Taneja More articles by this author Expand All Advertisement PDF downloadLoading ...

Patient-specific 3D models are being used increasingly in medicine for many applications including surgical planning, procedure rehearsal, trainee education, and patient education. To date, experiences on the use of 3D models to facilitate patient understanding of their disease and surgical plan are limited. The purpose of this study was to investigate in the context of renal and prostate cancer the impact of using 3D printed and augmented reality models for patient education. Patients with MRI-visible prostate cancer undergoing either robotic assisted radical prostatectomy or focal ablative therapy or patients with renal masses undergoing partial nephrectomy were prospectively enrolled in this IRB approved study (n = 200). Patients underwent routine clinical imaging protocols and were randomized to receive pre-operative planning with imaging alone or imaging plus a patient-specific 3D model which was either 3D printed, visualized in AR, or viewed in 3D on a 2D computer monitor. 3D uro-oncologic models were created from the medical imaging data. A 5-point Likert scale survey was administered to patients prior to the surgical procedure to determine understanding of the cancer and treatment plan. If randomized to receive a pre-operative 3D model, the survey was completed twice, before and after viewing the 3D model. In addition, the cohort that received 3D models completed additional questions to compare usefulness of the different forms of visualization of the 3D models. Survey responses for each of the 3D model groups were compared using the Mann-Whitney and Wilcoxan rank-sum tests. All 200 patients completed the survey after reviewing their cases with their surgeons using imaging only. 127 patients completed the 5-point Likert scale survey regarding understanding of disease and surgical procedure twice, once with imaging and again after reviewing imaging plus a 3D model. Patients had a greater understanding using 3D printed models versus imaging for all measures including comprehension of disease, cancer size, cancer location, treatment plan, and the comfort level regarding the treatment plan (range 4.60–4.78/5 vs. 4.06–4.49/5, p < 0.05). All types of patient-specific 3D models were reported to be valuable for patient education. Out of the three advanced imaging methods, the 3D printed models helped patients to have the greatest understanding of their anatomy, disease, tumor characteristics, and surgical procedure.

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2018PD47-09 OPTIMIZING USE OF MRI-US FUSION TARGETED BIOPSY: UPDATED EXPERIENCE IN 1639 COMBINED SYSTEMATIC AND TARGETED PROSTATE BIOPSIES Xiaosong Meng, Andrew B. Rosenkrantz, Richard Huang, Fang-Ming Deng, James S. Wysock, William C. Huang, Herbert Lepor, and Samir S. Taneja Xiaosong MengXiaosong Meng More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz More articles by this author , Richard HuangRichard Huang More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , James S. WysockJames S. Wysock More articles by this author , William C. HuangWilliam C. Huang More articles by this author , Herbert LeporHerbert Lepor More articles by this author , and Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2169AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adoption of prostate MRI and MRI-US fusion targeted biopsy (MRF-TB) has increased over the past few years. Although MRF-TB improves detection of clinically significant prostate cancer (csPCa) while limiting over-detection of indolent disease, it is not clear if both MRF-TB and systematic 12-core biopsy (SB) is necessary for all men. We hypothesized that MRF-TB might have the most benefit in men with high suspicion MRI regions of interest (ROI). In this study, we compare the relative cancer detection rates (CDR) of MRF-TB and SB for men presenting to our center for prostate biopsy (PBx). METHODS Between 6/12 and 10/17, a total of 2223 PBx was performed in 1960 men after pre-biopsy MRI and outcomes were recorded in an IRB-approved prospective database. Biopsy results, biopsy indications, and PI-RADS for ROI were queried from those who underwent both SB and MRF-TB using the Artemis/Pro-fuseTM (Eigen, Grass Valley) co-registration system. RESULTS 1639 PBx met inclusion criteria consisting of combined SB/MRF-TB, no prior treatment, no outside or 1.5T MRI, and available MRI suspicion score (mSS). MRF-TB detected fewer Gleason 6 (GS6) PCa [250(15%) vs 426(26%), p<0.001] and more GS ≥7 PCa [493(30%) vs 457(28%), p=0.021] as compared to SB in the cohort. When stratified by mSS, MRF-TB detected less GS6 PCa than SB for all mSS scores (Figure 1A). MRF-TB does not detect more GS ≥7 PCa for PI-RADS 2/3 ROI, but detects significantly more GS ≥7 PCa for mSS 4/5 ROI (Figure 1B). MRF-TB uniquely identified 27% (14), 19% (28), 30% (69) and 14% (22) compared to SB which uniquely identified 44% (23), 34% (50), 8% (19) and 3% (5) of all GS ≥7 PCa detected by combined SB/MRF-TB for mSS 2 (52), 3 (148), 4 (233) and 5 (157) ROI, respectively. CONCLUSIONS Overall, MRF-TB decreases over-detection of GS6 PCa as compared to SB, regardless of MRI suspicion score. MRF-TB is most useful in men with mSS 4/5 ROI as it significantly increases detection of GS ≥7 PCa compared to SB. Utilizing MRF-TB alone in men with mSS 2/3 ROI would avoid over-detection of GS6 PCa by 32%, but would miss 36.5% (73/200) of GS ≥7 PCa uniquely identified by SB, suggesting a continued need for combined SB/MRF-TB. Given that only 6% (24/390) of GS ≥7 PCa is uniquely identified by SB in men with mSS 4/5 ROI, MRF-TB alone may be sufficient. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e901 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Xiaosong Meng More articles by this author Andrew B. Rosenkrantz More articles by this author Richard Huang More articles by this author Fang-Ming Deng More articles by this author James S. Wysock More articles by this author William C. Huang More articles by this author Herbert Lepor More articles by this author Samir S. Taneja More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...