You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-18 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER USING COGNITIVE VERSUS SOFTWARE-BASED MRI-TARGETING DURING TRANSPERINEAL PROSTATE BIOPSY: A MULTI-INSTITUTIONAL ANALYSIS Benjamin Rosenfeld, Dylan M. Buller, William E. Martin, Amanda Sherman, William C. Faust, Serge Ginzburg, Joseph R. Wagner, Alexander Kutikov, Andres F. Correa, Kevin Pinto, Chia-Ling Kuo, Lucas Godoy, Peter C. Albertsen, and Benjamin T. Ristau Benjamin RosenfeldBenjamin Rosenfeld , Dylan M. BullerDylan M. Buller , William E. MartinWilliam E. Martin , Amanda ShermanAmanda Sherman , William C. FaustWilliam C. Faust , Serge GinzburgSerge Ginzburg , Joseph R. WagnerJoseph R. Wagner , Alexander KutikovAlexander Kutikov , Andres F. CorreaAndres F. Correa , Kevin PintoKevin Pinto , Chia-Ling KuoChia-Ling Kuo , Lucas GodoyLucas Godoy , Peter C. AlbertsenPeter C. Albertsen , and Benjamin T. RistauBenjamin T. Ristau View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A randomized trial in the transrectal prostate biopsy setting demonstrated no difference in detection of clinically significant prostate cancer (csPC) whether targeted biopsy (TB) of MRI lesions was performed using cognitive or software-based fusion (PMID 30522912). Retrospective data suggests similar lack of difference in the transperineal biopsy (TP-B) setting (PMID 33207137); however, prior analyses have not accounted for the impact of TP-B indication (biopsy naïve (BN), prior negative biopsy (PNB), active surveillance (AS)). We examined a large, multi-institutional cohort of men to assess differences in detection of csPC between cognitive and software-based TB stratified by TP-B indication. METHODS: Prospectively maintained TP-B databases across five institutions were retrospectively analyzed. All patients with PIRADS 3-5 lesions on MRI undergoing TB of the index lesion(s) were included. Baseline demographic and clinical data were captured. Primary outcome was detection of csPC (≥GG2) within a TB stratified by biopsy indication (BN, PNB, and AS) and whether cognitive or software-based fusion was used. Univariate and multivariate statistical analyses were performed. RESULTS: 1,546 TP-B (804 cognitive, 742 software) were included. Median age was 66 y, median PSA 6.9 ng/ml, and median prostate volume 48 cc. 758 were BN, 254 had PNB, and 510 were on AS. Overall csPC detection on TB was 40.9%. On multivariable analysis, there was no significant difference in detection of csPC between cognitive and software-based TB overall (OR 1.15, 95% CI 0.85-1.55, p=0.38). Stratified by biopsy indication, software-based targeting improved detection of csPC in the PNB population (OR 5.02, 95% CI 1.71-16.5, p<0.01). There was no significant difference for BN (OR 0.78, 95% CI 0.52-1.17, p=0.23) or AS (OR 1.59, 95% CI 0.92-2.79, p=0.10). CONCLUSIONS: In a large, multi-institutional cohort undergoing TB of suspicious MRI lesions, we found no significant difference overall in detection of csPC whether a cognitive or software-based technique was used. When stratified by biopsy indication, this lack of difference persisted for BN and AS patients; however, software-based fusion outperformed cognitive fusion in the PNB population. Source of Funding: Unfunded © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e790 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin Rosenfeld More articles by this author Dylan M. Buller More articles by this author William E. Martin More articles by this author Amanda Sherman More articles by this author William C. Faust More articles by this author Serge Ginzburg More articles by this author Joseph R. Wagner More articles by this author Alexander Kutikov More articles by this author Andres F. Correa More articles by this author Kevin Pinto More articles by this author Chia-Ling Kuo More articles by this author Lucas Godoy More articles by this author Peter C. Albertsen More articles by this author Benjamin T. Ristau More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: We investigated ethnic differences in the risk of post-pyelonephritic renal scarring in infants and children for possible genetic determinants.Materials and Methods: We searched all peer reviewed articles published from 1980 through 2006 in the PubMed (R), MEDLINE (R) (Ovid), Cochrane Central Register of Controlled Trials and EMBASE (R) databases for the keywords, "renal scarring and pyelonephritis," "renal fibrosis" and "kidney scarring." References were included only when they specified acute pyelonephritis defined by a fever, positive urine culture and areas of photopenia in the renal cortex on 99mtechnetium dimercapto-succinic acid renal scans, repeat dimercapto-succinic acid scans obtained at least 3 months after acute pyelonephritis to assess for renal cortical scar formation and absence of recurrent urinary tract infection during followup. When possible data were analyzed according to patients and renal units.Results: Among 23 references the overall rates of renal scarring in terms of patients and renal units were 41.6% and 37.0%, respectively. In terms of patients the incidence of renal scarring following acute pyelonephritis varied by region, from 26.5% (Australia) to 49.0% (Asia). In terms of renal units the incidence of acquired renal cortical scarring varied by region, from 16.7% (Middle East) to 58.4% (Asia). When combined by vesicoureteral reflux status children and renal units with refluxing ureters exhibited an increased risk of renal scarring (odds ratios 2.8 and 3.7, respectively).Conclusions: Although scarring was different across some regions, only scarring in Asian studies comparing patients displayed a statistically significant difference. A regional effect explained the heterogeneity observed in the overall estimate for patients and partly for renal units. The greatest risk of renal scarring may be imparted by the presence of vesicoureteral reflux.

PURPOSE OF REVIEW:Traditional management of vesicoureteral reflux focuses on preventing renal complications associated with ascending urinary tract infection by either providing continuous antibiotic prophylaxis to sterilize the urine and thus prevent recurrent infection, or abolishing reflux via surgical intervention. This review will consider the rationale for antibiotic prophylaxis in light of contemporary data regarding the natural history of vesicoureteral reflux, urinary tract infection and renal scarring, as well as the efficacy of various treatment strategies. RECENT FINDINGS:Recent studies have shown that in grades I-IV vesicoureteral reflux, open surgical intervention compared with antibiotic prophylaxis is no better at preventing renal complications. Endoscopic subureteral injection of biomaterials has been proposed as a cost-effective, minimally invasive alternative to surgical or medical intervention; however, given the variety of materials and techniques, the literature has yet to achieve consensus on its efficacy. The first study to compare antibiotic prophylaxis with increased surveillance and prompt treatment of urinary tract infection shows no difference between the two approaches in low-grade (grades I-II) vesicoureteral reflux. SUMMARY:Recent studies have challenged the traditional paradigm of aggressive vesicoureteral reflux management with surgery or antibiotic prophylaxis. In light of these findings, pediatric urologists will need to reexamine treatment modalities for vesicoureteral reflux.