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Combining Percentage prostate-Specific Antigen Reduction and Multiparametric Magnetic Resonance imaging to Reduce Unnecessary Biopsy After Focal Therapy With High-Intensity Focused Ultrasound for prostate Cancer

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INTERNATIONAL JOURNAL OF UROLOGY 2025年第0期 2025 Feb 19页

作者： Hsieh, Po-Fan Naruse, Jun Yuzuriha, Soichiro Umemoto, Tatsuya Huang, Chi-Ping Shoji, Sunao China Med Univ Hosp Dept Urol Taichung Taiwan China Med Univ Sch Med Taichung Taiwan Tokai Univ Sch Med Dept Urol Isehara Kanagawa Japan

Objectives To test the feasibility of combining percentage prostate-specific antigen (PSA) reduction and multiparametric magnetic resonance imaging (mpMRI) to determine the clinical scenario in which follow-up biopsy could be avoided after focal therapy (FT) with high-intensity focused ultrasound (HIFU) for prostate cancer. Methods We reviewed 90 men treated with FT. Percentage PSA reduction was calculated by PSA nadir within postoperative 6 months. mpMRI was arranged at postoperative 6 months, followed by routine biopsy. Logistic regression analyses were performed to identify predictors for clinically significant prostate cancer (csPC) on follow-up biopsy. Receiver operating characteristic curve analysis was done to assess the area under the curve (AUC). The diagnostic performance of percentage PSA reduction and mpMRI to predict csPC was also calculated. Results Eight patients had csPC recurrence. Percentage PSA reduction and prostate imaging-reporting and data system (PI-RADS) >= 3 at postoperative 6 months were predictors for csPC (p = 0.033 and p = 0.02, respectively). The AUC of mpMRI, percentage PSA reduction, and their combination were 0.95, 0.816, and 0.982, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of PSA reduction < 70% and PI-RADS >= 3 to predict csPC were 87.5%, 69.5%, 21.9%, 98.3%, and 87.5%, 96.3%, 70%, 98.8%, respectively. Using the criteria of PSA reduction < 70% or PI-RADS >= 3 to determine biopsy candidates could avoid 60% of biopsies, without missing csPC. Conclusion For patients whose PSA reduction > 70% and PI-RADS < 3, we suggested avoiding routine biopsy at 6 months after FT with HIFU.

关键词： focal therapy multiparametric magnetic resonance imaging prostate cancer prostate imaging-reporting and data system prostate-specific antigen

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Developing a diagnostic model for predicting prostate cancer: a retrospective study based on Chinese multicenter clinical data

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Asian Journal of Andrology 2024年第1期26卷 34-40页

作者： Chang-Ming Wang Lei Yuan Xue-Han Liu Shu-Qiu Chen Hai-Feng Wang Qi-Fei Dong Bin Zhang Ming-Shuo Huang Zhi-Yong Zhang Jun Xiao Tao Tao Department of Urology The First Affiliated Hospital of USTCDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefei 230001China Department of Radiology The First Affiliated Hospital of USTCDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefei 230001China Core Facility Center for Medical Sciences The First Affiliated Hospital of USTcDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefei 230001China Department of Urology Affiliated Zhongda Hospital of Southeast UniversityNanjing 210009China Department of Urology Shanghai East HospitalTongji University School of MedicineShanghai 200120China Department of Urology Shanghai Changhai HospitalSecond Military Medical UniversityShanghai 200000China Department of Urology Affiliated Anhui Provincial Hospital of Anhui Medical UniversityHefei 230001China

The overdiagnosis of prostate cancer(PCa)caused by nonspecific elevation serum prostate-specific antigen(PSA)and the overtreatment of indolent PCa have become a global problem that needs to be solved *** aimed to construct a prediction model and provide a risk stratification system to reduce unnecessary *** this retrospective study,clinical data of 1807 patients from three Chinese hospitals were *** final model was built using stepwise logistic regression *** apparent performance of the model was assessed by receiver operating characteristic curves,calibration plots,and decision curve ***,a risk stratification system of clinically significant prostate cancer(csPCa)was created,and diagnosis-free survival analyses were *** multivariable screening and evaluation of the diagnostic performances,a final diagnostic model comprised of the PSA density and prostate imaging-reporting and data system(PI-RADS)score was *** validation in the development cohort and two external cohorts showed excellent discrimination and ***,we created a risk stratification system using risk thresholds of 0.05 and 0.60 as the cut-off *** follow-up results indicated that the diagnosis-free survival rate for csPCa at 12 months and 24 months postoperatively was 99.7%and 99.4%,respectively,for patients with a risk threshold below O.05 after the initial negative prostate biopsy,which was significantly better than patients with higher *** diagnostic model and risk stratification system can achieve a personalized risk calculation of *** provides a standardized tool for Chinese patients and physicians when considering thenecessity of prostatebiopsy.

关键词： nomogram prostate biopsy prostate cancer prostate imaging-reporting and data system prostate-specific antigen density

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Multiparameter MRI features of prostatic malakoplakia

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BRITISH JOURNAL OF RADIOLOGY 2024年第1165期98卷 131-135页

作者： Zeng, Han-Jiang Yang, Ling Yao, Jin Sichuan Univ West China Hosp Dept Radiol 37 Guoxue St Chengdu 610041 Sichuan Peoples R China

Objective To summarize the multiparameter MRI (mpMRI) features of prostatic *** Eleven patients (median age 62 years;IQR 59-71 years) with pathologically confirmed prostatic malakoplakia were included in this study. MpMRI features of the lesions were retrospectively reviewed and *** The prostate imaging-reporting and data system (PI-RADS) scores of the patients were 4 or 5, with a medium diameter of 3.7 cm (IQR 2.0-5.2 cm). All the lesions involved the peripheral zone, of which three cases (3/11, 27.3%) involved the transition zone simultaneously. A diffuse symmetrical distribution was found in five cases, a focal distribution in five cases, and a focal symmetrical distribution in one case. Both the surgical capsule and prostatic margin were bulged and compressed, but no signs of infiltration were found. Nearly all the lesions had moderate hypointensity on T2-weighted images and slightly higher signal intensity on T1-weighted images. Among the lesions, early enhancement occurred in all cases, prolonged enhancement occurred in eight cases, and ring enhancement persisted in one case. All lesions displayed periprostatic enhancement in the delayed *** Lesions distributed diffusely and symmetrically in the peripheral zone with preserved surgical capsule and margin are characteristic features of malakoplakia as opposed to cancer, especially in those with slightly high T1 signal intensity and delayed periprostatic enhancement. Those locally distributed lesions with the above signs should also be *** in knowledge Prostatic malakoplakia are more likely to distribute diffusely and symmetrically, with slightly high T1 signal intensity and delayed periprostatic enhancement.

关键词： multiparameter MRI prostatic malakoplakia prostate imaging-reporting and data system granulomatous prostatitis

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Added Value of prostate-specific Antigen Density in Selecting prostate Biopsy Candidates Among Men with Elevated prostate-specific Antigen and PI-RADS ≥3 Lesions on Multiparametric Magnetic Resonance imaging of the prostate: A systematic Assessment by PI-RADS Score

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European Urology Focus 2024年第4期10卷 634-640页

作者： Pellegrino, Francesco Stabile, Armando Sorce, Gabriele Quarta, Leonardo Robesti, Daniele Cannoletta, Donato Cirulli, Giuseppe Barletta, Francesco Scuderi, Simone Mazzone, Elio de Angelis, Mario Brembilla, Giorgio De Cobelli, Francesco Salonia, Andrea Montorsi, Francesco Briganti, Alberto Gandaglia, Giorgio Division of Oncology/Unit of Urology Soldera Prostate Cancer Laboratory Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy Vita-Salute San Raffaele University Milan Italy Department of Radiology IRCCS San Raffaele Scientific Institute Vita‐Salute San Raffaele University Milan Italy

Background: A significant proportion of patients with positive multiparametric magnetic resonance imaging (mpMRI;prostate imaging-reporting and data system [PI-RADS] scores of 3–5) have negative biopsy results. Objective: To systematically assess all prostate-specific antigen density (PSAD) values and identify an appropriate cutoff for identification of patients with positive mpMRI who could potentially avoid biopsy on the basis of their PI-RADS score. Design, setting, and participants: The study included a cohort of 1341 patients with positive mpMRI who underwent combined targeted and systematic biopsies. Outcome measurements and statistical analysis: Multivariable logistic regression analysis (MVA) was used to assess the association between PSAD and the risk of clinically significant prostate cancer (csPCa, grade group ≥2) after adjusting for confounders. We used locally weighted scatterplot smoothing to explore csPCa risk according to PSAD and PI-RADS scores. PSAD utility was observed only for patients with PI-RADS 3 lesions, so we plotted the effect of each PSAD value as a cutoff for this subgroup in terms of biopsies saved, csPCa cases missed, and clinically insignificant PCa (ciPCa, grade group 1) cases not detected. Results and limitations: Overall, 667 (50%) csPCa cases were identified. On MVA, PSAD independently predicted csPCa (odds ratio 1.57;p < 0.001). For PI-RADS ≥4 lesions, the csPCa risk was ≥40% regardless of PSAD. Conversely, among patients with PI-RADS 3 lesions, csPCa risk ranged from 0% to 60% according to PSAD values, and a PSAD cutoff of 0.10 ng/ml/cm³ corresponded to a threshold probability of 10% for csPCa. Using this PSAD cutoff for patients with PI-RADS 3 lesions would have saved 32% of biopsies, missed 7% of csPCa cases, and avoided detection of 34% of ciPCa cases. Limitations include selection bias and the high experience of the radiologists and urologists involved. Conclusions: Patients with PI-RADS ≥4 lesions should undergo

关键词： Magnetic resonance imaging prostate Biopsy prostate imaging-reporting and data system prostate-specific antigen density Prostatic Cancer

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prostate magnetic resonance imaging and the value of experience:An intrareader variability study

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Asian Journal of Urology 2023年第4期10卷 488-493页

作者： Thomas Whish-Wilson Jo-Lynn Tan William Cross Lih-Ming Wong Tom Sutherland Department of Surgery St Vincent's Hospital Melbourne41 Victoria PdeFitzroy VICAustralia Department of Surgery The University of MelbourneMelbourne VICAustralia Faculty of Medicine The University of MelbourneMelbourne VICAustralia Medical Imaging Department St Vincent's Hospital Melbourne41 Victoria PdeFitzroy VICAustralia

Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over *** An experienced genitourinary radiologist re-reported his original 100 consecutive mpMRIp scans using prostate imaging-reporting and data system version 2(PI-RADS v2)after 5 years of further experience comprising>1000 *** agreement was measured using Cohen's ***,specificity,negative predictive value(NPV),positive predictive value(PPV),and accuracy were calculated,and comparison of sensitivity was performed using McNemar's *** Ninety-six mpMRIp scans were included in our final *** the 96 patients,53(55.2%)patients underwent subsequent biopsy(n=43)or prostatectomy(n=15),with 73 lesions *** agreement(Cohen's kappa 0.55)was seen in the number of lesions identified at initial reporting and on re-reading(81 vs.39 total lesions;and 71 vs.37 number of PI-RADS≥3 lesions).For clinically significant prostate cancer,re-reading demonstrated an increase in specificity(from 43%to 89%)and PPV(from 62%to 87%),but a decrease in sensitivity(from 94%to 72%,p=0.01)and NPV(from 89%to 77%).Conclusion The intraobserver agreement for a novice to experienced radiologist reporting mpMRIp using PI-RADS v2 is *** sensitivity is off-set by improved specificity and PPV,which validate mpMRIp as a gold standard for prebiopsy screening.

关键词： prostate cancer Magneticresonance imaging prostate imaging-reporting and data system Intrareader prostate biopsy

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Clinical implementation of pre-biopsy magnetic resonance imaging pathways for the diagnosis of prostate cancer

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BJU INTERNATIONAL 2022年第4期129卷 480-490页

作者： Israel, Bas Immerzeel, Jos van der Leest, Marloes Hannink, Gerjon Zamecnik, Patrik Bomers, Joyce Schoots, Ivo G. Van Basten, Jean-Paul Debruyne, Frans van Oort, Inge Sedelaar, Michiel Barentsz, Jelle Radboud Univ Nijmegen Med Ctr Radboud Inst Hlth Sci Dept Med Imaging Nijmegen Netherlands Radboud Univ Nijmegen Med Ctr Radboud Inst Hlth Sci Dept Urol Nijmegen Netherlands Andros Clin Dept Urol Arnhem Netherlands Radboud Univ Nijmegen Med Ctr Dept Operating Rooms Nijmegen Netherlands Erasmus MC Dept Radiol & Nucl Med Rotterdam Netherlands Netherlands Canc Inst Dept Radiol Amsterdam Netherlands Canisius Wilhelmina Hosp Dept Urol Nijmegen Netherlands

Objective To assess the outcomes of pre-biopsy magnetic resonance imaging (MRI) pathways, as a tool in biopsy-naive men with suspicion of prostate cancer, in routine clinical practice. Secondary outcomes included a comparison of transrectal MRI-directed biopsy (TR-MRDB) and transperineal (TP)-MRDB in men with suspicious MRI. Patients and Methods We retrospectively assessed a two-centre cohort of consecutive biopsy-naive men with suspicion of prostate cancer who underwent a prostate imaging-reporting and data system version 2 (PI-RADS v2) compliant pre-biopsy MRI in a single, high-volume centre between 2015 and 2019 (Centre 1). Men with suspicious MRI scans underwent TR-MRDB in Centre 1 and TP-MRDB with additional random biopsies (RB) in Centre 2. The MRI and histopathology were assessed in the same institution (Centre 1). Outcomes included: (i) overall detection rates of Grade Group (GG) 1, GG >= 2, and GG >= 3 cancer in men with suspicious MRI;(ii) Biopsy-avoidance due to non-suspicious MRI;and (iii) Cancer detection rates and biopsy-related complications between TR- and TP-MRDB. To reduce confounding bias for MRDB comparisons, inverse probability weighting (IPW) was performed for age, digital rectal examination, prostate-specific antigen (PSA), prostate volume, PSA density, and PI-RADS category. Results Of the 2597 men included, the overall GG 1, GG >= 2, and GG >= 3 prevalence was 8% (210/2597), 27% (697/2597), and 15% (396/2597), respectively. Biopsy was avoided in 57% (1488/2597) of men. After IPW, the GG 1, GG >= 2 and GG >= 3 detection rates after TR- and TP-MRDB were comparable at 24%, 57%, and 32%;and 18%, 64%, and 38%, respectively;with mean differences of -5.7% (95% confidence interval [CI] -13% to 1.4%), 6.1% (95% CI -2.1% to 14%), and 5.7% (95% CI -1.7% to 13%). Complications were similar in TR-MRDB (0.50%) and TP-MRDB with RB (0.62%;mean difference 0.11%, 95% CI -0.87% to 1.1%). Conclusion This high-volume, two-centre study shows pre-biopsy MRI as a de

关键词： biopsy diagnostic imaging multiparametric magnetic resonance imaging prostate imaging-reporting and data system prostate cancer risk stratification transrectal transperineal

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Usefulness of grayscale values of hypoechoic lesions matched with target lesions observed on magnetic resonance imaging for the prediction of clinically significant prostate cancer

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BMC UROLOGY 2022年第1期22卷 1-8页

作者： Kim, Dong Gyun Yoo, Jeong Woo Koo, Kyo Chul Ha Chung, Byung Lee, Kwang Suk Natl Hlth Insurance Serv Ilsan Hosp Dept Urol Goyang South Korea Yonsei Univ Gangnam Severance Hosp Urol Sci Inst Dept UrolColl Med 211 Eonju Ro Seoul 06273 South Korea

Background To analyze grayscale values for hypoechoic lesions matched with target lesions evaluated using prebiopsy magnetic resonance imaging (MRI) according to the prostate imaging-reporting and data system (PI-RADS). Methods We collected data on 420 target lesions in patients who underwent MRI/transrectal ultrasound fusion-targeted biopsies between January 2017 and September 2020. Images of hypoechoic lesions that matched the target lesions on MRI were stored in a picture archiving and communication system, and their grayscale values were estimated using the red/green/blue scoring method through an embedded function. We analyzed imaging data using grayscale values. Results Of the 420 lesions, 261 (62.1%) were prostate cancer lesions. There was no difference in the median grayscale values between benign and prostate cancer lesions. However, grayscale ranges (41.8-98.5 and 42.6-91.8) were significant predictors of prostate cancer and clinically significant prostate cancer (csPC) in multivariable logistic regression analyses. Area under the curve for detecting csPC using grayscale values along with conventional variables (age, prostate-specific antigen levels, prostate volume, previous prostate biopsy results, and PI-RADS scores) was 0.839, which was significantly higher than that for detecting csPC using only conventional variables (0.828;P = 0.036). Subgroup analysis revealed a significant difference for PI-RADS 3 lesions between grayscale values for benign and cancerous lesions (74.5 vs. 58.8, P = 0.008). Grayscale values were the only significant predictive factor (odds ratio = 4.46, P = 0.005) for csPC. Conclusions Distribution of grayscale values according to PI-RAD 3 scores was potentially useful, and the grayscale range (42.6-91.8) was a potential predictor for csPC diagnosis.

关键词： Grayscale Hypoechoic lesion prostate imaging-reporting and data system prostate cancer Target biopsy

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Simplified PI-RADS-based biparametric MRI: A rationale for detecting and managing prostate cancer

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CLINICAL imaging 2021年 80卷 290-291页

作者： Scialpi, Michele Univ Perugia Santa Maria della Misericordia Hosp Dept Med & Surg Div Diagnost Imaging Perugia Italy

Biparametric MRI is a potential and valid alternative to multiparametric MRI. The simplified prostate imaging reporting and data system (S-PI-RADS)-based biparametric MRI represents the rationale for the validation and standardization in clinical practice of MRI in detecting, managing and guiding biopsy in naive men with suspicion prostate cancer.

关键词： prostate cancer Magnetic resonance imaging prostate imaging-reporting and data system

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Ancillary imaging and clinical features for the characterization of prostate lesions: A proposed approach to reduce false positives

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JOURNAL OF MAGNETIC RESONANCE imaging 2021年第6期53卷 1887-1897页

作者： Lee, Chul-Min Park, Kye Jin Kim, Mi-Hyun Kim, Jeong Kon Univ Ulsan Asan Med Ctr Dept Radiol Coll Med 86 Asanbyeongwon Gil Seoul 05507 South Korea Hanyang Univ Sch Med Dept Radiol Med Ctr Seoul South Korea

The relatively low specificity and positive predictive value of the prostate imaging-reporting and data system (PI-RADS) can lead to considerable false-positive results and unnecessary biopsies. The aim of this study was to propose ancillary features (AFs) indicating clinically significant prostate cancer (csPCa) or benign tissues in PI-RADS category >= 3 lesions and determine the usefulness of these AFs in reducing false-positive assessments of suspicious lesions in men at csPCa risk. This was a retrospective study, which included 199 men. A 3T, including turbo spin echo T-2-weighted, echo-planar diffusion-weighted, and spoiled gradient echo dynamic contrast-enhanced (DCE) images, was used. Five AFs (prostate-specific antigen density >= 0.15 ng/mL(2);size >= 10 mm;heterogeneous T2 signal intensity;circumscribed nodule in the junction of peripheral and transition zone;and DCE time curves) indicating csPCa or non-csPCa were evaluated by three independent readers. The sensitivity and specificity of each AF were calculated. Inter-reader agreement was evaluated using kappa statistics. Univariate and multivariate logistic regression analyses were conducted to determine significant AFs. The reduction in positive call rates and csPCa detection rates with combined AF use were calculated and compared with the findings obtained with PI-RADS use alone. The sensitivities and specificities of the AFs indicating csPCa were 72.1%-96.5% and 27.4%-75.2% for reader 1, 66.3%-96.5% and 23.9%-62.0% for reader 2, and 67.4%-96.5% and 34.5%-78.8% for reader 3, with moderate to substantial inter-reader agreement (Fleiss kappa, 0.551-0.643). The combined use of two or more AFs for assessing PI-RADS >= 3 lesions resulted in a 19.6%-30.7% reduction in positive calls (p < .05) compared to PI-RADS use alone while preserving the csPCa detection rates (p >= .06) for three readers. The use of AFs in combination with PI-RADS can reduce positive calls and false positives without csPCa under-detection

关键词： ancillary features false-positive prostate prostate imaging-reporting and data system

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Effectiveness and Safety of Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms from Benign Prostatic Hyperplasia in Men with Concurrent Localized prostate Cancer

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 2021年第7期32卷 1053-1061页

作者： Parikh, Nainesh Keshishian, Edward Manley, Brandon Grass, G. Daniel Torres-Roca, Javier Boulware, David Feuerlein, Sebastian Pow-Sang, Julio M. Bagla, Sandeep Yamoah, Kosj Bhatia, Shivank H Lee Moffitt Canc Ctr & Res Inst Dept Diagnost Imaging & Intervent Radiol Tampa FL 33612 USA H Lee Moffitt Canc Ctr & Res Inst Dept Genitourinary Oncol Tampa FL 33612 USA H Lee Moffitt Canc Ctr & Res Inst Dept Radiat Oncol Tampa FL 33612 USA H Lee Moffitt Canc Ctr & Res Inst Dept Biostat Tampa FL 33612 USA Prostate Ctr USA Merrifield VA USA Univ Miami Miller Sch Med Dept Intervent Radiol Miami FL 33136 USA

Purpose: To assess the effectiveness and safety of prostatic artery embolization (PAE) on lower urinary tract symptoms (LUTS) in the setting of localized prostate cancer (PCa). Materials and Methods: This was a retrospective, single-center, institutional review board-approved study from December 2016 to June 2020 of 21 patients (median age, 72;range, 63-83 years) with moderate LUTS and localized PCa. Clinical effectiveness was evaluated at 6 and 12 weeks using International prostate Symptom Score (IPSS) and quality of life (QoL) improvement. Seventeen patients were scheduled to receive definitive radiotherapy (RT) after PAE;13 patients completed RT. Short-term imaging signs of oncologic progression were evaluated at 6 and 12 weeks defined by at least one of the following on magnetic resonance imaging: increased prostate imaging-reporting and data system score of index lesion(s) to at least 4, new extracapsular extension, seminal vesicle involvement, or pelvic lymphadenopathy. Nonparametric Wilcoxon signed-rank test was used for analysis. Results: IPSS improved by a median of 12 (n = 19, P <.0001) and 14 (n = 14, P <.0001) at 6 and 12 weeks, respectively. QoL improved by a median of 2 (n = 19, P <.0001) and 3 (n = 3, P <.0001) at 6 and 12 weeks. prostate volume decreased by a median of 24% (n = 19, P <.0001) and 36% (n = 12, P =.015) at 6 and 12 weeks. No patients demonstrated disease progression at 6 (n = 16) or 12 (n = 8) weeks by imaging. No patients experienced increased prostate-specific antigen after RT, grade >= 3 adverse events, or greater genitourinary toxicity. Conclusions: PAE is effective and safe for the treatment of men with LUTS from benign prostatic hyperplasia in the setting of concomitant, localized, non-obstructive PCa.

关键词： BPH benign prostatic hyperplasia CTCAE Common Terminology Criteria for Adverse Events GU genitourinary IPSS International prostate Symptom Score LUTS lower urinary tract symptoms PAE prostatic artery embolization PCa prostate cancer PIRADS prostate imaging-reporting and data system PSA prostate-specific antigen RT radiotherapy QoL quality of life

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