Is PI-RADS 3/total lesion ratio associated with clinically-significant prostate cancer in patients with equivocal-risk lesions on multi-parametric MRI?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 149-149
Author(s):  
Kamyar Ghabili ◽  
Matthew Swallow ◽  
Alfredo Suarez-Sarmiento ◽  
Jamil Syed ◽  
Michael Leapman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Area Under The Curve ◽  
Lesion Volume ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Psa Density ◽  
Increased Risk ◽  
Positive Core ◽  
Clinically Significant

149 Background: Prostate imaging reporting and data system (PI-RADS) category 3 (P3) provides an equivocal assessment of prostate cancer (PCa). We aimed to investigate imaging parameters including the ratio of P3-to-total regions of interest (ROI) that may assist in identifying P3 lesions harboring clinically-significant PCa (csPCa). Methods: We retrospectively queried our institutional MRI-ultrasound fusion biopsy database to identify patients without a prior diagnosis of PCa and with at least one P3 lesion on multi-parametric MRI (mpMRI) who underwent fusion biopsy during Feb 2015-Oct 2017. mpMRI findings were assessed, including prostate and P3 volumes, number of ROIs, and P3-to-total ROIs ratio (P3 lesion volume/total ROIs volumes). Logistic regression and area under the curve (AUC) were used to assess the ability of clinical and mpMRI characteristics to predict csPCa, defined as any grade group (GG)≥2 cancer or GG 1 cancer in > 2 cores or > 50% of any positive core from targeted biopsy of the P3 lesion. Results: Of 127 men with at least one P3 lesion, 29 (22.8%) had csPCa on the biopsy of P3 lesions. Patients with csPCa in P3 lesions had smaller prostate volumes (42.1mL vs 56mL, p = 0.003), lower P3/total ROIs ratios (0.46 vs 1.00, p < 0.001), and higher numbers of total ROIs (2 vs 1, p = 0.004). Compared with patients who had a P3/total ROIs ratio > 0.58, men with ratios < 0.58 were more likely to be diagnosed with csPCa in a P3 lesion (57.1% vs 9%, p < 0.001). Using a threshold of 0.58, P3/total ROIs ratio was 76.1% sensitive and 80.6% specific for csPCa in a P3 lesion. On multivariate analysis, smaller prostate volume (OR1.04, 95%CI 1.01-1.07, p = 0.01) and lower P3/total ROIs ratio (OR1.04, 95%CI 1.02-1.07, p = 0.003) were associated with an increased risk of csPCa in P3 lesions. P3/total ROIs ratio (AUC 0.73) and prostate volume (AUC 0.70) were superior to PSA density (AUC 0.65) for the prediction of csPCa in P3 lesions. Conclusions: Our data indicated that prostate volume and P3/total ROIs ratio outperformed PSA density in and were associated with detecting csPCa in P3 lesions. P3/total ROIs ratio could be used to avoid 80.6% of unnecessary biopsies of a P3 lesion in men with multiple ROIs.

Naive patients with suspicious prostate cancer and positive multiparametric magnetic resonance imaging (mp-MRI): is it time for fusion target biopsy alone?

2021 ◽  
pp. 205141582110237
Author(s):  
Enrico Checcucci ◽  
Sabrina De Cillis ◽  
Daniele Amparore ◽  
Diletta Garrou ◽  
Roberta Aimar ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Detection Rate ◽  
Resonance Imaging ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Final Pathology ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Clinically Significant

Objectives: To determine if standard biopsy still has a role in the detection of prostate cancer or clinically significant prostate cancer in biopsy-naive patients with positive multiparametric magnetic resonance imaging. Materials and methods: We extracted, from our prospective maintained fusion biopsy database, patients from March 2014 to December 2018. The detection rate of prostate cancer and clinically significant prostate cancer and complication rate were analysed in a cohort of patients who underwent fusion biopsy alone (group A) or fusion biopsy plus standard biopsy (group B). The International Society of Urological Pathology grade group determined on prostate biopsy with the grade group determined on final pathology among patients who underwent radical prostatectomy were compared. Results: Prostate cancer was found in 249/389 (64.01%) and 215/337 (63.8%) patients in groups A and B, respectively ( P=0.98), while the clinically significant prostate cancer detection rate was 57.8% and 55.1% ( P=0.52). No significant differences in complications were found. No differences in the upgrading rate between biopsy and final pathology finding after radical prostatectomy were recorded. Conclusions: In biopsy-naive patients, with suspected prostate cancer and positive multiparametric magnetic resonance imaging the addition of standard biopsy to fusion biopsy did not increase significantly the detection rate of prostate cancer or clinically significant prostate cancer. Moreover, the rate of upgrading of the cancer grade group between biopsy and final pathology was not affected by the addition of standard biopsy. Level of evidence: Not applicable for this multicentre audit.

scholarly journals PSA Density Help to Identify Patients With Elevated PSA Due to Prostate Cancer Rather Than Intraprostatic Inflammation: A Prospective Single Center Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Salvatore M. Bruno ◽  
Ugo G. Falagario ◽  
Nicola d’Altilia ◽  
Marco Recchia ◽  
Vito Mancini ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Prostate Volume ◽  
Multivariable Analysis ◽  
Binary Logistic Regression Analysis ◽  
Single Center ◽  
Negative Biopsy ◽  
Psa Density ◽  
Clinically Significant ◽  
Prostatic Inflammation

The association between PSA density, prostate cancer (PCa) and BPH is well established. The aim of the present study was to establish whether PSA density can be used as a reliable parameter to predict csPCa and to determine its optimal cutoff to exclude increased PSA levels due to intraprostatic inflammation. This is a large prospective single-center, observational study evaluating the role of PSA density in the discrimination between intraprostatic inflammation and clinically significant PCa (csPCa). Patients with PSA ≥ 4 ng/ml and/or positive digito-rectal examination (DRE) and scheduled for prostate biopsy were enrolled. Prostatic inflammation (PI) was assessed and graded using the Irani Scores. Multivariable binary logistic regression analysis was used to assess if PSA density was associated with clinically significant PCa (csPCa) rather than prostatic inflammation. A total of 1988 patients met the inclusion criteria. Any PCa and csPCa rates were 47% and 24% respectively. In the group without csPCa, patients with prostatic inflammation had a higher PSA (6.0 vs 5.0 ng/ml; p=0.0003), higher prostate volume (58 vs 52 cc; p&lt;0.0001), were more likely to have a previous negative biopsy (29% vs 21%; p=0.0005) and a negative DRE (70% vs 65%; p=0.023) but no difference in PSA density (0.1 vs 0.11; p=0.2). Conversely in the group with csPCa, patients with prostatic inflammation had a higher prostate volume (43 vs 40 cc; p=0.007) but no difference in the other clinical parameters. At multivariable analysis adjusting for age, biopsy history, DRE and prostate volume, PSA density emerged as a strong predictor of csPCA but was not associated with prostatic inflammation. The optimal cutoffs of PSA density to diagnose csPCa and rule out the presence of prostatic inflammation in patients with an elevated PSA (&gt;4 ng/ml) were 0.10 ng/ml2 in biopsy naïve patients and 0.15 ng/ml2 in patients with a previous negative biopsy. PSA density rather than PSA, should be used to evaluate patients at risk of prostate cancer who may need additional testing or prostate biopsy. This readily available parameter can potentially identify men who do not have PCa but have an elevated PSA secondary to benign conditions.

Periprostatic venous androgen levels in a subset of patients with prostate cancer: An investigation into a novel role of testosterone in localized prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 341-341
Author(s):  
Lewis Thomas ◽  
Mohammad Alyamani ◽  
Jianbo Li ◽  
Andrei Purysko ◽  
Eric A. Klein ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Venous Blood ◽  
Venous Drainage ◽  
Increased Risk ◽  
Vein Diameter ◽  
Clinically Significant ◽  
The Relationship ◽  
Androgen Levels

341 Background: While androgens drive prostate cancer (PCa), studies of systemic levels in eugonadal patients have not shown a relationship with development or progression of PCa. This study characterizes the relationship between systemic, local venous, and tissue androgen levels to understand the regulation and influence of androgens on localized PCa. Methods: Peripheral & periprostatic venous blood & prostate tissue were collected from patients undergoing radical prostatectomy (RP). Androgen levels (testosterone (T) and dihydrotestosterone (DHT)) were assessed by mass spectrometry. PCa grade and stage, PSA, prostate volume, and periprostatic vein diameter (PPVD) on MRI were recorded. A second cohort of patients undergoing just prostate MRI (non-surgical) was assessed to investigate the relationship between PPVD and disease severity. Results: Samples were collected from 176 patients. Analysis identified a subset of patients with elevated periprostatic T (ppT) relative to systemic T (sT) including 25% with ppT/sT > 2, 14% with ppT/sT > 4, and 7% with ppT/sT > 10. Patients with ppT/sT > 4 had supraphysiologic T levels in the periprostatic venous blood (mean 4223ng/mL). These patients also had higher than predicted levels of tissue T and DHT (tT/sT of 0.48 vs 0.24 (p = 0.004) and tDHT/sT of 7.31 vs 4.72 (p = 0.011)). In the surgical cohort, PPVD was increased in patients with elevated ppT/sT levels (5.8mm vs 3.7mm, p = 0.013). In the biopsy cohort (n = 200), increased PPVD was associated with an increased risk of diagnosis of PCa (4.39mm vs 3.43mm p = 0.006) and clinically significant PCa (4.35mm vs 3.43mm p = 0.01). Conclusions: In a subset of patients with PCa, periprostatic venous T levels were highly elevated compared to peripheral levels. Tissue T and DHT were also increased, and MRI demonstrated increased PPVD. We hypothesize that collateralization of venous drainage from the gonadal vein leads to both high local T and dilated veins. In a biopsy cohort, increased PPVD was associated with an increased risk of diagnosis of any and clinically significant PCa, suggesting that high periprostatic androgen levels may play a role in development of PCa.

Comparing Micro-Ultrasound to mpMRI in Detecting Clinically Significant Prostate Cancer

2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Guan Hee Tan ◽  
Brian Wodlinger ◽  
Christian Pavlovich ◽  
Laurence Klotz
Keyword(s):  
Prostate Cancer ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Grade Group ◽  
Interval Method ◽  
Lower Specificity ◽  
Lesion Analysis ◽  
The Difference ◽  
Clinically Significant ◽  
Jeffreys Interval

Objectives To compare the performance of micro-ultrasound (mUS) with multi-parametric magnetic resonance imaging (mpMRI) in detecting clinically significant prostate cancer. Materials and Methods Retrospective data from consecutive patients with any indication for prostate biopsy in 2 academic institutions were included. The operator, blinded to mpMRI, would first scan the prostate and annotate any mUS lesions. All mUS lesions were biopsied. Any mpMRI lesions that did not correspond to mUS lesion upon unblinding were additionally biopsied. Grade group (GG) ≥ 2 was considered clinically significant cancer. The Jeffreys interval method was used to compare performance of mUS with mpMRI with the non-inferiority limit set at −5%. Results Imaging and biopsy were performed in 82 patients with 153 lesions. mUS had similar sensitivity to mpMRI (per-lesion analysis: 78.4% versus 72.5%), but lower specificity, positive predictive value, negative predictive value, and area under the curve. Micro-ultrasound found GG ≥ 2 in 13% of cases missed by mpMRI, while mpMRI found GG ≥ 2 in 11% of cases missed by mUS. The difference 0.020 (95% CI −0.070 to 0.110) was not statistically significant (P = 0.33). Conclusion The sensitivity of mUS in detecting GG ≥ 2 disease was similar to that of mpMRI, but the specificity was lower. Further evaluation with a larger sample size and experienced operators is warranted.

MRI targeted biopsy dramatically increases detection of clinically significant prostate cancer while reducing the risk of indolent cancer detection.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 108-108
Author(s):  
Michael Ahdoot ◽  
Amir H Lebastchi ◽  
Sandeep Gharam ◽  
Patrick H Gomella ◽  
John Dibianco ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Volume ◽  
Targeted Biopsy ◽  
Grade Group ◽  
Patient Demographics ◽  
Sextant Biopsy ◽  
Group 3 ◽  
Male Patients ◽  
Clinically Significant

108 Background: MRI fusion prostate biopsy has been shown to improve detection of clinically significant prostate cancer, however the degree of this benefit is poorly characterized in large clinical trials. Methods: 1750 MRI targeted plus sextant biopsies were performed in 1742 male patients from 2007 to 2017. Patient demographics, PSA, prostate volume, primary and secondary Gleason scores, Johns Hopkins Grade Groups, number of MRI targeted lesions, number of cores obtained, and biopsy yield were recorded. Results: The patient population consisted of men averaging 62.9-year-old (36-86) with a mean PSA 9.6ng/mL, and prostate volume of 59.2 ml. A total of 804 cancers were detected on sextant biopsy and 839 were detected on MRI targeted biopsy. Relative to targeted biopsy, sextant biopsy detected only significantly more Gleason 6 disease (14% vs 21.5%, p < 0.0001) than targeted biopsy. Targeted biopsy detected more Gleason 7 (21% vs 16.6%, p = 0.0009) and Gleason 8-10 (13.4% vs 9.4%). Additionally, Gleason 7 sub-stratification demonstrated substantially more Gleason 4+3 detection in targeted group vs sextant biopsy (4% vs 0.5%, p < 0.0001). When stratified by Grade Group targeted biopsy detected 76% more Grade Group 3-5 cancers (p < 0.0001) and 17.7% less Gleason Group 1-2 cancers (p < 0.0001). Only 1.7% of Grade Group 3-5 cancers were detected on sextant biopsy alone, where as 15.7% of Grade Group 3-5 cancers were detected on targeted biopsy alone. Conclusions: MRI targeted biopsy significantly increases the likelihood of detecting clinically significant cancer and decreases the risk of indolent cancer detection. These finding strongly support the use of MRI targeted biopsy when possible.

scholarly journals Comparison of different thresholds of PSA density for risk stratification of PI-RADSv2.1 categories on prostate MRI

2021 ◽  
Author(s):  
Rossano Girometti ◽  
Gianluca Giannarini ◽  
Valeria Panebianco ◽  
Silvio Maresca ◽  
Lorenzo Cereser ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Net Benefit ◽  
Characteristic Analysis ◽  
Prostate Imaging ◽  
Psa Density ◽  
Group 2 ◽  
Clinically Significant ◽  
Sensitivity Specificity

Objectives: To compare the effect of different PSA density (PSAD) thresholds on the accuracy for clinically significant prostate cancer (csPCa) of the Prostate Imaging Reporting And Data System v.2.1 (PI-RADSv2.1). Methods: We retrospectively included 123 biopsy-naïve men who underwent multiparametric magnetic resonance imaging (mpMRI) and transperineal mpMRI-targeted and systematic prostate biopsy between April 2019 and October 2020. mpMRI, obtained on a 3.0T magnet with a PI-RADSv2.1-compliant protocol, was read by two radiologists (>1500/>500 mpMRI examinations). csPCa was defined as International Society of Urogenital Pathology grading group ≥2. Receiver operating characteristic analysis was used to calculate per-index lesion sensitivity, specificity, and area under the curve (AUC) of PI-RADSv.2.1 categories after adjusting for PSAD ≥0.10,≥0.15, and ≥0.20 ng/mL ml−1. Per-adjusted category cancer detection rate (CDR) was calculated, and decision analysis performed to compare PSAD-adjusted PI-RADSv.2.1 categories as a biopsy trigger. Results: csPCa prevalence was 43.9%. PSAD-adjustment increased the CDR of PI-RADSv2.1 category 4. Sensitivity/specificity/AUC were 92.6%/53.6%/0.82 for unadjusted PI-RADS, and 85.2%/72.4%/0.84, 62.9%/85.5%/0.83, and 92.4%/53.6%/0.82 when adjusting PI-RADS categories for a 0.10, 0.15, and 0.20 ng/ml ml−1 PSAD threshold, respectively. Triggering biopsy for PI-RADS four lesions and PSAD ≥0.10 ng/mL ml−1 was the strategy with greatest net benefit at 30 and 40% risk probability (0.307 and 0.271, respectively). Conclusions: PI-RADSv2.1 category four with PSAD ≥0.10 ng/mL ml−1 was the biopsy-triggering cut-off with the highest net benefit in the range of expected prevalence for csPCa. Advances in knowledge: 0.10 ng/mL ml−1 is the PSAD threshold with higher clinical utility in stratifying the risk for prostate cancer of PI-RADSv.2.1 categories.

Role of core location in targeted MRI-ultrasound fusion biopsy of prostate lesions.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 136-136
Author(s):  
Amanda Lu ◽  
Kamyar Ghabili ◽  
Kevin Nguyen ◽  
Preston Sprenkle
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
High Volume ◽  
Central Core ◽  
Lesion Volume ◽  
Fusion Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Targeted Mri

136 Background: Targeted mpMRI fusion biopsy has gained adoption with superior clinically significant cancer detection rates and accuracy over template biopsy. We sought to establish the role of biopsy location within a prostate lesion to detect clinically significant prostate cancer. Methods: From Nov 2016-Aug 2017, 110 patients with positive multiparametric-MRI (mpMRI) underwent targeted and systematic MRI-US fusion biopsy at our institution for clinical suspicion or known history of prostate cancer. Lesions were scored by Prostate imaging reporting and data system (PI-RADS) classification schema by experienced genitourinary radiologists. Biopsy was performed by an oncology-trained urologist (PS) performing a high volume of fusion biopsies. 5 cores were taken from each lesion, each corresponding to a predetermined location (central, medial, lateral, apex, and base of the lesion). Cancer detection rates (CDR) were calculated on a per lesion basis from biopsy histology. Results: 154 prostate lesions were identified and biopsied with an average volume of 1.31 mL. Detection of clinically significant cancer (G>3+4) did not differ significantly among the 5 locations (Table 1). The central core detected slightly more G≥3+4 cancers than the apex core. No concordance of pathology grade was found between the central core and location of the peripheral core (medial, lateral, apex, or base). In 32% (50/154) of lesions, the peripheral cores had a higher Gleason score than the central core. Biopsy of only the central core missed 40% (21/52) of G≥3+4 cancers and 17% (4/24) of G>3+4 cancers. Lesions with higher PIRADs score were more likely to detect cancer in both the central and peripheral cores, but lesion volume was not a significant predictor. Conclusions: Location of biopsy cores within mpMRI-identified prostate lesions has little correlation with detection of clinically significant cancer. However, targeted biopsy of only the center of a lesion can miss 17% of Gleason >3+4 cancers. [Table: see text]

Clinical utility of PSA density and PI-RADS for deferring biopsy for the detection of clinically significant prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 298-298
Author(s):  
Matthew Truong ◽  
Erica Stevens ◽  
Ryan Ward ◽  
Jennifer Bullen ◽  
Ethan Austhof ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Regression Models ◽  
Diagnostic Group ◽  
Data Systems ◽  
Grade Group ◽  
Prostate Mri ◽  
Logistic Regression Models ◽  
Psa Density ◽  
Clinically Significant

298 Background: We sought to identify PSA density (PSAD) and Prostate Imaging-Reporting and Data Systems (PI-RADS) category cut-offs that would allow deferring biopsy in men with suspicion for clinically significant prostate cancer (csPCa). Methods: Our institution’s prostate MRI registry (n = 1718) was queried for patients who had MRI-guided biopsy (MRI-GB) and/or systematic biopsy (SB) performed after prostate MRI between January 2013 and October 2018 (n = 676). Patients in the diagnostic group (either biopsy naïve or with prior negative biopsy) and patients with PCa on active surveillance (AS) were considered eligible. PSA, PSAD, and PI-RADS category were entered into logistic regression models for predicting csPca (grade group [GG] ≥ 2) at biopsy. Receiver operating characteristic (ROC) analysis was performed to assess model accuracy and results were stratified by biopsy indication and PI-RADS categories. Results: Logistic regression models that combined PSAD and PI-RADS categories had the highest ROC’s in both the diagnostic and AS groups (AUC=0.830 and 0.778, respectively). For diagnostic group patients with PSAD ≤0.15, csPCa was found in 6/89 (6.7%) of negative MRI patients (i.e. PI-RADS ≤ 2), 4/90 (4.4%) of PI-RADS 3 patients, 59/159 (37%) of PI-RADS 4-5 patients. If a PSAD cutoff of ≤ 0.15 and PI-RADS category ≤ 3 MRI were used in combination as criteria for biopsy deferral, only 10/526 (1.9%) of patients would have had csPCa missed on subsequent biopsy. Among patients in the AS group with a negative MRI, 0/22(0%) and 3/8 (37.5%) had csPCA if the PSAD was ≤0.15 and >0.15, respectively. Conclusions: For the diagnostic group of patients undergoing prostate biopsy, PSAD cut off ≤0.15 is useful for deferring biopsy only in patients with a PI-RADS ≤ 3. Confirmatory biopsy in patients should be strongly considered before enrolling patients in AS even in the setting of a negative MRI if the PSAD is > 0.15.

Detection of clinically significant prostate cancer after negative fusion and systematic biopsy.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 288-288
Author(s):  
Jeffrey Twum-Ampofo ◽  
Carl Ceraolo ◽  
Andrew Gusev ◽  
Adam S. Feldman
Keyword(s):  
Prostate Cancer ◽  
False Negative ◽  
High Rate ◽  
Repeat Biopsy ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Suspicious Lesion ◽  
Sextant Biopsy ◽  
Clinically Significant ◽  
Systematic Biopsy

288 Background: MRI/Ultrasound fusion biopsy of the prostate has enhanced the detection of clinically significant prostate cancer (csPCa). Detection of csPCa is greatest when fusion and systematic biopsies are combined. However, the finding of a negative fusion and negative systematic biopsy in patients with suspicious lesion on imaging raises the question of either falsely positive imaging or a false negative biopsy. Methods: We retrospectively reviewed our database of patients undergoing MRI/transrectal US-guided fusion biopsy. All images were graded according to the Prostate Imaging Reporting and Data System version (PIRADS) 2.0. Patients underwent targeted biopsy followed by systematic 12-core double sextant biopsy within the same session. csPCa was defined as Grade Group (GG) ≥2 PCa. Patients with no prostate cancer (PCa) found on biopsies were followed. MRI studies with PIRADS v2 score ≤ 2 were considered to have no MRI evidence of PCa. Results: A total of 400 patients had at least one PIRADS ≥3 lesion and underwent fusion/systematic biopsy. Of these, 113 (28.3%) patients had no evidence of PCa on either fusion or systematic biopsy. Median follow-up was 32.5 months. 44 (39%) patients underwent repeat MRI and of these, 24 (54%) had no evidence of PCa on repeat MRI. PIRADS lesion disappearance was associated with lower PSA Density (PSAd) (0.12 vs 0.20; P = 0.0319) and decreased progression to repeat biopsy (8.33% vs 95%; P < 0.0001). Patients who had a repeat biopsy had a greater PSAd ( 0.21 vs 0.12; P = 0.0054). Of 113 patients with negative initial biopsy, 23 (20.4 %) underwent repeat biopsy: 16 (14.2 %) had PCa and 11 (9.7%) had csPCa. Thus, 48% of patients who underwent repeat biopsy had csPCa. Among patients with a PCa on repeat biopsy, cancer was sampled by MRI targeted cores in 80% of patients. Conclusions: Despite a negative initial fusion/systematic biopsy, at least 10% of patients were subsequently diagnosed with clinically significant PCa. The combination of elevated PSAd and the persistence of a suspicious lesion on repeat MRI appears selective for previously missed PCa. However, after negative fusion biopsy, repeat MRI yields a high rate of PIRADS lesion disappearance in patients with low PSAd.

scholarly journals Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients

2021 ◽  
pp. 039139882198906
Author(s):  
Brianda Ripoll ◽  
Antonio Rubino ◽  
Martin Besser ◽  
Chinmay Patvardhan ◽  
William Thomas ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ct Scan ◽  
Thrombotic Event ◽  
Area Under The Curve ◽  
Whole Body ◽  
Bleeding Events ◽  
Heparin Resistance ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Clinically Significant

Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.

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