Multi-parametric MRI prostate PIRAD scoring in a district general hospital: Correlating PIRADS 3 results with histological findings

Objective: Prostate cancer is the most common male cancer in the UK. In many hospitals, patients are now being referred for a multi parametric (mp) MRI scan of their prostate as part of an evaluation for the presence of prostate cancer, prior to an ultrasound guided biopsy. PI-RADS score of 3 are defined as “equivocal” for the presence of prostate cancer. Thus, a PIRADS three lesion does not confidently determine whether there is significant prostate disease or not. Our aim is to determine the correlation of PIRADS three prostatic lesions with histology proven, clinically significant cancer. Methods: We performed a retrospective review on a cohort of 143 consecutive patients. Each patient underwent a mp-MRI scan of their prostate given a PIRADS score. PIRADS three lesions were analysed further based on histology and categorised into malignant and non-malignant lesions. PSA results and prostatic volume of PIRADS three lesions were also analysed. Results: We identified forty five patients with PIRADS 3 lesions out of 143 patients. Thirty-two patients subsequently underwent trans-rectal/trans-perineal ultrasound guided biopsy. 43% of patients were found to have had a malignant prostatic adenocarcinoma on histology. The remaining 56% had non-malignant findings. Of those with malignant disease, there was a higher median PSA and lower mean prostatic volume. Conclusions: The study confirms that a score of PIRADS three does not accurately differentiate between malignant and non-malignant lesions. Further investigations such as ultrasound-guided prostate biopsy and PSA parameters are required to accurately ascertain the nature of a prostate lesion with PIRADS score 3. Advances in knowledge: An ultrasound-guided prostate biopsy in patients with PIRADS 3 remains of paramount importance when distinguishing malignant versus non-malignant lesions. Multicentre data of MRI findings with PIRADS three scores is required to yield a sample size large enough to carry out statistical analysis.

Frequency and clinical significance of prostatic involvement in men with febrile urinary tract infection: a prospective observational study

Background: Frequent asymptomatic involvement of the prostate has been demonstrated in men with febrile urinary tract infection (fUTI). In view of this, men with fUTI are often given a longer duration of antibiotic treatment; however, evidence to support this is limited. Methods: We prospectively studied adult men with fUTI admitted under the Department of Medicine in a tertiary care hospital in southern India. fUTI was defined as fever of ≥38°C with at least one symptom/sign of UTI and pyuria, requiring hospitalization. We estimated serum total prostate-specific antigen (PSA) levels at enrollment, one month and three months after treatment completion. We assessed prostatic volume by transrectal ultrasonography (TRUS) and estimated the serum high sensitivity C-reactive protein (hs-CRP) levels at baseline and after three months. Results: We enrolled 64 men (median [IQR] age 53 [45-60] years); 50 patients completed follow-up. At baseline, 24 (38%) of 64 patients had elevated serum PSA values compared to age-specific upper limit. The median (IQR) serum PSA level was 2.15 (1.18-3.02) ng/mL and median (IQR) serum hs-CRP level was 2.23 (1.85-2.74) mg/dL (N=64). At three months, serum PSA levels decreased by ≥25% in 47 (94%) of 50 patients. The median (IQR) of prostatic volume was 25.4 (18.9-34) mL at baseline (N=64), and ≥10% decrease in prostatic volume was observed in 24 (48%) of 50 patients at three months. The change in the serum PSA levels did not correlate with clinical findings like prostatic tenderness or with prostatic volume changes. Further, serum PSA levels did not correlate with hs-CRP levels. On follow-up, seven patients had lower urinary tract symptoms; only one of them had recurrent fUTI. Conclusions: Asymptomatic prostatic involvement, although common in men with fUTI, does not seem to influence the treatment outcomes.

Frequency and clinical significance of prostatic involvement in men with febrile urinary tract infection: a prospective observational study

Background: Frequent asymptomatic involvement of the prostate has been demonstrated in men with febrile urinary tract infection (fUTI). In view of this, men with fUTI are often given a longer duration of antibiotic treatment; however, evidence to support this is limited. Methods: We prospectively studied adult men with fUTI admitted under the Department of Medicine in a tertiary care hospital in southern India. fUTI was defined as fever of ≥38°C with at least one symptom/sign of UTI and pyuria, requiring hospitalization. We estimated serum total prostate-specific antigen (PSA) levels at enrollment, one month and three months after treatment completion. We assessed prostatic volume by transrectal ultrasonography (TRUS) and estimated the serum high sensitivity C-reactive protein (hs-CRP) levels at baseline and after three months. Results: We enrolled 64 men (median [IQR] age 53 [45-60] years); 50 patients completed follow-up. At baseline, 24 (38%) of 64 patients had elevated serum PSA values compared to age-specific upper limit. The median (IQR) serum PSA level was 2.15 (1.18-3.02) ng/mL and median (IQR) serum hs-CRP level was 2.23 (1.85-2.74) mg/dL (N=64). At three months, serum PSA levels decreased by ≥25% in 47 (94%) of 50 patients. The median (IQR) of prostatic volume was 25.4 (18.9-34) mL at baseline (N=64), and ≥10% decrease in prostatic volume was observed in 24 (48%) of 50 patients at three months. The change in the serum PSA levels did not correlate with clinical findings like prostatic tenderness or with prostatic volume changes. Further, serum PSA levels did not correlate with hs-CRP levels. On follow-up, seven patients had lower urinary tract symptoms; only one of them had recurrent fUTI. Conclusions: Asymptomatic prostatic involvement, although common in men with fUTI, does not seem to influence the treatment outcomes.

Frequency and clinical significance of prostatic involvement in men with febrile urinary tract infection: a prospective observational study

Background: Frequent asymptomatic involvement of the prostate has been demonstrated in men with febrile urinary tract infection (fUTI). In view of this, men with fUTI are often given a longer duration of antibiotic treatment; however, evidence to support this is limited. Methods: We prospectively studied adult men with fUTI admitted under the Department of Medicine in a tertiary care hospital in southern India. fUTI was defined as fever of ≥38°C with at least one symptom/sign of UTI and pyuria, requiring hospitalization. We estimated serum total prostate-specific antigen (PSA) levels at enrollment, one month and three months after treatment completion. We assessed prostatic volume by transrectal ultrasonography (TRUS) and estimated the serum high sensitivity C-reactive protein (hs-CRP) levels at baseline and after three months. Results: We enrolled 64 men (median [IQR] age 53 [45-60] years); 50 patients completed follow-up. At baseline, the median (IQR) serum PSA level was 2.15 (1.18-3.02) ng/mL and median (IQR) serum hs-CRP level was 2.43 (2.28-2.58) mg/L. At three months, serum PSA levels decreased by ≥25% in 47 (94%) of 50 patients. The median (IQR) of prostatic volume was 25.4 (18.9-34) mL at baseline, and ≥10% decrease in prostatic volume was observed in 24 (48%) of 50 patients at three months. The change in the serum PSA levels did not correlate with clinical findings like prostatic tenderness or with prostatic volume changes. Further, serum PSA levels did not correlate with hs-CRP levels. On follow-up, seven patients had lower urinary tract symptoms; only one of them had recurrent fUTI. Conclusions: Asymptomatic prostatic involvement, although common in men with fUTI, does not seem to influence the treatment outcomes.

Evaluation of canine prostate volume in calculated tomographic images - comparison of two assessment methods

Background Since most prostatic diseases are associated with the organ’s enlargement, evaluation of prostatic size is a main criterion in the diagnosis of prostatic state of health. While enlargement is a non-uniform process, volumetric measurements are believed to be advantageous to any single dimensional parameter for the diagnosis of prostatomegaly. In a previous study, volume was analysed with a slice addition technique (SAT), which was validated as highly accurate. Irrespective of high accuracy, SAT represents a complex and time-consuming procedure, which limits its clinical use. Thus, demand exists for more practical volume assessment methods. In this study, the prostatic volume of 95 canine patients (58 intact males, 37 neutered males) were analysed retrospectively by using the ellipsoid formula (Formula) and an imaging “wrap” function tool (Wrap) to help assess accuracy and applicability. Accuracy was checked against phantom measurements and results were compared to SAT measurements of the same patient pool obtained from a previously published paper. Patients were grouped according to prostatic structure (H = homogeneous, I = inhomogeneous, C = cystic) and volume using the SAT (volume group = vg: 1, 2 and 3). Results High correlation between the Formula or Wrap volume and the phantom volume was found, the values being higher for the Formula. Mean Formula volumes (vg 1: 2.2 cm3, vg 2: 14.5 cm3, vg 3: 109.4 cm3, respectively) were significantly underestimated, while mean Wrap volumes (vg 1: 3.8 cm3, vg 2: 19.5 cm3, vg 3: 159.2 cm3) were statistically equivalent to SAT measurements (vg 1: 3.1 cm3, vg 2: 18.6 cm3, vg 3: 157.2 cm3, respectively). Differences between Formula and SAT volumes ranged from 22.4–31.1%, while differences between Wrap and SAT volumes were highest in small prostates (vg 1: 22.1%) and fell with increasing prostatic size (vg 3: 1.3%). Conclusion The Wrap function is highly accurate, less time-consuming and complex compared to SAT and could serve as beneficial tool for measuring prostatic volume in clinical routine after further validation in future studies. The Formula method cannot be recommended as an alternative for volumetric measurements of the prostate gland due to its underestimation of volumes compared to SAT results.

Digital radiography and ultrasonography in evaluation of the canine prostate

This study aimed to evaluate the canine prostate using ultrasonography and digital radiography. The study involved 21 intact dogs of mixed breed, with a mean weight of 8.7 ± 3.09 kg and without previous hormonal treatment. The dogs were divided into three groups according to the age: GI (0-3 years); GII (3-7 years); GIII (7+ years). Prostates from each animal were qualitatively and quantitatively evaluated by means of digital rectal examination, ultrasonography and digital radiography. A total of 882 measurements were obtained and 84 qualitative analyses. The results demonstrated association and high agreement between digital rectal examination and radiography for prostatomegaly diagnosis (p = 0.0030; K = 0.829268). Ultrasonography and digital rectal examination did not present an association and had low agreement for diagnosis of alterations in prostatic parenchyma (p = 1; K = 0.049383). Also, there was a difference between ultrasonographic and radiographic measurements (height: p = 0.0002; length: p < 0.0001; width: p < 0.0001). However, the measurements from distinct radiographic projections showed no difference between each other (width: p = 0.3543; length: p = 0.3079 and p = 0.9725; height: p = 0.3208). Prostatic volume based on ultrasonographic measurements showed a positive correlation being proportional to the age of the dog (p = 0.0383). It was concluded that both methods, ultrasonography and radiography, are relevant diagnostic tools in evaluating the canine prostate, beyond just complementing each other. There are limitations associated with both imaging methods, which should be taken into consideration when planning a specific investigation of the canine prostate.