Application of 16 G Biopsy Needle in Transperineal Template-Guided Prostate Biopsy

<b><i>Background:</i></b> The aim of this study was to evaluate the clinical value of 16 G biopsy needle in transperineal template-guided prostate biopsy (TTPB), compared with 18 G biopsy needle. <b><i>Methods:</i></b> The patients who underwent TTPB from August 2020 to February 2021 were randomized into 2 groups using a random number table. The control group (<i>n</i> = 65) and the observation group (<i>n</i> = 58) performed biopsy with 18 G (Bard MC l820) and 16 G (Bard MC l616) biopsy needles, respectively. Positive rate of biopsy, Gleason score, complications, and pain score were statistically analyzed. <b><i>Results:</i></b> The age, prostate volume, PSA, and the number of cores were comparable between the 2 groups. The positive rate of biopsy in the observation group was 68.9% (40/58), meanwhile the control group was 46.2% (30/65). There was statistical difference between the 2 groups (<i>p</i> = 0.011). Gleason score of the observation group (8 [7–9]) was higher than that of the control group (8 [6–9]) (<i>p</i> = 0.038). There was no significant difference in pain score and complications including hematuria, hematospermia, perineal hematoma, infection, and urinary retention between the 2 groups (<i>p</i> &#x3e; 0.05). <b><i>Conclusions:</i></b> 16 G biopsy needle significantly improved the positive rates and accurately evaluate the nature of lesions, meanwhile did not increase the incidence of complications compared with 18 G biopsy needle.

Influence of Biopsy Gleason Score on the Risk of Lymph Node Invasion in Patients With Intermediate-Risk Prostate Cancer Undergoing Radical Prostatectomy

Objective: To analyze the influence of biopsy Gleason score on the risk for lymph node invasion (LNI) during pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy (RP) for intermediate-risk prostate cancer (PCa).Materials and Methods: We retrospectively analyzed 684 patients, who underwent RP between 2014 and June 2020 due to PCa. Univariable and multivariable logistic regression, as well as binary regression tree models were used to assess the risk of positive LNI and evaluate the need of PLND in men with intermediate-risk PCa.Results: Of the 672 eligible patients with RP, 80 (11.9%) men harbored low-risk, 32 (4.8%) intermediate-risk with international society of urologic pathologists grade (ISUP) 1 (IR-ISUP1), 215 (32.0%) intermediate-risk with ISUP 2 (IR-ISUP2), 99 (14.7%) intermediate-risk with ISUP 3 (IR-ISUP3), and 246 (36.6%) high-risk PCa. Proportions of LNI were 0, 3.1, 3.7, 5.1, and 24.0% for low-risk, IR-ISUP1, IR-ISUP 2, IR-ISUP-3, and high-risk PCa, respectively (p &lt; 0.001). In multivariable analyses, after adjustment for patient and surgical characteristics, IR-ISUP1 [hazard ratio (HR) 0.10, p = 0.03], IR-ISUP2 (HR 0.09, p &lt; 0.001), and IR-ISUP3 (HR 0.18, p &lt; 0.001) were independent predictors for lower risk of LNI, compared with men with high-risk PCa disease.Conclusions: The international society of urologic pathologists grade significantly influence the risk of LNI in patients with intermediate- risk PCa. The risk of LNI only exceeds 5% in men with IR-ISUP3 PCa. In consequence, the need for PLND in selected patients with IR-ISUP 1 or IR-ISUP2 PCa should be critically discussed.

Evaluation of four pre-operative models for prediction of biochemical recurrence after radical prostatectomy in localized prostate cancer

Background: Biochemical recurrence (BCR) can be seen in the early or late period after radical prostatectomy (RP). Various models have been developed to predict BCR. Objective: In our study we evaluated accuracy of four pre-operative models (GP score, PRIX, D’Amico risk classification, CAPRA) in predicting BCR after RP in Turkish patients. Methods: Age, preoperative total prostate specific antigen (PSA) values, clinical stages, total number of cores taken in biopsy, number of positive cores, preoperative biopsy Gleason score (GS), follow-up time and presence of BCR after RP were recorded. BCR was defined as a total PSA value > 0.2 ng / dl twice consecutively after RP. Classifications or scoring was performed according to pre-operative models. The 1, 3 and 5 year (yr) BCR-free rates of the patients were determined for each model. Also the accuracy of four predictive models for predicting 1, 3 and 5-yr BCR was evaluated. Results: For all pre-operative models there was statistically significant difference between risk groups in BCR free rates at 1, 3 and 5-yr after RP (p<0.001). The Harrell’s concordance index for 1-yr BCR predictions was 0,802, 0,831, 0,773 and 0,745 for the GP score, PRIX, CAPRA and D’Amico and respectively. For 3-yr BCR predictions it was 0,798, 0,791, 0,723 and 0,714 for the GP score, PRIX, CAPRA and D’Amico and respectively. Finally, The Harrell’s concordance index for 5-yr BCR predictions was 0,778, 0,771, 0,702 and 0,693 for the GP score, PRIX, CAPRA and D’Amico and respectively. Conclusion: In prediction of BCR, accuracy of GP scoring and PRIX seems slightly higher than CAPRA and D’Amico risk classification. Surely our results should be supported by head to head comparisons with in other larger cohorts

Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy

Background: The impact of MRI-lesion targeted (TB) and systematic biopsy (SB) Gleason score (GS) as a predictor for final pathological GS still remains unclear. Methods: All patients with TB + SB, and subsequent radical prostatectomy (RP) between 01/2014-12/2020 were analyzed. Rank correlation coefficient predicted concordance with pathological GS for patients’ TB and SB GS, as well as for the combined effect of SB + TB. Results: Of 159 eligible patients, 77% were biopsy naïve. For SB taken in addition to TB, a Spearman’s correlation of +0.33 was observed regarding final GS. Rates of concordance, upgrading, and downgrading were 37.1, 37.1 and 25.8%, respectively. For TB, a +0.52 correlation was computed regarding final GS. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. For the combination of SB + TB, a correlation of +0.59 was observed. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). Conclusions: GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB GS with regard to final pathology. The combined effect of SB + TB led to the highest concordance rate and the lowest upgrading rate.

311 Can We Predict Extraprostatic Extension (EPE) Prior To Radical Prostatectomy? – A Single Institution Comparison of Pre-Operative Biopsy Histology and Multiparametric MRI (mpMRI) With Radical Prostatectomy Specimen Histology

Introduction Prostate biopsies and mpMRI play an integral role in diagnosis of prostate cancer. The aim of our study was to assess the ability to predict EPE based on pre-operative histology and mpMRI. Method We retrospectively analysed 235 patients who underwent radical prostatectomy between January 2015 and April 2017. All patients underwent pre-biopsy mpMRI scans and prostate biopsies. All mpMRIs were reported by dedicated uro-radiologists and all histology was reported by dedicated uro-pathologists. Results 17/25 patients showing EPE on mpMRI had it confirmed on final histology. a53/210 patients showing organ-confirmed disease on mpMRI had EPE on final histology. 40/49 patients who had Gleason 6 adenocarcinoma were organ-confined. 61/186 patients with &gt; Gleason 7 adenocarcinoma had EPE. Sensitivity of mpMRI was 25% with a specificity of 95%. The positive predictive value (PPV) was 68% and negative predictive value (NPV) was 75%. The specificity of pre-biopsy Gleason score &gt; 7 to predict EPE was 81% and sensitivity was 33% with a PPV of 87%. Conclusions Our data suggests that by using &gt; Gleason 7 and mpMRI as a combination, we can reliably predict EPE on final histology which in turn will help counsel patients appropriately for treatment options. Further data collection is ongoing at our institution.

Comparative Oncological Outcomes Following Radical Prostatectomy or External Beam Radiation Therapy Plus Androgen Deprivation Therapy in Men with Clinical T3b Prostate Cancer

Purpose To compare oncological outcomes in men with clinical T3b prostate cancer who underwent radical prostatectomy (RP) or a combination of radiation therapy plus androgen deprivation therapy (HT + RT).Materials and Methods Men with clinical T3b prostate cancer who underwent RP or HT + RT between 2007 and 2014 were evaluated. All patients were relatively healthy, with Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 without nodal or distant metastasis. Cancer-specific survival (CSS) was analyzed. Age, biopsy Gleason score, and initial prostate specific antigen (PSA) concentration were adjusted by propensity score matching. Cox proportional hazard model was used to assess factors prognostic of CSS.Results Of the 152 patients with clinical T3b prostate cancer, 45 underwent RP and 107 underwent HT + RT between 2007 and 2014. Mean CSS was significantly longer in the RP than in the HT + RT group (p = 0.029). Age, biopsy Gleason score, and pretreatment PSA concentration were significantly higher in the HT + RT group. In the propensity score matched population of 34 patients each, CSS remained significantly longer in the RP than in the HT + RT group (125.21 ± 5.10 months vs. 107.73 ± 9.01 months, p = 0.041). Multivariate analysis showed that undergoing HT + RT was the only significant poor prognostic factor for CSS (hazard ratio = 2.849; 95% confidence interval, 1.086–7.473, p = 0.033).Conclusion CSS was significantly longer in men with clinical T3b prostate cancer who underwent RP than HT + RT, suggesting that RP should be the initial treatment of choice for these patients.

Favorable intermediate risk prostate cancer with biopsy Gleason score of 6

Background To identify potential prognostic factors among patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6. Methods From 2003 to 2019, favorable intermediate risk patients who underwent radical prostatectomy were included in this study. All patients were evaluated preoperatively with MRI. Using PI-RADS scores, patients were divided into two groups, and clinic-pathological outcomes were compared. The impact of preoperative factors on significant pathologic Gleason score upgrading (≥ 4 + 3) and biochemical recurrence were assessed via multivariate analysis. Subgroup analysis was performed in patients with PI-RADS ≤ 2. Results Among the 239 patients, 116 (48.5%) were MRI-negative (PI-RADS ≤ 3) and 123 (51.5%) were MRI-positive (PI-RADS > 3). Six patients in the MRI-negative group (5.2%) were characterized as requiring significant pathologic Gleason score upgrading compared with 34 patients (27.6%) in the MRI-positive group (p < 0.001). PI-RADS score was shown to be a significant predictor of significant pathologic Gleason score upgrading (OR = 6.246, p < 0.001) and biochemical recurrence (HR = 2.595, p = 0.043). 10-years biochemical recurrence-free survival was estimated to be 84.4% and 72.6% in the MRI-negative and MRI-positive groups (p = 0.035). In the 79 patients with PI-RADS ≤ 2, tumor length in biopsy cores was identified as a significant predictor of pathologic Gleason score (OR = 11.336, p = 0.014). Conclusions Among the patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6, preoperative MRI was capable of predicting significant pathologic Gleason score upgrading and biochemical recurrence. Especially, the patients with PI-RADS ≤ 2 and low biopsy tumor length could be a potential candidate to active surveillance.

Testosterone recovery after androgen deprivation therapy in prostate cancer: building a predictive model

Purpose: To analyze variability, associated factors, and the design of nomograms for individualized testosterone recovery after androgen deprivation therapy (ADT) withdrawal.Methods: A longitudinal study was performed on 208 patients in 2003-2019 period. The castrate and normogonadic levels were defined as testosterone, 0.50 and 3.50 ng/ml respectively. Cumulative incidence curve describes testosterone recovery. A univariate and multivariate analysis was performed to predict testosterone recovery with the candidate prognostic factors: PSA at diagnosis, Clinical stage, biopsy Gleason score, age at cessation of ADT, duration of ADT, primary therapy for patients, and LHRH agonist. Results: The median follow­up of the study was 80 months, interquartile range (49,99). The 25% and 81% of patients did not recover the castrate and normogonadic level, respectively. Months of ADT and age at ADT withdrawal were significant predictors for testosterone recovery. We built two nomograms of testosterone estimation recovery at 12, 24, 36 and 60 months. The castration recovery model shows good calibration. The c-index was 0.677, with areas under the ROC­curve (AUC) of 0.74, 0.78, 0.78 and 0.78, at 12, 24, 36 and 60 months, respectively. The normogonadic recovery model had an overestimation of high probabilities. The c­index was 0.683, with AUC values of 0.81, 0.71, 0.71 and 0.70 at 12, 24, 36 and 60 months, respectively.Conclusion: Depending on the age of patients and time of treatment, clinicians can discontinue ADT to maintain castrate levels without treatment with enough confidence, or even recover testosterone to normogonadic levels in short courses of treatment with high probabilities.

Predictive Factors for Positive Surgical Margins in Patients With Prostate Cancer After Radical Prostatectomy: A Systematic Review and Meta-Analysis

Background and ObjectivesPrevious studies have demonstrated that positive surgical margins (PSMs) were independent predictive factors for biochemical and oncologic outcomes in patients with prostate cancer (PCa). This study aimed to conduct a meta-analysis to identify the predictive factors for PSMs after radical prostatectomy (RP).MethodsWe selected eligible studies via the electronic databases, such as PubMed, Web of Science, and EMBASE, from inception to December 2020. The risk factors for PSMs following RP were identified. The pooled estimates of standardized mean differences (SMDs)/odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A fixed effect or random effect was used to pool the estimates. Subgroup analyses were performed to explore the reasons for heterogeneity.ResultsTwenty-seven studies including 50,014 patients with PCa were eligible for further analysis. The results showed that PSMs were significantly associated with preoperative prostate-specific antigen (PSA) (pooled SMD = 0.37; 95% CI: 0.31–0.43; P &lt; 0.001), biopsy Gleason Score (&lt;6/≥7) (pooled OR = 1.53; 95% CI:1.31–1.79; P &lt; 0.001), pathological Gleason Score (&lt;6/≥7) (pooled OR = 2.49; 95% CI: 2.19–2.83; P &lt; 0.001), pathological stage (&lt;T2/≥T3) (pooled OR = 3.90; 95% CI: 3.18–4.79; P &lt; 0.001), positive lymph node (PLN) (pooled OR = 3.12; 95% CI: 2.28–4.27; P &lt; 0.001), extraprostatic extension (EPE) (pooled OR = 4.44; 95% CI: 3.25–6.09; P &lt; 0.001), and seminal vesicle invasion (SVI) (pooled OR = 4.19; 95% CI: 2,87–6.13; P &lt; 0.001). However, we found that age (pooled SMD = 0.01; 95% CI: −0.07–0.10; P = 0.735), body mass index (BMI) (pooled SMD = 0.12; 95% CI: −0.05–0.30; P = 0.162), prostate volume (pooled SMD = −0.28; 95% CI: −0.62–0.05; P = 0.097), and nerve sparing (pooled OR = 0.90; 95% CI: 0.71–1.14; P = 0.388) had no effect on PSMs after RP. Besides, the findings in this study were found to be reliable by our sensitivity and subgroup analyses.ConclusionsPreoperative PSA, biopsy Gleason Score, pathological Gleason Score, pathological stage, positive lymph node, extraprostatic extension, and seminal vesicle invasion are independent predictors of PSMs after RP. These results may helpful for risk stratification and individualized therapy in PCa patients.