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Purpose: Our aim was to evaluate whether transperineal (TP) MRI-targeted prostate biopsy (TBx) may improve the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology 2, in comparison to transrectal (TR) TBx. Materials and Methods: A multicenter retrospective cohort study comprising patients who underwent MRIguided prostate biopsy was conducted. To address possible benefits of TP-TBx in the detection of prostate cancer (PCa) and csPCa, a cohort of patients undergoing TP-TBx were compared to patients undergoing TRTBx. Multivariable logistic regression analyses were performed to assess predictors of PCa and csPCa detection. Results: Overall, 1,936 and 3,305 patients who underwent TR-TBx vs TP-TBx at 10 referral centers were enrolled. The rate of PCa and csPCa diagnosed was higher for TP-TBx vs TR-TBx (64.0% vs 50%, p <0.01 and 49% vs 35%, p <0.01). At multivariable analysis adjusted for age, biopsy na€ıve/repeated biopsy, cT stage, Prostate ImagingeReporting and Data System, prostate volume, PSA, and number of biopsy cores targeted, TP-TBx was an independent predictor of PCa (odds ratio [OR] 1.37, 95% CI 1.08e1.72) and csPCa (1.19, 95% CI 1.12e1.50). When considering the approach according to the site of the index lesion, TP-TBx had a significantly higher likelihood than TR-TBx to detect csPCa in the apex (OR 4.81, 95% CI 1.03e6.27), transition/central zone (OR 2.67, 95% CI 1.42e5.00), and anterior zone (OR 5.62, 95% CI 1.74e8.13). Conclusions: The use of TP-TBx allows a better cancer grade definition and PCa risk assessment. This has important implication in the decision-making process and in patient counseling for further therapies. [ABSTRACT FROM AUTHOR]

Purpose: Robot-assisted radical prostatectomy (RARP) is associated with poorer postoperative urinary continence in older men. However, published studies reporting conflicting results have design limitations with insufficient data at the extremes of age. The purpose of this study was to assess the effect of age on post-RARP urinary continence. Materials and Methods: This study included 5,648 patients from 2 prospective Australian databases who underwent a primary RARP for prostate cancer between 2008 and 2019. Significant urinary bother and pad-usage were evaluated 12 months post-RARP by EPIC-26 (Expanded Prostate Cancer Index Composite) questionnaires, independently collected by third parties. Multivariable logistic regression was used to investigate the relationship between continence and age. Results: Percentages of significant bother increased with age: 4.2%, 6.8% 9.1% and 12.9% at age groups <55, 55-64, 65e74 and -75 years, respectively. Compared with men aged 65-69 years, the odds of significant bother in patients <55 years was significantly lower (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.32e0.75, p[0.001). Corresponding OR found no significant difference in bother in patients -70 (OR 1.24, 95% CI 0.94e1.63, p[0.13) or -75 years (OR 1.41, 95% CI 0.88e2.25, p[0.16). Pad-free rates markedly decreased with age: 86%, 79%, 68% and 50% at ages, <55, 55-64, 65e74 and -75 years, respectively. Corresponding social continence (0e1 pads/day) rates also decreased with age: 98%, 96%, 92% and 85%. Conclusions: Urinary bother and pad-usage post-RARP are excellent in young men but worsen with age. Older patients were only slightly more likely to be "significantly bothered" by incontinence despite higher pad-usage. [ABSTRACT FROM AUTHOR]

Purpose: Accurate risk stratification remains a barrier for the safety of active surveillance in patients with intermediate-risk prostate cancer. [68Ga]Ga-PSMA-11 prostate-specific membrane antigen positron emission tomography/computerized tomography (68Ga-PSMA PET/CT) and the maximum standardized uptake value (SUVmax) may improve risk stratification within this population. Materials and Methods: We reviewed men with International Society for Urological Pathology Grade Group (GG) 2e3 disease on transperineal template biopsy undergoing 68Ga-PSMA PET/CT from November 2015 to January 2021. Primary outcome was the presence of high percentage Gleason pattern 4 (GP4) disease per segment at surgery at 3 thresholds: >/<50% GP4, >/<20% GP4, and >/<10% GP4. SUVmax was compared by GP4, and multivariable logistic regression examined the relationship between SUVmax and GP4. Secondary outcome was association between SUVmax and pathological upgrading (GG 1/2 to GG 3 from biopsy to surgery). Results: Of 220 men who underwent biopsy, 135 men underwent surgery. SUVmax was higher in high GP4 groups: 5.51 (IQR 4.19e8.49) vs 3.31 (2.64e4.41) >/<50% GP4 (p <0.001); 4.77 (3.31e7.00) vs 3.13 (2.64e4.41) >/<20% GP4 (p <0.001); and 4.54 (6.10e3.13) vs 3.03 (2.45e3.70) >/<10% GP4 (p <0.001). SUVmax remained an independent predictor of >50% (OR[1.39 [95%CI 1.18e1.65], p <0.001) and >20% (OR[1.24 [1.04e1.47], p[0.015) GP4 disease per-segment, and of pathological upgrading (OR[1.22 [1.01e1.48], p[0.036). SUVmax threshold 4.5 predicted >20% GP4 with 58% specificity, 85% sensitivity, positive predictive value 75% and negative predictive value 72%. Threshold 5.4 predicted pathological upgrading with 91% specificity and negative predictive value 94%. Conclusions: SUVmax on 68Ga-PSMA PET/CT is associated with GP4. SUVmax may improve risk stratification for men with intermediate-risk prostate cancer. [ABSTRACT FROM AUTHOR]