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Background Although renal cell carcinoma (RCC) is believed to have a strong hereditary component, there is a paucity of published guidelines for genetic risk assessment. A panel of experts was convened to gauge current opinions. Methods A North American multidisciplinary panel with expertise in hereditary RCC, including urologists, medical oncologists, clinical geneticists, genetic counselors, and patient advocates, was convened. Before the summit, a modified Delphi methodology was used to generate, review, and curate a set of consensus questions regarding RCC genetic risk assessment. Uniform consensus was defined as ≥85% agreement on particular questions. Results Thirty-three panelists, including urologists (n = 13), medical oncologists (n = 12), genetic counselors and clinical geneticists (n = 6), and patient advocates (n = 2), reviewed 53 curated consensus questions. Uniform consensus was achieved on 30 statements in specific areas that addressed for whom, what, when, and how genetic testing should be performed. Topics of consensus included the family history criteria, which should trigger further assessment, the need for risk assessment in those with bilateral or multifocal disease and/or specific histology, the utility of multigene panel testing, and acceptance of clinician-based counseling and testing by those who have experience with hereditary RCC. Conclusions In the first ever consensus panel on RCC genetic risk assessment, 30 consensus statements were reached. Areas that require further research and discussion were also identified, with a second future meeting planned. This consensus statement may provide further guidance for clinicians when considering RCC genetic risk assessment. Lay summary The contribution of germline genetics to the development of renal cell carcinoma (RCC) has long been recognized. However, there is a paucity of guidelines to define how and when genetic risk assessment should be performed for patients with known or suspected hereditary RCC. Without guidelines, clinicians struggle to define who requires further evaluation, when risk assessment or testing should be done, which genes should be considered, and how counseling and/or testing should be performed. To this end, a multidisciplinary panel of national experts was convened to gauge current opinion on genetic risk assessment in RCC and to enumerate a set of recommendations to guide clinicians when evaluating individuals with suspected hereditary kidney cancer.

Objective To determine whether a combination of prostate cancer gene 3 (PCA3) and magnetic resonance imaging (MRI) suspicion score (mSS) could further optimize detection of prostate cancer on MRI fusion-targeted biopsy (MRF-TB) among men with no history of biopsy. Materials and Methods We included in this study 187 men presenting to our institution between June 2012 and August 2014 who underwent multiparametric MRI (mpMRI) and PCA3 before MRF-TB. Biopsy results, stratified by biopsy indication and PCA3 score, were recorded. Receiver operating characteristics curves and multivariable logistic regressions were used to model the association of PCA3 and mSS with cancer detection on MRF-TB. Results PCA3 is associated with cancer detection on MRF-TB for men with no prior biopsies (area under the curve: 0.67, 95% confidence interval: 0.59-0.76). Using a cutoff of ≥35, PCA3 was associated with cancer risk among men with mSS 2-3 ( P = .004), but not among those with mSS 4-5 ( P = .340). The interaction of PCA3 and mSS demonstrated significantly higher discrimination for cancer than mSS alone (area under the curve: 0.83 vs 0.79, P = .0434). Conclusion Urinary PCA3 is associated with mSS and the detection of cancer on MRF-TB for men with no prior biopsies. PCA3 notably demonstrates a high negative predictive value among mSS 2-3. However, in the case of high-suspicion mpMRI, PCA3 is not associated with cancer detection on MRF-TB, adding little to cancer diagnosis. Further studies are needed to evaluate the utility of PCA3 in predicting cancer among men with normal mpMRI.

Item does not contain fulltext OBJECTIVES: Recent advances have led to the use of magnetic resonance imaging (MRI) alone or with fusion to transrectal ultrasound (TRUS) images for guiding biopsy of the prostate. Our group sought to develop consensus recommendations regarding MRI-guided prostate biopsy based on currently available literature and expert opinion. METHODS: The published literature on the subject of MRI-guided prostate biopsy was reviewed using standard search terms and synthesized and analyzed by four different subgroups from among the authors. The literature was grouped into four categories-MRI-guided biopsy platforms, robotic MRI-TRUS fusion biopsy, template mapping biopsy and transrectal MRI-TRUS fusion biopsy. Consensus recommendations were developed using the Oxford Center for Evidence Based Medicine criteria. RESULTS: There is limited high level evidence available on the subject of MRI-guided prostate biopsy. MRI guidance with or without TRUS fusion can lead to fewer unnecessary biopsies, help identify high-risk (Gleason >/= 3 + 4) cancers that might have been missed on standard TRUS biopsy and identify cancers in the anterior prostate. There is no apparent significant difference between MRI biopsy platforms. Template mapping biopsy is perhaps the most accurate method of assessing volume and grade of tumor but is accompanied by higher incidence of side effects compared to TRUS biopsy. CONCLUSIONS: Magnetic resonance imaging-guided biopsies are feasible and better than traditional ultrasound-guided biopsies for detecting high-risk prostate cancer and anterior lesions. Judicious use of MRI-guided biopsy could enhance diagnosis of clinically significant prostate cancer while limiting diagnosis of insignificant cancer.

Objectives To evaluate the cancer detection rates for men undergoing 12-core systematic prostate biopsy with negative prebiopsy multiparametric magnetic resonance imaging (mpMRI) results. Materials and Methods Clinical data from consecutive men undergoing prostate biopsy who had undergone prebiopsy 3T mpMRI from December 2011 to August 2014 were reviewed from an institutional review board-approved prospective database. Men with negative prebiospy mpMRI results (negMRI) before biopsy were identified for the present analysis. Clinical features, cancer detection rates and negative predictive values were summarized. Results Seventy five men with negMRI underwent systematic 12-core biopsy during the study period. In the entire cohort, men with no previous biopsy, men with previously negative biopsy and men enrolled in active surveillance protocols, the overall cancer detection rates were 18.7, 13.8, 8.0 and 38.1%, respectively, and the detection rates for Gleason score (GS) ≥7 cancer were 1.3, 0, 4.0 and 0%, respectively. The NPVs for all cancers were 81.3, 86.2, 92.0, and 61.9, and for GS ≥7 cancer they were 98.7, 100, 96.0 and 100%, respectively. Conclusions A negative prebiopsy mpMRI confers an overall NPV of 82% on 12-core biopsy for all cancer and 98% for GS ≥7 cancer. Based on biopsy indication, these findings assist in prebiopsy risk stratification for detection of high-risk disease and may provide guidance in the decision to pursue biopsy.

MRF-TB (magnetic resonance imaging-ultrasound fusion targeted prostate biopsy) may improve the detection of prostate cancer in men presenting for prostate biopsy. We report clinical outcomes of 12-core systematic biopsy and MRF-TB in men who presented for primary biopsy and further describe pathological characteristics of cancers detected by systematic biopsy and not by MRF-TB.Clinical outcomes of 452 consecutive men who underwent prebiopsy multiparametric magnetic resonance imaging followed by MRF-TB and systematic biopsy at our institution between June 2012 and June 2015 were captured in an institutional review board approved database. Clinical characteristics, biopsy results and magnetic resonance imaging suspicion scores were queried from the database.Prostate cancer was detected in 207 of 382 men (54.2%) with a mean±SD age of 64±8.5 years and mean±SEM prostate specific antigen 6.8±0.3 ng/ml who met study inclusion criteria. The cancer detection rate of systematic biopsy and MRF-TB was 49.2% and 43.5%, respectively (p=0.006). MRF-TB detected more Gleason score 7 or greater cancers than systematic biopsy (117 of 132 or 88.6% vs 102 of 132 or 77.3%, p=0.037). Of 41 cancers detected by systematic biopsy but not by MRF-TB 34 (82.9%) demonstrated Gleason 6 disease, and 26 (63.4%) and 34 (82.9%) were clinically insignificant by Epstein criteria and a UCSF CAPRA (University of California-San Francisco-Cancer of the Prostate Risk Assessment) score of 2 or less, respectively.In men presenting for primary prostate biopsy MRF-TB detects more high grade cancers than systematic biopsy. Most cancers detected by systematic biopsy and not by MRF-TB are at clinically low risk. Prebiopsy magnetic resonance imaging followed by MRF-TB decreases the detection of low risk cancers while significantly improving the detection and risk stratification of high grade disease.

Objective To report outcomes of magnetic resonance imaging (MRI)-ultrasound fusion–targeted biopsy (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy. Materials and Methods Between June 2012 and August 2014, 210 men presenting to our institution for prostate biopsy with ≥1 prior negative biopsy underwent multiparametric MRI followed by MRF-TB and SB and were entered into a prospective database. Clinical characteristics, maximum mpMRI suspicion scores (mSS), and biopsy results were queried from the database, and the detection rates of Gleason ≥7 prostate cancer (PCa) and overall PCa were compared between biopsy techniques using McNemar's test. Results Forty seven (29%) of 161 men meeting inclusion criteria (mean age, 65 ± 8 years; mean prostate-specific antigen, 8.9 ± 8.9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDRs) of 21.7% and 18.6% (P = .36), respectively, and CDR for Gleason score (GS) ≥7 disease of 14.9% and 9.3% (P = .02), respectively. Of 26 men with GS ≥7 disease, MRF-TB detected 24 (92.3%) whereas SB detected 15 (57.7%; P < .01). Using UCSF-CAPRA criteria, only 1 man was restratified from low risk to higher risk based on SB results compared to MRF-TB alone. Among men with mSS

Three Tesla multiparametric magnetic resonance imaging with PI-RADS™ (Prostate Imaging Reporting and Data System) version 2 scoring is a common tool in prostate cancer diagnosis which informs the likelihood of a cancerous lesion. We investigated whether PI-RADS version 2 also predicts adverse pathology features mainly in patients with biopsy Gleason score 3 + 4 disease.We reviewed the records of 326 consecutive men with a preoperative template and/or magnetic resonance imaging-ultrasound fusion biopsy Gleason score of 6-7 from a prospectively maintained database of men who underwent robotic radical prostatectomy. The primary analysis was done in patients with biopsy Gleason score 3 + 4 to assess the primary outcome of adverse pathology features on univariate and multivariate logistic regression. The secondary outcome was biochemical recurrence-free survival using the Kaplan-Meier method. Similar analysis was done in patients with a biopsy Gleason score of 6-7.Of men with Gleason score 3 + 4 findings 27%, 15%, 36% and 23% showed a PI-RADS version 2 score of 0-2, 3, 4 and 5, respectively. On univariate analysis PI-RADS version 2 category 5 predicted adverse pathology features vs categories 0-2 (OR 10.7, 95% CI 3.7-31, p ≤0.001). On multivariate analysis the PI-RADS version 2 category 5 was associated with adverse pathology when adjusting for preoperative magnetic resonance imaging targeted biopsy (OR 11.4, 95% CI 3.7-35, p ≤0.0001). In men with a targeted biopsy Gleason score of 3 + 4 prostate cancer PI-RADS version 2 category 5 was associated with adverse pathology (OR 14.7, 95% CI 1.5-146.9, p = 0.02). Of men with biopsy Gleason score 3 + 4 disease 92% and 58% with a PI-RADS version 2 score of 4 and 5, respectively, had 2-year biochemical recurrence-free survival.A PI-RADS version 2 category 5 lesion in patients with a biopsy Gleason score 3 + 4 lesion predicted adverse pathology features and biochemical recurrence-free survival. These findings suggest that preoperative 3 Tesla multiparametric magnetic resonance imaging may serve as a prognostic marker of treatment outcomes independently of biopsy Gleason score or biopsy type.

The objectives of this study were to 1) describe the patterns of repeat prostate biopsy in men with a previous negative biopsy and 2) identify predictors of prostate cancer diagnosis on repeat biopsy in these men.From a university faculty group practice we identified 1,837 men who underwent prostate biopsy between January 1, 1995 and January 1, 2010. Characteristics of repeat biopsy were examined, including the indication for biopsy, the number of repeat biopsies performed, the number of cores obtained and total prostate specific antigen before biopsy. Features of prostate cancer diagnosed on repeat biopsy were examined, including Gleason score, number of positive cores, percent of tumor and treatment choice. Multivariable logistic regression was done to identify prostate cancer predictors.Initial biopsy was negative in 1,213 men. In 255 men a total of 798 repeat biopsies were performed. Of the 63 men diagnosed with prostate cancer Gleason score was 6 or less in 33 (52%), 7 in 22 (35%) and 8-9 in 8 (13%). When categorized by Epstein criteria, the rate of clinically insignificant cancer diagnosis decreased substantially by the third and fourth repeat biopsies. Repeat biopsy in men older than 70 years, biopsies including more than 20 cores and the fourth repeat biopsy were associated with an increased likelihood of prostate cancer diagnosis.In men selected for multiple repeat biopsies clinically significant cancer is found at each sampling round. Given the continued likelihood of cancer detection even by the fifth biopsy, early consideration of saturation or image guided biopsy may be warranted in the repeat biopsy population.

INTRODUCTION AND OBJECTIVES: Mounting evidence suggests that MRI-ultrasound fusion-targeted prostate biopsy (MRFTB) may provide clinical benefit for men with suspicion of prostate cancer. We investigated outcomes of MRF-TB over time to evaluate how the performance characteristics vary with increasing operator experience. METHODS: Between June 2012 and April 2015, 566 men underwent MRF-TB by a single surgeon. A total of 429 men with no prior prostate cancer therapy had pre-biopsy multiparametric MRI (mpMRI) performed at our institution and reviewed by a single radiologist. During this time period, quality assurance efforts included team review of MRI interpretation, biopsy maps and outcome, and discussion of discrepant cases or unexpected pathology findings. We evaluated the cancer detection rates (CDR) among men with high mpMRI suspicion scores (mSS) as a function of operator experience. Trend was assessed using the Cochrane-Armitage test, and characteristics between groups were compared by chi-square or one-way ANOVA. RESULTS: All subjects were grouped according to the order of biopsy (1-60, 61-120, 121-180, 181-240, 241-300, 301-360, 361-429). Among groups, there was no difference in serum PSA (p 1⁄4 0.131) or mSS distribution (p 1⁄4 0.957). Cancer detection among men with mSS 4 or 5 demonstrated a significant, increasing trend as a function of biopsy experience, with CDRs of 63.0%, 69.6%, 77.8%, 68.2%, 88.0%, 84.0%, and 85.7% for groups 1-7, respectively (p 1⁄4 0.014). The CDR among men with mSS 2 or 3 did not demonstrate a trend (p 1⁄4 0.386) (Figure 1). CONCLUSIONS: Among men undergoing pre-biopsy mpMRI followed by MRF-TB, the rate of cancer detection appears to increase as a function of biopsy experience for men with high mpMRI suspicion (mSS 4-5), while little to no change is noted in men at lower suspicion (mSS 2-3). Improved outcomes over time may, in part, reflect evolution of MRI technique and interpretation, but these results additionally suggest that operator experience in the conduct of MRF-TB may play a significant role in optimizing cancer detection. Source of Funding: The Joseph and Diane Steinberg Charitable Trust

INTRODUCTION AND OBJECTIVES: MRI-targeted prostate biopsy (PB) is increasingly being utilized to aid cancer diagnosis in clinical practice. Our objective was to develop a nomogram to predict the probability of Gleason score 7 prostate cancer (CaP) on MRI targeted and systematic prostate biopsy in men with no previous biopsy. METHODS: From June 2012 to June 2015, MR-US fusion targeted prostate biopsy was performed on approximately 1,140 men with suspicious regions identified on pre-biopsy 3T multiparametric-MRI along with systematic 12 core biopsy, utilizing the ProFuse|Artemis system. Logistic regression modeling was used to evaluate predictors of Gleason score 7 CaP, and corresponding nomograms were generated. Models were created with a randomly selected training sample (n1⁄4232), tested (n1⁄459), and then validated (n1⁄498). Bias-corrected using bootstrap resampling, and Akaike information criterion was used to select best-fit models. RESULTS: A total of 389 men with no previous biopsy and complete records were included for analysis (median age 66 years, PSA 4.8 ng/ml, prostate volume 46 cc, PSA density 0.09 ng/ml-cc). Statistically significant independent positive predictors of CaP on targeted and systematic PB were found to be PSA density, age, and MRI suspicion score (MRIss). A CaP probability nomogram (Figure 1) was generated using the predictors and model performance characteristics bias-corrected areas under the receiver-operating characteristic curves (AUC) were validated (Figure 2). CONCLUSIONS: PSA density, age, and MRI suspicion score predict CaP on MRI-targeted and systematic biopsy. Our CaP probability nomogram may allow further individualization of the decision to perform PB in men with clinical suspicion of prostate cancer and no previous biopsy. Source of Funding: None

Advances in multiparametric magnetic resonance imaging (mpMRI) hold promise for the improved detection and characterization of prostate cancer. MpMRI combines diffusion-weighted imaging, dynamic contrast-enhanced sequences, or spectroscopy with conventional T2-weighted sequences. With a combination of anatomic and functional imaging sequences to identify suspicious regions in the prostate, pre-biopsy mpMRI has the potential to improve prostate cancer detection and risk stratification through MRI-targeted biopsy. In this chapter we review the role of mpMRI in prostate cancer detection, the outcomes of MRI-targeted biopsy, and the critical concepts currently under evaluation in validation of an MRI-based prostate cancer risk stratification strategy.

Introduction Multiparametric-MRI (mp-MRI) is an evolving noninvasive imaging modality that increases the accurate localization of prostate cancer at the time of MRI targeted biopsy, thereby enhancing clinical risk assessment, and improving the ability to appropriately counsel patients regarding therapy. Material and methods We used MEDLINE/PubMed to conduct a comprehensive search of the English medical literature. Articles were reviewed, data was extracted, analyzed, and summarized. In this review, we discuss the mp-MRI prostate exam, its role in targeted prostate biopsy, along with clinical applications and outcomes of MRI targeted biopsies. Results Mp-MRI, consisting of T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and possibly MR spectroscopy, has demonstrated improved specificity in prostate cancer detection as compared to conventional T2-weighted images alone. An MRI suspicion score has been developed and is depicted using an institutional Likert or, more recently, a standardized reporting scale (PI-RADS). Techniques of MRI-targeted biopsy include in-gantry MRI guided biopsy, TRUS-guided visual estimation biopsy, and software co-registered MRI-US guided biopsy (MRI-US fusion). Among men with no previous biopsy, MRI-US fusion biopsy demonstrates up to a 20% increase in detection of clinically significant cancers compared to systematic biopsy while avoiding a significant portion of low risk disease. These data suggest a potential role in reducing over-detection and, ultimately, over-treatment. Among men with previous negative biopsy, 72–87% of cancers detected by MRI targeted biopsy are clinically significant. Among men with known low risk cancer, repeat biopsy by MR-targeting improves risk stratification in selecting men appropriate for active surveillance secondarily reducing the need for repetitive biopsy during surveillance. Conclusions Use of mp-MRI for targeting prostate biopsies has the potential to reduce the sampling error associated with conventional biopsy by providing better disease localization and sampling. MRI-ultrasound fusion-targeted prostate biopsy may improve the identification of clinically significant prostate cancer while limiting detection of indolent disease, ultimately facilitating more accurate risk stratification. Literature supports the clinical applications of MRI-targeted biopsy in men who have never been biopsied before, those with a prior negative biopsy, and those with low risk disease considering active surveillance.

Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB).To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI.Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included.All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB.Detection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test.MRF-TB detected fewer GS 6 PCas (75 vs 121; p0.001) and more GS ≥7 PCas (158 vs 117; p0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population.MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted.We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.

INTRODUCTION AND OBJECTIVES: While PCA3 has been shown to be predictive of prostate cancer (CaP) detection in the setting of systematic biopsy (SB), performance in the setting of targeted MRI-ultrasound fusion biopsy (MRF-TB) is not well described. METHODS: Biopsy results in all men undergoing both SB and MRF-TB, using the Artemis/Pro fuse system, between June 2012 and June 2014 were reviewed. PCA3 scores, highest MRI suspicion score (mSS), and cancer detection rates were extracted from 143 patients without a previous cancer diagnosis. Receiver operating characteristics (ROC) were analyzed to determine the performance of PCA3 in predicting cancer on MRF-TB at varying thresholds. In bivariable analyses, the association between elevated PCA3 and MRF-TB findings were analyzed. The predictive capability of PCA3þmSS was compared to that of mSS alone by fitting multivariable logistic regression models and comparing ROC and areas under the curve (AUC). RESULTS: Table 1 summarizes the predictive capability for Gleason 3þ3 or higher disease on MRF-TB, stratified by threshold. In bivariable analyses using a threshold of 35, a greater proportion of those with a high PCA3 demonstrated cancer on MRF-TB than those with a low PCA3 (46.8% vs. 18.8%, p < 0.001). Similarly, patients with a high PCA3 and mSS 3 were more likely to have cancer on MRF-TB than those with a low PCA3 and mSS 3 (48.8% vs. 26.7%, p 1⁄4 0.004). In multivariable analyses, a logistic regression model containing both PCA3 and mSS was associated with significantly higher discrimination of cancer on MRF-TB compared to a model of mSS alone (AUC 0.786 vs. 0.741, p 1⁄4 0.038). Potential study cohort outcomes by threshold are detailed in Table 2 CONCLUSIONS: The predictive capability of PCA3 for prostate cancer is retained in the setting of MRF-TB. Addition of PCA3 to mSS would improve the overall diagnostic accuracy of MRF-TB, but further work is needed to determine the impact of PCA3 at individual thresholds.

INTRODUCTION AND OBJECTIVES: The aim of the study was to compare partial cystectomy (PC) and radical cystectomy (RC) with respect to 90-day mortality as well as long-term, all cause (ACM) and cancer specific mortality (CSM). METHODS: Using the SEER-Medicare database 3913 patients with T2-T3 urothelial carcinoma of the urinary bladder (UCUB) who underwent either RC (n1⁄43419) or PC (n1⁄4494) were identified. After propensity score matching to reduce potential treatment selection bias, 90day mortality, ACM-free and CSM-free rates between patients treated with PC and RC were estimated. Multivariable regression models (MVA) addressed 90-day mortality as well as 5-years ACM and CSM. RESULTS: After matching, 33% (n1⁄4494) and 67% (n1⁄4988) patients treated respectively with PC or RC remained. Median follow-up was 26months. The 90-daymortality rate was 3.2% (n1⁄416) after PC and 8.1% (n1⁄480) after RC (p1⁄40.001). In MVA, PC vs. RC was associated with a lower 90-day mortality (p

INTRODUCTION AND OBJECTIVES: Multi-parametric MRI (mpMRI) suspicion scores (mSS) can help predict the likelihood of prostate cancer (PCa) on prostate biopsy (PB). In combination with MRI fusion targeted biopsy (MRF-TB), mSS has the potential to reduce over-detection of indolent PCa through avoidance of low risk biopsies. In this study we report the relationship of mSS and PB outcomes among men undergoing systematic biopsy (SB) and MRF-TB following mpMRI. METHODS: Between 6/2012 and 8/2014, all 824 men presenting to our institution for prostate biopsy underwent pre-biopsy mpMRI followed by PB. Outcomes were recorded in an IRB-approved database. For this analysis, biopsy results and mSS were queried from those who underwent both SB and MRF-TB using the Artemis/Profuse (Eigen, Grass Valley) co-registration system. RESULTS: 604 men (mean age 65 8 years; BMI 27.1 4.3; PSA 6.7 7.2 ng/ml) met inclusion criteria. Overall, increasing mSS correlates with a step-wise increase in detection of GS 7 PCa with both SB [r1⁄4.95] and MRF-TB [r1⁄40.95]. This finding is not seen in GS6 PCa detection with either SB [r1⁄4-0.10] or MRF-TB [r1⁄4-0.23] (See figure 1). For mSS 4/5, MRF-TB detected fewer GS6 PCa [p1⁄40.013] and detected more GS 7 PCa [p1⁄40.001] as compared to SB. When evaluating the cohort by PB indication, for mSS 4/5, FB detected less GS6 PCa than SB only in biopsy naive men [p1⁄40.021], but was similar to SB in men with prior negative PB [p1⁄40.628] or on active surveillance [p1⁄40.114]. However, FB detected more GS 7 PCa compared to SB in all three cohorts with mSS 4/5 [p

INTRODUCTION AND OBJECTIVES: MR-US fusion biopsy (MR-US-FB) represents a potentially useful tool to assess for PCa progression in patients on active surveillance (AS). It is unknown whether MR-US-FB is superior to TRUS saturation biopsy to accurately characterize disease reclassification. We analyzed our initial experience with MR-US-FB compared with TRUS saturation biopsy in patients on AS. METHODS: 90 patients undergoing surveillance biopsy were analyzed. 35 patients with previously diagnosed PCa on active surveillance underwent MR-US-FB (UroNav, Invivo) with standard 12-core TRUS biopsy in same procedure from 7/2014-10/2014. Patients first had multiparametric prostate MRI (3T without endorectal coil) and target lesions of interest (LOI) for biopsy were marked. Median number of LOI/ patient was 2. Median number of cores per LOI was 3. These patients were compared to a cohort of 55 patients from 2011-2013 undergoing saturation ( 20 cores) TRUS biopsy as part of an active surveillance protocol. RESULTS: Overall, there was no difference between groups in cancer detection or reclassification (p>0.05). Results summarized in table below. The mean total number of cores was higher with saturation biopsy vs. MR-US-FB (20 1.5 vs. 18 5.4, p

confirmatory biopsy. If so, confirmatory biopsy might be avoided for men at low risk of reclassification. METHODS: Our cohort included 444 patients who qualified for AS on initial findings from December 2007 to December 2013 and who received both an MRI and a confirmatory biopsy. We used logistic regression to assess whether the MRI result (no focal/dominant lesion vs focal/dominant lesion) and proportion of positive cores at initial biopsy could predict high-grade cancer (Gleason 7) on confirmatory biopsy. We also performed decision curve analyses to assess if either of the logistic regression models would be clinically helpful. We assessed the decision curve analysis up to a threshold probability of 15% for high-grade cancer, which we considered the highest threshold for which a physician would forgo a confirmatory biopsy. RESULTS: The median age was 62 years (IQR 56, 67) and 48% of patients were found to have a dominant or focal lesion on MRI. About 1 in 8 patients were found to have high-grade cancer on confirmatory biopsy, of whom 50 had 3þ4, 6 had 4þ3, 3 had Gleason 8 and 1 patient had Gleason 9 disease. MRI results and proportion of positive biopsy cores were significantly associated with high-grade cancer on confirmatory biopsy on both univariate and multivariable logistic regression (all p

We present a novel method for the joint segmentation of anatomical and functional images. Our proposed methodology unifies the domains of anatomical and functional images, represents them in a product lattice, and performs simultaneous delineation of regions based on random walk image segmentation. Furthermore, we also propose a simple yet effective object/background seed localization method to make the proposed segmentation process fully automatic. Our study uses PET, PET-CT, MRI-PET, and fused MRI-PET-CT scans (77 studies in all) from 56 patients who had various lesions in different body regions. We validated the effectiveness of the proposed method on different PET phantoms as well as on clinical images with respect to the ground truth segmentation provided by clinicians. Experimental results indicate that the presented method is superior to threshold and Bayesian methods commonly used in PET image segmentation, is more accurate and robust compared to the other PET-CT segmentation methods recently published in the literature, and also it is general in the sense of simultaneously segmenting multiple scans in real-time with high accuracy needed in routine clinical use.