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Objectives: To evaluate the clinicopathological differences between Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2) category 1 and 2 groups. Materials and Methods . We retrospectively reviewed our two institutional clinical databases: (1) transrectal ultrasound (TRUS)/magnetic resonance imaging (MRI) fusion biopsy cohort ( n = 706) and (2) radical prostatectomy (RP) cohort ( n = 1403). Subsequently, we performed comparative analyses between PI-RADSv2 category 1 and 2 groups. Clinically significant prostate cancer (csPCa) was defined as the presence of Gleason score (GS) ≥ 3 + 4 in a single biopsy core, and adverse pathology (AP) was defined as high-grade (primary Gleason pattern 4 or any pattern 5) and/or non-organ-confined disease (pT3/N1). We also performed multivariate logistic regression analyses for AP., Results: In the TRUS/MRI fusion biopsy cohort, no significant differences in detection rates of all cancer (18.2% vs. 29.0%, respectively, P = 0.730) or csPCa (9.1% vs. 9.9%, respectively, P = 0.692) were observed between PI-RADSv2 category 1 and 2 groups. There were no significant differences in pathologic outcomes including Gleason score (≥4 + 3, 21.2% vs. 29.9%, respectively, P = 0.420) or detection rate of AP (27.3% vs. 33.8%, respectively, P = 0.561) between the two groups in the RP cohort either. PI-RADSv2 category 1 or 2 had no significant association with AP, even in univariate analysis ( P = 0.299)., Conclusions: PI-RADSv2 categories 1 and 2 had similar performance to predict clinicopathological outcomes. Consequently, these two categories may be unified into a single category. Negative mpMRI does not guarantee the absence of AP, as with csPCa., Competing Interests: All the authors had no conflicts of interest in this study., (Copyright © 2020 Jung Kwon Kim et al.)

Objectives: To validate how established markers of extraprostatic extension (EPE) are applied to anterior prostate cancers (APCs), and to investigate other novel markers if available., Methods: Among 614 histopathologically confirmed APCs from 2011 to 2016, 221 lesions with PiRADS (verion 2) scores ≥ 4 on 3-T multi-parametric MRI were analyzed retrospectively. Two radiologists independently assessed capsular morphology qualitatively with 5-point scale (normal, thinning, bulging, loss, extracapsular disease), and capsule contact length (arc), tumor dimension, and their ratio (arc-dimension ratio) quantitatively. Reproducibility in measurement was assessed with κ and intra-class correlation coefficients (ICCs). Logistic regression analysis was done to find meaningful indicators of EPE. Diagnostic performance of markers was compared to one another with generalized linear model and multi-reader multi-case ROC analysis., Results: Reproducibility was moderate to substantial (κ 0.45-0.73) for qualitative, and moderate to almost perfect (ICC 0.50-0.87) for quantitative features of EPE. Capsular morphology (odds ratio [OR] 1.818), capsule contact length (OR 1.115), tumor dimension (OR 1.035), and arc-dimension ratio (OR 1.846) were independently associated with EPE (p ≤ 0.019). Capsular bulging and capsule contact length of 10 mm as thresholds of EPE demonstrated sensitivity/specificity of 0.58/0.85 and 0.77/0.68, respectively. Capsule contact length yielded greatest AUC (0.784), followed by capsular morphology (0.778), arc-dimension ratio (0.749), and tumor dimension (0.741). Diagnostic performance of capsular morphology, capsule contact length, and arc-dimension ratio was comparable in predicting EPE., Conclusions: Existing markers of EPE applicable regardless of locations of tumors apply similarly to APCs. Arc-dimension ratio may be a novel marker of EPE of APCs., Key Points: • Existing imaging markers of extraprostatic extension (EPE) which have been applied regardless of locations of tumors are reflected similarly to anterior prostate cancers (APCs). • Measuring tumor dimension without capsular assessment may result in insufficient pre-operative prediction of EPE of APCs. • Arc-dimension ratio (capsule contact length divided by tumor dimension) exhibited highest OR and comparable performance to existing features in predicting EPE of APCs.

Purpose: To evaluate the characteristics and histological outcomes in patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions undergoing magnetic resonance imaging-guided fusion-targeted biopsy (MRIFTB)., Methods: We retrospectively reviewed 138 patients with PI-RADS category 3 lesions classified using multiparametric MRI who underwent MRIFTB between May 2016 and March 2018. The study population included biopsy-naïve and patients with prior negative biopsy. Univariate and multivariate analyzes were performed to determine significant predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The definition of csPCa was set at Gleason score ≥ 3 + 4., Results: Overall, 114 (82.6%) biopsied lesions were benign and 24 (17.4%) were identified as prostate cancer. Of these 24 lesions, 14 (58.3%) harbored csPCa. Peripheral zone (PZ) lesions were more likely to be associated with malignant disease than transition zone lesions (13.7 vs. 6.2%). Multivariate logistic analysis revealed that age, PZ location, and prostate-specific antigen (PSA) density (P < 0.05) were independent predictors of both PCa and csPCa., Conclusions: A non-negligible number of PI-RADS 3 patients harbor csPCa. Moreover, age, lesion location, and PSA density could be potential clinical predictors of PCa and csPCa. Physicians should be aware of the cancer prevalence of PI-RADS 3 lesions, as the use of the aforementioned factors can help in the decision-making process for these patients.

Background: To evaluate the effectiveness of an antibiotic regimen for prostate biopsy by analyzing patients who were hospitalized because of complications after transrectal ultrasound-guided prostate biopsy., Methods: We reviewed retrospectively the medical records of 10,339 patients who underwent transrectal ultrasound-guided prostate biopsy at our institution from May 2003 to April 2017. We excluded patients with low quality data. All patients underwent urine culture before transrectal ultrasound-guided prostate biopsy and received intravenous antibiotic agents 30-60 minutes before biopsy. Patients were either given prophylactic quinolone or cephalosporin (second or third generation). Clinicopathologic factors including patient age, antibiotic regimen, number of biopsy cores, body mass index, prostate specific antigen, prostate volume, and infection-related complications that required hospitalization were subsequently analyzed., Results: A total of 9,487 patients were included in the final analysis, of whom 33 patients (0.35%) were hospitalized because of infection-related complications. Infection-related hospitalization rates were lower in patients who received cephalosporin (0.2%) than in patients who received quinolone (1.59%). At our institution, cephalosporin has been used predominantly to prevent post-biopsy infections since February 2013. Only five patients (0.12%) developed infection-related complications of the 3,863 patient who underwent transrectal ultrasound-guided prostate biopsy since February 2013. Multivariable analysis revealed that use of second- or third-generation cephalosporin was the only independent predictor of infection-related complications., Conclusion: Implementing an effective antibiotic prophylaxis regimen at our institution by using second- or third-generation cephalosporin could reduce infection-related complications after transrectal ultrasound-guided prostate biopsy.

Objectives: Diffusion-weighted imaging (DWI) has been shown to be an important component of multiparametric magnetic resonance imaging (mpMRI). We compared performance of DWI for detection of prostate cancer (PCa) in peripheral zone (PZ) and transition zone (TZ) of prostate., Materials and Methods: We reviewed data of 460 subjects who underwent preoperative 3.0-Tesla mpMRI and subsequently radical prostatectomy. Level of suspicion for PCa was graded using 5-grade Likert-scale from DWI. Topographic analyses were performed for location of tumor foci at each surgical specimen. Among those with DWI grade ≥ III, we analyzed concordance rate on the location of radiologic and pathologic index lesions between DWI and surgical specimens., Results: Among 460 patients, 351 (76.3%) patients showed suspicious DWI lesions (57.5% in PZ, 42.5% in TZ). Multivariates regression analyses revealed significant associations between high DWI grade and adverse pathologic outcomes including pathologic stage, Gleason score, tumor volume and extracapsular extension (all p < 0.05). Overall concordance rates between DWI and surgical specimen were 75.8%, significantly higher in PZ than TZ (82.2% vs. 67.1% p = 0.002). Such concordance rate showed a positive linear association with increase in DWI grading (p < 0.001). Among 109 patients with DWI grade I-II, 28 (25.7%) harbored high grade disease (pathologic Gleason score ≥ 4 + 3)., Conclusions: DWI detects tumors in PZ of prostate more accurately than those in TZ. Such accuracy of DWI was shown to be more evident with higher DWI grade. Meanwhile, a negative DWI did not guarantee absence of high grade PCa., Competing Interests: The authors have declared that no competing interests exist.

Objectives: There is little data about the clinical value of core length for prostate biopsy (PBx). We investigated the clinical values of various clinicopathological biopsy-related parameters, including core length, in the contemporary multi-core PBx., Patients and Methods: Medical records of 5,243 consecutive patients who received PBx at our institution were reviewed. Among them, 3,479 patients with prostate-specific antigen (PSA) ≤ 10 ng/ml level who received transrectal ultrasound (TRUS)-guided multi (≥ 12)-core PBx at our institution were analyzed for prostate cancer (PCa). Gleason score upgrading (GSU) was analyzed in 339 patients who were diagnosed with low-risk PCa and received radical prostatectomy. Multivariate logistic regression analyses for PCa detection and prediction of GSU were performed., Results: The mean age and PSA of the entire cohort were 63.5 years and 5.4 ng/ml, respectively. The overall cancer detection rate was 28.5%. There was no statistical difference in core length between patients diagnosed with PCa and those without PCa (16.1 ± 1.8 vs 16.1 ± 1.9 mm, P = 0.945). The core length was also not significantly different (16.4 ± 1.7 vs 16.4 ± 1.6mm, P = 0.889) between the GSU group and non-GSU group. Multivariate logistic regression analyses demonstrated that the core length of PBx did not affect PCa detection in TRUS-guided multi-core PBx (P = 0.923) and was not prognostic for GSU in patients with low-risk PCa (P = 0.356)., Conclusions: In patients undergoing contemporary multi-core PBx, core length may not have significant impact on PCa detection and also GSU following radical prostatectomy among low-risk PCa group.

Objective: To investigate the impact of prostatic apical shape from preoperative magnetic resonance imaging on early recovery of urinary continence after robot-assisted radical prostatectomy (RARP)., Materials and Methods: We reviewed the records of 1011 patients who underwent RARP at a tertiary center from October 2007 to March 2013. Patients were stratified into 4 different groups by prostatic apical shapes as shown on preoperative magnetic resonance imaging (groups A-D). The early recovery of urinary continence was defined as 0 or 1 security pad/d within 12 weeks after the surgery. The association between early recovery of continence and various factors was analyzed., Results: Overall, 807 patients (79.8%) showed early recovery of urinary continence. The numbers of patients in groups A, B, C, and D were 88 (8.7%), 478 (47.3%), 167 (16.5%), and 278 (27.5%), respectively. There were no significant differences in the rates of early recovery of urinary continence between different groups (P = .257). On multivariate analysis, the patient's age (odds ratio [OR], 0.960; P = .004), preoperative International Index of Erectile Function-5 score (OR, 1.029; P = .009), neurovascular bundle preservation (OR, 1.586; P = .013), and membranous urethral length (OR, 1.104; P = .001) were revealed as independent prognostic factors in the early recovery of urinary continence., Conclusion: The results of our study showed that the prostatic apical shape does not influence the early recovery of urinary continence. We believe this is another strong point of RARP compared with conventional open surgery, particularly for patients with complex type of apical shape., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: The dorsal vascular complex (DVC) of the prostate is considered to be a functional structure having smooth muscles that are connected to the detrusor apron. We conducted this study to provide basic information regarding DVC size as measured by magnetic resonance imaging and to investigate whether DVC size is related to the recovery of continence following radical prostatectomy (RP)., Methods: We prospectively collected data that included the results of prostate MRI and continence recovery of patients who underwent RP. From April 2006 through February 2010, 862 patients underwent RP. Of these, a total of 731 cases were included in the final analysis. The height and width of the DVC were measured in the T1-weighted axial image at the level that showed the puboprostatic ligament., Results: The continence rate of the total patient cohort at 12 months was 96.7 %. The mean width, height and area of the DVC were 2.0 ± 0.4 cm, 1.2 ± 0.3 cm and 1.8 ± 0.6 cm(2), respectively, and there was no linear correlation between continence recovery and these parameters. However, the patients who had a moderately large-sized DVC (2.3-2.8 cm(2)) regained their continence significantly sooner (mean duration = 2.1 months) than those with small (3.7 months, p = 0.002) or extremely large DVC (4.0 months, p = 0.006). In a multivariate analysis, DVC size, age, transfusion and the length of membranous urethra were significant predictors of continence recovery., Conclusion: The patients who had a moderately large DVC regained continence faster following RP.

Background: Currently, controversy continues regarding the association between diabetes mellitus (DM) and prostate cancer (PCa). We investigated the impact of DM in PCa detection among men who underwent contemporary multi-core prostate biopsy., Methods: In this retrospective study, we reviewed records of 3,925 men who underwent multi (≥ 12)-core prostate biopsy at our institution. Biopsy outcomes were analyzed with respect to various variables, including DM, patient age, body mass index (BMI), prostate-specific antigen (PSA), digital rectal exam (DRE) finding, ultrasound finding, and prostate volume., Results: Among 3,925 subjects, 607 (15.5%) reported having DM at biopsy. Overall PCa was detected from biopsy in 1,387 (35.3%) patients, and high grade (biopsy Gleason score ≥ 7) PCa in 781 (19.9%). In multivariate analysis incorporating variables of patient age, BMI, PSA, DRE finding, ultrasound finding, and prostate volume, DM was observed to be significantly associated with higher odds of overall PCa detection via contemporary prostate biopsy (OR = 1.46, P = 0.019). When analyzed by tumor grade, DM was significantly associated with higher rate of high grade PCa detection from biopsy in multivariate analysis (OR = 1.54, P = 0.036) whereas DM and detection of low grade (biopsy Gleason score ≤ 6) PCa demonstrated no significant association (OR = 1.11, P = 0.558)., Conclusions: Our results showed DM was independently associated with the detection of high grade PCa via contemporary multi-core prostate biopsy. Further investigations would be needed to elucidate exact biologic basis of relationship between the two diseases., (Copyright © 2011 Wiley Periodicals, Inc.)

Objectives: A paucity of data exists on actual pathology of the contemporary patients strictly categorized as having low-risk prostate cancer. We tried to identify useful preoperative predictors of Gleason score upgrading in patients who underwent radical retropubic prostatectomy (RRP) for low-risk prostate cancer diagnosed via multi-core prostate biopsy., Methods: A total of 203 patients who underwent radical RRP for low-risk prostate cancer, as defined by D'Amico et al.'s classification (clinical stage < or = T2a, biopsy Gleason sum < or = 6, and PSA < or = 10 ng/ml), detected via multi (> or = 12)-core prostate biopsy were enrolled. We reviewed patients preoperative and pathological data., Results: Among all subjects, 81 (39.9%) were upgraded to Gleason score > or = 7 after RRP, whereas no downgrading was observed. In multivariate analysis, only preoperative PSA level (P = 0.024) and number of positive cores (P = 0.027) were observed to be independent predictors of Gleason score upgrading following RRP. Also, Gleason core upgrading was observed to be significantly associated with extraprostatic extension of tumor (P < 0.001) and positive surgical margin (P = 0.002)., Conclusions: A significant proportion of patients with low-risk prostate cancer as defined by D'Amico et al.'s classification diagnosed via multi-core prostate biopsy in contemporary period may have Gleason score upgrading following RRP. For patients with low-risk prostate cancer, preoperative PSA level and number of positive cores may be useful predictors of Gleason score upgrading, which was observed to significantly associated with other adverse pathologic features.

Aim: To compare the prostate volume, as measured by transrectal ultrasonography (TRUS) and by MRI, with that of the actual prostate volume measured after a radical prostatectomy (RRP)., Materials and Methods: This prospective study included 21 patients who had undergone RRP. TRUS prostate volumes were calculated using the prolate ellipsoid volume formula, with the anteroposterior diameter measured from axial (TRUS-V1) and mid-sagittal images (TRUS-V2). Two prolate ellipsoid volumes (MRI-EV1 and MRI-EV2) were calculated from the MRI using the same method, and planimetric volume (MRI-PV). The actual prostate volume (Actual-V) was measured in a measuring jug within 1 h after RRP., Results: Mean of Actual-V was 40.3ml (21.0-82.0). In paired sample tests, the correlation coefficients (R) for all methods were over 0.8. In a Student's t test (paired), MRI-PV (p = 0.620), MRI-EV2 (p = 0.703) and TRUS-V1 (p = 0.099) showed no significant differences compared to the Actual-V. The linear regression models of these three methods were y = 1.025x - 0.268, y = 0.946x + 2.979 and y = 1.046x + 0.381, respectively., Conclusions: Between two TRUS volumes, TRUS-V1 was shown to be superior to TRUS-V2. In MRI, MRI-EV2 was more accurate than MRI-EV1. However, MRI-PV was the most accurate method. TRUS-V1 and MRI-EV2 could be used instead of MRI-PV in general clinical settings., ((c) 2008 S. Karger AG, Basel.)

Purpose: We evaluated the effect of intracapsular anesthesia and periprostatic nerve block during transrectal ultrasound guided prostate biopsy., Materials and Methods: In a prospective, randomized, double-blind, placebo controlled study 152 consecutive patients were randomized into 3 groups. Group 1 of 41 patients was administered intraprostatic local anesthesia into the right and left sides with a total of 2 ml 1% lidocaine and a periprostatic injection of 2 ml saline later. Group 2 of 49 patients was administered intraprostatic injection of 2 ml saline, followed by periprostatic local anesthesia with 2 ml 1% lidocaine. Group 3 of 62 patients received intraprostatic and periprostatic local anesthesia with 2 ml 1% lidocaine. Patients were asked to grade the pain level using a 10-point linear visual analog pain scale 1) when the transrectal ultrasound probe was inserted, 2) during anesthesia, 3) during biopsy and 4) 20 minutes after biopsy. One-way ANOVA and the Kruskal-Wallis test with the Tukey post hoc test were used to compare patient characteristics and pain scale responses among the 3 groups., Results: No major complications, including sepsis and severe rectal bleeding, were noted in any patient. There were statistically significant differences in pain scores among groups 1 to 3 during anesthesia (mean +/- SD 5.6 +/- 2.5, 6.7 +/- 2.3 and 4.9 +/- 2.1, p = 0.003) and during biopsy (4.3 +/- 2.7, 4.5 +/- 2.6 and 2.7 +/- 2.1, respectively, p = 0.032). There were no differences in pain scores among the 3 groups during probe insertion (p = 0.39)., Conclusions: A combination of intracapsular anesthesia and periprostatic nerve block is an effective and useful technique that is well tolerated by the patient. It decreases the level of pain and discomfort associated with the prostatic biopsy procedure.

Objective: We wanted to assess the relationship between pain and the prostate volume during transrectal ultrasound (TRUS) guided biopsy., Materials and Methods: Between July and September 2006, 71 patients scheduled for TRUS biopsy of the prostate were considered for inclusion to this study. These patients underwent periprostatic neurovascular bundle block with lidocaine prior to biopsy. Pain was assessed using a Visual Analogue Scale (VAS) during periprostatic neurovascular bundle block (VAS 1), during biopsy (VAS 2), and 20 minutes after biopsy (VAS 3). The mean pain scores were analyzed in the large prostate group (prostate volume > 40 cc) and the small prostate group (prostate volume< or =40 cc). P values < 0.05 were considered significant., Results: The mean prostate volume was 42.2 cc (standard deviation: 8.6). The mean pain scores of VAS 1, 2 and 3 were 4.70+/-1.61, 3.15+/-2.44 and 1.05+/-1.51, respectively. In the large prostate group, the mean pains scores of VAS 1, 2 and 3 were 4.75+/-1.76, 3.51+/-2.76 and 1.29+/-1.70, respectively, whereas in the small prostate group, the means pain scores were 4.66+/-1.46, 2.77+/-2.0, and 0.80+/-1.26, respectively. Although there were no statistical differences of VAS 1, the larger prostate group revealed higher pain scores of VAS 2 and 3 compared with the small prostate group (p < 0.05)., Conclusion: Patients with larger prostate volumes tend to feel more pain during and after TRUS guided prostate biopsy. Our findings suggest that additional analgesic strategies may be necessary when the patients with larger prostate undergo TRUS guided prostate biopsy.

Objectives: To investigate the significance of variations in neurovascular bundle (NVB) formation observed on preoperative magnetic resonance imaging (MRI) regarding postoperative potency after nerve-sparing radical retropubic prostatectomy (RRP)., Methods: Preoperative MRI was performed in 93 patients who underwent bilateral nerve-sparing RRP for clinically localized prostate cancer and were followed up for at least 12 months after surgery. Judging from the MRI scans, patients were categorized into three groups: group 1, patients with no definite NVB observed on MRI, group 2, those with probable NVB formation observed on MRI but not definite, and group 3, those with NVB more definitely observed on MRI. Patients' erectile function status was assessed preoperatively and postoperatively using the International Index Erectile Function 5-item (IIEF-5) questionnaire., Results: Of the 93 patients, 40.9% were in group 1, 21.5% in group 2, and 37.6% in group 3 according to the MRI findings. The patient characteristics, including age, serum prostate-specific antigen, pathologic Gleason score, and preoperative IIEF-5 scores, were not significantly different among the three groups. However, the changes in the IIEF-5 scores after bilateral nerve-sparing RRP demonstrated a significantly larger decrease for group 1 compared with groups 2 and 3. Similar trends were observed when patients 60 years old or younger and those older than 60 years were analyzed separately., Conclusions: In patients with no definite NVB formation observed on MRI, the nerves associated with erectile function may run along both sides of the prostate and spread more anteriorly than those with the NVB more definitely observed. Thus, to preserve the NVBs completely at all times, it would be important to widely dissect the lateral aspects of the prostate during nerve-sparing RRPs.

Objectives: To investigate the impact of the variations in the shape of the prostatic apex observed on preoperative magnetic resonance imaging (MRI) on patients' status regarding urinary continence after undergoing radical retropubic prostatectomy, as well as the prevalence of such variations., Methods: We performed a retrospective analysis of 156 patients who had undergone preoperative MRI of the prostate and were followed up postoperatively by review of the records. For our analyses, patients were categorized into four different groups according to the shape of the prostatic apex shown on the midsagittal MRI scan. Patient status, including early (within 3 months after surgery) recovery of urinary continence, was also assessed., Results: Group 1 was the largest with 59 patients (37.8%), group 2 had 39 patients (25%), group 3 had 24 (15.3%), and group 4 had 34 patients (21.8%). Group 4 was composed of patients with the prostatic apex not overlapping with membranous urethra either anteriorly or posteriorly on MRI and had a significantly greater percentage (83.3% versus 66.7%) of patients with an early return of urinary continence after radical retropubic prostatectomy compared with the other groups (P = 0.014). On multivariate analysis of the predictive factor for the early return of urinary continence, anterior or posterior overlapping of the membranous urethra with the prostatic apex as shown on preoperative MRI was the only variable significantly associated with an early return of continence., Conclusions: The results of our study provide objective evidence that variations in the shape of the prostatic apex in relation to the membranous urethra may significantly affect early recovery of urinary continence after radical retropubic prostatectomy.

Purpose: To evaluate the usefulness of prostate health index (PHI) as an indicator for recommending magnetic resonance imaging (MRI) in patients with prostate-specific antigen (PSA) gray zone level < 10 ng/mL. Methods: 443 patients who underwent prostate biopsy (PB) after serum PHI test and MRI between April 2019 and December 2022 were enrolled. For patients with visible lesion on MRI with Prostate Imaging Reporting and Data System Score (PI-RADS) ≥ 3, MRI-targeted PB was performed in addition to systematic 12-core PB. Results: The optimal cutoff value of PHI for predicting PI-RADS ≥ 3 lesions was 39.6, which was significantly associated with overall prostate cancer (OR 3.07, p = 0.018) and clinically significant prostate cancer (csPCa) (OR 4.15, p = 0.006) at MRI-targeted PB cores. When MRI was restricted to patients with PHI ≥ 39.6 alone, 28.7% of unnecessary MRI could be saved at the cost of missing 13.6% of csPCa. When omitting MRI for patients with PHI < 39.6 and PSAD < 0.12 ng/mL2, unnecessary MRI could be reduced by 20.1% with the risk of missing 6.2% of csPCa. With addition of systematic PB, 21.0% of patients with negative MRI-targeted PB were diagnosed as csPCa. Conclusions: For patients in PSA gray zone, PHI of 39.6 might be an indicator for MRI and further MRI-targeted PB in additional to PSAD of 0.12 ng/mL2, reducing 20.1% of unnecessary MRI with the minimal risk of missing 6.2% of csPCa. To maximize csPCa detection, combining both MRI-targeted and systematic PB should be also considered. [ABSTRACT FROM AUTHOR]

Objective: To identify patients who can safely evade the magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and data system (PI-RADS) 3 lesion. Materials and methods: Overall, 755 men with PI-RADS 3–5 lesions who underwent MRIFTB were retrospectively analyzed. Univariate and multivariate analyses were performed to determine significant predictors for clinically significant prostate cancer (CSPCa), defined as Gleason grade group ≥ II. Detection rates and negative predictive values of CSPCa were estimated according to various clinical settings. Results: Median age, prostate-specific antigen (PSA), and PSA density of patients were 66.0 years, 7.39 ng/mL, and 0.19 ng/mL, respectively. Overall detection rates of CSPCa according to PI-RADS 3 (n = 347), 4 (n = 260), and 5 (n = 148) lesions were 15.0%, 30.4%, and 80.4%, respectively. The negative predictive value (NPV) of PI-RADS 3 lesion on MRI was 15.0%. On multivariate analysis, age [≥ 65 years, odds ratio (OR) = 0.427], PSA density (≥ 0.20 ng/mL2, OR = 0.234), prior negative biopsy history (OR = 2.231), and PI-RADS score (4, OR = 0.427; 5, OR = 0.071) were independent predictors for the absence of CSPCa by MRIFTB. When assessed according to various conditions, NPVs of PI-RADS 3 lesions were relatively high in subgroups with low PSA density (< 0.20 ng/mL2) regardless of age or prior biopsy history (NPV range 91.1–91.9%). Contrarily, NPVs in subgroups with high PSA density were relatively low and varied according to age or prior biopsy history groups (NPV range 50.0–86.8%). Conclusions: Men with the PI-RADS 3 lesion and low PSA density might safely evade the MRIFTB, regardless of age or prior biopsy history. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the value of elastography in evaluating focal lesions detected by transrectal sonography and to suggest a reference strain index. Methods: Sixty‐nine patients with focal lesions on transrectal sonography were referred to our department for prostate biopsy. Focal lesions were classified as either highly or less suspicious lesions by our criteria. A strain index from elastography was calculated for the focal lesions. Systematic 12‐core randomized biopsies plus 2 targeted biopsies were performed. The mean strain indices for malignant and benign focal lesions were compared, and a cutoff strain index was attained to maximize the sensitivity and specificity for prostate cancer. Strain indices were correlated with Gleason scores. Results: The mean strain index ± SD for malignant focal lesions (3.26 ± 1.77) was significantly higher than that for benign focal lesions (2.16 ± 1.52; P =.008). The sensitivity, specificity, and area under the receiver operating characteristic curve for diagnosing cancer were 66.7%, 71.1%, and 0.701, respectively, at a strain index cutoff value of greater than 2.4. The strain index showed a moderate linear correlation with the Gleason score (r = 0.441; P =.013). Conclusions: Any focal lesion on transrectal sonography with a strain index of greater than 2.4 is at risk for prostate cancer. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? It has been reported that patients with Gleason 6 prostate cancer detected in a single microfocal positive core may actually harbour more aggressive disease. Meanwhile, several studies analyzing cases of single microfocal prostate cancer included a significant number of patients with serum PSA ≥ 10 ng/mL. Also, significant proportions of currently available published data on actual pathological characteristics of prostate cancer with favourable biopsy features were obtained from patients who underwent prostate biopsies performed in non-systematic fashion at different institutions and/or via non-contemporary scheme, such as sextant biopsy. Although PSA density can be considered an independent predictor of pathologically insignificant tumour among the patients with PSA ≤ 10 ng/mL and only a single microfocal tumour detected via multi (≥12)-core biopsy, clinical and biopsy-related parameters currently available have limited value in predicting pathologically insignificant or unfavourable prostate cancer in such patients. OBJECTIVE • To examine potential predictors of pathological outcomes for a single microfocal (≤3 mm) positive prostate cancer detected via contemporary biopsy scheme in patients presenting with prostate-specific antigen (PSA) ≤10 ng/mL. PATIENTS AND METHODS • We reviewed the data of 119 patients who had prebiopsy PSA ≤ 10 ng/mL and a single microfocal (≤3 mm) Gleason ≤6 prostate cancer identified via multicore (≥12) biopsy and who subsequently underwent radical prostatectomy (RP). • We assessed the rates of insignificant prostate cancer (organ-confined and pathological Gleason ≤6 with tumour volume <0.5 mL) and unfavourable prostate cancer (upstaging and/or upgrading) by analysing pathological findings. • Potential preoperative predictors of insignificant or unfavourable prostate cancer were analysed. Multivariable models for predicting insignificant and unfavourable tumours were devised and evaluated. RESULTS • Overall rates of insignificant and unfavourable prostate cancer were 44.5% and 24.4%, respectively. In multivariate analysis, only PSA density was an independent predictor of insignificant prostate cancer. • Predictive accuracies of multivariable models for predicting insignificant prostate cancer did not exceed 68.2%. No significant predictor for pathologically unfavourable tumour was found in multivariate analysis. • All versions of the multivariable model devised for prediction of unfavourable tumour showed predictive accuracies ≤66.9%. CONCLUSION • Although PSA density can be considered an independent predictor of pathologically insignificant tumour among patients with PSA ≤10 ng/mL and only a single microfocal tumour detected via multicore (≥12) biopsy, the clinical and biopsy-related parameters that are currently available have limited value in predicting pathologically insignificant or unfavourable prostate cancer in such patients. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the analgesic effect of additional intrarectal lidocaine gel instillation during transrectal ultrasound guided prostate biopsy and identified the procedural steps that benefit from lidocaine gel instillation. Materials and Methods: A total of 250 consecutive patients scheduled for prostate biopsy were randomized into 2 groups. In the 125 group 1 patients lidocaine gel was instilled intrarectally before periprostatic neurovascular bundle block. The 125 patients in group 2 underwent only periprostatic neurovascular bundle block without lidocaine gel instillation. Of the 250 patients 90 in group 1 and 113 in group 2, in whom 12 systematic cores were obtained, were enrolled for data analysis. Pain was assessed using a visual analog scale during periprostatic neurovascular bundle block (visual analog scale 1), during biopsy (visual analog scale 2) and 20 minutes after biopsy (visual analog scale 3). Differences between the visual analog scale scores of the 2 groups at each procedural step were evaluated using the unpaired t test with p <0.05 considered significant. Results: In terms of pain experienced during the 3 procedural steps scores were significantly different during biopsy (p <0.01). Visual analog scale scores of patients in group 1 showed a tendency to be lower than the scores of patients in group 2 during periprostatic neurovascular bundle block and 20 minutes after biopsy (p = 0.11 and 0.20, respectively). Conclusions: Intrarectal lidocaine gel instillation before periprostatic neurovascular bundle block produces a significant additional analgesic effect during biopsy. The procedure is simple, safe and rapid, and it should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy. [Copyright &y& Elsevier]