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We aimed to evaluate the effect of 5 alpha-reductase inhibitor (5-ARI) treatment on prostate cancer (PCa) and clinically significant PCa (csPCa) detection in patients undergoing transrectal ultrasound (TRUS)/magnetic resonance imaging (MRI) fusion biopsy in the current era of multi-parametric MRI (mpMRI). We retrospectively reviewed our TRUS/MRI fusion biopsy database (n = 706). Eighty (11.3%) patients who had used 5-ARI for more than one year at the time of biopsy were stratified as 5-ARI group. Subsequently, we performed comparative analyses of 5-ARI and non-5-ARI groups. csPCa was defined by a Gleason score ≥3 + 4 in a single biopsy core. Chi-squared test was used to evaluate the performance of mpMRI in predicting PCa/csPCa between the two groups. Multivariate logistic regression analyses were performed to evaluate the significant variables associated with PCa detection. There were no significant differences in PCa/csPCa detection rates between 5-ARI and non-5-ARI groups (all, P > 0.05). In multivariate logistic regression analyses for the evaluation of variables associated with csPCa detection, age (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.035–1.090; P < 0.001), pre-biopsy PSA (OR, 1.062; 95% CI, 1.034–1.090; P < 0.001), prostate volume on TRUS (OR, 0.956; 95% CI, 0.943–0.970, P < 0.001), and PI-RADsV2 category (OR, 5.528; 95% CI, 3.017–10.131; P < 0.001) were found to be significant predictors. However, 5-ARI had no significant association with PCa detection (P = 0.384). Conclusively, 5-ARI therapy did not adversely affect PCa/csPCa detection after TRUS/MRI fusion biopsy, which suggests that exposure to 5-ARI may not impair the performance of mpMRI. [ABSTRACT FROM AUTHOR]

There are many medical demands that still need to be resolved for prostate cancer (PCa), including better diagnosis and predictive medicine. For this to be accomplished, diverse medical data need to be integrated with the development of intelligent software (SW) based on various types of medical data. Various types of information technology have been used to address these medical demands of PCa. We initiated the PROstate Medical Intelligence System Enterprise-Clinical, Imaging, and Pathology (PROMISE CLIP) and a multicenter, big data study to develop PCa SW for patients with PCa and clinicians. We integrated the clinical data of 7257 patients, 610 patients' imaging data, and 39,000 cores of pathology digital scanning data from four tertiary hospitals in South Korea. We developed the PROMISE CLIP registry based on integrated clinical, imaging, and pathology data. Related intelligent SW has been developed for helping patients and clinicians decide on the best treatment option. The PROMISE CLIP study directs guidelines for intelligent SW development to solve medical demands for PCa. The PROMISE CLIP registry plays an important role in advancing PCa research and care. [ABSTRACT FROM AUTHOR]

Abstract Purpose We want to investigate whether MR-US fusion can improve the detection rates of clinically significant prostate cancer in patients with prior negative prostate biopsy with PSA level <10 ng/mL. Methods Thirty nine patients who had previous a history of negative prostate biopsy and PSA levels <10 ng/mL were included in this study. MR was performed before the biopsy and graded using PIRADS V2. We labeled patients with index lesions with PIRADS scores of 3 or above as the MR-positive group, while patients with PIRADS scores of 1 or 2 were the MR-negative group. Two cores of added biopsy (AB) were performed per each index lesion under MR-US fusion. Twelve cores randomized systematic biopsy (SB) were followed. In MR negative group, two cores of AB were obtained in transition zone, followed by SB. Overall cancer and clinically significant cancer detection rates by patients and by cores were analyzed, and compared between MR-positive and negative group. Results The overall cancer detection rates were 51.3% by patient based and 13.8% by core based. While all of AB positive cancer patients were clinically significant cancer patients, five out of seven (71.4%) AB negative cancer patients were clinically insignificant cancer patients. AB results turned another four cancer patients from insignificant to significant cancer. The cancer detection rates between MR-positive and negative group were statistically significant. Conclusions Additional biopsy using MR–US fusion showed improved detection of clinically significant prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Interest in an ultrasound-mediated delivery system for effective T1 -MRI of prostate cancer without adverse effects has steadily increased.Purpose: To develop an ultrasound-responsive dual-modal ultrasound (US)/T1 -MRI contrast agent for efficient diagnosis of prostate cancer cells overexpressing prostate-specific membrane antigen (PSMA) and assess their potential.Study Type: In vitro.Subjects: Two prostate cancer cell lines.Field Strength/sequence: Each study group underwent 3.0T MRI under a TR 400 msec, TE 10 msec, a 240 × 240 matrix, a flip angle 90°, a slice thickness 3 mm, NSA with 4, bandwidth 115 Hz/pixel, and an FOV of 120 × 120 mm.Assessment: Microscopes, quantitative and qualitative analyzing instruments, and clinical devices were used for assessing this novel contrast agent and its diagnosis effects.Statistical Tests: We used linear regression analyses to determine the longitudinal relaxivity (r1 ) values of our US/T1 -MRI contrast agent and gadobutrol.Results: Microbubble+Fe3+ melanin nanoparticle+peptides (MB+Fe3+ MNPPs) had a good US contrast effect, like a commercial US agent. The differences of US intensities between them was below 5%. The r1 values of MB+Fe3+ MNPPs and gadobutrol were 4.5 and 3.7 s-1 /mM, respectively. More than hundreds of Fe3+ MNPPs were located in prostate cancer cells treated with MB+Fe3+ MNPPs and US stimulus, but the number of Fe3+ MNPPs was below dozens in the other prostate cancer cells expressing less PSMA. The former cells with MB+Fe3+ MNPPs and US stimulus only showed the highest T1 -MRI signal because of synergy effects of the peptides targeting the cells and US stimulus for delivery of Fe3+ MNPPs to the cells. No cytotoxicity of MB+Fe3+ MNPPs was confirmed by using a WST assay. Viability of the cells with the complexes was above 90%.Data Conclusion: We synthesized MB+Fe3+ MNPPs as a potential US/T1 -MRI contrast agent. This complex was applicable for diagnosing desired prostate cancer cells.Level Of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1610-1616. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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) ≤10ng/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 5.4ng/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 ± 1.9mm, 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. [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]

Photoacoustic (PA) imaging is used widely in cancer diagnosis. However, the availability of PA agents has not made great progress due to the limitations of the one currently in use, porphyrin. Porphyrin–Micelle (PM), developed by synthesizing porphyrin and PEG-3.5k, confirmed the amplification of the PA agent signal, and added binding affinity in an LNCaP model by attaching prostate-specific membrane antigen PSMA. Compared to the previously used porphyrin, a superior signal was confirmed, and the potential of PMP was confirmed when it showed a signal superior to that of hemoglobin at the same concentration. In addition, in the in vivo mouse experiment, it was confirmed that the signal in the LNCaP xenograft model was stronger than that in the PC-3 xenograft model, and the PMP signal was about three times higher than that of PM and porphyrin. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI and US is essential. The purpose of our study was to show any decrease in errors using a real-time nonrigid registration technique for prostate biopsy. Nineteen patients with suspected prostate cancer were prospectively enrolled in this study. Registration accuracy was calculated by the measuring distance of corresponding points by rigid and nonrigid registration between MRI and US, and compared for rigid and nonrigid registration methods. Overall cancer detection rates were also evaluated by patient and by core. Prostate volume was measured automatically from MRI and manually from US, and compared to each other. Mean distances between the corresponding points in MRI and US were 5.32 ± 2.61 mm for rigid registration and 2.11 ± 1.37 mm for nonrigid registration (p < 0.05). Cancer was diagnosed in 11 of 19 patients (57.9%), and in 67 of 266 biopsy cores (25.2%). There was no significant difference in prostate-volume measurement between the automatic and manual methods (p = 0.89). In conclusion, nonrigid registration reduces targeting errors. [ABSTRACT FROM AUTHOR]

A combined transrectal ultrasound and photoacoustic (TRUS–PA) imaging probe was developed for the clear visualization of morphological changes and microvasculature distribution in the prostate, as this is required for accurate diagnosis and biopsy. The probe consisted of a miniaturized 128-element 7 MHz convex array transducer with 134.5° field-of-view (FOV), a bifurcated optical fiber bundle, and two optical lenses. The design goal was to make the size of the TRUS–PA probe similar to that of general TRUS probes (i.e., about 20 mm), for the convenience of the patients. New flexible printed circuit board (FPCB), acoustic structure, and optical lens were developed to meet the requirement of the probe size, as well as to realize a high-performance TRUS–PA probe. In visual assessment, the PA signals obtained with the optical lens were 2.98 times higher than those without the lens. Moreover, the in vivo experiment with the xenograft BALB/c (Albino, Immunodeficient Inbred Strain) mouse model showed that TRUS–PA probe was able to acquire the entire PA image of the mouse tight behind the porcine intestine about 25 mm depth. From the ex vivo and in vivo experimental results, it can be concluded that the developed TRUS–PA probe is capable of improving PA image quality, even though the TRUS–PA probe has a cross-section size and an FOV comparable to those of general TRUS probes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association of prostate size with aggressiveness of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Methods: We evaluated the association of RRP specimen weight and prostate volume measured by transrectal ultrasound (TRUS) with pathologic tumor grade, extraprostatic extension of disease, surgical margin status, and seminal vesicle invasion by reviewing data of 346 consecutive patients who underwent RRP for clinically localized prostate cancer at our institution without receiving preoperative radiation or hormonal treatment. Results: A strong correlation was observed between RRP specimen weight and TRUS-measured prostate volume (Spearman r = 0.76; P <0.001). After adjustment for multiple variables including age, body mass index, and preoperative prostate-specific antigen level, RRP specimen weight was observed to be significantly associated with presence of Gleason pattern 4 or greater at RRP in an inverse fashion (P = 0.03). Regarding other adverse pathologic features, prostate weight was also significantly inversely associated with extraprostatic extension of prostate cancer (P = 0.04) and surgical margin positivity (P = 0.002). When TRUS-measured prostate volume was applied in place of RRP specimen weight, results were the same. Conclusions: Our data indicate that prostate size may be a useful predictor of tumor aggressiveness in Korean men with clinically localized prostate cancer. Further efforts should be made to elucidate actual mechanisms behind the association of prostate size and/or in vivo androgenicity with aggressiveness of prostate cancer. [Copyright &y& Elsevier]

Objectives: To investigate the impact of variations in bony pelvic dimensions observed from preoperative magnetic resonance imaging on operative time, intraoperative blood loss, and surgical margin status on performing open radical retropubic prostatectomy. Methods: A prospective study was undertaken in which preoperative magnetic resonance imaging was performed in 190 patients who were diagnosed with clinically localized prostate cancer before radical retropubic prostatectomy. Using the magnetic resonance image findings, various bony pelvic dimensions were measured. The associations of the measured pelvic dimensions and various clinicopathologic factors with the operative time, estimated blood loss, and surgical margin status were analyzed on multivariate analyses. Results: For operative time, none of the individual pelvic dimensions measured demonstrated significant associations on univariate analysis. In contrast, only the newly developed parameter, the pelvic dimension index, approached significance (P = 0.095). Only body mass index (BMI) proved to be independently associated with the operative time on multivariate analysis (P = 0.030). Also, only the prostate volume (P = 0.015) was independently associated with the estimated blood loss. For the surgical margin status, the preoperative PSA level (P = 0.041), pathologic Gleason score (P = 0.015), and BMI (P = 0.020), along with the pelvic dimension index (P = 0.048), demonstrated significant associations on univariate analyses. However, only the PSA level (P = 0.071) and BMI (P = 0.059) approached significance on multivariate analysis. Conclusions: Our results have demonstrated that variations in the bony pelvic dimensions might have some impact, but not significantly so, on open radical retropubic prostatectomy compared with other patient-related baseline factors such as the BMI or prostate volume. [Copyright &y& Elsevier]