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Objective: To compare the efficacy of multiparametric magnetic resonance imaging (mpMRI)‐directed and micro‐ultrasonography (micro‐US)‐directed biopsy for detecting clinically significant (Grade Group >1) prostate cancer (csPCa). Materials and Methods: A total of 203 patients were prospectively enrolled at three institutions across Germany and Austria in the period from January 2019 to December 2019. During each biopsy, the urologist was blinded to the mpMRI report until after the micro‐US targets had been assessed. After unblinding, targets were then sampled using software‐assisted fusion, followed by systematic samples. The primary outcome measure was non‐inferiority of micro‐US to detect csPCa, with a detection ratio of at least 80% that of mpMRI. Results: A total of 79 csPCa cases were detected overall (39%). Micro‐US‐targeted biopsy detected 58/79 cases (73%), while mpMRI‐targeted biopsy detected 60/79 (76%) and non‐targeted (completion sampling) samples detected 45/79 cases (57%). mpMRI‐targeted samples alone detected 7/79 (9%) csPCa cases which were missed by micro‐US‐targeted and non‐targeted samples. Three of these seven were anterior lesions with 2/7 in the transition zone. Micro‐US‐targeted samples alone detected 5/79 (6%) and completion sampling alone detected 4/79 cases (5%). Micro‐US was non‐inferior to mpMRI and detected 97% of the csPCa cases detected by mpMRI‐targeted biopsy (95% CI 80–116%; P = 0.023). Conclusions: This is the first multicentre prospective study comparing micro‐US‐targeted biopsy with mpMRI‐targeted biopsy. The study provides further evidence that micro‐US can reliably detect cancer lesions and suggests that micro‐US biopsy might be as effective as mpMRI for detection of csPCA. This result has significant implications for increasing accessibility, reducing costs and expediting diagnosis. [ABSTRACT FROM AUTHOR]

Background: A higher incidence of bladder cancer has been reported in men compared with women. Clinical gender differences have been observed but are less well described., Objective: This retrospective analysis further examines clinical differences in the development and manifestation of bladder cancer between men and women., Methods: Consecutive male and female patients with bladder cancer treated between 1969 and 1997 at a single center (University Hospital of Innsbruck, Innsbruck, Austria) were included in the study. Patient characteristics regarding age, tumor classification, localization, and recurrence were compared between male and female patients. Statistical analysis was conducted using the t test, the chi(2) test, and the Kaplan-Meier method, with the log-rank test for subgroup analysis., Results: In the 1,269 patients (876 men, 393 women) who were examined, 1,744 tumors were found. The male-to-female bladder cancer incidence ratio was 2.2:1. Tumors were diagnosed at a significantly younger age in men than in women (mean age: 62 years vs 67 years, respectively; P < 0.001). No difference in the histology of tumors was observed between the sexes. Muscle-invasive tumors more frequently occurred in men than in women (39.8% vs 34.5%; P = NS). In men compared with women, primary tumors were more aggressive (grade 2, 36.6% vs 28.2%; P < 0.001) and tumor recurrences were more invasive (59.0% vs 57.8%; P = NS). Tumors were more often located in the urethra in men than in women (43 [3.4%] vs 9 [1.8%]; P = 0.034), the trigonum (246 [19.8%] vs 75 [14.9%]; P < 0.001), and the bladder dome or vault (128 [10.3%] vs 37 [7.4%]; P = 0.015). Generally, no difference in survival rate was observed between the sexes; only in the subgroup of muscle-invasive tumors (n = 455) did women have a worse overall survival rate than did men (P = 0.022)., Conclusions: Clinical gender differences in bladder cancer appear to have a higher incidence in men than in women. In this analysis, women were older at the age of detection, but had less-invasive and less-aggressive tumors than did men. However, women with muscle-invasive disease had a worse overall survival rate than did men in the same subset.

Purpose: Endoscopy done under fluorescence induced by 5-aminolevulinic acid has proved to be a procedure with high sensitivity for detecting transitional cell carcinoma of the bladder. In this multicenter, parallel group, phase III study we compared 5-aminolevulinic acid fluorescence endoscopy guided transurethral bladder resection with transurethral bladder resection done using only white light endoscopy. The proportion of tumor-free resected cases in the 2 groups was evaluated., Materials and Methods: After patient stratification according to participating centers and European Organization for the Research and Treatment of Cancer risk score 65 and 64 were randomized to the 5-aminolevulinic acid fluorescence and white light endoscopy groups, respectively. Residual tumor was evaluated in the 2 groups by repeat transurethral resection 10 to 14 days later. Analysis was performed according to the intent to treat principle with all patients randomized, followed by per protocol analysis., Results: Intent to treat analysis revealed that in the white light endoscopy group 40.6% of cases were resected tumor-free at primary resection, whereas with 5-aminolevulinic acid fluorescence endoscopy guided transurethral resection 61.5% were resected tumor-free (p <0014). On protocol analysis 46.9% patients in the white light and 67.3% in the 5-aminolevulinic acid fluorescence endoscopy groups were resected tumor-free (p <0.031). No difference was noted in the 2 groups in regard to side effects or laboratory findings., Conclusions: The risk of residual tumor after transurethral resection of transitional cell carcinoma is significantly decreased by 5-aminolevulinic acid fluorescence endoscopy.