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Background: The quality of prostate biopsy is affected by sampling (does the urologist take cores from the right place?) and the histological evaluation (does the pathologist grade correctly?)., Objective: To evaluate the relative contribution of sampling and histological evaluation to the reliability of prostate biopsy in terms of concordance with grading of the surgical specimen., Design, Setting, and Participants: We identified 848 prostate cancer patients who underwent radical prostatectomy between 2015 and 2017 at our institution with external or internal biopsies. Since 2016, a dedicated uropathologist has reviewed all the biopsies sampled externally., Outcome Measurements and Statistical Analysis: We considered the discordance between biopsy and final pathology as a proxy for the quality of prostate biopsy, and calculated the corresponding discordance rate for each biopsy setting., Results and Limitations: We observed the highest rate of grade discordance for patients who had an external biopsy without internal review (66%). Biopsies both sampled and reviewed internally had the lowest discrepancy rate (39%; p<0.0001 compared to external biopsies). Biopsies sampled outside our institution and reviewed internally had an intermediate discordance rate (51%; p=0.003)., Conclusions: The quality of prostate biopsy is influenced by both sampling and evaluation. Highly experienced pathological evaluation of needle biopsies is crucial, but biopsy quality also strongly depends on the quality of the sampled material. Future studies should investigate the mechanism underlying discordance in sampling. Consideration should be given to regionalization of prostate biopsy., Patient Summary: The quality of prostate biopsy varies between specialist and community centers. We found that this variation is affected by both sampling (does the urologist take cores from the right place?) and histological evaluation (does the pathologist grade correctly?)., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: We aimed to test the association between age, BMI and sex-hormone-binding globulin (SHBG) in a homogenous cohort of white-European men presenting for primary couple's infertility., Design: Retrospective study., Methods: Data from 1547 infertile men were analysed. Health-significant comorbidities were scored with the Charlson comorbidity index (CCI). Fasting serum hormones were measured in every patient. Age was considered according to quartile groups (<33, 33-41, >41 years) and BMI as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obesity (>30 kg/m2). Descriptive statistics and linear regression analysis tested the associations between age, BMI and SHBG., Results: Median SHBG levels increased across quartiles of age and decreased along with BMI increases (all P < 0.001). For each year increase in age, SHBG increased 0.32 nmol/L; conversely, for each unit increase in BMI, SHBG decreased by 1.1 nmol/L (all P < 0.001). SHBG levels decline with increasing BMI was greater than SHBG progressive increase with age. Overall, BMI explained 3.0 times more of the variability in SHBG than did ageing. At multivariate linear model, age and BMI were the most significant factors influencing SHBG concentration (all P < 0.001), after accounting for CCI, albumin levels and smoking status., Conclusions: We found a wide distribution of SHBG concentrations across age and BMI values in primary infertile men. The association between BMI and lowered SHBG levels seems to be greater than the association of ageing with increased SHBG.

Background: Preoperative assessment of the risk of lymph node invasion (LNI) is mandatory to identify prostate cancer (PCa) patients who should receive an extended pelvic lymph node dissection (ePLND)., Objective: To update a nomogram predicting LNI in contemporary PCa patients with detailed biopsy reports., Design, Setting, and Participants: Overall, 681 patients with detailed biopsy information, evaluated by a high-volume uropathologist, treated with radical prostatectomy and ePLND between 2011 and 2016 were identified., Outcome Measurements and Statistical Analysis: A multivariable logistic regression model predicting LNI was fitted and represented the basis for a coefficient-based nomogram. The model was evaluated using the receiver operating characteristic-derived area under the curve (AUC), calibration plot, and decision-curve analyses (DCAs)., Results and Limitations: The median number of nodes removed was 16. Overall, 79 (12%) patients had LNI. A multivariable model that included prostate-specific antigen, clinical stage, biopsy Gleason grade group, percentage of cores with highest-grade PCa, and percentage of cores with lower-grade disease represented the basis for the nomogram. After cross validation, the predictive accuracy of these predictors in our cohort was 90.8% and the DCA demonstrated improved risk prediction against threshold probabilities of LNI ≤20%. Using a cutoff of 7%, 471 (69%) ePLNDs would be spared and LNI would be missed in seven (1.5%) patients. As compared with the Briganti and Memorial Sloan Kettering Cancer Center nomograms, the novel model showed higher AUC (90.8% vs 89.5% vs 89.5%), better calibration characteristics, and a higher net benefit at DCA., Conclusions: An ePLND should be avoided in patients with detailed biopsy information and a risk of nodal involvement below 7%, in order to spare approximately 70% ePLNDs at the cost of missing only 1.5% LNIs., Patient Summary: We developed a novel nomogram to predict lymph node invasion (LNI) in patients with clinically localized prostate cancer based on detailed biopsy reports. A lymph node dissection exclusively in men with a risk of LNI >7% according to this model would significantly reduce the number of unnecessary pelvic nodal dissections with a risk of missing only 1.5% of patients with LNI., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.)