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Purpose: This study aims to develop and validate predictive nomograms for prostate cancer (PCa) and clinically significant PCa (csPCa) in prostate‐specific antigen (PSA) gray zone of 4−10 ng/mL, utilizing transrectal ultrasound five‐grade scoring system (TRUS‐5), prostate imaging reporting and data system (PI‐RADS) score based on multiparametric magnetic resonance imaging (mpMRI) and clinical parameters. Method: A retrospective analysis was conducted on a cohort of 383 patients with elevated PSA levels in the gray zone who underwent initial TRUS‐guided 12‐core prostate biopsy between January 2018 and December 2020. Multivariate logistic regression analyses were utilized to identify independent predictors for PCa and csPCa and to establish predictive nomograms. The diagnostic performance, calibration ability, and clinical usefulness of each model were assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA), respectively. Results: Two diagnostic nomograms were developed based on five risk factors (age, free/total PSA [(f/t) PSA] ratio, prostate volume [PV], TRUS‐5, and PI‐RADS score) to predict PCa and five risk factors (PSA, (f/t) PSA, PV, TRUS‐5, and PI‐RADS score) for csPCa of PSA gray zone patients. The TRUS‐5/PI‐RADS combined model demonstrated higher area under the curves (AUCs) (0.865 for PCa and 0.910 for csPCa) compared to the models based on PI‐RADS score or TRUS‐5 (p < 0.05), as well as the greater net benefits across a wide range of threshold probabilities for PSA gray zone patients. Conclusion: The current study presented valuable TRUS‐5/PI‐RADS combined nomograms for predicting PCa or csPCa in patients within the PSA gray zone, which may serve as useful tools for the clinical management of PCa and csPCa. [ABSTRACT FROM AUTHOR]

Objective: Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). Methods: A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as "targeted prostate biopsy", "fusion prostate biopsy", "cognitive prostate biopsy", "MRI-guided biopsy", and "transrectal ultrasound prostate biopsy". Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. Conclusion: mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background and objective: High-resolution micro-ultrasound (microUS) is an advanced imaging tool. Our objective was to determine whether systematic microUS use for transrectal biopsy (TRBx) improves the detection rate for clinically significant prostate cancer (csPCa) in comparison to transperineal biopsy (TPBx) performed with magnetic resonance imaging (MRI)/conventional transrectal ultrasound (TRUS) fusion software. Methods: We retrospectively analyzed data for men who underwent prostate biopsies, including those on active surveillance (AS). TRBx was performed under microUS guidance, while MRI/TRUS fusion was consistently used to guide TPBx. Patients were matched according to propensity score matching (PSM). The primary endpoint was comparison of the csPCa detection rate with the two approaches. Secondary endpoints included predictors of csPCa (International Society of Urological Pathology grade group ≥2, assessed via multivariable logistic regression) and complication rates. Key findings and limitations: Overall, 1423 patients were enrolled. After applying PSM we identified an analytical cohort of 1094 men, 582 in the TRBx group and 512 in the TPBx group. There was no significant difference in the csPCa detection rate between the TRBx (45%) and TPBx (51%) groups (p = 0.07). Complications occurred in nine of 1094 patients (1%). On adjusted multivariable analysis, TPBx had a similar csPCa detection rate to TRBx (adjusted odds ratio [aOR] 1.26;p = 0.09). Predictors of csPCa detection were a positive family history (aOR 1.68; 95% confidence interval [CI] 1.20–2.35; p = 0.002); age (aOR 1.04, 95% CI 1.02–1.06; p

Introduction. Currently, urologists are divided on which method is most effective for treating bladder neck contracture (BNC) after surgery: transurethral resection (TUR) or incision.Objective. The study aimed to assess the balloon dilation safety and success in patients with recurrent bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH).Materials & Methods. This study involved 110 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent TUR of the bladder neck and were divided into 2 groups: group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, while the control group B (n = 65) included men who were treated with alpha-blockers alone.Results. In 9 months after TUR and 3 months after the fourth balloon dilation procedure in group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life (QoL) was 4.2 ± 1.2 (p > 0.05). In group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (p > 0.05), respectively. Additionally, the mean flow rate in group A was 13.2 ± 5.4 ml/s, while in group B, it was 8.7 ± 4.9 ml/s (p < 0.05). There was a significant decrease in the post-void residual urine volume (PVR) from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in group A, whereas, in group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (p > 0.05). Also, 28.0% of patients of group B, and 13.3% of patients of group A underwent repeated TUR of the bladder neck in 9 months follow-up period (p < 0.05).Conclusion. Balloon dilation procedure is a relatively safe less invasive procedure and can reduce the BNC recurrence rate and consequently the rate of repeated transurethral interventions.

BACKGROUND: Male infertility is a widespread issue that many couples are dealing with. Medical practitioners have begun to use modern diagnostic methods such as transrectal ultrasonography (TRUS) and scrotal ultrasound (US) to better understand the reasons and potential remedies for this disease. With the aid of these imaging tools, the male reproductive system can be thoroughly examined to assess structural abnormalities and other acquired illnesses that may be contributing factors to infertility. AIM/OBJECTIVE: To identify the underlying causes of male infertility through the use of transrectal ultrasound (TRUS) and scrotal ultrasound, with a focus on emphasizing their diagnostic role. RESULTS: In our study encompassing 127 male participants aged between 22 and 70 years (mean age 38.11), 121 individuals presented with primary infertility, while 6 exhibited secondary infertility. Transrectal Ultrasound (TRUS) findings indicated a range of abnormalities, 20 unilateral seminal vesicle agenesis, 5 unilateral atrophic seminal vesicle, 5 bilateral seminal vesicle agenesis, 1 bilateral atrophic seminal vesicles, 4 seminal vesicle calculi, 2 vas deferens calculi, 2 testicular microlithiasis, 14 ejaculatory duct calculi, 1 ejaculatory duct stricture, 1 epidydymal head cyst, 16 prostatic cysts, 6 prostatitis and 57 normal studies. Among the 121 patients, 51 underwent scrotal ultrasound which revealed 13 normal, 24 varicoceles, 2 hydroceles, 1 spermatocele, 9 epidydymal cysts, 5 epidydymitis, 4 atrophic testis, 1 epidydymo-orchitis and 1 undescended testis. CONCLUSION: Ultrasounds of the scrotum and transrectum are crucial for identifying anomalies in male infertility that can be corrected. The likelihood of becoming a parent is increased by these imaging modalities, which also improve clinical assessments and guide treatment plans. [ABSTRACT FROM AUTHOR]

Background and objective: This study aimed to determine the difference in prostate volume (PV) derived from transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (mpMRI), and to further investigate the role of TRUS prostate-specific antigen density (PSAD) and mpMRI-PSAD in prostate cancer (PCa) detection in biopsy-naïve men. Methods: Patients who underwent an initial prostate biopsy within 3 mo after mpMRI between January 2016 and December 2021 were analyzed retrospectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both TRUS-PSAD and mpMRI-PSAD for PCa detection were calculated and compared. The Pearson correlation coefficient, Bland-Altman plot, and receiver operating characteristic curve were also utilized to explore the interests of this study. Key findings and limitations: The median prostate-specific antigen level of 875 patients was 9.79 (interquartile range [IQR]: 7.09–13.50) ng/ml. The median mpMRI-PV and TRUS-PV were 41.92 (IQR: 29.29–60.73) and 41.04 (IQR: 29.24–57.27) ml, respectively, demonstrating a strong linear correlation (r = 0.831, 95% confidence interval: 0.809, 0.850; p

Accurate prostate volume estimation is crucial for effective prostate disease management. Ultrasound (US) imaging, particularly transrectal ultrasound, offers a cost-effective and rapid assessment. However, US images often suffer from artifacts and poor contrast, making prostate volume estimation challenging. This review explores recent advancements in deep learning (DL) techniques for automatic prostate segmentation in US images as a primary step toward prostate volume estimation. We examine various DL architectures, including traditional U-Net modifications and innovative designs incorporating residual connections, multi-directional image data, and attention mechanisms. Additionally, we discuss pre-processing methods to enhance image quality, the integration of shape information, and strategies to improve the consistency and robustness of DL models. The effectiveness of these techniques is evaluated through metrics such as the Dice Similarity Coefficient, Jaccard Index, and Hausdorff Distance. The review highlights the potential of DL in improving prostate volume estimation accuracy and reducing clinical workload while also identifying areas for future research to enhance model performance and generalizability. [ABSTRACT FROM AUTHOR]

Aims: To investigate the correlation between time-intensity curve (TIC) parameters obtained from transrectal contrast-enhanced ultrasound (TR-CEUS) and important pathological prognostic factors in rectal adenocarcinoma. Material and methods: We retrospectively included 477 patients with pathologically confirmed rectal adenocarcinoma. TIC parameters were derived from preoperative dynamic TR-CEUS images. These parameters included peak intensity (PI), time to peak (TTP), mean transit time (MTT), slope (S), and area under the curve (AREA). Pathological prognostic factors included TN stage, tumor diameter, lymphovascular invasion (LVI), perineural invasion, and tumor differentiation. Spearman’s correlation analysis and binary logistic regression were used to analyze the association between TIC parameters and pathological prognostic factors. Results: pT1-2 stages rectal carcinomas exhibited higher PI-max, PI-min, S-max, S-min, AREA-max, and AREA-min than pT3-4 stages (all p<0.05). pN0 stage rectal adenocarcinomas displayed higher PI-max, S-max, AREA-max, PI-ratio, S-ratio, and AREA-ratio than pN1-2 stage (all p<0.05). PI-ratio and S-ratio were higher in the LVI-negative and tumor diameter ≥4cm group compared to the LVI-positive and tumor diameter <4cm group, respectively (p<0.05). Well-differentiated rectal adenocarcinomas displayed higher PI-max, AREA-max, PI-ratio, S-ratio, and AREA-ratio than the moderate-poor differentiated group (all p<0.05). PI-max, S-max, AREA-max, PI-ratio, S-ratio, and AREA-ratio were negatively correlated with pN stage (all p<0.05). PI-ratio and S-ratio were independent predictive factors for the pN stage (OR=0.774, OR=1.048). S-ratio and AREA-ratio were independent predictive factors for tumor differentiation (OR=1.071, OR=0.911). Conclusions: TIC parameters derived from TR-CEUS exhibit correlations with specific pathological prognostic factors in rectal adenocarcinomas. This non-invasive method may hold promise for preoperatively assessing the prognosis of rectal adenocarcinoma patients. [ABSTRACT FROM AUTHOR]

To investigate geometric and dosimetric inter-observer variability in needle reconstruction for temporary prostate brachytherapy. To assess the potential of registrations between transrectal ultrasound (TRUS) and cone-beam computed tomography (CBCT) to support implant reconstructions. The needles implanted in 28 patients were reconstructed on TRUS by three physicists. Corresponding geometric deviations and associated dosimetric variations to prostate and organs at risk (urethra, bladder, rectum) were analyzed. To account for the found inter-observer variability, various approaches (template-based, probe-based, marker-based) for registrations of CBCT to TRUS were investigated regarding the respective needle transfer accuracy in a phantom study. Three patient cases were examined to assess registration accuracy in-vivo. Geometric inter-observer deviations >1 mm and >3 mm were found for 34.9% and 3.5% of all needles, respectively. Prostate dose coverage (changes up to 7.2%) and urethra dose (partly exceeding given dose constraints) were most affected by associated dosimetric changes. Marker-based and probe-based registrations resulted in the phantom study in high mean needle transfer accuracies of 0.73 mm and 0.12 mm, respectively. In the patient cases, the marker-based approach was the superior technique for CBCT-TRUS fusions. Inter-observer variability in needle reconstruction can substantially affect dosimetry for individual patients. Especially marker-based CBCT-TRUS registrations can help to ensure accurate reconstructions for improved treatment planning. [ABSTRACT FROM AUTHOR]

Aim: Prostate cancer (PCa) is one of the most common neoplasms in men. However, the value of ultrasound-based radiomics for diagnosing PCa remains uncertain. Material and methods: We retrospectively analyzed ultrasonic and clinical data from 373 patients. Patients were divided into two groups according to the pathological results. Radiomics features were extracted from TRUS, and we screened the optimal features to construct radiomics models. Relationships between clinical characteristics and prostate lesions were identified by univariate and multivariate logistic regression analysis. Finally, a clinical-radiomics model was developed, and then visualized in the form of a nomogram. Results: Of the 373 patients, 178 had benign disease and 195 had malignant disease. The support vector machine (SVM) classification model showed the best performance, while the diagnostic performance of the clinical model was poorer than that of the radiomics model (p<0.05) or the combined (clinical-radiomics) model (p<0.05). In general, the combined model demonstrated the highest AUC and proved to be more advantageous. Conclusion: The prediction model we constructed based on TRUS predicted PCa preoperatively with high efficiency. In addition, combining radiomics with clinical factors improved diagnostic accuracy [ABSTRACT FROM AUTHOR]

Purpose: To relate the prostate volume category (PVC) assessed with digital rectal examination (DRE)—small, median, and large—and the prostate volumes (PVs) assessed with magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). To compare the clinically significant prostate cancer (csPCa) discrimination ability of two predictive models based on DREPVC and MRI-PV. Materials and Methods: A prospective trial of 2,090 men with prostate-specific antigen >3 ng/mL and/or PCa suspicious DRE were prospectively recruited in 10 centers from Catalonia (Spain), between 2021 and 2022, in whom DRE-PVC was assessed. Pre-biopsy MRI, and 12-core TRUS-random biopsy was always performed after 2- to 6-core TRUS-fusion targeted biopsy of prostate imaging-report and data system >3 lesions. In 370 men (17.7%) the DRE-PVC was unconclusive. Among the 1,720 men finally analyzed the csPCa (grade group >2) detection was 42.4%. Results: The median (interquartile range) of TRUS and MRI-PVs of small prostates were 33 mL (19–37 mL) and 35 mL (23–30 mL), p=0.410; in median prostates they were 51 mL (38–58 mL) and 55 mL (48–63 mL) respectively, p

Purpose: Utility of prostate-specific antigen density (PSAd) for risk-stratification to avoid unnecessary biopsy remains unclear due to the lack of standardization of prostate volume estimation. We evaluated the impact of ellipsoidal formula using multiparametric magnetic resonance (MRI) and semi-automated segmentation using tridimensional ultrasound (3D-US) on prostate volume and PSAd estimations as well as the distribution of patients in a risk-adapted table of clinically significant prostate cancer (csPCa). Methods: In a prospectively maintained database of 4841 patients who underwent MRI-targeted and systematic biopsies, 971 met inclusions criteria. Correlation of volume estimation was assessed by Kendall's correlation coefficient and graphically represented by scatter and Bland–Altman plots. Distribution of csPCa was presented using the Schoots risk-adapted table based on PSAd and PI-RADS score. The model was evaluated using discrimination, calibration plots and decision curve analysis (DCA). Results: Median prostate volume estimation using 3D-US was higher compared to MRI (49cc[IQR 37–68] vs 47cc[IQR 35–66], p < 0.001). Significant correlation between imaging modalities was observed (τ = 0.73[CI 0.7–0.75], p < 0.001). Bland–Altman plot emphasizes the differences in prostate volume estimation. Using the Schoots risk-adapted table, a high risk of csPCa was observed in PI-RADS 2 combined with high PSAd, and in all PI-RADS 4–5. The risk of csPCa was proportional to the PSAd for PI-RADS 3 patients. Good accuracy (AUC of 0.69 and 0.68 using 3D-US and MRI, respectively), adequate calibration and a higher net benefit when using 3D-US for probability thresholds above 25% on DCA. Conclusions: Prostate volume estimation with semi-automated segmentation using 3D-US should be preferred to the ellipsoidal formula (MRI) when evaluating PSAd and the risk of csPCa. [ABSTRACT FROM AUTHOR]

Purpose: To relate the prostate volume category (PVC) assessed with digital rectal examination (DRE)—small, median, and large—and the prostate volumes (PVs) assessed with magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). To compare the clinically significant prostate cancer (csPCa) discrimination ability of two predictive models based on DREPVC and MRI-PV. Materials and Methods: A prospective trial of 2,090 men with prostate-specific antigen >3 ng/mL and/or PCa suspicious DRE were prospectively recruited in 10 centers from Catalonia (Spain), between 2021 and 2022, in whom DRE-PVC was assessed. Pre-biopsy MRI, and 12-core TRUS-random biopsy was always performed after 2- to 6-core TRUS-fusion targeted biopsy of prostate imaging-report and data system >3 lesions. In 370 men (17.7%) the DRE-PVC was unconclusive. Among the 1,720 men finally analyzed the csPCa (grade group >2) detection was 42.4%. Results: The median (interquartile range) of TRUS and MRI-PVs of small prostates were 33 mL (19–37 mL) and 35 mL (23–30 mL), p=0.410; in median prostates they were 51 mL (38–58 mL) and 55 mL (48–63 mL) respectively, p<0.001; in large prostates 80 mL (60–100 mL) and 95 mL (75–118 mL) respectively, p<0.001. The predictive models sharing the MRI-PV and DREPVC showed areas under the curves of 0.832 (95% confidence interval [CI], 0.813–0.851) and 0.828 (95% CI, 0.809–0.848) respectively, p=0.632, as well as similar net benefit and clinical utility. Conclusions: PVC was unconclusive in 17% of DREs. MRI-PV overestimated the TRUS-PV in median and large prostates. The predictive models based on MRI-PV and DRE-PVC showed similar efficacy to predict csPCa. PVC assessed with DRE is helpful to predict the csPCa risk before MRI. [ABSTRACT FROM AUTHOR]

ackground. Endoscopic and histological studies play a decisive role in the diagnosis of inflammatory bowel diseases, as they allow confirming the diagnosis, determining the degree of inflammatory activity, the extent of intestinal damage, and monitoring the course of disease and the effectiveness of therapy. However, it is not possible to assess the state of all intestinal layers with colonoscopy. Modern non-invasive methods such as ultrasound, computed tomography, and magnetic resonance imaging cope best with this purpose. With their help, you can assess the state of the intestinal wall and obtain a cross-sectional image of the intestine, evaluate extraintestinal structures (lymph nodes, vessels, fatty tissue). It can be said that endoscopy and ultrasound search for the same type of information but look at different things. Deepening the knowledge about the role of ultrasound of the distal parts of the colon in ulcerative colitis (UC) will contribute to the improvement of diagnosis, development of methods for determining the activity of UC, control of therapy, which will allow optimizing the choice of adequate treatment measures. The goal of the work: to improve the diagnosis of ulcerative colitis based on the study of ultrasonographic parameters of the rectum. Materials and methods. Transrectal ultrasound was performed on an expert-class SonoScape S60 ultrasound scanner using a low-frequency convex probe of 3.5 MHz and a rectovaginal convex probe of 6 MHz. Transperineal and transrectal approaches were used. Results. Wall thickness and submucosal thickness differed significantly in moderate and severe UC. Analysis of transrectal ultrasound indicators depending on the endoscopic activity of the UC revealed no significant differences in the rectal wall thickness. But there was a tendency to increase in the thickness of the mucous layer and the coefficient of deformation with increasing endoscopic activity. Most patients had an increase in the degree of blood flow density, which depended on the disease severity. During the regression analysis, a relationship was found between the intestinal wall thickness (r = 0.44; p = 0.0121) and submucosal layer thickness (r = 0.86; p = 0.006) with the Mayo index. A correlation was revealed between the thickness of the colon wall and the frequency of bowel movements (r = 0.37; p = 0.018), leukocytosis (r = 0.38; p = 0.016) and erythrocyte sedimentation rate (r = 0.35; p = 0.027). The blood flow density in the intestinal wall positively correlated with the presence of edema (r = 0.32; p = 0.045), the severity of the vascular pattern (r = 0.42; p = 0.008), the presence of erosions (r = 0.4; p = 0.011) and bleeding of the mucous membrane (r = 0.50; p = 0.001). The coefficient of deformation positively correlated with the presence of flatulence (r = 0.35; p = 0.048). Conclusions. Endoscopic examination in patients with UC should be supplemented with transrectal ultrasound. A correlation was found between the intestinal wall thickness and the thickness of the submucosal layer in patients with UC and the Mayo index. A tendency to increase in the thickness of the mucous layer and the coefficient of deformation with increasing endoscopic activity was determined. Relationships between endoscopic and ultrasound parameters can be used to assess disease activity. [ABSTRACT FROM AUTHOR]

Purpose We aimed to develop an artificial intelligence (AI) model based on transrectal ultrasonography (TRUS) images of biopsy needle tract (BNT) tissues for predicting prostate cancer (PCa) and to compare the PCa diagnostic performance of the radiologist model and clinical model. Methods A total of 1696 2D prostate TRUS images were involved from 142 patients between July 2021 and May 2022. The ResNet50 network model was utilized to train classification models with different input methods: original image (Whole model), BNT (Needle model), and combined image [Feature Pyramid Networks (FPN) model]. The training set, validation set, and test set were randomly assigned, then randomized 5-fold cross-validation between the training set and validation set was performed. The diagnostic effectiveness of AI models and image combination was accessed by an independent testing set. Then, the optimal AI model and image combination were selected to compare the diagnostic efficacy with that of senior radiologists and the clinical model. Results In the test set, the area under the curve, specificity, and sensitivity of the FPN model were 0.934, 0.966, and 0.829, respectively; the diagnostic efficacy was improved compared with the Whole and Needle models, with statistically significant differences (P  < 0.05), and was better than that of senior radiologists (area under the curve: 0.667). The FPN model detected more PCa compared with senior physicians (82.9% vs. 55.8%), with a 61.3% decrease in the false-positive rate and a 23.2% increase in overall accuracy (0.887 vs. 0.655). Conclusion The proposed FPN model can offer a new method for prostate tissue classification, improve the diagnostic performance, and may be a helpful tool to guide prostate biopsy. Key messages What is already known on this topic   The application of artificial intelligence in transrectal ultrasound can assist in the diagnosis of prostate cancer (PCa). What this study adds   Differing from previous studies, our study combined magnetic resonance imaging fusion targeted biopsy and systematic biopsy, in analyzing segmented needle tract ultrasound images of prostate biopsies. Excluding the interference of inaccurate region of interest outlining, a deep learning PCa diagnostic model with better diagnostic efficacy was constructed. How this study might affect research, practice, or policy   Through our model screening, a greater number of suspected PCa patients who need further biopsy can receive the proper diagnosis and treatment, avoiding unnecessary biopsy in patients without PCa. [ABSTRACT FROM AUTHOR]

Prostate biopsy and image-guided treatment procedures are often performed under the guidance of ultrasound fused with magnetic resonance images (MRI). Accurate image fusion relies on accurate segmentation of the prostate on ultrasound images. Yet, the reduced signal-to-noise ratio and artifacts (e.g., speckle and shadowing) in ultrasound images limit the performance of automated prostate segmentation techniques and generalizing these methods to new image domains is inherently difficult. In this study, we address these challenges by introducing a novel 2.5D deep neural network for prostate segmentation on ultrasound images. Our approach addresses the limitations of transfer learning and finetuning methods (i.e., drop in performance on the original training data when the model weights are updated) by combining a supervised domain adaptation technique and a knowledge distillation loss. The knowledge distillation loss allows the preservation of previously learned knowledge and reduces the performance drop after model finetuning on new datasets. Furthermore, our approach relies on an attention module that considers model feature positioning information to improve the segmentation accuracy. We trained our model on 764 subjects from one institution and finetuned our model using only ten subjects from subsequent institutions. We analyzed the performance of our method on three large datasets encompassing 2067 subjects from three different institutions. Our method achieved an average Dice Similarity Coefficient (Dice) of 94.0±0.03 and Hausdorff Distance (HD95) of 2.28 mm in an independent set of subjects from the first institution. Moreover, our model generalized well in the studies from the other two institutions (Dice: 91.0±0.03; HD95: 3.7 mm and Dice: 82.0±0.03; HD95: 7.1 mm). We introduced an approach that successfully segmented the prostate on ultrasound images in a multi-center study, suggesting its clinical potential to facilitate the accurate fusion of ultrasound and MRI images to drive biopsy and image-guided treatments.

Objectives The aim of this study was to develop a model for predicting the Gleason score of patients with prostate cancer based on ultrasound images. Methods Transrectal ultrasound images of 838 prostate cancer patients from The Cancer Imaging Archive database were included in this cross-section study. Data were randomly divided into the training set and testing set (ratio 7:3). A total of 103 radiomic features were extracted from the ultrasound image. Lasso regression was used to select radiomic features. Random forest and broad learning system (BLS) methods were utilized to develop the model. The area under the curve (AUC) was calculated to evaluate the model performance. Results After the screening, 10 radiomic features were selected. The AUC and accuracy of the radiomic feature variables random forest model in the testing set were 0.727 (95% CI, 0.694-0.760) and 0.646 (95% CI, 0.620-0.673), respectively. When PSA and radiomic feature variables were included in the random forest model, the AUC and accuracy of the model were 0.770 (95% CI, 0.740-0.800) and 0.713 (95% CI, 0.688-0.738), respectively. While the BLS method was utilized to construct the model, the AUC and accuracy of the model were 0.726 (95% CI, 0.693-0.759) and 0.698 (95% CI, 0.673-0.723), respectively. In predictions for different Gleason grades, the highest AUC of 0.847 (95% CI, 0.749-0.945) was found to predict Gleason grade 5 (Gleason score ≥9). Conclusions A model based on transrectal ultrasound image features showed a good ability to predict Gleason scores in prostate cancer patients. Advances in knowledge This study used ultrasound-based radiomics to predict the Gleason score of patients with prostate cancer. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the efficacy and safety of transvaginal approach combined intracavitary and interstitial brachytherapy (IC/IS BT) assisted by transrectal ultrasound (TRUS) for treatment of locally advanced cervical cancer (LACC). Materials and Methods: A total of 30 patients of LACC treated with external beam radiotherapy and IC/IS BT via transvaginal approach assisted by transrectal ultrasound were observed retrospectively. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were analyzed using the Kaplan–Meier method. Late adverse events were also evaluated to assess the safety of IC/IS BT. Results: The median follow-up period was 22 months. The 2-year LC, PFS, and OS were 90%, 61%, and 82%, respectively. We observed no critical complications related to the IC/IS BT technique. Late adverse events of grade 3 or more included one case of grade 4 colon perforation. Conclusion: Our patient series demonstrated that radiotherapy combined with transvaginal approach, TRUS-assisted IC/IS BT achieves favorable local control and safety for LACC. [ABSTRACT FROM AUTHOR]

Many radiologists and urologists believe that magnetic resonance imaging (MRI) is superior to transrectal ultrasonography (TRUS) in the detection and assessment of prostate cancer. Thus, they relied on MRI alone for tumor characterization. However, the role of TRUS in prostate cancer assessment remains unclear. This information on TRUS findings can aid radiologists and urologists in detecting, targeting, and staging cancers. Additionally, there are some imaging features that are unseen on MRI, but are visible on TRUS. However, few studies have addressed the added value of TRUS in the preoperative evaluation of prostate cancer. This review aimed to assess the added value of TRUS to preoperative MRI for prostate cancer detection, characterization, and staging.

Objective: Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). Methods: A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as “targeted prostate biopsy”, “fusion prostate biopsy”, “cognitive prostate biopsy”, “MRI-guided biopsy”, and “transrectal ultrasound prostate biopsy”. Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. Conclusion: mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life.

Accurate prostate volume estimation is crucial for effective prostate disease management. Ultrasound (US) imaging, particularly transrectal ultrasound, offers a cost-effective and rapid assessment. However, US images often suffer from artifacts and poor contrast, making prostate volume estimation challenging. This review explores recent advancements in deep learning (DL) techniques for automatic prostate segmentation in US images as a primary step toward prostate volume estimation. We examine various DL architectures, including traditional U-Net modifications and innovative designs incorporating residual connections, multi-directional image data, and attention mechanisms. Additionally, we discuss pre-processing methods to enhance image quality, the integration of shape information, and strategies to improve the consistency and robustness of DL models. The effectiveness of these techniques is evaluated through metrics such as the Dice Similarity Coefficient, Jaccard Index, and Hausdorff Distance. The review highlights the potential of DL in improving prostate volume estimation accuracy and reducing clinical workload while also identifying areas for future research to enhance model performance and generalizability.

Purpose: Constructing a machine learning model based on transrectal ultrasound (TRUS) combined with contrast-enhanced ultrasound (CEUS) to predict preoperative regional lymph node metastasis (RLNM) of rectal cancer and provide new references for decision-making. Materials and methods: 233 patients with rectal cancer were enrolled and underwent TRUS and CEUS prior to surgery. Clinicopathological and ultrasound data were collected to analyze the correlation of RLNM status, clinical features and ultrasound parameters. A 75% training set and 25% test set were utilized to construct seven machine learning algorithms. The DeLong test was used to assess the model's diagnostic performance, then chose the best one to predict RLNM of rectal cancer. Results: The diagnostic performance was most dependent on the following: MMT difference (36), length (30), location (29), AUC ratio (27), and PI ratio (24). The prediction accuracy, sensitivity, specificity, precision, and F1 score range of KNN, Bayes, MLP, LR, SVM, RF, and LightGBM were (0.553–0.857), (0.000–0.935), (0.600–1.000), (0.557–0.952), and (0.617–0.852), respectively. The LightGBM model exhibited the optimal accuracy (0.857) and F1 score (0.852). The AUC for machine learning analytics were (0.517–0.941, 95% CI: 0.380–0.986). The LightGBM model exhibited the highest AUC (0.941, 95% CI: 0.843–0.986), though no statistic significant showed in comparison with the SVM, LR, RF, and MLP models (P > 0.05), it was significantly higher than that of the KNN and Bayes models (P

Purpose: Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx. Methods: A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound. Results: MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program. Conclusion: MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice. [ABSTRACT FROM AUTHOR]

Accurate and robust prostate segmentation in transrectal ultrasound (TRUS) images is of great interest for ultrasound-guided brachytherapy for prostate cancer. However, the current practice of manual segmentation is difficult, time-consuming, and prone to errors. To overcome these challenges, we developed an accurate prostate segmentation framework (A-ProSeg) for TRUS images. The proposed segmentation method includes three innovation steps: (1) acquiring the sequence of vertices by using an improved polygonal segment-based method with a small number of radiologist-defined seed points as prior points; (2) establishing an optimal machine learning-based method by using the improved evolutionary neural network; and (3) obtaining smooth contours of the prostate region of interest using the optimized machine learning-based method. The proposed method was evaluated on 266 patients who underwent prostate cancer brachytherapy. The proposed method achieved a high performance against the ground truth with a Dice similarity coefficient of 96.2% ± 2.4%, a Jaccard similarity coefficient of 94.4% ± 3.3%, and an accuracy of 95.7% ± 2.7%; these values are all higher than those obtained using state-of-the-art methods. A sensitivity evaluation on different noise levels demonstrated that our method achieved high robustness against changes in image quality. Meanwhile, an ablation study was performed, and the significance of all the key components of the proposed method was demonstrated. [ABSTRACT FROM AUTHOR]

Abstract Background To determine whether transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise is associated with immediate, early and long-term urinary continence after radical prostatectomy. Materials and methods Data from 114 patients with localized prostate cancer (PC) who underwent RP at Henan Cancer Hospital from November 2018 to April 2021 were included in the retrospective study. Of the 114 patients, 50 patients in the observation group underwent transrectal ultrasound and urologist_dually guided PFME, and 64 patients in the control group underwent verbally_guided PFME. Contractile function of the external urinary sphincter was in the observation group was evaluated. The immediate, early and long-term urinary continence rates were assessed in both groups, and the factors affecting urinary continence were analyzed. Results The urinary continence rate at 2 weeks and 1, 3, 6 and 12 months in the observation group after RP was significantly higher than that in the control group (52.0% vs. 29.7%, 70.0% vs. 39.1%, 82% vs. 57.8, 88% vs. 70.3%, 98.0 vs. 84.4%, p

Abstract Background Prostate biopsy (PB) is the gold standard for verifying the diagnosis of prostate cancer in men with clinical symptoms. Transrectal ultrasound (TRUS)-guided PB is the most common method for diagnosis; however, it has a few adverse effects. Mild consequences like bleeding and pain are prevalent but temporary. Since the relationship between erectile dysfunction and lower urinary tract symptoms (LUTS) and TRUS-guided PB is inconsistent in the literature, we aimed to conduct a study on these two consequences on males within 1 month following TRUS-guided PB. Methods Patients with a PSA ≥ 4 ml/ng who were determined to undergoTRUS-guided PB were enrolled in this prospective study. Patients' urinary symptoms and erectile function were evaluated using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) questionnaires the day before and 1 month after PB. Also, using uroflowmetry, the patients' urinary peak flow rate (Qmax) was recorded. SPSS version 18 was used to compare and analyze variables. Results The mean age of the participants was 67.47 ± 9.38 years. Before the PB, the IIEF-5 score was 20.19 ± 7.24, and after the PB, it was 20.25 ± 7.24 (p = 0.865). The Qmax level rose from 7.35 ± 2.15 to 7.74 ± 2 ml/s (p = 0.07). After TRUS-guided PB, the average IPSS score reduced from 11.48 ± 9.93 to 9.88 ± 8.22 which was statistically significant (p

Purpose: To investigate the diagnostic efficacy of fusion guided multiparametric MRI (mpMRI)—transrectal ultrasound (TRUS) biopsy versus systematic biopsy of the prostate in patients with suspicion of prostate cancer. Methods: A total of 185 patients with PI‐RADS 3 lesions or higher underwent fusion guided targeted and systematic prostate biopsy. Histology of samples was correlated with PI‐RADS score and biopsy method for each patient. Results: A total of 81/185 (43.8%) cases positive for cancer were detected; 23/81 (28.4%) cases with clinically insignificant prostate cancer—insPCa and 58/81 (71.6%) cases with clinically significant prostate cancer—csPCa. There was a statistically significant difference in the overall detection of adenocarcinomas between methods (p =.035, McNemar test). Moreover, there was a statistically significant difference in the detection of insPCa between the two methods (p =.004, McNemar test). Systematic biopsy detected 13 patients with insPCa more (14.4%) than the targeted biopsy method. However, there is no statistical difference in the detection rate of csPCa between the two methods (p = 1, McNemar test). When both techniques were combined more cases of csPCa were detected. Conclusion: The combined implementation of fusion‐guided targeted mpMRI–TRUS and systematic biopsy of the prostate provides higher detection number of csPCa, compared to each method alone. The potential of fusion‐guided mpMRI‐TRUS biopsy of the prostate needs to be further assessed since each method has its limitations; therefore, systematic prostate biopsy still plays an important role in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate the effectiveness of the additive transurethral anesthetic agent to transrectal anesthetic agent. Methods: Transrectal ultrasound-guided 12 core prostate biopsy planned, 237 patients included in our study. The patients randomly divided into two groups. Group 1 (n=113): Only transrectal 2% lidocaine, Group 2 (n=124): Transrectal + Transurethral(Sandwiches) lidocaine gel given to the patients 10 min before the procedure as anesthesia. Immediately after the biopsy, the patient questioned about the level of pain he felt during the needle entry. The evaluation measured by the VAS score. Immediately after biopsy satisfaction rate with the procedure and if rebiopsy was required, acceptance was scored between 1 and 4. The two groups compared statistically. Results: The mean VAS score of Group 1 and Group 2 was 4.88±1.89 and 3.77±1.83, respectively. The pain level of Group 2 was lower than Group 1' pain level. The difference between the two groups was considered statistically significant (p<0.001). The patient satisfaction rates of Group 1 and Group 2 found to be 2.45±0.71 and 2.78±0.66, and the acceptance rate of rebiopsy was 2.81±0.69 and 3.02±0.51, respectively. The patient satisfaction rate and acceptance rate of the rebiopsy of Group 2 were higher than Group 1. Patient satisfaction level (p<0.001) and rebiopsy acceptance rate (p=0.014) between the two groups found to be statistically significant. Conclusion: In the TRUS-guided prostate biopsies, sandwich anesthesia is a cheap, convenient, tolerable, and effective method. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore transrectal ultrasound (TRUS) findings of prostate cancer (PCa) guided by multiparametric magnetic resonance imaging (mpMRI) and to improve the Prostate Imaging Reporting and Data System (PI-RADS) system for avoiding unnecessary mpMRI-guided targeted biopsy (TB). From January 2018 to October 2019, fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients. The study included 188 suspicious lesions on mpMRI in 156 patients, all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy (SB). Univariate analyses were performed to investigate the relationship between TRUS features and PCa. Then, logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa. The detection rates of PCa based on TB alone, SB alone, and combined SB and TB were 55.9% (105 of 188), 52.6% (82 of 156), and 62.8% (98 of 156), respectively. The significant predictors of PCa on TRUS were hypoechogenicity (odds ratio [OR]: 9.595, P = 0.002), taller-than-wide shape (OR: 3.539, P = 0.022), asymmetric vascular structures (OR: 3.728, P = 0.031), close proximity to capsule (OR: 3.473, P = 0.040), and irregular margins (OR: 3.843, P = 0.041). We propose subgrouping PI-RADS score 3 into categories 3a, 3b, 3c, and 3d based on different numbers of TRUS predictors, as the creation of PI-RADS 3a (no suspicious ultrasound features) could avoid 16.7% of mpMRI-guided TBs. Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.

The purpose of this study was to analyze the value of transrectal shear-wave elastography (SWE) in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy (RP). Preoperative clinicopathological variables, multiparametric magnetic resonance imaging (mp-MRI) manifestations, and the maximum elastic value of the prostate (Emax) on SWE were retrospectively collected. The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology, and parameters with statistical significance were selected. The diagnostic performance of various models, including preoperative clinicopathological variables (model 1), preoperative clinicopathological variables + mp-MRI (model 2), and preoperative clinicopathological variables + mp-MRI + SWE (model 3), was evaluated with area under the receiver operator characteristic curve (AUC) analysis. Emax was significantly higher in prostate cancer with extracapsular extension (ECE) or seminal vesicle invasion (SVI) with both P < 0.001. The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa, respectively. Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE (model 2 vs model 1, P = 0.031; model 3 vs model 1, P = 0.002; model 3 vs model 2, P = 0.018) and SVI (model 2 vs model 1, P = 0.147; model 3 vs model 1, P = 0.037; model 3 vs model 2, P = 0.134). SWE is valuable for identifying patients at high risk of adverse pathology.

Background: To determine whether transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise is associated with immediate, early and long-term urinary continence after radical prostatectomy. Materials and methods: Data from 114 patients with localized prostate cancer (PC) who underwent RP at Henan Cancer Hospital from November 2018 to April 2021 were included in the retrospective study. Of the 114 patients, 50 patients in the observation group underwent transrectal ultrasound and urologist_dually guided PFME, and 64 patients in the control group underwent verbally_guided PFME. Contractile function of the external urinary sphincter was in the observation group was evaluated. The immediate, early and long-term urinary continence rates were assessed in both groups, and the factors affecting urinary continence were analyzed. Results: The urinary continence rate at 2 weeks and 1, 3, 6 and 12 months in the observation group after RP was significantly higher than that in the control group (52.0% vs. 29.7%, 70.0% vs. 39.1%, 82% vs. 57.8, 88% vs. 70.3%, 98.0 vs. 84.4%, p < 0.05). The contractile function of the external urinary sphincter was obviously correlated with urinary continence at multiple visits after RP, except for the 12-month visit. Transrectal ultrasound and urologist-dually guided PFME was verified to be an independent positive factor for urinary continence at 2 weeks and 1, 3, 6 and 12 months using logistic regression analysis. However, TURP was a negative factor for postoperative urinary continence at different times. Conclusions: Transrectal ultrasound and urologist_dually guided PFME had a significant role in improving immediate, early and long-term urinary continence after RP and acted as an independent prognostic factor. [ABSTRACT FROM AUTHOR]

Introduction: Prostate cancer is a common malignancy affecting men and the second leading cause of cancer related death in India. Numerous molecular biomarkers have been evaluated for their potential role in predicting disease progression, their response to therapy and survival. Erythroblast Transformation Specific (ETS) related Gene (ERG) is one of the newest addition in the existing list of biomarkers of prostate cancer. Aim: To analyse the expression of ERG in prostatic adenocarcinoma and to evaluate its association with World Health Organisation (WHO) grade group. Materials and Methods: This was a prospective observational study was conducted in the Department of Pathology in association with Department of Urology, IPGME&R, SSKM Hospital, Kolkata, West Bengal, India. The duration of the study was 1.5 years, from January 2019 to June 2020. A total of 267 cases of Transrectal Ultrasound (TRUS) guided tru-cut biopsy was included. Clinical data including preoperative Prostate Specific Antigen (PSA) level, Digital Rectal Examination (DRE) were obtained. Histopathological reports were prepared by two pathologists along with Gleason scoring and WHO grading as per 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Formalin Fixed Paraffin Embedded (FFPE) sections of representative blocks of each tumour was selected for Immunohistochemistry (IHC) study. Only the cases which had more than 10% nuclear staining were considered as positive. Statistical analysis was performed with help of Epi Info (TM) 7.2.2.2 and Chi-square test was used to test the association of different study variables. Results: The mean age of the study participants was 65.55 years, and the age range was 45-93 years. Among the 80 malignant cases where, ERG immunostaining was assessed, 28 cases (35%) showed positive expression. Among these positive cases, 50% cases were weakly positive, 28.57% showed moderate positivity and 21.43% had strong positive expression. Highest positivity was observed in WHO grade group V (44.83%). The intensity of ERG expression was also higher in high grade group (13) than low grade group cancer patients. Conclusion: ERG expression in the prostate cancer can be a prognostic factor as the expression and intensity of expression both increases with higher grade group of cancer. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound's versatility and ease of use has expanded its application in many clinical settings. Technological advancements with contrast-enhanced ultrasound (CEUS) have allowed high quality imaging similar to CT or MRI with lower risk of contrast toxicity and radiation exposure. In this review article we examine the development of CEUS and its vast applications in the field of urology. Methods: A PubMed literature search was performed using keywords: contrast enhanced ultrasound, prostate cancer, renal cancer, and multiparametric ultrasound. Results: The development of CEUS has improved transrectal ultrasound imaging with increased detection of prostate cancer (PCa). Further enhancements of CEUS such as subharmonic imaging (SHI), flash replenishment imaging (FRI) and contrast ultrasound dispersion imaging (CUDI) allow improved PCa diagnosis. CEUS has also emerged as an important tool in characterizing suspicious renal mass without compromising renal function with contrast imaging. Conclusion: CEUS has modernized imaging and diagnosis of prostate and renal cancer. Future advancements and utilization of CEUS will allow its expansion into other urological subspecialties. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the role of transrectal, transvaginal, or transperineal ultrasound (US) in evaluation of perianal fistula and to assess the possibility of its role as a first‐line investigation for diagnosis and for follow‐up as well as a possible substitute for magnetic resonance imaging (MRI). Methods: This is a retrospective observational study of 200 patients. All the patients complaining of discharging wound, acute or chronic pain in the perianal region and patients suspected clinically having perianal sinus/fistula, referred for ultrasound evaluation were included in the study. Male patients were scanned by transrectal and transperineal ultrasound, and females by transrectal, transvaginal and transperineal approach. All the patients were followed up with referring surgeon till surgical cure, discharge, and follow‐up. Out of total 200 patients, 47 were female and 153 were male patients. Patients were in age range from 16 to 74 years. The path, direction, extent, diameter and internal branching and openings of tracts were recorded. Presence, location and extent of any collection/abscess was also noted. Results: Fistulae and sinus tracts are seen as hypo to anechoic tracts ranging from 2 to 10 mm in diameter. Air and mixed echogenic moving collection were noted in active tracts. Fibrous tracts were seen as well defined, echogenic structures. Depending on the chronicity and localization, walls of abscesses appeared ill defined or well defined. Findings of transrectal, transvaginal, and transperineal USG were confirmed with intraoperative findings in 200 cases. Out of which 148 patients were followed up clinically till tracts were closed. In 54 patients, there was recurrence that were operated again and followed up with ultrasound. In total 33 had internal collection along the tracts and in the perianal region. Conclusion: Transrectal, transvaginal, and perineal ultrasound together have the potential to reach the sensitivity of MRI. Ultrasound has its greatest advantage in being cheap, easily reproducible and an excellent modality for follow‐up. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the use of rectal mucosal cleansings before transrectal ultrasound-guided prostate biopsy with a transrectal approach, comparing the safety profile of chlorhexidine and povidone-iodine.MethodsWe conducted a retrospective analysis of our prospectively maintained database between August 2019 to September 2020 in a high-volume hospital in Cali, Colombia. 428 consecutive patients who underwent TRUS-PB with a transrectal approach were included in this study. 117 patients received povidone-iodine and 311 patients received chlorhexidine for rectal mucosa cleansings. After the procedure, we conducted telephone follow-ups at 48 hours, 7 days, and 30 days. The complications were registered in our database. Analysis was performed using STATA 15.ResultsThere was a statistically significant increased risk of hematuria, urinary retention, and rectal bleeding in those patients exposed to Chlorhexidine (p

Objective To evaluate the teaching effect of stepped training model in transrectal ultrasound-guided transperineal prostate biopsy(PB). Methods Forty doctor trainees in the department of urology of Peking Union Medical College Hospital were randomly divided into two groups: experimental group and control group, with 20 trainees in each group. The experimental group received the stepped teaching model; The control group received the traditional training model. Both groups participated in the training of transperineal PB guided by transrectal ultrasound. One week later, all the members were tested for manipulation and surveyed by the teaching satisfaction questionnaires. Results Eighteen trainees in the experimental group could successfully perform transperineal PB independently, while only twelve trainees in the control group could operate independently, and the completion time of the experimental group was less than that of the control group(P＜0.01). The questionnaire survey showed that the teaching satisfaction score of trainees in the experimental group was higher than that in the control group(P＜0.01). Conclusions The stepped teaching model of transperineal PB guided by transrectal ultrasound is effective in clinical training.

Abstract Background Prostate cancer is the most common cancer in elderly men, and the second leading cause of cancer-related death in developed countries. For a long time, TRUS is used in screening, diagnosis of prostate lesions. Recently the implementation of multi parametric MRI into a screening program currently seems to be the most promising technique to improve the early detection of prostate cancer. Results Thirty Patients were referred from urological outpatient clinics complaining of urological symptoms (dysuria, frequency and urine retention). The study was carried, and the patients were submitted to Ultrasonography, conventional magnetic resonance, diffusion weighted images and MR spectroscopy techniques, these results were correlated with histopathological data. In this study Conventional MRI has moderate sensitivity 81.8% and low specificity 37.3% in diagnosing prostate malignancy. Using of mpMRI combination of diffusion-weighted, Dynamic contrast enhanced and MR spectroscopic imaging is a promising approach for discriminating between benign and malignant lesions in the PZ and increase sensitivity 100% and specificity 96.6% in diagnosing prostate malignancy. Conclusions The standard for the definitive diagnosis of prostate cancer is trans-rectal ultrasound biopsy. However, TRUS guided biopsy has a significant sampling error and can miss up to 30% of cancers and may show underestimation of Gleason grade, especially in anteriorly located tumors. It may lead to an increase in complications. MRI has an essential role to play in making safer in diagnosis. It can aid in staging also and surgery or radiation treatment planning. Although T2W MRI has been used widely for diagnosis on the basis of its excellent soft tissue resolution, but its accuracy for the detection and localization of cancer prostate is unsatisfactory. The implementation of multi parametric MRI: MR spectroscopy, Dynamic contrast enhanced and diffusion weighted imaging into a diagnosis program improve the diagnostic performance. These advances are beginning to translate into better treatment selection and more accurate image-guided therapies. In addition, early detection of local recurrence.

Introduction: Prostate cancer is a common malignancy affecting men and the second leading cause of cancer related death in India. Numerous molecular biomarkers have been evaluated for their potential role in predicting disease progression, their response to therapy and survival. Erythroblast Transformation Specific (ETS) related Gene (ERG) is one of the newest addition in the existing list of biomarkers of prostate cancer. Aim: To analyse the expression of ERG in prostatic adenocarcinoma and to evaluate its association with World Health Organisation (WHO) grade group. Materials and Methods: This was a prospective observational study was conducted in the Department of Pathology in association with Department of Urology, IPGME&R, SSKM Hospital, Kolkata, West Bengal, India. The duration of the study was 1.5 years, from January 2019 to June 2020. A total of 267 cases of Transrectal Ultrasound (TRUS) guided tru-cut biopsy was included. Clinical data including preoperative Prostate Specific Antigen (PSA) level, Digital Rectal Examination (DRE) were obtained. Histopathological reports were prepared by two pathologists along with Gleason scoring and WHO grading as per 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Formalin Fixed Paraffin Embedded (FFPE) sections of representative blocks of each tumour was selected for Immunohistochemistry (IHC) study. Only the cases which had more than 10% nuclear staining were considered as positive. Statistical analysis was performed with help of Epi Info (TM) 7.2.2.2 and Chi-square test was used to test the association of different study variables. Results: The mean age of the study participants was 65.55 years, and the age range was 45-93 years. Among the 80 malignant cases where, ERG immunostaining was assessed, 28 cases (35%) showed positive expression. Among these positive cases, 50% cases were weakly positive, 28.57% showed moderate positivity and 21.43% had strong positive expression. Highest positivity was observed in WHO grade group V (44.83%). The intensity of ERG expression was also higher in high grade group (13) than low grade group cancer patients. Conclusion: ERG expression in the prostate cancer can be a prognostic factor as the expression and intensity of expression both increases with higher grade group of cancer.

Objective: A reproduction management strategy is an essential component of any cattle production operation. Options include palpation per rectum, transrectal sonography, or biochemical blood tests. To determine the best method, veterinary costs must be weighed against operational costs of maintaining open cattle. Materials and Methods: An online literature search using PubMed, Medline, CINAHL, EBSCO, and Google Scholar was completed to find relevant articles regarding pregnancy detection in cattle, costs of reproductive management in cattle, and pregnancy loss in cattle. Priority was given to original research articles pertaining to palpation per rectum, transrectal ultrasound, fetal gender, and pregnancy loss. Results: Transrectal sonography can detect a pregnancy up to 15 days earlier than palpation per rectum and has sensitivities and specificities as high as 97% when performed between days 21 and 35 post artificial insemination. Conclusion: Cattle producers can be confident that transrectal sonography is a useful tool in the beef and dairy cattle industry. Its use facilitates reproductive management decisions, such as re-breeding or culling, thus reducing expenses, and increasing profitability. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is the most common cancer in elderly men, and the second leading cause of cancer-related death in developed countries. For a long time, TRUS is used in screening, diagnosis of prostate lesions. Recently the implementation of multi parametric MRI into a screening program currently seems to be the most promising technique to improve the early detection of prostate cancer. Results: Thirty Patients were referred from urological outpatient clinics complaining of urological symptoms (dysuria, frequency and urine retention). The study was carried, and the patients were submitted to Ultrasonography, conventional magnetic resonance, diffusion weighted images and MR spectroscopy techniques, these results were correlated with histopathological data. In this study Conventional MRI has moderate sensitivity 81.8% and low specificity 37.3% in diagnosing prostate malignancy. Using of mpMRI combination of diffusion-weighted, Dynamic contrast enhanced and MR spectroscopic imaging is a promising approach for discriminating between benign and malignant lesions in the PZ and increase sensitivity 100% and specificity 96.6% in diagnosing prostate malignancy. Conclusions: The standard for the definitive diagnosis of prostate cancer is trans-rectal ultrasound biopsy. However, TRUS guided biopsy has a significant sampling error and can miss up to 30% of cancers and may show underestimation of Gleason grade, especially in anteriorly located tumors. It may lead to an increase in complications. MRI has an essential role to play in making safer in diagnosis. It can aid in staging also and surgery or radiation treatment planning. Although T2W MRI has been used widely for diagnosis on the basis of its excellent soft tissue resolution, but its accuracy for the detection and localization of cancer prostate is unsatisfactory. The implementation of multi parametric MRI: MR spectroscopy, Dynamic contrast enhanced and diffusion weighted imaging into a diagnosis program improve the diagnostic performance. These advances are beginning to translate into better treatment selection and more accurate image-guided therapies. In addition, early detection of local recurrence. [ABSTRACT FROM AUTHOR]

Abstract Objectives To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy. Methods The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy. Results A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm3), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3. Conclusions Early prostate cancer, large prostate, effect of local anesthesia, doctor–patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.

Abstract Background To evaluate the diagnostic performance of multiparametric transrectal ultrasound (TRUS) and to design diagnostic scoring systems based on four modes of TRUS to predict peripheral zone prostate cancer (PCa) and clinically significant prostate cancer (csPCa). Methods A development cohort involved 124 nodules from 116 patients, and a validation cohort involved 72 nodules from 67 patients. Predictors for PCa and csPCa were extracted to construct PCa and csPCa models based on regression analysis of the development cohort. An external validation was performed to assess the performance of models using area under the curve (AUC). Then, PCa and csPCa diagnostic scoring systems were established to predict PCa and csPCa. The diagnostic accuracy was compared between PCa and csPCa scores and PI-RADS V2, using receiver operating characteristics (ROC) and decision curve analysis (DCA). Results Regression models were established as follows: PCa = − 8.284 + 4.674 × Margin + 1.707 × Adler grade + 3.072 × Enhancement patterns + 2.544 × SR; csPCa = − 7.201 + 2.680 × Margin + 2.583 × Enhancement patterns + 2.194 × SR. The PCa score ranged from 0 to 6 points, and the csPCa score ranged from 0 to 3 points. A PCa score of 5 or higher and a csPCa score of 3 had the greatest diagnostic performance. In the validation cohort, the AUC for the PCa score and PI-RADS V2 in diagnosing PCa were 0.879 (95% confidence interval [CI] 0.790–0.967) and 0.873 (95%CI 0.778–0.969). For the diagnosis of csPCa, the AUC for the csPCa score and PI-RADS V2 were 0.806 (95%CI 0.700–0.912) and 0.829 (95%CI 0.727–0.931). Conclusions The multiparametric TRUS diagnostic scoring systems permitted better identifications of peripheral zone PCa and csPCa, and their performances were comparable to that of PI-RADS V2.

John Panzone, Timothy Byler, Gennady Bratslavsky, Hanan Goldberg Urology Department, SUNY Upstate Medical University, Syracuse, NY, USACorrespondence: Hanan Goldberg, Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA, Tel +1-315-271-4173, Email gohanan@gmail.comAbstract: Transrectal ultrasound (TRUS) has been an invaluable tool in the assessment of prostate size, anatomy and aiding in prostate cancer (PCa) diagnosis for decades. Emerging techniques warrant an investigation into the efficacy of TRUS, how it compares to new techniques, and options to increase the accuracy of prostate cancer diagnosis. Currently, TRUS is used to guide both transrectal and transperineal biopsy approaches with similar cancer detection rates, but lower rates of infection have been reported with the transperineal approach, while lower rates of urinary retention are often reported with the transrectal approach. Multiparametric MRI has substantial benefits for prostate cancer diagnosis and triage such as lesion location, grading, and can be combined with TRUS to perform fusion biopsies targeting specific lesions. Micro-ultrasound generates higher resolution images that traditional ultrasound and has been shown effective at diagnosing PCa, giving it the potential to become a future standard of care. Finally, high-intensity focused ultrasound focal therapy administered via TRUS has been shown to offer safe and effective short-term oncological control for localized disease with low morbidity, and the precise nature makes it a viable option for salvage and repeat therapy.Keywords: transrectal ultrasound, prostate cancer, transperineal biopsy