Optimal PSA density threshold and predictive factors for the detection of clinically significant prostate cancer in patient with a PI-RADS 3 lesion on MRI.

INTRODUCTION: While Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions usually justify prostate biopsy (PBx), the management of a PI-RADS 3 lesion can be discussed. The aim of our study was to determine the optimal prostate-specific antigen density (PSAD) threshold and predictive factors of clinically significant prostate cancer (csPCa) in patients with a PI-RADS 3 lesion on MRI. PATIENTS AND METHODS: Using our prospectively maintained database, we conducted a monocentric retrospective study, including all patients with a clinical suspicious of prostate cancer (PCa), all of them had a PI-RADS 3 lesion on the mpMRI prior to PBx. Patients under active surveillance or displaying suspicious digital rectal examination were excluded. Clinically significant (csPCa) was defined as PCa with any ISUP grade group ≥ 2 (Gleason ≥ 3 + 4). RESULTS: We included 158 patients. The detection rate of csPCa was 22.2%. In case of PSAD ≤ 0.15 ng/ml/cm3, PBx would be omitted in 71.5% (113/158) of men at the cost of missing 15.0% (17/113) of csPCa. With a threshold of 0.15 ng/ml/cm3, the sensitivity and the specificity were 0.51 and 0.78 respectively. The positive predictive value was 0.40 and the negative predictive value was 0.85. According to multivariate analysis, age (OR = 1.10, CI95% 1.03-1.19, P = 0.007), and PSAD ≥ 0.15 ng/ml/cm3 (OR = 3.59, CI95% 1.41-9.47, P = 0.008) were independent predictive factors of csPCa. Previous negative PBx was negatively associated with csPCa (OR = 0.24, CI 95% 0.07-0.66, P = 0.01). CONCLUSION: Our result suggests that the optimal PSAD threshold was 0.15 ng/ml/cm3. However, in this case omitting PBx in 71.5% of cases would be at the cost of missing 15.0% of csPCa. PSAD should not be used alone, other predictive factors as age and PBx history should also be considered in the discussion with the patient, to avoid PBx while missing few csPCa.

Impact of Multiparametric MRI and PSA Density on the Initial Indication or the Maintaining in Active Surveillance During Follow-Up in low-Risk Prostate Cancer.

INTRODUCTION: A greater selection of candidates for active surveillance (AS) of prostate cancer (PCa) may decrease the rate of delayed treatment. We aimed to study: 1) the impact of MRI and PSA density (PSAd) at baseline on the final status, and 2) the impact of bio-clinical features during the follow-up on pursuing AS. MATERIALS AND METHODS: This retrospective, monocentric study between June 2013 and July 2020, included 99 patients in AS (median follow-up: 19 months [18-92]). All MRI were reviewed by a single radiologist. Lost to follow-up were 17 patients and 6 patients chose treatment by themselves. Treatment was proposed in case of upgrading (≥ GG2) or increasing PCa volume. RESULTS: Impact of MRI and PSAd at baseline:  Combining PSAd ≤ 0.15 and PIRADS ≤ 3, the probability to remain in AS was 72%. This rate reached 83% when PSAd ≤ 0.10 was associated to normal MRI.  During follow-up:  One hundred fifty-seven prostatic biopsies (PBx) were performed and 38 (24%) found PCa upgrading. The association between negative MRI and PSAd ≤ 0.10, during follow-up, had an excellent NPV to predict treatment (95%). This combination concerned 25% (37/151) of surveillance biopsies that could have been avoided at the cost of delaying upgrading in 3% (1/37). In multivariate analysis, only PIRADS ≥ 4 before PBx was associated to a risk of treatment during follow-up (OR, 10.4 [95% CI, 4.2-25.8]; P < .0001). CONCLUSION: Using PSAd and MRI at baseline to select patients showed excellent performances to predict the maintenance in AS. During follow-up, MRI PIRADS ≥ 4 was associated to an increased risk of treatment.

Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser.

OBJECTIVE: To evaluate the long-term reported clinical outcomes after photovaporization of the prostate (PVP) with the XPS-GreenLight laser in patients with symptomatic benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS: A prospective longitudinal study was performed for all consecutive patients with BPE who underwent PVP at our institution between 2010 and 2012. Patient-reported clinical outcomes were assessed at 1 mo, 3 mo, 12 mo, and 57 mo using International Prostate Symptoms Score, International Continence Society, and International Index of Erectile Function short-form questionnaires. Maximum flow rate (Qmax), postvoid residual urine measurements were assessed at 3 mo and 12 mo. Long-term satisfaction, complications, and reoperation rates were assessed by questionnaires. Prostate-specific antigen was measured at 3 mo, 12 mo, and 57 mo. INTERVENTION: A single surgeon (GF) has practiced photovaporization with a Moxy fiber, under transrectal ultrasonography monitoring. Long-term clinical outcomes were evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary measurement was the reoperation. RESULTS AND LIMITATIONS: Eighty-four patients of 102 answered the long-term questionnaire. The mean age was 68±7.2 yr. The mean follow-up was 57.4±6.8 mo. The mean prostate volume was 73±38ml. After treatment, the mean International Prostate Symptoms Score decreased significantly from 19.9±6.4 to 6.1±5.6, 3.9±3.4, and 5.9±5.8, respectively, at 3 mo, 12 mo, and 57 mo. The mean prostate-specific antigen level decreased significantly (-56%) from 4.5±4.3ng/ml preoperatively to 2.0±2.0ng/ml and 2.6±2.2ng/ml, respectively, at 12 mo and 57 mo. The mean Qmax increased from 9.6±3.8ml/s preoperatively to 23.9±11.5ml/s and 25.2±9.2ml/s, respectively, at 3 mo and 12 mo. Overall reoperation rate was 4.8%(4/84). Limitations include the single surgeon single center design study and the lack of long-term objectives data such as urodynamic parameters (postvoid residual urine and Qmax). CONCLUSIONS: Photovaporization of the prostate with the XPS-GreenLight laser is an effective technique able to durably improve reported clinical outcomes in patients with BPE. PATIENT SUMMARY: In this study we looked at the long-term outcomes after laser therapy with XPS-GreenLight laser for benign prostatic enlargement. We found a few reoperation rates and good stable reported clinical outcomes after a mean follow-up of 57 mo. We conclude that this laser technique can offer durably good reported clinical outcomes.

The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer.

OBJECTIVE: Compared with standard systematic transrectal ultrasound (TRUS)-guided biopsies (SBx), targeted biopsies (TBx) using magnetic resonance imaging (MRI)/TRUS fusion could increase the detection of clinically significant prostate cancer (PCa-s) and reduce non-significant PCa (PCa-ns). This study aimed to compare the performance of the two approaches. MATERIALS AND METHODS: A prospective, single-center study was conducted on all consecutive patients with PCa suspicion who underwent prebiopsy multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS). All patients underwent mpMRI/TRUS fusion TBx (two to four cores/target) using UroStation™ (Koelis, Grenoble, France) and SBx (10-12 cores) during the same session. PCa-s was defined as a maximal positive core length ≥4 mm or Gleason score ≥7. RESULTS: The study included 191 patients (at least one suspicious lesion: PI-RADS ≥3). PCa was detected in 55.5% (106/191) of the cases. The overall PCa detection rate and the PCa-s detection rate were not significantly higher in TBx alone versus SBx (44.5% vs 46.1%, p = .7, and 38.2% vs 33.5%, p = .2, respectively). Combined TBx and SBx diagnosed significantly more PCa-s than SBx alone (45% vs 33.5%, p = .02). PCa-s was detected only by TBx in 12% of cases (23/191) and only by SBx in 7.3% (14/191). Gleason score was upgraded by TBx in 16.8% (32/191) and by SBx in 13.6% (26/191) of patients (p = .4). CONCLUSIONS: The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.

Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival.

OBJECTIVES: Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as

[Idiopathic acute partial renal infarction]. / Infarctus rénal partiel aigu idiopathique.

Renal infarction is a rare disease which must be considered in any case of low back pain. The most frequent causes are related to emboligenic heart disease, renal artery fibrodysplasia or trauma. The authors report the second published case of idiopathic renal infarction. The diagnosis is usually suggested by contrast-enhanced abdominal CT scan, but is confirmed and refined by selective renal arteriography or CT angiography. Treatment may be medical or surgical depending on the severity of the lesions and the patient's general state. The therapeutic indications are discussed in the light of a review of the literature.

Allelic losses in localized prostate cancer: association with prognostic factors.

PURPOSE: Loss of heterozygosity (LOH) is the most consistent genetic alteration in prostate cancer (CaP), frequently associated with advanced cancer and metastasis. We performed LOH analysis on 6 chromosomal regions of interest in localized CaP to obtain an overview of allelic losses in organ confined tumors and test the association with the usual prognostic factors. MATERIALS AND METHODS: Tumoral and normal DNA were extracted from 48 radical prostatectomy specimens (all organ confined) with a Gleason score of 5 to 7. Biological and pathological data, such as prostate specific antigen (PSA), Gleason score and perineural invasion (PNI), were correlated with allelic losses at 7q31, 8p22, 12p13, 13q14, 16q23.2 and 18q21. Analysis was done by genotyping using highly informative microsatellites markers. RESULTS: The rate of LOH was 25% for chromosomes 13 and 18, and between 40% and 47% for chromosomes 7, 8, 12 and 16. The mean frequency of overall LOH events was less than 34%. Except for the 12p13 and 16q23.2 loci no significant correlation was found between LOH and PSA or Gleason score. PNI was significantly associated with LOH on 8p22 (p = 0.003) and with a high frequency of LOH events (greater than 34%) (p = 0.02). CONCLUSIONS: The frequency of allelic losses in localized and differentiated CaP is associated with PNI but not with the usual prognostic markers, such as PSA and Gleason score. The relationship between LOH on 8p22 and PNI suggests the presence on this region of a gene involved in epithelium/nerve interaction.