The Prognostic Association of Prostate MRI PI-RADS™ v2 Assessment Category and Risk of Biochemical Recurrence after Definitive Local Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis.

PURPOSE: Although the Prostate Imaging-Reporting and Data System™ version 2 (PI-RADS™ v2) is a reliable diagnostic tool for significant prostate cancer, less is known about the prognostic significance of the structured reporting scheme for estimating oncologic outcomes after treatment. We aimed to synthesize the available evidence regarding the association of PI-RADS v2 score and risk of biochemical recurrence (BCR) among patients undergoing primary definitive treatment for prostate cancer. MATERIALS AND METHODS: We systematically queried the PubMed® and Web of Science™ databases to identify studies addressing the association between the PI-RADS v2 and treatment outcomes. We included studies through November 2020 that assessed the independent prognostic significance of PI-RADS v2. After assessing risk of bias and quality, we conducted a formal meta-analysis to estimate the pooled effects of prostate magnetic resonance imaging (MRI) classification on the risk of BCR. RESULTS: We identified 9 and 7 eligible studies including 2,274 and 1,215 patients for the systematic review and meta-analysis, respectively. Eight were conducted in the context of radical prostatectomy and 1 post-radiation. Among patients treated with radical prostatectomy, higher PI-RADS v2 scores were significantly associated with risk of BCR (pooled HR 3.06, 95% CI 2.16-4.33; p <0.01). There was no significant heterogeneity among studies. For all studies, PI-RADS v2 score remained significantly associated with BCR (pooled HR 3.19, 95% CI 2.28-4.45; p <0.01). CONCLUSIONS: Prostate MRI findings assessed with the PI-RADS v2 classification were independently associated with risk of BCR after definitive local therapy, primarily based on data from radical prostatectomy. These findings support the prognostic significance of MRI, in addition to its role in prostate cancer diagnosis.

The EZ Trainer: validation of a portable and inexpensive simulator for training basic laparoscopic skills.

PURPOSE: We assessed the face and content validity of a new portable laparoscopic trainer, the EZ Trainer. MATERIALS AND METHODS: The portable, affordable EZ trainer system was conceived, designed and commissioned by academic surgeons from the departments of urology at our 2 institutions with the express purpose of advancing laparoscopic surgical training. A total of 42 participants, including general surgeons, obstetricians/gynecologists, urologists and industry representatives, assessed the face and the content validity of the trainer using a standard questionnaire. Participants were stratified into high (greater than 30 laparoscopic cases per year) and low (less than 30 cases per year) volume laparoscopists. RESULTS: Of the participants 96% rated the trainer as a realistic laparoscopic training format. Of high volume laparoscopists 81.5% rated the trainer as comfortable to use, 92.6% found that the trainer was a realistic practice format, 70.4% would purchase the trainer for personal use and 85.2% would recommend that the trainer be made available to surgical residents in their discipline. Of low volume laparoscopists 87% rated the trainer as comfortable to use, 93.3% found that the trainer was a realistic practice format, 73.3% would purchase the trainer for personal use and 80% would recommend that the trainer be made available to diverse surgical residents. CONCLUSIONS: The EZ trainer system has face and content validity as a portable laparoscopic trainer across a broad range of surgical disciplines.