Prostate cancer: diagnostic performance of real-time shear-wave elastography.

PURPOSE: To prospectively evaluate the performance of real-time ultrasonographic (US) shear-wave elastography (SWE) in the diagnosis of peripheral zone prostate cancer in patients with high and/or increasing prostate-specific antigen levels and/or abnormal digital rectal examination results. MATERIALS AND METHODS: After signing an informed consent form, men referred for transrectal prostate biopsy were enrolled in this prospective HIPAA-compliant two-center study, which was conducted with institutional review board approval. Transrectal US SWE of the prostate was performed after a conventional transrectal US examination and immediately before US-guided 12-core sextant biopsy. For each sextant, the maximum SWE value was measured and matched to the pathologic results of that sextant biopsy. The diagnostic performance of SWE was assessed at both patient and sextant levels. The elasticity value maximizing the Youden index was used to derive sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The elasticity values were matched to pathologic results for a total of 1040 peripheral zone sextants in 184 men. One hundred twenty-nine positive biopsy findings (size, ≥3 mm; Gleason score, ≥6) were identified in 68 patients. The sextant-level sensitivity, specificity, PPV, NPV, and area under the receiver operating characteristic curve for SWE with a cutoff of 35 kPa for differentiating benign from malignant lesions were 96% (95% confidence interval [CI]: 95%, 97%), 85% (95% CI: 83%, 87%), 48% (95% CI: 46%, 50%), 99% (95% CI: 98%, 100%), and 95% (95% CI: 93%, 97%), respectively. CONCLUSION: Use of a 35-kPa threshold at SWE may provide additional information for the detection and biopsy guidance of prostate cancer, enabling a substantial reduction in the number of biopsies while ensuring that few peripheral zone adenocarcinomas are missed.

Gender and Racial Diversity among U.S. Urology Residency Programs and Efforts to Improve It: You Can't Be What You Can't See.

INTRODUCTION: The U.S. urology workforce lacks ethnic and gender diversity. Few programs exist to increase diversity, and little is known on their effectiveness. We assessed the landscape of specific programs designed to increase underrepresented in medicine (URiM) and female student participation in the U.S. Urology Match, and understand the concerns and attitudes of those students. METHODS: To better understand urology-specific programs, we sent an 11-item survey to all 143 urology residency programs. To better understand the concerns and attitudes of URiM and female students participating in the U.S. Urology Match, we sent a 12-item survey to the students who participated in the Match from 2017 to 2021. Lastly, we evaluated trends in match rate using Match data from 2019 to 2021. RESULTS: Among programs, 43% responded to our survey. Most residency programs offer a wide array of initiatives to increase their diversity, with unconscious bias training being the most frequent (78.7%). Programs with at least 1 female faculty member were associated with increased recruitment of female residents over time (p=0.047). A similar trend was seen in programs with URiM faculty. Among students, 10.5% responded to our survey, of whom 79.2% were unaware of any programs at their institution geared toward URiM or female students. Match data revealed that women were more likely to match (p=0.002), and URiM students were less likely to match (p <0.001) compared to the overall Match rate. CONCLUSIONS: Urology programs are making substantial efforts to improve diversity, but the message is lacking reach. Having a diverse faculty did make a difference in programs' ability to diversify.

Business and Practice Readiness of Early Career Urologists: an Unmet Need.

INTRODUCTION: Business education in surgical residency, defined as contract negotiation, investing, financial planning and information on practice types, is currently lacking, and it is unknown if early career urologists possess this business education. Thus, we investigated how young urologists perceive their business knowledge and which vehicles of education they most prefer. METHODS: A 12-question survey was distributed to all urology residents, fellows and recent graduates to assess their self-reported business preparedness. Questions were administered concerning financial planning, familiarity with business models, ancillary income opportunities, coding and billing, contract negotiation, and awareness/use of AUA (American Urological Association) resources. Data were stratified by training year and practice type. The respondents were also asked their most preferred format for business education. RESULTS: A response rate of 10% was obtained with 230 total responses, including 89 (38.7%) from practicing urologists and 141 (61.3%) from trainees. The majority (88.3%) of respondents were not comfortable planning the business side of their practice and 71% were not aware of the AUA resources. Only 8% of practicing urologists and trainees were extremely comfortable with contract negotiation and 70% were not comfortable with assessing their own financial value. A majority was interested in podcasts, websites and online education. CONCLUSIONS: The survey results demonstrate a significant unmet need among early career urologists regarding business education. This self-reported lack of business literacy presents a blind spot in urological training. The development of an accessible business curriculum along with practical resources may have a vital role in the promotion of wellness and financial success among early career urologists.

Shear wave ultrasound elastography of the prostate: initial results.

PURPOSE: This prospective study was to evaluate shear wave elastography (SWE) in the detection of prostate cancer (PC). METHODS: Patients scheduled for a transrectal ultrasound (TRUS) biopsy of the prostate because of elevated prostate-specific antigen levels or abnormal digital rectal examination result underwent a standard TRUS and SWE. A second TRUS examination and sextant biopsy by a second physician blinded to SWE results was then performed. Pathologic result was reviewed, and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. RESULTS: A total of 53 patients (318 sextants) participated in the study. Mean age was 64.2 years (range, 53-79 years). A total of 26 foci of PC were detected in 11 patients (20.7%). On the basis of the receiver operating characteristic curve, a value of 37 kPa was used as the cutoff between benign and malignant. This produced a sensitivity of 96.2% (25/26), a specificity of 96.2% (281/292), a PPV of 69.4% (25/36), and an NPV of 99.6% (281/282). Six (55%) of 11 false-positive samples were secondary to benign calcifications. The Young modulus of PC ranged from 30 to 110 kPa (mean [SD], 58.0 [20.7] kPa). At the patient level, if a cutoff of 40 kPa was used, all PCs would have been detected, and the positive biopsy rate would be 11 (50%) of 22 compared to 11 (20.8%) of 53 without SWE--a 140% increase in the positive biopsy rate. CONCLUSIONS: Shear wave elastography has a high sensitivity, specificity, PPV, and NPV for the detection of PC. With a high PPV, patients with elevated prostate-specific antigen levels or abnormal results in the digital rectal examination and negative SWE may not require biopsy. This could significantly reduce the negative biopsy rate in PC detection.