Significant prostate cancer risk after MRI-guided biopsy showing benign findings: Results from a cohort of 381 men.

BACKGROUND: MRI-guided biopsy (MGB) contributes to the diagnosis of clinically significant Prostate Cancer (csPCa). However, there are no clear recommendations for the management of men after a negative MGB. The aim of this study was to assess the risk of csPCa after a first negative MGB. METHODS: Between 2014 and 2020, we selected men with a PI-RADS score ≥ 3 on MRI and a negative MGB (showing benign findings) performed for suspected prostate cancer. MGB (targeted and systematic biopsies) was performed using fully integrated mobile fusion imaging (KOELIS). The primary endpoint was the rate of csPCa (defined as an ISUP grade ≥ 2) diagnosed after a first negative MGB. RESULTS: A total of 381 men with a negative MGB and a median age of 65 (IQR: 59-69, range: 46-85) years were included. During the median follow-up of 31 months, 124 men (32.5%) had a new MRI, and 76 (19.9%) were referred for a new MGB, which revealed csPCa in 16 (4.2%) of them. We found no statistical difference in the characteristics of men diagnosed with csPCa compared with men with no csPCa after the second MGB. CONCLUSION: We observed a risk of significant prostate cancer in 4% of men two years after a negative MRI-guided biopsy. Performing a repeat MRI could improve the selection of men who will benefit from a repeat MRI-guided biopsy, but a clear protocol is needed to follow these patients.

MRI evaluation following partial HIFU therapy for localized prostate cancer: A single-center study.

OBJECTIVE: To evaluate the value of MRI for surveillance of primary hemi-HIFU therapy for localized PCa in a single-center. PATIENTS AND METHODS: Patients with localized prostate cancer were treated with hemi-HIFU from October 2009 to March 2014. All patients performed MRI before focal therapy, the reader was blinded to the treatment. Oncological failure was defined as positive biopsy or biochemical recurrence (Phoenix). RESULTS: Twenty-five patients were treated with hemi-HIFU in one center. The median nadir PSA was 1.45±1.4ng/mL. Prostate volume decreased from 45 cc to 25 cc on MRI findings. At 20 months, none of the patients had histological recurrence. Biochemical-free survival rate was 88%. MRI evaluation had a negative predictive value of 100% on the treated area and 81% on the untreated area. PSAd≥0.1ng/mL(2) was a predictive factor for cancer on untreated area (P=0.042). CONCLUSION: MRI control at 6 months is a potentially effective evaluation of treated area after hemi-HIFU and may replace randomized biopsies if PSAd<0.1ng/mL(2) during follow-up. LEVEL OF EVIDENCE: 4.

[XPS Greenlight photoselective vaporization for benign prostatic hyperplasia: analysis of the learning curve and contribution of transrectal ultrasound monitoring]. / Traitement de l'hyperplasie bénigne de prostate par photovaporisation au laser Greenlight XPS: analyse de la courbe d'apprentissage et apport de l'échographie endorectale peropératoire.

INTRODUCTION: The aim of this study was to analyze the XPS laser learning curve of one single surgeon with no previous experience of PVP and the impact of the use of reel time transrectal ultrasound (TRUS) monitoring. MATERIALS AND METHODS: Retrospective analysis of the first 100 patients: group 1 (1st-49th patient without TRUS) and group 2 (50th-100th with TRUS). The learning curve was analyzed through technical variables: vaporization time/intervention time (VT/IT) (%), energy delivered (J)/prostate volume (J/mL) and delivered energy (J/s or Watt), peroperative conversion into monopolar transurethral resection, postoperative complication, duration of catheterization and hospitalization and evolution of International Prostate Symptom Score (IPSS), PSA level, prostate residual volume and Qmax. Relationships between variables were evaluated by analysing the covariance (R 2 software. 14.2). RESULTS: A significant increase in VT/IT (P=0.0001) and the energy delivered per mL prostate (P=0.043) was reported in group 1. The average energy delivered per second was significantly higher in group 2 (P=0.0016). No difference was observed in terms of intra- or postoperative complication and catheterization time. The duration of hospitalization was significantly shorter in group 2 (P=0.03). The use of TRUS was associated with a gain of energy delivered by prostate volume at the end of learning curve (P=0.018). Prostate residual volume was significantly lower in the group 2 (P=0.0004). CONCLUSION: In our experience, 50 procedures are required to achieve the learning curve of PVP. The use of reel time TRUS would increase the energy delivered by prostate volume.

TRUS-MRI image registration: a paradigm shift in the diagnosis of significant prostate cancer.

Accuracy of multiparametric MRI has greatly improved the ability of localizing tumor foci of prostate cancer. This property can be used to perform a TRUS-MR image registration, new technological advance, which allows for an overlay of an MRI onto a TRUS image to target a prostate biopsy toward a suspicious area Three types of registration have been developed: cognitive-based, sensor-based, and organ-based registration. Cognitive registration consists of aiming a suspicious area during biopsy with the knowledge of the lesion location identified on multiparametric MRI. Sensor-based registration consists of tracking in real time the TRUS probe with a magnetic device, achieving a global positioning system which overlays in real-time prostate image on both modalities. Its main limitation is that it does not take into account prostate and patient motion during biopsy. Two systems (Artemis and Uronav) have been developed to partially circumvent this drawback. Organ-based registration (Koelis) does not aim to track the TRUS probe, but the prostate itself to compute in a 3D acquisition the TRUS prostate shape, allowing for a registration with the corresponding 3D MRI shape. This system is not limited by prostate/patient motion and allows for a deformation of the organ during registration. Pros and cons of each technique and the rationale for a targeted biopsy only policy are discussed.

[Is statin use associated with D'Amico risk groups and biochemical recurrence after radical prostatectomy?]. / Impact de la prise de statines sur les groupes à risques de progression de D'Amico et la survie sans récidive biologique après prostatectomie totale.

OBJECTIVE: To examine the association between statin use and prostate cancer (PC) stratified with D'Amico risk groups and biochemical recurrence (BR) in patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS: All medical charts of patients managed from 2004 to 2008 for PC with RP were reviewed retrospectively. The use and the type of statin were identified. Patients were split according to the use (S+) or not (S-) of statin. The two groups were compared using the Chi(2) test. A logistic regression was performed for multivariate analysis. RESULTS: Overall, 377 patients were included. Mean age was 64 (48-76) (median, range). Ninety-seven patients (27.5%) used statin for at least a year. Groups S- and S+ were comparable in terms of age, obesity, diabetes, preoperative PSA, biopsy Gleason score or clinical stage. The use of statin was statistically associated with D'Amico risk groups (P=0.003). The number of high-risk PC was higher in Group S+ (23.7% vs. 10.7%) with an odds ratio of 2.4 (P=0.009). With a mean follow up of 33±10 months, the overall 2-years-BR was 89%. The 2-years-BR was higher in the S+ (93% vs. 88%, P=0.16). After adjustment, this difference was statistically significant with a hazard ratio of 0.46 (P=0.036). CONCLUSION: The use of statin was associated with high risk PC in this study. Surprisingly, the statin use seem also to be associated with better disease-free survival, independently of other risk factors.

[Recent advances in contrast-enhanced ultrasound for oncology applications]. / Développements récents en imagerie ultrasonore de contraste à visée oncologique.

The combined use of high-end ultrasound units and sonographic contrast agents provide valuable information for lesion characterization and follow-up of patients under targeter treatments, especially oncologic patients. Early published results for liver pathology have created a place for this technique as a reference method leading to the publication of European guidelines. New oncologic applications have emerged over the last several years for lesions accessible by ultrasound with varied diagnostic value based on each target organ. Contrast-enhanced sonography is rapidly gaining ground for the follow-up of patients under targeted treatment, physical or drug induced, with major implications for the validation of concepts, and management of patients based on reliable early evaluation of therapeutic response to treatment. The purpose of this paper is to review recent advances in this field of sonographic imaging to better understand the role of ultrasound in oncologic pathology.

[MRI and staging evaluation of prostate cancer]. / IRM et bilan d'extension du cancer de la prostate.

MRI can assess local and locoregional spread of a newly diagnosed prostate cancer by detecting extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node invasion. Endorectal MRI remains the only accurate means to assess local extension. Pelvic MRI with surface coils and the use of superparamagnetic particules provide the sensitivity and the specificity which have never been obtained by the sole measurement of node size of the lymphatic chains draining the prostate gland. With the endorectal coil, only direct signs of extracapsular extension have been maintained and indirect signs have been discarded, giving their too low specificity. Early SVI can only be consistently detected if result of TRUS guided biopsies show involvement of the prostate base. With the pelvic phased array coil, superparamagnetic particules show that metastatic lymph nodes have a specific MR signal which can be detected in normal size nodes. Indications of imaging relies on results of parametrers available before MR imaging. More important than PSA level and Gleason score on biopsies is the so called quantitative histology, represented by the number of sextants involved by tumor and the amount of cancer (measured in mm of tumor) present on biopsies which determine a risk of extraprostatic spread. Of the risk of extraprostatic spread depends indication of MR, which is most probably unnecessary in patients at low risk (<20%) of extraprostatic extension.

[Predicting prostate cancer with dynamic endorectal coil MR and proton spectroscopic MR imaging]. / Détection du cancer de la prostate par IRM endorectale dynamique et spectroscopique-proton.

PURPOSE: Determine the feasibility of dynamic gadolinium enhanced MRI and spectroscopic imaging in routine clinical practice using standard equipment and its usefulness for patients with negative biopsies and high degree of suspicion of prostate cancer. PATIENTS AND METHODS: Fifty five patients underwent endorectal MRI using T2W spin echo (SE) imaging, dynamic gadolinium enhanced imaging and proton spectroscopic imaging before repeat US-guided transrectal biopsies. The statistical analysis consisted in the correlation of the results obtained with each of the two MRI techniques and the results of the biopsies in the corresponding prostate lobe. RESULTS: 32 patients were included in the analysis. Biopsies revealed cancer for 15 patients. The statistical analysis showed a lack of significant correlation between T2W-SE imaging and biopsy results. A correlation with statistical significance was found between dynamic gadolinium enhanced imaging and biopsies (p=0,0018) and between spectroscopic imaging results and biopsies in the corresponding lobe (p=0,0001). CONCLUSION: Endorectal MRI with a standard clinical equipment using dynamic gadolinium enhanced imaging and spectroscopic imaging may be used in clinical routine to improve detection and localization in prostate cancer compared to T2 weighted spin echo imaging.

Trans-rectal ultrasonography (TRUS) with lipiodol injection for localization of the prostatic apex before radiotherapy planning.

PURPOSE: To evaluate reliability of Trans-rectal ultra-sonography (TRUS) guidance with lipiodol injection for prostate localization before radiotherapy planning. MATERIAL AND METHODS: From October 1997 to March 2000, 31 patients with prostatic adenocarcinoma and six patients with anastomotic recurrence after radical prostatectomy had TRUS-guided injection of lipiodol. Two milliliters of lipiodol were injected into each side of the prostate and 1 ml into both seminal vesicles with a 22 Gauge CHIBA needle and US probe guide before radiotherapy planning. We had established a contrast quality index (0 for no prostate enhancement to 5 for efficient pacification without any diffusion). On simulation films, we had performed anatomic measurements for comparison with other anatomic studies. RESULTS: For all 37 patients, TRUS-guided injection was well tolerated. Among 31 patients with the prostate in situ, three had no apex opacification and 15 had no vesicle enhancement or peri-vesicle space diffusion. However, in 19 patients there was good contrast quality with an index score of > or =3. The majority of patients had prostatic apex between 1.5 and 3.5 cm from ischial tuberosities ligne (27 from 28 evaluable for apex). Among 19 evaluable patients, 15 had seminal vesicles 2-4 cm above the top of pubis. For six patients with anastomotic recurrence after radical prostatectomy, lipiodol was precious aid to locate it. We had only one failure because of a precocious bladder absorption relating to a delay which is too long between rectal probe locating and portal films. CONCLUSION: TRUS injection of lipiodol is a simple, inexpensive, relatively safe technique for localization of prostatic apex, but not appropriate for seminal vesicles enhancement. This is also an interesting method to locate anastomotic recurrence.

Radiologic features of a metastatic carcinoma to the ureter.

2 cases of metastasis to the ureter from carcinoma of the stomach are presented. The clinical and radiologic features are reviewed. Metastasis to the ureter is rare. A plea for vigorous evaluation and early detection of this entity is made.

Ultrasonographic patterns of testicular non-Hodgkin's lymphoma: a report of five cases.

We report five cases of non-Hodgkin's testicular lymphoma. All have the same ultrasonographic findings: well-defined areas of low degree of echogenicity within the testis. Ultrasonography could be a good means of routine study for a scrotal mass before orchiectomy and for a follow-up of contralateral testis after orchiectomy.

[Is percutaneous transluminal angioplasty of the femoral and popliteal arteries a justifiable procedure? A discussion in relation to 58 attempts]. / L'angioplastie transluminale percutanée (ATP) des artères fémorales et poplitées est-elle justifiée? Réflexions à propos de 58 tentatives.

Angioplasty of the femoral and popliteal arteries was attempted in 58 cases over a period of 2 years. Ideal cases for treatment by percutaneous transluminal angioplasty (PTA) are those with stenoses less than 3 cm or obliterations less than 6 cm in length where the onset was between 6 months and 2 years previously. Immediate success was obtained in 50 cases (86 patients), failures usually being observed in very advanced cases. Permeability after 2 years, by actuarial calculation, was observed in 85 p. cent of cases and there were 7 complications (12 p. cent) in the 58 patients, one of whom required urgent surgery. This method represents an alternative procedure to conventional surgical shunts in young subjects, those at high surgical risk, and those with lesions in two zones. These results illustrate the value of early diagnosis, by arteriography of the lower limbs, to detect recent lesions responding best to PTA and thus to gain time in the long and painful history of this disease.