[Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: A single center experience.] / Comparación de la resonancia magnética biopsia próstata transrectal guiada por ultrasonido con fusión de resonancia magnética con la biopsia próstata sistemática: resultados de un solo centro.

OBJECTIVE: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates. PATIENTS AND METHODS: The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests. RESULTS: A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy. CONCLUSION: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.

OBJETIVO: Comparar la biopsia sistemática próstata con fusión de resonancia transrectal vs la biopsia prostática sistemática, en términos de detección de cáncer de próstata.PACIENTES Y MÉTODOS: Los datos de pacientes con RNM y PIRADS (Prostate Imaging Reporting and Data System) 3 o más y que recibieron una biopsia prostática transrectal con biopsia simultanea de 12 cilindros sistemática entre junio 2016 y junio 2019 en nuestro centro académico fueron retrospectivamente revisados. Los datos radiológicos, clínicos y patológicos fueron también revisados. La diferencia estadística entre los grupos fue determinada utilizando los tests de McNemar. RESULTADOS: Un total de 344 pacientes fueron incluidos en el estudio. Como resultado de la biopsia transrectal sistemática y dirigida, 117 pacientes fueron diagnosticados de cáncer de próstata. Las tasas de patología benigna en pacientes con PIRADS 3, PIRADS 4 y PIRADS 5 fueron de 93,8%, 68,5%, y 46,4%, respectivamente. Los pacientes fueron divididos en 2 grupos como ISUP grado 1 y ISUP grado 2 o más, las tasas de detección de cáncer fueron superiores en los pacientes que recibieron una biopsia transrectal dirigida vs sistemática (12,5% vs. 6,4%, p=0,007 y 17,4% vs. 8,7%, p<0,001, respectivamente). La detección de cáncer por biopsia dirigida fue superior en pacientes con alta densidad de PSA (24,5% vs. 41,4%, p=0,001) a diferencia de la biopsia sistemática.CONCLUSIÓN: La biopsia transrectal dirigida fue superior a la biopsia sistemática en el diagnóstico de cáncer de próstata. Los clínicos deberían ser más selectivos al tomar la decisión de qué biopsia hacer en un paciente con PIRADS 3. La densidad de PSA se puede utilizar como criterio para realizar una biopsia dirigida.

The role of histopathological and biochemical parameters for predicting metastatic disease on 68 Ga-PSMA-11 PET in prostate cancer.

BACKGROUND: The aim of this study was to evaluate the role of histopathological and biochemical parameters in the prediction of the presence and number of PSMA positive lesions consistent with the metastatic spread of prostate cancer on 68 Ga-PSMA PET images. METHODS: Biochemical, histopathological and imaging data of 302 prostate cancer patients who underwent 68 Ga-PSMA-11 PET/CT or PET/MR imaging for primary staging were retrospectively analyzed. Patients were divided into two groups as "PET positive" and "PET negative" according to the presence of pathologic extraprostatic PSMA involvement. "PET positive" patients were additionally divided into two groups: oligometastatic (1-3 metastatic lesion) and multimetastatic (>3 metastatic lesions). RESULTS: The mean age of patients was 66.8 ± 7.6 years. Imaging modality was PET/MR in 223 (73.8%) and PET/CT in 79 (26.2%) of patients. Total PSA, PSA density (PSAD), ALP, and tumor ratio in biopsy specimens were found to be significantly higher in "PET positive" group compared to "PET negative" group and in multimetastatic group compared to oligometastatic group. PET positivity was observed in 3.8% of the low-intermediate risk groups (ISUP 1-3 and total PSA ≤ 20 ng/ml and PSAD < 0.15 ng/ml/cc). This ratio was 46% in the high-risk group (ISUP 4-5 or total PSA > 20 ng/ml or PSAD ≥ 0.15 ng/ml/cc) with a relative risk of 12 (p < .001). The prediction models to predict the PET positivity and the presence of distant metastasis had AUCs of 0.901 and 0.925, respectively; with ALP, total PSA, and tumor ratio in needle biopsy specimen as significant independent predictors (p < .05). CONCLUSIONS: In this study, 68 Ga-PSMA-11 PET positivity was significantly higher in the high-risk patient group than in the low-intermediate risk groups. The prediction models used for predicting the PET positivity and the presence of distant metastasis on PET imaging were successful with high discriminatory powers. In addition to total PSA and ISUP GG, ALP and tumor ratio in biopsy specimens can be used to identify high-risk patients.

External validation of a prostate cancer nomogram on magnetic resonance/transrectal ultrasound fusion biopsy in men with prior negative systematic biopsy.

OBJECTIVE: To observe how the nomogram, which was created by Truong et al, works in an independent patient group by performing external validation. PATIENTS AND METHODS: One hundred and eighty-one patients who had at least one prior negative 12-core standard systematic biopsy and lesions with PI-RADS scores of 3 or higher that were detected as a result of mpMRI were included in the study. Targeted biopsy with 12-core standard systematic biopsy was performed on all patients. Clinical and pathological features of the patients were recorded. The discrimination, calibration and decision curve analysis were performed to externally validate the nomogram. RESULTS: A total of 181 patients with previous negative 12-core systematic biopsies were analysed. One hundred and thirty-four patients (74%) had benign pathology. Radiological volume and PI-RADS scores of 4 and 5 were found as independent predictors of benign pathology. The area under the curve (CI 95%) was found to be 0.80 (0.73-0.87), indicating good discrimination. The median residual was calculated as -0.0873, the intercept as -0.0690, the slope as 0.8927 and r2 as 0.2586, indicating good calibration. The standardised net benefit of follow-up decisions was found to be 0.54 and 0.36 at the probability threshold of 0.7 and 0.8, respectively. CONCLUSION: The original model showed good discrimination and calibration with our data. Defining a high probability threshold for clinical use would be appropriate for centres with high benign biopsy rates similar to our centre.

Comparison of corporal plication for the correction of congenital penile curvature in pre-pubertal and post-pubertal patients: Does age matter?

We retrospectively reviewed and compared the results of corporal plication procedures for the correction of congenital penile curvature (CPC) between pre-pubertal and post-pubertal boys and find whether age matters in the success rates. We reviewed the records of 32 patients with CPC without hypospadias treated by simple plication near the 12 o'clock position between 1998 and 2018 in our clinic. Patients under 13 years of age and not had puberty yet were accepted as pre-pubertal. Residual curvature less than 10° during follow-up was accepted as a surgical success. The mean age of the pre-pubertal group was 8.3 (2-12) years, while 16.2 (14-21) for the post-pubertal patients. The mean follow-up was 38.7 (24-154) months in the pre-pubertal group and 45.1 (23-150) months in the post-pubertal group. The success rates of corporal plication in pre-pubertal and post-pubertal groups were 78% and 83% respectively (p = .753). The success rates of corporal plication were similar between pre-pubertal and post-pubertal boys. However, as the series was small further studies should be favoured to determine the effect of age on success rates.