Effectiveness of Magnetic Resonance Imaging/Ultrasound-guided Target Biopsy in Detecting Clinically Significant Prostate Cancer.

BACKGROUND/AIM: To evaluate the effectiveness of magnetic resonance imaging/ultrasound (MRI-US)-guided fusion biopsy in the detection of clinically significant prostate cancer (CSPC) and analyze the clinical features of patients highly suspected of having prostate cancer (PCa) but shown to be negative in target biopsies (TB) among patients with prostate imaging reporting and data system (PI-RADS) 4 or 5 lesions on multiparametric MRI (mpMRI) evaluations. PATIENTS AND METHODS: We retrospectively evaluated all patients who underwent MRI/transrectal ultrasound (TRUS)-guided fusion biopsies at our institution between April 2018 and April 2022. All patients with at least one PI-RADS 3 or higher lesion and prostate-specific antigen (PSA) ≤20 ng/ml were enrolled in our study and subjected to TB in the region of interest (ROI). CSPC was defined as grade group (GG) ≥2 (equivalent to a Gleason score of 3+4). RESULTS: The detection rates of CSPC were higher in patients who underwent systematic biopsy (SB) and TB (54%; 177/328) than in those who underwent SB alone (39%; 128/328). Significant differences were noted in the detection of CSPC depending on age, prostate volume, PI-RADS score, PSA density (PSAD), number of biopsies obtained, lesion location, and ROI. CONCLUSION: MRI/TRUS-guided fusion prostate biopsy increased the detection rate of CSPC. PCa was less likely to be detected in patients with a low PSAD, large prostate volume and no family history among those with PI-RADS 4 or 5 lesions and should be considered in such patients and addressed by performing additional SB for improving CSPC detection rate.

The clinical impact of ureteroscopy for upper tract urothelial carcinoma: A multicenter study.

BACKGROUND: With the development of kidney-sparing surgery and neoadjuvant chemotherapy, ureteroscopic biopsy (URSBx) has become important for the management of upper tract urothelial carcinoma (UTUC). METHODS: We retrospectively analyzed data from 744 patients with UTUC who underwent radical nephroureterectomy (RNU), stratified into no ureteroscopy (URS), URS alone, and URSBx groups. Intravesical recurrence-free survival (IVRFS) was examined using the Kaplan-Meier method. We conducted Cox regression analyses to identify risk factors for IVR. We investigated differences between clinical and pathological staging to assess the ability to predict the pathological tumor stage and grade of RNU specimens. RESULTS: Kaplan-Meier curves and multivariate Cox regression revealed significantly more IVR and inferior IVRFS in patients who underwent URS and URSBx. Superficial, but not invasive, bladder cancer recurrence was more frequent in the URS and URSBx groups than in the no URS group. Clinical and pathological staging agreed for 55 (32.4%) patients. Downstaging occurred for 48 (28.2%) patients and clinical understaging occurred for 67 (39.4%) patients. Upstaging to muscle-invasive disease occurred for 39 (35.8%) of 109 patients with ≤cT1 disease. Clinical and pathological grading were similar for 72 (42.3%) patients. Downgrading occurred for 5 (2.9%) patients, and clinical undergrading occurred for 93 (54.7%) patients. CONCLUSION: URS and URSBx instrumentation will be risk factors for superficial, but not invasive, bladder cancer recurrence. Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred for a large proportion of patients with UTUC who underwent RNU. These data emphasize the challenges involved in accurate UTUC staging and grading.

Novel technique for cognitive magnetic resonance imaging-transperineal ultrasound fusion transperineal prostate biopsy with injection of bubbled jelly into urethra after abdominoperineal excision.

Introduction: Prostate biopsy is commonly performed using a transrectal ultrasound probe through a transrectal or transperineal approach. However, this is not possible for patients without a rectum. Case presentation: A 75-year-old male was referred to our hospital because of an elevated prostate-specific antigen and a suspicious prostate lesion (PIRADS 5) in the left peripheral zone. The patient had previously undergone abdominoperineal resection for rectal cancer, which excluded the use of transrectal ultrasound. We describe the use of the transperineal ultrasound-guided biopsy with cognitive magnetic resonance imaging-transperineal ultrasound fusion and the utility of the injection of bubbled lidocaine jelly into urethra to improve its visualization. The pathological findings revealed clinically significant cancer with a Gleason score of 5 + 4. Conclusion: Cognitive magnetic resonance imaging-transperineal ultrasound fusion transperineal prostate biopsy with injection of bubbled jelly into urethra is a feasible and practical technique that does not require any specialized equipment.

Comparison of neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma in real-world practice: a multicenter retrospective study.

BACKGROUND: Multiple studies have demonstrated the effectiveness of neoadjuvant chemotherapy and adjuvant chemotherapy in patients with upper tract urothelial carcinoma compared with surgery alone. However, no clinical trial has established the superiority of neoadjuvant chemotherapy or adjuvant chemotherapy in terms of perioperative outcomes. METHODS: We conducted a retrospective analysis encompassing 164 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy and received perioperative chemotherapy. Of these patients, 65 (39.6%) and 99 (60.4%) received neoadjuvant chemotherapy and adjuvant chemotherapy, respectively. Recurrence-free survival and cancer-specific survival were computed using the Kaplan-Meier method. Additionally, we conducted Cox regression analyses to evaluate the risk factors for recurrence-free survival and cancer-specific survival. RESULTS: Pathological downstaging was seen in 37% of the neoadjuvant chemotherapy group. However, no pathological complete response was observed in this cohort. The Kaplan-Meier curves demonstrated significantly lower recurrence-free survival and cancer-specific survival in patients who received adjuvant chemotherapy. Multivariate Cox regression analysis revealed patients treated with adjuvant chemotherapy exhibited a marked association with inferior recurrence-free survival and cancer-specific survival. CONCLUSION: Our study has suggested that neoadjuvant chemotherapy would be more effective in high-risk upper tract urothelial carcinoma patients compared with adjuvant chemotherapy.