Do commonly used prostate medications alter prostate MRI and fusion biopsy performance?

AIMS: To determine whether phosphodiesterase inhibitors (PDEi) or α-antagonists (AA) were associated with differences in region of interest (ROI) characteristics or prostate cancer detection on fusion biopsy (FB). MATERIALS AND METHODS: Records from 847 consecutive patients undergoing FB at three separate institutions over a period of 2 years were retrospectively reviewed. Associations between medication use, Prostate Imaging Reporting & Data System (PIRADS) scores, and ROI locations were assessed with ordinal logistic regression. Associations with lesion size and International Society of Urologic Pathology (ISUP) grade group (GG) on biopsy were tested using multivariate regression. RESULTS: Medication use included PDEi in 14.2% and AA in 23.0%. PDEi use was associated with 19.3% smaller lesion diameter (-2.8 mm; CI from -4.8 to -0.7; p < 0.01) and lower PIRADS scores on MRI (OR 0.60; CI 0.40 - 1.00; p = 0.05). AA use was associated with higher PIRADS scores (OR 1.43; CI 0.97 - 2.11; p = 0.06), fewer positive fusion-directed biopsy cores (-28.6%, CI from -57.9 to 0.01%, p = 0.05), and downgrading on final pathology (-19%; CI from -40 to 2%; p = 0.06). CONCLUSION: For PIRADS scores ≥ 3, PDEi use is associated with smaller ROI and lower PIRADS scores, while AA use is associated with higher PIRADS scores. Neither medication was associated with differences in biopsy GG. Prospective studies are needed to investigate the discordance between multi-parametric magnetic resonance imaging (mpMRI) results and oncologic outcomes associated with PDEi and AA use.

Initial Experience of Magnetic Resonance Imaging Fusion Biopsy in the Community Setting.

INTRODUCTION: Magnetic resonance imaging fusion biopsy is diagnostically superior to transrectal ultrasound guided biopsy for detecting clinically significant prostate cancer. Fusion biopsy has an expanding role at major academic centers. However, the reproducibility of outcomes in the community setting is unknown. Our goal was to determine if there are significant differences in the yield of clinically significant prostate cancer upon implementation of fusion biopsy in the community setting. METHODS: We compared biopsy results from the first consecutive 175 patients undergoing fusion biopsy at an academic setting to the first 175 patients undergoing fusion biopsy at a community practice. Patients treated at an academic setting were matched to nonacademic setting treated patients using Mahalonobis distance matching. A treatment effects model was used to evaluate the effect of practice setting on the rate of clinically significant prostate cancer detection. RESULTS: The matching model resulted in 160 community based patients matched to 150 academic based patients. Balance was verified by reduction in standardized differences and variances ratios between samples. Standard errors and the 95% CI were calculated from 3,000 bootstrap samples. Practice setting had no significant effect on clinically significant prostate cancer detection, clinically significant prostate cancer detection by fusion biopsy, upgrading by fusion cores, upgrading by template cores, clinically significant prostate cancer missed by template cores or clinically significant prostate cancer missed by fusion cores. CONCLUSIONS: A sample-matched analysis of the first consecutive patients enrolled in fusion biopsy at an academic versus a community setting indicates that practice setting did not have a significant effect on the overall detection of clinically significant prostate cancer. This lends support to the use of fusion biopsy outside of academic centers.

A rare case of a retroperitoneal lymphangioma causing chronic flank pain in an adult.

Retroperitoneal lymphangiomas are exceedingly rare and typically asymptomatic. We present a case of a 27 year-old female with chronic right flank pain and cross-sectional imaging showing a large multi-cystic mass located medial and inferior to the right kidney. The patient underwent an uncomplicated robotic-assisted, laparoscopic resection of the mass with final pathology showing a benign lymphangioma. This case highlights the importance of recognizing retroperitoneal lymphangiomas as atypical causes of chronic flank pain and demonstrates that these benign tumors can be successfully resected robotically. Given today's urology residency training, urologists are likely uniquely positioned to best manage these peri-renal lymphatic malformations.

Ureteral function is modulated by a local renin-angiotensin system.

PURPOSE: Although many aspects of ureteral physiology are well characterized, the exact mechanism of ureteral smooth muscle modulation has not been fully established. In other smooth muscle contractility is modulated by angiotensin II (AngII). We determined the presence of a local ureteral renin-angiotensin system and characterized the functional role of AngII in ureteral smooth muscle. MATERIALS AND METHODS: Reverse transcriptase-polymerase chain reaction was performed to determine the expression of angiotensinogen, renin, angiotensin-converting enzyme and angiotensin receptor subtype 1 mRNA. The presence of AngII in ureteral tissue was determined by immunohistochemistry. Human and pig ureteral smooth muscle strips were suspended in tissue baths to determine the effect of the AngII receptor antagonist losartan on the frequency and amplitude of spontaneous ureteral contractions. Electrical field stimulation was performed before and after exposure to losartan. RESULTS: Angiotensinogen, renin, angiotensin-converting enzyme and angiotensin receptor subtype 1 mRNA expression was detected in human ureter. Immunoreactivity for AngII was demonstrated in smooth muscle bundles and blood vessels of the ureter. Losartan decreased the amplitude and frequency of spontaneous ureteral contractions as well as the contractile response to electrical field stimulation in a dose dependent manner. CONCLUSIONS: Gene expression of AngII precursors and receptor, and localization of AngII in the ureter suggest the presence of a local renin-angiotensin system in the ureter. The effect of AngII receptor antagonist on contractile responses suggests that AngII modulates ureteral smooth muscle contractile function. Therefore, a local renin-angiotensin system may have an important role in ureteral function under physiological and pathological conditions.