Prostate cancer in PI-RADS scores 1 and 2 version 2.1: a comparison to previous PI-RADS versions.

PURPOSE: To evaluate the validity of PI-RADS categories 1 and 2 version 2.1 (V2.1) as predictors of the absence of carcinoma and to reevaluate lesions that were analysed as suspicious prior to PI-RADS or according to PI-RADS versions 1 and 2 and classified as PI-RADS 1 or 2 in V2.1. METHODS: Retrospective evaluation of 1170 multiparametric MRIs performed at one academic teaching hospital (2012-2019). Study cohort comprised 188 men that achieved PI-RADS scores 1 or 2 (V2.1) and underwent systematic and targeted biopsy, split into one group with suspect findings in the original reports that were created prior to PI-RADS or with version 1 and 2, and another group with unremarkable reports. Differences in presence of prostate cancer and PSA density were assessed by Chi-square and Fisher's exact test, and the negative predictive value (NPV) for both groups was conducted. RESULTS: The NPV for clinically significant carcinoma (csCa) was 89.1% for 55 men with suspect findings in the original report and 93.2% for 133 men with negative MRI. There was no difference between the groups regarding the detection of csCa (p = 0.103). PSA density was significantly higher in the group with suspect original reports (p = 0.015). CONCLUSION: A PI-RADS score 1 or 2 appears less likely to miss existing prostate cancer, although a small amount of csCa can be overlooked. In case of clinical suspicion or elevated PSA density and PI-RADS score 1 or 2, an individual decision has to be taken if biopsy is necessary or if monitoring is sufficient.

Impact of magnetic resonance imaging-guided prostate biopsy in the supine position on the detection of significant prostate cancer in an inhomogeneous patient cohort.

OBJECTIVE: The aim of this study was to determine the tumour detection rate of magnetic resonance-guided biopsy (MRGB) in the supine position for significant prostate cancer in an inhomogeneous patient cohort. MATERIALS AND METHODS: Thirty-two consecutive patients with a total prostate-specific antigen > 4 ng/ml and/or a tumour-suspicious palpable lesion upon digital rectal examination and a cancer-suspicious region in multiparametric magnetic resonance imaging (MRI) underwent MRGB in a standard 1.5 T magnet. Diagnostic MRI was performed in 20 patients at the authors' institute and 12 men at another location. Eight patients were investigated at 3 T and 24 at 1.5 T. Twenty men had prior negative biopsies and 12 were biopsy naïve. All biopsies were performed in the supine position using a table-mounted device and an 18 G biopsy gun. RESULTS: The overall tumour detection rate was 53% (17/32). Two cores (median; range 1-4) were extracted. Clinically significant cancers were found in 94% (16/17). None of the patients showed any postbiopsy complications. The prostate volumes of patients with cancer were significantly lower (39.3 ml) than those of men without cancer (49.7 ml). No significant differences were found between the numbers of tumour-positive and tumour-negative collected cores. In a median follow-up of 14 months, no cancer was detected in the negative biopsy group. CONCLUSION: MRGB in the supine position can be a valuable tool to detect significant prostate cancer, even in a patient cohort with different prebiopsy pathways. The biopsy method could be a reasonable alternative to MRGB in the prone position.

How good is post-biopsy multiparametric magnetic resonance imaging in detecting and characterising the index lesion of localised prostate cancer?

OBJECTIVE: The aim of this study was to evaluate the accuracy of multiparametric endorectal magnetic resonance imaging (mp-MRI) in detecting and characterising the largest tumour lesion, which is defined as the index tumour of prostate cancer. MATERIAL AND METHODS: A total of 55 patients with proven histological prostate cancer underwent post-biopsy MRI at 1.5 T and subsequent radical prostatectomy. The maximum tumour diameter (MTD) of the index lesion was determined independently by MRI and histopathology in a prospective manner. The detection rate of the index lesion, the MTD and volume by pathology, and the pathological tumour (pT) stage were correlated with the MTD by MRI using Pearson's correlation. RESULTS: Pathohistology revealed 158 cancer foci. MRI detected 55 foci. The sensitivity, specificity, accuracy, and negative and positive predictive values of mp-MRI for index lesion detection were 89%, 100%, 90%, 44% and 100%, respectively. Three positive correlations were found: one between the MTD of the index lesion by MRI and the MTD by pathology (Pearson coefficient = 0.890, p < 0.01), a second between the MTD by MRI and the index tumour volume at pathology (Pearson coefficient = 0.786, p < 0.01), and a third between the MTD and the pT stage (Pearson coefficient = 0.678, p < 0.01). CONCLUSION: mp-MRI can accurately detect the index lesion and estimate the TVP of localised prostate cancer.

In vitro and in vivo comparison of egg yolk-based and soybean lecithin-based extenders for cryopreservation of bovine semen.

Semen diluents containing egg yolk as a cryoprotectant may pose hygienic risks and are difficult to standardize. Although a new generation of semen diluents free of animal ingredients is available, egg yolk-containing extenders are still widely used for cryopreserving semen. We compared the effects of using different extenders on bovine sperm function in vitro and on fertility in vivo. A soy lecithin extender (SL; AndroMed) and an egg yolk-containing (TRIS-EY) extender were tested. No differences (P>0.05) were detected between the two extenders for sperm-zona pellucida binding capacity (HZI=115+/-13). Assessment of the inducibility of the acrosome reaction with progesterone showed no differences (P>0.05) between extenders for live acrosome-reacted sperm (15+/-2.36 and 14.42+/-2.02%, respectively, for SL and TRIS-EY). However, post-thaw sperm motility was significantly lower (P<0.05) when semen was extended in the TRIS-EY diluent. Field trials revealed that nonreturn rates of SL-extended semen showed significantly higher insemination success (P<0.0001) compared with the nonreturn rates for the TRIS-EY extender (70.45 and 67.85%, respectively). We suggest that consistent with quality standards that should be required for cryoprotectant media and because of the superior quality of the egg yolk-free extender, a defined soybean lecithin-containing diluter might be the better choice as a semen extender in the future.