Prostate International最新文献

Purpose

To assess temporal improvement of prostate image reporting and data system (PIRADS) 3-5 lesion correlation to histopathologic findings from radical prostatectomy (RP) in prostate cancer (PCa).

Materials and methods

A total of 1481 patients who underwent RP for biopsy-proven PCa between 2015 and 2019 were divided into 14 groups of 100 sequential readings for the evaluation of histopathological correlation with PIRADS readings. Temporal trends of PIRADS distribution and predictive performance for RP pathology were evaluated to assess underlying changes in prostate magnetic resonance imaging (MRI) interpretation by radiologists.

Results

PIRADS 4-5 lesions were significantly correlated with the increasing rates of Gleason Group (GG) upgrade (p = 0.044) and decreasing rate of GG downgrade (p = 0.016) over time. PIRADS ≥3 lesions read after median 2 years of experience were shown to independently predict intermediate–high-risk (GG ≥ 3) PCa (odds ratio 2.93, 95% confidence interval 1.00–8.54; P= 0.049) in RP pathology. Preoperative GG ≥ 3 biopsy lesions with PIRADS 4-5 lesions were significantly more susceptible to GG upgrade (P= 0.035) and GG ≥ 4 RP pathology (p = 0.003) in experienced reads, in contrast to insignificant findings in early readings (p = 0.588 and 0.248, respectively).

Conclusion

Preoperative MRI reports matched with RP pathology suggest an improved prediction of adverse pathology in PIRADS 3-5 lesions over time, suggesting a temporal change in PIRADS interpretation and predictive accuracy. Institutions with low volume experience should use caution in solely relying on MRI for predicting tumor characteristics. Future prospective trials and larger scale assessments are required to further validate our results.

Objective

To evaluate the short-term efficacy of Dutasteride in the management of chronic prostatitis (CP)/chronic pelvic pain syndrome.

Materials and methods

A randomized placebo-controlled double-blind study was conducted that including 50 patients diagnosed with CP based on the presence of pelvic pain for ≥3 months of the preceding 6 months. Patients were randomized into 2 equal groups to evaluate Dutasteride of 0.5 mg once daily that was given for 3 months compared to a placebo.

Results

Forty-nine patients were evaluated after the follow-up period with no statistically significant difference in the perioperative demographic data. The mean age of the Dutasteride group was 48.3 (range 41–62) compared to a mean age of 46.5 (range 44–60) in the placebo group. There was a highly statistically significant improvement in the Dutasteride group compared to its preoperative parameters and the placebo compared group in the terms of pain, urinary scores, and total National Institutes of Health CP symptom score. Moderate and marked improvement in patients’ symptomatology was seen in 56% of the dutasteride group, while only 8% in the dutasteride group failed to show an improvement with no significant side effects noted in our study.

Conclusion

The short-term outcome of dutasteride therapy showed an improvement in the National Institutes of Health-CP symptom score compared to a placebo in the treatment of category IIIB CP.

The trial was registered in the clinical trial.gov registry with a registration number

NCT04756206.

Background

The aim of this study is to investigate chronological changes of lower urinary tract symptoms (LUTS) in patients with prostate cancer who underwent low-dose-rate brachytherapy (LDR-BT) followed by the insertion of SpaceOAR® system (SpaceOAR).

Methods

In this retrospective study, 483 patients with localized prostate cancer underwent LDR-BT at the Gifu University Hospital between August 2004 and December 2020. SpaceOAR was inserted in 30 patients after LDR-BT (SpaceOAR group), and 453 patients received LDR-BT alone (non-SpaceOAR group). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), quality of life due to urinary symptoms (IPSS-QOL), and uroflowmetry (UFM), including maximum flow rate (Qmax), voided volume, and post-voided residual urine (PVR), were evaluated before LDR-BT, and at 1, 3, 6, 9, and 12 months after LDR-BT. The outcomes were chronological changes in IPSS, OABSS, and IPSS-QOL compared to pretreatment values and those of covariates in relation to UFM.

Results

The IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with either group. According to the PVR interaction effect, the insertion of SpaceOAR was significantly affected by chronological changes in PVR (P = 0.001). Three months after LDR-BT, PVR in the SpaceOAR group was significantly higher than that in the non-SpaceOAR group (49.8 mL vs. 30.5 mL; P = 0.002).

Conclusion

SpaceOAR use may temporally increase PVR; however, IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with LUTS before and after LDR-BT. The combination of LDR-BT and SpaceOAR may be acceptable for treating patients with prostate cancer regarding the chronological changes in LUTS after brachytherapy.

Background

Fluoroquinolone-resistant (FQR) Escherichia coli (E. coli) causes transrectal prostate biopsy infections. We seek to further identify fluoroquinolones resistance by the incorporation of genetic profiling to influence antibiotic selection for transrectal prostate biopsy and whether the addition of this genetic testing could improve the prediction of FQR detection at the time of biopsy.

Materials and methods

In this prospective observational cohort study, rectal swabs were collected within 30 days of an upcoming prostate biopsy. These swabs were sent for phenotypic and genotypic assessment to predict FQR on the day of the biopsy. Phenotype: Specimens were inoculated onto MacConkey agar containing ciprofloxacin using standard culture techniques to determine FQR status. Genotype: We compared cultures to polymerase chain reaction (PCR) sequence typing (E.coli- ST131/H30/ST69) and bacterial plasmids (gyrA, qnrQ, and qnrS). The presence of FQR on this testing was compared to the second rectal swab collected just before biopsy (2 hours after ciprofloxacin prophylaxis), which served as the gold standard for FQR.

Results

Overall, the FQR rate was 23.6%. The bacterial plasmids (qnr) were present in 54.1% of samples, and multidrug-resistant E. coli ST131 was present in 12.5% of samples. In comparison, phenotypic assessment using rectal culture had a better prediction for the presence of FQR as compared to genotypic testing [area under the curve (AUC) = 0.85 in phenotype arm vs. AUC = 0.45 in genotype arm].

Conclusion

We detected a high prevalence of FQR genes in the rectum, but the addition of PCR-based genotyping did not improve the prediction of culture-based FQR at the time of biopsy.

Background

Homologous Recombination Repair (HRR) is the most reliable and important signaling pathway for repairing DNA damage. We initiated a calibration project to better understand the NGS landscape for HRR gene testing in China, provide indications for testing standardization, and guide clinical practice.

Methods

A questionnaire was used to collect laboratory information, panel design for HRR gene testing, tissue sample test parameters, plasma ctDNA sample test parameters, and procedures for variant interpretation. The testing quality of the participating laboratories was further evaluated by external quality assessment (EQA), which provided 5 FFPE slices and 5 mimic ctDNA samples as standard references for evaluation. Test results and reports were collected to assess laboratory performance.

Results

Our results showed that different laboratories had significant differences in sequencing platforms, library construction technologies, genes in the testing panel, detectable mutation types, probe coverage regions, sequencing parameters, variants interpretation guidelines, and positive test rates. For the EQA test, the overall pass rate was about 60%. The average accuracy for tissue samples and ctDNA samples was 79.55% and 74.13%, respectively. It is worth noting that variants in tandem repetition regions and splice sites, and those with low allele frequency were more prone to misdetection. The most common reasons for misdetection were as follows: the testing panel did not cover the genes or the whole exon and splice sites of the genes; the variants were misclassified as benign or likely benign, and the variants failed the QC criteria.

Conclusions

The discrepancies observed in our survey and EQA test affect the authenticity of HRR gene test results for prostate cancer, underlining the need to establish guidelines for HRR gene testing and variant interpretation in China, and to optimize HRR gene testing in clinical practice to improve management and patient care.

With the dogma of sterile urine no longer held as truth, numerous studies have implicated distinct changes in microbial diversity and composition to diseased subgroups in both benign and malignant urological diseases, ranging from overactive bladder to bladder and prostate cancer. Further facilitated by novel and effective techniques of urine culture and sequencing, analysis of the genitourinary microbiome holds high potential to identify biomarkers for disease and prognosis. However, the low biomass of samples included in microbiome studies of the urinary tract challenge researchers to draw definitive conclusions, confounded by technical and procedural considerations that must be addressed. Lack of samples and adequate true negative controls can lead to overestimation of microbial influence with clinical relevance. As such, results from currently available studies and assessment of their limitations required a thorough understanding. The purpose of this narrative review was to summarize notable microbiome studies in the field of urology with a focus on significant findings and limitations of study design. Methodological considerations in future research are also discussed.

Purpose

Questionnaire forms (QFs) are used in the evaluation of all patients presenting with lower urinary tract symptoms (LUTSs). Our study aims to investigate the compatibility of the three QFs with each other and to investigate the relationship between education level and complete completion of these forms.

Materials and methods

A total of 224 patients between February 2018 and February 2019 were included. The patients were divided into 3 groups as primary, intermediate, and advanced according to their education level and the patients who gave incomplete answers to the questions were determined.

Results

The mean age of the patients was 61.0 ± 7.57(45-85), International Prostate Symptom Score (IPSS) value was 16.2 ± 8.3(1-35), the international incontinence form–male lower urinary tract symptoms (ICIQ-MLUTS) value was 16.5 ± 7.9(0-38), the visual prostate symptom score (VPSS) value was 9.9 ± 3.0(3-16). There was a significant correlation between the three QFs (P < 0.05). The correlation between IPSS and ICIQ-MLUTS was strong (r = 0.745). The incomplete response rate was 32.1% (n = 72) in ICIQ-MLUTS, 16.5% (n = 37) in VPSS, and 10.7% (n = 24) in IPSS (P < 0.05). The incomplete response rate was not affected by education. The rate of patients who could be questioned with ICIQ-MLUTS but not with the other two QFs varied between 12.9% and 85.2%, depending on the symptoms.

Conclusions

Each QF has its advantages and disadvantages. The strong correlation between IPSS and ICIQ-MLUTS found in our study indicates that these tools can be used interchangeably in daily clinical practice. ICIQ-MLUTS can evaluate symptoms that are not present in other QFs. In the evaluation of illiterate patients, VPSS should be used without any alternative.

Background

Prostate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry.

Methods

Transrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications.

Results

Of 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02–1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding.

Conclusion

Non-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy.

Purpose

To validate the diagnostic yield of multiparametric magnetic resonance imaging (mpMRI) for local biochemical recurrence after radical prostatectomy in patients with biochemical recurrence using large consecutive patient data.

Materials and methods

Of 4632 patients who underwent radical prostatectomy for prostate adenocarcinoma, 748 patients with prostate-specific antigen > 0.2 ng/mL and second confirmatory level were retrospectively identified. Among them, 468 patients who underwent multiparametric magnetic resonance imaging were analyzed. The primary outcome measure was the diagnostic yield of multiparametric magnetic resonance imaging for local recurrence, and the secondary measure was its accuracy, using the response to salvage radiotherapy as reference.

Results

Only 33 patients (7.1%) showed positive imaging findings. The positive and negative predictive values were 84.8% (28/33) and 37.5% (45/120), respectively. The sensitivity and specificity were 27.2% (28/103) and 90% (45/50), respectively. The overall accuracy was 47.7% (73/153). In multivariate logistic regression analysis, prostate-specific antigen level at recurrence was found to be the only factor significantly higher in the positive image findings group.

Conclusions

The universal use of multiparametric magnetic resonance imaging resulted in a low-diagnostic yield for local recurrence in patients with biochemical recurrence after radical prostatectomy. The results suggest that selective use of multiparametric magnetic resonance imaging should be considered in patients with a higher prostate-specific antigen threshold.

Objective

The present study aimed to evaluate the predictive value of bony pelvic parameters measured by computerized tomography (CT) for use in the estimation of the likely technical difficulties that may be encountered when performing open radical prostatectomy (RP) for localized prostate cancer.

Material and methods

One hundred patients, undergoing open RP for localized prostate cancer, were evaluated between October 2016 to November 2018. All operations were performed by the same experienced surgeon. Pelvic parameters were measured using spiral CT images. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Positive surgical margin (PSM), presence of vesicourethral anastomosis stricture (VUAS) and urine leakage, operative time, urethral catheterization time, and estimated blood loss were used as indicators of operative difficulty. Univariate and multivariate analyses were performed to determine the significance of these variables.

Results

There was no significant correlation between the pelvic parameters of the patients and the presence of PSM, VUAS, and urine leakage. Only PSA levels and pathological tumor stage were higher in patients with PSM (p = 0.002 and p = 0.001). On univariate and multivariate analyses, none of the individual pelvic parameters assessed showed a significant relationship with the operation time, estimated blood loss, and urethral catheterization time. In univariate analysis, there was a significant relationship between PSA levels and pathological tumor stage and operation time (p = 0.048 and p = 0.001, respectively).

Conclusion

Bony pelvic parameters may not be a significant factor in influencing the perioperative outcomes of open RP. Higher PSA levels and pathological tumor stage may lead to surgical margin positivity and longer operative time.