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BAUS/BJUI/USANZ Joint Session AUA 2019

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British Association of Urological Surgeons/BJU International/Urological Society of Australia and New Zealand (BAUS/BJUI/USANZ) Joint Session AUA 2019

Sunday, May 5th 2:00 – 5.00 PM. McCormick Place Convention Center South Building – Room S102 BC

 

Registries /Smart Data /Complications – CHAIR: Duncan Summerton

 
1400-1420 Alan Partin

A contemporary look at biomarkers for diagnosis of Prostate Cancer
1420-1440 Chris Harding (BJUI sponsored BAUS lecture)

The Mesh Story – lessons learned and future plans
1440-1500 Nick Watkin

PROMs in Urology
1500-1520 Stephen Mark

Big Data and Urology – a pilot trial in New Zealand
1520-1540 Afternoon tea
 

Education /Training /Innovation – CHAIR: Prokar Dasgupta

 
1540-1600 Andrew Hung (BJUI sponsored lecture)

The emerging role of Artificial Intelligence in Surgical Science
1600-1620 Jonathan Kam

Zero learning curve Percutaneous Nephrolithotomy Access – Prone endoscopic combined intrarenal surgery and multimedia training aid to teach urology trainees
1620-1640 Madhu Koya (BJUI sponsored USANZ lecture)

Cx bladder reduces flexible cystoscopy in haematura and superficial TCC
1640-1700 Kamran Ahmad

Innovation in healthcare systems
1700-1705 BJUI Coffey-Krane Award for trainees based in The Americas presented by Prokar Dasgupta
1700-1900 BJUI Reception

 

Article of the week: A clinical prediction tool to determine the need for concurrent systematic sampling at the time of MRI‐guided biopsy

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Every week, the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an editorial written by a prominent member of the urological community. These are intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation. 

If you only have time to read one article this week, it should be this one.

A clinical prediction tool to determine the need for concurrent systematic sampling at the time of magnetic resonance imaging‐guided biopsy

Niranjan J. Sathianathen*, Christopher A. Warlick*, Christopher J. Weight*, Maria A. Ordonez*, Benjamin Spilseth†, Gregory J. Metzger†, Paari Murugan‡ and Badrinath R. Konety*

 

Departments of *Urology, †Radiology, and ‡Pathology, University of Minnesota, Minneapolis, MN, USA

 

Read the full article

Abstract

Objective

To develop a clinical prediction tool that characterises the risk of missing significant prostate cancer by omitting systematic biopsy in men undergoing transrectal ultrasonography/magnetic resonance imaging (TRUS/MRI)‐fusion‐guided biopsy.

Patients and methods

A consecutive sample of men undergoing TRUS/MRI‐fusion‐guided biopsy with the UroNav® system (Invivo International, Best, The Netherlands) who also underwent concurrent systematic biopsy was included. By comparing the grade of cancer diagnosed on targeted and systematic biopsy cores, we identified cases where clinically significant disease (Gleason score ≥3+4) was only found on systematic and not targeted cores. Multivariable logistic regression analyses were used to identify predictive factors for finding significant cancer on systematic cores only. We then used these data to develop a nomogram and evaluated its utility using decision curve analysis.

Fig 1. Nomogram for predicting the diagnosis of clinically significant on systematic biopsy only and missed on targeted biopsy.

Results

Of the 398 men undergoing TRUS/MRI‐fusion‐guided biopsy in our study, there were 46 (11.6%) cases in which clinically significant cancer was missed on targeted biopsy and detected on systematic biopsy. The clinical setting, number of MRI lesions identified, and the highest Prostate Imaging‐Reporting and Data System (PI‐RADS) score of the lesions, were all found to be predictors of this. Our model had a good discriminative ability (concordance index = 0.70). The results from our decision curve analysis show that this model provides a higher net clinical benefit than either biopsying all men or omitting biopsy in all patients when the threshold probability is <30%.

Conclusion

We found that omitting concurrent systematic biopsy in men undergoing TRUS/MRI‐fusion‐guided biopsy would miss significant disease in more than one in 10 patients. We propose a prediction model with good discriminative ability that can be used to improve patient selection for performing concurrent systematic biopsy in order to minimise the number of missed significant cancers. It is important that our model is validated in external cohorts before being employed in routine clinical practice.

Read more Articles of the week

Editorial: Can systematic biopsy be safely avoided at the time of MRI/ultrasonography fusion biopsy?

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In clinical practice, the need for maximising prostate cancer detection is often balanced against the theoretical risks of infection, bleeding, and pain associated with taking additional cores. In this novel study, Sathianathen et al. [1] provide a tool for measuring the oncological benefit of including concurrent systematic biopsy (SB) at the time of MRI‐guided targeted biopsy (TB). There were several key findings: (i) Amongst patients undergoing MRI‐guided biopsy (all biopsy settings), 11.6% were found to have significant cancers detected by SB alone; (ii) Amongst patients who had clinically significant cancers detected by SB alone, 52.2% were sampled within sextants outside the targeted regions of interest; (iii) According to the proposed nomogram, patients with prior negative biopsies, fewer MRI lesions, and lower Prostate Imaging‐Reporting and Data System (PI‐RADS) scores were at the lowest risk of missing significant cancer when SB was omitted.

Based on the present study, biopsy setting appears to be a key factor for deciding whether to omit SB. In the subset of patients undergoing primary biopsy, the authors found that 18.5% of cancers were detected by SB alone. These results are consistent with those of the MRI‐FIRST trial, which showed 14% of cancers were detected by SB only, 20% by TB only, and 66% by combining both techniques [2]. MRI‐FIRST concluded that in the primary biopsy setting, there was no difference between SB and TB in detection of clinically significant prostate cancer, although combining both techniques provided the highest detection rate.

Prior negative biopsy cohorts are generally at lower risk of harbouring significant cancer, as many cancers have already been ‘selected out’ by initial biopsies. In this setting, TB plays an important role in sampling tumour foci in difficult‐to‐reach regions of the prostate (e.g., anterior and apical) [3]. According to the authors’ nomogram, prior negative biopsy patients were least likely to benefit from concurrent SB. While the authors suggest a paradigm of selectively omitting SB, some authors have proposed omitting both TB and SB altogether in select patients. A previously reported multi‐institutional nomogram can be used to predict benign pathology after MRI‐guided biopsy, which can help reduce the number of unnecessary biopsies after MRI in the prior negative biopsy setting [4]. This clinical tool was further externally validated and optimised by Bjurlin et al. [5].

The ‘active surveillance (AS)’ setting typically refers to a confirmatory MRI‐guided biopsy in men with Grade Group 1 prostate cancer prior to enrollment in AS. Recently, the presence of cribriform morphology in Grade Group 2 patients was confirmed to be a key poor prognostic feature that would exclude patients from AS [6]. The present study, however, did not account for different Gleason pattern 4 morphologies in their analysis, as ‘significant cancer’ was defined by Grade Group alone. Studies by independent groups have found that TB combined with SB was more accurate than either modality alone for detecting cribriform at the time of MRI‐guided biopsy [7, 8]. Therefore, concurrent SB is required to properly sample cribriform cancers in patients who are considering AS.

In this study, Sathianathen et al. [1] provide clinicians with a clinical tool for quantifying the added oncological value of concurrent SB. However, concurrent SB is probably prudent for most patients, particularly for those considering AS or focal therapy for which accurate determination of whole gland grade, cancer volume, and cribriform status are essential. As reducing the number of cores has not yet been shown to reduce biopsy‐related complications, are we willing to suboptimise cancer sampling without proven compensation?

by Matthew Truong

References

  1. Sathianathen, NJ, Warlick, CA, Weight, CJ et al. A clinical prediction tool to determine the need for concurrent systematic sampling at the time of magnetic resonance imaging‐guided biopsy. BJU 2019; 123: 612– 7
  3. Salami, SS, Ben‐Levi, E, Yaskiv, O et al. In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12‐core biopsy still necessary in addition to a targeted biopsy? BJU Int 2015; 115: 562– 70
  4. Truong, M, Wang, B, Gordetsky, JB et al. Multi‐institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12‐core systematic biopsy. Cancer 2018; 124: 278– 85
  5. Bjurlin, MA, Renson, A, Rais‐Bahrami, S et al. Predicting benign prostate pathology on magnetic resonance imaging/ultrasound fusion biopsy in men with a prior negative 12‐core systematic biopsy: external validation of a prognostic nomogram. Eur Urol Focus 2018. [Epub ahead of print] https://doi.org/10.1016/j.euf.2018.05.005
  6. Kweldam, CF, Kümmerlin, IP, Nieboer, D et al. Presence of invasive cribriform or intraductal growth at biopsy outperforms percentage grade 4 in predicting outcome of Gleason score 3+4=7 prostate cancer. Mod Pathol 2017; 30: 1126– 32
  7. Truong, M, Feng, C, Hollenberg, G et al. A comprehensive analysis of cribriform morphology on magnetic resonance imaging/ultrasound fusion biopsy correlated with radical prostatectomy specimens. J Urol 2018; 199: 106– 13
  8. Prendeville, S, Gertner, M, Maganti, M et al. Role of magnetic resonance imaging targeted biopsy in detection of prostate cancer harboring adverse pathological features of intraductal carcinoma and invasive cribriform carcinoma. J Urol 2018; 200: 104– 13

 

 

April 2019 – About the cover

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April’s Article of the Month (Prostate cancer mortality rates in Peru and its geographical regions) has been written by a multi-disciplinary, international team from Peru, Brazil, Mexico and the USA.

The cover picture shows Peru’s most famous landmark, the Inca city of Machu Picchu in the Andes mountains. It was built in the 15th century but abandoned after about 80 years, and, although it was known locally, it was not known to the outside world until 1911. Now it receives almost 1.5 million visitors each year, putting strain on the site but providing important tourist revenue.

 

 

 

Article of the month: Prostate cancer mortality rates in Peru and its geographical regions

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Every month, the Editor-in-Chief selects an Article of the Month from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an editorial written by a prominent member of the urological community. These are intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation. 

If you only have time to read one article this week, it should be this one.

Prostate cancer mortality rates in Peru and its geographical regions

Junior Smith Torres-Roman*†, Eloy F. Ruiz‡, Jose Fabian Martinez-Herrera§, Sonia Faria Mendes Braga, Luis Taxa**, Jorge Saldaña-Gallo*, Mariela R. Pow-Sang††, Julio M. Pow-Sang‡‡ and Carlo La Vecchia§§

 

*Clinica de Urologia Avanzada UROZEN, Lima, †Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga, Ica, ‡CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru, §Cancer Center, Medical Center American British Cowdray, Mexico City, Mexico, Department of Social and Preventive Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, **Instituto Nacional de Enfermedades Neoplásicas, ††Department of Urology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru, ‡‡Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA, and §§Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy

 

Read the full article

Abstract

Objective

To evaluate the mortality rates for prostate cancer according to geographical areas in Peru between 2005 and 2014.

Materials and Methods

Information was extracted from the Deceased Registry of the Peruvian Ministry of Health. We analysed age‐standardised mortality rates (world population) per 100 000 men. Spatial autocorrelation was determined according to the Moran Index. In addition, we used Cluster Map to explore relations between regions.

Fig. 1. Peru geographical zones by provinces. The asterisk denotes the province of Callao. Source: National Statistics Institute

Results

Mortality rates increased from 20.9 (2005–2009) to 24.1 (2010–2014) per 100 000 men, an increase of 15.2%. According to regions, during the period 2010–2014, the coast had the highest mortality rate (28.9 per 100 000), whilst the rainforest had the lowest (7.43 per 100 000). In addition, there was an increase in mortality in the coast and a decline in the rainforest over the period 2005–2014. The provinces with the highest mortality were Piura, Lambayeque, La Libertad, Callao, Lima, Ica, and Arequipa. Moreover, these provinces (except Arequipa) showed increasing trends during the years under study. The provinces with the lowest observed prostate cancer mortality rates were Loreto, Ucayali, and Madre de Dios. This study showed positive spatial autocorrelation (Moran’s I: 0.30, P= 0.01).

Conclusion

Mortality rates from prostate cancer in Peru continue to increase. These rates are higher in the coastal region compared to those in the highlands or rainforest.

Read more Articles of the week

 

Editorial: The burden of urological cancers in low‐ and middle‐income countries

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The burden of cancer in low‐ and middle‐income countries (LMICs) continues to rise [1]. Evaluation of geographical differences in cancer mortality statistics is specifically of interest in LMICs as (inter)national guidelines are potentially less embedded in standard care, and objective measurements to assess underlying mechanisms/explanations for the burden of cancer are often lacking. Monitoring mortality statistics in these countries can thus help assess the effectiveness of national and regional health systems in treating and caring for patients with cancer [1].

Torres‐Roman et al. [2] deserve to be congratulated for their efforts to monitor mortality rates for prostate cancer at both a regional and national level in Peru. The CONCORD initiative from the WHO previously reported prostate cancer statistics for Peru, but data were limited to the capital area of Lima [1]. Torres‐Raman et al. [2] report prostate cancer mortality rates between 2005 and 2014 based on data from the Peruvian Ministry of Health, which covers ~70% of all healthcare providers in Peru. Apart from an overall increase of 15% in mortality rates, substantial variation was observed by geographical region. Mortality rates increased by 16% in the coastal region and highlands, whereas in the rainforest region the rates decreased by 19% [2]. One potential explanation for these observed differences could be the difference in ethnic and racial characteristics. The coastal region in Peru has a strong African influence and also has a larger proportion of men aged >65 years. In addition to potential differences in access to healthcare, some of the variation in prostate cancer mortality statistics most likely reflects a deficiency in reporting systems. Even though this study has its limitations due to missing data and lack of information on other important variables, such as ethnicity and socioeconomic status, it provides a first base for a critical assessment of prostate cancer care in Peru.

Studies like this one from Torres‐Roman et al. [2] show that there is a need for improvement and standardisation of (prostate) cancer care in LMICs, but also a need for improvement in data capturing, so that objective measurements can be put in place. The years of healthy life lost due to prostate cancer, as well as other urological cancers, in LMICs is increasing substantially. Even though each tumour group has its own specifications in terms of prevention and control, an epidemiological assessment of cancer burden based on the experience for urological cancers (i.e., prostate, bladder, kidney and testicular) can therefore inform future assessments of cancer burden. The urological tumour group covers both common and less common cancers (e.g. prostate vs kidney cancer), sex‐specific and cancers that affect both sexes (e.g. testicular vs bladder cancer), cancers with less known risk factors and those strongly linked with lifestyle risk factors (e.g. prostate vs bladder cancer).

It is encouraging to see an increase in the number of studies evaluating the burden of cancer in LMICs [3]; however, given the consistency in observations of an increase in mortality, there is an urgent need to further invest in prevention and management, as well as the infrastructure to collect all relevant data at a national level in these LMICs. Accurate information about cancer burden and how this varies between regions is essential to plan for an adequate health‐system response.

References

  1. Allemani, C, Matsuda, T, Carlo, V et al. Global surveillance of trends in cancer survival 2000‐14 (CONCORD‐3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population‐based registries in 71 countries. Lancet 2018; 391: 1023– 75
  2. Torres‐Roman, J, Ruiz, E, Martinez‐Herrera, J et al. Prostate cancer mortality rates in Peru and its geographic regions. BJU Int 2019; 123: 595– 601
  3. Carioli, G, Vecchia, C, Bertuccio, P et al. Cancer mortality predictions for 2017 in Latin America. Ann Oncol 2017; 28: 2286– 97

 

The 7th BJUI Social Media Awards (2019)

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#EAU19 played host to the 7th BJUI Social Media Awards in Barcelona last week and it was the best fun yet!! From our humble beginnings in the back of an Irish Bar in San Diego in 2013, we have blossomed into a swish reception on a rooftop terrace at the Crowne Plaza in Barcelona. But the spirit remains the same – urologists and allied health practitioners with an interest in social media, gathering together to meet up in person and enjoy a fun evening.

We usually alternate the Awards between the annual congresses of the American Urological Association (AUA) and of the European Association of Urology (EAU), however we retained them in Europe for two years running this time as some of us are giving the AUA a skip. Apologies AUA friends, we will be back with you next year. However it is a measure of how the EAU Annual Congress has risen that so many US uro-twitterati were in attendance again this year. #EAU19 attracted about 13,000 people from more than 100 countries, including a very healthy gathering from my adopted home country of Australia.

On therefore to the Awards. These took place on Sunday 17th March 2019 in the Crowne Plaza Hotel, Barcelona. Over 75 of the most prominent uro-twitterati from all over the world turned up to enjoy the hospitality of the BJUI and to hear who would be recognised in the 2019 BJUI Social Media Awards. Individuals and organisations were recognised across 12 categories including the top gong, The BJUI Social Media Award 2019, awarded to an individual, organization, innovation or initiative who has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the outstanding Urology Match portal, followed in 2014 by Dr Stacy Loeb for her outstanding individual contributions, and in 2015 by the #UroJC twitter-based journal club. In 2017 we recognised the #ilooklikeaurologist social media campaign which we continue to promote, and in 2018 we recognised @BURSTurology.  This year our Awards Committee consisted of members of the BJUI Editorial Board – Declan Murphy, Prokar Dasgupta, Matt Bultitude, and Stacy Loeb, as well as BJUI Managing Editor Scott Millar whose team in London drive the content across our social platforms. The Committee reviewed a huge range of materials and activity before reaching their final conclusions.

The full list of winners is as follows:

  • Most Read Blog@BJUI – “PRECISION delivers on the PROMIS of mpMRI in early detection of prostate cancer”. Awarded to myself!

  • Most Commented Blog@BJUI – “The future of Urological Surgical Training” – Dr Daron Smith, London, UK. Accepted by Matt Bultitude.

  • Best BJUI Tube Video – “Super‐mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1–2 cm lower‐pole renal calculi: an international multicentre randomised controlled trial”. Accepted by the boss himself, Professor Guohua Zeng, Guangzhou, China.

  • Best Urology Conference for Social Media – awarded to the EAU for #EAU19. This is the fourth time EAU have scooped this!! Continuously raising their game in social media. Accepted by Prof Jim Catto on behalf of the EAU Communications Department.

  • Innovation Award – awarded to the #UroSoMe initiative, led by Dr Jeremy Teoh from Hong Kong. Outstanding campaign to bring the global uro-twitterati together.

  • Best Social Media Campaign – awarded to the “#RudeFood – food porn for a purpose” campaign led by @ANZUPtrials in Australia, and championed by a number of big-name celebrity chefs in Australia. It uses the visual power of food to draw attention to #BelowTheBelt cancers. Accepted by Niranjan Sathianathen on behalf of ANZUP.

  • Most Social Trainee – Awarded to Dr Daniel Christidis (1986-2018) . A very emotional award to recognise Dan, a most social trainee from Melbourne, tragically lost in a shark attack in November 2018. Collected by Sophie Rintoul-Hoad on behalf of his many friends around the world.

  • The BJUI Social Media Award 2019 – Awarded to Nature Reviews Urology to recognise their vision in commissioning the piece “Both Sides of the Scalpel”, with co-authors Stephen Fry (patient) and Ben Challacombe (surgeon) describing their respective experience of managing Stephen’s prostate cancer.

This story garnered worldwide attention due to the profile of Stephen Fry and his 12.7m Twitter followers. Editor-in-Chief Annette Fenner accepted the Award, along with Ben Challacombe and Stephen Fry who sent this personalized video message.

A special thanks to our outstanding BJUI team at BJUI in London, Scott Millar and team, who manage our social media and website activity as well as the day-to-day running of our busy journal.

See you all in Washington for #AUA20 where we will present the 8th BJUI Social Media Awards ceremony!

 

by Declan Murphy, Peter MacCallum Cancer Centre, Melbourne, Australia

Associate Editor, BJUI

@declangmurphy

 

 

EAU19 Barcelona – Highlights Days 1 and 2

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The European Association of Urology Congress brings together delegates from across the globe to showcase cutting-edge urological research, and the 34th EAU Congress in Barcelona was no different. With a record high number of 5,500 abstracts submitted, over 1,600 presentations were due to be presented over five days. Adding to that a dizzying selection of 79 courses and hands-on workshops, this year’s EAU Congress was set to be one of the biggest to date.

After missing my flight here, I also missed the lines:

and swiftly registered to join a sea of red and yellow bags, coloured appropriately for the Spanish setting. With a big day ahead, the Catalonian capital had turned up the weather and the Fira Gran Via was humming with excitement.

The scientific program was already off to a flying start with a number of Urology beyond Europe sessions. These showcased the links between EAU and international urological societies, including USANZ, SIU and the CAU to name a few, and offered a chance to discuss regional differences in practice patterns and cutting-edge work from all corners of the globe.

Laser focus during a hands-on flexible ureteroscopy workshop

The evening approached rapidly, leaving no time for a siesta, as delegates made their way to the official opening ceremony. Prof Christopher Chapple welcomed delegates from around the world to make the most of what EAU19 had in store over the next four days. Presentation of EAU awards ensued, including the Crystal Matula and award for Best Prostate Cancer Research.

The end of formal proceedings had us seeing red, literally, as the Red area set alight with song and dance over a fiery backdrop in a vibrant performance from the opera Carmen.

This was soon to be eclipsed by two aerial silk acrobats accompanying an emphatic rendition of Freddie Mercury’s 1992 Olympic classic, Barcelona.

As the ceremony came to a close, it was time to network with colleagues and enjoy some Catalonian cuisine.

Court was in session early on Saturday morning, as a plenary on nightmares in stone disease chaired by Tim O’Brien and Thomas Knoll kicked off Day 2. With a medico-legal theme, Palle Osther spoke about the forgotten stent and sung the importance of leaving no stone unturned.

He was followed by horror stories of bowel injury during PCNL.

The mood was very different across the hall, however, as delegates geared up for a live surgery session courtesy of the Section of Uro-Technology, including a number from Barcelona’s own Fundació Puigvert Hospital.

Presenting and learning from live surgery is always a privilege, and all were grateful to those patients who generously agreed to participate.

With no shortage of residents at this year’s congress,

the European Society of Residents in Urology and Young Urology Office ran the extremely useful YUORDay19, covering ‘need to know’ information for residents, with topics ranging from the recent PRECISION and POUT trials to career advice and surgical tips and tricks.

EAU Guidelines also proved hugely popular once again, with delegates lining up to collect their copy of the brand new edition.

No meeting would be complete without a plethora of debates, and EAU19 was no different. The Controversies in Guidelines sessions covered a range of contentious topics in areas such as MRI-guided prostate biopsy, TURBT and adjuvant chemotherapy in UTUC. It was often standing room only, forcing a one-in one-out policy with some lines wrapping around the presentation rooms.

Pitting subspecialty heavyweights against each other, these sessions brought out a fighting spirit in all, even threatening to turn colleagues into enemies.

Fortunately, all ended well as another riveting day came to a close.

Barcelona has been the perfect setting to reunite with old friends and meet new ones at EAU19. Days 1 and 2 were a brilliant start to my first EAU congress, leaving me excited to see what the next three days have to offer.

by Arveen Kalapara, Research Fellow, Department of Urology, University of Minnesota

@ArveenKalapara

 

Article of the week: Ultrasound characteristics of regions identified as suspicious by MRI predict the likelihood of clinically significant cancer on MRI–ultrasound fusion‐targeted biopsy

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Every week, the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an editorial written by a prominent member of the urological community, and a video made by the authors. These are intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation. 

If you only have time to read one article this week, it should be this one.

 

The ultrasound characteristics of regions identified as suspicious by magnetic resonance imaging (MRI) predict the likelihood of clinically significant cancer on MRI–ultrasound fusion‐targeted biopsy

Benjamin Press*, Andrew B. Rosenkrantz†, Richard Huang‡ and Samir S. Taneja§ 
 
*Rutgers New Jersey Medical School, Newark, NJ, †Department of Radiology, ‡Department of Urology, and §Departments of Urology and Radiology, NYU Langone Health, New York, NY, USA
 
Read the full article

Abstract

Objective

To determine whether the presence of an ultrasound hypoechoic region at the site of a region of interest (ROI) on magnetic resonance imaging (MRI) results in improved prostate cancer (PCa) detection and predicts clinically significant PCa on MRI–ultrasonography fusion‐targeted prostate biopsy (MRF‐TB).

Materials and Methods

Between July 2011 and June 2017, 1058 men who underwent MRF‐TB, with or without systematic biopsy, by a single surgeon were prospectively entered into an institutional review board‐approved database. Each MRI ROI was identified and scored for suspicion by a single radiologist, and was prospectively evaluated for presence of a hypoechoic region at the site by the surgeon and graded as 0, 1 or 2, representing none, a poorly demarcated ROI‐HyR, or a well demarcated ROI‐HyR, respectively. The interaction of MRI suspicion score (mSS) and ultrasonography grade (USG), and the prediction of cancer detection rate by USG, were evaluated through univariate and multivariate analysis.

Results

For 672 men, the overall and Gleason score (GS) ≥7 cancer detection rates were 61.2% and 39.6%, respectively. The cancer detection rates for USGs 0, 1 and 2 were 46.2%, 58.6% and 76.0% (P < 0.001) for any cancer, and 18.7%, 35.2% and 61.1% (P < 0.001) for GS ≥7 cancer, respectively. For MRF‐TB only, the GS ≥7 cancer detection rates for USG 0, 1 and 2 were 12.8%, 25.7% and 52.0%, respectively (P < 0.001). On univariate analysis, in men with mSS 2–4, USG was predictive of GS ≥7 cancer detection rate. Multivariable regression analysis showed that USG, prostate‐specific antigen density and mSS were predictive of GS ≥7 PCa on MRF‐TB.

Conclusions

Ultrasonography findings at the site of an MRI ROI independently predict the likelihood of GS ≥7 PCa, as men with a well‐demarcated ROI‐HyR at the time of MRF‐TB have a higher risk than men without.
Read more Articles of the week
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