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The significance of anterior prostate lesions on multiparametric magnetic resonance imaging in African-American men

INTRODUCTION African-American (AA) men tend to harbor high-risk prostate cancer (PCa) and exhibit worse outcomes when compared to other groups. It has been postulated that AA men may harbor more anterior prostate lesions (APLs) that are undersampled by the standard transrectal ultrasound guided-biopsy (SBx), potentially resulting in greater degree of Gleason score (GS) upgrading at radical prostatectomy. We aimed to evaluate the detection rate of anterior PCa significance of APLs in AA men on multiparametric magnetic resonance imaging (mpMRI) and compare it to a matched cohort of White/Other (W/O) men. MATERIALS AND METHODS A review of 1,267 men who had an mpMRI with suspicious prostate lesions and who underwent magnetic resonance transrectal ultrasound fusion-guided biopsy (FBx) with concurrent SBx in the same biopsy session was performed. All AA men were matched to a control group of W/O using a 1:1 propensity score-matching algorithm with age, prostate-specific antigen, and prostate volume as matching variables. Logistic regression analysis was used to determine predictors of APLs in AA men. RESULTS Of the 195 AA men who underwent mpMRI, 93 (47.7%) men had a total of 109 APLs. Prior negative SBx was associated with the presence of APLs in AA men (Odds ratio = 1.81; 95% CI: 1.03-3.20; P = 0.04). On multivariate logistic regression analysis, smaller prostate (P = 0.001) and rising prostate-specific antigen (P = 0.007) were independent predictors of cancer-positive APLs in AA men. Comparative analysis of AA (93/195, 47.7%) vs. W/O (100/194, 52%) showed no difference in the rates of APLs (P = 0.44) or in cancer detection rate within those lesions or the distribution of GS within those cancers (P = 0.63) despite an overall higher cancer detection rate in AA men (AA: 124/195 [63.6%] vs. W/O: 97/194 [50.0%], P = 0.007). In cases where APLs were positive for PCa on FBx, the GS of APL was equal to the highest GS of the entire gland in 82.9% (29/35) and 90.9% (30/33) of the time in AA and W/O men, respectively. CONCLUSION Cancer-positive APLs represented the highest risk GS in most cases. AA men with prior negative SBx are twice as likely to harbor a concerning APL. In our cohort, AA and W/O men had comparable rates of APLs on mpMRI. Thus, differences in APLs do not explain the higher risk of AA men for deahth due to PCa. However, targeting of APLs via FBx can clinically improve PCa risk stratification and guide appropriate treatment options.

DCE MRI of prostate cancer

DCE MRI is an established component of multi-parametric MRI of the prostate. The sequence highlights the vascularization of cancerous lesions, allowing readers to corroborate suspicious findings on T2W and DW MRI and to note subtle lesions not visible on the other sequences. In this article, we review the technical aspects, methods of evaluation, limitations, and future perspectives of DCE MRI.

Determinants and prognostic implications of malignant ascites in metastatic papillary renal cancer

OBJECTIVE To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic effect on the survival of these patients. METHODS A retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000-2014) was undertaken. Logistic regression to identify predictors of the development of malignant ascites and Kaplan-Meier analysis to estimate survival was done. RESULTS Overall, 106 consecutive patients with metastatic pRCC were identified; sufficient data were available in 100 patients to enable assessment of ascites. Further, 20% had evidence of malignant ascites. Median age at diagnosis of ascites was 48.0 years (26.1-76.6 years) and median time to development of ascites from initial diagnosis of metastatic disease was 16.0 (0-73.3) months. There was no significant difference in the incidence of ascites between patients with hereditary and sporadic pRCC (P = 0.803) or among patients with different subtypes of pRCC (P = 0.456). Elevated platelet-lymphocyte ratio predicted development of malignant ascites in our cohort (P = 0.009). Median overall survival was shorter for patients who developed ascites [25.0 (10.2-39.8) months] compared with patients who did not develop this complication [42.5 (30.5-54.4) months, P = 0.041]. CONCLUSION To our knowledge, this is the first systematic evaluation of the incidence, predictors, and prognostic effect of ascites in metastatic pRCC. Malignant ascites is a common manifestation of metastatic pRCC and is associated with a shorter overall survival. An elevated platelet-lymphocyte ratio predicts a higher risk of developing malignant ascites.

MP05-19 PRIOR NEGATIVE FUSION-GUIDED PROSTATE BIOPSY: WHEN IS A REPEAT BIOPSY NECESSARY?

INTRODUCTION AND OBJECTIVES: The Prostate ImagingReporting and Data System (PIRADS) score was developed to evaluate the likelihood of malignancy for lesions seen in the peripheral zone and transition zone on multi-parametric Magnetic Resonance Imaging (MRI) of the prostate. We aim to determine if this same scoring system can be used to evaluate central zone lesions on MRI. METHODS: A retrospective review was performed of 73 patients who underwent MR/US fusion-guided biopsy of 139 suspicious lesions between February 2014 and October 2015. All patients underwent a 3 Tesla multi-parametric MRI. Indications for MRI include an abnormal digital rectal exam, PSA velocity >0.75ng/dl/year and patients on active surveillance. Our multi-parametric MRI sequence involved T2, diffusion weighted imaging and dynamic contrast enhancement. Using a 3-dimensional model software [InVivo (Phillips), Gainesville (USA)], at least 3 MR/US fusion-guided biopsies were performed on each prostate lesion seen on MRI regardless of PIRADS score under local anesthesia in the outpatient clinic. RESULTS: There were 80 peripheral zone lesions, 32 transitional zone lesions and 27 central zone lesions that were biopsied. Median PIRADS score for central zone lesions was 3 (range 1-5). Compared to the peripheral and transition zone, central zone lesions graded PIRADS 4 and 5 were more likely to be false positive, p1⁄40.012. Only two patients (7%) had clinically significant prostate cancer (Gleason >3+3) seen on central zone lesion. Both patients had lesions which were graded as PIRADS 3. Both lesions involved the transition zone as well and encompassed at least 50% of the entire central zone and transition zone. Both patients previously had transrectal ultrasound guided biopsy of the prostates which were negative for cancer. Both patients underwent a robotic assisted laparoscopic prostatectomy which yielded a Gleason score that were similar to MRI fusion biopsy. CONCLUSIONS: Lesions involving only the central zone seen on multi-parametric MRI are less concerning for malignancy and should not be given equal weightage as peripheral zone lesions. In our series, no lesions involving solely the central zone, regardless of PIRADS score was positive for malignancy on MR/US fusion-guided biopsy. A better PIRADS scoring system should be developed to help identify central zone lesions with malignant potential.

Multi-institutional evaluation of multiparametric MRI and fusion-guided prostate biopsy in a biopsy-naive population.

60 Background: Multiparametric MRI (mpMRI) and fusion biopsy (FB) has proven beneficial in men with a prior negative systematic biopsy (SB) or diagnosis of prostate cancer (CaP). The aim of the study was to evaluate mpMRI and FB in a biopsy-naive population. Methods: A multi-institutional review was performed on patients with no prior biopsy history who underwent mpMRI followed by concurrent FB and SB. Imaging protocol was standardized across institutions. Gleason score (GS) distribution/risk classifications were recorded. Univariate analysis was performed to compare FB versus SB. Results: A total of 361 biopsy-naive men were identified from 4 institutions. GS distribution/risk classification for FB and SB are presented in the table. Overall cancer detection rate (CDR) was 65.4%. In biopsy-naive men, FB detected a greater absolute number of high grade disease with 13% more high risk CaP than SB (78 vs 69). Additionally, FB detected 21% fewer cases of GS 6 CaP (57 vs 69). The CDR for FB alone was 57.3% wit...

Corrigendum to “A Case of In-Bore Transperineal MRI-Guided Prostate Biopsy of a Patient with Ileal Pouch-Anal Anastomosis”

[This corrects the article DOI: 10.1155/2015/676930.].