Research Presentation Session: Genitourinary

RPS 1507 - Prostate imaging and cancer management

March 1, 14:00 - 15:30 CET

7 min
Clinically significant prostate cancer detection of MRI in-bore biopsy after negative targeted plus systematic MRI/US fusions-guided biopsy
Matthias Boschheidgen, Düsseldorf / Germany
Author Block: M. Boschheidgen, M. Quentin, J. P. Radtke, T. Ullrich, L. R. Drewes, B. Valentin, P. Albers, G. Antoch, L. Schimmöller; Düsseldorf/DE
Purpose: This study aimed to discuss the challenges of patients with suspicion of clinically significant prostate cancer (csPC) on multiparametric prostate MRI (mpMRI), but negative or inconclusive MRI/US fusion-guided biopsy (FB) in clinical practice; and to evaluate the utility of MRI in-bore biopsy (IB) in patients with discordant imaging and histopathologic results following FB.
Methods or Background: Consecutive patients who underwent IB after FB between 01/2014 and 05/2022 with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 lesions on mpMRI at 3T, without histologically confirmed csPC, were included. The primary objective was the detection rate of csPC. Secondary objectives were to analyze these cases regarding clinical parameters, MRI parameters, and lesion localization.
Results or Findings: In the final cohort of 51 patients, the overall PC detection rate with IB was 71% and 47% for csPC. IB resulted in a Gleason score upgrade in 55% of cases with initial low-grade PC. The detected csPC was most commonly located apical and/or anterior. The detection rate of PC in PI-RADS category 4 was 58% and 94% in PI-RADS 5 (csPC 39% and 61%, respectively). Patients with csPC showed significantly smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and older age.
Conclusion: In a relevant proportion of patients with PI-RADS 4 or 5 but negative or inconclusive findings on previous FB and persistent suspicion of csPC, a csPC could be verified by subsequent IB. Therefore, IB might serve as a backup solution in cases of uncertainty.
Limitations: The limitations of this study were that it was a single-centre and retrospective design.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethikkommission Universität Düsseldorf.
7 min
Magnetic resonance imaging characteristics and oncological follow-up of patients with high grade prostate cancer
Matthias Boschheidgen, Düsseldorf / Germany
Author Block: M. Boschheidgen, L. R. Drewes, B. Valentin, J. P. Radtke, P. Albers, G. Antoch, L. Schimmöller; Düsseldorf/DE
Purpose: This study aimed to analyse multiparametric MRI characteristics of patients with ISUP 4 or 5 prostate cancer (PC) on biopsy and to investigate the correlation with biochemical recurrence (BCR) after radical prostatectomy (RPE).
Methods or Background: In this single-centre cohort study, consecutive patients with mpMRI and ISUP 4 or 5 PC at the time of biopsy and/or RPE were retrospectively analysed. Clinical, MR-guided biopsy and mpMRI parameters were assessed. A subcohort of patients with RPE and follow-up was analysed separately. A univariate and multivariate analysis was performed to determine parameters which enable the identification of patients facing an elevated risk of BCR after RPE.
Results or Findings: 145 patients (mean age 70 years, median PSA 10.9 ng/ml) were analysed. 99% had PI-RADS score of 4 or 5, 48% revealed MRI T3 stage and median tumour diameter was 15mm. Cancerous areas showed a median ADC value of 668 ×10−3 mm2/s and exhibited contrast enhancement in 94% of the cases. For patients with and without BCR after RPE (n=82), MRI parameters were different for contact length to pseudocapsule, MRI cT3 stage, and localization of the index lesion (p<0.05). PSAD and MRI cT3 stage were independent parameters for the risk of BCR when incorporating clinical, biopsy, and MRI parameters.
Conclusion: ISUP 4 or 5 PC had distinctive MRI characteristics and were detected on MRI in all included cases. PSAD and cT3 stage on MRI are significant predictors for BCR after RPE. These results may help clinicians, to identify patients at higher risk for recurrence at follow-up. MRI has the ability to identify high-risk prostate cancer and may play a role in clinical risk stratification and prediction of biochemical recurrence after radical prostatectomy.
Limitations: The limitations of this study were that it was a single-centre, retrospective design.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethikkommission der Universität Düsseldorf.
7 min
Five-year outcomes after transurethral ultrasound ablation (TULSA) of localised prostate cancer
Jurgen Fütterer, Nijmegen / Netherlands
Author Block: J. Fütterer1, D. Bonekamp2, T. Persigehl3, S. Arora4, S. Raman5, K. J. Macura6, A. Oto7, T. Tirkes8, D. Costa9; 1Nijmegen/NL, 2Heidelberg/DE, 3Cologne/DE, 4New Haven, CT/US, 5Los Angeles, CA/US, 6Baltimore, MD/US, 7Chicago, IL/US, 8Indianapolis, IN/US, 9Dallas, TX/US
Purpose: This study aimed to discuss the magnetic resonance imaging-guided transurethral ultrasound ablation (TULSA) of the prostate using ultrasound to thermally coagulate tissue in-bore. Closed-loop control matches real-time feedback from MRI thermometry to the ablative energy administered to the prescribed volume. We report the 5-year follow-up from the TACT pivotal study.
Methods or Background: 115 men with localised prostate cancer (PCa) were enrolled across 13 sites in 5 countries. Eligibility included Grade Group (GG) 1-2, stage≤T2b, and PSA≤15 ng/mL. Men received a single, whole-gland TULSA treatment sparing the prostatic urethra and urinary sphincter. Primary endpoints at 1 year were PSA reduction and adverse events. Secondary endpoints included 10-core biopsy and mpMRI at 1 year and adverse events, quality of life, PSA, and salvage treatment to 5 years.
Results or Findings: At baseline, (median [IQR]) age was 65 (59-69) years. By 5 years, PSA decreased from 6.3 (4.6-7.9) ng/mL pre-treatment to 0.63 (0.18-1.9) ng/mL (n=68), and 25 men (21.7%) received salvage treatment, without unexpected complications (10 prostatectomy, 11 radiotherapy, 3 ADT, 1 surgery and radiation). Median prostate volume at baseline and 1 year was 37.3 and 2.8 cc (92% decrease). At baseline and 1 year, 72/115 (63%) and 17/111 (15%) had ≥GG2 disease. By 5 years, 61/66 (92%) recovered pad-free continence; 80/92 (87%) preserved IIEFQ2≥2 erections. 12 men incurred Grade 3 adverse events (10%), with no Grade≥4 event or rectal injury. Intraprocedural imaging parameters, positive MRI and rising PSA at 1 year predicted the risk of salvage therapy by 5 years.
Conclusion: Effective disease control was achieved in 78% of men at 5 years after a single TULSA procedure. Favourable safety and functional outcomes were durable to 5 years.
Limitations: Modern protocols may translate into improved rates of local control in contemporary cases. A randomized controlled trial comparing TULSA with radical prostatectomy is underway (NCT05027477).
Funding for this study: The funding for this study was received from Profound Medical.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No information was provided by the submitter.
7 min
Expect the unexpected: unveiling discrepancies in prostate cancer diagnosis with an MRI-pathology discordance analysis
Arnaldo Stanzione, Napoli / Italy
Author Block: A. Stanzione1, K-L. Lee2, N. Sanmugalingam2, I. Rajendran2, N. Sushentsev2, I. Caglič2, T. Barrett2; 1Naples/IT, 2Cambridge/UK
Purpose: This study aimed to investigate the underlying explanations for inconsistent results between prostate MRI and biopsy outcomes in biopsy-naïve patients. Additionally, it seeks to shed light on diagnostic errors and potential enhancements in the prostate cancer (PCa) diagnostic process.
Methods or Background: A retrospective analysis was conducted on 2780 biopsy-naïve patients undergoing prostate MRI at a tertiary referral centre from October 2015 to June 2022. Patients exhibiting discordance between MRI and biopsy results were categorized into two groups: MRI-negative/Biopsy-positive and MRI-positive/Biopsy-negative (biopsy-positive defined as Gleason score ≥ 3+4). An expert uroradiologist reviewed cases with discrepancies, reassessing PI-RADS scores retrospectively, identifying previously unreported MRI targets, and evaluating MRI scan quality (MRI-negative/Biopsy-positive group). Categories for discrepancies included MRI overcalls (including known pitfalls), benign pathology findings, and errors in biopsy targeting.
Results or Findings: Patients who did not undergo biopsy (n=1258), with indeterminate MRI findings (PI-RADS 3, n=204), or with clinically insignificant PCa (Gleason score 3+3, n=216) were excluded. Of the remaining patients, 32/1102 (3%) were classified as MRI-negative/Biopsy-positive and 117/1102 (11%) as MRI-positive/Biopsy-negative. In the MRI-negative/Biopsy-positive group, 44% of the scans were deemed non-diagnostic quality. Upon retrospective image review, target lesions were identified in 28% of cases. In the MRI-positive/Biopsy-negative group, 42% were attributed to MRI overcalls, while 32% had benign pathology findings explaining the observed abnormalities on MRI. Biopsy targeting errors accounted for 11% of cases.
Conclusion: Prostate MRI demonstrated a high diagnostic accuracy, with low occurrences of discrepant findings. To further minimize these, it is essential to ensure optimal MRI quality and expert image assessment. Common reasons for MRI-positive/Biopsy-negative cases included benign pathology findings and MRI overcalls.
Limitations: The limitations of this study were that it was of retrospective design and single-centre.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Local IRB.
7 min
Integrated diagnostics for the detection of prostate cancer through the integration of data derived from a breath analysis device, MRI, and molecular analysis: a proof-of-concept study
Martina Pecoraro, Rome / Italy
Author Block: M. Pecoraro, S. Novelli, E. Messina, L. Laschena, C. Catalano, V. Panebianco; Rome/IT
Purpose: This study aimed to deliver novel, cost-effective, evidence-based, non-invasive predictive risk-adapted diagnostic pathways for faster, earlier, more precise, accessible, and affordable detection and screening of prostate cancer.
Methods or Background: A prospective single-centre cohort study, enrolling patients with PCa suspicion who underwent MRI, MRI-directed fusion biopsy (MRDB), was conducted. Patients also underwent breath analysis using a non-invasive device and molecular analysis (mir-302a-5p and 367). A network-based analysis was used to identify biomarkers drivers of clinically significant PCa.
Results or Findings: Overall, 46 men were enrolled and underwent MR for clinical suspicion of prostate cancer; during the day of the scan or the day of the biopsy procedure, patients also underwent breath analysis and plasma sampling for microRNA expression analysis. A total of 38 patients represented the entire cohort: 12 (31.5%) were negative for PCa, 8 (21.0%) had grade group (GG) 1 PCa, and 18 (47.3%) had GG >1 PCa. The proposed additional non-invasive analysis, including clinical data, MRI biomarkers, breath sensing and microRNAs, provided a higher net benefit with a biopsy avoidance rate of about 23% at a low disease probability.
Conclusion: The integration of multimodal data, including results from medical devices, imaging and omics can further improve the diagnostic pathway of patients with clinical suspicion of prostate cancer.
Limitations: The main limitation is the small sample cohort.
Funding for this study: This study was supported by the Italian National Complementary Plan - D3-4-HEALTH project - funded by the Next Generation EU.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No information was provided by submitter.
7 min
Surveillance of one-year post-focal cryotherapy for clinically significant prostate cancer using mpMRI and PIRADS v2.1: an initial experience from a prospective phase II mandatory biopsy study
Jyothirmayi Velaga, Singapore / Singapore
Author Block: J. Velaga, K. J. Tay, G. Hang, Y. G. Tan, N. Lath, J. S. Yuen, M. Chua, N. T. Ngo, Y. M. Law; Singapore/SG
Purpose: This study aimed to discuss the challenges of multiparametric magnetic resonance imaging (mpMRI) surveillance post-focal cryotherapy (FT) of prostate cancer as post-treatment artefacts alter mpMRI findings. In this initial experience, we assessed the diagnostic performance of mpMRI in detecting clinically significant prostate cancer (csPCa) after FT.
Methods or Background: This single-centre phase II prospective clinical trial recruited 28 men with localized csPCa for FT between October 2019 and April 2021. 12-month post-FT mpMRI was performed prior to biopsy and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of all mpMRI-positive subjects were analysed. Chi square goodness of fit test correlated biopsy-positive PIRADS3 (P3) and PIRADS4/5 lesions with histology grade group. One-way ANOVA test assessed the performance of ADC values in differentiating csPCa, non-csPCa and benign lesions.
Results or Findings: Sensitivity, specificity, PPV and NPV of mpMRI were 100%, 14.28%, 53.84% and 100% for subjects with histologically proven cancer. Correlation of PIRADS v2.1 scores with histologically proven prostate cancer was statistically significant (p<0.5). Correlation of P3 lesions with non-csPCa was statistically significant (p<0.02535). Higher ADC value was associated with benign histology (adjusted odds ratio OR 0.97, 95% confidence interval: 0.94, 0.99) (p=0.008). Among the malignant lesions, higher ADC value was associated with non-csPCa (adjusted OR: 0.97; 95% CI: 0.95, 0.99) (p=0.032).
Conclusion: mpMRI is highly sensitive in detecting residual cancer. ADC values and PIRADS scores may be of value in differentiating csPCa from non-csPCa with a potential for risk stratification of men requiring re-biopsy versus non-invasive surveillance of remnant prostate.
Limitations: The limitation of the study was the small sample size.
Funding for this study: Funding was received from the National Medical Research Council, Singapore.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study received IRB approval (SingHealth 2018/2482)
7 min
Diagnostic performance of PSMA-PET/CT and multiparametric MRI assessed using the PI-RR scoring system for the detection of prostate cancer local recurrence and lymph node metastases
Ludovica Laschena, Rome / Italy
Author Block: L. Laschena, A. Dehghanpour, E. Messina, M. Bicchetti, C. Catalano, V. Panebianco; Rome/IT
Purpose: This study aimed to discuss MRI and PSMA-PET/CT recommendations for patients at risk of developing prostate cancer (PCa) recurrence. Recently the Prostate Imaging for Recurrence Reporting (PI-RR) system has been proposed to standardize MRI acquisition, interpretation, and reporting in case of PCa local recurrence suspicion after therapies with curative intent. The study aimed (1) to determine the diagnostic yield and clinical value of PET/CT and MRI using PI-RR, and (2) to stratify results according to patient’s pre/post-operative risk.
Methods or Background: Retrospective multi-center study; 119 patients with clinical suspicion of PCa recurrence underwent MRI and PET/CT in close succession. Exclusion criteria included lack of sufficient follow-up data, pelvic radiation therapy (previous 6 months), and history of hormone therapy. PI-RR score was assigned independently by two experienced uroradiologists. PET/CT images were reviewed by an expert nuclear medicine physician. Reference-standard was defined using histopathologic findings, follow-up imaging or clinical response to treatment. Sensitivity, specificity, PPV, NPV, and accuracy were calculated. The intraclass-correlation coefficient was used to determine inter-reader agreement.
Results or Findings: MRI resulted positive (PI-RR ≥3) in 69 cases, PET/CT in 48 cases. We found a statistically significant difference in terms of rate of PCa recurrence between MRI and PET/CT (p=0.006).
MRI (PI-RR ≥3) and PET-CT reveal respectively: sensitivity of 86% and 71%; specificity of 78% and 52%, PPV of 74% and 51%; NPV of 89% and 73%; accuracy of 81% and 60% for PCa recurrence detection. At multivariate analysis, only age (0.002) and PI-RR ≥ 3 (0.001) independently correlate with recurrence.
Conclusion: MRI proved its strong diagnostic performance in detecting PCa recurrence. Therefore, low-risk patients should be directed to MRI to rule out local recurrence; high-risk patients should be investigated using PET/CT to rule in local and distant recurrence.
Limitations: The limitations of this study were the high-volume tertiary referral centre and limited reproducibility.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Institutional Ethics Committee.
7 min
Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy
Li Chen, Beijing / China
Author Block: Q. Peng, L. Xu, G. Zhang, J. Zhang, X. Zhang, X. Bai, L. Chen, Z. Jin, H. Sun; Beijing/CN
Purpose: This study aimed to assess the effect of preoperative MRI with standardized Prostate Imaging–Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP).
Methods or Background: This cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between 2017 and 2022. The patients were divided into a PI-RADS group and a non-PI-RADS group. The pathological outcomes included pathological T stage (pT2 vs. pT3–4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed.
Results or Findings: A total of 380 patients were included, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3–4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3–4 (p < 0.001) in the cT1–2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089).
Conclusion: Preoperative MRI with standardized PI-RADS assessment could reduce the proportion of patients with non-organ-confined PCa undergoing PR and slightly reduce the PSM rate compared with non-PI-RADS assessment.
Limitations: This is a single-centre and retrospective cohort study, and our analysis lacks complete insight into the surgical protocol decisions of patients.
Funding for this study: This work is supported by grants from the National High-Level Hospital Clinical Research Funding (Grant No. 2022-PUMCH-A-033, 2022-PUMCH-A-035, and 2022-PUMCH-B-069), the CAMS Innovation Fund for Medical Sciences (CIFMS) (Grant No. 2022-I2M-C&T-B-019), and the 2021 Key Clinical Specialty Program of Beijing.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Institutional Review Board (IRB number I-22PJ1031).
7 min
ProstaPilot: prostate cancer screening by magnetic resonance imaging with a biparametric protocol, preliminary cohort analysis after the first screening round
Michal Standara, Brno / Czechia
Author Block: M. Standara, M. Stanik, J. Kristek, O. Majek, M. Uher; Brno/CZ
Purpose: This study aimed to validate the accuracy of biparametric magnetic resonance (bpMRI) prostate protocol in a screening population and its potential benefits in the screening of clinically significant prostate cancer (csPC). While PSA screening can reduce prostate cancer mortality, the risk of overdiagnosis and overtreatment of non-significant prostate cancer is a concern.
Methods or Background: The ProstaPilot prospective cohort study enrolled 422 men aged 50-69 years between May 2022 and May 2023 who had not undergone PSA or prostate MRI in the past two years. If a patient had a PSA elevation ≥ 3 ng/ml, they were advised to undergo a systematic biopsy. If a patient had abnormal findings on bpMRI (PI-RADS 4-5 lesion), they underwent systematic and MRI/US targeted biopsy. The bpMRI was performed with a 15-minute PI-RADS compliant non-contrast protocol, and csPC was defined as ISUP grade ≥ 2 prostate cancer. The data underwent statistical analyses.
Results or Findings: In the first screening round, a positive MRI result was recorded in 17 (4.0%) men, and a positive PSA test result was found in 25 (5.9%) men, of whom seven (1.7%) had positive both MRI and PSA tests. Prostate biopsy was recommended to 35 study participants (8.3%) based on one or both positive tests. Of these, three men refused biopsy, and in the MRI-positive group, eight (1.9%) csPC and seven (1.7%) ISUP1 carcinomas were detected, while in the PSA-positive group, four (0.9%) and four (0.9%) carcinomas detected, respectively.
Conclusion: More clinically significant cancers were detected in the MRI-positive group than in the PSA-positive group. Due to limited capacity, MRI cannot be performed on all screened men. Further studies are needed to determine the optimal PSA level at which men should undergo bpMRI.
Limitations: No limitations were identified.
Funding for this study: Funding for this study was provided by the Ministry of Health of the Czech Republic: grant nr. NU22-09-00539 and Ministry of Health, Czech Republic – conceptual development of research organization (MOÚ, 00209805).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by Masaryk Memorial Cancer Institute Ethics committee: Ref. Nr. 2021/1715/MOU.
7 min
Reduction of total perfusion of prostatic adenoma following prostate artery embolisation for benign prostatic hyperplasia (BPH)
Ailin Dehghanpour, Rome / Italy
Author Block: A. Dehghanpour, S. Cipollari, E. Messina, L. Laschena, C. Catalano, V. Panebianco; Rome/IT
Purpose: This study aimed to assess changes in total prostate and central gland volumes and changes in perfusion following prostate artery embolisation in patients with symptomatic benign prostatic hyperplasia (BPH).
Methods or Background: In this prospective study, we included patients with symptomatic BPH refractory to medical therapy with no evidence or previous history of prostate cancer. Patients underwent multiparametric prostate MRI (mpMRI) prior to endovascular prostate artery embolisation; a follow-up mpMRI was performed 4 weeks after the procedure. Total prostate and central gland volumes were measured on both the baseline and follow-up mpMRI. A quantitative map of the Area Under the Curve (AUC), which represents the integral of the contrast agent concentration over time, was generated using the OleaSphere software from the perfusion-weighted images. The mean AUC value for all voxels within the central gland was then calculated. Embolisation procedures were performed through a femoral trans-arterial access, a microcatheter was used to catheterize prostate arteries bilaterally, and embolisation was achieved using non-reabsorbable microparticles (300-500 um), following contrast-enhanced cone-beam CT to confirm the correct positioning of the microcatheter.
Results or Findings: 27 patients were included in the study. Baseline total gland volume was 62 cc, central gland volume was 37, mean AUC of central gland perfusion was 31819.28. Technical procedural success was obtained in 25/27 patients (92%). Non-major or minor complications were reported following the procedures. A significant reduction of BPH symptoms was achieved in 22/27 patients (81%). There was a significant reduction in total prostate and central gland volumes (16.2%, p=0.021) and mean AUC perfusion values (14%, p=0.008).
Conclusion: Prostate artery embolisation is a safe and effective procedure for the treatment of symptomatic BPH. Central gland volume and perfusion were significantly reduced at follow-up mpMRI compared to baseline.
Limitations: The limitation of this study was the limited sample size.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Institutional Ethical Committee.
7 min
Oncological and functional outcomes following MicroUS-guided focal laser ablation of localised prostate cancer: comparison of single and multi-laser fibers settings
François Cornud, Paris / France
Author Block: F. Cornud, A. Lefevre, M. Galiano; Paris/FR
Purpose: This study aimed to evaluate the safety, feasibility, and short-term functional and oncological outcomes of focal laser ablation (FLA) of tumours at low risk of progression, under micro-ultrasound guidance.
Methods or Background: 58 PI-RADS>2 lesions were treated in 55 patients between July 2020 and June 2023 with a follow-up of 12 months for 29 patients. The mean age was 69±7.4 years. The mean PSA level was 7.9±3.5 ng/ml. The large tumour axis was ≤20mm. Gleason score was 6 in 10 lesions (10/58,17.2%) and 3+4 in 43 lesions (43/58,74.5%). The first 21 (21/58,36%) and the last 37 lesions (37/58,64%) were treated with a single and multifiber mode, respectively, using the Echolaser® system operating at 1064nm. Image fusion was used to cover the MRI-delineated target volume. A prostato-rectal hydrodissection was performed for posteromedial tumours. DCE-MRI was performed 4 days after FLA to evaluate the ablated volume.
Results or Findings: MicroUS visualised 53 tumours (53/58,91.4%). The multifiber mode achieved larger ablation volumes (19.1±11.8 vs 5.9±3.5cc, p=0.0001). A prostate-rectal fistula occurred postoperatively in a patient with a posteromedial lesion, which was treated surgically. Urinary and erectile functions were not affected by FLA. At 12 months follow-up of 34 tumours in 29 patients, in-field targeted biopsies (TB) diagnosed 13 recurrences (13/34,38.2%, Gleason pattern 4 in 8/13 tumours, 61.5%). Ten (10/13,77%) occurred with a single fibre setting. Four out-field recurrences (4/34,11.7%) were diagnosed. After retreatment of 6 recurrences, TB showed, at 12 months, an 80% negative TB-biopsy rate.
Conclusion: Multifiber microUS-guided FLA is a safe and feasible modality with promising short-term oncological and functional outcomes. Caution is required in posteromedial lesions.
Limitations: Long-term results are required to validate our findings
Funding for this study: The authors or the institution did not receive any funding to conduct this study
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved after written informed consent was obtained from the patients. This single-centre study was approved by our Institutional Review Board.
7 min
The accuracy of the MRI pathway in the detection of index prostate cancer lesion: a single-centre experience
Selahattin Durmaz, Istanbul / Turkey
Author Block: S. Durmaz, B. Coşkun, M. Kılıc, S. Madendere, T. Esen, M. Vural; Istanbul/TR
Purpose: This study aimed to examine the accuracy of the MRI pathway in detecting index prostate cancer (PCa) lesions in biopsy-naive men.
Methods or Background: A retrospective review of 379 biopsy-naive men who underwent multiparametric MRI and subsequent in-bore prostate biopsy for the high-likelihood target (PI-RADS 4-5) was conducted. We identified 110 men with PCa who underwent radical prostatectomy as a definitive treatment and included them in this study. An analysis of the results from multiparametric MRI, in-bore needle biopsy, and whole-mount step-section specimens was conducted to determine the accuracy of the MRI pathway in detecting index lesions, which are defined as lesions with a higher GG and a larger volume. We also evaluated the results of in-bore prostate biopsy and final pathology for GG group compliance.
Results or Findings: In total, 122 high-likelihood targets (PI-RADS 4: 85 targets, PI-RADS 5: 37 targets) were biopsied. Whole-mount specimen analysis revealed multifocal involvement in 75 (68,2%) patients. A total of 83 non-biopsied tumour foci were identified at final pathology and more than half (44/83) of these foci were harbouring ISUP GG 1 tumour. Except for one patient, the index PCa focus was successfully detected and sampled by the MRI pathway approach.
At final pathology, upgrade and downgrade rates were 27,3% (30/110), and 10% (11/110) respectively. The remaining 69 (62,7%) patients had concordant ISUP GG with in-bore biopsy pathology. The majority of the upgraded group was composed of ISUP GG1 patients (20/30).
Conclusion: According to our findings, the MRI pathway is a safe and accurate approach in biopsy-naive men with high-likelihood multiparametric MRI findings.
Limitations: The limitations of this study included;
• It's retrospective design.
• Being a single-institution study with an experienced uroradiologist and uropathologist, a factor, which may limit its generalizability.
• Selection bias due to patient recruitment over 11 years.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by our Institutional Review Board and the requirement for informed written consent was waived.

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