ACR Stakeholder Prostate Summit.

Multi-parameter magnetic resonance imaging has been widely used in the diagnosis and evaluation of prostate cancer, and has important guiding significance for clinical diagnosis of prostate cancer and their treatment. This article studies the value of transrectal multiparametric ultrasound (mpUSS) in the diagnosis of clinically meaningful prostate cancer. 102 patients with high risk factors for prostate cancer were examined by mpUSS and mpMRI. The transrectal biopsy (SB) results of the prostate system were regarded as the excellent standard, and the diagnostic value of mpUSS, mpMRl and mpUSS combined with mpMRl examination for clinically meaningful prostate cancer was analyzed. The results showed that 58 of the 102 patients with SB were diagnosed with prostate cancer. Among them, 43 cases were detected by mpUSS, 50 cases were detected by mpMRl, 42 cases were detected by mpUSS combined with mpMRI (series), and 56 cases were detected by mpUSS combined with mpMRl (parallel). Grouped by Gleason score, the detection rate of mpUSS for clinically significant prostate cancer was 83.74%, and the detection rate of mpMRl was 93.5%. The comparison between the two was not statistically significant (P > 0.05), but when the two inspection methods were combined. The detection rate was 97.8%, which was significantly higher than the two inspection methods alone. Therefore, we conclude that mpUSS can be used as an imaging test for the diagnosis of prostate cancer. In addition, mpUSS has a high application value in the diagnosis of prostate cancer. The detection rate of mpUSS combined with mpMRl examination for clinically meaningful prostate cancer is significantly higher than that of mpMRl examination alone, which can be used as a diagnostic technique for early diagnosis of meaningful prostate cancer and can be used as a guide clinicians’ early diagnosis and treatment of meaningful prostate cancer.

Imaging is central to the diagnosis, staging, treatment planning, and monitoring of prostate cancer (PCa). Unequal access to new imaging techniques may directly contribute to gaps in PCa treatment and outcome. Thus, identifying disparities in PCa diagnosis and treatment are centrla to informing strategies to promote equitable cancer care. This review examines the existing evidence regarding clinical and sociodemographic factors associated with disparities in imaging utilization and treatment for PCa. Major areas of disparities identified include healthcare and research access. Sociodemographic disparities are present in screening and diagnosis; Black patients are consistently less likely to receive both prostate multiparametric MRI and timely molecular imaging used to evaluate for biochemical recurrence. Regional variation in appropriate and inappropriate diagnostic imaging also contributes to corresponding differences in outcomes, especially between urban and rural settings. Delays in PCa imaging and diagnosis also delay definitive treatment or placement on active surveillance, with prominent differences by race and measures of social advantage Recognition of these disparities in PCa imaging and treatment can reinforce actions to improve equitable access to patients affected by PCa. Identifying modifiable steps in the PCa diagnosis, staging, and treatment workflow may inform interventions to bridge gaps in cancer outcome.

This article is a primer on the technical aspects of performing a high-quality dynamic contrast-enhanced MRI (DCE-MRI) examination of the prostate gland. DCE-MRI is emerging as a useful clinical technique as part of a multi-parametric approach for evaluating the extent of primary and recurrent prostate cancer. Performing a high-quality DCE-MRI examination requires a good understanding of the technical aspects and limitations of image acquisition and postprocessing techniques.

At present, increased early detection of prostate cancer appears to be the most feasible way to reduce cancer-related mortality. As a result significant efforts have been made to identify more men with curable cancer. This article reviews the role of serum prostate-specific antigen in an early detection or screening strategy and describes efforts to enhance the specificity of prostate-specific antigen testing.

Prostate MRI: Toward Imaging Tumor Histology.

The Usefulness of the Detection of GSTP1 Methylation in Urine as a Biomarker in the Diagnosis of Prostate Cancer

Introduction While prostate cancer (PCa) diagnosis and treatment are known to increase mental health (MH) risks, less is understood about the psychological distress during each specific phase of the journey, such as that instigated by erectile dysfunction (ED) and urinary incontinence (UI). Clarifying MH risks for patients with ED and UI throughout the prostate cancer care continuum is crucial for appropriate patient counseling, timely intervention, and improved support. Objective To assess the incidence and risk of MH disorders among men with ED and UI as they progress through evaluation and management of PCa. Methods A retrospective cohort study was conducted using IBM MarketScan claims database between 2011–2020. Using ICD9/10 and CPT codes, we identified all patients with a diagnosis of PCa and matched each to a control without PCa by age and Charlson comorbidity index (CCI), modified to exclude cancer diagnoses. Controls with elevated PSA or biopsy were also excluded. For PCa cases, groups were a time-varying covariate that patients moved through depending on where they were in the prostate cancer journey. The six groups analyzed were: controls, pre-cancer (PCa patients prior to work-up of elevated PSA or diagnosis), elevated PSA/biopsy (PCa patients prior to PCa diagnosis), watching (PCa patients with a diagnosis of PCa without treatment), prostatectomy and radiation. We noted the first diagnosis of ED and UI for each patient as well as any MH diagnoses, including depressive disorders, anxiety disorders, substance use disorders, and self-harm/suicidality. Multivariable Cox proportional hazard models were used to assess the relationship between PCa, ED, or UI, and MH diagnoses. Interaction terms between PCa status and ED or UI were included to test for differential responses to urologic comorbidities between cancer patients and cancer-free controls. Results A total of 1,323,072 men (661,536 controls; 661,536 PCa patients) were included in the analysis. PCa patients without ED or UI showed a significantly decreased risk of being diagnosed with a MH condition compared to controls (HR for the pre-cancer, elevated PSA/biopsy, watching, prostatectomy and radiation groups: 0.902 (0.88-0.92), 0.811 (0.78-0.85), 0.96 (0.94-0.97) 0.79 (0.752-0.835) and 0.93 (0.89-0.96), respectively; p <0.001). MH diagnosis was significantly increased in controls with ED (HR: 1.61 (1.13-1.19); p<0.001) and the effect was significantly ameliorated in the watching, prostatectomy and radiation groups (ED*group interaction HRs: 0.87 (0.84–0.90), 0.87 (0.81-0.93) and 0.85 (0.79-0.92), respectively; p<0.01). UI also significantly increased the likelihood of a MH diagnosis in controls (HR: 2.02 (1.94-2.10); p<0.001) and the effect was significantly dampened in all PCa groups (UI*group interaction HR for the pre-cancer, elevated PSA/biopsy, watching, prostatectomy and radiation groups: 0.85 (0.76-0.95), 0.80 (0.67-0.97), 0.69 (0.65-0.72), 0.55 (0.51-0.60) and 0.70 (0.62-0.78), respectively; p<0.02). Conclusions ED and UI were independently linked to higher MH risk, particularly among controls, but their effect was less pronounced in men with PCa-supporting the "cancer paradox," where psychological impact of functional decline is mitigated by cancer context. Appropriate counseling and resources are necessary to support patients at all stages in the PCa journey to further decrease the risk of MH diagnoses. Disclosure No

IntroductionProstate cancer, a major global health issue, necessitates early and precise detection for effective management. Traditional diagnostic methods like DRE, PSA tests, and biopsies have drawbacks in accuracy and safety....

Functional Magnetic Resonance Imaging in Prostate Cancer

237 Background: Polygenic scores are strongly associated with age at diagnosis of prostate cancer (PCa) but have not been clearly shown to discriminate between indolent and aggressive PCa. P-CARE (Prostate CAncer integrated Risk Evaluation) is an integrated model that combines a 601-variant polygenic hazard score (PHS601), genetic ancestry, and family history. We hypothesize that among men diagnosed with PCa, those with higher P-CARE scores are more likely to develop metastatic disease. Methods: We analyzed genetic and phenotypic data from a diverse, national cohort of men diagnosed with PCa (Million Veteran Program, n=69,901, 6413 metastatic). We used Cox proportional hazards models to test P-CARE and PHS601 for association with age at onset of metastatic PCa (birth-met analysis). We also tested P-CARE for association with metastasis-free survival after diagnosis of localized PCa, with or without accounting for PSA, stage, and age at diagnosis (localized-met analysis). PCa was detected/treated too late if the patient had definitive treatment for localized disease but developed metastasis. Thus, onset of metastasis was time of first treatment or diagnosis of metastasis, whichever occurred first. Participants who never experienced metastasis were censored at time of first treatment or last follow-up/death.We repeated this analysis within men with African genetic ancestry (n=16,889). Confidence intervals for hazard ratios (HR) were estimated using 100-fold bootstrapping. For external validation of direction of effect, we tested P-CARE for association with age at diagnosis of clinically significant PCa in cohorts from the PRACTICAL Consortium (Cohort of Swedish Men [COSM, n=2163], ProtecT [n=1583]). Results: P-CARE was associated with birth-met and localized-met in the full MVP cohort and among men with African ancestry. In the full cohort, patients in the highest 20% of P-CARE (based on percentiles of men of European ancestry with PCa) compared with the lowest 20% had a HR (HR 80/20 ) of 1.58 [95% CI 1.48–1.68] and 1.32 [1.23–1.40] for birth-met and localized-met, respectively. The corresponding HR 80/20 values for PHS601 alone were 1.29 [1.20–1.37] and 1.16 [1.07–1.25]. When accounting for PSA, stage, and age at diagnosis, P-CARE HR 80/20 was 1.05 [0.99-1.11] for localized-met. Among men with African ancestry, HR 80/20 was 1.43 [1.26–1.62] and 1.17 [1.03–1.34] for birth-met and localized-met, respectively. Within the PRACTICAL cohorts, P-CARE was associated with development of clinically significant PCa (COSM: 1.33 [1.16–1.57], ProtecT: 1.67 [1.34–2.10]). Conclusions: Among men diagnosed with PCa, P-CARE and PHS601 are moderately specific for metastatic disease. We are currently studying P-CARE in ProGRESS (ClinicalTrials.gov ID NCT05926102), a nationwide randomized clinical trial to evaluate precision PCa screening in the VA healthcare system.

An estimated one in three gay and bisexual (GB) male couples receive a prostate cancer (PCa) diagnosis over their life course with limited understanding of the impacts on their relationships. Psychological distress related to PCa diagnosis and treatment-related side effects have been shown to disrupt established GB partnership dynamics. Communication barriers often develop within GB relationships affected by PCa, further exacerbating couple tensions, isolating partners, and lowering quality of life for both patients and partners. In order to elaborate on these phenomena following a PCa diagnosis, we conducted focus group discussions with GB men in relationships. Men were recruited nationally through PCa support groups, and after completing consent procedures, they were invited to one of two focus group discussions conducted through video conference. Topics discussed included the diagnosis and medical decision making pertaining to PCa; healthcare provider experiences; the emotional, physical, and sexual impact of PCa diagnosis and treatment; sources of support and appraisal of resources; and partner involvement and communication. There were twelve GB men who participated in focus group discussions that were audio-recorded and transcribed, and analyzed using a thematic approach. GB couple experiences with PCa during and after treatment choice and recovery identified common patient-provider communication barriers. In particular, GB men reported difficulties in disclosing their sexuality and relationship to their providers, limiting conversations about treatment choice and partner engagement in care. Both patients and partners experienced times of being alone after treatment, either by choice or to give space to their partner. However, partners often did not explicitly discuss their preferences for being alone or together, which resulted in partners' disengagement in their relationship and the prostate cancer healthcare process. This disengagement could blunt the notable PCa survival benefits of partnership for GB men.

Introduction: The use of pre-biopsy MRI scans is now a standard of care in the evaluation of men with elevated prostate-specific antigen (PSA); however, the use of biparametric MRI (bpMRI) has been a source of controversy amongst health professionals. The study aimed to analyse our experience with the use of bpMRI in evaluating suspected prostate cancer in conjunction with other clinical indicators, such as PSA density (PSAD) and family history of prostate cancer.Methods: This retrospective, single-centre study consisted of 404 patients who had an MRI due to elevated PSA and subsequent prostate biopsies.Result: The average age of the study population was 69.7±7.3 years, with the majority of the patients above 70 years. A statistically significant positive correlation was observed between PSAD and Prostate Imaging-Reporting and Data System (PI-RADS) scores (r=0.2, p<0.001). Higher PSAD groups showed an increased proportion of PI-RADS 4 and 5 lesions. There was a significant positive correlation (r=0.2, p<0.001) between PSAD and International Society of Urological Pathology (ISUP) grade, indicating that the detection of clinically significant and higher-grade prostate cancer increases with PSAD. High-risk prostate cancers (ISUP grades 4 and 5) were detected in the high-risk category of PSAD (14.6% and 18%, respectively). PI-RADS scores correlated significantly with ISUP grades (r=0.3, p<0.001). Conclusion: Our study demonstrated that bpMRI-detected PI-RADS scores significantly correlated with PSAD, histological diagnosis (ISUP grade), and clinically significant prostate cancer detection. bpMRI has a role in the diagnostic value of prostate cancer when combined with PSAD and a family history of prostate cancer. It is effective in detecting clinically significant prostate cancers at a lower cost and shorter time while eliminating the potential harm of the use of gadolinium.

Racial disparity in the use of prostate magnetic resonance imaging (MRI) presents obstacles to closing gaps in prostate cancer diagnosis, treatment, and outcome. To identify clinical, sociodemographic, and structural processes underlying racial disparity in the use of prostate MRI among men with a new diagnosis of prostate cancer. This population-based cohort study used mediation analysis to assess claims in the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database for prostate MRI among 39 534 patients with a diagnosis of localized prostate cancer from January 1, 2011, to December 31, 2015. Statistical analysis was performed from April 1, 2020, to September 1, 2021. Diagnosis of prostate cancer. Claims for prostate MRI within 6 months before or after diagnosis of prostate cancer were assessed. Candidate clinical and sociodemographic meditators were identified based on their association with both race and prostate MRI, including the Index of Concentration at the Extremes (ICE), as specified to measure racialized residential segregation. Mediation analysis was performed using nonlinear multiple additive regression trees models to estimate the direct and indirect effects of mediators. A total of 39 534 eligible male patients (3979 Black patients [10.1%] and 32 585 White patients [82.4%]; mean [SD] age, 72.8 [5.3] years) were identified. Black patients with prostate cancer were less likely than White patients to receive a prostate MRI (6.3% vs 9.9%; unadjusted odds ratio, 0.62, 95% CI, 0.54-0.70). Approximately 24% (95% CI, 14%-32%) of the racial disparity in prostate MRI use between Black and White patients was attributable to geographic differences (SEER registry), 19% (95% CI, 11%-28%) was attributable to neighborhood-level socioeconomic status (residence in a high-poverty area), 19% (95% CI, 10%-29%) was attributable to racialized residential segregation (ICE quintile), and 11% (95% CI, 7%-16%) was attributable to a marker of individual-level socioeconomic status (dual eligibility for Medicare and Medicaid). Clinical and pathologic factors were not significant mediators. In this model, the identified mediators accounted for 81% (95% CI, 64%-98%) of the observed racial disparity in prostate MRI use between Black and White patients. In this this population-based cohort study of US adults, mediation analysis revealed that sociodemographic factors and manifestations of structural racism, including poverty and residential segregation, explained most of the racial disparity in the use of prostate MRI among older Black and White men with prostate cancer. These findings can be applied to develop targeted strategies to improve cancer care equity.

IntroductionDiagnosis of prostate cancer (PCa) is based on prostate biopsy that is performed when prostate specific antigen (PSA) is persistently altered over time and/or abnormal digital rectal examination is found. Serum PSA levels increase in both PCa and benign prostatic hyperplasia, leading to an increased number of unnecessary biopsies. There is an urgent need to unravel PCa-specific molecular signatures.Patients and methodsThis study aimed at characterizing a panel of circulating micro RNAs (miRNAs) that could distinguish PCa from benign prostatic hyperplasia in a population of age-matched patients with increased PSA levels. Both miRNAs targeting genes involved in PCa onset and miRNAs whose role in PCa has been highlighted in other studies were included. For this purpose, let-7c, let-7e, let-7i, miR-26a-5p, miR-26b-5p, miR-24-3p, miR-23b-3p, miR-27-b-3p, miR-106a-5p, miR-20b-5p, miR-18b-5p, miR-19b-2-5p, miR-363-3p, miR-497, miR-195, miR-25-3p, miR-30c-5p, miR-622, miR-874-3p, miR-346 and miR-940 were assayed through real-time PCR in 64 patients with PCa and compared with 60 patients with benign prostatic hyperplasia. The ability of miRNAs to predict the stage of disease was also analyzed.ResultsLet-7c, let-7e, let-7i, miR-26a-5p, miR-26b-5p, miR-18b-5p and miR-25-3p were able to discriminate patients with PCa from those harboring benign prostatic hyperplasia, both presenting altered PSA levels (>3 ng/mL). MiR-25-3p and miR-18b-5p showed the highest sensitivity and specificity to predict PCa, respectively. The combination of these two miRNAs improved the overall sensitivity. A correlation between pathological Gleason score and miRNA expression levels was reported; miR-363-3p, miR-26a-5p, miR-26b-5p, miR-106a-5p, miR-18b-5p, miR-25-3p and let-7i decreased in expression concomitantly with an increase in malignancy.ConclusionThis study confirms serum miRNAs to be reliable candidates for the development of minimally invasive biomarkers for the diagnosis and prognosis of PCa, particularly in those cases where PSA acts as a flawed marker.

Background: Prostate cancer is the most common cancer in men in Europe. Both the European Association of Urologists (EAU) and the National Institute of Clinical Excellence (NICE) provide evidence-based guidelines for the diagnosis and management of prostate cancer. NICE is a national body involved in the production of efficacious guidelines for a wide spectrum of diseases across many specialities, whereas EAU is a specialist body of urologists and members of the urology multidisciplinary team across Europe. This paper describes the areas of agreement and explains the variations between these two often-quoted documents. Objectives: The objective of this paper is to review the guidelines of prostate cancer and to offer a comparison of prostate cancer guidance management for urologists and associated healthcare professionals. Conclusion: Both guidelines agree on areas of established consensus, especially in the diagnosis and staging of prostate cancer. There are however differences in the treatment algorithms, especially in advanced and metastatic disease. The differences in general seem to be due to the different functions and make-ups of the two bodies rather than disagreement on current evidence.