Imaging of the Prostate

Oxidative Stress Measured by Urine F2-Isoprostane Level is Associated With Prostate Cancer

NOVEL STAGING TOOL FOR LOCALIZED PROSTATE CANCER: A PILOT STUDY USING GENETIC ADAPTIVE NEURAL NETWORKS

We thank Drs. Lehrer and Rheinstein for their interest in our study1 and their comments regarding the important topic of prostate cancer screening in healthy older men. They reported estimates of 5-year relative survival among men in the United States with prostate cancer as they age, comparing age ranges of 75 to 79 years, 80 to 84 years, and ≥85 years. Relative survival is defined as the overall survival of patients with prostate cancer divided by the overall survival of a similar cancer-free population.2 It is appropriate to consider a prognosis statistic and compare it with the life expectancy of the patients. However, problems inherent to defining a sufficiently similar cancer-free population (necessary for estimating relative survival) pose challenges to the interpretation of this analysis. The comparison of multiple age groups, including one at the extreme of life expectancy, may introduce additional bias. Nevertheless, the trend reported by the authors is consistent with the results of our study, namely that men with prostate cancer fare worse than those without prostate cancer, and that the older men are when diagnosed with prostate cancer, the worse the prognosis.1 Lehrer and Rheinstein raised concerns that the relative survival rates for men in these older age ranges are not substantially different from the survival probabilities in the United States among all men of those ages. They argued that the comparable percentages across groups are evidence that healthy older men would not benefit from screening. Critically, however, their relative survival estimates did not account for the varying disease stage or aggressiveness of prostate cancer. Our study demonstrated that the absolute incidence of specifically high-risk prostate cancer increased with age among all men in Norway.1 By measuring relative survival using all prostate cancer, Lehrer and Rheinstein have diluted the mortality risk by including men with low-risk prostate cancer. Men with low-risk disease most likely were diagnosed because their physicians thought they were healthy enough to warrant the workup required to diagnose prostate cancer (ie, they were healthier than the normal population).3 The comparable values for SEER*Stat relative survival and life expectancy for the general population suggest that, overall, healthier-than-average older men with above-average life expectancies might lose their survival advantage if they are diagnosed with prostate cancer. The results of our study using Norwegian data indicated that it is men aged 70 to 79 years who have the greatest absolute incidence of being diagnosed with high-risk prostate cancer.1 High-risk disease comprises localized prostate cancers that are curable with definitive treatment but highly prone to becoming metastatic or fatal.4 With a life expectancy of >10 years, a healthy man aged 70 to 79 years could live long enough to develop metastatic disease or die of his cancer. Current National Comprehensive Cancer Network guidelines actually recommend radical therapy for men with high-risk disease whose expected survival is >5 years.5 We do not advocate for the universal screening of older men. Rather, the results of our study1 suggest that older men are among those with the highest incidence of potentially lethal disease. Conversations regarding the pros and cons of screening may be worthwhile for those older men who are healthy enough to benefit from the treatment of high-risk disease. No specific funding was disclosed. Tyler M. Seibert was supported by grant K08EB026503 from the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health for work performed as part of the current study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Seibert also has received grant funding from Varian Medical Systems, past honoraria for providing medical education materials from WebMD Inc, and honoraria from HealthLytix Inc for work performed outside of the current study. Minh-Phuong Huynh-Le reports no conflicts of interest.

Objective To investigate the application value of contrast-enhanced transrectal ultrasound (CE-TRUS) in differential diagnosis of prostate benign and malignant lesions. Methods A retrospective analysis of patients with prostate lesions detected by CE-TRUS from January 2014 to December 2016 in Southwest Hospital of Third Military Medical University was performed. Seventy-two cases of prostate disease with 88 lesions were confirmed by transrectal prostate biopsy under ultrasound guidance. The age of patients with benign and malignant lesions, serum prostate specific antigen (PSA), and the size of prostate and prostate inner gland were compared by independent sample t test. Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, and the sensitivity, specificity and accuracy of CE-TRUS in diagnosis of benign and malignant prostate lesions were calculated. Results Sixty-seven lesions in 52 patients were benign prostatic diseases, and 21 lesions in 20 patients were prostate cancer in this study. The size of prostate and prostate inner gland were not different between patients with prostate cancer and benign prostatic diseases [(58.33±34.99) cm3 vs (57.14±24.42) cm3, t=0.185, P=0.854; (34.98±19.96) cm3 vs (33.89±17.65) cm3, t=0.213, P=0.832]. Most of prostate cancer lesions were in prostate outer gland area (15/21), and contrast-enhanced ultrasound imaging showed contrast enhancement increased mostly in arterial phase and faded faster than the surrounding tissues (16/21). However, most of prostate benign lesions were in prostate inner gland (47/67), and contrast-enhanced ultrasound imaging showed contrast enhancement was mostly equal with the surrounding tissue in arterial phase and faded the same as the surrounding tissues in venous phase (47/67). Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, the sensitivity of CE-TRUS in diagnosis of benign and malignant prostate lesions was 85.71%, the specificity was 91.04%, and the accuracy was 89.77%. Two lesions were in prostate inner and outer gland border areas in the three missed prostate cancer lesions, and Gleason scores were all medium and high differentiated group. Six prostate benign lesions were diagnosed as malignant lesions, five lesions were confirmed prostate hyperplasia with chronic prostatitis and one was confirmed granulomatous inflammation with coagulation necrosis by transrectal prostate biopsy under ultrasound guidance. Conclusion CE-TRUS can effectively identify prostate benign and malignant lesions, and provides reliable information for accurate diagnosis of prostate cancer. Key words: Prostatic neoplasms; Ultrasonography; Contrast media; Diagnosis, differential

PEARLS: Is Our Use of Prostate-specific Membrane Antigen Positron Emission Tomography-Computed Tomography Meaningful for Our Patients?

Prostate Specific Antigen Isoforms and Human Glandular Kallikrein 2—Which Offers the Best Screening Performance in a Predominantly Black Population?

To provide physicians with a review of diagnosis, screening, staging evaluation, treatment options, prognosis, psychosocial issues, economic considerations, and future research directions in the management of patients with all stages of prostate cancer. A MEDLINE search of articles relating to the diagnosis, staging, screening, surgery, radiation therapy, medical management, and research in prostate cancer. Emphasis on information reported from government- and nongovernment-sponsored large cooperative trials, consensus development conferences, and proceedings of prostate cancer organ site workshops. Results of randomized treatment trials and consensus summary statements are reported where long-term results (> 5 years follow-up) are available for localized prostate cancer treatment and where survival outcomes are available for metastatic disease treatment. Both qualitative and quantitative data are reported. Information on staging, management, and prognosis of localized prostate cancer is based on studies that are predominantly nonrandomized, include heterogeneous patient groups, and often use differing outcome measures. Information on management of metastatic prostate cancer is more quantitative and includes side effects of treatment and survival results obtained from randomized, prospective, multi-institutional studies. Despite the increase in prostate cancer incidence and detection, substantial controversy still exists about the advisability and effectiveness of screening programs, the most appropriate staging evaluation, and the optimal management of patients with all stages of prostate cancer. Although randomized, prospective studies attempt to address some of these issues, physicians must appreciate inherent ambiguities involved in recommending staging and treatment choices.

Emerging evidence suggests that the SAM pointed domain containing ETS transcription factor (SPDEF) plays a significant role in tumorigenesis in prostate, breast, colon, and ovarian cancer. However, there are no in vivo studies with respect to the role of SPDEF in tumor metastasis. The present study examined the effects of SPDEF on tumor cell metastasis using prostate tumor cells as a model. Utilizing two experimental metastasis models, we demonstrate that SPDEF inhibits cell migration and invasion in vitro and acts a tumor metastasis suppressor in vivo. Using stable expression of SPDEF in PC3-Luc cells and shRNA-mediated knockdown of SPDEF in LNCaP-Luc cells, we demonstrate for the first time that SPDEF diminished the ability of disseminated tumors cells to survive at secondary sites and establish micrometastases. These effects on tumor metastasis were not a result of the effect of SPDEF on cell growth as SPDEF expression had no effect on cell growth in vitro or subcutaneous tumor xenograft-growth in vivo. Transcriptional analysis of several genes associated with tumor metastasis, invasion, and the epithelial-mesenchymal transition demonstrated that SPDEF expression selectively down-regulated MMP9 and MMP13 in prostate cancer cells. Further analysis indicated that forced MMP9 or MMP13 expression rescued the invasive phenotype in SPDEF expressing PC3 cells in vitro, suggesting that the effects of SPDEF on tumor invasion are mediated, in part, through the suppression of MMP9 and MMP13 expression. These results demonstrate for the first time, in any system, that SPDEF functions as a tumor metastasis suppressor in vivo.

Micro-Ultrasound: a way to bring imaging for prostate cancer back to urology.

LOW SERUM TESTOSTERONE LEVELS ARE ASSOCIATED WITH POSITIVE SURGICAL MARGINS IN RADICAL RETROPUBIC PROSTATECTOMY: HYPOGONADISM REPRESENTS BAD PROGNOSIS IN PROSTATE CANCER

PD37-01 CONTEMPORARY TRENDS IN TREATMENT PATTERNS FOR MEN DIAGNOSED WITH CLINICALLY LOCALIZED PROSTATE CANCER

Accurate staging of prostate cancer (PCa) is the basis for the risk stratification to select targeted treatment. Therefore, this study aimed to compare the diagnostic accuracy rates of magnetic resonance imaging (MRI) and digital rectal examination (DRE) for preoperative T staging of potentially resectable PCa. From March 2021 to March 2022, patients with PCa with T staging by prostate biopsy were included. All examinations used postoperative histopathologic T staging as the reference standard. All patients underwent DRE and MRI before the puncture. Two blinded urologists and radiologists independently evaluated DRE and MRI, respectively. Before the examination, patients were then divided into early- (T1, T2) and late-(T3, T4) stage cancer. Analysis of a paired sample sign test was performed to determine differences between DRE and MRI. A total of 136 study participants with PCa were evaluated histopathologically, of whom 71% (97/136) and 29% (39/136) were at the early- and late-stage cancer, respectively. MRI had a significantly higher accuracy (91.9% vs. 76.5%, P < 0.001) compared with DRE. Further, MRI showed a higher sensitivity than DRE to diagnose early PCa (92.8% vs. 74.2%; P < 0.001). However, the specificity was not significantly different between them (89.7% vs. 82.1%; P = 0.375). Area under the curve (receiver operating curve) values were calculated as 0.78 ± 0.038 (95% confidence interval [CI], 0.71-0.86), 0.91 ± 0.028 (95% CI, 0.86-0.97), and 0.872 ± 0.028 (95% CI, 0.80-0.92) for DRE-, MRI-, MRI + DRE-based PCa predictions, respectively. The prediction performance of MRI was better than that of DRE (DeLong test, z = 3.632, P = 0.0003) and MRI + DRE (DeLong test, z = 3.715, P = 0.0002). For resectable PCa, the diagnostic potential of MRI in assessing the T stage was higher than that of DRE. However, DRE is still valuable, especially for patients with locally advanced PCa.

Ultra-Low Risk Prostate Cancer Treated with Cryotherapy versus Radiation Therapy

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.

3-Dimensional Elastic Registration System of Prostate Biopsy Location by Real-Time 3-Dimensional Transrectal Ultrasound Guidance With Magnetic Resonance/Transrectal Ultrasound Image Fusion