OBJECTIVES

To determine the incidence of prostate cancer on follow up after an initial negative MRI- fusion biopsy of the prostate, and to determine the change in PSA and MRI results on follow-up.

MRI-fusion prostate biopsy registry from 2018 to 2022 was obtained then histopathology, MRI results, and PSA results were obtained. Repeat PSA and MRI results at extracted at 3 years. PSA mean, range, and change were then determined. MRI results were extracted to determine progression, regression, or persistence.

A total of 670 prostate biopsies were done in the study period, of which 70 were included. PSA on biopsy 9.93 (3.35 – 55.0) with corresponding PIRADS lesions 3, 4, and 5 (n=55, n=19, and n=6). No patient was subsequently diagnosed with prostate cancer on follow-up. PSA mean 7.03, 6.44, 5.27, and 6.07 at 3years interval from biopsy. Repeat prostate MRI showed persistence in 1 and regression in 6 patients.

After a negative MRI-fusion biopsy of the prostate no patient developed prostate cancer with a general decrease in trend in PSA and MRI on follow-up. These patients may have longer interval follow-up periods given the clinical scenario but would be best to test this method in prospective trials first.

Introduction: Prostate cancer is a significant health problem worldwide. Transrectal ultrasound guided biopsy has limitations in the detection of clinically significant disease, hence, new imaging including multiparametric MRI and MRI targeted biopsy is developed. In most centers, reading and contouring of the prostate and identification of significant lesions on MRI are performed by radiologists. In this institution, these steps are performed by a urologist. Objective: To determine the clinically significant cancer detection rate in patients undergoing MRI fusion-targeted and random systematic prostate biopsy where MRI PIRADS scoring, identification of lesions and contouring are performed by a trained urologist in a Philippine tertiary hospital. Methods: This is a cross-sectional study of patients who underwent MRI fusion prostate biopsy in the Philippine General Hospital (PGH) from June 2021 to June 2023. Clinically significant cancer (csCancer) detection rates were calculated for MRI fusion prostate biopsy, random systematic prostate biopsy, and PIRADS scoring. Concordance was also determined between PIRADS scores and histopathological results. Results: Forty six (46) patients who underwent MRI fusion biopsy in PGH were included in the study, representing a total of 90 lesions identified by urologists using mpMRA with PIRADS scores of at least 3. Of the patients, 13 (14.4%) were diagnosed with csCancer, while a large proportion was diagnosed with benign prostatic tissue. The csCancer detection rate of MRI fusion biopsy was 28.3% (13/46) and 8.7% (4/46) for random biopsy. The csCancer detection rate was 11.1%, 14.6%, and 36.4% for PIRADS 3, 4, and 5, respectively. Conclusion The detection rate of clinically significant prostate cancer using MRI fusion-targeted prostate biopsy based on urologist-performed MRI reading and contouring was superior to random systematic approach. The positive predictive value of PIRADS scores when interpreted by urologists was lower compared to reported values in the literature and did not show concordance. This may reflect lowered thresholds for labeling prostate lesions as suspicious in urologists.
Prostatic Neoplasms

Synovial sarcoma is an extremely rare soft tissue cancer that predominantly affects young adults, typically occurring at the para-articular region of the extremities. Primary synovial sarcoma of the prostate is exceptionally uncommon in clinical practice.

Presented here is a case of a 29-year-old male with prostatic synovial sarcoma. He experienced lower urinary tract symptoms and eventually had urine retention. Also discussed here are the imaging findings, treatment plan, and differential diagnosis.

The patient experienced urinary frequency, dysuria, and acute urinary retention, which led to the insertion of a Foley catheter. Subsequent ultrasound scans revealed a large lobulated solid prostate gland. A prostate biopsy confirmed the presence of a malignant spindle cell neoplasm, indicating a prostatic stromal sarcoma. Immunohistomorphologic findings (TLE-1+, STAT6-, S100-, CD34-, ER-, PR-) were consistent with a diagnosis of Monophasic Synovial Sarcoma. The patient underwent six cycles of neoadjuvant chemotherapy before a Radical Prostatectomy was performed. The postoperative course was uneventful, and the patient was discharged in a significantly improved condition.

Given the rarity of this condition, the authors are reporting a case of prostatic synovial sarcoma and how they managed it. They performed a radical prostatectomy with neoadjuvant chemotherapy, which had a positive effect. Subsequent postoperative monitoring and imaging showed no further symptoms.

INTRODUCTION: 68Ga-PSMA PET is an effective imaging modality in the evaluation of prostate cancer. However, there is limited data on its use in the evaluation of therapeutic response, particularly in radioligand therapy. OBJECTIVE: Our aim is to investigate the diagnostic accuracy of 68Ga-PSMA PET hybrid imaging in evaluating response to 177Lu-PSMA therapy in patients with mCRPC compared with the standard use of serum PSA. METHODOLOGY: A systematic review was done according to the Cochrane diagnostic accuracy reviews guidelines and the PRISMA checklist of literature from January 2015 to August 2020. Literature search, study selection, and data extraction were conducted by 2 reviewers. Statistical analysis of data was done using Meta-DiSc v1.4 RESULTS: A total of 5 studies were included following screening. A total of 128 patients were included in the review. Using PSA response as the reference standard, the pooled sensitivity and specificity of 68Ga-PSMA PET hybrid imaging to evaluate treatment response to 177Lu-PSMA therapy was 85% (Cl: 74 to 92%) and 74% (Cl: 62 to 84%), respectively. The computed diagnostic accuracy was 79.7%. CONCLUSION 68Ga-PSMA PET hybrid imaging is an effective diagnostic procedure in evaluating treatment response to 177Lu-PSMA therapy ligand therapy with good sensitivity, specificity, and diagnostic accuracy.
Gallium ; lutetium ; prostatic neoplasms

Magnetic resonance imaging (MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s) on MRI. The role of concurrent systematic in addition to targeted biopsies is currently unclear. Using our prospectively maintained database, we identified men with at least one Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May 2020. Clinically significant prostate cancer (csPCa) was defined as any Gleason grade group ≥2 cancer. Of 545 patients who underwent MRI fusion-targeted biopsy, 222 (40.7%) were biopsy naïve, 247 (45.3%) had previous prostate biopsy(s), and 76 (13.9%) had known prostate cancer undergoing active surveillance. Prostate cancer was more commonly found in biopsy-naïve men (63.5%) and those on active surveillance (68.4%) compared to those who had previous biopsies (35.2%; both P < 0.001). Systematic biopsies provided an incremental 10.4% detection of csPCa among biopsy-naïve patients, versus an incremental 2.4% among those who had prior negative biopsies. Multivariable regression found age (odds ratio [OR] = 1.03, P = 0.03), prostate-specific antigen (PSA) density ≥0.15 ng ml^-2 (OR = 3.24, P < 0.001), prostate health index (PHI) ≥35 (OR = 2.43, P = 0.006), higher PI-RADS score (vs PI-RADS 3; OR = 4.59 for PI-RADS 4, and OR = 9.91 for PI-RADS 5; both P < 0.001) and target lesion volume-to-prostate volume ratio ≥0.10 (OR = 5.26, P = 0.013) were significantly associated with csPCa detection on targeted biopsy. In conclusion, for men undergoing MRI fusion-targeted prostate biopsies, systematic biopsies should not be omitted given its incremental value to targeted biopsies alone. The factors such as PSA density ≥0.15 ng ml^-2, PHI ≥35, higher PI-RADS score, and target lesion volume-to-prostate volume ratio ≥0.10 can help identify men at higher risk of csPCa.
Male ; Humans ; Prostate/pathology* ; Prostatic Neoplasms/pathology* ; Prostate-Specific Antigen ; Magnetic Resonance Imaging/methods* ; Image-Guided Biopsy/methods* ; Retrospective Studies

This study explored a new model of Prostate Imaging Reporting and Data System (PIRADS) and adjusted prostate-specific antigen density of peripheral zone (aPSADPZ) for predicting the occurrence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The demographic and clinical characteristics of 853 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), PSAD of peripheral zone (PSADPZ), aPSADPZ, and peripheral zone volume ratio (PZ-ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves. The AUCs of PSA, PSAD, PSADPZ, aPSADPZ, and PZ-ratio were 0.669, 0.762, 0.659, 0.812, and 0.748 for PCa diagnosis, while 0.713, 0.788, 0.694, 0.828, and 0.735 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa. The new model significantly improved the diagnostic accuracy of PCa (0.945 vs 0.830, P < 0.01) and csPCa (0.937 vs 0.845, P < 0.01) compared with the base model. In addition, the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold. This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators. Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.
Male ; Humans ; Prostate/pathology* ; Prostate-Specific Antigen/analysis* ; Prostatic Neoplasms/diagnostic imaging* ; Biopsy ; Nomograms ; Retrospective Studies

We aimed to study radiomics approach based on biparametric magnetic resonance imaging (MRI) for determining significant residual cancer after androgen deprivation therapy (ADT). Ninety-two post-ADT prostate cancer patients underwent MRI before prostatectomy (62 with significant residual disease and 30 with complete response or minimum residual disease [CR/MRD]). Totally, 100 significant residual, 52 CR/MRD lesions, and 70 benign tissues were selected according to pathology. First, 381 radiomics features were extracted from T2-weighted imaging, diffusion-weighted imaging, and apparent diffusion coefficient (ADC) maps. Optimal features were selected using a support vector machine with a recursive feature elimination algorithm (SVM-RFE). Then, ADC values of significant residual, CR/MRD lesions, and benign tissues were compared by one-way analysis of variance. Logistic regression was used to construct models with SVM features to differentiate between each pair of tissues. Third, the efficiencies of ADC value and radiomics models for differentiating the three tissues were assessed by area under receiver operating characteristic curve (AUC). The ADC value (mean ± standard deviation [s.d.]) of significant residual lesions ([1.10 ± 0.02] × 10^-3 mm² s^-1) was significantly lower than that of CR/MRD ([1.17 ± 0.02] × 10^-3 mm² s^-1), which was significantly lower than that of benign tissues ([1.30 ± 0.02] × 10^-3 mm² s^-1; both P < 0.05). The SVM feature models were comparable to ADC value in distinguishing CR/MRD from benign tissue (AUC: 0.766 vs 0.792) and distinguishing residual from benign tissue (AUC: 0.825 vs 0.835) (both P > 0.05), but superior to ADC value in differentiating significant residual from CR/MRD (AUC: 0.748 vs 0.558; P = 0.041). Radiomics approach with biparametric MRI could promote the detection of significant residual prostate cancer after ADT.
Male ; Humans ; Prostatic Neoplasms/drug therapy* ; Androgen Antagonists/therapeutic use* ; Androgens ; Neoplasm, Residual ; Retrospective Studies ; Magnetic Resonance Imaging/methods* ; Diffusion Magnetic Resonance Imaging/methods*

This study investigated whether free prostate-specific antigen (fPSA) performs better than total PSA (tPSA) in predicting prostate volume (PV) in Chinese men with different PSA levels. A total of 5463 men with PSA levels of <10 ng ml^-1 and without prostate cancer diagnosis were included in this study. Patients were classified into four groups: PSA <2.5 ng ml^-1, 2.5-3.9 ng ml^-1, 4.0-9.9 ng ml^-1, and 2.5-9.9 ng ml^-1. Pearson/Spearman's correlation coefficient (r) and receiver operating characteristic (ROC) curves were used to evaluate the ability of tPSA and fPSA to predict PV. The correlation coefficient between tPSA and PV in the PSA <2.5 ng ml^-1 cohort (r = 0.422; P < 0.001) was markedly higher than those of the cohorts with PSA levels of 2.5-3.9 ng ml^-1, 4.0-9.9 ng ml^-1, and 2.5-9.9 ng ml^-1 (r = 0.114, 0.167, and 0.264, respectively; all P ≤ 0.001), while fPSA levels did not differ significantly among different PSA groups. Area under ROC curve (AUC) analyses revealed that the performance of fPSA in predicting PV ≥40 ml (AUC: 0.694, 0.714, and 0.727) was better than that of tPSA (AUC = 0.545, 0.561, and 0.611) in men with PSA levels of 2.5-3.9 ng ml^-1, 4.0-9.9 ng ml^-1, and 2.5-9.9 ng ml^-1, respectively, but not at PSA levels of <2.5 ng ml^-1 (AUC: 0.713 vs 0.720). These findings suggest that the relationship between tPSA and PV may vary with PSA level and that fPSA is more powerful at predicting PV only in the ''gray zone'' (PSA levels of 2.5-9.9 ng ml^-1), but its performance was similar to that of tPSA at PSA levels of <2.5 ng ml^-1.
Male ; Humans ; Prostate-Specific Antigen ; Prostate ; East Asian People ; Prostatic Neoplasms/diagnosis* ; ROC Curve

Male ; Humans ; Prostatic Neoplasms/pathology* ; Prostatic Neoplasms, Castration-Resistant/pathology* ; Hormones ; Androgen Antagonists/therapeutic use*

Mitogen-activated protein kinase-8-interacting protein 2 (MAPK8IP2) is a scaffold protein that modulates MAPK signal cascades. Although MAPK pathways were heavily implicated in prostate cancer progression, the regulation of MAPK8IP2 expression in prostate cancer is not yet reported. We assessed MAPK8IP2 gene expression in prostate cancer related to disease progression and patient survival outcomes. MAPK8IP2 expression was analyzed using multiple genome-wide gene expression datasets derived from The Cancer Genome Atlas (TCGA) RNA-sequence project and complementary DNA (cDNA) microarrays. Multivariable Cox regressions and log-rank tests were used to analyze the overall survival outcome and progression-free interval. MAPK8IP2 protein expression was evaluated using the immunohistochemistry approach. The quantitative PCR and Western blot methods analyzed androgen-stimulated MAPK8IP2 expression in LNCaP cells. In primary prostate cancer tissues, MAPK8IP2 mRNA expression levels were significantly higher than those in the case-matched benign prostatic tissues. Increased MAPK8IP2 expression was strongly correlated with late tumor stages, lymph node invasion, residual tumors after surgery, higher Gleason scores, and preoperational serum prostate-specific antigen (PSA) levels. MAPK8IP2 upregulation was significantly associated with worse overall survival outcomes and progression-free intervals. In castration-resistant prostate cancers, MAPK8IP2 expression strongly correlated with androgen receptor (AR) signaling activity. In cell culture-based experiments, MAPK8IP2 expression was stimulated by androgens in AR-positive prostate cancer cells. However, MAPK8IP2 expression was blocked by AR antagonists only in androgen-sensitive LNCaP but not castration-resistant C4-2B and 22RV1 cells. These results indicate that MAPK8IP2 is a robust prognostic factor and therapeutic biomarker for prostate cancer. The potential role of MAPK8IP2 in the castration-resistant progression is under further investigation.
Male ; Humans ; Androgens/therapeutic use* ; Receptors, Androgen/genetics* ; Prognosis ; Mitogen-Activated Protein Kinase 8/therapeutic use* ; Cell Line, Tumor ; Prostatic Neoplasms/pathology* ; Prostatic Neoplasms, Castration-Resistant/drug therapy* ; Gene Expression Regulation, Neoplastic