The purpose of this review was to evaluate the current role of multiparametric magnetic resonance imaging (mp-MRI) in the management of prostate cancer (PC). The diagnosis of PC remains controversial owing to overdetection of indolent disease, which leads to overtreatment and subsequent patient harm. mp-MRI has the potential to equilibrate the imbalance between detection and treatment. The limitation of the data for analysis with this new technology is problematic, however. This issue has been compounded by a paradigm shift in clinical practice aimed at utilizing this modality, which has been rolled out in an ad hoc fashion often with commercial motivation. Despite a growing body of literature, pertinent clinical questions remain. For example, can mp-MRI be calibrated to reliably detect biologically significant disease? As with any new technology, objective evaluation of the clinical applications of mp-MRI is essential. The focus of this review was on the evaluation of mp-MRI of the prostate with respect to clinical utility.
*Disease Management ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Prostate/*pathology ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery

Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.
Humans ; Image Interpretation, Computer-Assisted/methods ; Image-Guided Biopsy/methods ; Magnetic Resonance Imaging/*methods ; Male ; Neoplasm Recurrence, Local/diagnosis ; Practice Guidelines as Topic ; Prostate/pathology ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/surgery ; Watchful Waiting

OBJECTIVETo study the technique and clinical outcomes of laparoscopic radical prostatectomy for high risk prostate cancer.

METHODSA total of 65 patients with high risk prostate cancer were treated with surgery in the First Affiliated Hospital of Nanjing Medical University from January 2011 to June 2013. The mean age was 67 years (range 45-75 years). The mean preoperative prostate specific antigen (PSA) level was 26.7 µg/L (range 11.2-65.5 µg/L). The transrectal biopsy revealed Gleason score of 3+3 in 4 patients, Gleason 3+4 in 27 patients, Gleason 4+3 in 11 patients, Gleason 4+4 in 21 patients and Gleason 4+5 in 2 patients. The bone metastasis was excluded by scintigraphy examination. The surgical procedures were performed through transperitoneal approach. Extended pelvic lymph nodes dissection was performed after the removal of the prostate. Adjuvant radiotherapy or hormonal therapy was administrated according to the pathological results. Serum PSA was detected every 1 to 2 month and urinary continence was evaluated every 3 month in the first year, and then serum PSA was detected every 2 to 3 month.

RESULTSThe mean operative time was (134±21) minutes and the median blood loss was (300±146) ml. Bladder neck reconstruction was performed in 15 cases. The drainage was removed on postoperative day 4 and the catheter was removed on day 7. Pathologic results demonstrated pT2 in 25 patients, pT3a in 28 patients, pT3b in 9 patients and pT4 in 3 patients. Positive surgical margin was presented in 15 patients. A median of 19 lymph nodes (range 11-24 nodes) were retrieved during lymphadenectomy and 11 patients had lymph nodes metastasis with a total of 19 positive nodes. Forty-three patients recovered continence after the removal of catheter. Eleven patients received adjuvant hormonal therapy and 19 patients received adjuvant radiation therapy. With the median of 20 months follow-up (range 12-30 months), 5 patients got biochemical recurrence.

CONCLUSIONSLaparoscopic radical prostatectomy with extended lymph nodes dissection for high risk prostate cancer is safe and technical feasible. It provides accurate information on tumor stage and grade. It is an important component of multimodality for the treatment of high risk prostate cancer.

Aged ; Biopsy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; Postoperative Period ; Prostate-Specific Antigen ; blood ; Prostatectomy ; Prostatic Neoplasms ; diagnosis ; surgery

Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; surgery ; Carcinoma, Pancreatic Ductal ; pathology ; Diagnosis, Differential ; Humans ; Male ; Prostate ; pathology ; Prostatic Intraepithelial Neoplasia ; pathology ; Prostatic Neoplasms ; diagnosis ; pathology ; surgery

Prostate-specific antigen (PSA) is recognized as an organ-specific marker with low specificity and sensitivity in discriminating prostate cancer (PCa) from other benign conditions, such as prostatic hyperplasia or chronic prostatitis. Thus, in the case of clinical suspicion, a PCa diagnosis cannot be made without a prostate biopsy. [-2]proPSA (p2PSA), a precursor of PSA, has been investigated as a new marker to accurately detect PCa. The aim of this systematic review was to discuss the available literature regarding the clinical validity and utility of p2PSA and its derivatives, p2PSA/fPSA (%p2PSA) and the Prostate Health Index (PHI). A systematic search of the PubMed and Scopus electronic databases was performed in accordance with the PRISMA statement (http://www.prisma-statement.org), considering the time period from January 1990 to January 2014 and using the following search terms: proprostate specific antigen, proenzyme PSA, proPSA, [-2]proPSA, p2PSA, Prostate Health Index, and PHI. To date, 115 studies have been published, but only 35 were considered for the qualitative analysis. These studies suggested that p2PSA is the most cancer-specific form of PSA, being preferentially expressed in PCa tissue and being significantly elevated in the serum of men with PCa. It is now evident that p2PSA, %p2PSA, and PHI measurements improve the specificity of the available tests (PSA and derivatives) in detecting PCa. Moreover, increasing PHI values seem to correlate with more aggressive disease. Some studies have compared p2PSA and its derivatives with other new biomarkers and found p2PSA to be significantly more accurate. Indeed, the implementation of these tests in clinical practice has the potential to significantly increase the physician's ability to detect PCa and avoid unnecessary biopsies, while also having an effective impact on costs. Further studies in large, multicenter, prospective trials are required to confirm these encouraging results on the clinical utility of these new biomarkers.
Humans ; Male ; Prostate-Specific Antigen/*blood ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery ; Protein Isoforms/blood ; Protein Precursors/*blood ; Sensitivity and Specificity ; Severity of Illness Index ; Tumor Markers, Biological/blood

PURPOSE: To evaluate the concordance of cancer location of the tissue mapping from a mechanical pressure transducer with magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS: A total of 60 indentations were performed on 5 prostate specimens obtained after radical prostatectomy utilizing a robotic indentation system. The mechanical elastic moduli of suspected malignant lesions were calculated and mapped, and their locations were compared with suspicious areas of malignancy on MRI scans. RESULTS: The concordance rate between the location mapping from the robotic indentation system and MRI scans results was 90.0% (54/60). The sensitivity and specificity of the robotic indentation system were 87.9% (29/33) and 92.6% (25/27), respectively. The positive predictive value and negative predictive value were 93.5% (29/31) and 93.1% (27/29), respectively. CONCLUSION: The locations of malignant lesions derived from our robotic indentation system correlated strongly with the locations of suspected areas of malignancy on MRI scans. Our robotic system may provide a more targeted biopsy of the prostate than conventional non-targeted systemic biopsy, possibly improving the diagnostic accuracy of prostatic biopsies for cancer.
Aged ; Biopsy/methods ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Predictive Value of Tests ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery ; Robotics/instrumentation/*methods ; Sensitivity and Specificity

OBJECTIVE: To retrospectively determine the optimal b value of diffusion-weighted imaging (DWI) for predicting the presence of localized prostate cancer, and to evaluate the utility of DWI under different b values in differentiating between cancers and benign prostatic tissues. MATERIALS AND METHODS: Eighty patients with suspected prostate cancer underwent MRI including DWI at 3T, followed by radical prostatectomy. DWI was examined under different b values. Apparent diffusion coefficient (ADC) maps were generated by using b = 0, and other b values of 300, 700, 1000 or 2000 s/mm2. For predicting the presence of cancers, four different ADC maps were analyzed independently by two blinded readers. ADCs were measured in benign and malignant tissues. RESULTS: For predicting the presence of 110 prostate cancers, the sensitivity and area under the curve (AUC) for an experienced reader was significantly greater at b = 1000 (85% and 0.91) than b = 300, 700 or 2000 s/mm2 (p < 0.01). For a less-experienced reader, the AUC was significantly greater at b = 700, 1000 or 2000 than b = 300 s/mm2 (p < 0.01). Mean ADCs of the cancers in sequence from b = 300 to 2000 s/mm2 were 1.33, 1.03, 0.88 and 0.68 x 10(-3) mm2/s, which were significantly lower than those of benign tissues (p < 0.001). CONCLUSION: The optimal b value for 3T DWI for predicting the presence of prostate cancer may be 1000 s/mm2.
Aged ; Aged, 80 and over ; Area Under Curve ; Biopsy ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Predictive Value of Tests ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery ; Retrospective Studies ; Sensitivity and Specificity

The necessity of routine prostate biopsy prior to transurethral resection of the prostate (TURP) in elderly comorbid patients with a high prostate specific antigen (PSA) level remains controversial. We assessed the role of TURP in prostate cancer diagnosis in these individuals. A total of 197 patients underwent TURP in conjunction with prostatic needle biopsy. Pathologic reviews of specimens of TUR chips and biopsy cores were analyzed. Overall, prostate cancer (CaP) was detected in 114 patients (57.6%). Ninety-eight cancers (86%) were detected with TURP and biopsy, and seven cancers (6.1%) with only TURP. The Gleason score of a TUR-specimen was identical to that of the biopsy-core in 43.9% of cases. Variables associated with diagnostic accuracy in the TUR-specimens included the prebiopsy PSA level, prostate specific antigen density (PSAD), and the Gleason score in biopsy cores. In patients with a PSA level and a PSAD that was greater than 15.4 ng/mL and 0.69 ng/mL/g, respectively, 100% of the cancers were detected in the TUR-specimens. Our results suggest that a prostatic biopsy might be omitted prior to TURP in elderly patients with significant co-morbidity and levels for PSA of >15.4 ng/mL.
Aged ; Aged, 80 and over ; Area Under Curve ; Biopsy, Needle ; Comorbidity ; Humans ; Male ; Neoplasm Grading ; Prostate/*surgery ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/*diagnosis/epidemiology/*pathology/surgery ; ROC Curve ; Transurethral Resection of Prostate

OBJECTIVE: The purpose of the current study was to develop support vector machine (SVM) and artificial neural network (ANN) models for the pre-operative prediction of advanced prostate cancer by using the parameters acquired from transrectal ultrasound (TRUS)-guided prostate biopsies, and to compare the accuracies between the two models. MATERIALS AND METHODS: Five hundred thirty-two consecutive patients who underwent prostate biopsies and prostatectomies for prostate cancer were divided into the training and test groups (n = 300 versus n = 232). From the data in the training group, two clinical decision support systems (CDSSs-[SVM and ANN]) were constructed with input (age, prostate specific antigen level, digital rectal examination, and five biopsy parameters) and output data (the probability for advanced prostate cancer [> pT3a]). From the data of the test group, the accuracy of output data was evaluated. The areas under the receiver operating characteristic (ROC) curve (AUC) were calculated to summarize the overall performances, and a comparison of the ROC curves was performed (p < 0.05). RESULTS: The AUC of SVM and ANN is 0.805 and 0.719, respectively (p = 0.020), in the pre-operative prediction of advanced prostate cancer. CONCLUSION: The performance of SVM is superior to ANN in the pre-operative prediction of advanced prostate cancer.
Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Biopsy, Needle ; *Decision Support Systems, Clinical ; Humans ; Male ; Middle Aged ; *Neural Networks (Computer) ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery ; ROC Curve ; Sensitivity and Specificity ; *Support Vector Machines

The objective of this study was to evaluate the prognostic roles of the prostate volume, tumor volume, and tumor percentage as a function of the pathologic T stage in radical prostatectomy specimens. This study included 259 patients who underwent radical prostatectomy between 2005 and 2010. The mean follow-up period was 41.2 months. In all of the specimens, prostate volume (P = 0.021), the Gleason score (P = 0.035), and seminal vesicle invasion (P = 0.012) were independent predictors of biochemical recurrence (BCR). In the T2 group, multivariate analysis showed that the BCR was significantly associated with prostate specific antigen (PSA) (P = 0.028), a lower prostate volume (P = 0.004), and the Gleason score (P = 0.040). The Kaplan-Meier survival curve showed that a smaller prostate volume was significantly associated with a greater risk of BCR (< 30 vs > or = 30 mL; P = 0.010). In the T3 group, patients with seminal vesicle invasion had a significantly shorter mean BCR-free survival (P = 0.030). In this study, tumor volume and tumor percentage did not predict BCR. Notably, a lower prostate volume is an independent predictor for BCR only in the organ-confined radical prostatectomy specimens. But, prostate volume could not predict BCR in most locally advanced tumors.
Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis ; Neoplasm Staging ; Organ Size ; Predictive Value of Tests ; Prostate/*pathology ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*pathology/surgery ; Retrospective Studies ; Risk Factors