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BMC Urology Jan 2024To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the... (Meta-Analysis)
Meta-Analysis
Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis.
BACKGROUND
To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH).
METHODS
A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4.
RESULTS
Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term.
CONCLUSION
PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
Topics: Male; Humans; Prostate; Prostatic Hyperplasia; Treatment Outcome; Transurethral Resection of Prostate; Embolization, Therapeutic; Arteries; Minimally Invasive Surgical Procedures; Lower Urinary Tract Symptoms; Observational Studies as Topic
PubMed: 38281906
DOI: 10.1186/s12894-023-01397-1 -
International Journal of Medical... Jan 2024Prostate cancer is currently the second most prevalent cancer among men. Accurate diagnosis of prostate cancer can provide effective treatment for patients and greatly... (Review)
Review
BACKGROUND
Prostate cancer is currently the second most prevalent cancer among men. Accurate diagnosis of prostate cancer can provide effective treatment for patients and greatly reduce mortality. The current medical imaging tools for screening prostate cancer are mainly MRI, CT and ultrasound. In the past 20 years, these medical imaging methods have made great progress with machine learning, especially the rise of deep learning has led to a wider application of artificial intelligence in the use of image-assisted diagnosis of prostate cancer.
METHOD
This review collected medical image processing methods, prostate and prostate cancer on MR images, CT images, and ultrasound images through search engines such as web of science, PubMed, and Google Scholar, including image pre-processing methods, segmentation of prostate gland on medical images, registration between prostate gland on different modal images, detection of prostate cancer lesions on the prostate.
CONCLUSION
Through these collated papers, it is found that the current research on the diagnosis and staging of prostate cancer using machine learning and deep learning is in its infancy, and most of the existing studies are on the diagnosis of prostate cancer and classification of lesions, and the accuracy is low, with the best results having an accuracy of less than 0.95. There are fewer studies on staging. The research is mainly focused on MR images and much less on CT images, ultrasound images.
DISCUSSION
Machine learning and deep learning combined with medical imaging have a broad application prospect for the diagnosis and staging of prostate cancer, but the research in this area still has more room for development.
Topics: Male; Humans; Artificial Intelligence; Prostatic Neoplasms; Prostate; Machine Learning; Magnetic Resonance Imaging; Image Processing, Computer-Assisted
PubMed: 37977054
DOI: 10.1016/j.ijmedinf.2023.105279 -
European Urology Focus Sep 2023The optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised.
BACKGROUND
The optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised.
OBJECTIVE
To present medium-term radiological and clinical follow-up of biopsy-negative lesions.
DESIGN, SETTING, AND PARTICIPANTS
The records for men who underwent multiparametric MRI at the UCLH one-stop clinic for suspected prostate cancer between September 2017 and March 2020 were reviewed (n = 1199). Patients with Likert 4 or 5 lesions were considered (n = 495), and those with a subsequent negative MRI-TB comprised the final study population (n = 91).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Baseline and follow-up MRI and biopsy data (including prostate-specific antigen [PSA], prostate volume, radiological scores, and presence of any noncancerous pathology) were extracted from reports. The last follow-up date was the date of the last test or review in clinic.
RESULTS AND LIMITATIONS
Median follow-up was 1.8 yr (656 d, interquartile range [IQR] 359-1008). At baseline, the median age was 65.4 yr (IQR 60.7-70.0), median PSA was 7.1 ng/ml (IQR 4.7-10.0), median prostate volume was 54 ml (IQR 39.5-75.0), and median PSA density (PSAD) was 0.13 ng/ml (IQR 0.09-0.18). Eighty-six men (95%) had Likert 4 lesions, while the remaining five (5%) had Likert 5 lesions. Only 21 men (23%) had a single lesion; most had at least two. Atrophy was the most prevalent pathology on MRI-TB, present in 64 men (74%), and followed by acute inflammation in 42 (46%), prostatic intraepithelial neoplasia in 33 (36%), chronic inflammation in 18 (20%), atypia in 13 (14%), and granulomatous inflammation in three (3%). Fifty-eight men had a second MRI study (median 376 d, IQR 361-412). At the second MRI, median PSAD decreased to 0.11 ng/ml (IQR 0.08-0.18). A Likert 4 or 5 score persisted only in five men (9%); 40 men (69%) were scored Likert 3, while the remaining 13 (22%) were scored Likert 2 (no lesion). Of 45 men with a Likert ≥3 score, most only had one lesion at the second MRI (28 men; 62%). Of six men with repeat MRI-TB during the study period, two were subsequently diagnosed with prostate cancer and both had persistent Likert 4 scores (at baseline and at least one follow-up MRI).
CONCLUSIONS
Most biopsy-negative MRI lesions in the prostate resolve over time, but any persistent lesions should be closely monitored.
PATIENT SUMMARY
Lesions in the prostate detected via magnetic resonance imaging (MRI) scans that are negative for cancer on biopsy usually resolve. Repeat MRI can indicate persistent lesions that might need a second biopsy.
Topics: Male; Humans; Aged; Prostate; Prostate-Specific Antigen; Follow-Up Studies; Biopsy; Magnetic Resonance Imaging; Prostatic Neoplasms; Inflammation
PubMed: 37031096
DOI: 10.1016/j.euf.2023.03.011 -
World Journal of Urology Nov 2023Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate... (Review)
Review
PURPOSE
Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx.
METHODS
A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound.
RESULTS
MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program.
CONCLUSION
MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.
Topics: Male; Humans; Magnetic Resonance Imaging; Prostatic Neoplasms; Biopsy; Prostate-Specific Antigen; Prostate; Image-Guided Biopsy
PubMed: 37555985
DOI: 10.1007/s00345-023-04521-w -
Minerva Surgery Dec 2023
Topics: Male; Humans; Prostate; Biopsy; Prostatic Neoplasms; Magnetic Resonance Imaging
PubMed: 35332762
DOI: 10.23736/S2724-5691.21.09424-7 -
The Journal of Urology Mar 2024We sought to examine the association of extraprostatic extension (EPE) with biochemical recurrence (BCR) separately in men with Grade Group (GG) 1 and GG2 prostate... (Review)
Review
PURPOSE
We sought to examine the association of extraprostatic extension (EPE) with biochemical recurrence (BCR) separately in men with Grade Group (GG) 1 and GG2 prostate cancer (PCa) treated with radical prostatectomy.
MATERIALS AND METHODS
We reviewed our institutional database of patients who underwent radical prostatectomy for PCa between 2005 and 2022 and identified patients with GG1 and GG2 disease on final pathology. Fine-Gray competing risk models with an interaction between EPE (yes vs no) and GG (GG1 vs GG2) were used to examine the relationship between disease group and BCR-free survival.
RESULTS
The cohort consisted of 6309 men, of whom 169/2740 (6.2%) with GG1 disease had EPE while 1013/3569 (28.4%) with GG2 disease had EPE. Median follow-up was 4 years. BCR occurred in 400/6309 (6.3%) patients. For men with GG1, there was no statistically significant difference in BCR-free survival for men with vs without EPE (subdistribution HR = 0.88; 95% CI: 0.37-2.09). However, for GG2 patients BCR-free survival was significantly worse for those with vs without EPE (subdistribution HR = 1.97, 95% CI: 1.54-2.52).
CONCLUSIONS
Although there is a subset of GG1 PCas capable of invading through the prostatic capsule, patients with GG1 PCa and EPE at prostatectomy experience similar biochemical recurrence and survival outcomes compared to GG1 patients without EPE. However, among men with GG2, EPE connotes a worse prognosis.
Topics: Humans; Male; Prostatic Neoplasms; Prostate; Prostatectomy; Neoplasm Grading; Prognosis
PubMed: 38109699
DOI: 10.1097/JU.0000000000003825 -
Journal of Endourology Aug 2023Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment...
Holmium Laser Enucleation of the Prostate Robot-Assisted Simple Prostatectomy for Lower Urinary Tract Symptoms in Patients with Extremely Large Prostates ≥200 cc: A Comparative Analysis.
Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of ≥200 cc. Between 2009 and 2020 a total of 53 patients with a prostate volume of ≥200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc 204.5 cc, = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s +10.70 mL/s, = 0.724) and a reduction of the IPSS score (-12.50 -9, = 0.246) as well as improvement of the QoL (-3 -3, = 0.880). Median operative time was similar in both groups (150 minutes 132.5 minutes, = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g 180 g, = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL 0.8 ng/mL, = 0.112). Despite a similar median catheterization time (3 days 2 days, = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days 3 days, = 0.052). Complication rates were similar in both groups (32% 36%, = 0.987). Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates ≥200 cc. These findings will require external validation at other high-volume centers.
Topics: Male; Humans; Prostate; Quality of Life; Lasers, Solid-State; Robotics; Treatment Outcome; Prostatic Hyperplasia; Prostatectomy; Lower Urinary Tract Symptoms; Laser Therapy; Holmium
PubMed: 37335047
DOI: 10.1089/end.2022.0851 -
BMC Medical Genomics Jan 2024Dysbacteriosis of intestinal tract may cause systemic inflammation, making distant anatomical locations more susceptible to illness. Recent research has demonstrated...
BACKGROUND
Dysbacteriosis of intestinal tract may cause systemic inflammation, making distant anatomical locations more susceptible to illness. Recent research has demonstrated that the microbiome can affect both prostatitis and the inflammation of the prostate that is linked to prostate cancer. It is still unclear, though, whether this relationship indicates causation. We conducted a Mendelian randomization investigation on two samples to fully uncover gut microbiota's potential genetic causal role in prostatitis.
METHOD
Prostatitis (1859 prostatitis cases and 72,799 controls) was utilized as the outcome, while SNPs highly linked with 196 microbial taxa (18 340 people) were chosen as instrumental factors. Random effects, inverse variance weighting, weighted medians, and MR-Egger were used to analyze causal effects. The Cochran's Q test, funnel plot, leave-one-out analysis, and MR-Egger intercept test were all used in the sensitivity analysis.
RESULTS
A causal effect in lowering the incidence of prostatitis is anticipated for five gut microorganisms (Methanobacteria, Methanobacteriaceae, Erysipelatoclostridium, Parasutterella, and Slackia; P < 0.05). Four gut bacteria, including Faecalibacterium, LachnospiraceaeUCG004, Sutterella, and Gastranaerophilales, are predicted to play a causal role in increasing the risk of prostatitis (P < 0.05). There were no discernible estimates of pleiotropy or heterogeneity.
CONCLUSION
Our investigation established the genetic links between nine gut microorganisms and prostatitis, which may offer fresh perspectives and a theoretical framework for the future prevention and management of prostatitis.
Topics: Male; Humans; Prostatitis; Gastrointestinal Microbiome; Inflammation; Nonoxynol; Polymorphism, Single Nucleotide; Genome-Wide Association Study
PubMed: 38273299
DOI: 10.1186/s12920-024-01812-y -
Radiologic Clinics of North America Jan 2024The aim of this article is to review the technical and clinical considerations encountered with PI-RADS 3 lesions, which are equivocal for clinically significant... (Review)
Review
The aim of this article is to review the technical and clinical considerations encountered with PI-RADS 3 lesions, which are equivocal for clinically significant Prostate Cancer (csPCa) with detection rates ranging between 10% and 35%. The number of PI-RADS 3 lesions reported vary according to several factors including MRI quality and radiologist training/expertise among the most influential. PI-RADS v.2.1 updated definitions for scores 2 and 3 in the PZ and scores 1 and 2 in the TZ is reviewed. The role of DWI role is highlighted in the assessment of the TZ with the possibility of upgrading score 2 lesions to score 3 based on DWI score. Given the increased utilization for prostate MRI, biparametric MRI can be considered as an alternative for low-risk patients where there is a need to rule out csPCa acknowledging this technique may increase the number of indeterminate cases going for biopsies. Management of patients with equivocal lesions at mpMRI and factors influencing biopsy decision process remain as an unmet need and additional studies using molecular/imaging markers as well as artificial intelligence tools are needed to further address their role in proper patient selection for biopsy.
Topics: Male; Humans; Prostate; Prostatic Neoplasms; Magnetic Resonance Imaging; Research Design; Artificial Intelligence; Image-Guided Biopsy
PubMed: 37973244
DOI: 10.1016/j.rcl.2023.06.008 -
Japanese Journal of Radiology May 2024This study aimed to assess whether short repetition time (TR) diffusion-weighted imaging (DWI) could improve diffusion contrast in patients with prostate cancer (PCa)...
PURPOSE
This study aimed to assess whether short repetition time (TR) diffusion-weighted imaging (DWI) could improve diffusion contrast in patients with prostate cancer (PCa) compared with long TR (conventional) reference standard DWI.
MATERIALS AND METHODS
Our Institutional Review Board approved this retrospective study and waived the need for informed consent. Twenty-five patients with suspected PCa underwent multiparametric magnetic resonance imaging (mp-MRI) using a 3.0-T system. DWI was performed with TR of 1850 ms (short) and 6000 ms (long) with b-values of 0, 1000, and 2000s/mm. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual score, apparent diffusion coefficient (ADC), and diagnostic performance were compared between short and long TR DWI for both b-values. The statistical tests included paired t-test for SNR and CNR; Wilcoxon signed-rank test for VA; Pearson's correlation and Bland-Altman plot analysis for ADC; and McNemar test and receiver operating characteristic analysis and Delong test for diagnostic performance.
RESULTS
Regarding b1000, CNR and visual score were significantly higher in short TR compared with long TR (P = .003 and P = .002, respectively), without significant difference in SNR (P = .21). Considering b2000, there was no significant difference in visual score between short and long TR (P = .07). However, SNR and CNR in long TR were higher (P = .01 and P = .04, respectively). ADC showed significant correlations, without apparent bias for ADC between short and long TR for both b-values. For diagnostic performance of DWI between short and long TR for both b-values, one out of five readers noted a significant difference, with the short TR for both b-values demonstrating superior performance.
CONCLUSIONS
Our data showed that the short TR DWI may provide better image quality than did the long TR DWI and may improve visualization and diagnostic performance of PCa for readers.
Topics: Humans; Male; Prostatic Neoplasms; Diffusion Magnetic Resonance Imaging; Retrospective Studies; Aged; Middle Aged; Signal-To-Noise Ratio; Aged, 80 and over; Prostate; Image Enhancement; Sensitivity and Specificity; Reproducibility of Results
PubMed: 38123889
DOI: 10.1007/s11604-023-01519-7