The disappearing PI-RADS 5 prostate lesion

© The Canadian Journal of Urology™. Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) identifies prostate cancer on the basis of multiparametric MRI (mpMRI). As an assessment tool, it correctly predicts clinically significant cancer in the vast majority of cases. In this light, we report a rare patient, for whom a PI-RADS 5 lesion vanished over the course of 13 months

Are all biopsies created equal? comparison of extended sextant prostate biopsies performed with and without MRI-TRUS fusion biopsy system.

117 Background: Extended sextant systematic prostate biopsies have the inherent risk of under-sampling prostate cancer. Fusion guided multiparametric magnetic resonance imaging (mpMRI) biopsies have been employed to better represent the disease and guide treatment. We sought to determine if due to heightened suspicion of cancer and/or visualization of mpMRI there were any discrepancies between systematic biopsies done with a Fusion System as compared to those done without (TRUS alone). Methods: From a prospectively collected database, we performed a review collecting age, race, clinical stage, PSA, and time until repeat systematic biopsy as part of fusion guided biopsy (IB). We also collected pathology results reported as Gleason Score (GS), for both the patients’ OB and our IB. Patients were stratified into groups based on time between OB and IB/fusion biopsy ( &lt; 6 months, &lt; 1 year and &lt; 2 years). Results: 69 patients with a previous OB underwent combined fusion and IB within our designated time intervals. Cancer detection rates between the OB and IB results were similar at 6 months, 1 year and 2 years (80 vs 90%, 87.5 vs 87.5% and 65 vs 69%). Detection rates of GS ≥ 3+4 were higher with IB within 12 months compared with IB from 12-24 months (72.7 vs 40.9%, p = 0.03 OR 3.85 (1.09-13.66). Of the patients who were upgraded (n = 24), 54.2% (n = 13) went from benign pathology to a diagnosis of prostate adenocarcinoma. Of all OB GS 3+3 (n = 31), 29% were restaged to higher risk disease on IB. Rates of IB upgrading were similar within 6 months, 1 year and 2 year, 40%, 33.33% and 31.91%). Patients who were upgraded on IB compared to those who were not upgraded were of similar age (67.0 ± 6.53 vs 66.50 ± 6.47), race (17.4% African-American vs 13%), PSA (7.60 ± 5.61 vs 7.50 ± 4.39) and prostate volume on MRI (51.30 ± 26.87 vs 59.26 ± 38.52). Conclusions: A systematic biopsy at our referral center during a mpMRI fusion biopsy was over 3.5 times more likely to detect GS ≥ 3+4 when done within 1 year of the outside biopsy. There continued to be a risk, 34.7% overall, of disease upgrading in all time periods. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH </jats:p

A multiparametric magnetic resonance imaging-based virtual reality surgical navigation tool for robotic-assisted radical prostatectomy

© 2019 by Turkish Association of Urology. Objective: Increased computational power and improved visualization hardware have generated more opportunities for virtual reality (VR) applications in healthcare. In this study, we test the feasibility of a VR-assisted surgical navigation system for robotic-assisted radical prostatectomy. Material and methods: The prostate, all magnetic resonance imaging (MRI) visible tumors, and important anatomic structures like the neurovascular bundles, seminal vesicles, bladder, and rectum were contoured on a multiparametric MRI using an in-house segmentation software. Three-dimensional (3-D) VR models were rendered and evaluated in a side room of the operating room. While interacting with the VR platform, a real-time stereo video capture of the in situ prostate was obtained to render a second 3-D model. The MRI-based model was then overlaid on the real-time model by using an automated alignment algorithm. Results: Ten patients were included in this study. All MRI-based VR models were examined by surgeons immediately prior to surgery and at important steps where visualization of the tumors and their proximity to surrounding anatomic structures were critical. This was mainly during the preparation of the prostatic pedicles, neurovascular plexus, the apex, and bladder neck. All participants found the system useful, especially for tumors with locally aggressive growth patterns. For small and centrally located tumors, the system was not considered beneficial due to lack of integration into the robotic console. A fully integrated system with real-time overlays within the robotic stereo viewer was found to be the ideal scenario. Conclusion: We deployed a preliminary VR-assisted surgical navigation tool for robotic-assisted radical prostatectomies