Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy

PURPOSE Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-ra-diotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy. METHODS A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T en-dorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling. RESULTS Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI. CONCLUSION This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.This research was supported in part by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Center for Cancer Research (ZIA BC 011552). This research was also made possible in part through the NIH Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, the Howard Hughes Medical Institute, the American Association for Dental Research, the Colgate-Palmolive Company, and other private donors

MRI in active surveillance: a critical review

INTRODUCTION: Recent technological advancements and the introduction of modern anatomical and functional sequences have led to a growing role for multiparametric magnetic resonance imaging (mpMRI) in the detection, risk assessment and monitoring of early prostate cancer. This includes men who have been diagnosed with lower-risk prostate cancer and are looking at the option of active surveillance (AS). The purpose of this paper is to review the recent evidence supporting the use of mpMRI at different time points in AS, as well as to discuss some of its potential pitfalls. METHODS: A combination of electronic and manual searching methods were used to identify recent, important papers investigating the role of mpMRI in AS. RESULTS: The high negative predictive value of mpMRI can be exploited for the selection of AS candidates. In addition, mpMRI can be efficiently used to detect higher risk disease in patients already on surveillance. CONCLUSION: Although there is an ongoing debate regarding the precise nature of its optimal implementation, mpMRI is a promising risk stratification tool and should be considered for men on AS

(081) Fertility Trends in Men with Prior History of Anabolic Steroid Use: Results from a Standardized Treatment Regimen

Abstract Introduction The management of infertility in men who have previously used anabolic steroids poses a complicated clinical challenge. Addressing the infertility issues in this specific population requires a comprehensive approach that considers the underlying physiological alterations caused by anabolic steroid use and tailors treatment interventions accordingly to restore and optimize reproductive function. In this study, we report an analysis of sperm parameter recovery and fertility outcomes in men who had azoospermia or severe oligospermia caused by anabolic steroid use and underwent a standardized treatment regimen for recovery of spermatogenesis. Objective The study aims to assess the longitudinal trends in sperm concentrations, determine the proportion of men achieving normozoospermia, and evaluate subsequent pregnancy rates in this specific population. Additionally, the study seeks to identify potential predictors for improved semen parameters and successful pregnancy outcomes. Methods A retrospective analysis of the period spanning from 2018 to 2022 was conducted on a cohort of men with a prior history of anabolic steroid use who complained of infertility. The standardized treatment approach involved the cessation of testosterone replacement therapy (TRT) and the administration of a combination regimen comprising clomiphene citrate and human chorionic gonadotropin (hCG) for a minimum of 3 to 6 months. Following adequate treatment, men were contacted in March 2023 to determine the most up-to-date pregnancy outcomes. Statistical analysis was performed utilizing SPSS, employing univariate logistic regression analysis to establish a predictive mathematical model. The level of statistical significance was defined as p 15 million/cc), and 5 (27.8%) remained azoospermic following medical treatment for 6 months. Among the 24 couples who responded to the follow-up call, a total of 9 (37.5%) achieved a successful subsequent pregnancy. Of these, 33.3% (3 couples) used assisted reproductive technology (ART), while 66.7% (6 couples) conceived naturally. On logistic regression analysis, no significant predictors for improved sperm parameters or successful pregnancy were identified. Conclusions Despite the implementation of appropriate treatment regimens, a significant proportion of men with a prior history of anabolic steroid use continue to exhibit severe oligospermia, with more than half failing to demonstrate substantial improvement in their semen parameters even after undergoing a six-month medical treatment protocol. Moreover, only a fraction of men, estimated to be 1 in 6, achieve normozoospermia following medical treatment after anabolic steroid use. Future work should continue to explore predictors for improved sperm parameters on follow-up as well as subsequent successful pregnancy in men with prior history of anabolic steroid use. Disclosure No

Multiparametric MRI/ultrasound fusion-guided biopsy decreases detection of indolent cancer in African-American men

© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. Background:Analysis of systematic 12-core biopsies (SBx) has shown that African-American (AA) men tend to harbor higher risk prostate cancer (PCa) at presentation relative to other races. Multiparametric magnetic resonance imaging (mpMRI) and MRI-ultrasound fusion-guided biopsy (FBx) have been shown to diagnose more intermediate- and high-risk PCa in the general population; however, the efficacy in AA remains largely uncharacterized. We aim to evaluate the utility of FBx in an AA patient cohort.Methods:Men suspected of PCa underwent an mpMRI and FBx with concurrent SBx from 2007 to 2015 in this institutional review board-approved prospective cohort study. Patient demographics, imaging and fusion biopsy variables were collected. ‡ 2, Mann-Whitney U-test and McNemar\u27s tests were performed to compare proportions, means and paired variables, respectively. Clinically significant PCa (CSPCa) was defined as Gleason score 3/43+4.Results:Fusion biopsy demonstrated exact agreement with SBx risk categories in 64% of AA men. There was no statistically significant difference in the detection of CSPCa between FBx vs SBx (68 vs 62 cases, P=0.36). However, FBx detected 41% fewer cases of clinically insignificant PCa (CIPCa) compared with SBx (FBx 30 vs SBx 51 cases, P=0.0004). The combined FBx/SBx biopsy approach detected significantly more cases of CSPCa (FBx/SBx 80 vs SBx 62 cases, P=0.004) while detecting comparable number of cases of CIPCa (FBx/SBx 45 vs SBx 51 cases, P=0.37) compared with SBx alone. FBx/SBx also detected more CSPCa in patients with a history of prior negative SBx (FBx/SBx 28 vs 19 cases, P=0.003).Conclusions:FBx when used in combination with SBx detected more cases of CSPCa while not significantly increasing the diagnosis of CIPCa in AA men. Future multicenter studies will be needed to validate ultimately the clinical implications of FBx in AA patients