Detection of recurrent prostate cancer after primary radiation therapy: An evaluation of the role of multiparametric 3T magnetic resonance imaging with endorectal coil

Objectives: The value of multiparametric magnetic resonance imaging (mpMRI) in staging prostate cancer (PCa) before salvage prostatectomy is currently unclear because of the minimal data comparing mpMRI results to final pathologic stage at surgery. The aim of the study is to determine the diagnostic performance of mpMRI in characterizing viable recurrent tumor and lymph node metastasis following radiation therapy (RT) failure. Methods and materials: Between January 2007 and July 2014, 19 patients with biopsy-proven recurrent PCa after primary RT underwent 3T mpMRI and subsequent salvage prostatectomy with extended pelvic lymphadenectomy. mpMRI images were independently reviewed by 2 genitourinary MRI radiologists (R1 and R2), blinded to the pathology results, to evaluate extraprostatic extension (EPE), seminal vesicle invasion (SVI), and pelvic lymph node metastasis (PLNM). Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic curves, and interobserver agreement (R1 and R2) were evaluated for each outcome on a per-patient basis. Final pathologic results were used as a gold standard for comparison in all patients. A multivariate analysis was conducted to assess the relationship between the index lesion's apparent diffusion coefficient value and its enhancement characteristics with the Gleason score. Results: EPE was found in 14 (73.7%) patients, SVI in 13 (68.4%), and PLNMin 5 (26.3%). mpMRI sensitivity for PLNM was 60.0% (R1 and R2) with specificity of 85.7% (R1) and 92.8% (R2). With regards to SVI, the sensitivity was 61.5% (R1) and 76.9% (R2), with a specificity of 66.6% (R1 and R2). Sensitivity for EPE was 50.0% (R1) and 71.43% (R2), with a specificity of 80.0% (R1) and 100.00% (R2). No significant associations were found at multivariate analysis. The evaluation of PLNM, SVI, and PCa recurrence within the prostate demonstrated moderate interobserver agreement (kappa, 0.51-0.57). Conclusions: mpMRI has good accuracy for detecting PLNM, SVI, and EPE after RT. mpMRI provides useful information in locally recurrent PCa following primary radiation therapy. (C) 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved

Metastatic prostate cancer in the modern era of PSA screening

ABSTRACT Introduction To characterize initial presentation and PSA screening status in a contemporary cohort of men treated for metastatic prostate cancer at our institution. Materials and methods We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respectively, and developed metastases. Groups 3 and 4 had asymptomatic and symptomatic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening. Results Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis. Conclusion Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after definitive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screening at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened

Congenital rubella syndrome surveillance in India, 2016–21: Analysis of five years surveillance data

Background: In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016–2021 from 14 sentinel sites to describe the epidemiology of CRS. Method: We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. Results: During 2016–21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6–16.2), cataract (OR = 7.8, 95% CI: 5.4–11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3–13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2–12.2) and glaucoma (OR = 3.1, 95% CI: 1.2–8.1). Nomogram, along with a web version, was developed. Conclusions: Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites