previous negative biopsy, and continued suspicion of prostate cancer, we are seeing an increased utilization on mpMRI in biopsy naive men. We performed a systematic review and meta-analysis of prospective studies looking at the performance of mpMRI on prostate cancer detection in men who had never undergone a previous biopsy of the prostate.METHODS: We searched the Pubmed, Embase and Cochrane databases for studies assessing the performance of mpMRI on prostate cancer detection at biopsy. Studies were included if they were prospective, included only patients with no previous prostate biopsy, and reported biopsy outcomes for all patients including those with a negative mpMRI. Each mpMRI was classified as either positive or negative for suspicion of prostate cancer. We used standard methods recommended for meta-analyses of diagnostic test evaluation and reported the pooled sensitivity, specificity, and positive and negative likelihood ratios for mpMRI on the detection of any and clinically significant prostate cancer (csPCa). csPCa was defined according to the definition used in each paper, which was usually any Gleason 7 or a minimum length of Gleason 6. Summary receiver operating characteristic (SROC) curves were used to assess the performance of mpMRI on prostate cancer detection.RESULTS: Ten studies met the inclusion criteria comprising 2,194 patients. If a biopsy was only to be performed in men with a positive mpMRI, then 7.4 to 58.5% of biopsies could have been avoided, with only 2.3-36% of cancers and 6.3-30.8% of csPCa being missed. Of the ten studies we found, nine had data available for a metaanalysis of any prostate cancer and five had data available for a metaanalysis of csPCa. For any prostate cancer, the pooled sensitivity and specificity were 0.83 (95% CI, 0.75-0.88), and 0.71 (0.46-87), while the positive and negative likelihood ratio were 2.9 (1.3-6.0) and 0.23 (0.15-0.35), respectively. The AUC for any prostate cancer detection was 0.87 and the diagnostic odds ratio (DOR) was 12.3 (4.3-34.7). For csPCa, the pooled sensitivity and specificity was 0.83 (0.75-0.88) and 0.58 (0.46e0.69), while, the positive and negative likelihood ratio was 2 (CI, 1.5-2.5), and 0.28 (0.19-0.39), respectively. The AUC for csPCa detection was 0.66 and the DOR was 7.1 (4.5-11.1).CONCLUSIONS: A meta-analysis of prospective studies in men with no previous biopsy of the prostate confirms that mpMRI of the prostate accurately detects prostate cancer and can help avoid unnecessary biopsies.

Purpose: Cloquet's node, located at the junction between the deep inguinal nodes and the external iliac chain, is easily accessible and commonly excised during pelvic lymph node dissection for prostate cancer. However, we hypothesize that Cloquet's node is not part of lymphatic metastatic spread of prostate cancer. Materials and Methods: Between September 2016 and June 2019, 105 consecutive patients with high-risk prostate cancer (cT3a or Grade Group 4/5, or prostate specific antigen >20 ng/ml) underwent a laparoscopic radical prostatectomy and pelvic lymph node dissection. First, Cloquet's node was identified, retrieved and submitted separately to pathology as right and left Cloquet's node. Next, a pelvic lymph node dissection was completed including the external iliac, obturator fossa and hypogastric nodal packets. Each lymph node was cut into 3 mm slices which were separately embedded in paraffin, stained with hematoxylin and eosin, and examined microscopically. Results: The final analysis included 95 patients. In this high-risk population, the median number of nodes removed was 22 (IQR 18e29); 39/95 patients (41%) had lymph node metastasis. The median number of Cloquet's nodes removed was 2 (IQR 2e3). Cloquet's node was negative in all but 1 patient (1.1%), who had very high-risk features and high metastatic burden in the lymph nodes. Conclusions: In high-risk prostate cancer, metastasis to the ilioinguinal node of Cloquet is rare. Given this low prevalence, Cloquet's node can be safely excluded from the pelvic lymph node dissection template.

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