Side-specific, Microultrasound-based Nomogram for the Prediction of Extracapsular Extension in Prostate Cancer

Pedraza, Adriana; Parekh, Sneha; Joshi, Himanshu; Grauer, Ralph; Wagaskar, Vinayak; Zuluaga, Laura; Gupta, Raghav; Barthe, Flora; Nasri, Jordan; Pandav, Krunal; Patel, Dhruti; Gorin, Michael A.; Menon, Mani; Tewari, Ashutosh

doi:10.1016/j.euros.2022.12.005

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…It employs high‐frequency waves of 29 MHz to achieve a resolution of 70 µm while remaining simple for operators to use. Despite being a recent addition to the field, preliminary findings indicate that MUS is as effective as mpMRI in detecting csPCa and extracapsular extension (ECE) 14–18 . Therefore, our study seeks to evaluate the accuracy of a transrectal MUS in identifying the IL in prostate cancer compared with mpMRI.…”

Section: Introductionmentioning

confidence: 99%

Microultrasound in the detection of the index lesion in prostate cancer

Pedraza,

Gupta,

Musheyev

et al. 2023

The Prostate

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Introduction and ObjectiveThe natural progression of prostate cancer is primarily driven by an index lesion (IL). Studies have shown that different metastases within the same patient arise from a single precursor cell. Therefore, our aim is to assess the effectiveness of transrectal microultrasound (MUS) in comparison to multiparametric magnetic resonance imaging (mpMRI) for detecting the IL in prostate cancer. We used quarter‐mount pathological results as the reference standard for this evaluation.Materials and MethodsThree hundred and sixty‐three patients who underwent Robot‐Assisted Radical Prostatectomy (RARP) from June 2021 to August 2022 were included. All received mpMRI and MUS before RARP. MUS was performed by experienced operators blinded to mpMRI and biopsy results. The IL in the radical prostatectomy specimen was defined as the lesion with extraprostatic extension, the highest Grade Group (GG), or the largest tumor volume if the GG was the same. The correlation between imaging and final pathology findings was performed. A descriptive statistical analysis is presented.ResultsThe patients' prostates were analyzed in 12 regions (anterior/posterior, right/left, apex/mid/base). A total of 4308 regions were identified. Of these, 935 were involved by the ILs. Compared with final pathology, MUS demonstrated a sensitivity, specificity, PPV, and NPV of 68.7%, 96.3%, 80.8%, and 93.1%, respectively, while mpMRI showed a sensitivity, specificity, PPV, and NPV of 68.6%, 97.2%, 86.1%, and 92.5%, respectively, for the detection of the IL. Most of the lesions missed by MUS were located in the anterior zone (62%).ConclusionMUS exhibits a diagnostic performance similar to mpMRI when it comes to detecting the IL in prostate cancer. MUS is a cost‐effective option, offers real‐time evaluation, and has no delay in the acquisition process.

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Section: Introductionmentioning

confidence: 99%

Microultrasound in the detection of the index lesion in prostate cancer

Pedraza,

Gupta,

Musheyev

et al. 2023

The Prostate

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“…In fact, all the patients who underwent TR SAFE achieved negative surgical margins. This could be explained by the ability of the MUS to provide a real-time assessment of the tumour location and potential ECE [30][31][32][33][34], making it a valuable pre-and intraoperative tool. On the other hand, Elsayed et al analysed the superiority of a technique combining HD of the NVB with the preservation of puboprostatic ligaments, endopelvic fascia, and the dorsal venous complex.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, all the patients who underwent TR SAFE achieved negative surgical margins. This could be explained by the ability of the MUS to provide a real‐time assessment of the tumour location and potential ECE [30–34], making it a valuable pre‐ and intraoperative tool.…”

Section: Discussionmentioning

confidence: 99%

Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Pedraza,

Gupta,

Joshi

et al. 2023

BJU International

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ObjectiveTo provide a summary of our initial experience and assess the impact of the Saline‐Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot‐Assisted Laparoscopic Radical Prostatectomy (RALP).Patients and MethodsFrom January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro‐ultrasound or transperitoneal. Its principle entails a low‐pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day.ResultsAt follow‐up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log‐rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.ConclusionsThe use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.

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“…ECE and SVI are two crucial pathologic features of PCa, which have a significant impact on patient prognosis and surgical strategy [35]. The incidence of ECE and SVI appeared to be heterogeneous, with recent studies reporting rates ranging from 17% to 54% for ECE [6,7,36] and 8% to 17.6% for SVI [37][38][39]. In our study cohort, the incidence of ECE and SVI was found to be 46.8% and 17.4%, respectively, which is consistent with these reported in recent research.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Nomograms Based on Nutritional Risk Index for Predicting Extracapsular Extension and Seminal Vesicle Invasion in Patients Undergoing Radical Prostatectomy

Liu,

Li,

et al. 2023

World J Oncol

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Background:The aim of the study was to investigate the predictive value of the nutritional risk index (NRI) for extracapsular extension (ECE) and seminal vesicle invasion (SVI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP), and further develop and validate predictive nomograms for ECE and SVI based on the NRI. Methods:We retrospectively analyzed 734 PCa patients who underwent RP between 2010 and 2020 in the Department of Urology at Peking University Third Hospital. The enrolled patients were randomly divided into a primary cohort (n = 489) and a validation cohort (n = 245) in a 2:1 manner. The baseline NRI of patients was calculated using serum albumin level and body mass index, and a malnutrition status was defined as NRI ≤ 98. Univariate and multivariate logistic regression analyses were conducted to identify predictors for ECE and SVI. Nomograms for predicting ECE and SVI were established based on the results of the multivariate logistic regression analysis. The performance of the nomograms was estimated using Harrell's concordance index (C-index), the area under curve (AUC) of receiver operating characteristic (ROC) curves and the calibration curves.Results: In the primary cohort, 70 (14.3%) patients with NRI ≤ 98 were classified as malnutrition, while the remaining 419 (85.7%) patients with NRI > 98 were considered to have normal nutrition. The nomograms for predicting ECE and SVI shared common factors including NRI, percentage of positive biopsy cores (PPC) and biopsy Gleason score, while prostate-specific antigen (PSA) levels and PSA density (PSAD) were only incorporated in ECE nomogram. The C-indexes of the nomograms for predicting ECE and SVI were 0.785 (95% confidence interval (CI): 0.745 -0.826) and 0.852 (95% CI: 0.806 -0.898), respectively. The calibration curves demonstrated excellent agreement between the predictions by the nomograms and the actual observations. The results remained reproducible when the nomograms were applied to the validation cohort. Conclusions:The NRI is significantly associated with ECE and SVI in PCa patients. The nomogram established based on the NRI in our study can provide individualized risk estimation for ECE and SVI in PCa patients, and may be valuable for clinicians in making well-informed decisions regarding treatment strategies and patient management.

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Side-specific, Microultrasound-based Nomogram for the Prediction of Extracapsular Extension in Prostate Cancer

Cited by 9 publications

References 36 publications

Microultrasound in the detection of the index lesion in prostate cancer

Microultrasound in the detection of the index lesion in prostate cancer

Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Development and Validation of Nomograms Based on Nutritional Risk Index for Predicting Extracapsular Extension and Seminal Vesicle Invasion in Patients Undergoing Radical Prostatectomy

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