Publications by authors named "Eldred-Evans D"

Background: Magnetic resonance imaging (MRI) of the prostate is a new, more accurate, non-invasive test for prostate cancer diagnosis.

Aim: To understand the acceptability of MRI for patients and GPs for prostate cancer diagnosis.

Design And Setting: Qualitative study of men who had undergone a prostate MRI for possible prostate cancer, and GPs who had referred at least one man for possible prostate cancer in the previous 12 months in West London and Devon.

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Article Synopsis
  • The study aimed to compare biopsy recommendation rates and accuracy between the Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) and the Likert scale for detecting significant and insignificant prostate cancer in men aged 50-69 participating in the IP1-PROSTAGRAM trial.
  • Men were screened using Prostagram MRI, and results showed that more patients were recommended for biopsy with the Likert scale compared to PI-RADSv2 when the MRI score was ≥3, though accuracy in detecting cancer was similar for both systems.
  • The findings indicate that while the Likert scale may suggest more biopsy recommendations, both methods have comparable effectiveness in identifying clinically significant prostate cancer.
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Background: The use of prostate-specific antigen (PSA) testing to screen for prostate cancer has been fraught with under- and overdiagnosis. Short, noncontrast magnetic resonance imaging (MRI) might detect more grade group ≥2 cancers with similar rates of biopsy.

Objective: To evaluate strategies that combined PSA and MRI to select men based in the community for a prostate biopsy.

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Background: The IP1-PROSTAGRAM study showed that a short, non-contrast MRI detected more significant cancers with similar rates of biopsy compared to PSA. Herein, we compare the expected and perceived burden of PSA, MRI and ultrasound as screening tests.

Methods: IP1-PROSTAGRAM was a prospective, population-based, paired screening study of 408 men conducted at seven UK primary care practices and two imaging centres.

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Background: Prostate cancer (PCa) has a high lifetime prevalence (one out of six men), but currently there is no widely accepted screening programme. Widely used prostate specific antigen (PSA) test at cut-off of 3.0 ng/mL does not have sufficient accuracy for detection of any prostate cancer, resulting in numerous unnecessary prostate biopsies in men with benign disease and false reassurance in some men with PCa.

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  • Diagnostic prostate biopsy methods have evolved significantly, shifting from finger-guided techniques to advanced MRI-directed strategies and transperineal approaches.
  • The adoption of transperineal biopsy has decreased the risk of infections and enhanced antibiotic usage.
  • Future advancements may include image fusion for 3D-ultrasonography, molecular targeting with PET imaging, and the use of robotic assistance in biopsies.
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  • The RAPID diagnostic pathway aims to improve efficiency in prostate imaging and diagnosis while reducing patient burden through better standardization of procedures.
  • A study involving 2130 patients revealed that 43% could avoid biopsy, with significant variations in biopsy avoidance rates across different sites.
  • The pathway also reduced the time to diagnosis from 32.1 days in the pre-RAPID cohort to 15.9 days, with similar cancer detection rates regardless of anesthesia used during transperineal targeted biopsy.
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Background: Although multiparametric magnetic resonance imaging (MRI) has high sensitivity, its lower specificity leads to a high prevalence of false-positive lesions requiring biopsy.

Objective: To develop and externally validate a scoring system for MRI-detected Prostate Imaging Reporting and Data System (PIRADS)/Likert ≥3 lesions containing clinically significant prostate cancer (csPCa).

Design, Setting, And Participants: The multicentre Rapid Access to Prostate Imaging and Diagnosis (RAPID) pathway included 1189 patients referred to urology due to elevated age-specific prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE); April 27, 2017 to October 25, 2019.

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Objectives: This study aimed to understand and explore patient and general practitioner (GP) experiences of 'traditional' and 'one-stop' prostate cancer diagnostic pathways in England.

Design: Qualitative study using semi-structured interviews, analysed using inductive thematic analysis SETTING: Patients were recruited from National Health Service (NHS) Trusts in London and in Devon; GPs were recruited via National Institute for Health Research (NIHR) Clinical Research Networks. Interviews were conducted in person or via telephone.

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Background And Objectives: Prostate cancer screening studies has previously not been able to reflect a diverse group of participants. We evaluated a range of recruitment strategies and their ability to recruit from the Black population and areas of deprivation.

Methods: IP1-PROSTAGRAM was a prospective, population-based, paired screening study of 408 participants conducted at seven UK primary care practices and two imaging centres.

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Introduction: Novel screening tests used to detect a target condition are compared against either a reference standard or other existing screening methods. However, as it is not always possible to apply the reference standard on the whole population under study, verification bias is introduced. Statistical methods exist to adjust estimates to account for this bias.

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Article Synopsis
  • The study investigates the effectiveness of multiparametric ultrasound compared to multiparametric MRI in diagnosing clinically significant prostate cancer among at-risk patients.
  • Conducted in seven UK hospitals, the research involved patients undergoing both imaging techniques, followed by targeted biopsies regardless of test results.
  • The goal was to assess the agreement in identifying suspicious lesions between the two methods, specifically looking at their capability to detect significant cancer indicated by higher Gleason scores.
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Background: Focal therapy aims to treat areas of cancer to confer oncological control whilst reducing treatment-related functional detriment.

Objective: To report oncological outcomes and adverse events following focal high-intensity focused ultrasound (HIFU) for treating nonmetastatic prostate cancer.

Design, Setting, And Participants: An analysis of 1379 patients with ≥6 mo of follow-up prospectively recorded in the HIFU Evaluation and Assessment of Treatment (HEAT) registry from 13 UK centres (2005-2020) was conducted.

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Importance: Screening for prostate cancer using prostate-specific antigen (PSA) testing can lead to problems of underdiagnosis and overdiagnosis. Short, noncontrast magnetic resonance imaging (MRI) or transrectal ultrasonography might overcome these limitations.

Objective: To compare the performance of PSA testing, MRI, and ultrasonography as screening tests for prostate cancer.

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Purpose: We compared clinically significant prostate cancer detection by visual estimation and image fusion targeted transperineal prostate biopsy.

Materials And Methods: This multicenter study included patients with multiparametric magnetic resonance imaging lesions undergoing visual estimation or image fusion targeted transperineal biopsy (April 2017-March 2020). Propensity score matching was performed using demographics (age and ethnicity), clinical features (prostate specific antigen, prostate volume, prostate specific antigen density and digital rectal examination), multiparametric magnetic resonance imaging variables (number of lesions, PI-RADS® score, index lesion diameter, whether the lesion was diffuse and radiological T stage) and biopsy factors (number of cores, operator experience and anesthetic type).

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Purpose Of Review: Rapid advances in imaging of the prostate have facilitated the development of focal therapy and provided a non-invasive method of estimating tumour volume. Focal therapy relies on an accurate estimate of tumour volume for patient selection and treatment planning so that the optimal energy dose can be delivered to the target area(s) of the prostate while minimising toxicity to surrounding structures. This review provides an overview of different imaging modalities which may be used to optimise tumour volume assessment and critically evaluates the published evidence for each modality.

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In the past decade rigorous debate has taken place about population-based screening for prostate cancer. Although screening by serum PSA levels can reduce prostate cancer-specific mortality, it is unclear whether the benefits outweigh the risks of false-positive results and overdiagnosis of insignificant prostate cancer, and it is not recommended for population-based screening. MRI screening for prostate cancer has the potential to be analogous to mammography for breast cancer or low-dose CT for lung cancer.

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The clinical utility of systematic prostate biopsy in addition to multi-parametric magnetic resonance imagining (mp-MRI) targeted biopsy pathways remains unclear. Despite radiological advancements in mp-MRI and utilisation of international standardised reporting systems (i.e.

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Purpose: The added value of nontargeted systematic prostate biopsies when performed alongside magnetic resonance imaging targeted biopsies in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal nontargeted systematic prostate biopsies, when performed alongside targeted systematic prostate biopsies, using pre-biopsy multiparametric magnetic resonance imaging.

Materials And Methods: Consecutive patients referred with a suspicion of prostate cancer (April 2017 to October 2019) underwent pre-biopsy multiparametric magnetic resonance imaging.

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Purpose: Transrectal ultrasound (TRUS)-guided biopsy has been the traditional biopsy route in the detection of prostate cancer. However, due to concern regarding overdetection of low-risk cancer and missed clinically significant cancers as well as risk of sepsis, alternative approaches have been explored. Transperineal template biopsy-sampling the gland every 5 m to 10 mm-reduces error by sampling the whole prostate but increases risk of detecting clinically insignificant cancers as well as conferring risks of side effects such as urinary retention and bleeding.

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Objective: To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study.

Patients And Methods: PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification after a previous non-magnetic resonance imaging (MRI)-guided transrectal ultrasonography-guided biopsy underwent a 3-Tesla (3T) multiparametic (mp)MRI consisting of T2-weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE.

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Objective: To compare the clinical validity and utility of Likert assessment and the Prostate Imaging Reporting and Data System (PI-RADS) v2 in the detection of clinically significant and insignificant prostate cancer.

Patients And Methods: A total of 489 pre-biopsy multiparametric magnetic resonance imaging (mpMRI) scans in consecutive patients were subject to prospective paired reporting using both Likert and PI-RADS v2 by expert uro-radiologists. Patients were offered biopsy for any Likert or PI-RADS score ≥4 or a score of 3 with PSA density ≥0.

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Article Synopsis
  • The study evaluated the impact of focal cryotherapy on urinary and sexual function in men with clinically significant prostate cancer.
  • Patients reported their outcomes using IPSS and IIEF-15 questionnaires, with results showing a high likelihood of returning to baseline urinary (87%) and erectile functions (89%) at 18-24 months post-treatment.
  • The main limitation of the study was that only about half of the participants completed the follow-up questionnaires, which could affect the reliability of the findings.
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