Robotic assisted laparoscopic prostatectomy in a patient with prostate cancer and complex urinary tract malformation.

We present a case of prostate cancer with abnormal renal and ureteric anatomy who underwent robotic assisted laparoscopic prostatectomy. This is a 59-year-old European patient who presented with lower urinary tract symptoms (LUTS) and pelvic pain. Investigations revealed prostate cancer as well as a supernumerary right kidney and an atrophic horseshoe left kidney draining into the left seminal vesicle.

Laparoscopic heminephrectomy for duplex system: observed difference in outcomes between upper and lower pole resections.

Introduction: Renal duplication is a relatively common congenital abnormality of the urinary tract, but symptomatic duplex kidney is a rare presentation in adults. Traditionally, the treatment of choice for poorly functioning moiety has been heminephrectomy. There is extensive literature detailing the outcomes of minimally invasive upper pole heminephrectomy, but comparatively little published regarding lower pole resection, especially in adult patients.

Zone-specific logistic regression models improve classification of prostate cancer on multi-parametric MRI.

Objectives: To assess the interchangeability of zone-specific (peripheral-zone (PZ) and transition-zone (TZ)) multiparametric-MRI (mp-MRI) logistic-regression (LR) models for classification of prostate cancer.

Methods: Two hundred and thirty-one patients (70 TZ training-cohort; 76 PZ training-cohort; 85 TZ temporal validation-cohort) underwent mp-MRI and transperineal-template-prostate-mapping biopsy. PZ and TZ uni/multi-variate mp-MRI LR-models for classification of significant cancer (any cancer-core-length (CCL) with Gleason > 3 + 3 or any grade with CCL ≥ 4 mm) were derived from the respective cohorts and validated within the same zone by leave-one-out analysis.

Logistic regression model for diagnosis of transition zone prostate cancer on multi-parametric MRI.

Objectives: We aimed to develop logistic regression (LR) models for classifying prostate cancer within the transition zone on multi-parametric magnetic resonance imaging (mp-MRI).

Methods: One hundred and fifty-five patients (training cohort, 70 patients; temporal validation cohort, 85 patients) underwent mp-MRI and transperineal-template-prostate-mapping (TPM) biopsy. Positive cores were classified by cancer definitions: (1) any-cancer; (2) definition-1 [≥Gleason 4 + 3 or ≥ 6 mm cancer core length (CCL)] [high risk significant]; and (3) definition-2 (≥Gleason 3 + 4 or ≥ 4 mm CCL) cancer [intermediate-high risk significant].

Can multiparametric magnetic resonance imaging predict upgrading of transrectal ultrasound biopsy results at more definitive histology?

Objective: To determine whether multiparametric magnetic resonance imaging (mp-MRI) has a role in reducing the uncertainty in risk stratification by transrectal ultrasound (TRUS) biopsy, using histology at transperineal template-guided prostate mapping (TPM) biopsy as the reference test.

Materials And Methods: Overall, 194 patients underwent TRUS biopsy, who were followed up in less than 18 months by means of (a) mp-MRI with pelvic phased array using T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences and (b) TPM biopsy. Of those patients, low risk on TRUS biopsy was defined in 4 different ways--(a) definition 1: Gleason 3+3 (any cancer core length) (n = 137), (b) definition 2: maximum cancer core length (MCCL)<50% (any Gleason score) (n = 62), (c) definition 3: Gleason 3+3 and MCCL<50% (n = 52), and (d) definition 4: Gleason 3+3, MCCL<50%, prostate-specific antigen level<10 ng/ml, and<50% positive cores (n = 28).

The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level--can it rule out clinically significant prostate cancer?

Purpose: To assess the performance of multiparametric magnetic resonance imaging (mp-MRI) in patients with previous negative transrectal ultrasound (TRUS) guided prostate biopsy.

Materials And Methods: Fifty-four patients with at least 1 previous negative TRUS prostate biopsy underwent mp-MRI in the form of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging. This was followed by transperineal template systematic prostate biopsies.

Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer.

Purpose: Multiparametric magnetic resonance imaging can be used to guide prostate biopsy by targeting biopsies to areas in the prostate at high risk for cancer. We compared the detection of clinically significant and insignificant cancer by transperineal magnetic resonance imaging targeted biopsy and transperineal template guided prostate biopsy.

Materials And Methods: A total of 182 men with a lesion suspicious for cancer on multiparametric magnetic resonance imaging underwent transperineal magnetic resonance imaging targeted biopsy using a cognitive registration technique, followed by systematic transperineal template guided prostate biopsy.