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UP-02.126 Negative Predictive Value of Prostate Histoscanning (Computer-Aided Tissue Characterization for Detection of Prostate Cancer): Preliminary Results
UNMODERATED POSTER SESSIONS
diagnosis was maintained, with statistical significance only for highest tertil (OR 2.25; p ⫽ 0.014). Association was maintained for%Fat (OR per 10% change; p ⫽ 0.022) and BFM (OR per 10 Kg change; p ⫽ 0.043). For PCa patients no significant differences of BMI,%Fat and BFM were detected among clinical staging (p ⫽ 0.05), biopsy Gleason score (p ⫽ 0.843) and clinical D’Amico progression risk groups (p ⫽ 0.799). The assessment through age adjusted odds ratio for the relation between BMI,%Fat and BFM and different PCa aggressiveness groups found no differences. Conclusions: This study corroborates previous data where higher BMI represents increase risk of PCa diagnosis. We also show for the first time that among Caucasian men, obesity, otherwise defined by higher%Fat or BFM, represents an increased risk of overdetection of PCa. Unlike previous reported series, BMI,%Fat and BFM were not predictors of PCa aggressiveness.
UP-02.126 Negative Predictive Value of Prostate Histoscanning (Computer-Aided Tissue Characterization for Detection of Prostate Cancer): Preliminary Results Markovsky O1, Durner L1, Sarbia M2, Obernerder R1, Kriegmair M1 1 Urologische Klinik Dr. Castringius München-Planegg, 2Pathologie, ErnstPlatz-Strasse, Munich, Germany Introduction and Objectives: Recently a new imaging method (Prostate HistoScanning) was introduced with promising results regarding specificity and sensitivity in diagnosing prostate cancer. To define the negative predictive value of this new technique we performed a study on patients scheduled for radical cystoprostatectomy. Material and Methods: Between January and March 2011 we examined 38 patients (average age: 61.3 a, median: 60) scheduled for radical cystoprostatectomy due to muscleinvasive urothelial carcinoma. None of these patients was suspected to have prostate cancer. Prior to surgery we performed HistoScanning of the prostate. HistoScanning results were obtained preoperatively and assigned in a three section model (apex, left and right) of the prostate, not known to the performing surgeon. Presence of a lesion was defined as a HistoScanning positive volume bigger than 0.1 ccm. The pathologist prepared 3mm step sections of the prostate. Local-
ization and size of prostate cancer lesions were determined and assigned in the same three section prostate model. The results were compared regarding presence and size of tumor. Results: HistoScanning findings showed 21 patients with signals greater than 0.1 ccm. Histopathology findings showed 17 patients with prostate cancer. The average HistoScanning positive volume was 0.38 ccm (min/max: 0,14 ccm/3.28 ccm; median: 0.37 ccm), the average size of tumor in pathology was 0.22 ccm (min/max: 0.005 ccm/1.26 ccm; median: 0,11 ccm). The prediction of presence of tumor was correct in 11/21 cases. Regarding the absence of tumor it was as high as 11/17. Hence the negative predictive value results in 0.65.
UP-02.126, Table 1.
HistoScanning ⫹ HistoScanning ⫺
Pathology ⴙ 11
Pathology ⴚ 10
21
6
11
17
17
21
Conclusion: HistoScanning may prove useful in ruling out prostate cancer. Certainly a greater number of patients is needed to confirm these preliminary results. Therefore this pilot study should be continued in a multi centre setting to gather valid data. A high negative predictive value would especially be of great value in handling patients with rising PSA and previous negative biopsies.
UP-02.127 Topical Diltiazem Before Transrectal Ultrasonography Guided Biopsy of the Prostate: A Randomized, Double Blind, Placebo Controlled Trial Marshall D1, Zargar H2, King Q2 Depts. of Urology, 1Hawkes Bay District Health Board, Hastings, 2MidCentral District Health Board, Palmerston North, New Zealand Introduction and Objective: Transrectal ultrasound (TRUS) guided biopsy of prostate is the gold standard method of diagnosing prostate cancer. Infiltration of local anaesthetic around the prostatic nerve bundles reduces pain associated with the procedure. Some discomfort associated with the procedure is secondary to spasm of the anal sphincter. It has been shown
UROLOGY 78 (Supplement 3A), September 2011
that using topical Glyceryl Trinitrate (GTN) cream can reduce the discomfort associated with anal sphincter spasm. GTN has been associated with headache in up to 10% of patients. Experience from colorectal surgery has demonstrated that topical Diltiazem can also relax the anal sphincter. We evaluate the use of topical Diltiazem cream as an adjunct to periprostatic nerve block in reducing pain associated with TRUS guided prostatic biopsy. Materials and Method: Patients undergoing TRUS biopsy of the prostate were randomized into Diltiazem and placebo groups. Both the doctor and the patient were blinded as to which group the patient was in. A questionnaire was used to assess discomfort associated with various parts of the procedure using a 10cm visual analogue scale (VAS). One hundred patients were required to detect a change in mean pain score of 1 unit with a power of 90% using a two-sided significance of 5%. Results: Between September 2009 and September 2010, 120 patients were enrolled in the trial. There were no significant differences in age, PSA, and prostate volumes between the two groups. For insertion of the probe the mean VAS was higher for the Diltiazem group (not statistically significant). For discomfort due to the presence of the probe, pain during the biopsy, and overall pain prior to leaving the department the mean VAS was higher for the placebo group (not statistically significant). Subgroup analysis by age (ⱖ60 and ⬍60years) showed differences favouring the Diltiazem group were more pronounced in the ⬍60 group. There were no side effects associated with diltiazem use in our trial. Conclusion: Diltiazem cream has a better side effect profile than GTN cream. We have demonstrated trends favouring Diltiazem use as an adjunct to local anaesthetic in TRUS biopsy of the prostate, however this did not reach a statistically significant level.
UP-02.128 Prostatic Dynamic Contrast Enhanced MR: Comparison Before and After HIFU Treatment for Prostate Cancer Giulianelli R, Attisani F, Albanesi L, Brunori S, Gentile B, Mavilla L, Mirabile G, Shestani T, Pisanti F, Schettini M Dept. of Urology, Villa Tiberia Clinic, Rome, Italy Introduction and Objective: The aim of the study is to evaluate the diagnostic per-
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diagnosis was maintained, with statistical significance only for highest tertil (OR 2.25; p ⫽ 0.014). Association was maintained for%Fat (OR per 10% change; p ⫽ 0.022) and BFM (OR per 10 Kg change; p ⫽ 0.043). For PCa patients no significant differences of BMI,%Fat and BFM were detected among clinical staging (p ⫽ 0.05), biopsy Gleason score (p ⫽ 0.843) and clinical D’Amico progression risk groups (p ⫽ 0.799). The assessment through age adjusted odds ratio for the relation between BMI,%Fat and BFM and different PCa aggressiveness groups found no differences. Conclusions: This study corroborates previous data where higher BMI represents increase risk of PCa diagnosis. We also show for the first time that among Caucasian men, obesity, otherwise defined by higher%Fat or BFM, represents an increased risk of overdetection of PCa. Unlike previous reported series, BMI,%Fat and BFM were not predictors of PCa aggressiveness.
UP-02.126 Negative Predictive Value of Prostate Histoscanning (Computer-Aided Tissue Characterization for Detection of Prostate Cancer): Preliminary Results Markovsky O1, Durner L1, Sarbia M2, Obernerder R1, Kriegmair M1 1 Urologische Klinik Dr. Castringius München-Planegg, 2Pathologie, ErnstPlatz-Strasse, Munich, Germany Introduction and Objectives: Recently a new imaging method (Prostate HistoScanning) was introduced with promising results regarding specificity and sensitivity in diagnosing prostate cancer. To define the negative predictive value of this new technique we performed a study on patients scheduled for radical cystoprostatectomy. Material and Methods: Between January and March 2011 we examined 38 patients (average age: 61.3 a, median: 60) scheduled for radical cystoprostatectomy due to muscleinvasive urothelial carcinoma. None of these patients was suspected to have prostate cancer. Prior to surgery we performed HistoScanning of the prostate. HistoScanning results were obtained preoperatively and assigned in a three section model (apex, left and right) of the prostate, not known to the performing surgeon. Presence of a lesion was defined as a HistoScanning positive volume bigger than 0.1 ccm. The pathologist prepared 3mm step sections of the prostate. Local-
ization and size of prostate cancer lesions were determined and assigned in the same three section prostate model. The results were compared regarding presence and size of tumor. Results: HistoScanning findings showed 21 patients with signals greater than 0.1 ccm. Histopathology findings showed 17 patients with prostate cancer. The average HistoScanning positive volume was 0.38 ccm (min/max: 0,14 ccm/3.28 ccm; median: 0.37 ccm), the average size of tumor in pathology was 0.22 ccm (min/max: 0.005 ccm/1.26 ccm; median: 0,11 ccm). The prediction of presence of tumor was correct in 11/21 cases. Regarding the absence of tumor it was as high as 11/17. Hence the negative predictive value results in 0.65.
UP-02.126, Table 1.
HistoScanning ⫹ HistoScanning ⫺
Pathology ⴙ 11
Pathology ⴚ 10
21
6
11
17
17
21
Conclusion: HistoScanning may prove useful in ruling out prostate cancer. Certainly a greater number of patients is needed to confirm these preliminary results. Therefore this pilot study should be continued in a multi centre setting to gather valid data. A high negative predictive value would especially be of great value in handling patients with rising PSA and previous negative biopsies.
UP-02.127 Topical Diltiazem Before Transrectal Ultrasonography Guided Biopsy of the Prostate: A Randomized, Double Blind, Placebo Controlled Trial Marshall D1, Zargar H2, King Q2 Depts. of Urology, 1Hawkes Bay District Health Board, Hastings, 2MidCentral District Health Board, Palmerston North, New Zealand Introduction and Objective: Transrectal ultrasound (TRUS) guided biopsy of prostate is the gold standard method of diagnosing prostate cancer. Infiltration of local anaesthetic around the prostatic nerve bundles reduces pain associated with the procedure. Some discomfort associated with the procedure is secondary to spasm of the anal sphincter. It has been shown
UROLOGY 78 (Supplement 3A), September 2011
that using topical Glyceryl Trinitrate (GTN) cream can reduce the discomfort associated with anal sphincter spasm. GTN has been associated with headache in up to 10% of patients. Experience from colorectal surgery has demonstrated that topical Diltiazem can also relax the anal sphincter. We evaluate the use of topical Diltiazem cream as an adjunct to periprostatic nerve block in reducing pain associated with TRUS guided prostatic biopsy. Materials and Method: Patients undergoing TRUS biopsy of the prostate were randomized into Diltiazem and placebo groups. Both the doctor and the patient were blinded as to which group the patient was in. A questionnaire was used to assess discomfort associated with various parts of the procedure using a 10cm visual analogue scale (VAS). One hundred patients were required to detect a change in mean pain score of 1 unit with a power of 90% using a two-sided significance of 5%. Results: Between September 2009 and September 2010, 120 patients were enrolled in the trial. There were no significant differences in age, PSA, and prostate volumes between the two groups. For insertion of the probe the mean VAS was higher for the Diltiazem group (not statistically significant). For discomfort due to the presence of the probe, pain during the biopsy, and overall pain prior to leaving the department the mean VAS was higher for the placebo group (not statistically significant). Subgroup analysis by age (ⱖ60 and ⬍60years) showed differences favouring the Diltiazem group were more pronounced in the ⬍60 group. There were no side effects associated with diltiazem use in our trial. Conclusion: Diltiazem cream has a better side effect profile than GTN cream. We have demonstrated trends favouring Diltiazem use as an adjunct to local anaesthetic in TRUS biopsy of the prostate, however this did not reach a statistically significant level.
UP-02.128 Prostatic Dynamic Contrast Enhanced MR: Comparison Before and After HIFU Treatment for Prostate Cancer Giulianelli R, Attisani F, Albanesi L, Brunori S, Gentile B, Mavilla L, Mirabile G, Shestani T, Pisanti F, Schettini M Dept. of Urology, Villa Tiberia Clinic, Rome, Italy Introduction and Objective: The aim of the study is to evaluate the diagnostic per-
S303