Archive for category: Latest Articles

Abstract

Objectives

To assess the concordance between biopsy and radical prostatectomy (RP) specimens using the 2005 Gleason Score (GS) and the ISUP 2014/ WHO 2016 modified GS system, accounting for the introduction of transperineal biopsy and pre-biopsy multiparametric MRI (mpMRI).

Patients and Methods

Between 2002 and 2019, we identified 2431 patients with paired biopsy and RP histopathology, from a prospectively recorded and maintained prostate cancer database.

Biopsy specimens were graded according to the 2005 GS or ISUP 2014 modified GS system, according to the year of diagnosis.

Multivariable logistic regression analysis was conducted to retrospectively assess the impact of PSA, PSA density, age, pre-biopsy mpMRI, and biopsy method, on the rate of upgraded disease.

The Kappa coefficient was used to establish the degree of change in concordance between groups.

Results

Overall, 24% of patients had upgraded disease and 8% of patients had downgraded disease when using the updated ISUP 2014 criteria.

Agreement in the updated ISUP 2014 cohort was 68% compared with 55% in the 2005 GS group, which was validated by a kappa co-efficient that was good (k=0.5 ± 0.4) and poor (k=0.3 ± 0.1), respectively.

In multivariable models, a change in ISUP grading system independently improved overall disease concordance (p=0.02), and there were no other co-segregated patient or pathological factors such as PSA, total number of cores, maximum cancer length, biopsy route or the use of mpMRI that impacted this finding.

Conclusion

The 2014 ISUP modification of the Gleason grading system improves overall concordance between biopsy and surgical specimens, and thus allows more accurate prognostication and management in high-grade disease, independent of more extensive prostate sampling and the use of mpMRI.

Abstract

Objective

To review of the existing literature, current guidelines and standard of practice related to prostate cancer in transgender women, as the transgender population share many of the same healthcare needs as their cisgender counterparts, but may have additional specialist needs.

Materials and methods

We performed a non-systematic review of the literature, current guidelines and standard of practice related to prostate cancer in transgender women.

Results

Our search revealed 10 case reports of prostate cancer in transgender women, four specialist opinion papers, six cohort studies, and four systematic reviews. The information in these publications were assimilated to produce a review of prostate cancer in transgender women.

Conclusion

The risk of prostate cancer in transgender women who are not on gender-affirming hormone therapy (GAHT) or who have not had gender-affirming surgery (GAS) and gender non-conforming individuals (who may never commence GAHT or have GAS) is the same as that in the cis male population. In these patients, healthcare professionals need to be able to discuss screening, diagnostic and treatment options considering future wishes for gender-affirming treatment. Prostate cancer incidence in transgender women on GAHT or following GAS is lower than age-matched cis-male counterparts, but diagnosis and treatment is more nuanced. The present review discusses the existing literature about development and incidence of prostate cancer in this population, and makes recommendations about screening, the usefulness of diagnostic tools e.g. prostate-specific antigen and magnetic resonance imaging, and considerations when formulating treatment. Potential directions for future research are discussed, which will hopefully lead to development of robust evidence-based guidelines for the diagnosis and management of prostate cancer in transgender women.

Abstract

Objective

To review of the existing literature, current guidelines and standard of practice related to prostate cancer in transgender women, as the transgender population share many of the same healthcare needs as their cisgender counterparts, but may have additional specialist needs.

Materials and methods

We performed a non-systematic review of the literature, current guidelines and standard of practice related to prostate cancer in transgender women.

Results

Our search revealed 10 case reports of prostate cancer in transgender women, four specialist opinion papers, six cohort studies, and four systematic reviews. The information in these publications were assimilated to produce a review of prostate cancer in transgender women.

Conclusion

The risk of prostate cancer in transgender women who are not on gender-affirming hormone therapy (GAHT) or who have not had gender-affirming surgery (GAS) and gender non-conforming individuals (who may never commence GAHT or have GAS) is the same as that in the cis male population. In these patients, healthcare professionals need to be able to discuss screening, diagnostic and treatment options considering future wishes for gender-affirming treatment. Prostate cancer incidence in transgender women on GAHT or following GAS is lower than age-matched cis-male counterparts, but diagnosis and treatment is more nuanced. The present review discusses the existing literature about development and incidence of prostate cancer in this population, and makes recommendations about screening, the usefulness of diagnostic tools e.g. prostate-specific antigen and magnetic resonance imaging, and considerations when formulating treatment. Potential directions for future research are discussed, which will hopefully lead to development of robust evidence-based guidelines for the diagnosis and management of prostate cancer in transgender women.

Abstract

Introduction

Thulium Fiber Laser (TFL) is the latest laser technology, which has gained increased attention for its role in stone lithotripsy. Findings from in vitro studies have shown that it can potentially deliver reduced retropulsion and efficient stone clearance. A number of clinical studies on TFL have now been reported.

Our aim was to perform an up-to-date review to scope its current status in stone lithotripsy and provide a guide for the clinical urologist

Methods

A review of world literature was performed in order to identify original articles on TFL for stone lithotripsy. Our clinical experiences of using the technology have also been shared.

Results

To date there have been 11 clinical studies published on TFL for stone lithotripsy. Three of these have been in the setting of mini percutaneous nephrolithotomy (PCNL) and the remainder have been on ureteroscopy (URS). There has only been one randomised study on this technology, which has been for URS. For URS, range of settings has been 0.1-4J x 7-300Hz for both URS and mini PCNL. Stones ranging from 0.4-3.2cm and 1.5-3cm have been treated with URS and mini PCNL, respectively. Final stone free rate (SFR) for TFL has ranged from 66.6 -100% and 85-100% for URS and mini PCNL respectively. Average length of stay ranged from 0.5-2.4 days in URS group but no studies reported this for mini PCNL. Operative times in all the studies (both URS and mini PCNL) were less than 60 minutes.

Conclusion

Initial clinical studies reveal that TFL appears to be efficacious in setting of stone lithotripsy. However, further randomised trials are warranted to delineate its formal position as well as determine the optimal settings for use in clinical practice.

Objective

To assess automatic computer-aided in situ recognition of the morphological features of pure and mixed urinary stones using intra-operative digital endoscopic images acquired in a clinical setting.

Materials and Methods

In this single-centre study, a urologist with 20 years’ experience intra-operatively and prospectively examined the surface and section of all kidney stones encountered. Calcium oxalate monohydrate (COM) or Ia, calcium oxalate dihydrate (COD) or IIb, and uric acid (UA) or IIIb morphological criteria were collected and classified to generate annotated datasets. A deep convolutional neural network (CNN) was trained to predict the composition of both pure and mixed stones. To explain the predictions of the deep neural network model, coarse localization heat-maps were plotted to pinpoint key areas identified by the network.

Results

This study included 347 and 236 observations of stone surface and stone section, respectively; approximately 80% of all stones exhibited only one morphological type and approximately 20% displayed two. A highest sensitivity of 98% was obtained for the type ‘pure IIIb/UA’ using surface images. The most frequently encountered morphology was that of the type ‘pure Ia/COM’; it was correctly predicted in 91% and 94% of cases using surface and section images, respectively. Of the mixed type ‘Ia/COM + IIb/COD’, Ia/COM was predicted in 84% of cases using surface images, IIb/COD in 70% of cases, and both in 65% of cases. With regard to mixed Ia/COM + IIIb/UA stones, Ia/COM was predicted in 91% of cases using section images, IIIb/UA in 69% of cases, and both in 74% of cases.

Conclusions

This preliminary study demonstrates that deep CNNs are a promising method by which to identify kidney stone composition from endoscopic images acquired intra-operatively. Both pure and mixed stone composition could be discriminated. Collected in a clinical setting, surface and section images analysed by a deep CNN provide valuable information about stone morphology for computer-aided diagnosis.