Faculty Bibliography

INTRODUCTION: Multiparametric-MRI (mp-MRI) is an evolving noninvasive imaging modality that increases the accurate localization of prostate cancer at the time of MRI targeted biopsy, thereby enhancing clinical risk assessment, and improving the ability to appropriately counsel patients regarding therapy. MATERIAL AND METHODS: We used MEDLINE/PubMed to conduct a comprehensive search of the English medical literature. Articles were reviewed, data was extracted, analyzed, and summarized. In this review, we discuss the mp-MRI prostate exam, its role in targeted prostate biopsy, along with clinical applications and outcomes of MRI targeted biopsies. RESULTS: Mp-MRI, consisting of T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and possibly MR spectroscopy, has demonstrated improved specificity in prostate cancer detection as compared to conventional T2-weighted images alone. An MRI suspicion score has been developed and is depicted using an institutional Likert or, more recently, a standardized reporting scale (PI-RADS). Techniques of MRI-targeted biopsy include in-gantry MRI guided biopsy, TRUS-guided visual estimation biopsy, and software co-registered MRI-US guided biopsy (MRI-US fusion). Among men with no previous biopsy, MRI-US fusion biopsy demonstrates up to a 20% increase in detection of clinically significant cancers compared to systematic biopsy while avoiding a significant portion of low risk disease. These data suggest a potential role in reducing over-detection and, ultimately, over-treatment. Among men with previous negative biopsy, 72-87% of cancers detected by MRI targeted biopsy are clinically significant. Among men with known low risk cancer, repeat biopsy by MR-targeting improves risk stratification in selecting men appropriate for active surveillance secondarily reducing the need for repetitive biopsy during surveillance. CONCLUSIONS: Use of mp-MRI for targeting prostate biopsies has the potential to reduce the sampling error associated with conventional biopsy by providing better disease localization and sampling. MRI-ultrasound fusion-targeted prostate biopsy may improve the identification of clinically significant prostate cancer while limiting detection of indolent disease, ultimately facilitating more accurate risk stratification. Literature supports the clinical applications of MRI-targeted biopsy in men who have never been biopsied before, those with a prior negative biopsy, and those with low risk disease considering active surveillance.

INTRODUCTION: Surgical treatment of penile cancer is usually associated with mutilation; alterations in self-esteem and body image; affecting sexual and urinary functions; and declined health-related quality of life. Recently, organ sparing treatment has appeared and led to limiting these complications. MATERIAL AND METHODS: An extensive review of the literature concerning penile-preserving strategies was conducted. The focus was put on indications, general principles of management, surgical options and reconstructive techniques, the most common complications, as well as functional and oncological outcomes. RESULTS: Analyzed methods, e.g.: topical chemotherapy, laser ablation therapy, radiotherapy, Moh's microscopic surgery, circumcision, wide local excision, glans resurfacing and glansectomy are indicated in low-stage tumors (Tis, Ta-T2). After glansectomy, reconstruction is also possible. CONCLUSIONS: Organ sparing techniques may achieve good anatomical, functional, and psychological outcomes without compromising local cancer control, which depends on early diagnosis and treatment. Penile sparing strategies are acceptable treatment approaches in selected patients with low-stage penile cancer after establishing disease-risk and should be considered in this population.

BACKGROUND: MRI-ultrasound fusion-targeted prostate biopsy (MRF-TB) may improve detection of prostate cancer (PCa) in men presenting for prostate biopsy. We report clinical outcomes of 12-core systematic biopsy (SB) and MRF-TB in men presenting for primary biopsy and further describe pathological characteristics of cancers detected by SB and not by MRF-TB. MATERIALS & METHODS: Clinical outcomes of 435 consecutive men who underwent pre-biopsy mpMRI followed by MRF-TB and SB at our institution between June 2012 and March 2015 were captured in an IRB-approved database Clinical characteristics, biopsy results and MRI suspicion scores (mSS) were queried from the database. RESULTS: Among 370 men (mean age 64+/-8.5 years; mean PSA 6.8, SEM 0.3 ng/mL) who met inclusion criteria, PCa was detected in 200 (54.1%) cases. Cancer detection rates for SB and MRF-TB were 47.3% and 43.5%, respectively (p = 0.104). MRF-TB detected more Gleason score >/=7 cancers than SB (114/128 (89.1%) vs 95/128 (74.2%), respectively, p = 0.008). Of 39 cancers detected by SB, but not by MRF-TB, 32/39 (82.1%) demonstrated Gleason 6 disease, and 24/39 (61.5%) and 32/39 (82.1%) were clinically insignificant by Epstein and UCSF CAPRA (score