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Darlinghurst, Australia

Stricker P.D.,St Vincents Prostate Cancer Center
BJU international | Year: 2012

• Currently there is significant confusion and polarisation about prostate cancer screening for both patients and physicians alike. • We propose a risk-adjusted testing programme, which would lead to fewer patients who need to be tested and treated to save a life and also eliminate inappropriate prostate-specific antigen testing in the elderly and patients with severe co-morbidities where there is no clear benefit. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL. Source

Moore B.M.,Garvan Institute of Medical Research | Moore B.M.,St Vincents Prostate Cancer Center | Savdie R.,Garvan Institute of Medical Research | Savdie R.,St Vincents Prostate Cancer Center | And 7 more authors.
BJU International | Year: 2012

OBJECTIVE To examine whether nerve-sparing surgery (NSS) is a risk factor for positive surgical margins (PSMs) in patients with either organ-confined prostate cancer or extracapsular extension (ECE). PATIENTS AND METHODS Clinicopathological outcome data on 945 consecutive patients treated with radical prostatectomy (RP) were prospectively collected. All patients underwent RP (bilateral, unilateral or non-NSS) by one surgeon between 2002 and 2007. Risk of PSMs and their locations with respect to NSS was determined by multivariate logistic regression analysis adjusting for preoperative risk factors for PSMs within pT2, pT3a and pT3b tumours. RESULTS Overall a PSM was identified in 19.6% of patients in an unscreened population with mean prostate-specific antigen (PSA) level of 8.1 ng/mL. There was no significant difference in rates of PSMs between NSS groups on multivariate analysis (P= 0.147). There was no significant difference in pT2 (P= 0.880), pT3a (P= 0.175) or pT3b (P= 0.354) tumours. The only significant predictor of PSMs was preoperative PSA level (risk ratio 1.289, P= 0.006). There was no significant difference in the location of PSMs except for the pT3a group, where the patients that had bilateral NSS were at higher risk of a posterolateral PSM (P= 0.028). CONCLUSIONS With appropriate selection of patients, NSS does not increase the risk of PSMs, whether the cancer is organ confined or ECE is present. The adverse impact of the NSS procedure in the hands of an experienced surgeon is minimal and is a realistic compromise to obtain the increase in health-related quality of life offered by NSS. © 2011 BJU INTERNATIONAL. Source

Tran M.,St Vincents Prostate Cancer Center | Tran M.,Garvan Institute of Medical Research | Tran M.,University of Sydney | Thompson J.,St Vincents Prostate Cancer Center | And 15 more authors.
BJU International | Year: 2016

Objective To evaluate the accuracy of combined multiparametric magnetic resonance imaging (mpMRI) and transperineal template-guided mapping biopsy (TTMB) for identifying lobes with significant prostate cancer (PCA) for the application of hemi-ablative focal therapy (FT). Patients and Methods From January 2012 to January 2014, 89 consecutive patients, aged ≥40 years, with a PSA level ≤15 ng/mL, underwent in sequential order: mpMRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients who met consensus guidelines for FT. Lobes were stratified into lobes with significant cancer (LSC), lobes with insignificant cancer and lobes with no cancer. Using histopathology at RP, the predictive performance of combined mpMRI + TTMB in identifying LSC was evaluated. Results The sensitivity, specificity and positive predictive value for mpMRI + TTMB for LSC were 97, 61 and 83%, respectively. The negative predictive value (NPV), the primary variable of interest, for mpMRI + TTMB for LSC was 91%. Of the 50 patients, 21 had significant unilateral disease on mpMRI + TTMB. Two of these 21 patients had significant bilateral disease on RP not identified on mpMRI + TTMB. Conclusions In the selection of candidates for FT, a combination of mpMRI and TTMB provides a high NPV in the detection of LSC. © 2015 BJU International. Source

Valerio M.,University College London | Valerio M.,University of Lausanne | Stricker P.D.,St Vincents Prostate Cancer Center | Ahmed H.U.,University College London | And 6 more authors.
Prostate Cancer and Prostatic Diseases | Year: 2014

Background:To evaluate the safety and clinical feasibility of focal irreversible electroporation (IRE) of the prostate.Methods:We assessed the toxicity profile and functional outcomes of consecutive patients undergoing focal IRE for localised prostate cancer in two centres. Eligibility was assessed by multi-parametric magnetic resonance imaging (mpMRI) and targeted and/or template biopsy. IRE was delivered under transrectal ultrasound guidance with two to six electrodes positioned transperineally within the cancer lesion. Complications were recorded and scored accordingly to the NCI Common Terminology Criteria for Adverse Events; the functional outcome was physician reported in all patients with at least 6 months follow-up. A contrast-enhanced MRI 1 week after the procedure was carried out to assess treatment effect with a further mpMRI at 6 months to rule out evidence of residual visible cancer.Results:Overall, 34 patients with a mean age of 65 years (s.d.=±6) and a median PSA of 6.1 ng ml-1 (interquartile range (IQR)= 4.3-7.7) were included. Nine (26%), 24 (71%) and 1 (3%) men had low, intermediate and high risk disease, respectively (D'Amico criteria). After a median follow-up of 6 months (range 1-24), 12 grade 1 and 10 grade 2 complications occurred. No patient had grade >/= 3 complication. From a functional point of view, 100% (24/24) patients were continent and potency was preserved in 95% (19/20) men potent before treatment. The volume of ablation was a median 12 ml (IQR=5.6-14.5 ml) with the median PSA after 6 months of 3.4 ng ml-1 (IQR=1.9-4.8 ng ml-1). MpMRI showed suspicious residual disease in six patients, of whom four (17%) underwent another form of local treatment.Conclusions:Focal IRE has a low toxicity profile with encouraging genito-urinary functional outcomes. Further prospective development studies are needed to confirm the functional outcomes and to explore the oncological potential. © 2014 Macmillan Publishers Limited. Source

Thompson J.E.,St Vincents Prostate Cancer Center | Thompson J.E.,Garvan Institute of Medical Research | Thompson J.E.,Kinghorn Cancer Center | Thompson J.E.,University of New South Wales | And 22 more authors.
Journal of Urology | Year: 2014

Purpose Multiparametric magnetic resonance imaging appears to improve prostate cancer detection but prospective studies are lacking. We determined the accuracy of multiparametric magnetic resonance imaging for detecting significant prostate cancer before diagnostic biopsy in men with abnormal prostate specific antigen/digital rectal examination. Materials and Methods In this single center, prospective study men older than 40 years with abnormal prostate specific antigen/digital rectal examination and no previous multiparametric magnetic resonance imaging underwent T2-weighted, diffusion-weighted and dynamic contrast enhanced imaging without an endorectal coil. Imaging was allocated alternately to 1.5/3.0 Tesla. Imaging was double reported independently using PI-RADS (Prostate Imaging Reporting and Data System) by specialist radiologists. Transperineal grid directed 30-core biopsy was performed with additional magnetic resonance imaging directed cores for regions of interest outside template locations. Four significant cancer definitions were tested. Chi-square and logistic regression analysis was done. Men undergoing prostatectomy were analyzed. Results Of the 165 men who enrolled in the study 150 were analyzed. Median age was 62.4 years, median prostate specific antigen was 5.6 ng/ml, 29% of patients had an abnormal digital rectal examination and 88% underwent initial biopsy. Multiparametric magnetic resonance imaging was positive (PI-RADS 3 to 5) in 66% of patients, 61% had prostate cancer and 30% to 41% had significant prostate cancer (definitions 1 to 4). For significant cancer sensitivity was 93% to 96%, specificity was 47% to 53%, and negative and positive predictive values were 92% to 96% and 43% to 57%, respectively (definitions 1 to 4). Radical prostatectomy results in 48 men were similar. Aggregate PI-RADS (4 to 20) performed similarly to overall PI-RADS (1 to 5). Negative and positive predictive values (100% and 71%, respectively) were similar in men at higher risk, defined as prostate specific antigen greater than 10 ng/ml with abnormal digital rectal examination. On multivariate analysis PI-RADS score was associated with significant prostate cancer (p <0.001) but magnet strength was not. Adding PI-RADS to the multivariate model improved the AUC from 0.810 to 0.913 (95% CI 0.038-0.166, p = 0.002). Radiologist agreement was substantial (weighted κ = 0.626). Conclusions Multiparametric magnetic resonance imaging reported by expert radiologists achieved an excellent negative predictive value and a moderate positive predictive value for significant prostate cancer at 1.5 and 3.0 Tesla. © 2014 by American Urological Association Education and Research, Inc. Source

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