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The purpose of this study was to assess whether Immune CompleX Predictive Index (iXip) improves diagnostic accuracy of multiparametric prostate MRI (mpMRI) for clinically significant prostate cancer. This study included 72 patients (mean age: 68±8 years) with suspicion of prostate cancer and available iXip score. mpMRI images were evaluated by two radiologists according to the PI-RADS v2.1. Reference standard was based on fusion biopsy and standard transperineal 12-point biopsy. Diagnostic accuracy of iXip, mpMRI and their combination were calculated. Optimal cutoff of iXip with sensitivity and specificity was identified using the Youden index. Patients with clinically significant prostate cancers had significantly higher iXip values compared to patients without clinically significant prostate cancers (median 0.411 vs 0.273; p=0.026). The AUROC for iXip was 0.795 (95% CI 0.579-1.000, p=0.026). Sensitivity and specificity were 75% and 100% respectively for mpMRI alone, and 100% and 80% respectively for mpMRI combined with iXip > 0.375. The combination of mpMRI with a cutoff value of iXip > 0.375 has a very high sensitivity for the diagnosis of prostate cancer and a moderately high specificity.

Introduction: The most relevant risk factor in T1G3 NMI transitional cell carcinoma of the bladder (TCCB) is the presence of Tis. The long term results of conservative management still are a matter of controversy. The role of BCG in preventing progression and death in this category of NMI TCCB is not definitely proved. The published experiences of conservative treatment of high risk TCCB often include unselected patients, small numbers and short follow-up. Immediate radical cystectomy is advocated by many urologists. Objectives: The aim of the study is to identify the survival risk factors in 236 selected patients conservatively treated. Methods: Between January 1976 and December 2005, 236 patients with T1G3 bladder tumors were treated by TUR plus adjuvant intravesical therapy. Patients with previuos T1G3, Tis, more than 3 tumors or greater than 3 cm were excluded. Tumors were primary in 177 (75.3%) and single in 144 (61.5%) cases. Urinary cytology was obtained within 30 days after TUR, the last 51 (21.6%) patients, since 2000, were submitted to re-TUR. A sequential combination of mitomycin C (30mg/30ml) and epirubicin (50mg/50ml) was adopted in 106 patients (44.9%). BCG or other agents were given intravesically in 85 (36.0%) and 38 (16.1%) patients respectively for 12 months. Seven (3%) patients refused intravescical therapy. In the case of Ta-T1 recurrence. TUR and one year of adjuvant intravesical therapy were repeated. Patients went off study if Tis, T1G3 or T-category tumor over T1 were detected. Age, previuos history, number of tumors, time to recurrence, re-TUR, adjuvant therapy, and response to treatment were considered for survival in multivariate analysis. Results: At a mean follow-up period of 52 months (range: 3-246 months), 116 patients (49.2%) recurred. The recurring tumor was T1 in 47 (40.5%) cases and T1G3 in 33 cases (28.4%). In 11 additional patients (9.5%) a Tis was detected. Twenty-five patients (10.6%) progressed and 15 patients (6.4%) underwent cystectomy. Median overall survival was 167 months. Median survival in 195 patients (82.6%) preserving their bladder was 119 months. The 5-year progression-free survival rate was 87.8%. Thirty-two patients (13.6%) died, 22 (9.3%) for bladder cancer.. Recurrence was found significantly lower in single tumors (p=0.012) and in BCG-treated patients (