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Objective: To compare the efficacy of multiparametric magnetic resonance imaging (mpMRI)‐directed and micro‐ultrasonography (micro‐US)‐directed biopsy for detecting clinically significant (Grade Group >1) prostate cancer (csPCa). Materials and Methods: A total of 203 patients were prospectively enrolled at three institutions across Germany and Austria in the period from January 2019 to December 2019. During each biopsy, the urologist was blinded to the mpMRI report until after the micro‐US targets had been assessed. After unblinding, targets were then sampled using software‐assisted fusion, followed by systematic samples. The primary outcome measure was non‐inferiority of micro‐US to detect csPCa, with a detection ratio of at least 80% that of mpMRI. Results: A total of 79 csPCa cases were detected overall (39%). Micro‐US‐targeted biopsy detected 58/79 cases (73%), while mpMRI‐targeted biopsy detected 60/79 (76%) and non‐targeted (completion sampling) samples detected 45/79 cases (57%). mpMRI‐targeted samples alone detected 7/79 (9%) csPCa cases which were missed by micro‐US‐targeted and non‐targeted samples. Three of these seven were anterior lesions with 2/7 in the transition zone. Micro‐US‐targeted samples alone detected 5/79 (6%) and completion sampling alone detected 4/79 cases (5%). Micro‐US was non‐inferior to mpMRI and detected 97% of the csPCa cases detected by mpMRI‐targeted biopsy (95% CI 80–116%; P = 0.023). Conclusions: This is the first multicentre prospective study comparing micro‐US‐targeted biopsy with mpMRI‐targeted biopsy. The study provides further evidence that micro‐US can reliably detect cancer lesions and suggests that micro‐US biopsy might be as effective as mpMRI for detection of csPCA. This result has significant implications for increasing accessibility, reducing costs and expediting diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: There is still a lack of availability of high-quality multiparametric magnetic resonance imaging (mpMRI) interpreted by experienced uro-radiologists to rule out clinically significant PC (csPC). Consequently, we developed a new imaging method based on computed tomographic ultrasound (US) supported by artificial neural network analysis (ANNA). Methods: Two hundred and two consecutive patients with visible mpMRI lesions were scanned and recorded by robotic CT-US during mpMRI-TRUS biopsy. Only significant index lesions (ISUP ≥2) verified by whole-mount pathology were retrospectively analyzed. Their visibility was reevaluated by 2 blinded investigators by grayscale US and ANNA. Results: In the cohort, csPC was detected in 105 cases (52%) by mpMRI-TRUS biopsy. Whole-mount histology was available in 44 cases (36%). In this subgroup, mean PSA level was 8.6 ng/mL, mean prostate volume was 33 cm3, and mean tumor volume was 0.5 cm3. Median PI-RADS and ISUP of index lesions were 4 and 3, respectively. Index lesions were visible in grayscale US and ANNA in 25 cases (57%) and 30 cases (68%), respectively. Combining CT-US-ANNA, we detected index lesions in 35 patients (80%). Conclusions: The first results of multiparametric CT-US-ANNA imaging showed promising detection rates in patients with csPC. US imaging with ANNA has the potential to complement PC diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the therapy of stress urinary incontinence in a preclinical setting cells were injected into the urethrae of minipigs; however, cells injected by William's needle were frequently misplaced or lost; thus, we investigated if needle‐free cell injections using a novel waterjet technology facilitates precise injections in the urethral sphincter complex. Materials and Methods: Porcine adipose tissue‐derived stromal cells (pADSCs) were isolated from boars, expanded, labelled, and injected in the sphincter of female pigs by waterjet employing two different protocols. After incubation for 15 min or 3 days, the urethrae of the pigs were examined. Injected cells were visualised by imaging and fluorescence microscopy of tissue sections. DNA of injected male cells was verified by polymerase chain reaction (PCR) of the sex‐determining region (SRY) gene. Cell injections by William's needle served as controls. Results: The new waterjet technology delivered pADSCs faster and with better on‐site precision than the needle injections. Bleeding during or after waterjet injection or other adverse effects, such as swelling or urinary retention, were not observed. Morphologically intact pADSCs were detected in the urethrae of all pigs treated by waterjet. SRY‐PCR of chromosomal DNA and detection of recombinant green fluorescent protein verified the injection of viable cells. In contrast, three of four pigs injected by William's needle displayed no or misplaced cells. Conclusion: Transurethral injection of viable pADSCs by waterjet is a simple, fast, precise, and yet gentle new technology. This is the first proof‐of‐principle concept study providing evidence that a waterjet injects intact cells exactly in the tissue targeted in a preclinical in vivo situation. To further explore the clinical potential of the waterjet technology longer follow‐up, as well as incontinence models have to be studied. [ABSTRACT FROM AUTHOR]

Multiparametric MRI (mpMRI) is one of the primary diagnostic tools for detecting clinically relevant prostate cancer. It should be routinely used in addition to urological investigations owing to its higher diagnostic yield than systematic biopsies. However, combining targeted and systematic biopsies achieves the highest diagnostic rate. The Prostate Imaging Reporting and Data System (PI-RADS Version 2.1) standardizes the acquisition and interpretation of mpMRI of the prostate. It consists of high-resolution T2- and diffusion-weighted images, the corresponding apparent diffusion coefficient (ADC) maps, and a dynamic contrast-enhanced sequence. Reports describe the increasing likelihood of clinically significant prostate cancer with PI-RADS categories 1-5. The MRI sequence determining the PI-RADS category of a lesion depends on its location within the prostate: in the transitional zone, the T2-weighted sequence and, in the peripheral zone, the diffusion-weighted sequence are the primary determinants. The diffusion-weighted and contrast-enhanced sequences provide secondary classification for the transitional and peripheral zones, respectively. This review summarizes and illustrates the diagnostic criteria defined in PI-RADS 2.1. In addition, evidence for mpMRI of the prostate, its indication and implementation are described., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)