ABSTRACT Purpose: To validate the Barcelona magnetic resonance imaging predictive model (BCN-MRI PM) in men with pre-biopsy multiparametric MRI (mpMRI) reported with the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, followed by transrectal and transperineal prostate biopsies. Materials and Methods: Prospective analysis of 3,264 men with PSA >3.0 ng/mL and/or abnormal digital rectal examination who were referred to ten participant centers in the csPCa early detection program of Catalonia (Spain), between 2021 and 2023. MpMRI was reported with the PI-RADS v2.1, and 2- to 4-core MRI-transrectal ultrasound (TRUS) fusion-targeted biopsy of suspected lesions and/or 12-core systematic biopsy were conducted. 2,295 (70.3%) individuals were referred to six centers for transrectal prostate biopsies, while 969 (39.7%) were referred to four centers for transperineal prostate biopsies. CsPCa was classified whenever the International Society of Urologic Pathology grade group was 2 or higher. Results: CsPCa was detected in 41% of transrectal prostate biopsies and in 45.9% of transperineal prostate biopsies (p <0.016). Both BCN-MRI PM calibration curves were within the ideal correlation between predicted and observed csPCa. Areas under the curve and 95% confidence intervals were 0.847 (0.830-0.857) and 0.830 (0.823-0.855), respectively (p = 0.346). Specificities corresponding to 95% sensitivity were 37.6 and 36.8%, respectively (p = 0.387). The Net benefit of the BCN-MRI PM was similar with both biopsy methods. Conclusions: The BCN-MRI PM has been successfully validated when mpMRI was reported with the PI-RADS v2.1 and prostate biopsies were conducted via the transrectal and transperineal route. Purpose BCNMRI BCN prebiopsy pre (mpMRI PIRADS PI RADS (PI-RADS v21 v v2 1 Methods 3264 3 264 3,26 30 0 >3. ngmL ng mL andor Spain, Spain , (Spain) 202 2023 4core core 4 MRItransrectal TRUS (TRUS fusiontargeted fusion targeted 12core 12 2295 295 2,29 70.3% 703 70 (70.3% 96 39.7% 397 39 7 (39.7% higher Results 41 459 45 9 45.9 p <0.016. 0016 <0.016 . 016 <0.016) 95 0847 847 0.84 0.8300.857 08300857 0.857 830 857 (0.830-0.857 0830 0.83 0.8230.855, 08230855 0.823 0.855 823 855 (0.823-0.855) 0.346. 0346 0.346 346 0.346) 376 37 6 37. 368 36 8 36.8% 0.387. 0387 0.387 387 0.387) methods Conclusions v2. route 326 26 3,2 >3 (Spain 20 229 29 2,2 70.3 (70.3 39.7 (39.7 45. 001 <0.01 01 084 84 0.8 8300 0.8300.85 0830085 0857 0.85 83 85 (0.830-0.85 083 8230 0.8230.855 0823085 0823 0.82 0855 82 (0.823-0.855 034 0.34 34 36.8 038 0.38 38 32 3, > 22 2, 70. (70. 39. (39. 00 <0.0 08 0. 0.8300.8 083008 085 (0.830-0.8 0.8230.85 082308 082 (0.823-0.85 03 0.3 36. (70 (39 <0. 0.8300. 08300 (0.830-0. 0.8230.8 08230 (0.823-0.8 (7 (3 <0 0.8300 (0.830-0 0.8230. (0.823-0. ( < (0.830- 0.8230 (0.823-0 (0.830 (0.823- (0.83 (0.823 (0.8 (0.82 (0. (0

OBJECTIVES: Prostatic brachytherapy by permanent implant of I125 or Pd103 is a therapeutic option in the treatment of organ confined prostate cancer. We analyze preliminary results and complications after five years in the group of patients who received I125 low dose rate brachytherapy as the only intention-tocure treatment and evaluate the differences with the standard treatment (surgery). METHODS: From a case series of more than 400 patients treated with brachytherapy as radical intentionto- cure monotherapy for organ-confined prostate cancer we excluded patients with less than 12 months of follow-up for statistical analysis; the study group includes 275 patients enrolled between april 1999 and December 2003. Mean follow-up is 31 months (12- 68). Biochemical failure was defined in accordance to the ASTRO criteria. Statistical survival analysis was carried out with the SPSS statistical software using the Kaplan Meyer method. Urinary and gastrointestinal complications were evaluated in accordance to the RTOG criteria. RESULTS: Mean age was 68 years (range 49-83 years). 93% of the patients presented a clinical stage ≤ 3dT2a and 7% T2b, with 60 8% of the cases having a PSA ≤3d 10 ng/ml. Gleason score was ≤3d 6 in 94% of the cases. 9% of the cases had a prostate volume > 50 cc. Overall 5 year survival was 96%, with a 97% disease-free survival and a 99% biochemical failure-free survival. Figure 3 and tables II-VI summarize the complications in various series including this. CONCLUSIONS: Multiple published series seem to show similar results on biochemical control of the disease when comparing surgery and low dose rate brachytherapy in organ-confined disease. In comparison to surgery, brachytherapy has the advantage of having a lower percentage of immediate postoperative complications, lower incontinence rate, and a higher number of patients preserving erectile function.

OBJETIVO: La braquiterapia prostática con implantes permanentes de semillas de I125 ó 103Pd es una opción terapéutica en el tratamiento del cáncer prostático organoconfinado. Analizamos los resultados preliminares y las complicaciones a cinco años en el grupo de pacientes tratados con braquiterapia de baja tasa (I125) como tratamiento único de intención curativa y evaluamos las diferencias existentes con el tratamiento estándar (cirugía). MÉTODOS: Sobre una casuística que supera los 400 pacientes tratados con braquiterapia como monoterapia y con intención curativa radical por adenocarcinoma de próstata organoconfinado, hemos excluido el grupo de pacientes con un seguimiento menor a 12 meses para el análisis estadístico de resultados y complicaciones, por lo tanto el grupo a estudio consta de 275 pacientes reclutados desde abril de 1999 a diciembre del 2003. El seguimiento medio de la serie es de 31 meses (12-68 m). Se consideró fallo bioquímico cuando los pacientes cumplieron los criterios marcados por la ASTRO. El análisis estadístico de supervivencia se realizó con el paquete estadístico SPSS y el método de Kaplan-Meyer. Las complicaciones urinarias y digestivas fueron evaluadas de acuerdo con los criterios de la RTOG RESULTADOS: La edad media del grupo fue de 68 años con un rango (49-83 años). El 93% de los pacientes presentaron un estadio clínico ≤ T2a y un 7% de estadios T2b con PSA ≤ 10 ng/ml en el 68% de los casos. El Gleason fue ≤ 6 en el 94% de los casos. Un 9% de los casos tratados presentaban un volumen prostático >50cc. la supervivencia global a los 5 años es del 96%, con una supervivencia libre de enfermedad de 97% y una con una supervivencia libre de fallo bioquímico del 99% al mismo tiempo. Las complicaciones de las diferentes series incluida la nuestra están recogidas en la Figura 3 y Tablas II-VI. CONCLUSIÓN: Las múltiples series publicadas en la literatura parecen poner de manifiesto los mismos resultados de control bioquímico de la enfermedad cuando se compara la cirugía con la braquiterapia de baja tasa en enfermedad organoconfinada. La braquiterapia presenta frente a la cirugía la ventaja de tener menor porcentaje de complicaciones en el postoperatorio inmediato, menor índice de incontinencias y una preservación de la función eréctil en mayor número de pacientes.