ABSTRACT Purpose: To evaluate the effectiveness of mapping-targeted biopsies (MTB) on the index lesion for the detection of clinically significant prostate cancer (csPCa) in transperineal fusion-image prostate biopsies. Materials and Methods: A retrospective analysis was conducted on 309 men with suspected PCa who underwent prostate biopsies at the Creu Blanca reference center in Barcelona, Spain. The Prostate Imaging-Reporting and Data System (PI-RADS v.2.1) of the magnetic resonance images (MRI) were reclassified by an expert radiologist reading of pre-biopsy biparametric MRI used for segmentation of suspected lesions. Transperineal MTB of suspicious lesions and 12-core systematic biopsies were performed using the Artemis™ platform. CsPCa was defined as International Society of Urological Pathology grade group ≥ 2. Results: CsPCa was detected in 192 men (62.1%), with detection rates of 6.3% for PI-RADS 2, 26.8% for PI-RADS 3, 87.3% for PI-RADS 4, and 93.1% for PI-RADS 5. MTB of the index lesion identified 185 csPCa (96.3%). CsPCa was detected solely in systematic biopsies in three cases (1.6%), while an additional four cases (2.1%) were identified only in the second suspected lesion. A predictive model for csPCa detection in MTB of the index lesion was developed, with an AUC of 0.918 (95% CI 0.887-0.950). Conclusions: This model had the potential to avoid 23.3% of prostate biopsies without missing additional csPCa cases. MTB of the index lesion was highly effective for identifying csPCa in fusion transperineal prostate biopsies. A developed predictive model successfully reduced the need for almost one quarter of biopsies without missing csPCa cases. Purpose mappingtargeted mapping targeted (MTB (csPCa fusionimage image Methods 30 Barcelona Spain ImagingReporting Imaging Reporting PIRADS PI RADS v.2.1 v21 v 2 1 (MRI prebiopsy pre biopsy 12core core 12 Artemis platform Results 19 62.1%, 621 62.1% , 62 (62.1%) 63 6 3 6.3 268 26 8 26.8 873 87 87.3 4 931 93 93.1 5 18 96.3%. 963 96.3% . 96 (96.3%) 1.6%, 16 1.6% (1.6%) 2.1% 21 (2.1% 0918 0 918 0.91 95% 95 (95 0.8870.950. 08870950 0.887 0.950 887 950 0.887-0.950) Conclusions 233 23 23.3 v.2. v2 62.1 (62.1% 6. 26. 87. 9 93. 96.3 (96.3% 1.6 (1.6% 2.1 (2.1 091 91 0.9 (9 8870 0.8870.950 0887095 0887 0.88 0950 0.95 88 0.887-0.950 23. v.2 62. (62.1 96. (96.3 1. (1.6 (2. 09 0. ( 0.8870.95 088709 088 0.8 095 0.887-0.95 v. (62. (96. (1. (2 0.8870.9 08870 08 0.887-0.9 (62 (96 (1 0.8870. 0.887-0. (6 0.8870 0.887-0 0.887-

Objectives: To familiarize the urologist with the various diagnostic tests currently available for bone mineral density measurement, as well as to perform an update on bone mineral densitometry. Methods: We review the currently available methods for the evaluation of bone mineral density, with special focus on dual energy X-ray ab-sorptiometry (DXA), considered the standard technique for the diagnosis of osteoporosis. We also review the role of peripheral densitometry and the use of ultrasounds for the evaluation of bone mass status. Results: We may consider lumbar vertebrae and hip DXA the standard technique for the evaluation of bone mass. Peripheral devices and ultrasounds will probably have a very important role in the future. The lack of large prospective evaluation studies imply that its use is not being advised in daily clinical practice for diagnosis and follow-up of osteoporosis. Conclusions: We, as urologists, should become aware of the importance of bone health of our patients, especially those with prostate cancer, specifically for those receiving androgen deprivation therapies. To know some features of osteoporosis and how to diagnose and follow it may be very useful to diminish the impact this disease represents for our patient´s morbidity and mortality.

Objetivo: Intentar familiarizar al urólogo con las diferentes técnicas diagnósticas que disponemos hoy en día para la medida de la DMO, así cómo realizar una revisión del estado actual de la densitometría ósea. Métodos: Llevamos a cabo una revisión de los métodos que disponemos en la actualidad para valorar la densidad mineral ósea, haciendo mayor hincapié en la absorciometría dual de rayos X (DXA), considerada en la actualidad cómo la técnica estándar para el diagnóstico de osteoporosis. Revisamos también el papel de la densitometría periférica y el uso de los ultrasonidos para la valoración del estado de la masa ósea del paciente. Resultados: Podemos considerar a la absorciometría dual de rayos X a nivel de columna lumbar y cadera cómo la técnica estándar para la valoración de la masa ósea. Los dispositivos periféricos, así como los ultrasonidos, probablemente desarrollarán un papel muy importante en el futuro. La falta de estudios amplios y prospectivos para su valoración implican que actualmente no se aconseje su utilización el la práctica clínica diaria para el diagnóstico y monitorización de la osteoporosis. Conclusiones: Debemos concienciarnos cómo urólogos de la importancia de la salud ósea de nuestros pacientes, especialmente de aquellos con cáncer de próstata y más específicamente de aquellos sometidos a deprivación andrógenica. Conocer algunos aspectos sobre la osteoporosis y sobre cómo realizar su diagnóstico y seguimiento, nos puede ser de utilidad para disminuir el impacto que representa esta patología sobre la morbilidad y mortalidad de nuestros pacientes.

Objetives: Ultrasound guided prostate biopsy is the only method to obtain the confirmation diagnosis of prostate cancer. Since its introduction at the end of the `80s multiple modifications of the technique have been implemented to improve cancer detection rates and to diminish the rate of false negative results, with maximum patient comfort and less complications. Methods: Bibliographic review and critical analysis of the literature on prostate biopsy. Results/Conclusions: Published studies suggest extensive biopsy schemes increase detection rates in comparison to sextant biopsies, both first and successive biopsies, being necessary to sample the most lateral areas of the gland and the dorsal apex where the diagnostic yield is greater. The indications for repeated biopsies after a negative one include high grade PIN and/or Atypical Small Acinar Proliferation (ASAP), persistent PSA elevation and/or total PSA doubling time increase. There is no consensus about the time for repeating biopsies, although it seems that cancer detection rates descend after the third biopsy. The introduction of periprostatic anesthetic blockage techniques has enabled pain control, mainly in more extensive biopsies.

Objetivo: La biopsia de próstata ecodirigida constituye el único método para obtener el diagnóstico de naturaleza de cáncer de próstata. Desde su introducción a finales de la década de los 80, se han producido múltiples modificaciones de la técnica con el objetivo de aumentar la tasa de detección de cáncer y disminuir la tasa de falsos negativos con el máximo confort y menor posibilidad de complicaciones. Métodos: Análisis crítico y revisión de conjunto de la literatura publicada sobre biopsia prostática hasta el momento. Resultados/Conclusiones: Los estudios publicados sugieren que los esquemas de biopsia extensos, tanto en las primeras biopsias como en las rebiopsias, aumentan la tasa de detección de cáncer en comparación con la biopsia por sextantes, siendo necesario incluir muestras procedentes de las porciones más laterales y apico-dorsales de la glándula donde el rendimiento diagnóstico es mayor. La rebiospia, tras una primera biopsia negativa, se indicará en los casos de primeras biopsias con PIN de AG y/o ASAP, elevación persistente de PSA y/o incremento del tiempo de doblaje de PSA total. No existe consenso respecto en que momento parar de rebiospiar, si bien parece que la tasa de detección de cáncer desciende a partir de la tercera rebiopsia. La introducción de las técnicas de bloqueo anestésico periprostático han permitido el control de dolor asociado en especial en la biopsias más extensas.