-4,7 Purpose: To develop an image-based technique capable of detection and grading of prostate cancer, which combines features extracted from multiparametric MRI into a single parameter map of cancer probability. Materials and Methods:A combination of features extracted from diffusion tensor MRI and dynamic contrast enhanced MRI was used to characterize biopsy samples from 29 patients. Support vector machines were used to separate the cancerous samples from normal biopsy samples and to compute a measure of cancer probability, presented in the form of a cancer colormap. The classification results were compared with the biopsy results and the classifier was tuned to provide the largest area under the receiver operating characteristic (ROC) curve. Based solely on the tuning of the classifier on the biopsy data, cancer colormaps were also created for whole-mount histopathology slices from four radical prostatectomy patients.Results: An area under ROC curve of 0.96 was obtained on the biopsy dataset and was validated by a ''leave-one-patientout'' procedure. The proposed measure of cancer probability shows a positive correlation with Gleason score. The cancer colormaps created for the histopathology patients do display the dominant tumors. The colormap accuracy increases with measured tumor area and Gleason score.Conclusion: Dynamic contrast enhanced imaging and diffusion tensor imaging, when used within the framework of supervised classification, can play a role in characterizing prostate cancer.

As the field continues to evolve, collaboration across the APAC region will be important to facilitate relevant research and collection and appraisal of data relevant to APAC populations. In the meantime, the APAC APCCC 2018 meeting highlighted the critical importance of a multidisciplinary team-based approach to treatment planning and care, delivery of best-practice care by clinicians with appropriate expertise, and the importance of patient information and support for informed patient choice.

Although androgen deprivation therapy (ADT) has been a cornerstone of the management of prostate cancer for more than 50 years, controversy remains regarding its optimum application. Intermittent androgen suppression (IAS) has been researched since the mid-1980s as a way of reducing the adverse effects and cost of continuous androgen suppression. With preclinical evidence suggesting a potential benefit in terms of time to androgen independence, IAS has been the focus of a number of clinical phase II and III trials. Overall, these trials suggest that IAS is neither inferior nor superior to continuous androgen suppression, with respect to time to castration resistance and cancer-specific survival, but has significant advantages in terms of adverse effects, quality of life and cost. A number of unresolved questions remain, however, including how to select patients for therapy, the optimum duration of therapy, when to restart therapy after the off cycle, and how to define progression to castration-resistant disease. Landmark randomized clinical trials comparing IAS to continuous androgen suppression are in progress and will hopefully answer many of these questions. In future, the use of second-line drugs in the off-treatment phase holds potential for delaying disease progression in men on IAS. At present, men with advanced disease who are deemed candidates for ADT should be informed of IAS as a treatment option, considered experimental from an informed consent point of view, but promising based on current evidence.

Rates of infection after TRUS biopsy and antibiotic resistance are increasing internationally. Treatment for urosepsis should be aggressive as 10% of those patients admitted required ICU admission. TRUS biopsy with ciprofloxacin prophylaxis led to infectious complications comparable with other international reports and appears to remain an appropriate prophylactic antibiotic of choice. Infections requiring hospital admission were all susceptible to a combination of ceftriaxone and gentamicin, and would be an effective initial antibiotic of choice.

Objective: The objective of this paper is to report on the pathologicand biochemical progression-free outcomes of patients whounderwent radical prostatectomy for high-risk localized prostatecancer.Methods: Data was collected prospectively from 299 patients whounderwent radical prostatectomy for high-risk clinically localizedprostate cancer by 2 surgeons at a single institution. High risk wasdefined as 1 or more of 3 adverse factors: prostate-specific antigen(PSA) >20, biopsy Gleason score 8 to 10 and clinical stage T3. PSArecurrence was defined as PSA >0.4 ng/mL or any salvage therapy.Results: Median age was 63.3 years (46.1-75.9). Median followupwas 4.7 years (range 0.5-17.3 years). PSA at diagnosis was>20 ng/mL in 31.4%. Biopsy Gleason score was 8 to 10 in 66.9%.Clinical stage was T3 in 24.4%. 81.6% of patients had a singlebaseline risk factor, 15.7% had 2 risk factors and 2.7% had all 3risk factors. Neoadjuvant therapy was administered to 184 patients(61.5%). Pathologic stage was organ-confined in 39.6%, specimenconfinedin 26%, non-specimen-confined in 26.4%, and 8% hadlymph node positive disease. Overall survival, cancer-specificsurvival and biochemical progression-free survival was 99%,99.67% and 70.2%, respectively. Univariate analysis showed thatPSA at diagnosis, percentage of cores positive and number of riskfactors were predictors of PSA recurrence (p < 0.05). Multivariateanalysis showed that PSA at diagnosis was an independent predictorof PSA recurrence (p < 0.05).Conclusion: Radical prostatectomy is associated with favourablebiochemical progression-free, clinical and overall survival inselected men with high-risk localized prostate cancer, and shouldtherefore be considered an option in these patients. Baseline PSA>20 ng/mL is a significant independent predictor of PSA recurrence.Objectif : L’objectif de cet article est de faire rapport sur les résultatsquant à la survie sans progression pathologique et biochimique despatients ayant subi une prostatectomie radicale pour traiter uncancer de la prostate localisé à risque élevé.Méthodologie : Les données ont été recueillies de manièreprospective chez 299 patients ayant subi une prostatectomieradicale réalisée par 2 chirurgiens dans un même établissementpour traiter un cancer de la prostate à risque élevé cliniquementlocalisé. Un risque élevé était défini comme au moins 1 des 3facteurs négatifs suivants : taux d’antigène prostatique spécifique(APS) > 20, score de Gleason de 8 à 10 à la biopsie, stade cliniqueT3. Une récidive avec anomalie de l’APS a été définie comme untaux d’APS > 0,4 ng/mL ou le recours à tout traitement de sauvetage.Résultats : L’âge médian était de 63,3 ans (46,1 à 75,9). Le suivimédian était de 4,7 ans (0,5 à 17,3 ans). Le taux d’APS au momentdu diagnostic était > 20 ng/mL chez 31,4 % des patients. Le scorede Gleason à la biopsie était de 8 à 10 dans 66,9 % des cas. Lestade clinique était de T3 dans 24,4 % des cas; 81,6 % des patientsprésentaient un seul facteur de risque au départ, 15,7 % présentaient2 facteurs de risque et 2,7 % présentaient les 3 facteurs de risque.Un traitement néoadjuvant a été administré à 184 patients(61,5 %). Le stade pathologique était confiné à l’organe dans39,6 % des cas, confiné à l’échantillon dans 26 % des cas, et nonconfiné à l’échantillon dans 26,4 % des cas; 8 % des patientsprésentaient une atteinte des ganglions lymphatiques. La survieglobale, la survie spécifique au cancer et la survie sans progressionbiochimique étaient de 99 %, 99,67 % et 70,2 %, respectivement.L’analyse univariée a montré que le taux d’APS au moment dudiagnostic, le pourcentage de carottes biopsiques positives et lenombre de facteurs de risque étaient des facteurs prédictifs derécidive avec anomalie de l’APS (p < 0,05). L’analyse multivariéea montré que le taux d’APS au moment du diagnostic était unfacteur prédictif indépendant de récidive avec anomalie de l’APS(p < 0,05).Conclusion : La prostatectomie radicale est associée à unesurvie sans progression biochimique, une survie clinique et unesurvie globale favorables chez des patients sélectionnés atteintsd’un cancer de la prostate localisé à risque élevé, et devrait êtreconsidérée comme une option de traitement chez ces patients.Un taux d’APS au départ > 20 ng/mL est un facteur de prédictionindépendant significatif de récidive avec anomalie de l’APS.