XXIII

we prospectively enrolled 100 patients scheduled for MRIguided reclassification biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e. PRIMUS score ≥3). All patients received target biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP≥2 cancer; csPCa) at reclassification biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared.

Results. 92 patients had a suspicious MRI lesion classified PI-RADS 3, 4 and 5 in respectively 28, 16 and 18 patients.

MicroUS identified lesions classified PRI-MUS 3, 4 and 5 in respectively 20, 50 and 12 patients, while 18 individuals had no suspicious lesions. 34 patients were upgraded to ISUP≥2 cancer and excluded from AS.

MicroUS and mpMRI showed a sensitivity of 94.1% and 100% and a NPV of 88.9% and 100% respectively in detecting ISUP≥2 patients. A microUS-mandated protocol would have avoided reclassification biopsies in 18 patients with no PRI-MUS ≥3 lesions at the cost of missing 4 upgraded patients.

Conclusion. MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered reclassification biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients.

digital rectal examination underwent transperineal prostate biopsy for abnormal PSA values (median 7.5 ng/ml). Before prostate biopsy, all patients underwent mpMRI and 68Ga-PET/CT examinations and mpMRI (PIRADS version 2 ≥ 3) or 68Ga-PET/CT index lesions suspicious for cancer (SUVmax ≥ 5 g/ml) underwent cognitive targeted cores (mpMRI-TPBx and PSMA-TPBx: four cores) combined with extended systematic prostate biopsy (eSPBx: median 18 cores). The procedure was performed transperineally using a tru-cut 18-gauge needle under sedation and antibiotic prophylaxis.

Results. PCa was found in 58/100 (58.0%) men; in detail, 44/58 (75.9%) were csPCa; mpMRI and 68Ga-PSMA showed 66/100 (66%) and 62/100 (60%) lesions suspicious for PCa, respectively. 68Ga-PSMA-TPBx vs. mpMRITPBx vs. eSPBx diagnosed 42 (95.4%) vs. 36 (81.8%) vs. 30 (68.2%) csPCa, respectively; mpMRI-TPBx vs. 68Ga-PSMATPBx showed a diagnostic accuracy of 76.9% vs. 84.9% in diagnosing csPCa.

Conclusion. 68GaPSMA PET/CT TPBx demonstrated good accuracy in the diagnosis of csPCa, which was not inferior to mpMRI TPBx (84.9% vs. 76.9%) improving the detection rate for cancer of systematic biopsy.

Diagnostic Difficulties In A Rare Case Of Renal Cell Carcinoma With Xp11 Translocation

Cirfeda P, Giurioli A, Campagna M, Colamonico O, Simoncini G, Leone M, DI Pinto A, Peluso M, Palazzo S.

Department of Urology, A. Perrino Hospital , Brindisi, Italy.

Targeted

BIOPSY: 68GA-PSMA PET/TC VS . MPMRI IN THE DIAGNOSIS OF CLINICALLY SIGNIFICANT PROSTATE CANCER (CSPCA)

Pepe P1, Tsirgiotis A1, Panella P1, Barbera M2, Cosentino S3, Pennisi M1, Fraggetta F4

1 Unità Operativa di Urologia/Prostate Cancer Unit - Azienda Ospedaliera Cannizzaro - Catania;

2 Unità Operativa di Anatomia Patologica - Azienda Ospedaliera Cannizzaro - Catania;

3 Servizio Medicina Nucleare - Azienda Ospedaliera CannizzaroCatania;

4 Unità Operativa di Urologia - Ospedale Giovanni Paolo II di Sciacca.

Introduction. To evaluate the diagnostic accuracy of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) vs. multiparametric magnetic resonance imaging (mpMRI) targeted biopsy (TPBx) in the diagnosis of clinically significant prostate cancer (csCaP: Grade Group ≥ 2). Materials and Methods. From January 2021 to June 2022, 100 patients (median age: 66 years) with negative

Translocation-associated renal cell carcinoma (t-RCC) is a relatively uncommon subtype of renal cell carcinoma characterized by recurrent gene rearrangements involving the TFE3 or TFEB loci. TFE3 and TFEB are members of the microphthalmia transcription factor (MiT) family, which regulate differentiation in melanocytes and osteoclasts. Renal cell carcinomas (RCCs) associated with Xp11 translocations have gene fusions involving TFE3, which has multiple gene partners. These tumors are histologically diverse, often have papillary, alveolar, and nested growth pattern with clear and eosinophilic cells and psammoma bodies and are seen commonly in children and young adults especially in women. The outcome of Xp11 translocation renal cell carcinoma is highly variable, with some patients surviving decades with indolent disease and others dying rapidly of progressive disease. For the aggressive cases of MiT family translocation carcinoma, the optimal therapy remains to be determined; however, new target therapies seem to be promising. We report a clinical case of a 49-year-old woman with an atypical clinical presentation and a very aggressive clinical course that represented a challenge in defining the diagnostic-therapeutic path.