Therefore, the gynecologists or the paramedics who perform the conventional Pap smears must not only be trained in the art of cell collection and smearing of the material onto the glass slides but also learn immediate wet fixation of the cervical cells. Liquid-based preparations have made all these steps relatively easy for them as the design of the Cervex brush is such that it mostly ensures the sampling of the complete TZ and the SCJ. Pre-fixation of cells occurs in the vial containing a weak fixative and the transfer of cells onto the glass slide is standardized by the automated stations designed for this purpose. This chapter gives an in depth description of the prerequisites and precautions while collecting and preparing a Pap smear with different devices, especially for settings where conventional smears are still the norm. Instructions for women undergoing Pap smear and the medical personnel who conduct this test are also highlighted.The artificial neural network (ANN) is a computer software design or model that simulates the biological neural network of the human brain. Instead of biological neurons, ANN is composed of many layers of nodes that carry the signal and process it to make the final decision. ANN is a modern technology that is widely used in different fields of science. The ANN is reshaping the medical system and the various areas of pathology. In this paper, the basic concept and applications of ANN in cytology have been discussed. In this paper, the various articles published on ANN in the field of cytology have been systemically reviewed. The ANN is relatively less used in cytology. After introducing convolutional neural network and whole slide scanners in the commercial market, it is now essential to have thorough knowledge in this field to start diagnostic application of ANN.

To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.

We retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups PSA <4, 4-10, >10ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.

Data from a total of 670 males were included in the analysis (standard TRUS,

=333; MRI/US fusion,

=337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 1 more efficient in patients with biopsy-naïve men with PSA 4-10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA less then 4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.

Androgen receptor pathway inhibitors (ARPIs) such as abiraterone and enzalutamide have been shown to prolong survival in patients with advanced prostate cancer. However, there is limited evidence on the anticancer effect of a reduced dose of ARPIs. This study compared the prognosis in patients with chemotherapy-naïve castration-resistant prostate cancer (CRPC) between ARPI treatment with standard dose and treatment with reduced dose.

Japanese patients who were treated with ARPI as first-line treatment for CRPC between 2014 and 2018 were included. The associations between dose reduction and clinicopathological factors, progression-free survival, and overall survival were investigated.

Of the 162 patients included, 33 (20.4%) patients had their dose reduced during ARPI treatment. In the multivariate analysis, higher PSA, abiraterone treatment, and dose reduction were significant prognostic factors for progression-free survival (PFS); however, dose reduction was not associated with overall survival. In the enzalutamide-treated group, the median PFS was 12.1months (95% CI, 8.5-21.4months) in the standard-dose group and 7.2months (95% CI, 5.0-11.5months) in the reduced-dose group (

=0.038).

This study suggests inferior oncological outcome when treated with reduced-dose ARPI for CRPC. Full-dose administration of ARPI for CRPC may be appropriate if feasible.

This study suggests inferior oncological outcome when treated with reduced-dose ARPI for CRPC. Full-dose administration of ARPI for CRPC may be appropriate if feasible.

To efficiently implement artificial intelligence (AI) software for medical applications, it is crucial to understand the acceptance, expected effects, expected performance, and concerns of software users. In this study, we examine the acceptance and expectation of the Dr. Answer AI software for prostate cancer.

We conducted an online survey for urologists from August 13 to September 18, 2020. The target software is an AI-based clinical software called Dr. Answer AI software, used for prostate cancer diagnosis. We collected data from 86 urologists and conducted a basic statistical and multiple regression analysis using the R package.

The compatibility was significantly associated with the intention to use the Dr. Answer AI software. The expected average accuracy for the software ranges from 86.91% to 87.51%, and the urologists perceived that the cloud method is suitable to introduce the software. The most desirable function of the software for the specialists is predicting the occurrence of extracapsular extension, seminal vesicle invasion, and lymph node metastasis after radical prostatectomy. Finally, the primary concerns involved the cost, compatibility with existing systems, and obtaining accurate information from the software.

Our results present an understanding of the acceptance, expected effects, expected performance, and concerns of software users. The results provide a guide to help AI software be properly developed and implemented in medical applications.

Our results present an understanding of the acceptance, expected effects, expected performance, and concerns of software users. The results provide a guide to help AI software be properly developed and implemented in medical applications.The expansion of the indication to use androgen deprivation therapy (ADT) to treat patients with advanced or metastatic prostate cancer has dramatically increased over the recent decades, resulting in the progress of patients’ survival. However, chronic health implications can become more apparent as the number of long-term cancer survivors is expected to be increased along with the adverse effect of ADT. In particular, interest in investigating ADT, especially luteinizing hormone-releasing hormone (LHRH) agonist association with cognitive dysfunction has been growing. Previous studies in animals and humans suggest that the level of androgen decreases with age and that cognitive decline occurs with decreases in androgen. Correspondingly, some of the extensive studies using common neurocognitive tests have shown that LHRH agonists may affect specific domains of cognitive function (e.g., visuospatial abilities and executive function). However, the results from these studies have not consistently demonstrated the association because of its intrinsic limitations. Large-scale studies based on electronic databases have also failed to show consistent results to make decisive conclusions because of its heterogeneity, complexity of covariates, and possible risk of biases. Thus, this review article summarizes key findings and discusses the results of several studies investigating the ADT association with cognitive dysfunction and risk of dementia from various perspectives.

To ensure reproducibility and representativeness of hypoechoic lesions in transrectal ultrasonography (TRUS), we used grayscale values and evaluated their usefulness in predicting prostate cancer (PCA).

A total of 172 patients scheduled for prostate biopsy for suspected PCA between October 2016 and May 2018 were prospectively enrolled. Patients underwent 12 core target biopsies for hypoechoic lesions in 12 areas of the prostate and two additional target biopsy cores for two hypoechoic lesions. We estimated the grayscale value of the image using a red/green/blue scoring method through a function embedded in the picture archiving and communication system. Imaging data were analyzed using estimated grayscale values.

Of the 127 patients (median age=68.5years, median prostate-specific antigen level=6.19ng/mL), 67 (52.8%) had PCA. Of 1778 biopsy lesions, 327 (18.4%) were PCA lesions. No differences in the grayscale values were found between PCA and benign lesions; however, the grayscale value between 28.0 and 57.0 for hypoechoic lesions was identified as a significant factor for predicting PCA in multivariable analysis (

). Multivariable analysis indicated a grayscale value between 34.0 and 48.0 as a predicting factor for clinically significant PCA (cs-PCA Gleason grade group ≥2) (

). The area under the curve (AUC) for predicting cs-PCA was higher for combined clinical and grayscale value parameters than for TRUS grayscale values (0.780 vs. 0.561,

).

Hypoechoic lesions that meet the quantitative criteria seem useful for predicting cs-PCA. The presence of hypoechoic lesions is not a predicting factor for PCA.

Hypoechoic lesions that meet the quantitative criteria seem useful for predicting cs-PCA. The presence of hypoechoic lesions is not a predicting factor for PCA.

This study aimed to assess the incidence of urinary tract infections (UTIs) after transperineal prostate biopsy (TP-PB) comparing patients who underwent antibiotic prophylaxis (AP) with patients who had no prophylaxis.

This prospective, double-center trial was conducted between August and December 2020. Patientcandidates to PB were included with 11 allocation to case (Group A-no AP) and control group (Group B-standard AP). All TP-PBs were performed in an outpatient settingunder local anesthesia. Data collected 2weeks after the procedure included incidence of UTIs or bacteriuria, evaluated with a urine culture (UC), main symptoms, and complications related to TP-PBs.

A total of 200 patients were included (100 patients in each group). The mean age was 66.2±7.7 in Group A and 67.4±8years in Group B (

=0.134). Mean prostate volume was 65.5±26.7 vs. 51±24.6cc (

<0.001), number of biopsy cores was 17.8±2.4 vs. 14.9±0.8 (

<0.001), and PSA value was 15.9±28.1 vs. 13.3±22.3ng/ml (

=0.017). Overall PCa detection rate was 55% vs. 59% (

=0.567). Postoperative UTI occurred in one patient in Group A vs. zero in Group B. Asymptomatic bacteriuria was present in 3 vs. 5 patients (

=0.470) and was not treated with antibiotics. Postoperative hematuria was observed in 13 patients vs. 29 (

<0.05), and acute urinary retention was observed in one patient in each group.

The incidence of bacteriuria and UTIs in TP-PBs is not related to AP. Therefore, AP could be discontinued in TP-PB candidates without the risk of increasing UTI-related complications.

The incidence of bacteriuria and UTIs in TP-PBs is not related to AP. Therefore, AP could be discontinued in TP-PB candidates without the risk of increasing UTI-related complications.