Objective: To demonstrate the association between magnetic resonance imaging ( MRI ) estimated lesion volume ( LV ), prostate cancer detection and tumour clinical significance, evaluating this variable alone and matched with Prostate Imaging Reporting and Data System version 2 ( PI ‐ RADS v2) score. Patients and methods: We retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal prostate MRI /ultrasonography fusion‐targeted biopsy between January 2014 and February 2016. Suspicious lesions were delineated using a ‘region of interest’ and the system calculated prostate volume and LV . Patients were divided in groups considering LV (≤0.5, 0.5–1, ≥1 mL) and PI ‐ RADS score (1–5). We considered clinically significant prostate cancer as all cancers with a Gleason score of ≥3 + 4 as suggested by PI ‐ RADS v2. A direct comparison between MRI estimated LV ( MRI LV ) and histological tumour volume ( HTV ) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t ‐test. MRI LV and HTV concordance was verified using a Bland–Altman plot. The chi‐squared test and logistic and ordinal regression models were used to evaluate difference in frequencies. Results: The MRI LV and PI ‐ RADS score were associated both with prostate cancer detection (both P < 0.001) and with significant prostate cancer detection ( P < 0.001 and P = 0.008, respectively). When the two variables were matched, increasing LV increased the risk within each PI ‐ RADS group. Prostate cancer detection was 1.4‐times higher for LV s of 0.5–1 mL and 1.8‐times higher for LV s of ≥1 mL; significant prostate cancer detection was 2.6‐times for LV s of 0.5–1 mL and 4‐times for LV s of ≥1 mL. There was a positive correlation between MRI LV and HTV ( r = 0.9876, P < 0.001). Finally, Bland–Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV . Study limitations include its monocentric and retrospective design and the limited cohort. Conclusions: This study demonstrates that PI ‐ RADS score and the MRI LV , independently and in combination, are associated with prostate cancer detection and with tumour clinical significance.

The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.