Erik Baubeta

Objective To determine the feasibility of a digitally automated population‐based programme for organised prostate cancer testing (OPT) in Southern Sweden. Patients and Methods A pilot project for a regional OPT was conducted between September 2020 and February 2021, inviting 999 randomly selected men aged 50, 56, or 62 years. Risk stratification was based on prostate‐specific antigen (PSA) level, PSA density (PSAD), and bi‐parametric prostate magnetic resonance imaging (MRI). Men with a PSA level of 3–99 ng/mL had an MRI, and men with elevated PSA level (≥3 ng/mL) had a urological check‐up, including a digital rectal examination and transrectal ultrasonography (TRUS). Indications for targeted and/or systematic transrectal prostate biopsies were suspicious lesions on MRI (Prostate Imaging‐Reporting and Data System [PI‐RADS] 4–5) and/or PSAD > 0.15 ng/mL/mL. Additional indications for prostate biopsies were palpable tumours, PSA ratio < 0.1, or cancer suspicion on TRUS. Patient selection, mail correspondence, data collection, and algorithm processing were performed by an automated digital management system. Feasibility is reported descriptively. Results A total of 418 men had a PSA test (42%), with increasing participation rates by age (50 years, 38%; 56 years, 44%; and 62 years, 45%). Among these, 35 men (8%) had elevated PSA levels (≥3 ng/mL: one of 139, aged 50 years; 10/143, aged 56 years; and 24/146, aged 62 years). On MRI, 16 men (48%) had a negative scan (PI‐RADS < 3), seven men (21%) had PI‐RADS 3, nine men (27%) had PI‐RADS 4, and one man (3%) had PI‐RADS 5. All men with PI‐RADS 4 or 5 underwent prostate biopsies, as well as two men with PI‐RADS 3 due to PSAD > 0.15 ng/mL/mL or a suspicious finding on TRUS. Prostate cancer was diagnosed in 10 men. Six men underwent active treatment, whereas four men were assigned to active surveillance. Conclusion Our OPT model is feasible from an operational point of view, but due to the limited scale of this study no conclusions can be made regarding the efficacy of the diagnostic model or outcome.

Background Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common. Purpose To investigate the reproducibility of one of these classifications and a new aggregated score. Material and Methods A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008–2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification. An aggregated score, the Infrapopliteal Total Atherosclerotic Burden (I-TAB) score, including all infrapopliteal arteries, was constructed and used for comparison. Results Inter-observer agreement on lesion severity for each evaluated artery was good; Krippendorff’s α for MRA 0.64–0.79 and DSA 0.66–0.84. Inter-observer agreement on TASC II grade, based on the selected target artery as stipulated, was poor; Krippendorff's α 0.14 (95% confidence interval [CI]=−0.05 to 0.30) for MRA and 0.48 (95% CI=0.33–0.61) for DSA. Inter-observer agreement for the new I-TAB score was good; Krippendorff's α 0.76 (95% CI=0.70–0.81) for MRA and 0.79 (95% CI=0.74–0.84) for DSA. Conclusion Reproducible assessment of infrapopliteal lesion severity can be achieved for separate arteries with both MRA and DSA using the TASC II definitions. However, poor inter-observer agreement in selecting the target artery results in low reproducibility of the overall infrapopliteal TASC II grade. An aggregated score, such as I-TAB, results in less variability and may provide a more robust evaluation tool of atherosclerotic disease severity.