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Patel N, Cricco-Lizza E, Kasabwala K, Xu C, Robinson BD, Khani F, Wang Y, Margolis D, Hu JC. The Role of Systematic and Targeted Biopsies in Light of Overlap on Magnetic Resonance Imaging Ultrasound Fusion Biopsy. Eur Urol Oncol 2018; 1:263-267. [DOI: 10.1016/j.euo.2018.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 11/26/2022]
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Thai JN, Narayanan HA, George AK, Siddiqui MM, Shah P, Mertan FV, Merino MJ, Pinto PA, Choyke PL, Wood BJ, Turkbey B. Validation of PI-RADS Version 2 in Transition Zone Lesions for the Detection of Prostate Cancer. Radiology 2018; 288:485-491. [PMID: 29786491 PMCID: PMC6071681 DOI: 10.1148/radiol.2018170425] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose To determine the association between Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores and prostate cancer (PCa) in a cohort of patients undergoing biopsy of transition zone (TZ) lesions. Materials and Methods A total of 634 TZ lesions in 457 patients were identified from a prospectively maintained database of consecutive patients undergoing prostate magnetic resonance imaging. Prostate lesions were retrospectively categorized with the PI-RADS version 2 system by two readers in consensus who were blinded to histopathologic findings. The proportion of cancer detection for all PCa and for clinically important PCa (Gleason score ≥3+4) for each PI-RADS version 2 category was determined. The performance of PI-RADS version 2 in cancer detection was evaluated. Results For PI-RADS category 2 lesions, the overall proportion of cancers was 4% (one of 25), without any clinically important cancer. For PI-RADS category 3, 4, and 5 lesions, the overall proportion of cancers was 22.2% (78 of 352), 39.1% (43 of 110), and 87.8% (129 of 147), respectively, and the proportion of clinically important cancers was 11.1% (39 of 352), 29.1% (32 of 110), and 77.6% (114 of 147), respectively. Higher PI-RADS version 2 scores were associated with increasing likelihood of the presence of clinically important PCa (P < .001). Differences were found in the percentage of cancers in the PI-RADS category between PI-RADS 3 and those upgraded to PI-RADS 4 based on diffusion-weighted imaging for clinically important cancers (proportion for clinically important cancers for PI-RADS 3 and PI-RADS 3+1 were 11.1% [39 of 352] and 30.8% [28 of 91], respectively; P < .001). Conclusion Higher PI-RADS version 2 scores are associated with a higher proportion of clinically important cancers in the TZ. PI-RADS category 2 lesions rarely yield PCa, and their presence does not justify targeted biopsy.
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Affiliation(s)
- Janice N. Thai
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Harish A. Narayanan
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Arvin K. George
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - M. Minhaj Siddiqui
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Parita Shah
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Francesca V. Mertan
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Maria J. Merino
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Peter A. Pinto
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Peter L. Choyke
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Bradford J. Wood
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Baris Turkbey
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
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Deane LA, Tan WP, Strong A, Lowe M, Antoine N, Ghai R, Ekbal S. Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation. Int Braz J Urol 2018; 44:1081-1088. [PMID: 30044594 PMCID: PMC6442172 DOI: 10.1590/s1677-5538.ibju.2017.0328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/25/2018] [Indexed: 03/07/2023] Open
Abstract
Objective: To evaluate whether color-coding of prostate core biopsy specimens aids in preservation of the neurovascular bundles from an oncological perspective. Materials and Methods: MRI guided transrectal ultrasound and biopsy of the prostate were performed in 51 consecutive patients suspected of being at high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor. Results: Of the 51 patients undergoing prostate biopsy, 30 (58.8%) were found to have cancer of the prostate: grade group 1 in 13.7%, 2 in 25.5%, 3 in 7.8%, 4 in 7.8% and 5 in 3.9% of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. Five patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic extension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy. Conclusion: Color-coding of prostate biopsy core specimens may assist in tailoring the approach for preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modification of the prostate biopsy protocol is valuable in larger groups of patients.
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Affiliation(s)
- Leslie A Deane
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Wei Phin Tan
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Andrea Strong
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Megan Lowe
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Nency Antoine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Ritu Ghai
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Shahid Ekbal
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Targets missed: predictors of MRI-targeted biopsy failing to accurately localize prostate cancer found on systematic biopsy. Prostate Cancer Prostatic Dis 2018; 21:549-555. [PMID: 29988101 DOI: 10.1038/s41391-018-0062-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/15/2018] [Accepted: 04/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy has improved the ability to localize and detect prostate cancer (PCa) with efficiency surpassing systematic biopsy. Nevertheless, some patients have PCa missed using the MRI-targeted biopsy sampling alone. We aim to identify clinical and imaging parameters associated with cases where targeted biopsy did not detect PCa compared to systematic biopsy. METHODS We conducted a retrospective review of patients who underwent MRI/US fusion-guided biopsy in addition to concurrent systematic, extended-sextant biopsy between 2014 and 2017. For patients with PCa detected on systematic biopsy not properly localized by MRI/US fusion-guided biopsy, the sextant distance from MRI-targeted lesion to the cancer-positive sextant was calculated and parameters potentially predicting this targeting miss were evaluated. RESULTS In all, 35/127 (27.6%) patients with single-session MRI/US fusion-guided biopsy plus standard biopsy finding PCa had lesions incorrectly localized. Of these, 15/35 (42.9%) were identified as possible fusion-software misregistrations. The remainder, 12/35 (34.3%), represented targeted biopsies one sextant away from the cancer focus and 8/35 (22.9%) targeted biopsies two sextants away from the cancer focus. Only 7/35 (20.0%) patients were determined to have clinically significant PCa, which represents 7/127 (5.5%) of the overall population. Lower MRI lesion volumes (p = 0.022), lesion density (p < 0.001), and PI-RADS scores (p < 0.001) were significantly associated with targeted biopsy missing PCa detected on systematic biopsy. CONCLUSION Clinically significant PCa is rarely missed utilizing MRI/US fusion-guided biopsy. With the majority of missed tumors representing targeting misregistrations or cases of low-grade cancer in sextants immediately adjacent to MRI suspicious lesions. Lower MRI lesion volumes, lesion density, and PI-RADS are predictors of cases with targeted biopsies missing cancer, for which systematic sampling of the sextants containing MRI targets and adjacent sextants would most optimize PCa detection.
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Role of Magnetic Resonance Imaging Targeted Biopsy in Detection of Prostate Cancer Harboring Adverse Pathological Features of Intraductal Carcinoma and Invasive Cribriform Carcinoma. J Urol 2018; 200:104-113. [DOI: 10.1016/j.juro.2018.01.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/30/2023]
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An JY, Sidana A, Choyke PL, Wood BJ, Pinto PA, Türkbey İB. Multiparametric Magnetic Resonance Imaging for Active Surveillance of Prostate Cancer. Balkan Med J 2018; 34:388-396. [PMID: 28990929 PMCID: PMC5635625 DOI: 10.4274/balkanmedj.2017.0708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Active surveillance has gained popularity as an acceptable management option for men with low-risk prostate cancer. Successful utilization of this strategy can delay or prevent unnecessary interventions - thereby reducing morbidity associated with overtreatment. The usefulness of active surveillance primarily depends on correct identification of patients with low-risk disease. However, current population-wide algorithms and tools do not adequately exclude high-risk disease, thereby limiting the confidence of clinicians and patients to go on active surveillance. Novel imaging tools such as mpMRI provide information about the size and location of potential cancers enabling more informed treatment decisions. The term “multiparametric” in prostate mpMRI refers to the summation of several MRI series into one examination whose initial goal is to identify potential clinically-significant lesions suitable for targeted biopsy. The main advantages of MRI are its superior anatomic resolution and the lack of ionizing radiation. Recently, the Prostate Imaging-Reporting and Data System has been instituted as an international standard for unifying mpMRI results. The imaging sequences in mpMRI defined by Prostate Imaging Reporting and Data System version 2 includes: T2-weighted MRI, diffusion-weighted MRI, derived apparent-diffusion coefficient from diffusion-weighted MRI, and dynamic contrast-enhanced MRI. The use of mpMRI prior to starting active surveillance could prevent those with missed, high-grade lesions from going on active surveillance, and reassure those with minimal disease who may be hesitant to take part in active surveillance. Although larger validation studies are still necessary, preliminary results suggest mpMRI has a role in selecting patients for active surveillance. Less certain is the role of mpMRI in monitoring patients on active surveillance, as data on this will take a long time to mature. The biggest obstacles to routine use of prostate MRI are quality control, cost, reproducibility, and access. Nevertheless, there is great a potential for mpMRI to improve outcomes and quality of treatment. The major roles of MRI will continue to expand and its emerging use in standard of care approaches becomes more clearly defined and supported by increasing levels of data.
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Affiliation(s)
- Julie Y An
- Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Maryland, USA
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Maryland, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Maryland, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Maryland, USA
| | - İsmail Barış Türkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Maryland, USA
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Dimitroulis P, Rabenalt R, Nini A, Hiester A, Esposito I, Schimmöller L, Antoch G, Albers P, Arsov C. Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy-Are 2 Biopsy Cores per Magnetic Resonance Imaging Lesion Required? J Urol 2018; 200:1030-1034. [PMID: 29733837 DOI: 10.1016/j.juro.2018.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE For multiparametric magnetic resonance imaging/ultrasound fusion prostate biopsy the number of biopsy cores obtained is arbitrarily established by urologists. Moreover, a general consensus is lacking on the number of biopsy cores to be obtained from a single magnetic resonance imaging lesion. Therefore, we evaluated the feasibility of obtaining only 1 biopsy core per magnetic resonance imaging lesion. MATERIALS AND METHODS We retrospectively evaluated a total of 2,128 biopsy cores of 1,064 prostatic lesions (2 cores per lesion) in 418 patients in regard to prostate cancer detection (histology) and the Gleason score of the first biopsy core compared to the second biopsy core. Two analyses were performed, including patient level analysis based on prostate cancer detection per patient and lesion level analysis based exclusively on the histology of each lesion regardless of the overall histological outcome of the case. RESULTS The overall prostate cancer detection rate was 45.7% (191 of 418 patients). The first biopsy core detected 170 of all 191 prostate cancers (89%). In 17 of these 170 prostate cancers (10%) the second biopsy core revealed Gleason score upgrading. Nine of the 21 prostate cancers (43%) missed by the first biopsy core had a Gleason score of 6. Altogether 537 of the 2,128 biopsy cores were positive, including 283 first (26.6%) and 254 second (24%) biopsy cores (p ≤0.001). The concordance between the first and second biopsy cores was 89% (κ = 0.71). There was a discrepancy with Gleason score upgrading in 28 of 212 lesions (13.2%) with positive first and second biopsy cores. CONCLUSIONS Our study shows that obtaining more than 1 biopsy core per magnetic resonance imaging lesion only slightly improves the prostate cancer detection rate and Gleason grading.
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Affiliation(s)
- Pantelis Dimitroulis
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Robert Rabenalt
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany.
| | - Alessandro Nini
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany; Unit of Urology, Division of Oncology, Department of Urology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Andreas Hiester
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Irene Esposito
- Department of Pathology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Christian Arsov
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
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Moore C. Can Negative Prostate Magnetic Resonance Imaging Give Us the Reassurance We Need To Avoid Standard Biopsy? An Evidence-based Practical Approach. Eur Urol 2018; 74:55-56. [PMID: 29685641 DOI: 10.1016/j.eururo.2018.03.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Caroline Moore
- Division of Surgical and Interventional Science, University College London, London, UK.
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60
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Calio BP, Sidana A, Sugano D, Gaur S, Maruf M, Jain AL, Merino MJ, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Risk of Upgrading from Prostate Biopsy to Radical Prostatectomy Pathology-Does Saturation Biopsy of Index Lesion during Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy Help? J Urol 2018; 199:976-982. [PMID: 29154904 DOI: 10.1016/j.juro.2017.10.048] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We sought to determine whether saturation of the index lesion during magnetic resonance imaging-transrectal ultrasound fusion guided biopsy would decrease the rate of pathological upgrading from biopsy to radical prostatectomy. MATERIALS AND METHODS We analyzed a prospectively maintained, single institution database for patients who underwent fusion and systematic biopsy followed by radical prostatectomy in 2010 to 2016. Index lesion was defined as the lesion with largest diameter on T2-weighted magnetic resonance imaging. In patients with a saturated index lesion transrectal fusion biopsy targets were obtained at 6 mm intervals along the long axis of the index lesion. In patients with a nonsaturated index lesion only 1 target was obtained from the lesion. Gleason 6, 7 and 8-10 were defined as low, intermediate and high risk, respectively. RESULTS Included in the study were 208 consecutive patients, including 86 with a saturated and 122 with a nonsaturated lesion. Median patient age was 62.0 years (IQR 10.0) and median prostate specific antigen was 7.1 ng/ml (IQR 8.0). The median number of biopsy cores per index lesion was higher in the saturated lesion group (4 vs 2, p <0.001). The risk category upgrade rate from systematic only, fusion only, and combined fusion and systematic biopsy results to prostatectomy was 40.9%, 23.6% and 13.8%, respectively. The risk category upgrade from combined fusion and systematic biopsy results was lower in the saturated than in the nonsaturated lesion group (7% vs 18%, p = 0.021). There was no difference in the upgrade rate based on systematic biopsy between the 2 groups. However, fusion biopsy results were significantly less upgraded in the saturated lesion group (Gleason upgrade 20.9% vs 36.9%, p = 0.014 and risk category upgrade 14% vs 30.3%, p = 0.006). CONCLUSIONS Our results demonstrate that saturation of the index lesion significantly decreases the risk of upgrading on radical prostatectomy by minimizing the impact of tumor heterogeneity.
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Affiliation(s)
- Brian P Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit L Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Schütz V, Kesch C, Dieffenbacher S, Bonekamp D, Hadaschik BA, Hohenfellner M, Radtke JP. Multiparametric MRI and MRI/TRUS Fusion Guided Biopsy for the Diagnosis of Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:87-98. [DOI: 10.1007/978-3-319-99286-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hakozaki Y, Matsushima H, Kumagai J, Murata T, Masuda T, Hirai Y, Oda M, Kawauchi N, Yokoyama M, Homma Y. A prospective study of magnetic resonance imaging and ultrasonography (MRI/US)-fusion targeted biopsy and concurrent systematic transperineal biopsy with the average of 18-cores to detect clinically significant prostate cancer. BMC Urol 2017; 17:117. [PMID: 29233150 PMCID: PMC5727964 DOI: 10.1186/s12894-017-0310-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study compared the detection rates for clinically significant prostate cancer (CSPC) between magnetic resonance imaging and ultrasonography (MRI/US)-fusion-targeted biopsy (TB), systematic biopsy (SB) and combination of TB and SB. Methods This prospective study evaluated simultaneous TB and SB for consecutive patients with suspicious lesions that were detected using pre-biopsy multiparametric MRI. A commercially available real-time virtual sonography system was used to perform the MRI/US-fusion TB with the transperineal technique. The prostate imaging reporting and data system version 2 (PI-RADS v2) was assigned to categorize the suspicious lesions. Results A total of 177 patients were included in this study. The detection rate for CSPC was higher using SB, compared to TB (57.1% vs 48.0%, p = 0.0886). The detection rate for CSPC was higher using the combination of TB and SB, compared to only SB (63.3% vs 57.1%, p = 0.2324). Multivariate analysis revealed that PIRADS v2 category 4 and an age of <65 years were independent predictors for TB upgrading (vs. the SB result). Conclusions PI-RADS v2 category 4 and an age of <65 years were predictive factors of upgrading the Gleason score by MRI/US-fusion TB. Thus, MRI/US-fusion TB may be appropriate for patients with those characteristics. Trial registration This study was retrospectively registered at the University Hospital Medical Information Network (UMINID000025911) in Jan 30, 2017.
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Affiliation(s)
- Yuji Hakozaki
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan.
| | - Hisashi Matsushima
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Jimpei Kumagai
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Taro Murata
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Tomoko Masuda
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Yoko Hirai
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Mai Oda
- Department of Radiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Nobuo Kawauchi
- Department of Radiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Munehiro Yokoyama
- Department of Pathology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Abstract
MR imaging is an important part of prostate cancer diagnosis. Variations in quality and skill in general practice mean results are not as impressive as they were in academic centers. This observation provides an impetus to improve the method. Improved quality assurance will likely result in better outcomes. Improved characterization of clinically significant prostate cancer may assist in making MR imaging more useful. Improved methods of registering MR imaging with transrectal ultrasound imaging and robotic arms controlling the biopsy can reduce the impact of inexperienced operators and make the entire system of MR imaging-guided biopsies more robust.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B69, Bethesda, MD 20892, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B69, Bethesda, MD 20892, USA.
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Schmidt-Bowman M, Reinstatler L, Raffin EP, Yared JE, Seigne JD, Sverrisson EF. Acquired Hemophilia presenting as Gross Hematuria following Kidney Stone - A Case Report and Review of the Literature. Int Braz J Urol 2017; 44:390-392. [PMID: 29144625 PMCID: PMC6050547 DOI: 10.1590/s1677-5538.ibju.2017.0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/29/2017] [Indexed: 12/05/2022] Open
Abstract
A rare condition in itself, acquired hemophilia A, seldom presents as isolated gross hematuria. It is a serious condition with a high mortality rate and thus clinical suspicion followed by prompt diagnosis is imperative (1). In fact, only 8 cases of such presentation of this condition have been reported thus far in the literature. Of these, none describe the initial presentation of hematuria with the inciting event of a kidney stone. We present a case of a 67-year-old man with signs and symptoms of nephrolithiasis accompanied by profuse hematuria, who was subsequently found to have developed expression of factor VIII inhibitor leading to acquired hemophilia A.
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Affiliation(s)
| | - Lael Reinstatler
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Eric P Raffin
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Joseph E Yared
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - John D Seigne
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Einar F Sverrisson
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
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Valle LGM, Rahal A, Falsarella PM, de Andrade JR, Smaletz O, Osawa A, Garcia RG. Prostate cancer recurrence in vas deferens - fusion image guide as an important tool in dignosis. Int Braz J Urol 2017; 44:192-195. [PMID: 29064653 PMCID: PMC5815551 DOI: 10.1590/s1677-5538.ibju.2017.0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/17/2017] [Indexed: 11/22/2022] Open
Abstract
The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.
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Affiliation(s)
| | - Antônio Rahal
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Priscila Mina Falsarella
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Oren Smaletz
- Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Akemi Osawa
- Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Rodrigo Gobbo Garcia
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
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Javitt MC, Kravtsov A, Keidar Z, Abadi S, Amiel GE. Multimodality Image Fusion with PSMA PET/CT and High-Intensity Focused Ultrasound Focal Therapy for Primary Diagnosis and Management of Prostate Cancer: A Planned Research Initiative. Rambam Maimonides Med J 2017; 8:RMMJ.10312. [PMID: 28777073 PMCID: PMC5652928 DOI: 10.5041/rmmj.10312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recent developments in diagnostic imaging herald a new approach to diagnosis and management of prostate cancer. Multimodality fusion that combines anatomic with functional imaging data has surpassed either of the two alone. This opens up the possibility to "find and fix" malignancy with greater accuracy than ever before. This is particularly important for prostate cancer because it is the most common male cancer in most developed countries. This article describes technical advances under investigation at our institution and others using multimodality image fusion of magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), and PSMA PET/CT (defined as the combination of prostate-specific membrane antigen [PSMA], positron emission tomography [PET], and computed tomography [CT]) for personalized medicine in the diagnosis and focal therapy of prostate cancer with high-intensity focused ultrasound (HiFUS).
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Affiliation(s)
- Marcia C Javitt
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | | | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Sobhi Abadi
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | - Gilad E Amiel
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
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67
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Defining Novel and Practical Metrics to Assess the Deliverables of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy. J Urol 2017; 199:969-975. [PMID: 28988963 DOI: 10.1016/j.juro.2017.09.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Multiparametric magnetic resonance/ultrasound targeted prostate biopsy is touted as a tool to improve prostate cancer care and yet its true clinical usefulness over transrectal ultrasound guided prostate biopsy has not been systematically analyzed. We introduce 2 metrics to better quantify and report the deliverables of targeted biopsy. MATERIALS AND METHODS We reviewed our prospective database of patients who underwent simultaneous multiparametric magnetic resonance/ultrasound targeted prostate biopsy and transrectal ultrasound guided prostate biopsy. Actionable intelligence metric was defined as the proportion of patients in whom targeted biopsy provided actionable information over transrectal ultrasound guided prostate biopsy. Reduction metric was defined as the proportion of men in whom transrectal ultrasound guided prostate biopsy could have been omitted. We compared metrics in our cohort with those in prior reports. RESULTS A total of 371 men were included in study. The actionable intelligence and reduction metrics were 22.2% and 83.6% in biopsy naïve cases, 26.7% and 84.2% in prior negative transrectal ultrasound guided prostate biopsy cases, and 24% and 77.5%, respectively, in active surveillance cases. No significant differences were observed among the groups in the actionable intelligence metric and the reduction metric (p = 0.89 and 0.27, respectively). The actionable intelligence metric was 25.0% for PI-RADS™ (Prostate Imaging Reporting and Data System) 3, 27.5% for PI-RADS 4 and 21.7% for PI-RADS 5 lesions (p = 0.73). Transrectal ultrasound guided prostate biopsy could have been avoided in more patients with PI-RADS 3 compared to PI-RADS 4/5 lesions (reduction metric 92.0% vs 76.7%, p <0.01). Our results compare favorably to those of other reported series. CONCLUSIONS The actionable intelligence metric and the reduction metric are novel, clinically relevant quantification metrics to standardize the reporting of multiparametric magnetic resonance/ultrasound targeted prostate biopsy deliverables. Targeted biopsy provides actionable information in about 25% of men. Reduction metric assessment highlights that transrectal ultrasound guided prostate biopsy may only be omitted after carefully considering the risk of missing clinically significant cancers.
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68
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Shah TT, To WKL, Ahmed HU. Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways. Expert Rev Anticancer Ther 2017; 17:1159-1168. [PMID: 28933973 DOI: 10.1080/14737140.2017.1383899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION With level 1 evidence now available on the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI) we must now utilise this data in developing an MRI-stratified diagnostic pathway for the early detection of prostate cancer. Areas covered: A literature review was conducted and identified seven randomised control trials (RCT's) assessing the diagnostic accuracy of such a pathway against the previously accepted systematic/random trans-rectal ultrasound guided (TRUS) biopsy pathway. The studies were heterogeneous in their design. Five studies assessed the addition of MRI-targeted biopsies to a standard care systematic TRUS biopsy pathway. Three of these studies showed either an increase in their diagnostic accuracy or the potential to remove systematic biopsies. Two studies looked specifically at a targeted biopsy only pathway and although the results were again mixed, there was no decrease in the diagnostic rate and overall significantly fewer biopsy cores were taken in the MRI group. Expert commentary: Results from these RCT's together with multiple retrospective and prospective studies point towards either an improved diagnostic rate for clinically significant cancer and/or a reduction in the need for systematic biopsies with a MRI-stratified pathway. The challenge for the urological community will be to implement pre-biopsy MRI into a routine clinical pathway with likely independent monitoring of standards.
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Affiliation(s)
- Taimur Tariq Shah
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK.,c Division of Surgery and Interventional Sciences , University College London , London , UK.,d Department of Urology , Whittington Hospitals NHS Trust , London , UK
| | - Wilson King Lim To
- c Division of Surgery and Interventional Sciences , University College London , London , UK
| | - Hashim Uddin Ahmed
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK
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69
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Hegde JV, Demanes DJ, Veruttipong D, Raince J, Park SJ, Raman SS, Nickols NG, King CR, Kishan AU, Steinberg ML, Kamrava M. Pretreatment 3T multiparametric MRI staging predicts for biochemical failure in high-risk prostate cancer treated with combination high-dose-rate brachytherapy and external beam radiotherapy. Brachytherapy 2017; 16:1106-1112. [PMID: 28807747 DOI: 10.1016/j.brachy.2017.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether pretreatment 3T multiparametric MRI (mpMRI) staging impacts biochemical recurrence-free survival (BRFS) or distant metastasis-free survival (DMFS) for men with high-risk prostate cancer treated with combination high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT). MATERIALS AND METHODS This institutional review board-approved retrospective study included a cohort of 37 men with high-risk prostate cancer treated with HDR brachytherapy and EBRT after 3T mpMRI. Kaplan-Meier analysis was used to evaluate whether mpMRI evidence of extracapsular extension or seminal vesicle invasion (SVI) resulted in differences in BRFS or DMFS. Pretreatment and treatment-related variables were evaluated for association with biochemical failure (Phoenix definition) and distant metastatic failure using univariate Cox regression analysis. RESULTS The median prostate-specific antigen at diagnosis was 9 ng/mL (range 2-100). Biopsy Gleason score (bGS) was ≤8 in 38% and nine in 62%. Clinical T-category was T1-T2 in 89%, T3a in 8%, and T3b in 3%. With a median followup of 30.6 months, actuarial 3-year BRFS and DMFS were 76% and 86%, respectively. Kaplan-Meier analysis revealed that mpMRI evidence of extracapsular extension or SVI resulted in significantly higher rates of both biochemical recurrence and distant failure. Using Cox regression analysis, only mpMRI evidence of SVI vs. no SVI predicted for biochemical failure (hazard ratio 13.98, p = 0.0055). CONCLUSIONS For high-risk prostate cancer treated with combination HDR brachytherapy and EBRT, mpMRI evidence of SVI predicted for biochemical failure, whereas traditional pretreatment variables did not. Therefore, pretreatment 3T mpMRI appears useful for identifying men who may benefit from treatment intensification.
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Affiliation(s)
- John V Hegde
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jagdeep Raince
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Sang-June Park
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- Departments of Radiology, Urology, and Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Christopher R King
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA
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70
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Lay N, Tsehay Y, Greer MD, Turkbey B, Kwak JT, Choyke PL, Pinto P, Wood BJ, Summers RM. Detection of prostate cancer in multiparametric MRI using random forest with instance weighting. J Med Imaging (Bellingham) 2017. [PMID: 28630883 DOI: 10.1117/1.jmi.4.2.024506] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A prostate computer-aided diagnosis (CAD) based on random forest to detect prostate cancer using a combination of spatial, intensity, and texture features extracted from three sequences, T2W, ADC, and B2000 images, is proposed. The random forest training considers instance-level weighting for equal treatment of small and large cancerous lesions as well as small and large prostate backgrounds. Two other approaches, based on an AutoContext pipeline intended to make better use of sequence-specific patterns, were considered. One pipeline uses random forest on individual sequences while the other uses an image filter described to produce probability map-like images. These were compared to a previously published CAD approach based on support vector machine (SVM) evaluated on the same data. The random forest, features, sampling strategy, and instance-level weighting improve prostate cancer detection performance [area under the curve (AUC) 0.93] in comparison to SVM (AUC 0.86) on the same test data. Using a simple image filtering technique as a first-stage detector to highlight likely regions of prostate cancer helps with learning stability over using a learning-based approach owing to visibility and ambiguity of annotations in each sequence.
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Affiliation(s)
- Nathan Lay
- National Institutes of Health, Clinical Center, Imaging Biomarkers and Computer Aided Diagnosis Laboratory, Bethesda, Maryland, United States
| | - Yohannes Tsehay
- National Institutes of Health, Clinical Center, Imaging Biomarkers and Computer Aided Diagnosis Laboratory, Bethesda, Maryland, United States
| | - Matthew D Greer
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Baris Turkbey
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Jin Tae Kwak
- National Institutes of Health, Clinical Center, Center for Interventional Oncology, Bethesda, Maryland, United States
| | - Peter L Choyke
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Peter Pinto
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Bradford J Wood
- National Institutes of Health, Clinical Center, Center for Interventional Oncology, Bethesda, Maryland, United States
| | - Ronald M Summers
- National Institutes of Health, Clinical Center, Imaging Biomarkers and Computer Aided Diagnosis Laboratory, Bethesda, Maryland, United States
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Giganti F, Moore CM. A critical comparison of techniques for MRI-targeted biopsy of the prostate. Transl Androl Urol 2017; 6:432-443. [PMID: 28725585 PMCID: PMC5503959 DOI: 10.21037/tau.2017.03.77] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
MRI-targeted biopsy is a promising technique that offers an improved detection of clinically significant prostate cancer over standard non-targeted biopsy. It is established that prostate MRI is of use in both the primary and repeat biopsy setting for the detection of significant prostate cancer. There are three approaches to targeting biopsies to areas of interest seen on prostate MRI. They each rely on the acquisition and reporting of a diagnostic quality multi-parametric MRI scan used to identify areas of interest, and the subsequent use of those diagnostic quality images in combination with real-time images of the prostate during the biopsy procedure. The three techniques are: visual registration of the MRI images with a real-time ultrasound image; software-assisted fusion of the MRI images and the real-time ultrasound images, and in-bore biopsy, which requires registration of a diagnostic quality MRI scan with a real time interventional MRI image. In this paper we compare the three techniques and evaluate those studies where there is a direct comparison of more than one MRI-targeting technique. PubMed was searched from inception to November 2016 using the search terms (cognitive registration OR visual registration OR fusion biopsy OR in-bore biopsy OR targeted biopsy) AND (prostate cancer OR prostate adenocarcinoma OR prostate carcinoma OR prostatic carcinoma OR prostatic adenocarcinoma) AND (MRI OR NMR OR magnetic resonance imaging OR mpMRI OR multiparametric MRI). The initial search included 731 abstracts. Eleven full text papers directly compared two or more techniques of MRI-targeting, and were selected for inclusion. The detection of clinically significant prostate cancer varied from 0% to 93.3% for visual registration, 23.2% to 100% for software-assisted registration and 29% to 80% for in-bore biopsy. Detection rates for clinically significant cancer are dependent on the prevalence of cancer within the population biopsied, which in turn is determined by the selection criteria [biopsy naïve, previous negative biopsy, prostate specific antigen (PSA) selection criteria, presence of a lesion on MRI]. Cancer detection rates varied more between study populations than between biopsy approaches. Currently there is no consensus on which type of MRI-targeted biopsy performs better in a given setting. Although there have been studies supporting each of the three techniques, substantial differences in methodology and reporting the findings make it difficult to reliably compare their outcomes.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Cabarrus MC, Westphalen AC. Multiparametric magnetic resonance imaging of the prostate-a basic tutorial. Transl Androl Urol 2017; 6:376-386. [PMID: 28725579 PMCID: PMC5503950 DOI: 10.21037/tau.2017.01.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer is the second most common cause of cancer related death in the United States and the most commonly diagnosed malignancy in men. In general, prostate cancer is slow growing, though there is a broad spectrum of disease that may be indolent, or aggressive and rapidly progressive. Screening for prostate is controversial and complicated by lack of specificity and over diagnosis of clinically insignificant cancer. Imaging has played a role in diagnosis of prostate cancer, primarily through systemic transrectal ultrasound (TRUS) guided biopsy. While TRUS guided biopsy radically changed prostate cancer diagnosis, it still remains limited by low resolution, poor tissue characterization, relatively low sensitivity and positive predictive value. Advances in multiparametric magnetic resonance imaging (mpMRI) have allowed more accurate detection, localization, and staging as well as aiding in the role of active surveillance (AS). The use of mpMRI for the evaluation of prostate cancer has increased dramatically and this trend is likely to continue as the technique is rapidly improving and its applications expand. The purpose of this article is to review the basic principles of mpMRI of the prostate and its clinical applications, which will be reviewed in greater detail in subsequent chapters of this issue.
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Affiliation(s)
- Miguel C Cabarrus
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Antonio C Westphalen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.,Department of Urology, University of California, San Francisco, San Francisco, CA, USA
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73
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Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40:1501-1513. [PMID: 28523447 DOI: 10.1007/s00270-017-1658-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Veltri
- Radiology Unit, Oncology Department, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy.
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | - Luigi Giorgi
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | | | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Herlemann A, Buchner A, Kretschmer A, Apfelbeck M, Stief CG, Gratzke C, Tritschler S. Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis. World J Urol 2017; 35:1517-1524. [PMID: 28493044 DOI: 10.1007/s00345-017-2045-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/02/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Gleason score upgrading should be considered when indicating surgery in prostate cancer (PCa) patients. In elderly patients, definitive treatment of low-risk PCa must be weighed with the risks of overtreatment. Our aim was to evaluate rates of Gleason score upgrading in patients ≥75 years undergoing radical prostatectomy (RP) for localized PCa and to identify predictors associated with upgrading. METHODS 3296 patients undergoing RP were retrospectively evaluated and categorized into age groups: <70 years (n = 2971) vs. ≥75 years (n = 325). We analyzed prostate-specific antigen (PSA), biopsy counts, Gleason score, pathologic T- and N-stage, and surgical margin. Propensity score matching was performed to compare rates of up- and downgrading on surgical specimen using the new five-tier pathologic grading system. Logistic regression was used to identify independent predictors of upgrading. RESULTS Preoperatively, patients ≥75 years had higher PSA (8.8 vs. 7.3 ng/mL) and lower proportion of grade group 1 (Gleason score 6) at biopsy (29.2 vs. 47.9%; both p < 0.001) compared to patients <70 years. At RP, patients ≥75 years were more likely to have extraprostatic disease (50 vs. 30%) and lower rates of grade group 1 (14.1 vs. 34.8%; both p < 0.001). Postoperative downgrading was similar (15.1 vs. 19.5%). However, patients ≥75 years had higher rates of postoperative upgrading (46.6 vs. 27.9%; p < 0.001). Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were associated with upgrading. CONCLUSIONS Patients ≥75 years not only demonstrated higher rates of advanced disease but more frequent upgrading on RP specimen. Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were predictive for upgrading. The increased risk of upgrading should be taken into consideration when discussing optimal treatment for this specific cohort.
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Affiliation(s)
- Annika Herlemann
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefan Tritschler
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Multiparametric MRI/ultrasound fusion-guided biopsy decreases detection of indolent cancer in African-American men. Prostate Cancer Prostatic Dis 2017; 20:348-351. [PMID: 28440325 DOI: 10.1038/pcan.2017.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Analysis of systematic 12-core biopsies (SBx) has shown that African-American (AA) men tend to harbor higher risk prostate cancer (PCa) at presentation relative to other races. Multiparametric magnetic resonance imaging (mpMRI) and MRI-ultrasound fusion-guided biopsy (FBx) have been shown to diagnose more intermediate- and high-risk PCa in the general population; however, the efficacy in AA remains largely uncharacterized. We aim to evaluate the utility of FBx in an AA patient cohort. METHODS Men suspected of PCa underwent an mpMRI and FBx with concurrent SBx from 2007 to 2015 in this institutional review board-approved prospective cohort study. Patient demographics, imaging and fusion biopsy variables were collected. χ2, Mann-Whitney U-test and McNemar's tests were performed to compare proportions, means and paired variables, respectively. Clinically significant PCa (CSPCa) was defined as Gleason score ⩾3+4. RESULTS Fusion biopsy demonstrated exact agreement with SBx risk categories in 64% of AA men. There was no statistically significant difference in the detection of CSPCa between FBx vs SBx (68 vs 62 cases, P=0.36). However, FBx detected 41% fewer cases of clinically insignificant PCa (CIPCa) compared with SBx (FBx 30 vs SBx 51 cases, P=0.0004). The combined FBx/SBx biopsy approach detected significantly more cases of CSPCa (FBx/SBx 80 vs SBx 62 cases, P=0.004) while detecting comparable number of cases of CIPCa (FBx/SBx 45 vs SBx 51 cases, P=0.37) compared with SBx alone. FBx/SBx also detected more CSPCa in patients with a history of prior negative SBx (FBx/SBx 28 vs 19 cases, P=0.003). CONCLUSIONS FBx when used in combination with SBx detected more cases of CSPCa while not significantly increasing the diagnosis of CIPCa in AA men. Future multicenter studies will be needed to validate ultimately the clinical implications of FBx in AA patients.
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This Month in Adult Urology. J Urol 2017. [DOI: 10.1016/j.juro.2016.10.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Giannarini G, Crestani A, Rossanese M, Ficarra V. Multiparametric Magnetic Resonance Imaging Targeted Biopsy for Early Detection of Prostate Cancer: All That Glitters Is Not Gold! Eur Urol 2017; 71:904-906. [PMID: 28094057 DOI: 10.1016/j.eururo.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 01/03/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy.
| | - Alessandro Crestani
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Marta Rossanese
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Vincenzo Ficarra
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy; Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
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VanderWeele DJ, Turkbey B, Sowalsky AG. PRECISION MANAGEMENT OF LOCALIZED PROSTATE CANCER. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016; 1:505-515. [PMID: 28133630 DOI: 10.1080/23808993.2016.1267562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The vast majority of men who are diagnosed with prostate cancer die of other causes, highlighting the importance of determining which patient has a risk of death from prostate cancer. Precision management of prostate cancer patients includes distinguishing which men have potentially lethal disease and employing strategies for determining which treatment modality appropriately balances the desire to achieve a durable response while preventing unnecessary overtreatment. AREAS COVERED In this review, we highlight precision approaches to risk assessment and a context for the precision-guided application of definitive therapy. We focus on three dilemmas relevant to the diagnosis of localized prostate cancer: screening, the decision to treat, and postoperative management. EXPERT COMMENTARY In the last five years, numerous precision tools have emerged with potential benefit to the patient. However, to achieve optimal outcome, the decision to employ one or more of these tests must be considered in the context of prevailing conventional factors. Moreover, performance and interpretation of a molecular or imaging precision test remains practitioner-dependent. The next five years will witness increased marriage of molecular and imaging biomarkers for improved multi-modal diagnosis and discrimination of disease that is aggressive versus truly indolent.
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Affiliation(s)
- David J VanderWeele
- Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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