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Gibson E, Bauman GS, Romagnoli C, Cool DW, Bastian-Jordan M, Kassam Z, Gaed M, Moussa M, Gómez JA, Pautler SE, Chin JL, Crukley C, Haider MA, Fenster A, Ward AD. Toward Prostate Cancer Contouring Guidelines on Magnetic Resonance Imaging: Dominant Lesion Gross and Clinical Target Volume Coverage Via Accurate Histology Fusion. Int J Radiat Oncol Biol Phys 2016; 96:188-96. [PMID: 27375167 DOI: 10.1016/j.ijrobp.2016.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/16/2016] [Accepted: 04/13/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Defining prostate cancer (PCa) lesion clinical target volumes (CTVs) for multiparametric magnetic resonance imaging (mpMRI) could support focal boosting or treatment to improve outcomes or lower morbidity, necessitating appropriate CTV margins for mpMRI-defined gross tumor volumes (GTVs). This study aimed to identify CTV margins yielding 95% coverage of PCa tumors for prospective cases with high likelihood. METHODS AND MATERIALS Twenty-five men with biopsy-confirmed clinical stage T1 or T2 PCa underwent pre-prostatectomy mpMRI, yielding T2-weighted, dynamic contrast-enhanced, and apparent diffusion coefficient images. Digitized whole-mount histology was contoured and registered to mpMRI scans (error ≤2 mm). Four observers contoured lesion GTVs on each mpMRI scan. CTVs were defined by isotropic and anisotropic expansion from these GTVs and from multiparametric (unioned) GTVs from 2 to 3 scans. Histologic coverage (proportions of tumor area on co-registered histology inside the CTV, measured for Gleason scores [GSs] ≥6 and ≥7) and prostate sparing (proportions of prostate volume outside the CTV) were measured. Nonparametric histologic-coverage prediction intervals defined minimal margins yielding 95% coverage for prospective cases with 78% to 92% likelihood. RESULTS On analysis of 72 true-positive tumor detections, 95% coverage margins were 9 to 11 mm (GS ≥ 6) and 8 to 10 mm (GS ≥ 7) for single-sequence GTVs and were 8 mm (GS ≥ 6) and 6 mm (GS ≥ 7) for 3-sequence GTVs, yielding CTVs that spared 47% to 81% of prostate tissue for the majority of tumors. Inclusion of T2-weighted contours increased sparing for multiparametric CTVs with 95% coverage margins for GS ≥6, and inclusion of dynamic contrast-enhanced contours increased sparing for GS ≥7. Anisotropic 95% coverage margins increased the sparing proportions to 71% to 86%. CONCLUSIONS Multiparametric magnetic resonance imaging-defined GTVs expanded by appropriate margins may support focal boosting or treatment of PCa; however, these margins, accounting for interobserver and intertumoral variability, may preclude highly conformal CTVs. Multiparametric GTVs and anisotropic margins may reduce the required margins and improve prostate sparing.
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Affiliation(s)
- Eli Gibson
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Biomedical Engineering, University of Western Ontario, London, Ontario, Canada; Centre for Medical Image Computing, University College London, London, UK; Department of Radiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Glenn S Bauman
- Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
| | - Cesare Romagnoli
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Derek W Cool
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Matthew Bastian-Jordan
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada; Queensland Health, Brisbane, Queensland, Australia
| | - Zahra Kassam
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Mena Gaed
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - Madeleine Moussa
- Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - José A Gómez
- Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - Stephen E Pautler
- Lawson Health Research Institute, London, Ontario, Canada; Department of Urology, University of Western Ontario, London, Ontario, Canada
| | - Joseph L Chin
- Lawson Health Research Institute, London, Ontario, Canada; Department of Urology, University of Western Ontario, London, Ontario, Canada
| | - Cathie Crukley
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aaron Fenster
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Biomedical Engineering, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Aaron D Ward
- Biomedical Engineering, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Centre, London, Ontario, Canada
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Abstract
PURPOSE OF REVIEW This review discusses the feasibility, recent advances and current status of in-bore MRI-guided interventional techniques for diagnosis and treatment of focal prostate cancer (PCa) and also explores the future applications, highlighting the emerging strategies for the treatment of PCa. RECENT FINDINGS Multiparametric MRI has opened up opportunities for diagnosis and targeted therapeutics to the site of disease within the organ wherein minimizing the incidence of treatment-related toxicity of whole gland therapy. MRI-guided targeted biopsy has a higher detection rate for significant cancer and lower rate of detection of insignificant cancer. In comparison to ultrasound-guided focal therapy, in-bore treatment provides the advantage of real time thermal monitoring during treatment and assessment of treatment coverage by an enhanced scan immediately post-treatment. Preliminary results of ongoing phase I and II in-bore focal PCa treatment trials via transperineal, transrectal and transurethral routes, using different energy modalities for the ablation, have shown promising results. SUMMARY Advances in multiparametric-MRI has opened up opportunities for in-bore targeted focal treatment of PCa in the correctly selected patient.
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Partial Gland Ablation for Prostate Cancer: Report of a Food and Drug Administration, American Urological Association, and Society of Urologic Oncology Public Workshop. Urology 2015; 88:8-13. [PMID: 26621480 DOI: 10.1016/j.urology.2015.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To summarize the discussion that took place at a public workshop, co-sponsored by the U.S. Food and Drug Administration, the American Urological Association, and Society of Urologic Oncology reviewing the current state of the art for partial gland ablation (PGA) for the management of patients with prostate cancer. The purpose of this workshop was to discuss potential indications, current available evidence, and designs for future trials to provide the evidence needed by patients and providers to decide how and when to use PGA. METHODS A workshop evaluating PGA for prostate cancer was held in New Orleans, Louisiana, in May 2015. Invited experts representing all stakeholders and attendees discussed the regulatory development of medical products, technology available, potential indications, and designs of trials to evaluate this modality of therapy. RESULTS The panel presented the current information on the technologies available to perform PGA, the potential indications, and results of prior consensus conferences. Use of magnetic resonance imaging for patient selection, guide therapy, and follow-up was discussed. Designs of trials to assess PGA outcomes were discussed. CONCLUSION The general consensus was that currently available technologies are capable of selective ablation with reasonable accuracy, but that criteria for patient selection remain debatable, and long-term cancer control remains to be established in properly designed and well-performed prospective clinical trials. Concerns include the potential for excessive, unnecessary use in patients with low-risk cancer and, conversely, that current diagnostic techniques may underestimate the extent and aggressiveness of some cancers, leading to inadequate treatment.
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Magnetic Resonance–Guided Thermal Therapy for Localized and Recurrent Prostate Cancer. Magn Reson Imaging Clin N Am 2015; 23:607-19. [DOI: 10.1016/j.mric.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Renard Penna R, Brenot-Rossi I, Salomon L, Soulié M. Imagerie du cancer de la prostate : IRM et imagerie nucléaire. Prog Urol 2015; 25:933-46. [DOI: 10.1016/j.purol.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/25/2022]
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Multiparametric MRI and post implant CT-based dosimetry after prostate brachytherapy with iodine seeds: The higher the dose to the dominant index lesion, the lower the PSA bounce. Radiother Oncol 2015; 117:258-61. [DOI: 10.1016/j.radonc.2015.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/21/2015] [Accepted: 08/03/2015] [Indexed: 11/21/2022]
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Toner L, Weerakoon M, Bolton DM, Ryan A, Katelaris N, Lawrentschuk N. Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy. Prostate Int 2015; 3:107-14. [PMID: 26779455 PMCID: PMC4685231 DOI: 10.1016/j.prnil.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Multiparametric magnetic resonance imaging (mpMRI) is an emerging technique aiming to improve upon the diagnostic sensitivity of prostate biopsy. Because of variance in interpretation and application of techniques, results may vary. There is likely a learning curve to establish consistent reporting of mpMRI. This study aims to review current literature supporting the diagnostic utility of mpMRI when compared with radical prostatectomy (RP) and template transperineal biopsy (TTPB) specimens. Methods MEDLINE and PubMed database searches were conducted identifying relevant literature related to comparison of mpMRI with RP or TTPB histology. Results Data suggest that compared with RP and TTPB specimens, the sensitivity of mpMRI for prostate cancer (PCa) detection is 80–90% and the specificity for suspicious lesions is between 50% and 90%. Conclusions mpMRI has an increasing role for PCa diagnosis, staging, and directing management toward improving patient outcomes. Its sensitivity and specificity when compared with RP and TTPB specimens are less than what some expect, possibly reflecting a learning curve for the technique of mpMRI.
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Affiliation(s)
- Liam Toner
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia
| | - Mahesha Weerakoon
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia
| | - Damien M Bolton
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - Andrew Ryan
- Department of Pathology, TissuPath Specialist Pathology Services, Melbourne, Australia
| | - Nikolas Katelaris
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Pitfalls in Interpreting mp-MRI of the Prostate: A Pictorial Review with Pathologic Correlation. Insights Imaging 2015; 6:611-30. [PMID: 26385690 PMCID: PMC4656245 DOI: 10.1007/s13244-015-0426-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/23/2015] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
Objectives The purpose of this pictorial review is to present a wide spectrum of prostate multiparametric MRI (mp-MRI) pitfalls that may occur in clinical practice, with radiological and pathological correlation. Methods All examinations were performed according to ESUR Guidelines protocols. Results and Conclusion mp-MRI imaging of the prostate often leads to interpreting doubts and misdiagnosis due to the many interpretative pitfalls that a tissue, whether healthy or treated, may cause. These “false-positive” findings may occur in each stage of the disease history, from the primary diagnosis and staging, to the post-treatment stage, and whether they are caused by the tissue itself or are iatrogenic, their recognition is critical for proper treatment and management. Knowledge of these known pitfalls and their interpretation in the anatomical-radiological context can help radiologists avoid misdiagnosis and consequently mistreatment. Main Messages • Some physiological changes in the peripheral and central zone may simulate prostate cancer. • Technical errors, such as mispositioned endorectal coils, can affect the mp-MRI interpretation. • Physiological changes post-treatment can simulate recurrence
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Abstract
Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa). Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - John Trachtenberg
- Prostate Centre, Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
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Zechmann CM. Imaging for Prostate Cancer. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mendez MH, Joh DY, Gupta R, Polascik TJ. Current Trends and New Frontiers in Focal Therapy for Localized Prostate Cancer. Curr Urol Rep 2015; 16:35. [DOI: 10.1007/s11934-015-0513-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Amini A, Westerly DC, Waxweiler TV, Ryan N, Raben D. Dose painting to treat single-lobe prostate cancer with hypofractionated high-dose radiation using targeted external beam radiation: Is it feasible? Med Dosim 2015; 40:256-61. [PMID: 25824420 DOI: 10.1016/j.meddos.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/15/2015] [Accepted: 02/13/2015] [Indexed: 12/25/2022]
Abstract
Targeted focal therapy strategies for treating single-lobe prostate cancer are under investigation. In this planning study, we investigate the feasibility of treating a portion of the prostate to full-dose external beam radiation with reduced dose to the opposite lobe, compared with full-dose radiation delivered to the entire gland using hypofractionated radiation. For 10 consecutive patients with low- to intermediate-risk prostate cancer, 2 hypofractionated, single-arc volumetric-modulated arc therapy (VMAT) plans were designed. The first plan (standard hypofractionation regimen [STD]) included the entire prostate gland, treated to 70 Gy delivered in 28 fractions. The second dose painting plan (DP) encompassed the involved lobe treated to 70 Gy delivered in 28 fractions, whereas the opposing, uninvolved lobe received 50.4 Gy in 28 fractions. Mean dose to the opposing neurovascular bundle (NVB) was considerably lower for DP vs STD, with a mean dose of 53.9 vs 72.3 Gy (p < 0.001). Mean penile bulb dose was 18.6 Gy for DP vs 19.2 Gy for STD (p = 0.880). Mean rectal dose was 21.0 Gy for DP vs 22.8 Gy for STD (p = 0.356). Rectum V70 (the volume receiving ≥70 Gy) was 2.01% for DP vs 2.74% for STD (p = 0.328). Bladder V70 was 1.69% for DP vs 2.78% for STD (p = 0.232). Planning target volume (PTV) maximum dose points were 76.5 and 76.3 Gy for DP and STD, respectively (p = 0.760). This study demonstrates the feasibility of using VMAT for partial-lobe prostate radiation in patients with prostate cancer involving 1 lobe. Partial-lobe prostate plans appeared to spare adjacent critical structures including the opposite NVB.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - David C Westerly
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Timothy V Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Nicole Ryan
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
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Marshall S, Taneja S. Focal therapy for prostate cancer: The current status. Prostate Int 2015; 3:35-41. [PMID: 26157765 PMCID: PMC4494637 DOI: 10.1016/j.prnil.2015.03.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 12/29/2022] Open
Abstract
Purpose In an era of increasing prostate cancer incidence and earlier detection, the assessment of clinical significance of prostate cancer is critical. Minimally invasive therapies are increasingly being investigated in localized prostate cancer. Methods and results In this review, we discuss the current status of magnetic resonance imaging targeted fusion prostate biopsy and focal therapy for prostate cancer, its rationale, and techniques. Conclusion Focal therapy offers a promising outlook for prostate cancer treatment, with the goal of effectively achieving cancer control while minimizing morbidity. Long term studies are needed.
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Cochet A, Kanoun S, Humbert O, Walker PM, Cormier L, Créhange G, Brunotte F. Quelle imagerie pour la prise en charge de la rechute biochimique du cancer de la prostate : TEP ou IRM ? Cancer Radiother 2014; 18:509-16. [DOI: 10.1016/j.canrad.2014.07.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/25/2022]
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Cancers de prostate : quelles techniques de radiothérapie pour quelles tumeurs ? Enjeux éthiques et méthodologiques. Cancer Radiother 2014; 18:369-78. [DOI: 10.1016/j.canrad.2014.07.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
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Abstract
Tissue-preserving focal therapies, such as brachytherapy, cryotherapy, high-intensity focused ultrasound and photodynamic therapy, aim to target individual cancer lesions rather than the whole prostate. These treatments have emerged as potential interventions for localized prostate cancer to reduce treatment-related adverse-effects associated with whole-gland treatments, such as radical prostatectomy and radiotherapy. In this article, the Prostate Cancer RCT Consensus Group propose that a novel cohort-embedded randomized controlled trial (RCT) would provide a means to study men with clinically significant localized disease, which we defined on the basis of PSA level (≤ 15 ng/ml or ≤ 20 ng/ml), Gleason grade (Gleason pattern ≤ 4 + 4 or ≤ 4 + 3) and stage (≤ cT2cN0M0). This RCT should recruit men who stand to benefit from treatment, with the control arm being whole-gland surgery or radiotherapy. Composite outcomes measuring rates of local and systemic salvage therapies at 3-5 years might best constitute the basis of the primary outcome on which to change practice.
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Anderson ES, Margolis DJA, Mesko S, Banerjee R, Wang PC, Demanes DJ, Kupelian P, Kamrava M. Multiparametric MRI identifies and stratifies prostate cancer lesions: implications for targeting intraprostatic targets. Brachytherapy 2014; 13:292-8. [PMID: 24709516 DOI: 10.1016/j.brachy.2014.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/07/2014] [Accepted: 01/28/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the ability of multiparametric (mp) MRI (mp-MRI) to identify, stratify, and localize biopsy-proven prostate cancer lesions in a risk-stratified patient population. METHODS AND MATERIALS We retrospectively analyzed 57 patients who had mp-MRI and core needle biopsy during diagnostic prostate cancer evaluation. The MRI sequences were scored for suspicion of cancer with a previously described system. Distributions of mp-MRI scores were compared across National Comprehensive Cancer Network prostate cancer risk groups. The mp-MRI-identified lesions were compared with the location of positive core needle biopsies to assess mp-MRI localization of true lesions. RESULTS The mp-MRI scoring system identified lesions in 84% (48/57) of the patients, including 100% (12/12) in the high-risk group. Scores assigned to lesions in patients in intermediate- and high-risk groups were statistically higher than those in the low-risk group, with a relative risk of 6.72 (95% confidence interval: 2.32-19.51, p<0.001) of having an aggressive score assigned in high-risk patients compared with the low-risk patients. In comparing the localization data from core needle biopsy, 68% of the patients had an MRI-identified lesion in or within one adjacent sextant of the same prostate hemigland, including 85% of aggressive lesions. CONCLUSIONS Use of mp-MRI at the time of diagnosis can identify intraprostatic lesions and assign suspicion for high-risk disease. These data show that high-risk patients are more likely to have suspicious imaging-identified lesions that correlate to the location of biopsy-proven prostate cancer. At this time, the use of mp-MRI to define focal targets represents a complementary tool to patient evaluation for focal therapy strategies.
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Affiliation(s)
- Erik S Anderson
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Medical Scientist Training Program, University of California Los Angeles, Los Angeles, CA
| | - Daniel J A Margolis
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Shane Mesko
- School of Medicine, University of California, Irvine, CA
| | - Robyn Banerjee
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Pin-Chieh Wang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - D Jeffrey Demanes
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Patrick Kupelian
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, Los Angeles, CA.
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Raskolnikov D, Rais-Bahrami S, Turkbey B, Rastinehad AR, Choyke PL, Wood BJ, Pinto PA. Current Ability of Multiparametric Prostate Magnetic Resonance Imaging and Targeted Biopsy to Improve the Detection of Prostate Cancer. UROLOGY PRACTICE 2014; 1:13-21. [PMID: 28989951 DOI: 10.1016/j.urpr.2014.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recent advancements in imaging technology have significantly increased the diagnostic accuracy of magnetic resonance imaging for prostate cancer. However, tissue diagnosis and grading remain the gold standard for diagnosis and prognostication. Because transrectal ultrasound guided prostate biopsy performs poorly, extensive research has been conducted into biopsy techniques that are guided by magnetic resonance imaging, including direct in-bore, cognitive fusion and magnetic resonance imaging/ultrasound fusion guided biopsies. METHODS The PubMed® database was searched from inception until January 15, 2014 for criteria pertaining to targeted prostate biopsy. RESULTS Initial studies of the 3 types of targeted prostate biopsy yielded similar results. Most importantly, targeted biopsy detects a greater amount of clinically significant prostate cancer than does transrectal ultrasound guided biopsy. Magnetic resonance imaging/ultrasound fusion guided biopsy has generated the most interest, as it is an office based procedure that does not require a significant change from the current workflow of transrectal prostate biopsy. These techniques hold great promise in the areas of patient selection for definitive treatment, appropriate screening, active surveillance and focal therapy for prostate cancer. CONCLUSIONS Targeted prostate biopsy has the potential to significantly improve the way patients are screened, treated and monitored in the setting of prostate cancer. These techniques allow for an individualized approach to each patient, which is a substantial improvement over the current practice of effectively random prostate biopsies. Large, multicenter studies are necessary to determine whether targeted prostate biopsy will become a definitive standard of care.
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Affiliation(s)
- Dima Raskolnikov
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
| | - Soroush Rais-Bahrami
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
| | - Baris Turkbey
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
| | - Ardeshir R Rastinehad
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
| | - Peter L Choyke
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
| | - Bradford J Wood
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
| | - Peter A Pinto
- Urologic Oncology Branch (DR, SR-B, PAP) and Molecular Imaging Program (BT, PLC), National Cancer Institute, and Center for Interventional Oncology (BJW, PAP), National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, and The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine (ARR), New Hyde Park, New York
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