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Abstract
Cancer therapy is mainly based on different combinations of surgery, radiotherapy, and chemotherapy. Additionally, targeted therapies (designed to disrupt specific tumor hallmarks, such as angiogenesis, metabolism, proliferation, invasiveness, and immune evasion), hormonotherapy, immunotherapy, and interventional techniques have emerged as alternative oncologic treatments. Conventional imaging techniques and current response criteria do not always provide the necessary information regarding therapy success particularly to targeted therapies. In this setting, MR imaging offers an attractive combination of anatomic, physiologic, and molecular information, which may surpass these limitations, and is being increasingly used for therapy response assessment.
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Patel P, Oto A. Magnetic Resonance Imaging of the Prostate, Including Pre- and Postinterventions. Semin Intervent Radiol 2016; 33:186-95. [PMID: 27582606 DOI: 10.1055/s-0036-1586144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article systematically reviews the rationale for magnetic resonance imaging in prostate cancer, in detection and following various treatment methods. A basic discussion of the identification of prostate cancer is imperative to understand postintervention imaging. Each available therapy, including surgery, radiation, hormone therapy, and focal therapies will be discussed along with associated imaging findings, providing the reader with a better understanding of current interventions in prostate cancer and imaging.
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Affiliation(s)
- Pritesh Patel
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, Illinois
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Renard-Penna R, Rouvière O, Puech P, Borgogno C, Abbas L, Roy C, Claudon M, Correas JM, Cormier L, Ploussard G, Mejean A, Tezenas-du-Montcel S, Rozet F. Current practice and access to prostate MR imaging in France. Diagn Interv Imaging 2016; 97:1125-1129. [PMID: 27451262 DOI: 10.1016/j.diii.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE To obtain an overview of the degree of discrepancy between current clinical practice of prostate magnetic resonance imaging (MRI) in France and recommendations. MATERIALS AND METHODS A brief survey was sent to 1229 members of the French society of urology in order to identify their indications of prostate MRI and its impact on patient management. The urologists were asked to answer several questions regarding age, practice modality, prostate MRI examinations (technique, indication before first biopsy, second biopsy, cancer staging, active surveillance, recurrence, focal therapy) and quality of reports. RESULTS A total of 445 responses were received (participation rate of 36%). The mean delay for obtaining an appointment for prostate MRI ranged between 15-30 days in 54%. Fifty-four percent of MRI reports contained a PIRADS score and 23% a Likert score. The indications of multiparametric-MRI were tumor detection/location prior to repeat biopsy (90%), cancer staging (85%), management of patients under active surveillance (85%), selection of candidates to focal therapy (63%), tumor detection/location in biopsy naïve patients (53%), detection of local recurrence after radical (51%). Only 119 urologists (28.6%) had access to image fusion (MRI and transrectal ultrasound) and 351 (85.4%) used cognitive fusion. Mostly, targeted biopsies are done by urologists alone (nearly 80%), a very few are done by radiologists (8%) or by the two of them in collaboration (12%). CONCLUSION The majority of urologists consider that prostate MRI is essential for the management of patients with prostate cancer. Practices are ahead of recommendations particularly before the first biopsy and in active surveillance.
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Affiliation(s)
- R Renard-Penna
- Department of radiology, hôpital Tenon, Pitié-Salpétrière hospital, AP-HP, GRC n(o) 5, ONCOTYPE-URO, institut universitaire de cancérologie, UPMC université Paris 06, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - O Rouvière
- Hospices civils de Lyon, department of urinary and vascular radiology, hôpital Édouard-Herriot, 69437 Lyon, France; Faculté de médecine Lyon Est, université de Lyon, université Lyon 1, 69003 Lyon, France
| | - P Puech
- Department of radiology, Inserm, university de Lille, U1189 - ONCO-THAI - Image assisted laser therapy for oncology, CHU de Lille, 59000 Lille, France
| | - C Borgogno
- Department of urology, René-Dubos hospital, 95300 Pontoise, France
| | - L Abbas
- AP-HP, Pitié-Salpétrière hospital, department of biostatistics, public health and medical information, 75013 Paris, France; Sorbonne université, UPMC université-Paris 06 UMR_S1136, Inserm UMR_S 1136, institut Pierre-Louis d'épidémiologie et de Santé publique, 75013 Paris, France
| | - C Roy
- Department of radiology B, universitary hospital of Strasbourg, Civil hospital, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - M Claudon
- Department of radiology adults, Brabois hospital, university of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - J-M Correas
- Department of radiology, hospital Necker, 75015 Paris, France
| | - L Cormier
- Bourgogne university, academic department of urology, 21000 Dijon, France
| | - G Ploussard
- Department of urology, Saint-Louis hospital, Assistance publique-Hôpitaux de Paris, université Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - A Mejean
- AP-HP, HEGP academic department of urology, 75007 Paris, France
| | - S Tezenas-du-Montcel
- AP-HP, Pitié-Salpétrière hospital, department of biostatistics, public health and medical information, 75013 Paris, France; Sorbonne université, UPMC université-Paris 06 UMR_S1136, Inserm UMR_S 1136, institut Pierre-Louis d'épidémiologie et de Santé publique, 75013 Paris, France
| | - F Rozet
- Montsouris institute, urology department, 75014 Paris, France
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Use of a Quality Improvement Initiative to Achieve Consistent Reporting of Level of Suspicion for Tumor on Multiparametric Prostate MRI. AJR Am J Roentgenol 2016; 206:1040-4. [PMID: 27105339 DOI: 10.2214/ajr.15.15768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the utility of a quality improvement (QI) initiative in achieving long-term adherence to an evolving structured format for reporting the level of suspicion for tumor on prostate MRI examinations. MATERIALS AND METHODS The original QI initiative occurred over a 4-month period in 2010, before which prostate MRI was reported using free text. The initiative consisted of development of a section-wide macro, an initial group training session, ordering physician input regarding the structured report's value, subsequent weekly sessions for ongoing review, and timely individualized feedback in instances of nonuse. The initial structured report included pick lists for describing the level of suspicion for tumor as negative, low, medium, or high. Pick lists were modified in 2011 to incorporate a 5-point Likert scale and again in 2015 to incorporate Prostate Imaging Data and Reporting System (PI-RADS) version 2. These refinements were implemented after accelerated training periods. The frequency of reports providing an MRI-based suspicion level during these periods was assessed. RESULTS Fifty-five percent of reports provided an MRI-based level of suspicion for tumor before the initiative. For various cohorts evaluated after the initiative (using structured reports based on the low, medium, or high scheme; a numeric Likert scale; or PI-RADS), this frequency improved to 95-100% (p < 0.001). Among reports without a suspicion level, potential confounding factors included marked artifact from hip prosthesis and overt diffuse tumor. CONCLUSION The QI initiative achieved excellent adherence in reporting a suspicion level for tumor on prostate MRI examinations. The described components of the initiative were useful for maintaining long-term adherence that persisted after serial modifications to the report lexicon.
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Oppenheimer DC, Weinberg EP, Hollenberg GM, Meyers SP. Multiparametric Magnetic Resonance Imaging of Recurrent Prostate Cancer. J Clin Imaging Sci 2016; 6:18. [PMID: 27195184 PMCID: PMC4863405 DOI: 10.4103/2156-7514.181494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Multiparametric magnetic resonance (MR) imaging of the prostate combines both morphological and functional MR techniques by utilizing small field of view T1-weighted, T2-weighted, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy to accurately detect, localize, and stage primary and recurrent prostate cancer. Localizing the site of recurrence in patients with rising prostate-specific antigen following treatment affects decision making regarding treatment and can be accomplished with multiparametric prostate MR. Several different treatment options are available for prostate cancer including radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, or a number of focal therapy techniques. The findings of recurrent prostate cancer can be different depending on the treatment the patient has received, and the radiologist must be able to recognize the variety of imaging findings seen with this common disease. This review article will detail the findings of recurrent prostate cancer on multiparametric MR and describe common posttreatment changes which may create challenges to accurate interpretation.
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Affiliation(s)
| | - Eric P Weinberg
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary M Hollenberg
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Steven P Meyers
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Abstract
The diagnosis and treatment of prostate cancer continue to evolve with advances in science and technology. The utilization of multiparametric MRI (mp-MRI) to identify lesions in the prostate has given clinicians the ability to visualize malignancy in the prostate with greater confidence. With this new ability came the advancement of fusion biopsy platforms, which allow for direct targeting of these lesions. As with any new technology in medicine, the proper use of these modalities and how they fit into current clinical practice need to be addressed. This review summarizes the current knowledge on how to best optimize which men undergo mp-MRI and fusion biopsies both in the screening and treatment settings.
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57
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Panebianco V, Barchetti F, Grompone MD, Colarieti A, Salvo V, Cardone G, Catalano C. Magnetic resonance imaging for localization of prostate cancer in the setting of biochemical recurrence. Urol Oncol 2016; 34:303-10. [PMID: 27012939 DOI: 10.1016/j.urolonc.2016.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/20/2016] [Accepted: 01/23/2016] [Indexed: 01/26/2023]
Abstract
The clinical suspicion of local recurrence of prostate cancer after radical treatment is based on the onset of biochemical failure. The use of multiparametric magnetic resonance imaging (MRI) for prostate cancer has increased over recent years, mainly for detection, staging, and active surveillance. However, suspicion of recurrence in the set of biochemical failure is becoming a significant reason for clinicians to request multiparametric MRI. Radiologists should be able to recognize the normal posttreatment MRI findings. Fibrosis and atrophic remnant seminal vesicles (SV) after radical prostatectomy are often found and must be differentiated from local relapse. Moreover, brachytherapy, external beam radiotherapy, and focal therapies tend to diffusely decrease the signal intensity of the peripheral zone on T2-weighted images due to the loss of water content, consequently mimicking tumor and hemorrhage. The combination of T2-weighted images and functional studies like diffusion-weighted imaging and dynamic contrast-enhanced imaging improves the identification of local relapse. Tumor recurrence tends to restrict on diffusion images and avidly enhances after contrast administration. The authors provide a review of the normal findings and the signs of local tumor relapse after radical prostatectomy, external beam radiotherapy, brachytherapy and focal therapies.
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Affiliation(s)
- Valeria Panebianco
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Flavio Barchetti
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Anna Colarieti
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Salvo
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Catalano
- Departement of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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58
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State-of-the-art imaging of prostate cancer. Urol Oncol 2016; 34:134-46. [DOI: 10.1016/j.urolonc.2015.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
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Bagade S, Fowler KJ, Schwarz JK, Grigsby PW, Dehdashti F. PET/MRI Evaluation of Gynecologic Malignancies and Prostate Cancer. Semin Nucl Med 2016; 45:293-303. [PMID: 26050657 DOI: 10.1053/j.semnuclmed.2015.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PET combined with cross-sectional anatomical imaging is an essential part of workup for most malignancies, in which CT or MRI provides anatomical context to the functional information from PET. Hybrid imaging with PET/CT has been extensively researched and implemented clinically in the evaluation and management of patients with gynecologic malignancies. Lately, integrated PET/MR scanners have become available. This new technology is fast gaining a role in clinical applications in the fields of oncology, neurology, and cardiology. MRI provides excellent soft tissue contrast especially in the pelvis and has been proven very useful for imaging prostate and female genital pathologies. The ability of PET to provide accurate functional imaging data with high sensitivity combined with the strength of MRI to provide accurate depiction of anatomy with high contrast and spatial resolution renders combined PET/MRI a desirable method for evaluation of gynecologic malignancies and other pelvic cancers such as prostate cancer. The goal of this article is to provide an overview of the published literature using PET/MRI in gynecologic and prostate cancers.
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Affiliation(s)
- Swapnil Bagade
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Kathryn J Fowler
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Julie K Schwarz
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Perry W Grigsby
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
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60
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Paparo F, Piccardo A, Bacigalupo L, Romagnoli A, Piccazzo R, Monticone M, Cevasco L, Campodonico F, Conzi GM, Carmignani G, Rollandi GA. Value of bimodal (18)F-choline-PET/MRI and trimodal (18)F-choline-PET/MRI/TRUS for the assessment of prostate cancer recurrence after radiation therapy and radical prostatectomy. ACTA ACUST UNITED AC 2016; 40:1772-87. [PMID: 25579170 DOI: 10.1007/s00261-014-0345-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between 27% and 53% of all patients who undergo radical prostatectomy (RP) or radiation therapy (RT) as the first-line treatment of prostate cancer (PCa) develop a biochemical recurrence. Imaging plays a pivotal role in restaging by helping to distinguish between local relapse and metastatic disease (i.e., lymph-node and skeletal metastases). At present, the most promising tools for assessing PCa patients with biochemical recurrence are multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET)/computed tomography (CT) with radio-labeled choline derivatives. The main advantage of mpMRI is its high diagnostic accuracy in detecting local recurrence, while choline-PET/CT is able to identify lymph-node metastases when they are not suspicious on morphological imaging. The most recent advances in the field of fusion imaging have shown that multimodal co-registration, synchronized navigation, and combined interpretation are more valuable than the individual; separate assessment offered by different diagnostic techniques. The objective of the present essay was to describe the value of bimodal choline-PET/mpMRI fusion imaging and trimodal choline-PET/mpMRI/transrectal ultrasound (TRUS) in the assessment of PCa recurrence after RP and RT. Bimodal choline-PET/mpMRI fusion imaging allows morphological, functional, and metabolic information to be combined, thereby overcoming the limitations of each separate imaging modality. In addition, trimodal real-time choline-PET/mpMRI/TRUS fusion imaging may be useful for the planning and real-time guidance of biopsy procedures in order to obtain histological confirmation of the local recurrence.
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Affiliation(s)
- Francesco Paparo
- Unit of Radiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy,
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61
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Review of Commonly Used Serum Tumor Markers and Their Relevance for Image Interpretation. J Comput Assist Tomogr 2016; 39:825-34. [PMID: 26248153 DOI: 10.1097/rct.0000000000000297] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serum tumor markers are firmly entrenched as one of the primary tools in an oncologist's armamentarium. They can be implemented in a broad range of applications from diagnostic assistance, assessing prognosis, or guiding therapeutic decisions. However, tumor markers also have limitations, which significantly impact how they should be used. Radiologists should be familiar with the following most prevalent tumor markers, which will all be discussed here: prostate-specific antigen (prostate), carcinoembryonic antigen (colon), α-fetoprotein (hepatocellular and testicular), carbohydrate antigen 19.9 (pancreas), cancer antigen 125 (ovarian), human chorionic gonadotropin/lactic dehydrogenase (testicular), and chromogranin A (neuroendocrine). This knowledge should avoid needless intervention, enhance image interpretation, and ultimately provide optimal patient care.
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62
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Maurer T, Eiber M, Fanti S, Budäus L, Panebianco V. Imaging for Prostate Cancer Recurrence. Eur Urol Focus 2016; 2:139-150. [PMID: 28723528 DOI: 10.1016/j.euf.2016.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/31/2016] [Accepted: 02/10/2016] [Indexed: 01/03/2023]
Abstract
CONTEXT Correct identification of metastatic sites in recurrent prostate cancer (PCa) is of crucial importance because it leads to further treatment decisions. OBJECTIVE To provide an overview on current imaging procedures and their performance in recurrent PCa. EVIDENCE ACQUISITION Medline search via PubMed was performed with the keywords imaging, recurrent, and prostate cancer as well as more detailed searches including the keywords bone scan, bone scintigraphy, computed tomography, magnetic resonance imaging, positron emission tomography, PET, choline, FDG, prostate-specific membrane antigen, and PSMA, with emphasis on recent literature from 2010 to the present. Non-English published literature was excluded. Abstracts and full-text articles were reviewed and assessed for relevant content. EVIDENCE SYNTHESIS In diagnostic imaging and particularly with newer technologies like positron emission tomography (PET), a profound lack of prospectively designed studies in recurrent PCa has to be noted. In most studies histologic validation has only been performed in a subset of patient cohorts. Heterogeneity of included patient cohorts, lack of standardized assessment, as well as diverging end points, hamper systematic comparison of different image modalities. Thus evidence for currently used imaging in recurrent PCa is only presented descriptively. CONCLUSIONS Computed tomography and magnetic resonance imaging (MRI) as well as bone scintigraphy still represent the standard imaging for recurrent PCa; however, particularly for detection of local recurrence, multiparametric MRI is a valuable imaging modality. PET using choline and particularly tracers against prostate-specific membrane antigen might improve visualization of metastatic lesions. These findings need to be validated in prospective trials. PATIENT SUMMARY Imaging of recurrent prostate cancer (PCa) is important to guide further treatment. Computed tomography, magnetic resonance imaging, and bone scintigraphy represent the current standard. Positron emission tomography, especially with cancer-specific tracers, might improve imaging of recurrent PCa in the future.
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Affiliation(s)
- Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
| | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Bologna, Italy
| | - Lars Budäus
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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Kawczyk-Krupka A, Wawrzyniec K, Musiol SK, Potempa M, Bugaj AM, Sieroń A. Treatment of localized prostate cancer using WST-09 and WST-11 mediated vascular targeted photodynamic therapy-A review. Photodiagnosis Photodyn Ther 2015; 12:567-74. [PMID: 26467273 DOI: 10.1016/j.pdpdt.2015.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/23/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is well known for its direct cytotoxicity of the free radical-producing photochemical reaction, indirect mechanisms of action including modulation of intrinsic anti-tumour immune activity, and occlusion of pathologically altered tumour vessels leading to tumour ischaemia. The aim of this work is to critically review the evidence base for the use of vascular targeted PDT (VTP) to treat low-risk prostate cancer, and to discuss perspectives and challenges yet to be overcome. A brief general overview of focal prostate cancer therapy was provided, followed by a discussion of both basic and clinical research pertaining to prostate cancer VTP, with a focus on the palladium-based WST-09 and WST-11 photosensitisers. MATERIALS AND METHOD Literature on VTP for prostate cancer with the fallowing medical subject headings search terms: prostate cancer, photodynamic therapy, vascular targeted photodynamic therapy, bacteriopheophorbide were reviewed. The articles were selected by their relevance to the topic. RESULTS The clinical and basic research data available to date show much promise for WST-09, and WST-11 based VTP eventually joining the standard urologist's armamentarium against prostate cancer. With good reported tolerability and efficacy VTP can be proposed as an intermediate treatment for local low risk disease, halfway between watchful waiting and radical therapy.
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Affiliation(s)
- A Kawczyk-Krupka
- School of Medicine with the Division of Dentistry in Zabrze, Department and Clinic of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland.
| | - K Wawrzyniec
- Department of Internal Diseases, 11 Listopada 48, 28-200 Staszów, Poland
| | - S K Musiol
- School of Clinical Medicine, University of Cambridge, Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 OSP, United Kingdom
| | - M Potempa
- School of Medicine with the Division of Dentistry in Zabrze, Department and Clinic of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland
| | - A M Bugaj
- School of Medicine with the Division of Dentistry in Zabrze, Department and Clinic of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland; College of Health, Beauty Care and Education, Brzeźnicka 3, 60-133 Poznań, Poland
| | - A Sieroń
- School of Medicine with the Division of Dentistry in Zabrze, Department and Clinic of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland
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64
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Detection of Local Recurrence of Prostate Cancer After Radical Prostatectomy Using Endorectal Coil MRI at 3 T: Addition of DWI and Dynamic Contrast Enhancement to T2-Weighted MRI. AJR Am J Roentgenol 2015; 205:807-16. [DOI: 10.2214/ajr.14.14275] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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65
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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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66
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Paparo F, Massollo M, Rollandi L, Piccardo A, Ruggieri FG, Rollandi GA. The clinical role of multimodality imaging in the detection of prostate cancer recurrence after radical prostatectomy and radiation therapy: past, present, and future. Ecancermedicalscience 2015; 9:570. [PMID: 26435743 PMCID: PMC4583244 DOI: 10.3332/ecancer.2015.570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Indexed: 12/18/2022] Open
Abstract
Detection of the recurrence sites in prostate cancer (PCa) patients affected by biochemical recurrence after radical prostatectomy (RP) and radiation therapy (RT) is still a challenge for clinicians, nuclear medicine physicians, and radiologists. In the era of personalised and precision care, this task requires the integration, amalgamation, and combined analysis of clinical and imaging data from multiple sources. At present, multiparametric Magnetic Resonance Imaging (mpMRI) and choline–positron emission tomography (PET) are giving encouraging results; their combination allows the effective detection of local, lymph nodal, and skeletal recurrences at low PSA levels. Future diagnostic perspectives include the clinical implementation of PET/MRI scanners, multimodal fusion imaging platforms for retrospective co-registration of PET and MR images, real-time transrectal ultrasound/mpMRI fusion imaging, and novel organ-specific PET radiotracers.
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Affiliation(s)
- Francesco Paparo
- Radiology Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Michela Massollo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Ludovica Rollandi
- Klinikum Augsburg Radiologie, Stelingstrasse 2, 86156 Augsburg, Germany
| | - Arnoldo Piccardo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Filippo Grillo Ruggieri
- Radiotherapy Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Gian Andrea Rollandi
- Radiology Unit, Department of Diagnostic Imaging, E O Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
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67
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Notley M, Yu J, Fulcher AS, Turner MA, Cockrell CH, Nguyen D. Pictorial review. Diagnosis of recurrent prostate cancer and its mimics at multiparametric prostate MRI. Br J Radiol 2015; 88:20150362. [PMID: 26268143 DOI: 10.1259/bjr.20150362] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Biochemical recurrence after treatment for prostate cancer (PCa) is a significant issue. Early diagnosis of local recurrence is important for making prompt treatment decisions and is strongly associated with patient prognosis. Without salvage therapy, the average time from development of local recurrence to distant metastasis is approximately 3 years. Biochemical recurrence does not differentiate local recurrence from systemic disease; there is no reliable way to clinically diagnose local recurrence. Recent advances in multiparametric MRI (mp-MRI) techniques have markedly improved detection of local recurrence following therapy. However, a wide variety of entities can mimic recurrent PCa at mp-MRI. Therefore, the purpose of this pictorial review is to discuss the MRI findings of locally recurrent PCa and its mimics, emphasizing the key MRI features that help to differentiate local recurrence from its mimics.
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Affiliation(s)
- Mark Notley
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Jinxing Yu
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Ann S Fulcher
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Mary Ann Turner
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Charles H Cockrell
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Don Nguyen
- 2 Department of Radiology, Allegheny General Hospital, Pittsburgh, PA, USA
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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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69
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Kim CK. Magnetic resonance imaging-guided prostate biopsy: present and future. Korean J Radiol 2015; 16:90-8. [PMID: 25598677 PMCID: PMC4296281 DOI: 10.3348/kjr.2015.16.1.90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/04/2014] [Indexed: 12/18/2022] Open
Abstract
Systemic transrectal ultrasound-guided biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer (PCa), but reveals a limited accuracy for the detection of cancer. Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value. The use of mp-MRI during a MRI-guided biopsy (MRGB) procedure improves the quality of a targeted biopsy. The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions. A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx. Moreover, it may decrease the detection of clinically insignificant cancers with fewer biopsy cores.
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Affiliation(s)
- Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Abstract
For many clinical issues regarding prostate cancer magnetic resonance imaging (MRI) is gaining increasing importance for prostate diagnostics. The high morphological resolution of T2-weighted sequences is unsurpassed compared to other imaging modalities. It enables not only the detection and localization of prostate cancer but also allows the evaluation of extracapsular extensions. Functional MRI methods, such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI and proton magnetic resonance spectroscopy ((1)H-MRS) increase the specificity and to a lesser extent, the sensitivity of diagnostics. In accordance with the interdisciplinary S3 guidelines, prostate MRI is recommended for patients with at least one negative biopsy for cancer detection. According to the guidelines areas suspected of being cancerous should be selectively biopsied in addition to the systematic biopsy. The transmission of findings about the suspected tumor areas according to the structured PI-RADS classification system has proven its worth. The localization and staging of prostate carcinoma is best achieved with the help of MRI and is recommended in the S3 guidelines especially for tumors with a clinical stage cT3/4 or with a Gleason grading system score ≥8. In addition to these applications MRI is mainly used under study conditions for local recurrence or active surveillance.
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Affiliation(s)
- T Franiel
- Institut für Diagnostische und Interventionelle Radiologie II, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland,
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71
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Kulik M, Nedelcu C, Martin F, Lebdai S, Rousselet MC, Azzouzi AR, Aubé C. Post-treatment MRI aspects of photodynamic therapy for prostate cancer. Insights Imaging 2014; 5:697-713. [PMID: 25288529 PMCID: PMC4263801 DOI: 10.1007/s13244-014-0359-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Photodynamic therapy is a new focal therapy for prostate cancer. METHODS In this technique, a photosensitising agent is introduced intravenously, then activated by local laser illumination to induce tumour necrosis. Treatment efficacy is assessed by magnetic resonance imaging (MRI). RESULTS AND CONCLUSIONS We illustrate specific post-treatment MRI aspects at early and late follow-up with pathological correlations. TEACHING POINTS • Dynamic phototherapy is a new and promising focal therapy for prostate cancer. • One-week MRI shows increased volume of the treated lobe and large, homogeneous necrosis area. • Six-month MRI shows significant changes of the prostate shape and signal. • Six-month MRI becomes "base line" appearance for further follow-up or monitoring.
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Affiliation(s)
- M Kulik
- Department of Radiology, CHU Angers, 4 rue Larrey, 49100, Angers, France,
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72
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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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73
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Domachevsky L, Jacene HA, Sakellis CG, Kim CK. Postradiation changes in tissues: evaluation by imaging studies with emphasis on fluorodeoxyglucose-PET/computed tomography and correlation with histopathologic findings. PET Clin 2014; 9:217-35. [PMID: 25030284 DOI: 10.1016/j.cpet.2013.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Efforts have been made to minimize the damage to adjacent normal tissues during radiotherapy, primarily by shifting from the use of conventional radiotherapy to more advanced techniques. Reviewing the overall pattern on combined anatomic and functional imaging can enhance diagnostic accuracy. Several radiotracers can be used; [(18)F]fluorodeoxyglucose is the most common. Familiarity with the type and timing of previous radiation therapy, the spectrum of imaging findings after radiation injury, and the appropriate use of the different radiotracers can be crucial. This article summarizes postradiation histologic findings and multimodality imaging findings, with emphasis on PET/computed tomography.
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Affiliation(s)
- Liran Domachevsky
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chun K Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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75
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Multiparametric MRI for recurrent prostate cancer post radical prostatectomy and postradiation therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:316272. [PMID: 24967355 PMCID: PMC4055489 DOI: 10.1155/2014/316272] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/25/2014] [Indexed: 12/30/2022]
Abstract
The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.
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76
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Yu J, Fulcher AS, Turner MA, Cockrell CH, Cote EP, Wallace TJ. Prostate cancer and its mimics at multiparametric prostate MRI. Br J Radiol 2014; 87:20130659. [PMID: 24646125 DOI: 10.1259/bjr.20130659] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
One in six males will develop prostate cancer during their lifetime. Prostate cancer is the second leading cause of cancer death in American males, behind only lung cancer. Unfortunately, even though this disease is so common, clinical screening methods such as prostate-specific antigen test and transrectal ultrasound-guided prostate biopsy lack sensitivity and specificity in diagnosing prostate cancer. In recent years, multiparametric prostate MRI has emerged as a very important tool in the diagnosis of prostate carcinoma with a high accuracy. However, diagnostic difficulty is often encountered even with an experienced abdominal radiologist. That is mainly because many normal and abnormal entities can mimic prostate carcinoma at multiparametric MRI. Therefore, the purpose of this pictorial review is to discuss the usefulness of multiparametric prostate MRI in the diagnosis of prostate carcinoma, emphasizing the key MRI features that help to make a distinction of prostate carcinoma from its mimics.
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Affiliation(s)
- J Yu
- Department of Radiology, Virginia Commonwealth University Health System Main Hospital, Richmond, VA, USA
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77
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Advanced imaging for the early diagnosis of local recurrence prostate cancer after radical prostatectomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:827265. [PMID: 24757679 PMCID: PMC3971570 DOI: 10.1155/2014/827265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/06/2014] [Indexed: 12/30/2022]
Abstract
Currently the diagnosis of local recurrence of prostate cancer (PCa) after radical prostatectomy (RT) is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA) higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI) in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence.
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78
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Fennessy FM, McKay RR, Beard CJ, Taplin ME, Tempany CM. Dynamic contrast-enhanced magnetic resonance imaging in prostate cancer clinical trials: potential roles and possible pitfalls. Transl Oncol 2014; 7:120-9. [PMID: 24772215 PMCID: PMC3998683 DOI: 10.1593/tlo.13922] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/04/2014] [Accepted: 03/06/2014] [Indexed: 12/21/2022] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluates the tissue microvasculature and may have a role in assessing and predicting therapeutic response in prostate cancer (PCa). In this review, we review principles of DCE-MRI and present the potential quantitative information that can be obtained. We discuss how it may be used as a biomarker for treatment with antiangiogenic and antivascular agents and potentially identify patients with PCa who may benefit from this form of therapy. Likewise, DCE-MRI may play a role in assessing response to combined androgen deprivation therapy and radiation therapy and theoretically could be a prognostic biomarker in evaluating second-generation hormone therapies. We also address the challenges of using DCE-MRI in PCa clinical trials and discuss the difficulties with standardization of this methodology to allow for biomarker validation, with particular reference to PCa.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, MA ; Department of Radiology, Dana-Farber Cancer Institute, Boston, MA
| | - Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Clair J Beard
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
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79
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Leake JL, Hardman R, Ojili V, Thompson I, Shanbhogue A, Hernandez J, Barentsz J. Prostate MRI: access to and current practice of prostate MRI in the United States. J Am Coll Radiol 2014; 11:156-60. [PMID: 24389134 PMCID: PMC4169888 DOI: 10.1016/j.jacr.2013.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/09/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE MRI of the prostate has increasingly become more important in clinical medicine because of the risk of over-detection of low-grade, low-volume prostate cancer, as well as because of the poor sampling of transrectal ultrasound-guided prostate biopsy in high-risk patients. We sought to determine the access, imaging protocols, and indications for MRI imaging of the prostate in the United States. METHODS A brief survey was sent through mailing lists to members of the Society of Abdominal Radiology and Texas Radiological Society. RESULTS Thirty-six academic centers responded to the survey, 88.9% of which routinely perform prostate MRI. Nine centers routinely performed imaging at 1.5T with an endorectal coil (25%), 11 performed at 3.0T without an endorectal coil (31%), and 10 performed at 3.0T with an endorectal coil (28%). All institutions used T1-weighted axial and orthogonal T2-weighted sequences. Most groups used diffusion-weighted imaging (94.7%) and dynamic contrast enhancement (81.6%). Only 21.1% of groups performing prostate MRI routinely performed MR spectroscopy as part of their protocol. CONCLUSIONS Prostate MRI is becoming a commonly performed examination at academic institutions, with most locations performing prostate MRI at minimum standards. There is a need to educate nonacademic practices regarding the addition of functional MRI techniques to anatomic techniques, increase the number of institutions that regularly perform prostate MRI, and increase access to direct MRI-guided biopsy in institutions that perform prostate MRI on a regular basis.
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Affiliation(s)
- James L Leake
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rulon Hardman
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ian Thompson
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alampady Shanbhogue
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Javier Hernandez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jelle Barentsz
- Department of Radiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
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Fedorov A, Fluckiger J, Ayers GD, Li X, Gupta SN, Tempany C, Mulkern R, Yankeelov TE, Fennessy FM. A comparison of two methods for estimating DCE-MRI parameters via individual and cohort based AIFs in prostate cancer: a step towards practical implementation. Magn Reson Imaging 2014; 32:321-9. [PMID: 24560287 DOI: 10.1016/j.mri.2014.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/20/2013] [Accepted: 01/07/2014] [Indexed: 12/17/2022]
Abstract
Multi-parametric Magnetic Resonance Imaging, and specifically Dynamic Contrast Enhanced (DCE) MRI, play increasingly important roles in detection and staging of prostate cancer (PCa). One of the actively investigated approaches to DCE MRI analysis involves pharmacokinetic (PK) modeling to extract quantitative parameters that may be related to microvascular properties of the tissue. It is well-known that the prescribed arterial blood plasma concentration (or Arterial Input Function, AIF) input can have significant effects on the parameters estimated by PK modeling. The purpose of our study was to investigate such effects in DCE MRI data acquired in a typical clinical PCa setting. First, we investigated how the choice of a semi-automated or fully automated image-based individualized AIF (iAIF) estimation method affects the PK parameter values; and second, we examined the use of method-specific averaged AIF (cohort-based, or cAIF) as a means to attenuate the differences between the two AIF estimation methods. Two methods for automated image-based estimation of individualized (patient-specific) AIFs, one of which was previously validated for brain and the other for breast MRI, were compared. cAIFs were constructed by averaging the iAIF curves over the individual patients for each of the two methods. Pharmacokinetic analysis using the Generalized kinetic model and each of the four AIF choices (iAIF and cAIF for each of the two image-based AIF estimation approaches) was applied to derive the volume transfer rate (K(trans)) and extravascular extracellular volume fraction (ve) in the areas of prostate tumor. Differences between the parameters obtained using iAIF and cAIF for a given method (intra-method comparison) as well as inter-method differences were quantified. The study utilized DCE MRI data collected in 17 patients with histologically confirmed PCa. Comparison at the level of the tumor region of interest (ROI) showed that the two automated methods resulted in significantly different (p<0.05) mean estimates of ve, but not of K(trans). Comparing cAIF, different estimates for both ve, and K(trans) were obtained. Intra-method comparison between the iAIF- and cAIF-driven analyses showed the lack of effect on ve, while K(trans) values were significantly different for one of the methods. Our results indicate that the choice of the algorithm used for automated image-based AIF determination can lead to significant differences in the values of the estimated PK parameters. K(trans) estimates are more sensitive to the choice between cAIF/iAIF as compared to ve, leading to potentially significant differences depending on the AIF method. These observations may have practical consequences in evaluating the PK analysis results obtained in a multi-site setting.
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Affiliation(s)
- Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
| | - Jacob Fluckiger
- Department of Radiology, Northwestern University, Chicago, Illinois 60611
| | - Gregory D Ayers
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee 37212
| | - Xia Li
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37212; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee 37212
| | | | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Robert Mulkern
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115
| | - Thomas E Yankeelov
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37212; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee 37212; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37212; Department of Physics, Vanderbilt University, Nashville, Tennessee 37212; Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee 37212
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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81
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Shukla-Dave A, Hricak H. Role of MRI in prostate cancer detection. NMR IN BIOMEDICINE 2014; 27:16-24. [PMID: 23495081 DOI: 10.1002/nbm.2934] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/08/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
The standard approach for the detection of prostate cancer--prostate-specific antigen (PSA) screening followed by transrectal ultrasonography (TRUS)-guided biopsy--has low sensitivity and provides limited information about the true extent and aggressiveness of the cancer. Improved methods are needed to assess the extent and aggressiveness of the cancer and to identify patients who will benefit from therapy. In recent years, there has been tremendous development of acquisition and processing tools for physiological and metabolic MRI techniques which play a potential role in the detection, localization and characterization of prostate cancer, such as dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI) and/or proton MR spectroscopic imaging ((1)H MRSI). The standard protocol for prostate MRI without the use of a contrast agent involves multi-planar T1 -weighted MRI, T2 -weighted MRI and DW-MRI. This review discusses the potential role of MRI in the detection of prostate cancer, specifically describing the status of MRI as a tool for guiding targeted prostate biopsies and for detecting cancer in the untreated and treated gland. In addition, future areas of MRI research are briefly discussed. Groups conducting clinical trials should consider the recommendations put forward by the European Consensus Meeting, which state that the minimum requirements for prostate MRI are T1 -weighted MRI, T2 -weighted MRI, DCE-MRI (which involves the use of a contrast agent) and DW-MRI with a pelvic phased-array coil and propose the use of transperineal template mapping biopsies as the optimal reference standard.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Muller BG, Fütterer JJ, Gupta RT, Katz A, Kirkham A, Kurhanewicz J, Moul JW, Pinto PA, Rastinehad AR, Robertson C, de la Rosette J, Sanchez-Salas R, Jones JS, Ukimura O, Verma S, Wijkstra H, Marberger M. The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel. BJU Int 2013; 113:218-27. [PMID: 24215670 DOI: 10.1111/bju.12243] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. METHODS Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? RESULTS Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. CONCLUSIONS The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.
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Affiliation(s)
- Berrend G Muller
- Department of Urology, AMC University Hospital, Amsterdam, the Netherlands
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83
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Strategies for imaging androgen receptor signaling pathway in prostate cancer: implications for hormonal manipulation and radiation treatment. BIOMED RESEARCH INTERNATIONAL 2013; 2013:460546. [PMID: 24286079 PMCID: PMC3830798 DOI: 10.1155/2013/460546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/16/2013] [Indexed: 12/22/2022]
Abstract
Prostate cancer (Pca) is a heterogeneous disease; its etiology appears to be related to genetic and epigenetic factors. Radiotherapy and hormone manipulation are effective treatments, but many tumors will progress despite these treatments. Molecular imaging provides novel opportunities for image-guided optimization and management of these treatment modalities. Here we reviewed the advances in targeted imaging of key biomarkers of androgen receptor signaling pathways. A computerized search was performed to identify all relevant studies in Medline up to 2013. There are well-known limitations and inaccuracies of current imaging approaches for monitoring biological changes governing tumor progression. The close integration of molecular biology and clinical imaging could ease the development of new molecular imaging agents providing novel tools to monitor a number of biological events that, until a few years ago, were studied by conventional molecular assays. Advances in translational research may represent the next step in improving the oncological outcome of men with Pca who remain at high risk for systemic failure. This aim may be obtained by combining the anatomical properties of conventional imaging modalities with biological information to better predict tumor response to conventional treatments.
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84
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Marigliano C, Donati OF, Vargas HA, Akin O, Goldman DA, Eastham JA, Zelefsky MJ, Hricak H. MRI findings of radiation-induced changes in the urethra and periurethral tissues after treatment for prostate cancer. Eur J Radiol 2013; 82:e775-81. [PMID: 24119430 DOI: 10.1016/j.ejrad.2013.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/15/2013] [Accepted: 09/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess radiotherapy (RT)-induced changes in the urethra and periurethral tissues after treatment for prostate cancer (PCa). METHODS AND MATERIALS This retrospective study included 108 men (median age, 64 years; range, 43-87 years) who received external-beam radiotherapy (EBRT) and/or brachytherapy for PCa and underwent endorectal-coil MRI of the prostate within 180 days before RT and a median of 20 months (range, 2-62 months) after RT. On all MRIs, two readers independently measured the urethral length (UL) and graded the margin definition (MD) of the urethral wall and the signal intensities (SIs) of the urethral wall and pelvic muscles on 4-point scales. RESULTS The mean urethral length decreased significantly from pre- to post-RT MRI (from 15.2 to 12.6mm and from 14.4 to 12.9 mm for readers 1 and 2, respectively; both p-values <0.0001). Brachytherapy resulted in greater urethral shortening than EBRT. After RT, SI in the urethral wall increased in 57% (62/108) and 35% (38/108) of patients (readers 1 and 2, respectively). The frequency and magnitude of SI increase in pelvic muscles depended on muscle location. In the obturator internus muscle, SI increased more often after EBRT than after brachytherapy, while in the periurethral levator ani muscle SI increased more often after brachytherapy than after EBRT. CONCLUSION After RT for PCa, MRI shows urethral shortening and increased SI of the urethral wall and pelvic muscles in substantial percentages of patients.
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Affiliation(s)
- Chiara Marigliano
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Radiology, University "Sapienza", Rome, Italy
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Kitajima K, Murphy RC, Nathan MA, Sugimura K. Update on positron emission tomography for imaging of prostate cancer. Int J Urol 2013; 21:12-23. [PMID: 23991644 DOI: 10.1111/iju.12250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/10/2013] [Indexed: 12/11/2022]
Abstract
Prostate cancer is the most common non-cutaneous malignancy among men in the Western world, and continues to be a major health problem. Imaging has recently become more important in the clinical management of prostate cancer patients, including diagnosis, staging, choice of optimal treatment strategy, treatment follow up and restaging. Positron emission tomography, a functional and molecular imaging technique, has opened a new field in clinical oncological imaging. The most common positron emission tomography radiotracer, 18F-fluorodeoxyglucose, has been limited in imaging of prostate cancer. Recently, however, other positron emission tomography tracers, such as 11C-acetate and 11C- or (18) F-choline, have shown promising results. In the present review article, we overview the potential and current use of positron emission tomography or positron emission tomography/computed tomography imaging employing the four most commonly used positron emission tomography radiotracers, 18F-fluorodeoxyglucose, 11C-acetate and 11C- or 18F-choline, for imaging evaluation of prostate cancer.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University School of Medicine, Kobe, Japan
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86
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Souvatzoglou M, Eiber M, Martinez-Moeller A, Fürst S, Holzapfel K, Maurer T, Ziegler S, Nekolla S, Schwaiger M, Beer AJ. PET/MR in prostate cancer: technical aspects and potential diagnostic value. Eur J Nucl Med Mol Imaging 2013; 40 Suppl 1:S79-88. [DOI: 10.1007/s00259-013-2445-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 01/29/2023]
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Meta-analysis of diffusion-weighted magnetic resonance imaging in detecting prostate cancer. J Comput Assist Tomogr 2013; 37:195-202. [PMID: 23493208 DOI: 10.1097/rct.0b013e3182801ae1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to determine the diagnostic performance of quantitative diffusion-weighted magnetic resonance imaging in detection of prostate cancer. METHODS A comprehensive search was performed for English articles published before May 2012 that fulfilled the following criteria: patients had histopathologically proved prostate cancer; diffusion-weighted imaging (DWI) was performed for the detection of prostate cancer, and data for calculating sensitivity and specificity were included. Methodological quality was assessed by using the quality assessment of diagnostic studies instrument. Publication bias analysis, homogeneity, inconsistency index, and threshold effect were performed by STATA version 12. RESULTS Of 119 eligible studies, 12 with 1637 malignant and 4803 benign lesions were included. There was notable heterogeneity beyond threshold effect and publication bias. The sensitivity and specificity with 95% confidence interval (CI) estimates of DWI on a per-lesion basis were 77% (CI, 0.76-0.84) and 84% (CI, 0.78-0.89), respectively, and the area under the curve of summary receiver operating characteristic curve was 0.88 (CI, 0.85-0.90). The overall positive and negative likelihood ratios with 95% CI were 4.93 (3.39-7.17) and 0.278 (0.19-0.39), respectively. CONCLUSIONS Quantitative DWI has a relative sensitivity and specificity to distinguish malignant from benign in prostate lesions. However, large-scale randomized control trials are necessary to assess its clinical value because of nonuniformed diffusion gradient b factor, diagnosis threshold, and small number of studies.
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Grant K, Lindenberg ML, Shebel H, Pang Y, Agarwal HK, Bernardo M, Kurdziel KA, Turkbey B, Choyke PL. Functional and molecular imaging of localized and recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2013; 40 Suppl 1:S48-59. [PMID: 23649462 DOI: 10.1007/s00259-013-2419-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 01/17/2023]
Abstract
Prostate cancer is the most common malignancy among American men. Imaging of localized and recurrent prostate cancer is challenging since conventional imaging techniques are limited. New imaging techniques such as multiparametric MRI and PET with targeted tracers have been investigated extensively in the last decade. As a result, the role of novel imaging techniques for the detection of localized and recurrent prostate cancer has recently expanded. In this review, novel functional and molecular imaging techniques used in the management of localized and recurrent prostate cancer are discussed.
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Affiliation(s)
- Kinzya Grant
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD 20892-1088, USA
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89
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Donati OF, Jung SI, Vargas HA, Gultekin DH, Zheng J, Moskowitz CS, Hricak H, Zelefsky MJ, Akin O. Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology 2013; 268:440-50. [PMID: 23481164 DOI: 10.1148/radiol.13122149] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare diagnostic accuracy of T2-weighted magnetic resonance (MR) imaging with that of multiparametric (MP) MR imaging combining T2-weighted imaging with diffusion-weighted (DW) MR imaging, dynamic contrast material-enhanced (DCE) MR imaging, or both in the detection of locally recurrent prostate cancer (PCa) after radiation therapy (RT). MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Fifty-three men (median age, 70 years) suspected of having post-RT recurrence of PCa underwent MP MR imaging, including DW and DCE sequences, within 6 months after biopsy. Two readers independently evaluated the likelihood of PCa with a five-point scale for T2-weighted imaging alone, T2-weighted imaging with DW imaging, T2-weighted imaging with DCE imaging, and T2-weighted imaging with DW and DCE imaging, with at least a 4-week interval between evaluations. Areas under the receiver operating characteristic curve (AUC) were calculated. Interreader agreement was assessed, and quantitative parameters (apparent diffusion coefficient [ADC], volume transfer constant [K(trans)], and rate constant [k(ep)]) were assessed at sextant- and patient-based levels with generalized estimating equations and the Wilcoxon rank sum test, respectively. RESULTS At biopsy, recurrence was present in 35 (66%) of 53 patients. In detection of recurrent PCa, T2-weighted imaging with DW imaging yielded higher AUCs (reader 1, 0.79-0.86; reader 2, 0.75-0.81) than T2-weighted imaging alone (reader 1, 0.63-0.67; reader 2, 0.46-0.49 [P ≤ .014 for all]). DCE sequences did not contribute significant incremental value to T2-weighted imaging with DW imaging (reader 1, P > .99; reader 2, P = .35). Interreader agreement was higher for combinations of MP MR imaging than for T2-weighted imaging alone (κ = 0.34-0.63 vs κ = 0.17-0.20). Medians of quantitative parameters differed significantly (P < .0001 to P = .0233) between benign tissue and PCa (ADC, 1.64 × 10(-3) mm(2)/sec vs 1.13 × 10(-3) mm(2)/sec; K(trans), 0.16 min(-1) vs 0.33 min(-1); k(ep), 0.36 min(-1) vs 0.62 min(-1)). CONCLUSION MP MR imaging has greater accuracy in the detection of recurrent PCa after RT than T2-weighted imaging alone, with no additional benefit if DCE is added to T2-weighted imaging and DW imaging.
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Affiliation(s)
- Olivio F Donati
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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Maturen KE, Feng MU, Wasnik AP, Azar SF, Appelman HD, Francis IR, Platt JF. Imaging Effects of Radiation Therapy in the Abdomen and Pelvis: Evaluating “Innocent Bystander” Tissues. Radiographics 2013; 33:599-619. [DOI: 10.1148/rg.332125119] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Prostate cancer recurrence after radical prostatectomy: the role of 3-T diffusion imaging in multi-parametric magnetic resonance imaging. Eur Radiol 2013; 23:1745-52. [DOI: 10.1007/s00330-013-2768-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/04/2012] [Accepted: 12/10/2012] [Indexed: 12/18/2022]
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Giovacchini G, Picchio M, Garcia-Parra R, Mapelli P, Briganti A, Montorsi F, Gianolli L, Messa C. [11C]choline positron emission tomography/computerized tomography for early detection of prostate cancer recurrence in patients with low increasing prostate specific antigen. J Urol 2012; 189:105-10. [PMID: 23164385 DOI: 10.1016/j.juro.2012.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The effectiveness of salvage therapy in prostate cancer is greater for low prostate specific antigen values. Therefore, early detection of tumor recurrence is warranted. [(11)C]choline positron emission tomography/computerized tomography has the potential of early restaging of prostate cancer with low prostate specific antigen, but the selection of patients at high risk for positive [(11)C]choline positron emission tomography/computerized tomography is desirable to optimize salvage therapy. MATERIALS AND METHODS This retrospective study included 75 patients with prostate cancer with an increasing prostate specific antigen less than 1.5 ng/ml after radical prostatectomy who never received antiandrogen deprivation therapy or salvage radiotherapy who underwent [(11)C]choline positron emission tomography/computerized tomography for the restaging of disease. Binary logistic regression was used to assess predictive factors of positive [(11)C]choline positron emission tomography/computerized tomography. Included variables were trigger prostate specific antigen, prostate specific antigen doubling time, age, pathological stage and Gleason score. RESULTS Median prostate specific antigen was 0.61 ng/ml. [(11)C]choline positron emission tomography/computerized tomography was positive in 16 of 75 patients (21%). On univariate analysis prostate specific antigen doubling time less than 6 months was the only factor significantly associated with an increased risk of positive [(11)C]choline positron emission tomography/computerized tomography (OR 7.77, 95% CI 2.34-25.80, p = 0.001). In patients with prostate specific antigen doubling time less than 6 months, the positive detection rate of [(11)C]choline positron emission tomography/computerized tomography increased to 50%. CONCLUSIONS In patients with prostate cancer with biochemical failure after radical prostatectomy and prostate specific antigen less than 1.5 ng/ml, prostate specific antigen doubling time less than 6 months predicts positive [(11)C]choline positron emission tomography/computerized tomography. In these patients [(11)C]choline positron emission tomography/computerized tomography may reduce by 50% the number in whom salvage therapy is initiated empirically without knowing the disease location.
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Lazzeri M, Guazzoni G, Montorsi F. Focal HIFU for prostate cancer. Lancet Oncol 2012; 13:e281-2; author reply e284. [DOI: 10.1016/s1470-2045(12)70305-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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