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Brizmohun Appayya M, Adshead J, Ahmed HU, Allen C, Bainbridge A, Barrett T, Giganti F, Graham J, Haslam P, Johnston EW, Kastner C, Kirkham AP, Lipton A, McNeill A, Moniz L, Moore CM, Nabi G, Padhani AR, Parker C, Patel A, Pursey J, Richenberg J, Staffurth J, van der Meulen J, Walls D, Punwani S. National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection - recommendations from a UK consensus meeting. BJU Int 2018; 122:13-25. [PMID: 29699001 PMCID: PMC6334741 DOI: 10.1111/bju.14361] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify areas of agreement and disagreement in the implementation of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway. MATERIALS AND METHODS Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California-Los Angeles (UCLA-RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of ≥7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required. RESULTS Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy. CONCLUSIONS Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk.
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Affiliation(s)
- Mrishta Brizmohun Appayya
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Jim Adshead
- Department of UrologyHertfordshire and Bedfordshire Urological Cancer CentreLister HospitalStevenageHertfordshireUK
| | - Hashim U. Ahmed
- Division of Surgery and Interventional ScienceFaculty of Medical SciencesUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Division of SurgeryDepartment of Surgery and CancerImperial College London and Imperial UrologyImperial College Healthcare NHS TrustLondonUK
| | - Clare Allen
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Alan Bainbridge
- Department of Medical PhysicsUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Tristan Barrett
- Department of RadiologyAddenbrooke's Hospital and University of CambridgeCambridgeUK
| | - Francesco Giganti
- Division of Surgery and Interventional ScienceFaculty of Medical SciencesUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - John Graham
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Phil Haslam
- Department of RadiologyFreeman HospitalNewcastle upon TyneUK
| | - Edward W. Johnston
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Christof Kastner
- Department of UrologyAddenbrooke's Hospital and University of CambridgeCambridgeUK
| | - Alexander P.S. Kirkham
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | | | - Alan McNeill
- Department of UrologyNHS LothianWestern General HospitalEdinburghUK
| | | | - Caroline M. Moore
- Division of SurgeryDepartment of Surgery and CancerImperial College London and Imperial UrologyImperial College Healthcare NHS TrustLondonUK
- Department of UrologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Ghulam Nabi
- Division of Cancer ResearchNinewells HospitalDundeeUK
| | - Anwar R. Padhani
- Paul Strickland Scanner CentreMount Vernon HospitalNorthwoodMiddlesexUK
| | - Chris Parker
- Department of Academic UrologyRoyal Marsden HospitalSuttonSurreyUK
| | - Amit Patel
- Department of RadiologyLister HospitalStevenageHertfordshireUK
| | | | - Jonathan Richenberg
- Department of RadiologyRoyal Sussex County Hospital Brighton and Brighton and Sussex Medical SchoolBrightonSussexUK
| | - John Staffurth
- Division of Cancer and GeneticsSchool of MedicineCardiff UniversityCardiffUK
| | | | - Darren Walls
- Division of Nuclear MedicineUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Shonit Punwani
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
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Role of Magnetic Resonance Imaging Targeted Biopsy in Detection of Prostate Cancer Harboring Adverse Pathological Features of Intraductal Carcinoma and Invasive Cribriform Carcinoma. J Urol 2018; 200:104-113. [DOI: 10.1016/j.juro.2018.01.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/30/2023]
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253
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Hansen NL, Barrett T, Kesch C, Pepdjonovic L, Bonekamp D, O'Sullivan R, Distler F, Warren A, Samel C, Hadaschik B, Grummet J, Kastner C. Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy-naïve men with suspicion of prostate cancer. BJU Int 2018; 122:40-49. [PMID: 29024425 DOI: 10.1111/bju.14049] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To analyse the detection rates of primary magnetic resonance imaging (MRI)-fusion transperineal prostate biopsy using combined targeted and systematic core distribution in three tertiary referral centres. PATIENTS AND METHODS In this multicentre, prospective outcome study, 807 consecutive biopsy-naïve patients underwent MRI-guided transperineal prostate biopsy, as the first diagnostic intervention, between 10/2012 and 05/2016. MRI was reported following the Prostate Imaging-Reporting and Data System (PI-RADS) criteria. In all, 236 patients had 18-24 systematic transperineal biopsies only, and 571 patients underwent additional targeted biopsies either by MRI-fusion or cognitive targeting if PI-RADS ≥3 lesions were present. Detection rates for any and Gleason score 7-10 cancer in targeted and overall biopsy were calculated and predictive values were calculated for different PI-RADS and PSA density (PSAD) groups. RESULTS Cancer was detected in 68% of the patients (546/807) and Gleason score 7-10 cancer in 49% (392/807). The negative predictive value of 236 PI-RADS 1-2 MRI in combination with PSAD of <0.1 ng/mL/mL for Gleason score 7-10 was 0.91 (95% confidence interval ± 0.07, 8% of study population). In 418 patients with PI-RADS 4-5 lesions using targeted plus systematic biopsies, the cancer detection rate of Gleason score 7-10 was significantly higher at 71% vs 59% and 61% with either approach alone (P < 0.001). For 153 PI-RADS 3 lesions, the detection rate was 31% with no significant difference to systematic biopsies with 27% (P > 0.05). Limitations include variability of multiparametric MRI (mpMRI) reading and Gleason grading. CONCLUSION MRI-based transperineal biopsy performed at high-volume tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of Gleason score 7-10 cancer. Prostate biopsies may not be needed for men with low PSAD and an unsuspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended.
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Affiliation(s)
- Nienke L Hansen
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lana Pepdjonovic
- Australian Urology Associates and Department of Surgery, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Florian Distler
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anne Warren
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Christina Samel
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jeremy Grummet
- Australian Urology Associates and Department of Surgery, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - Christof Kastner
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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254
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Negative Multiparametric Magnetic Resonance Imaging for Prostate Cancer: What's Next? Eur Urol 2018; 74:48-54. [DOI: 10.1016/j.eururo.2018.03.007] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 03/07/2018] [Indexed: 01/13/2023]
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255
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Xi Y, Liu A, Olumba F, Lawson P, Costa DN, Yuan Q, Khatri G, Yokoo T, Pedrosa I, Lenkinski RE. Low-to-high b value DWI ratio approaches in multiparametric MRI of the prostate: feasibility, optimal combination of b values, and comparison with ADC maps for the visual presentation of prostate cancer. Quant Imaging Med Surg 2018; 8:557-567. [PMID: 30140618 DOI: 10.21037/qims.2018.06.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Diffusion-weighted imaging (DWI) is considered by experts as one of the key elements in multi-parametric magnetic resonance imaging (mpMRI) employed in oncological studies outside the brain. A low-to-high b value ratio DWI has been proposed as an approach to decrease acquisition time and simplify the analysis of DWI data without the need to use a mathematical model. Methods Forty-three men with biopsy-proven prostate cancer (PCa) who underwent mpMRI of the prostate were included. Apparent diffusion coefficient (ADC) maps were created in the MRI scanner using a mono-exponential algorithm [b value (× number of averages) =0 (×1), 10 (×1), 25 (×1), 50 (×1), 100 (×1), 250 (×1), 450 (×1), 1,000 (×2), 1,500 (×3), and 2,000 (×5) s/mm2]. DWI ratio images were calculated with three previously estimated optimal b value combinations: (I) b=100 and b=1,000 s/mm2 (R1); (II) b=100 and b=1,500 s/mm2 (R2); and (III) b=100 and b=2,000 s/mm2 (R3). For quantitative analysis, contrast-to-noise ratio (CNR) between normal and cancerous tissue was compared between the ADC maps and the DWI ratio images in terms of noninferiority. For qualitative analysis, two radiologists read all images in a randomized order without knowing whether the presented image was an ADC map or a DWI ratio image. All images were scored in terms of artifacts, cancer conspicuity and overall image quality with a 5-point scale. Agreement between the readers was assessed by weighted kappa statistics. Agreement was considered as poor when kappa <0.4, fair to good when kappa >0.4 and <0.75 and excellent when kappa >0.75. Mean scores were compared between ADC and each of the DWI ratio images. Agreement between ADC maps and DWI ratio based synthetic ADC were assessed by intraclass correlation (ICC). Values less than 0.5, between 0.5 and 0.75, between 0.75 and 0.9, and greater than 0.90 were indicative of poor, moderate, good, and excellent reliability, respectively. Median difference between low and intermediate/high risk were tested. Results Quantitative analysis shows DWI ratio images were not inferior to ADC maps quantitatively [P=0.0298 (ADC vs. R1), <0.0001 (ADC vs. R2) and <0.0001 (ADC vs. R3)]. Qualitatively, DWI ratio images were no more than 0.5 point on Likert scale lower than ADC in overall quality [P=0.0043 (ADC vs. R1), <0.0001 (ADC vs. R2), <0.0001 (ADC vs. R3)]. Reader agreement for the qualitative analysis was good to excellent (weighted kappa =0.4-0.7). Agreement between ADC maps and the synthetic ADC's were excellent. Significant difference between low and intermediate/high risk were found in all measurements on average (all P values <0.05). Conclusions We presented an analytical method for searching for the optimal combination of high and low b values for DWI ratio images in terms of minimizing CNR between cancer and surrounding benign tissues. Optimized DWI ratio images are comparable both quantitatively and qualitatively to ADC maps for the interpretation of DWI data in the context of prostate mpMRI.
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Affiliation(s)
- Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alexander Liu
- Medical School, UT Southwestern Medical Center, Dallas, TX, USA
| | - Franklin Olumba
- Medical School, UT Southwestern Medical Center, Dallas, TX, USA
| | - Parker Lawson
- Medical School, UT Southwestern Medical Center, Dallas, TX, USA
| | - Daniel N Costa
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Qing Yuan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gaurav Khatri
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Takeshi Yokoo
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ivan Pedrosa
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Robert E Lenkinski
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
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Prostate Cancer Risk Assessment in Biopsy-naïve Patients: The Rotterdam Prostate Cancer Risk Calculator in Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound (TRUS) Fusion Biopsy and Systematic TRUS Biopsy. Eur Urol Oncol 2018; 1:109-117. [DOI: 10.1016/j.euo.2018.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/13/2018] [Indexed: 11/15/2022]
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257
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Boesen L, Nørgaard N, Løgager V, Balslev I, Bisbjerg R, Thestrup KC, Winther MD, Jakobsen H, Thomsen HS. Assessment of the Diagnostic Accuracy of Biparametric Magnetic Resonance Imaging for Prostate Cancer in Biopsy-Naive Men: The Biparametric MRI for Detection of Prostate Cancer (BIDOC) Study. JAMA Netw Open 2018; 1:e180219. [PMID: 30646066 PMCID: PMC6324414 DOI: 10.1001/jamanetworkopen.2018.0219] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Multiparametric magnetic resonance imaging (MRI) enhances detection and risk stratification for significant prostate cancer but is time-consuming (approximately 40 minutes) and expensive. Rapid and simpler (approximately 15-minute) biparametric MRI (bpMRI) using fewer scan sequences could be implemented as a prostate MRI triage test on a larger scale before performing biopsies. OBJECTIVES To assess the diagnostic accuracy and negative predictive value (NPV) of a novel bpMRI method in biopsy-naive men in detecting and ruling out significant prostate cancer in confirmatory biopsies. DESIGN, SETTING, AND PARTICIPANTS A single-institutional, paired, prospective cohort study of biopsy-naive men with clinical suspicion of prostate cancer from November 1, 2015, to June 15, 2017. INTERVENTIONS All patients underwent bpMRI (T2-weighted and diffusion-weighted imaging) followed by standard transrectal ultrasound-guided biopsies (all men) and targeted biopsies of men with suspicious bpMRI findings. MAIN OUTCOMES AND MEASURES Suspicion grades of bpMRI, biopsy results, and NPV of bpMRI were evaluated for detection of or ruling out significant prostate cancer (Gleason score ≥4 + 3 or maximum cancerous core length >50% for Gleason score 3 + 4). We compared the diagnostic performance of standard biopsies in all men vs standard plus targeted (combined) biopsies restricted to men with suspicious bpMRI findings. The reference standard was combined biopsy results from all men. RESULTS A total of 1020 men were enrolled, with a median age of 67 years (interquartile range, 61-71 years) and a median prostate-specific antigen level of 8.0 ng/mL (interquartile range, 5.7-13.0 ng/mL). Combined biopsies detected any and significant prostate cancer in 655 of 1020 men (64%) and 404 of 1020 men (40%), respectively. Restricting combined biopsies to men with suspicious bpMRI findings meant 305 of 1020 men (30%) with low-suspicious bpMRIs could avoid prostate biopsies (biopsy in 715 men with suspicious bpMRIs vs all 1020 men who required standard biopsies [70%]; P < .001). Significant prostate cancer diagnoses were improved by 11% (396 vs 351 men; P < .001), and insignificant prostate cancer diagnoses were reduced by 40% (173 vs 288 men; P < .001) compared with our current diagnostic standard, standard biopsies alone in all men. The NPV of bpMRI findings in ruling out significant prostate cancer was 97% (95% CI, 95%-99%). CONCLUSIONS AND RELEVANCE Low-suspicion bpMRI has a high NPV in ruling out significant prostate cancer in biopsy-naive men. Using a simple and rapid bpMRI method as a triage test seems to improve risk stratification and may be used to exclude aggressive disease and avoid unnecessary biopsies with its inherent risks. Future studies are needed to fully explore its role in clinical prostate cancer management.
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Affiliation(s)
- Lars Boesen
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Nis Nørgaard
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Ingegerd Balslev
- Department of Pathology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Rasmus Bisbjerg
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | | | - Mads D. Winther
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Henrik Jakobsen
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Henrik S. Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
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258
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Lughezzani G, Buffi NM, Lazzeri M. Diagnostic Pathway of Patients with a Clinical Suspicion of Prostate Cancer: Does One Size Fit All? Eur Urol 2018; 74:400-401. [PMID: 29803581 DOI: 10.1016/j.eururo.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Giovanni Lughezzani
- Department of Urology, Istituto Clinico Humanitas IRCCS, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Nicolo' Maria Buffi
- Department of Urology, Istituto Clinico Humanitas IRCCS, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS, Humanitas Clinical and Research Center, Rozzano, Italy
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Park SY, Zacharias C, Harrison C, Fan RE, Kunder C, Hatami N, Giesel F, Ghanouni P, Daniel B, Loening AM, Sonn GA, Iagaru A. Gallium 68 PSMA-11 PET/MR Imaging in Patients with Intermediate- or High-Risk Prostate Cancer. Radiology 2018; 288:495-505. [PMID: 29786490 DOI: 10.1148/radiol.2018172232] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose To report the results of dual-time-point gallium 68 (68Ga) prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)/magnetic resonance (MR) imaging prior to prostatectomy in patients with intermediate- or high-risk cancer. Materials and Methods Thirty-three men who underwent conventional imaging as clinically indicated and who were scheduled for radical prostatectomy with pelvic lymph node dissection were recruited for this study. A mean dose of 4.1 mCi ± 0.7 (151.7 MBq ± 25.9) of 68Ga-PSMA-11 was administered. Whole-body images were acquired starting 41-61 minutes after injection by using a GE SIGNA PET/MR imaging unit, followed by an additional pelvic PET/MR imaging acquisition at 87-125 minutes after injection. PET/MR imaging findings were compared with findings at multiparametric MR imaging (including diffusion-weighted imaging, T2-weighted imaging, and dynamic contrast material-enhanced imaging) and were correlated with results of final whole-mount pathologic examination and pelvic nodal dissection to yield sensitivity and specificity. Dual-time-point metabolic parameters (eg, maximum standardized uptake value [SUVmax]) were compared by using a paired t test and were correlated with clinical and histopathologic variables including prostate-specific antigen level, Gleason score, and tumor volume. Results Prostate cancer was seen at 68Ga-PSMA-11 PET in all 33 patients, whereas multiparametric MR imaging depicted Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions in 26 patients and PI-RADS 3 lesions in four patients. Focal uptake was seen in the pelvic lymph nodes in five patients. Pathologic examination confirmed prostate cancer in all patients, as well as nodal metastasis in three. All patients with normal pelvic nodes in PET/MR imaging had no metastases at pathologic examination. The accumulation of 68Ga-PSMA-11 increased at later acquisition times, with higher mean SUVmax (15.3 vs 12.3, P < .001). One additional prostate cancer was identified only at delayed imaging. Conclusion This study found that 68Ga-PSMA-11 PET can be used to identify prostate cancer, while MR imaging provides detailed anatomic guidance. Hence, 68Ga-PSMA-11 PET/MR imaging provides valuable diagnostic information and may inform the need for and extent of pelvic node dissection.
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Affiliation(s)
- Sonya Youngju Park
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Claudia Zacharias
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Caitlyn Harrison
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Richard E Fan
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Christian Kunder
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Negin Hatami
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Frederik Giesel
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Pejman Ghanouni
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Bruce Daniel
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Andreas M Loening
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Geoffrey A Sonn
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
| | - Andrei Iagaru
- From the Division of Nuclear Medicine and Molecular Imaging (S.Y.P., C.Z., C.H., N.H., A.I.) and Departments of Urology (R.E.F., G.A.S.), Pathology (C.K.), and Radiology (P.G., B.D., A.M.L.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany (F.G.)
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Swaan A, Mannaerts CK, Scheltema MJ, Nieuwenhuijzen JA, Savci-Heijink CD, de la Rosette JJ, van Moorselaar RJA, van Leeuwen TG, de Reijke TM, de Bruin DM. Confocal Laser Endomicroscopy and Optical Coherence Tomography for the Diagnosis of Prostate Cancer: A Needle-Based, In Vivo Feasibility Study Protocol (IDEAL Phase 2A). JMIR Res Protoc 2018; 7:e132. [PMID: 29784633 PMCID: PMC5987046 DOI: 10.2196/resprot.9813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Focal therapy for prostate cancer has been proposed as an alternative treatment to whole-gland therapies in selected men to diminish side effects in localized prostate cancer. As nowadays imaging cannot offer complete prostate cancer disease characterization, multicore systematic biopsies are recommended (transrectal or transperineal). Optical imaging techniques such as confocal laser endomicroscopy and optical coherence tomography allow in vivo, high-resolution imaging. Moreover, they can provide real-time visualization and analysis of tissue and have the potential to offer additive diagnostic information. OBJECTIVE This study has 2 separate primary objectives. The first is to assess the technical feasibility and safety of in vivo focal imaging with confocal laser endomicroscopy and optical coherence tomography. The second is to identify and define characteristics of prostate cancer and normal prostate tissue in confocal laser endomicroscopy and optical coherence tomography imaging by comparing these images with the corresponding histopathology. METHODS In this prospective, in vivo feasibility study, needle-based confocal laser endomicroscopy and optical coherence tomography imaging will be performed before transperineal template mapping biopsy or radical prostatectomy. First, confocal laser endomicroscopy and optical coherence tomography will be performed in 4 patients (2 for each imaging modality) undergoing transperineal template mapping biopsy to assess the feasibility and safety of confocal laser endomicroscopy and optical coherence tomography. If proven to be safe and feasible, confocal laser endomicroscopy and optical coherence tomography will be performed in 10 patients (5 for each imaging modality) undergoing radical prostatectomy. Confocal laser endomicroscopy and optical coherence tomography images will be analyzed by independent, blinded observers. Confocal laser endomicroscopy- and optical coherence tomography-based qualitative and quantitative characteristics and histopathology will be compared. The study complies with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) stage 2a recommendations. RESULTS At present, the study is enrolling patients and results and outcomes are expected in 2019. CONCLUSIONS Confocal laser endomicroscopy and optical coherence tomography are promising optical imaging techniques that can visualize and analyze tissue structure, possible tumor grade, and architecture in real time. They can potentially provide real-time, high-resolution microscopic imaging and tissue characteristics of prostate cancer in conjunction with magnetic resonance imaging or transrectal ultrasound fusion-guided biopsy procedures. This study will provide insight into the feasibility and tissue-specific characteristics of confocal laser endomicroscopy and optical coherence tomography for real-time optical analysis of prostate cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT03253458; https://clinicaltrials.gov/ct2/show/NCT03253458 (Archived by WebCite at http://www.webcitation.org/6z9owM66B). REGISTERED REPORT IDENTIFIER RR1-10.2196/9813.
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Affiliation(s)
- Abel Swaan
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Christophe K Mannaerts
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Jv Scheltema
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jakko A Nieuwenhuijzen
- Department of Urology, VU University Medical Center, VU University, Amsterdam, Netherlands
| | - C Dilara Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jean Jmch de la Rosette
- Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | | | - Ton G van Leeuwen
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Theo M de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel Martijn de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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261
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Velasquez MC, Prakash NS, Venkatramani V, Nahar B, Punnen S. Imaging for the selection and monitoring of men on active surveillance for prostate cancer. Transl Androl Urol 2018; 7:228-235. [PMID: 29732281 PMCID: PMC5911538 DOI: 10.21037/tau.2017.08.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Traditional prostate imaging is fairly limited, and only a few imaging modalities have been used for this purpose. Until today, grey scale ultrasound was the most widely used method for the characterization of the prostatic gland, however its limitations for prostate cancer (PCa) detection are well known and hence ultrasound is primarily used to localize the prostate and facilitate template prostate biopsies. In the past decade, multiparametric magnetic resonance imaging (mpMRI) of the prostate has emerged as a promising tool for the detection of PCa. Evidence has shown the value of mpMRI in the active surveillance (AS) population, given its ability to detect more aggressive disease, with data building up and supporting its use for the selection of patients suitable for surveillance. Additionally, mpMRI targeted biopsies have shown an improved detection rate of aggressive PCa when compared to regular transrectal ultrasound (TRUS) guided biopsies. Current data supports the use of mpMRI in patients considered for AS for reclassification purposes; with a negative mpMRI indicating a decreased risk of reclassification. However, a percentage of patients with negative imaging or low suspicion lesions can experience reclassification, highlighting the importance of repeat confirmatory biopsy regardless of mpMRI findings. At present, no robust data is available to recommend the substitution of regular biopsies with mpMRI in the follow-up of patients on AS and efforts are being made to determine the role of integrating genomic markers with imaging with the objective of minimizing the need of biopsies during the follow up period.
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Affiliation(s)
| | | | | | - Bruno Nahar
- Department of Urology, University of Miami, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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262
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Affiliation(s)
- Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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263
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Xu N, Wu YP, Chen DN, Ke ZB, Cai H, Wei Y, Zheng QS, Huang JB, Li XD, Xue XY. Can Prostate Imaging Reporting and Data System Version 2 reduce unnecessary prostate biopsies in men with PSA levels of 4–10 ng/ml? J Cancer Res Clin Oncol 2018; 144:987-995. [DOI: 10.1007/s00432-018-2616-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
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264
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Schoots IG. MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions? Transl Androl Urol 2018; 7:70-82. [PMID: 29594022 PMCID: PMC5861283 DOI: 10.21037/tau.2017.12.31] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This review focuses on indeterminate lesions on prostate magnetic resonance imaging (MRI), assigned as PI-RADS category 3. The prevalence of PI-RADS 3 index lesion in the diagnostic work-up is significant, varying between one in three (32%) to one in five (22%) men, depending on patient cohort of first biopsies, previously negative biopsies, and active surveillance biopsies. A management strategy must be developed for this group of men with an indeterminate suspicion of having clinically significant prostate cancer (csPCa). Currently available data show that the actual prevalence of csPCa after targeted biopsy in PI-RADS 3 lesions vary between patients groups from one in five (21%) to one in six (16%), depending on previous biopsy status. Although this prevalence is lower in comparison to PI-RADS 4 and PI-RADS 5 lesions, still a considerable proportion of men harbor significant disease. Men with such a PI-RADS 3 lesion should therefore be adequately managed. In general, the clinical approach of using a threshold of PI-RADS ≥4 instead of PI-RADS ≥3 to select MRI for targeted biopsies is not supported by data from our explorative literature search using current definitions of csPCa. A possible adaptation to the threshold of PI-RADS ≥4 in combination with other clinical markers could be considered within an active surveillance protocol, where the balance between the individual risk of missing csPCa and the constant process of repeating prostate biopsies is crucial. In the future, improvements in MR imaging and interpretation, combined with molecular biomarkers and multivariate risk models will all be employed in prostate cancer detection and monitoring. These combinations will aid decision-making in challenging circumstances, such as unclear and diagnostic equivocal results for csPCa at early detection.
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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265
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Kohestani K, Chilov M, Carlsson SV. Prostate cancer screening-when to start and how to screen? Transl Androl Urol 2018; 7:34-45. [PMID: 29594018 PMCID: PMC5861291 DOI: 10.21037/tau.2017.12.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Prostate-specific antigen (PSA) screening reduces prostate cancer (PCa) mortality; however such screening may lead to harm in terms of overdiagnosis and overtreatment. Therefore, upfront shared decision making involving a discussion about pros and cons between a physician and a patient is crucial. Total PSA remains the most commonly used screening tool and is a strong predictor of future life-threatening PCa. Currently there is no strong consensus on the age at which to start PSA screening. Most guidelines recommend PSA screening to start no later than at age 55 and involve well-informed men in good health and a life expectancy of at least 10–15 years. Some suggest to start screening in early midlife for men with familial predisposition and men of African-American descent. Others suggest starting conversations at age 45 for all men. Re-screening intervals can be risk-stratified as guided by the man’s age, general health and PSA-value; longer intervals for those at lower risk and shorter intervals for those at higher risk. Overdiagnosis and unnecessary biopsies can be reduced using reflex tests. Magnetic resonance imaging in the pre-diagnostic setting holds promise in pilot studies and large-scale prospective studies are ongoing.
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Affiliation(s)
- Kimia Kohestani
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marina Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sigrid V Carlsson
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
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266
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Verbeek JFM, Roobol MJ. What is an acceptable false negative rate in the detection of prostate cancer? Transl Androl Urol 2018; 7:54-60. [PMID: 29594020 PMCID: PMC5861290 DOI: 10.21037/tau.2017.12.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In prostate cancer (PCa) screening men and their physicians aim to rule out the presence of potentially life threatening PCa. To date, prostate specific antigen (PSA) testing and systematic prostate biopsy (Bx)—in case of an elevated PSA—are still the main modes of PCa detection. Often uncertainty remains when a PSA-test is <3.0 ng/mL or a Bx shows a benign result, leading to the continuous repeating of procedures. Here we assess the potential consequences of false negatives by studying follow-up data of a purely PSA-based approach with applying sextant Bx, an approach considered to have a high risk of missing PCa diagnosis. Methods Our study population consisted of 19,970 men from the ERSPC project section Rotterdam, initially screened in 1993–1999. We assessed clinically significant Gleason ≥3+4 PCa (csPCa) diagnosis within the 4-year screening interval and subsequent screening round 4 years later in men having a PSA <3.0 ng/mL at initial screening (no Bx) and men with Bx (PSA >3.0 ng/mL), but no PCa detected at that time. In addition, we addressed PCa mortality and PCa diagnosis for men with a negative PSA test and negative Bx, who were retested every 4 years covering a 15-year follow-up. Results A total of 14,935 men had PSA <3.0 ng/mL in the initial screening round, of whom 75 (0.5%) were diagnosed with csPCa at a subsequent screening examination and 2 (<0.1%) in the 4-year screening interval. For 2,260 men with a previously negative Bx at first screening, the figures were 17 (0.8%) and 2 (0.1%) respectively. Indolent PCa (Gleason ≤3+3) was diagnosed in 312 (2%) men with PSA <3.0 ng/mL initially and 115 (5%) men with initial negative Bx. After a 15-year follow-up, 45 (0.3%) PCa deaths occurred in men with initially low PSA, and 29 men (0.2%) had metastasis. For men with negative Bx, 11 (0.5%) PCa deaths occurred and 4 (0.2%) experienced metastasis. Conclusions The false negative rates for men with PSA <3.0 ng/mL and negative sextant Bx are extremely low but not negligible. Proper risk stratification before deciding to biopsy is expected to hardly miss any clinical significant PCa diagnosis. This is especially relevant with the increased use of the relatively expensive multi-parametric magnetic resonance imaging (mpMRI) guided targeted Bx procedures.
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Affiliation(s)
- Jan F M Verbeek
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
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267
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Prostate cancer detection in patients with prior negative biopsy undergoing cognitive-, robotic- or in-bore MRI target biopsy. World J Urol 2018; 36:761-768. [DOI: 10.1007/s00345-018-2189-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/19/2018] [Indexed: 12/28/2022] Open
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268
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High-Intensity Focused Ultrasound (HIFU) Options for High-Risk Prostate Cancer. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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269
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Prostate cancer in 2017: Advances in imaging. Nat Rev Urol 2017; 15:81-82. [PMID: 29231198 DOI: 10.1038/nrurol.2017.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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270
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Velasquez MC, Taylor Smith PJ, Prakash NS, Kava B, Kryvenko ON, Castillo-Acosta R, Bittencourt LK, Gonzalgo ML, Ritch C, Parekh DJ, Punnen S. Malakoplakia of the prostate diagnosed on multiparametric-MRI ultrasound fusion guided biopsy: A case report and review of the literature. Urol Case Rep 2017; 18:94-96. [PMID: 29785385 PMCID: PMC5958940 DOI: 10.1016/j.eucr.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/17/2017] [Accepted: 11/17/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Maria C Velasquez
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paul J Taylor Smith
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Bruce Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosa Castillo-Acosta
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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271
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Focal Ablation of Early-Stage Prostate Cancer: Candidate Selection, Treatment Guidance, and Assessment of Outcome. Urol Clin North Am 2017; 44:575-585. [PMID: 29107274 DOI: 10.1016/j.ucl.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prostate cancer lesions smaller than 0.5 m3, or Gleason pattern 3, are likely clinically insignificant. Clinically significant disease is often limited to a single index lesion. Focal ablation targets this index lesion, maintains oncological control, and minimizes complications by preserving healthy prostate tissue. Template mapping biopsy or multiparametric MRI-targeted biopsies are used to identify appropriate index lesions. Multiple energy modalities have been tested, including high-intensity frequency ultrasound, cryoablation, laser ablation, photodynamic therapy, focal brachytherapy, radiofrequency ablation, irreversible electroporation. Outcome is assessed by biopsy of the target area, triggered by prostate-specific antigen measurements or MRI imaging, or performed per protocol at 12 months.
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272
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Risk of Clinically Significant Prostate Cancer Associated With Prostate Imaging Reporting and Data System Category 3 (Equivocal) Lesions Identified on Multiparametric Prostate MRI. AJR Am J Roentgenol 2017; 210:347-357. [PMID: 29112469 DOI: 10.2214/ajr.17.18516] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study is to determine the frequency of clinically significant cancer (CSC) in Prostate Imaging Reporting and Data System (PI-RADS) category 3 (equivocal) lesions prospectively identified on multiparametric prostate MRI and to identify risk factors (RFs) for CSC that may aid in decision making. MATERIALS AND METHODS Between January 2015 and July 2016, a total of 977 consecutively seen men underwent multiparametric prostate MRI, and 342 underwent MRI-ultrasound (US) fusion targeted biopsy. A total of 474 lesions were retrospectively reviewed, and 111 were scored as PI-RADS category 3 and were visualized using a 3-T MRI scanner. Multiparametric prostate MR images were prospectively interpreted by body subspecialty radiologists trained to use PI-RADS version 2. CSC was defined as a Gleason score of at least 7 on targeted biopsy. A multivariate logistic regression model was constructed to identify the RFs associated with CSC. RESULTS Of the 111 PI-RADS category 3 lesions, 81 (73.0%) were benign, 11 (9.9%) were clinically insignificant (Gleason score, 6), and 19 (17.1%) were clinically significant. On multivariate analysis, three RFs were identified as significant predictors of CSC: older patient age (odds ratio [OR], 1.13; p = 0.002), smaller prostate volume (OR, 0.94; p = 0.008), and abnormal digital rectal examination (DRE) findings (OR, 3.92; p = 0.03). For PI-RADS category 3 lesions associated with zero, one, two, or three RFs, the risk of CSC was 4%, 16%, 62%, and 100%, respectively. PI-RADS category 3 lesions for which two or more RFs were noted (e.g., age ≥ 70 years, gland size ≤ 36 mL, or abnormal DRE findings) had a CSC detection rate of 67% with a sensitivity of 53%, a specificity of 95%, a positive predictive value of 67%, and a negative predictive value of 91%. CONCLUSION Incorporating clinical parameters into risk stratification algorithms may improve the ability to detect clinically significant disease among PI-RADS category 3 lesions and may aid in the decision to perform biopsy.
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273
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Shah TT, To WKL, Ahmed HU. Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways. Expert Rev Anticancer Ther 2017; 17:1159-1168. [PMID: 28933973 DOI: 10.1080/14737140.2017.1383899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION With level 1 evidence now available on the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI) we must now utilise this data in developing an MRI-stratified diagnostic pathway for the early detection of prostate cancer. Areas covered: A literature review was conducted and identified seven randomised control trials (RCT's) assessing the diagnostic accuracy of such a pathway against the previously accepted systematic/random trans-rectal ultrasound guided (TRUS) biopsy pathway. The studies were heterogeneous in their design. Five studies assessed the addition of MRI-targeted biopsies to a standard care systematic TRUS biopsy pathway. Three of these studies showed either an increase in their diagnostic accuracy or the potential to remove systematic biopsies. Two studies looked specifically at a targeted biopsy only pathway and although the results were again mixed, there was no decrease in the diagnostic rate and overall significantly fewer biopsy cores were taken in the MRI group. Expert commentary: Results from these RCT's together with multiple retrospective and prospective studies point towards either an improved diagnostic rate for clinically significant cancer and/or a reduction in the need for systematic biopsies with a MRI-stratified pathway. The challenge for the urological community will be to implement pre-biopsy MRI into a routine clinical pathway with likely independent monitoring of standards.
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Affiliation(s)
- Taimur Tariq Shah
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK.,c Division of Surgery and Interventional Sciences , University College London , London , UK.,d Department of Urology , Whittington Hospitals NHS Trust , London , UK
| | - Wilson King Lim To
- c Division of Surgery and Interventional Sciences , University College London , London , UK
| | - Hashim Uddin Ahmed
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK
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274
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[Indications and limits of ablative therapies in prostate cancer]. Prog Urol 2017; 27:865-886. [PMID: 28918871 DOI: 10.1016/j.purol.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To perform a state of the art about indications and limits of ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 107 articles were analysed. RESULTS The objective to combine reduction of side effects and oncological control has induced recent development of several ablative therapies. Beyond this heterogeneity, some preferential indications appear: unilateral cancer of low risk (but with significant volume, excluding active surveillance) or intermediate risk (excluding majority of grade 4); treatment targeted the index lesion, by quarter or hemi-ablation, based on biopsy and mpMRI. In addition, indications must considered specific limits of each energy, such as gland volume and tumor localization. CONCLUSION Based on new imaging and biopsy, ablative therapies will probably increased its role in the future in management of localize prostate cancer. The multiple ongoing trials will certainly be helpful to better define their indications and limits.
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275
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Tan TW, Png KS, Lee CH, Yuwono A, Yeow Y, Chong KT, Lee YM, Tan CH, Tan YK. MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men. J Endourol 2017; 31:1111-1116. [PMID: 28797178 DOI: 10.1089/end.2017.0485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To test the hypothesis that targeted biopsy has a higher detection rate for clinically significant prostate cancer (csPCa) than systematic biopsy. We defined csPCa as any Gleason sum ≥7 cancer. In patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, to determine if factors, such as prostate-specific antigen density (PSAD) and prostate health index (PHI), can predict csPCa and help select patients for biopsy. MATERIALS AND METHODS We report the first series of targeted biopsies in Southeast Asian men, with comparison against systematic biopsy. Consecutive patients were registered into a prospective institutional review board-approved database in our institution. We reviewed patients who underwent biopsy from May 2016 to June 2017. Inclusion criteria for our study were patients with at least one PI-RADS ≥3, and who underwent both targeted and systematic biopsies in the same sitting. RESULTS There were 115 patients in the study, of whom 74 (64.3%) had a previous negative systematic biopsy. Targeted biopsies detected significantly less Gleason 6 cancers than systematic biopsies (p < 0.01), and demonstrated significantly higher sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for the detection of csPCa. For patients with PI-RADS 3 lesions, PHI and PSAD were found to be the best predictors for csPCa. PSAD <0.10 ng/mL/mL had an NPV of 93% and sensitivity of 92%, while allowing 20% of patients to avoid biopsy. PHI cutoff of <27 would allow 34% of patients to avoid biopsy, with both sensitivity and NPV of 100%. CONCLUSIONS Targeted prostate biopsies were found to be significantly superior to systematic biopsies for the detection of csPCa, while detecting less Gleason 6 cancer. Usage of PSAD and PHI cutoff levels in patients with PI-RADS 3 lesions may enable a number of patients to avoid unnecessary biopsy.
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Affiliation(s)
- Teck Wei Tan
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Keng Siang Png
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Chau Hung Lee
- 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Arianto Yuwono
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Yuyi Yeow
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Kian Tai Chong
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Yee Mun Lee
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Cher Heng Tan
- 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital , Singapore, Singapore
| | - Yung Khan Tan
- 1 Department of Urology, Tan Tock Seng Hospital , Singapore, Singapore
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276
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Loeb S. Re: The Prostate Health Index Adds Predictive Value to Multi-parametric MRI in Detecting Significant Prostate Cancers in a Repeat Biopsy Population. Eur Urol 2017; 72:654-655. [PMID: 28687144 DOI: 10.1016/j.eururo.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 06/07/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA.
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277
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Tay KJ, Schulman AA, Sze C, Tsivian E, Polascik TJ. New advances in focal therapy for early stage prostate cancer. Expert Rev Anticancer Ther 2017. [PMID: 28635336 DOI: 10.1080/14737140.2017.1345630] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Prostate focal therapy offers men the opportunity to achieve oncological control while preserving sexual and urinary function. The prerequisites for successful focal therapy are to accurately identify, localize and completely ablate the clinically significant cancer(s) within the prostate. We aim to evaluate the evidence for current and upcoming technologies that could shape the future of prostate cancer focal therapy in the next five years. Areas covered: Current literature on advances in patient selection using imaging, biopsy and biomarkers, ablation techniques and adjuvant treatments for focal therapy are summarized. A literature search of major databases was performed using the search terms 'focal therapy', 'focal ablation', 'partial ablation', 'targeted ablation', 'image guided therapy' and 'prostate cancer'. Expert commentary: Advanced radiological tools such as multiparametric magnetic resonance imaging (mpMRI), multiparametric ultrasound (mpUS), prostate-specific-membrane-antigen positron emission tomography (PSMA-PET) represent a revolution in the ability to understand cancer function and biology. Advances in ablative technologies now provide a menu of modalities that can be rationalized based on lesion location, size and perhaps in the near future, pre-determined resistance to therapy. However, these need to be carefully studied to establish their safety and efficacy parameters. Adjuvant strategies to enhance focal ablation are under development.
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Affiliation(s)
- Kae Jack Tay
- a Department of Urology , Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center , Singapore.,b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Ariel A Schulman
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Christina Sze
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Efrat Tsivian
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Thomas J Polascik
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
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Rouvière O, Dagonneau T, Cros F, Bratan F, Roche L, Mège-Lechevallier F, Ruffion A, Crouzet S, Colombel M, Rabilloud M. Diagnostic value and relative weight of sequence-specific magnetic resonance features in characterizing clinically significant prostate cancers. PLoS One 2017; 12:e0178901. [PMID: 28599001 PMCID: PMC5466299 DOI: 10.1371/journal.pone.0178901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/19/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the diagnostic weight of sequence-specific magnetic resonance features in characterizing clinically significant prostate cancers (csPCa). Materials and methods We used a prospective database of 262 patients who underwent T2-weighted, diffusion-weighted, and dynamic contrast-enhanced (DCE) imaging before prostatectomy. For each lesion, two independent readers (R1, R2) prospectively defined nine features: shape, volume (V_Max), signal abnormality on each pulse sequence, number of pulse sequences with a marked (S_Max) and non-visible (S_Min) abnormality, likelihood of extracapsular extension (ECE) and PSA density (dPSA). Overall likelihood of malignancy was assessed using a 5-level Likert score. Features were evaluated using the area under the receiver operating characteristic curve (AUC). csPCa was defined as Gleason ≥7 cancer (csPCa-A), Gleason ≥7(4+3) cancer (csPCa-B) or Gleason ≥7 cancer with histological extraprostatic extension (csPCa-C), Results For csPCa-A, the Signal1 model (S_Max+S_Min) provided the best combination of signal-related variables, for both readers. The performance was improved by adding V_Max, ECE and/or dPSA, but not shape. All models performed better with DCE findings than without. When moving from csPCa-A to csPCa-B and csPCa-C definitions, the added value of V_Max, dPSA and ECE increased as compared to signal-related variables, and the added value of DCE decreased. For R1, the best models were Signal1+ECE+dPSA (AUC = 0,805 [95%CI:0,757–0,866]), Signal1+V_Max+dPSA (AUC = 0.823 [95%CI:0.760–0.893]) and Signal1+ECE+dPSA [AUC = 0.840 (95%CI:0.774–0.907)] for csPCa-A, csPCA-B and csPCA-C respectively. The AUCs of the corresponding Likert scores were 0.844 [95%CI:0.806–0.877, p = 0.11], 0.841 [95%CI:0.799–0.876, p = 0.52]) and 0.849 [95%CI:0.811–0.884, p = 0.49], respectively. For R2, the best models were Signal1+V_Max+dPSA (AUC = 0,790 [95%CI:0,731–0,857]), Signal1+V_Max (AUC = 0.813 [95%CI:0.746–0.882]) and Signal1+ECE+V_Max (AUC = 0.843 [95%CI: 0.781–0.907]) for csPCa-A, csPCA-B and csPCA-C respectively. The AUCs of the corresponding Likert scores were 0. 829 [95%CI:0.791–0.868, p = 0.13], 0.790 [95%CI:0.742–0.841, p = 0.12]) and 0.808 [95%CI:0.764–0.845, p = 0.006]), respectively. Conclusion Combination of simple variables can match the Likert score’s results. The optimal combination depends on the definition of csPCa.
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Affiliation(s)
- Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France
- Université de Lyon, Lyon, France; Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
- Inserm, U1032, LabTau, Lyon, France
- * E-mail:
| | - Tristan Dagonneau
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, Villeurbanne, France
| | - Fanny Cros
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France
| | - Flavie Bratan
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Roche
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, Villeurbanne, France
| | | | - Alain Ruffion
- Hospices Civils de Lyon, Department of Urology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Sébastien Crouzet
- Université de Lyon, Lyon, France; Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
- Inserm, U1032, LabTau, Lyon, France
- Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France
| | - Marc Colombel
- Université de Lyon, Lyon, France; Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
- Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France
| | - Muriel Rabilloud
- Université de Lyon, Lyon, France; Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, Villeurbanne, France
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279
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Wallis CJD, Haider MA, Nam RK. Role of mpMRI of the prostate in screening for prostate cancer. Transl Androl Urol 2017; 6:464-471. [PMID: 28725588 PMCID: PMC5503955 DOI: 10.21037/tau.2017.04.31] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Prostate cancer screening offers the opportunity to significantly reduce morbidity and mortality from this disease. Currently, serum prostate-specific antigen (PSA) testing is the most widely used screening modality. However, PSA testing continues to have low positive and negative predictive value leading to unnecessary invasive prostate biopsy while missing patients with aggressive forms of the disease. Magnetic resonance imaging (MRI) has been gaining an increasingly large role in the management of patients with early stage prostate cancer including diagnosis in patients with abnormal PSA levels, monitoring of patients on active surveillance, and staging prior to definitive interventions. MRI-based prostate cancer risk assessment has been shown to better distinguish between clinically-significant and insignificant tumors than PSA testing alone or from nomograms. Preliminary data indicate that, among unselected patients, MRI outperforms PSA in the identification of patients with clinically significant prostate cancer. Further work is needed to examine the role of mpMRI in prostate cancer screening.
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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