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Aker MN, Brisbane WG, Kwan L, Gonzalez S, Priester AM, Kinnaird A, Delfin MK, Felker E, Sisk AE, Kuppermann D, Marks LS. Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes. Cancer Med 2023; 12:9351-9362. [PMID: 36775929 PMCID: PMC10166973 DOI: 10.1002/cam4.5692] [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: 11/30/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa). METHODS 143 men with unilateral csPCa were enrolled in a prospective, observational trial of outpatient PGA-cryotherapy. Treatment was a 2-cycle freeze of the affected prostate part. Participants were evaluated with MRI-guided biopsy (MRGB) at baseline and at 6 months and 18 months after treatment. Absence of csPCa upon MRGB was the primary endpoint; quality-of-life at baseline and at 6 months after treatment was assessed by EPIC-CP questionnaires in the domains of urinary and sexual function. RESULTS Of the 143 participants, 136 (95%) completed MRGB at 6 months after treatment. In 103/136 (76%), the biopsy revealed no csPCa. Of the 103, 71 subsequently had an 18-month comprehensive biopsy; of the 71 with 18-month biopsies, 46 (65%) were found to have no csPCa. MRI lesions became undetectable in 96/130 (74%); declines in median serum PSA levels (6.9 to 2.5 ng/mL), PSA density (0.15 to 0.07), and prostate volume (42 to 34cc) were observed (all p < 0.01). Neither lesion disappearance on MRI nor PSA decline correlated with biopsy outcome. Urinary function was affected only slightly and sexual function moderately. CONCLUSION In the near to intermediate term, partial gland ablation with cryotherapy was found to be a safe and moderately effective treatment of intermediate-risk prostate cancer. Eradication of cancer was better determined by MRI-guided biopsy than by MRI or PSA.
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Affiliation(s)
- Mamdouh N Aker
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Wayne G Brisbane
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Samantha Gonzalez
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | | | - Adam Kinnaird
- Department of Urology, University of Alberta, Edmonton, Alberta, USA
| | - Merdie K Delfin
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Ely Felker
- Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles
| | - Anthony E Sisk
- Department of Pathology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - David Kuppermann
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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Surveillance Value of Apparent Diffusion Coefficient Maps: Multiparametric MRI in Active Surveillance of Prostate Cancer. Cancers (Basel) 2023; 15:cancers15041128. [PMID: 36831471 PMCID: PMC9953850 DOI: 10.3390/cancers15041128] [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: 12/13/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study aims to establish the value of apparent diffusion coefficient maps and other magnetic resonance sequences for active surveillance of prostate cancer. The study included 530 men with an average age of 66, who were under surveillance for prostate cancer. We have used multiparametric magnetic resonance imaging with subsequent transperineal biopsy (TPB) to verify the imaging findings. RESULTS We have observed a level of agreement of 67.30% between the apparent diffusion coefficient (ADC) maps, other magnetic resonance sequences, and the biopsy results. The sensitivity of the apparent diffusion coefficient is 97.14%, and the specificity is 37.50%. According to our data, apparent diffusion coefficient is the most accurate sequence, followed by diffusion imaging in prostate cancer detection. CONCLUSIONS Based on our findings we advocate that the apparent diffusion coefficient should be included as an essential part of magnetic resonance scanning protocols for prostate cancer in at least bi-parametric settings. The best option will be apparent diffusion coefficient combined with diffusion imaging and T2 sequences. Further large-scale prospective controlled studies are required to define the precise role of multiparametric and bi-parametric magnetic resonance in the active surveillance of prostate cancer.
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Wroclawski ML, Amaral BS, Kayano PP, Busato WFS, Westphal SJ, Montagna E, Bianco B, Soares A, Maluf FC, Lemos GC, Carneiro A. Knowledge, attitudes, and practices of active surveillance in prostate cancer among urologists: a real-life survey from Brazil. BMC Urol 2022; 22:86. [PMID: 35706024 PMCID: PMC9199143 DOI: 10.1186/s12894-022-01036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Active surveillance (AS) is the preferred treatment for patients with very low-and low-risk prostate cancer (PCa), but it is underperformed worldwide. This study aimed to report knowledge, attitudes, and practices (KAP) of AS for PCa among urologists in Brazil. Methods This cross-sectional study used a questionnaire with 50 questions divided into participant characteristics, knowledge regarding inclusion criteria for AS, follow-up, intervention triggers, acceptance, and practice for an index patient. Data analysis comprises absolute and relative frequencies of the variables. After that, a logistic regression was performed in order to verify possible patterns of answers provided by the respondents in the index patient questionnaire. Results Questionnaires were sent through the SurveyMonkey® platform to 5,015 urologists using email addresses and through social media. A total of 600 (12%) questionnaires returned and 413 (8.2%) were completed and included in the analysis. Only 53% of urologists adopt AS for low- and very-low-risk PCa. Inclusion criteria were patients with age > 50 years (32.2%), prostate specific antigen (PSA) < 10 ng/mL (87.2%), T1 clinical stage (80.4%), Biopsy Gleason score ≤ 6, positive cores ≤ 2 (44.3%), positive core involvement < 50% (45.3%), and magnetic resonance imaging findings (38.7%). The PSA doubling time was still used by 60.3%. Confirmatory biopsy (55.9%), PSA level (36.6%), and digital rectal examination (34.4%) were considered by most urologists for follow-ups. Patient preference (85.7%), upgrade of Gleason score (73.4%), and increased number of positive cores (66.8%) were associated with conversion to definitive treatment. In an index patient, non-acceptance and active treatment request were the most cited reasons for not performing AS. Conclusion There is significant variability in the KAP of AS in Brazil, which indicates the need to reinforce AS, its inclusion and follow-up criteria, and the benefits for physicians and the general population. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01036-1.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil. .,BP - A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil. .,Faculdade de Medicina do ABC, Santo Andre, SP, Brazil.
| | - Breno Santos Amaral
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
| | - Paulo Priante Kayano
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
| | | | | | - Erik Montagna
- Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil.,Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
| | - Andrey Soares
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil.,Centro Paulista de Oncologia - Oncoclínicas, São Paulo, SP, Brazil.,Latin American Cooperative Oncology Group - Genitourinary, Porto Alegre, RS, Brazil
| | - Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil.,BP - A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
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Satya P, Adams Jr. J, Venkataraman SS, Kumar D, Narayanan R, Nacev A, Macaluso Jr. JN. Office-Based, Single-Sided, Low-Field MRI-Guided Prostate Biopsy. Cureus 2022; 14:e25021. [PMID: 35719765 PMCID: PMC9198285 DOI: 10.7759/cureus.25021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/11/2022] Open
Abstract
This paper describes the workflow of transperineal prostate biopsy (TBx) using the single-sided, low-field Promaxo MRI system (Promaxo Inc., Oakland, California, United States) operating at a field strength ranging between 58 and 74 millitesla (mT). Prostate cancer (PCa) is the leading cause of cancer-related death and the second most frequently diagnosed cancer in men. Systematic biopsy (SBx) with 12-14 cores is the preferred standard of care procedure. The blinded approach of SBx, however, results in several shortcomings, including high rates of false negatives and increased infection rates due to the transrectal approach. The evolution of clinical use and scientific research using different prostate biopsy modalities is discussed, including the potential for the Promaxo MRI system to mitigate logistical constraints often associated with standard magnetic resonance (MR)-guided biopsy through the utilization of an office-based, low-field MRI.
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Giganti F, Stavrinides V, Moore CM. Magnetic Resonance Imaging–guided Active Surveillance of Prostate Cancer: Time to Say Goodbye to Protocol-based Biopsies. EUR UROL SUPPL 2022; 38:40-43. [PMID: 35243397 PMCID: PMC8885616 DOI: 10.1016/j.euros.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
Traditional protocols for active surveillance (AS) are commonly based on digital rectal examination, prostate-specific antigen (PSA), and standard transrectal biopsy, meaning that initial classification errors and inaccurate lesion monitoring can occur. Protocol-based biopsies are performed to assess changes in cancer grade and extent at prespecified intervals, but this approach represents a barrier to AS adherence and tolerability. There is evidence to support the use of magnetic resonance imaging (MRI) during AS, as this technique (associated with favourable PSA kinetics) offers an opportunity to follow patients on AS without the need for routine, protocol-based biopsies in the absence of signs of radiological progression provided that image quality, interpretation, and reporting of serial imaging are of the highest standards. Patient summary In this report we looked at the role of magnetic resonance imaging (MRI) scans in avoiding unnecessary prostate biopsies for patients being monitored for low- or intermediate-risk prostate cancer. We conclude that patients on active surveillance can be monitored with MRI scans over time and that biopsies could be used only when there are changes on MRI or a rising prostate-specific antigen (PSA) not explained by an increase in prostate size.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
- Corresponding author at: Division of Surgery & Interventional Science, University College London, London, UK.
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Kinnaird A, Yerram NK, O’Connor L, Brisbane W, Sharma V, Chuang R, Jayadevan R, Ahdoot M, Daneshvar M, Priester A, Delfin M, Tran E, Barsa DE, Sisk A, Reiter RE, Felker E, Raman S, Kwan L, Choyke PL, Merino MJ, Wood BJ, Turkbey B, Pinto PA, Marks LS. Magnetic Resonance Imaging-Guided Biopsy in Active Surveillance of Prostate Cancer. J Urol 2022; 207:823-831. [PMID: 34854746 PMCID: PMC10506469 DOI: 10.1097/ju.0000000000002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. Our study was designed to determine the prostate cancer upgrading rate when biopsy guided by magnetic resonance imaging (MRGBx) is used before entry and during AS. MATERIALS AND METHODS The cohort included 519 men with low- or intermediate-risk prostate cancer who enrolled in prospective studies (NCT00949819 and NCT00102544) between February 2008 and February 2020. Subjects were preliminarily diagnosed with Gleason Grade Group (GG) 1 cancer; AS began when subsequent MRGBx confirmed GG1 or GG2. Participants underwent confirmatory MRGBx (targeted and systematic) followed by surveillance MRGBx approximately every 12 to 24 months. The primary outcome was tumor upgrading to ≥GG3. RESULTS Upgrading to ≥GG3 was found in 92 men after a median followup of 4.8 years (IQR 3.1-6.5) after confirmatory MRGBx. Upgrade-free probability after 5 years was 0.85 (95% CI 0.81-0.88). Cancer detected in a magnetic resonance imaging lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS (HR 2.8; 95% CI 1.3-6.0), as did presence of GG2 (HR 2.9; 95% CI 1.1-8.2) In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25% and both in 47%. In 63 men undergoing prostatectomy, upgrading from MRGBx was found in only 5 (8%). CONCLUSIONS When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within a magnetic resonance imaging lesion or when pathology is GG2 than when these features are absent.
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Affiliation(s)
- Adam Kinnaird
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Edmonton, Alberta, Canada
- Cancer Research Institute of Northern Alberta (CRINA),Edmonton, Alberta, Canada
| | - Nitin K. Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Luke O’Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Wayne Brisbane
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Vidit Sharma
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ryan Chuang
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Rajiv Jayadevan
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan Priester
- Department of Bioengineering, UCLA, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Elizabeth Tran
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Danielle E. Barsa
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Anthony Sisk
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, California
| | - Robert E. Reiter
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ely Felker
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Steve Raman
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J. Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Leonard S. Marks
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
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Chandra MM, Greenspan SH, Li X, Yang J, Pryor AD, Shroyer ALW, Fitzgerald JP. Race-insurance disparities in prostate patients' magnetic resonance imaging biopsies and their subsequent cancer care: a New York State cohort study. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:435-455. [PMID: 34993264 PMCID: PMC8727785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
For organ-confined prostate cancer, socioeconomic factors influencing Magnetic Resonance Imaging (MRI)-guided biopsy utilization and downstream prostate cancer patients' care are unknown. This retrospective, observational cohort study used the New York Statewide Planning and Research Cooperative System (SPARCS) billing-code driven database to examine the impact of prostate patients' socioeconomic characteristics on prostate cancer care defined as initial biopsy, 2-month post-biopsy cancer diagnoses, and within 1-year cancer-related intervention, controlling for other risk factors. From 2011-2017, the population studied (n = 18,253) included all New York State-based, male, residents aged 18 to 75 without a prior prostatectomy receiving a first-time biopsy; 760 such patient records in 2016 were removed due to data quality concerns. Major exposures included patient age, race, ethnicity and insurance. The major outcome included receipt of MRI biopsy versus standard biopsy and for these sub-populations, subsequent 2-month post-biopsy metastatic versus non-metastatic prostate cancer diagnosis and within 1-year prostate cancer treatment (prostatectomy with or without radiation versus prostatectomy-only) were compared using dichotomous (primary) and time-to-event (secondary) endpoints. Of 17,493 patients with a first-time prostate biopsy, 3.89% had MRI guided biopsies; of the 17,128 patients with no pre-biopsy cancer diagnosis, the subsequent prostate cancer diagnosis rate was 42.59%. For 6,754 non-metastatic prostate cancer patients with 1-year follow-up, 1,674 (24.79%) received surgery (with or without radiation) and 495 (7.33%) received radiation-only. Holding other factors constant, multivariable regression models identified that race-insurance was a primary predictor of MRI-guided biopsy use. Compared to commercially insured White patients, Black patients across all insurance categories received MRI-guided biopsies less frequently; Commercially insured and self-pay Black patients also had increased chance of prostate cancer diagnosis. Across all insurers, Black patients had lower likelihood of prostatectomies. In contrast, Black and White patients with government insurance were more likely to have within 1-year radiation-only treatments versus commercially insured White patients. Thus, across the prostate cancer care continuum, race-insurance affected prostate cancer-related service utilization. Future research should evaluate the generalizability of these New York State findings.
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Affiliation(s)
- Mansi M Chandra
- Renaissance School of Medicine at Stony Brook UniversityStony Brook, NY 11794-8093, USA
| | - Seth H Greenspan
- Renaissance School of Medicine at Stony Brook UniversityStony Brook, NY 11794-8093, USA
| | - Xiaoning Li
- Renaissance School of Medicine at Stony Brook UniversityStony Brook, NY 11794-8093, USA
| | - Jie Yang
- Renaissance School of Medicine at Stony Brook UniversityStony Brook, NY 11794-8093, USA
| | - Aurora D Pryor
- Department of Surgery, Health, Stony Brook MedicineStony Brook, NY 11794-8191, USA
| | - Annie Laurie Winkley Shroyer
- Renaissance School of Medicine at Stony Brook UniversityStony Brook, NY 11794-8093, USA
- Stony Brook University School of Medicine’s Department of Urology and SurgeryStony Brook, NY 11794, USA
| | - John P Fitzgerald
- Stony Brook University School of Medicine’s Department of Urology and SurgeryStony Brook, NY 11794, USA
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The utility of prostate MRI within active surveillance: description of the evidence. World J Urol 2021; 40:71-77. [PMID: 34860274 PMCID: PMC8813688 DOI: 10.1007/s00345-021-03853-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose We present an overview of the literature regarding the use of MRI in active surveillance of prostate cancer. Methods Both MEDLINE® and Cochrane Library were queried up to May 2020 for studies of men on active surveillance with MRI and later confirmatory biopsy. The terms studied were ‘prostate cancer’ as the anchor followed by two of the following: active surveillance, surveillance, active monitoring, MRI, NMR, magnetic resonance imaging, MRI, and multiparametric MRI. Studies were excluded if pathologic reclassification (GG1 → ≥ GG2) and PI-RADS or equivalent was not reported. Results Within active surveillance, baseline MRI is effective for identifying clinically significant prostate cancer and thus associated with fewer reclassification events. A positive initial MRI (≥ PI-RADS 3) with GG1 identified at biopsy has a positive predictive value (PPV) of 35–40% for reclassification by 3 years. MRI possessed a stronger negative predictive value, with a negative MRI (≤ PI-RADS 2) yielding a negative predictive value of up to 85% at 3 years. Surveillance MRI, obtained after initial biopsy, yielded a PPV of 11–65% and NPV of 85–95% for reclassification. Conclusion MRI is useful for initial risk stratification of prostate cancer in men on active surveillance, especially if MRI is negative when imaging is obtained during surveillance. While useful, MRI cannot replace biopsy and further research is necessary to fully integrate MRI into active surveillance.
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Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort. J Urol 2021; 206:1147-1156. [PMID: 34503355 PMCID: PMC8734323 DOI: 10.1097/ju.0000000000001937] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We examined the demographic and clinicopathological parameters associated with the time to convert from active surveillance to treatment among men with prostate cancer. MATERIALS AND METHODS A multi-institutional cohort of 7,279 patients managed with active surveillance had data and biospecimens collected for germline genetic analyses. RESULTS Of 6,775 men included in the analysis, 2,260 (33.4%) converted to treatment at a median followup of 6.7 years. Earlier conversion was associated with higher Gleason grade groups (GG2 vs GG1 adjusted hazard ratio [aHR] 1.57, 95% CI 1.36-1.82; ≥GG3 vs GG1 aHR 1.77, 95% CI 1.29-2.43), serum prostate specific antigen concentrations (aHR per 5 ng/ml increment 1.18, 95% CI 1.11-1.25), tumor stages (cT2 vs cT1 aHR 1.58, 95% CI 1.41-1.77; ≥cT3 vs cT1 aHR 4.36, 95% CI 3.19-5.96) and number of cancerous biopsy cores (3 vs 1-2 cores aHR 1.59, 95% CI 1.37-1.84; ≥4 vs 1-2 cores aHR 3.29, 95% CI 2.94-3.69), and younger age (age continuous per 5-year increase aHR 0.96, 95% CI 0.93-0.99). Patients with high-volume GG1 tumors had a shorter interval to conversion than those with low-volume GG1 tumors and behaved like the higher-risk patients. We found no significant association between the time to conversion and self-reported race or genetic ancestry. CONCLUSIONS A shorter time to conversion from active surveillance to treatment was associated with higher-risk clinicopathological tumor features. Furthermore, patients with high-volume GG1 tumors behaved similarly to those with intermediate and high-risk tumors. An exploratory analysis of self-reported race and genetic ancestry revealed no association with the time to conversion.
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Samtani S, Burotto M, Roman JC, Cortes-Herrera D, Walton-Diaz A. MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer. Diagnostics (Basel) 2021; 11:diagnostics11091551. [PMID: 34573893 PMCID: PMC8466276 DOI: 10.3390/diagnostics11091551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).
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Affiliation(s)
- Suraj Samtani
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Fundacion Chilena de Inmuno Oncologia, Santiago 8420383, Chile
| | - Mauricio Burotto
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Oncología Médica, Clinica Universidad de los Andes, Santiago 7620157, Chile
| | - Juan Carlos Roman
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
| | | | - Annerleim Walton-Diaz
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
- Departamento de Oncologia Básico-Clinico Universidad de Chile, Santiago 8380455, Chile
- Correspondence:
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11
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Kang SK, Mali RD, Prabhu V, Ferket BS, Loeb S. Active Surveillance Strategies for Low-Grade Prostate Cancer: Comparative Benefits and Cost-effectiveness. Radiology 2021; 300:594-604. [PMID: 34254851 DOI: 10.1148/radiol.2021204321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Active surveillance (AS) is the recommended treatment option for low-risk prostate cancer (PC). Surveillance varies in MRI, frequency of follow-up, and the Prostate Imaging Reporting and Data System (PI-RADS) score that would repeat biopsy. Purpose To compare the effectiveness and cost-effectiveness of AS strategies for low-risk PC with versus without MRI. Materials and Methods This study developed a mathematical model to evaluate the cost-effectiveness of surveillance strategies in a simulation of men with a diagnosis of low-risk PC. The following strategies were compared: watchful waiting, prostate-specific antigen (PSA) and annual biopsy without MRI, and PSA testing and MRI with varied PI-RADS thresholds for biopsy. MRI strategies differed regarding scheduling and use of PI-RADS score of at least 3, or a PI-RADS score of at least 4 to indicate the need for biopsy. Life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated by using microsimulation. Sensitivity analysis was used to assess the impact of varying parameter values on results. Results For the base case of 60-year-old men, all strategies incorporating prostate MRI extended QALYs and life-years compared with watchful waiting and non-MRI strategies. Annual MRI strategies yielded 16.19 QALYs, annual biopsy with no MRI yielded 16.14 QALYs, and watchful waiting yielded 15.94 QALYs. Annual MRI with PI-RADS score of at least 3 or of at least 4 as the biopsy threshold and annual MRI with biopsy even after MRI with negative findings offered similar QALYs and the same unadjusted life expectancy: 23.05 life-years. However, a PI-RADS score of at least 4 yielded 42% fewer lifetime biopsies. With a cost-effectiveness threshold of $100 000 per QALY, annual MRI with biopsy for lesions with PI-RADS scores of 4 or greater was most cost-effective (incremental cost-effectiveness ratio, $67 221 per QALY). Age, treatment type, risk of initial grade misclassification, and quality-of-life impact of procedural complications affected results. Conclusion The use of active surveillance (AS) with biopsy decisions guided by findings from annual MRI reduces the number of biopsies while preserving life expectancy and quality of life. Biopsy in lesions with PI-RADS scores of 4 or greater is likely the most cost-effective AS strategy for men with low-risk prostate cancer who are younger than 70 years. © RSNA, 2021 Online supplemental material is available for this article. An earlier incorrect version appeared online. This article was corrected on July 13, 2021.
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Affiliation(s)
- Stella K Kang
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Rahul D Mali
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Vinay Prabhu
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Bart S Ferket
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
| | - Stacy Loeb
- From the Departments of Radiology (S.K.K., R.D.M., V.P.), Population Health (S.K.K., S.L.), and Urology (S.L.), New York University Grossman School of Medicine, 660 First Ave, Room 333, New York, NY 10016; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F.); and Manhattan VA Medical Center, New York, NY (S.L.)
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12
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Khalighinejad P, Parrott D, Clavijo Jordan V, Chirayil S, Preihs C, Rofsky NM, Xi Y, Sherry AD. Magnetic Resonance Imaging Detection of Glucose-Stimulated Zinc Secretion in the Enlarged Dog Prostate as a Potential Method for Differentiating Prostate Cancer From Benign Prostatic Hyperplasia. Invest Radiol 2021; 56:450-457. [PMID: 34086013 PMCID: PMC10042468 DOI: 10.1097/rli.0000000000000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In the United States, prostate cancer (PCa) is the most common cancer in men. Multi-parametric magnetic resonance imaging (MRI) is increasingly being relied upon for the diagnosis and characterization of PCa, but differentiating malignancy from benign prostatic hyperplasia (BPH) in the transition zone using MRI can be challenging. The characteristically high levels of zinc in human prostate tissue and a close relationship between malignant proliferation and zinc homeostatic dysregulation create opportunities to visualize PCa with novel contrast media. In mouse models, glucose-stimulated zinc secretion (GSZS) can be preferentially observed in healthy prostate tissue compared with malignant tissue; in vivo, these differences can be captured with MRI by using Gdl1, a gadolinium-based zinc-responsive contrast agent. In this study, we examined whether this technology can be applied in a large animal model by imaging older dogs with clinically diagnosed BPH. MATERIALS AND METHODS Four intact male dogs 6 years or older with enlarged prostates were imaged (T1-weighted turbo spin-echo, TE/TR, 12/400 milliseconds and T2-weighted, TE/TR, 112/5000 milliseconds) using a 3 T scanner before and at multiple time points after intravenous injection of 0.05 mmol/kg GdL1 plus either (a) 2 mL/kg of 50% dextrose in 1 session or (b) 2 mL/kg normal saline in another session. The two sessions were one week apart, and their order was randomly determined for each dog. During postprocessing, regions of interest were generated in prostate tissue and in paraspinal muscles to evaluate the contrast-to-noise ratio (CNR). The ratio of CNR at any postinjection time point compared with baseline CNR was defined as r-CNR. After the second imaging session, the dogs were euthanized, and their prostates were harvested for histopathological examination. Baseline and postintervention plasma and urine samples were analyzed for total zinc by inductively coupled plasma mass spectrometry. RESULTS The mean ± SD r-CNR values at 13 minutes postinjection in the dextrose versus saline imaging sessions were 134% ± 10% and 127% ± 7%, respectively (P < 0.01). The histopathologic evaluation of prostate tissues confirmed BPH in all dogs. Interestingly, prostatic intraepithelial neoplasia was detected in 1 animal, and a suspicious mass was found in the same region on T2-weighted scans. The r-CNR of the mass was calculated as 113% ± 4% and 111% ± 6% in the dextrose and saline groups, respectively, with no significant differences between the 2 interventions (P = 0.54), whereas there was a statistically significant difference between the r-CNR of the whole prostate in the dextrose (130% ±11%) and saline (125% ± 9%) interventions (P = 0.03). Inductively coupled plasma mass spectrometry analyses showed a significantly higher urinary zinc in the dextrose versus saline groups, but no differences were found in plasma zinc levels. CONCLUSIONS T1-weighted MRI of the enlarged canine prostate showed higher r-CNR after injection of GdL1 plus dextrose compared with GdL1 plus saline, consistent with GSZS from BPH tissues. One small region of neoplastic tissue was identified in a single dog on the basis of less GSZS from that region by MRI. These findings suggest a new method for the detection of PCa by MRI that could facilitate the differentiation of BPH from PCa in the transition zone.
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Affiliation(s)
- Pooyan Khalighinejad
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas
| | - Daniel Parrott
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Veronica Clavijo Jordan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown; VitalQuan, LLC, Dallas, TX
| | - Sara Chirayil
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas
| | - Christian Preihs
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown; VitalQuan, LLC, Dallas, TX
| | - Neil M. Rofsky
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - A. Dean Sherry
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
- Department of Chemistry & Biochemistry, the University of Texas at Dallas, Richardson
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13
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Padhani AR, Rouvière O, Schoots IG. Magnetic Resonance Imaging for Tailoring the Need to Biopsy During Follow-up for Men on Active Surveillance for Prostate Cancer. Eur Urol 2021; 80:564-566. [PMID: 34053779 DOI: 10.1016/j.eururo.2021.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK.
| | - Olivier Rouvière
- Department of Urinary and Vascular Imaging, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon 1, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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14
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O'Connor LP, Wang AZ, Yerram NK, Long L, Ahdoot M, Lebastchi AH, Gurram S, Zeng J, Harmon SA, Mehralivand S, Merino MJ, Parnes HL, Choyke PL, Shih JH, Wood BJ, Turkbey B, Pinto PA. Changes in Magnetic Resonance Imaging Using the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation Criteria to Detect Prostate Cancer Progression for Men on Active Surveillance. Eur Urol Oncol 2021; 4:227-234. [PMID: 33867045 PMCID: PMC9310665 DOI: 10.1016/j.euo.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The ability of serial magnetic resonance imaging (MRI) to capture pathologic progression during active surveillance (AS) remains in question. OBJECTIVE To determine whether changes in MRI are associated with pathologic progression for patients on AS. DESIGN, SETTING, AND PARTICIPANTS From July 2007 through January 2020, we identified all patients evaluated for AS at our institution. Following confirmatory biopsy, a total of 391 patients who underwent surveillance MRI and biopsy at least once were identified (median follow-up of 35.6 mo, interquartile range 19.7-60.6). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS All MRI intervals were scored using the "Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation" (PRECISE) criteria, with PRECISE scores =4 considered a positive change in MRI. A generalized estimating equation-based logistic regression analysis was conducted for all intervals with a PRECISE score of <4 to determine the predictors of Gleason grade group (GG) progression despite stable MRI. RESULTS AND LIMITATIONS A total of 621 MRI intervals were scored by PRECISE and validated by biopsy. The negative predictive value of stable MRI (PRECISE score <4) was greatest for detecting GG1 to?=?GG3 disease (0.94 [0.91-0.97]). If 2-yr surveillance biopsy were performed exclusively for a positive change in MRI, 3.7% (4/109) of avoided biopsies would have resulted in missed progression from GG1 to?=?GG3 disease. Prostate-specific antigen (PSA) density (odds ratio 1.95 [1.17-3.25], p?=? 0.01) was a risk factor for progression from GG1 to =GG3 disease despite stable MRI. CONCLUSIONS In patients with GG1 disease and stable MRI (PRECISE score <4) on surveillance, grade progression to?=?GG3 disease is not common. In patients with grade progression detected on biopsy despite stable MRI, elevated PSA density appeared to be a risk factor for progression to?=?GG3 disease. PATIENT SUMMARY For patients with low-risk prostate cancer on active surveillance, the risk of progressing to grade group 3 disease is low with a stable magnetic resonance image (MRI) after 2?yr. Having higher prostate-specific antigen density increases the risk of progression, despite having a stable MRI.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alex Z Wang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nitin K Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lori Long
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Johnathan Zeng
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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15
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Lacetera V, Antezza A, Papaveri A, Cappa E, Cervelli B, Gabrielloni G, Montesi M, Morcellini R, Parri G, Recanatini E, Beatrici V. MRI/US fusion prostate biopsy in men on active surveillance: Our experience. ACTA ACUST UNITED AC 2021; 93:88-91. [PMID: 33754618 DOI: 10.4081/aiua.2021.1.88] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
AIM The upgrading or staging in men with prostate cancer (PCA) undergoing active surveillance (AS), defined as Gleason score (GS) ≥ 3+4 or more than 2 area with cancer, was investigated in our experience using the software-based fusion biopsy (FB). METHODS We selected from our database, composed of 620 biopsies, only men on AS according to criteria of John Hopkins Protocol (T1c, < 3 positive cores, GS = 3+3 = 6). Monitoring consisted of PSA measurement every 3 months, a clinical examination every 6 months, confirmatory FB within 6 months and then annual FB in all men. The suspicious MRI lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) classification version 2. FB were performed with a transrectal elastic free-hand fusion platform. The overall and clinically significant cancer detection rate was reported. Secondary, the diagnostic role of systematic biopsies was evaluated. RESULTS We selected 56 patients on AS with mean age 67.4 years, mean PSA 6.7 ng/ml and at least one follow-up MRI-US fusion biopsy (10 had 2 or 3 follow-up biopsies). Lesions detected by MRI were: PIRADS-2 in 5, PIRADS-3 in 28, PIRADS-4 in 18 pts and PIRADS-5 in 5 patients. In each MRI lesion, FB with 2.1 ± 1.1 cores were taken with a mean total cores of 13 ± 2.4 including the systematic cores. The overall cancer detection rate was 71% (40/56): 62% (25/40) in target core and 28% (15/40) in systematic core. The overall significant cancer detection rate was 46% (26/56): 69% (18/26) in target vs 31% (8/26) in random cores. CONCLUSIONS The incidence of clinical significant cancer was 46% in men starting active surveillance, but it was more than doubled using MRI/US Target Biopsy 69% (18/26) rather than random cores (31%, 8/26). However, 1/3 of disease upgrades would have been missed if only the targeted biopsies were performed. Based on our experience, MRI/US fusion target biopsy must be associated to systematic biopsies to improve detection of significant cancer, reducing the risks of misclassification.
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Affiliation(s)
- Vito Lacetera
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | - Angelo Antezza
- Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti Torrette di Ancona.
| | - Alessio Papaveri
- Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti Torrette di Ancona.
| | - Emanuele Cappa
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | - Bernardino Cervelli
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | | | - Michele Montesi
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | - Roberto Morcellini
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | - Gianni Parri
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | - Emilio Recanatini
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
| | - Valerio Beatrici
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
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16
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Wu RC, Lebastchi AH, Hadaschik BA, Emberton M, Moore C, Laguna P, Fütterer JJ, George AK. Role of MRI for the detection of prostate cancer. World J Urol 2021; 39:637-649. [PMID: 33394091 DOI: 10.1007/s00345-020-03530-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/13/2020] [Indexed: 01/24/2023] Open
Abstract
The use of multiparametric MRI has been hastened under expanding, novel indications for its use in the diagnostic and management pathway of men with prostate cancer. This has helped drive a large body of the literature describing its evolving role over the last decade. Despite this, prostate cancer remains the only solid organ malignancy routinely diagnosed with random sampling. Herein, we summarize the components of multiparametric MRI and interpretation, and present a critical review of the current literature supporting is use in prostate cancer detection, risk stratification, and management.
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Affiliation(s)
- Richard C Wu
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Amir H Lebastchi
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Boris A Hadaschik
- University Hospital Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline Moore
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Pilar Laguna
- Department of Urology, Medipol University Research Hospital, Istanbul, Turkey
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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17
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Frantzi M, Gomez-Gomez E, Mischak H. Noninvasive biomarkers to guide intervention: toward personalized patient management in prostate cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2020.1804866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Maria Frantzi
- Department of Biomarker Research, Mosaiques Diagnostics GmbH, Hannover, Germany
| | | | - Harald Mischak
- Department of Biomarker Research, Mosaiques Diagnostics GmbH, Hannover, Germany
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
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18
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O'Connor LP, Wang AZ, Yerram NK, Lebastchi AH, Ahdoot M, Gurram S, Zeng J, Mehralivand S, Harmon S, Merino MJ, Parnes HL, Choyke PL, Turkbey B, Wood BJ, Pinto PA. Combined MRI-targeted Plus Systematic Confirmatory Biopsy Improves Risk Stratification for Patients Enrolling on Active Surveillance for Prostate Cancer. Urology 2020; 144:164-170. [PMID: 32679272 PMCID: PMC8916164 DOI: 10.1016/j.urology.2020.06.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the efficacy of combined MRI-targeted plus systematic 12-core biopsy (Cbx) to aid in the selection of patients for active surveillance (AS). METHODS From July 2007 to January 2020, patients with Gleason Grade Group (GG) 1 or GG 2 prostate cancer were referred to our center for AS consideration. All patients underwent an MRI and confirmatory combined MRI-targeted plus systematic biopsy (Cbx), and AS outcomes based on Cbx results were compared. Cox regression was used to identify predictors of AS failure, defined as progression to ≥ GG3 disease on follow-up biopsies. RESULTS Of 579 patients referred for AS, 79.3% (459/579) and 20.7% (120/579) had an initial diagnosis of GG1 and GG2 disease, respectively. Overall, 43.2% of patients (250/579) were upgraded on confirmatory Cbx, with 19.2% (111/579) upgraded to ≥ GG3. For the 226 patients followed on AS, 32.7% (74/226) had benign, 45.6% (103/226) had GG1, and 21.7% (49/226) had GG2 results on confirmatory Cbx. In total, 28.8% (65/226) of patients eventually progressed to ≥ GG3, with a median time to AS failure of 89 months. The median time from confirmatory Cbx to AS failure for the negative, GG1, and GG2 groups were 97, 97, and 32 months, respectively (p < .001). On multivariable regression, only age (hazard ratio 1.06 [1.02-1.11], p < .005) and GG on confirmatory Cbx (hazard ratio 2.75 [1.78-4.26], p < .005) remained as positive predictors of AS failure. CONCLUSION The confirmatory combined MRI-targeted plus systematic biopsy provides useful information for the risk stratification of patients at the time of AS enrollment.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alex Z Wang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nitin K Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Johnathan Zeng
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institutes, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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19
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Björnebo L, Olsson H, Nordström T, Jäderling F, Grönberg H, Eklund M, Lantz A. Predictors of adverse pathology on radical prostatectomy specimen in men initially enrolled in active surveillance for low-risk prostate cancer. World J Urol 2020; 39:1797-1804. [PMID: 32734463 PMCID: PMC8217019 DOI: 10.1007/s00345-020-03394-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/24/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate clinical variables, including magnetic resonance imaging (MRI) predictive of adverse pathology (AP) at radical prostatectomy (RP) in men initially enrolled in active surveillance (AS). Methods A population-based cohort study of men diagnosed with low-risk prostate cancer (PCa), in Stockholm County, Sweden, during 2008–2017 enrolled in AS their intended primary treatment followed by RP. AP was defined as ISUP grade group ≥ 3 and/or pT-stage ≥ T3. Association between clinical variables at diagnosis and time to AP was evaluated using Cox regression and multivariate logistic regression to evaluate the association between AP and clinical variables at last biopsy before RP. Results In a cohort of 6021 patients with low-risk PCa, 3116 were selected for AS and 216 underwent RP. Follow-up was 10 years, with a median time on AS of 23 months. 37.7% of patients had AP at RP. Clinical T-stage [Hazard ratio (HR): 1.81, 95% confidence interval (CI) 1.04–3.18] and PSA (HR: 1.31, 95% CI 1.17–1.46) at diagnosis and age [Odds Ratio (OR): 1.09, 95% CI 1.02–1.18), PSA (OR: 1.22, 95% CI 1.07–1.41), and PI-RADS (OR 1.66, 95% CI 1.11–2.55)] at last re-biopsy were significantly associated with AP. Conclusion PI-RADS score is significantly associated with AP at RP and support current guidelines recommending MRI before enrollment in AS. Furthermore, age, cT-stage, and PSA are significantly associated with AP. Electronic supplementary material The online version of this article (10.1007/s00345-020-03394-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Clinical Sciences, Danderyds Hospital, Danderyd Hospital, Danderyd, Sweden
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Anna Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Sklinda K, Mruk B, Walecki J. Active Surveillance of Prostate Cancer Using Multiparametric Magnetic Resonance Imaging: A Review of the Current Role and Future Perspectives. Med Sci Monit 2020; 26:e920252. [PMID: 32279066 PMCID: PMC7172004 DOI: 10.12659/msm.920252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Clinically, active surveillance involves continuous monitoring of patients who may be at risk for disease. Patients with low-grade and early-stage prostate cancer may benefit from active surveillance, rather than undergoing surgical and medical treatments that are associated with side effects. In these cases, the role of active surveillance is to ensure that there is no progression of the disease. However, active surveillance may be associated with a risk of under-diagnosis. Previously, the assignment of risk categories and patient monitoring were based on digital rectal examination, transrectal prostate biopsy, and monitoring of serum levels of prostate-specific antigen (PSA). Multiparametric magnetic resonance imaging (MRI) of the prostate gland has an estimated negative predictive value of 95% for the detection of prostate cancer, which makes this an effective imaging method for targeting biopsies and for monitoring patients over time. Also, multiparametric MRI-guided biopsy at the initial stage of the risk stratification for patients who are newly diagnosed with prostate cancer may reduce the number of underdiagnosed patients, improve long-term patient prognosis, and reduce the number of patients who are overtreated, which may reduce healthcare costs and reduce treatment morbidity. For these reasons, multiparametric MRI has become an accepted monitoring tool in patients who are enrolled in active surveillance programs. This review aims to present the current status of the use of multiparametric MRI in active surveillance of prostate cancer and to discuss future perspectives, supported by recent literature.
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Affiliation(s)
- Katarzyna Sklinda
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bartosz Mruk
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
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