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Liu Y, Zeng S, Xu R. Application of Multiple Ultrasonic Techniques in the Diagnosis of Prostate Cancer. Front Oncol 2022; 12:905087. [PMID: 35832558 PMCID: PMC9271763 DOI: 10.3389/fonc.2022.905087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Methods for diagnosing prostate cancer (PCa) are developing in the direction of imaging. Advanced ultrasound examination modes include micro-Doppler, computerized-transrectal ultrasound, elastography, contrast-enhanced ultrasound and microultrasound. When two or more of these modes are used in PCa diagnosis, the combined technique is called multiparameter ultrasound (mp-US). Mp-US provides complementary information to multiparameter magnetic resonance imaging (mp-MRI) for diagnosing PCa. At present, no study has attempted to combine the characteristics of different ultrasound modes with advanced classification systems similar to the PIRADS system in mpMRI for the diagnosis of PCa. As an imaging method, mp-US has great potential in the diagnosis of PCa.
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Affiliation(s)
- Yushan Liu
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Ran Xu,
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2
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The current role of MRI for guiding active surveillance in prostate cancer. Nat Rev Urol 2022; 19:357-365. [PMID: 35393568 DOI: 10.1038/s41585-022-00587-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 01/13/2023]
Abstract
Active surveillance (AS) is the recommended treatment option for low-risk and favourable intermediate-risk prostate cancer management, preserving oncological and functional outcomes. However, active monitoring using relevant parameters in addition to the usual clinical, biological and pathological considerations is necessary to compensate for initial undergrading of the tumour or to detect early progression without missing the opportunity to provide curative therapy. Indeed, several studies have raised concerns about inadequate biopsy sampling at diagnosis. However, the implementation of baseline MRI and targeted biopsy have led to improved initial stratification of low-risk disease; baseline MRI correlates well with disease characteristics and AS outcomes. The use of follow-up MRI during the surveillance phase also raises the question of the requirement for serial biopsies in the absence of radiological progression and the possibility of using completely MRI-based surveillance, with triggers for biopsies based solely on MRI findings. This concept of a tailored-risk, imaging-based monitoring strategy is aimed at reducing invasive procedures. However, the abandonment of serial biopsies in the absence of MRI progression can probably not yet be recommended in routine practice, as the data from real-life cohorts are heterogeneous and inconclusive. Thus, the evolution towards a routine, fully MRI-guided AS pathway has to be preceded by ensuring quality programme assessment for MRI reading and by demonstrating its safety in prospective trials.
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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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Hu L, Zhou DW, Fu CX, Benkert T, Xiao YF, Wei LM, Zhao JG. Calculation of Apparent Diffusion Coefficients in Prostate Cancer Using Deep Learning Algorithms: A Pilot Study. Front Oncol 2021; 11:697721. [PMID: 34568027 PMCID: PMC8458902 DOI: 10.3389/fonc.2021.697721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Apparent diffusion coefficients (ADCs) obtained with diffusion-weighted imaging (DWI) are highly valuable for the detection and staging of prostate cancer and for assessing the response to treatment. However, DWI suffers from significant anatomic distortions and susceptibility artifacts, resulting in reduced accuracy and reproducibility of the ADC calculations. The current methods for improving the DWI quality are heavily dependent on software, hardware, and additional scan time. Therefore, their clinical application is limited. An accelerated ADC generation method that maintains calculation accuracy and repeatability without heavy dependence on magnetic resonance imaging scanners is of great clinical value. Objectives We aimed to establish and evaluate a supervised learning framework for synthesizing ADC images using generative adversarial networks. Methods This prospective study included 200 patients with suspected prostate cancer (training set: 150 patients; test set #1: 50 patients) and 10 healthy volunteers (test set #2) who underwent both full field-of-view (FOV) diffusion-weighted imaging (f-DWI) and zoomed-FOV DWI (z-DWI) with b-values of 50, 1,000, and 1,500 s/mm2. ADC values based on f-DWI and z-DWI (f-ADC and z-ADC) were calculated. Herein we propose an ADC synthesis method based on generative adversarial networks that uses f-DWI with a single b-value to generate synthesized ADC (s-ADC) values using z-ADC as a reference. The image quality of the s-ADC sets was evaluated using the peak signal-to-noise ratio (PSNR), root mean squared error (RMSE), structural similarity (SSIM), and feature similarity (FSIM). The distortions of each ADC set were evaluated using the T2-weighted image reference. The calculation reproducibility of the different ADC sets was compared using the intraclass correlation coefficient. The tumor detection and classification abilities of each ADC set were evaluated using a receiver operating characteristic curve analysis and a Spearman correlation coefficient. Results The s-ADCb1000 had a significantly lower RMSE score and higher PSNR, SSIM, and FSIM scores than the s-ADCb50 and s-ADCb1500 (all P < 0.001). Both z-ADC and s-ADCb1000 had less distortion and better quantitative ADC value reproducibility for all the evaluated tissues, and they demonstrated better tumor detection and classification performance than f-ADC. Conclusion The deep learning algorithm might be a feasible method for generating ADC maps, as an alternative to z-ADC maps, without depending on hardware systems and additional scan time requirements.
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Affiliation(s)
- Lei Hu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Da Wei Zhou
- State Key Laboratory of Integrated Services Networks, School of Telecommunications Engineering, Xidian University, Xi'an, China
| | - Cai Xia Fu
- Magnetic Resonance (MR) Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Yun Feng Xiao
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Ming Wei
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Gong Zhao
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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5
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Correas JM, Halpern EJ, Barr RG, Ghai S, Walz J, Bodard S, Dariane C, de la Rosette J. Advanced ultrasound in the diagnosis of prostate cancer. World J Urol 2020; 39:661-676. [PMID: 32306060 DOI: 10.1007/s00345-020-03193-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of prostate cancer (PCa) can be challenging due to the limited performance of current diagnostic tests, including PSA, digital rectal examination and transrectal conventional US. Multiparametric MRI has improved PCa diagnosis and is recommended prior to biopsy; however, mp-MRI does miss a substantial number of PCa. Advanced US modalities include transrectal prostate elastography and contrast-enhanced US, as well as improved B-mode, micro-US and micro-Doppler techniques. These techniques can be combined to define a novel US approach, multiparametric US (mp-US). Mp-US improves PCa diagnosis but is not sufficiently accurate to obviate the utility of mp-MRI. Mp-US using advanced techniques and mp-MRI provide complementary information which will become even more important in the era of focal therapy, where precise identification of PCa location is needed.
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Affiliation(s)
- Jean-Michel Correas
- Department of Adult Radiology, Paris University and Necker University Hospital, 149 rue de Sèvres, 75015, Paris Cedex 15, France.
| | - Ethan J Halpern
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Sangeet Ghai
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Sylvain Bodard
- Department of Adult Radiology, Paris University and Necker University Hospital, 149 rue de Sèvres, 75015, Paris Cedex 15, France
| | - Charles Dariane
- Department of Urology, Paris University and European Hospital Georges Pompidou, Paris, France
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6
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Cantiello F, Russo GI, Kaufmann S, Cacciamani G, Crocerossa F, Ferro M, De Cobelli O, Artibani W, Cimino S, Morgia G, Damiano R, Nikolaou K, Kröger N, Stenzl A, Bedke J, Kruck S. Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis 2018; 22:206-220. [PMID: 30487646 DOI: 10.1038/s41391-018-0113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS. METHODS A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification. RESULTS In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83. CONCLUSIONS Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | - Sascha Kaufmann
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Fabio Crocerossa
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Walter Artibani
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Rocco Damiano
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Konstantin Nikolaou
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Nils Kröger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Arnulf Stenzl
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Bedke
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Stephan Kruck
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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7
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Glaser ZA, Porter KK, Thomas JV, Gordetsky JB, Rais-Bahrami S. MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence. Transl Androl Urol 2018; 7:S411-S419. [PMID: 30363494 PMCID: PMC6178314 DOI: 10.21037/tau.2018.03.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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8
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Schoots IG, Nieboer D, Giganti F, Moore CM, Bangma CH, Roobol MJ. Is magnetic resonance imaging-targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low-risk prostate cancer? A systematic review and meta-analysis. BJU Int 2018; 122:946-958. [PMID: 29679430 DOI: 10.1111/bju.14358] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematically review and meta-analyse evidence regarding the additional value of magnetic resonance imaging (MRI) and MRI-targeted biopsies to confirmatory systematic biopsies in identifying high-grade prostate cancer in men with low-risk disease on transrectal ultrasonography (TRUS) biopsy, as active surveillance (AS) of prostate cancer is recommended for men with Gleason 3 + 3 on standard TRUS-guided biopsy. Confirmatory assessment can include repeat standard TRUS-guided biopsy, and/or MRI with targeted biopsy when indicated. METHODS A systematic review of the Embase, Medline, Web-of-science, Google scholar, and Cochrane library was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Identified reports were critically appraised according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. Studies reporting men with Gleason 3 + 3 prostate cancer who had chosen AS based on transrectal systematic biopsy findings and had undergone MRI with systematic ± targeted biopsy at confirmatory assessment were included. The primary outcome was detection of any Gleason pattern ≥4. RESULTS Included reports (six) of men on AS (n = 1 159) showed cancer upgrading (Gleason ≥3 + 4) in 27% (95% confidence interval [CI] 22-34%) using a combined approach of MRI-targeted biopsies and confirmatory systematic biopsies. MRI-targeted biopsies alone would have missed cancer upgrading in 10% (95% CI 8-14%) and standard biopsies alone would have missed cancer upgrading in 7% (95% CI 5-10%). No pathway was more favourable than the other (relative risk [RR] 0.92, 95% CI 0.79-1.06). In all, 35% (95% CI 27-43%) of men with a positive MRI were upgraded, compared to 12% (95% CI 8-18%) of men with a negative MRI being upgraded (RR 2.77, 95% CI 1.76-4.38). CONCLUSIONS A pre-biopsy MRI should be performed before confirmatory systematic TRUS-guided biopsies in men on AS, together with MRI-targeted biopsies when indicated. A combined approach maximises cancer detection, although other factors within multivariate risk prediction can be used to aid the decision to biopsy in these men.
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London Hospital NHS Foundation Trust, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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9
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Curci NE, Lane BR, Shankar PR, Noyes SL, Moriarity AK, Kubat A, Brede C, Montgomery JS, Auffenberg GB, Miller DC, Montie JE, George AK, Davenport MS. Integration and Diagnostic Accuracy of 3T Nonendorectal coil Prostate Magnetic Resonance Imaging in the Context of Active Surveillance. Urology 2018; 116:137-143. [PMID: 29653121 DOI: 10.1016/j.urology.2018.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the integration of 3T nonendorectal coil multiparametric prostate magnetic resonance imaging (mpMRI) at 2 high-volume practices that routinely use mpMRI in the setting of active surveillance. MATERIALS AND METHODS This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, and dual-institution retrospective cohort study. Subjects undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month period (August 1, 2015-August 31, 2016) were selected based on predefined criteria: clinical T1/T2 Gleason 6 prostate cancer, prostate-specific antigen <15 ng/mL, ≥40 years old, mpMRI within 2 years of prostate biopsy, and Prostate Imaging Reporting and Data System (PI-RADS) v2 score assigned. Subjects surveilled for Gleason ≥3 + 4 prostate cancer were excluded. The primary outcome was detection of Gleason ≥3 + 4 prostate cancer on magnetic resonance-ultrasound fusion biopsy, standard biopsy, or prostatectomy within 6 months following mpMRI. Positive predictive values (PPVs) were calculated. RESULTS A total of 286 subjects (N = 193 from institution 1, N = 93 from institution 2) met the criteria. Most (87% [90 of 104]) with maximum PI-RADS v2 scores of 1-2 did not receive immediate biopsy or treatment and remained on active surveillance. Incidence and PPVs for PI-RADS v2 scores of ≥3 were the following: PI-RADS 3 (n = 57 [20%], PPV 21% [6 of 29]), PI-RADS 4 (n = 96 [34%], PPV 51% [39 of 77]), and PI-RADS 5 (n = 29 [13%], PPV 71% [20 of 28]). No Gleason ≥4 + 3 prostate cancer was identified for PI-RADS v2 scores of 1-3 (0 of 43 with histology). Following mpMRI and subsequent biopsy, 21% (61 of 286) of subjects were removed from active surveillance and underwent definitive therapy. CONCLUSION The 3T nonendorectal coil mpMRI has been integrated into the care of patients on active surveillance and effectively stratifies risk of Gleason ≥3 + 4 prostate cancer in this population.
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Affiliation(s)
- Nicole E Curci
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | | | - Sabrina L Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Andrew K Moriarity
- Advanced Radiology Services, Spectrum Health Medical Group, Grand Rapids, MI
| | - Anthony Kubat
- Department of Pathology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Chris Brede
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | | | | | | | | | | | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, Ann Arbor, MI; Department of Urology, Michigan Medicine, Ann Arbor, MI; Michigan Radiology Quality Collaborative, Ann Arbor, MI.
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10
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Giganti F, Moore CM. Magnetic resonance imaging in active surveillance-a modern approach. Transl Androl Urol 2018; 7:116-131. [PMID: 29594026 PMCID: PMC5861284 DOI: 10.21037/tau.2017.12.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In recent years, active surveillance has been increasingly adopted as a conservative management approach to low and sometimes intermediate risk prostate cancer, to avoid or delay treatment until there is evidence of higher risk disease. A number of studies have investigated the role of multiparametric magnetic resonance imaging (mpMRI) in this setting. MpMRI refers to the use of multiple MRI sequences (T2-weighted anatomical and functional imaging which can include diffusion-weighted imaging, dynamic contrast enhanced imaging, spectroscopy). Each of the parameters investigates different aspects of the prostate gland (anatomy, cellularity, vascularity, etc.). In addition to a qualitative assessment, the radiologist can also extrapolate quantitative imaging biomarkers from these sequences, for example the apparent diffusion coefficient from diffusion-weighted imaging. There are many different types of articles (e.g., reviews, commentaries, consensus meetings, etc.) that address the use of mpMRI in men on active surveillance for prostate cancer. In this paper, we compare original articles that investigate the role of the different mpMRI sequences in men on active surveillance for prostate cancer, in order to discuss the relative utility of the different sequences, and combinations of sequences. We searched MEDLINE/PubMed for manuscripts published from inception to 1st December 2017. The search terms used were (prostate cancer or prostate adenocarcinoma or prostatic carcinoma or prostate carcinoma or prostatic adenocarcinoma) and (MRI or NMR or magnetic resonance imaging or mpMRI or multiparametric MRI) and active surveillance. Overall, 425 publications were found. All abstracts were reviewed to identify papers with original data. Twenty-five papers were analysed and summarised. Some papers based their analysis only on one mpMRI sequence, while others assessed two or more. The evidence from this review suggests that qualitative assessments and quantitative data from different mpMRI sequences hold promise in the management of men on active surveillance for prostate cancer. Both qualitative and quantitative approaches should be considered when assessing mpMRI of the prostate. There is a need for robust studies assessing the relative utility of different combinations of sequences in a systematic manner to determine the most efficient use of mpMRI in men on active surveillance.
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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, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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11
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Schoots IG, Osses DF, Drost FJH, Verbeek JFM, Remmers S, van Leenders GJLH, Bangma CH, Roobol MJ. Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease. Transl Androl Urol 2018; 7:132-144. [PMID: 29594027 PMCID: PMC5861278 DOI: 10.21037/tau.2017.12.29] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The fear of undergrading prostate cancer (PCa) in men on active surveillance (AS) have led to strict criteria for monitoring, which have resulted in good long-term cancer-specific survival, proving the safety of this approach. Reducing undergrading, MRI-targeted biopsies are increasingly used in men with low-risk disease despite their undefined role yet. The objective of this study is to investigate the rate of upgrading using MRI-targeted biopsies in men with low-risk disease on AS, stratified on the basis of PI-RADS and PSA-density, with the aim to reduce potential unnecessary repeat biopsy procedures. Methods A total of 331 men were prospectively enrolled following the MRI-PRIAS protocol. MR imaging was according to Prostate Imaging Reporting and Data System (PI-RADSv2) guidelines. Suspicious MRI lesions (PI-RADS 3–5) were additionally targeted by MRI-TRUS fusion biopsies. Outcome measure was upgrading to Gleason score (GS) ≥3+4 with MRI-targeted biopsies, stratified for PI-RADS and PSA-density. Results In total, 25% (82/331) of men on AS showed upgrading from GS 3+3. Only 3% (11/331) was upgraded to GS ≥8. In 60% (198/331) a suspicious MRI lesion was identified, but in only 41% (82/198) of men upgrading was confirmed. PI-RADS 3, 4 and 5 categorized index lesions, showed upgrading in 30%, 34% and 66% of men, respectively. Stratification to PI-RADS 4–5, instead of PI-RADS 3–5, would have missed a small number of high volume Gleason 4 PCa in PI-RADS 3 category. However, further stratification into PI-RADS 3 lesions and PSA-density <0.15 ng/mL2 could result in a safe targeted biopsy reduction of 36% in this category, without missing any upgrades. Conclusions Stratification with the combination of PI-RADS and PSA-density may reduce unnecessary additional MRI biopsy testing. Overall, the high rate of detected upgrading in men on AS may result in an unintended tightening of continuing in AS. Since patients, included under current AS criteria showed extremely favorable outcome, there might be no need to further restrict continuing on AS with MRI and targeted biopsies.
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Daniel F Osses
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank-Jan H Drost
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan F M Verbeek
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Chris H Bangma
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Galgano SJ, Glaser ZA, Porter KK, Rais-Bahrami S. Role of Prostate MRI in the Setting of Active Surveillance for Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:49-67. [DOI: 10.1007/978-3-319-99286-0_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Glaser ZA, Gordetsky JB, Porter KK, Varambally S, Rais-Bahrami S. Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance. Front Oncol 2017; 7:256. [PMID: 29164056 PMCID: PMC5670116 DOI: 10.3389/fonc.2017.00256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
Background Active surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as one in four patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities. Methods An English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging, and biomarkers published within the past 3 years. Our Boolean criteria included the following terms: PCa, AS, imaging, biomarker, genetic, genomic, prospective, retrospective, and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search. Results Our review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting. Conclusion In the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure has shown some initial promise, but further validation is warranted.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
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