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Solyanik O, Chaloupka M, Clevert DA, Schmidt VF, Ingenerf M, Kazmierczak P, Stief CG, Ricke J, Apfelbeck M. Prospective close monitoring of the effect of vascular-targeted photodynamic therapy and high intensity focused ultrasound of localized prostate cancer by multiparametric magnetic resonance imaging. World J Urol 2024; 42:462. [PMID: 39088086 DOI: 10.1007/s00345-024-05143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 06/21/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE The aim of this study is to describe the anatomical and functional changes observed in multiparametric magnetic resonance imaging (mpMRI) during follow-up after focal therapy (FT) for localized prostate cancer (PCa). MATERIALS AND METHODS In this prospective study, we analyzed pre- and postoperatively acquired mpMRI of 10 patients after FT (7 days; 3, 6, 9, 12 months). 7/10 (70%) patients underwent vascular-targeted photodynamic therapy (VTP). 3/10 (30%) patients underwent high-intensity focused ultrasound (HIFU). MpMR image analysis was performed using a semi-automatic software for segmentation of the prostate gland (PG) and tumor zones. Signal intensities (SI) of T2-weighted (T2w), T1-weighted (T1w),diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) images as well as volumes of the prostate gland (PGV) and tumor volumes (TV) were evaluated at each time point. RESULTS The results showed a significant increase of PGV 7 days after FT (p = 0.042) and a significant reduction of PGV between 7 days and 6, 9 and 12 months after FT (p < 0.001). The TV increased significantly 7 days after FT (p < 0.001) and decreased significantly between 7 days and 12 months after FT (p < 0.001). There was a significant increase in SI of the ADC in the ablation zone after 6, 9 and 12 months after FT (p < 0.001). 1/9 patients (11%) had recurrent tumor on rebiopsy characterized as a a small focal lesion on mpMRI with strong diffusion restriction (low SI on ADC map and high SI on b-value DWI). CONCLUSION MpMRI is able to represent morphologic changes of the ablated zone after FT and might be helpful to detect recurrent tumor.
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Affiliation(s)
| | - Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Germany, Munich
| | - Vanessa F Schmidt
- Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Germany, Munich
| | - Maria Ingenerf
- Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Germany, Munich
| | - Philipp Kazmierczak
- Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Germany, Munich
| | - Christian G Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Germany, Munich
| | - Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
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2
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Chin J, Tan YG, Lee A, Ng TK, Shi R, Tang CYL, Thang SP, Tuan JKL, Cheng CWS, Tay KJ, Ho HSS, Wang HJ, Chiu PKF, Teoh JYC, Lam WWC, Law YM, Yuen JSP, Chen K. "Seeing Is Believing": Additive Utility of 68Ga-PSMA-11 PET/CT in Prostate Cancer Diagnosis. Cancers (Basel) 2024; 16:1777. [PMID: 38730729 PMCID: PMC11083035 DOI: 10.3390/cancers16091777] [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: 04/03/2024] [Revised: 04/27/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI, 68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of 68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. 68Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4-5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions, 68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4-5 lesions, 68Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of 68Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and 68Ga-PSMA-11 PET/CT.
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Affiliation(s)
- Joel Chin
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Alvin Lee
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Tze Kiat Ng
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Ruoyu Shi
- Department of Anatomical Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Charlene Yu Lin Tang
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Sue Ping Thang
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Jeffrey Kit Loong Tuan
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Programme, 20 College Rd, Singapore 169856, Singapore
| | | | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Hung-Jen Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie Wing-Chuen Lam
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
- SingHealth Duke-NUS Radiological Sciences Academic Clinical Programme, 20 College Rd, Singapore 169856, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - John Shyi Peng Yuen
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Programme, 20 College Rd, Singapore 169856, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Programme, 20 College Rd, Singapore 169856, Singapore
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3
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Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, Bomers JGR, Dudderidge T, Ehdaie B, Freeman A, Guillaumier S, Hindley R, Lakhani A, Pendse D, Punwani S, Rastinehad AR, Rouvière O, Sanchez-Salas R, Schoots IG, Sokhi HK, Tam H, Tempany CM, Valerio M, Verma S, Villeirs G, van der Meulen J, Ahmed HU, Shah TT. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations. Eur Urol 2024; 85:466-482. [PMID: 38519280 DOI: 10.1016/j.eururo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nikhil Mayor
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Cullen
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joyce G R Bomers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Amish Lakhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Olivier Rouvière
- Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France
| | | | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heminder K Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Henry Tam
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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4
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Raunig DL, Pennello GA, Delfino JG, Buckler AJ, Hall TJ, Guimaraes AR, Wang X, Huang EP, Barnhart HX, deSouza N, Obuchowski N. Multiparametric Quantitative Imaging Biomarker as a Multivariate Descriptor of Health: A Roadmap. Acad Radiol 2023; 30:159-182. [PMID: 36464548 PMCID: PMC9825667 DOI: 10.1016/j.acra.2022.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 12/02/2022]
Abstract
Multiparametric quantitative imaging biomarkers (QIBs) offer distinct advantages over single, univariate descriptors because they provide a more complete measure of complex, multidimensional biological systems. In disease, where structural and functional disturbances occur across a multitude of subsystems, multivariate QIBs are needed to measure the extent of system malfunction. This paper, the first Use Case in a series of articles on multiparameter imaging biomarkers, considers multiple QIBs as a multidimensional vector to represent all relevant disease constructs more completely. The approach proposed offers several advantages over QIBs as multiple endpoints and avoids combining them into a single composite that obscures the medical meaning of the individual measurements. We focus on establishing statistically rigorous methods to create a single, simultaneous measure from multiple QIBs that preserves the sensitivity of each univariate QIB while incorporating the correlation among QIBs. Details are provided for metrological methods to quantify the technical performance. Methods to reduce the set of QIBs, test the superiority of the mp-QIB model to any univariate QIB model, and design study strategies for generating precision and validity claims are also provided. QIBs of Alzheimer's Disease from the ADNI merge data set are used as a case study to illustrate the methods described.
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Affiliation(s)
- David L Raunig
- Department of Statistical and Quantitative Sciences, Data Science Institute, Takeda Pharmaceuticals, Cambridge, Massachusetts.
| | - Gene A Pennello
- Center for Devices and Radiological Health, US Food and Drug Administration Division of Imaging, Diagnostic and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Jana G Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Erich P Huang
- Biometric Research Program, Division of Cancer Treatment and Diagnosis - National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Huiman X Barnhart
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Nandita deSouza
- Division of Radiotherapy and Imaging, the Insitute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic Foundation, Cleveland, Ohio
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5
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Kotamarti S, Polascik TJ. Focal cryotherapy for prostate cancer: a contemporary literature review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:26. [PMID: 36760265 PMCID: PMC9906190 DOI: 10.21037/atm-21-5033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022]
Abstract
Objective To perform a comprehensive review of the contemporary literature regarding both functional and oncologic outcomes after primary focal cryotherapy for prostate cancer (PCa), providing these results as a foundation for discussing recent developments in the realm of focal therapy. Background Traditional treatments for PCa are often associated with debilitating functional side effects for patients. Due to advances in imaging and biopsy strategies, focal ablative therapies recently have garnered much interest and offer an alternative primary treatment for PCa patients with localized disease. Focal cryoablation utilizes heat extraction from tissues to generate an iceball and cause tissue destruction while sparing uninvolved prostatic regions. Optimized patient selection and postoperative management continue to be areas of interest and study as the field continues to develop. Methods A search was performed of the PubMed and Embase databases to identify articles pertaining to primary focal PCa cryoablation since our group's last comprehensive review in 2016. Conclusions Primary focal cryoablation for PCa offers optimized functional outcomes and a favorable adverse event profile. True evaluation of oncologic outcomes is hampered by lack of long-term follow-up and highly variable clinical endpoints across these studies. Nonetheless, outcomes appear adequate in the short- to medium-term time frame. Utilization of focal cryoablation is expected to grow with continued refinement of patient selection and management options in cases of treatment failure.
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Affiliation(s)
- Srinath Kotamarti
- Division of Urologic Surgery, Duke Cancer Institute, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urologic Surgery, Duke Cancer Institute, Durham, NC, USA
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6
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Ong S, Chen K, Grummet J, Yaxley J, Scheltema MJ, Stricker P, Tay KJ, Lawrentschuk N. Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus? BJU Int 2023; 131:20-31. [PMID: 36083229 PMCID: PMC10087270 DOI: 10.1111/bju.15883] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide a summary and discussion of international guidelines, position statements and consensus statements in relation to focal therapy (FT) for prostate cancer (PCa). METHODS The European Association of Urology-European Association of Nuclear Medicine-European Society for Radiotherapy and Oncology-European Society of Urogential Radiology-International Society of Urological Pathology-International Society of Geriatric Oncology and American Urological Association-American Society for Radiation Oncology-Society of Urologic Oncology guidelines were interrogated for recommendations for FT. PubMed and Ovid Medline were searched for consensus statements. Only studies in English since 2015 were included. Reference lists of the included articles were also interrogated and a manual search for studies was also performed. RESULTS Our results showed a lack of long-term randomised data for FT. International Urological guidelines emphasised the need for more high-quality clinical trials with robust oncological and toxicity outcomes. Consensus and positions statements were heterogenous. CONCLUSION A globally accepted guideline for FT planning, technique and follow-up are still yet to be determined. Well-designed studies with long-term follow-up and robust clinical and toxicity endpoints are needed to improve our understanding of FT and create uniform guidelines to streamline management and follow-up.
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Affiliation(s)
- Sean Ong
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Vic., Australia.,Department of Surgery, University of Melbourne, Melbourne, Vic., Australia
| | - Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - John Yaxley
- The University of Queensland, School of Medicine, Brisbane, QLD, Australia.,Wesley Urology Clinic, Wesley Hospital, Brisbane, QLD, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthijs J Scheltema
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Department of Urology, St Vincents Hospital and Campus, Sydney, NSW, Australia
| | - Phillip Stricker
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Department of Urology, St Vincents Hospital and Campus, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Vic., Australia.,Department of Surgery, University of Melbourne, Melbourne, Vic., Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia
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7
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Geboers B, Gondoputro W, Thompson JE, Reesink DJ, van Riel LAMJG, Zhang D, Blazevski A, Doan P, Agrawal S, Matthews J, Haynes AM, Liu Z, Delprado W, Shnier R, de Reijke TM, Lawrentschuk N, Stijns PEF, Yaxley JW, Scheltema MJ, Stricker PD. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Irreversible Electroporation-A Multicenter Validation Study. Eur Urol Focus 2022; 8:1591-1598. [PMID: 35577751 DOI: 10.1016/j.euf.2022.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/15/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Accurate monitoring following focal treatment of prostate cancer (PCa) is paramount for timely salvage treatment or retreatment. OBJECTIVE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) to detect residual PCa in the short-term follow-up of focal treatment with irreversible electroporation (IRE) using transperineal or transrectal template ± targeted biopsies. DESIGN, SETTING, AND PARTICIPANTS A retrospective international multicenter study of men with biopsy-proven PCa, treated with focal IRE, and followed by mpMRI (index-test) and template biopsies (reference-test) between February 2013 and January 2021, was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI were calculated for in- and outfield residual disease based on two definitions of significant PCa: University College London (UCL) 1-International Society of Urological Pathology (ISUP) ≥3 or ISUP ≥1 with maximum cancer core length (MCCL) ≥6 mm, and UCL2-ISUP ≥2 or ISUP ≥1 with MCCL ≥4 mm. RESULTS AND LIMITATIONS A total of 303 patients from five focal therapy centers were treated with primary IRE. The final analysis was performed on 217 men (median age 67, median prostate-specific antigen 6.2, 81% ISUP 2/3) who underwent both mpMRI and template biopsies. Multiparametric MRI missed 38/57 (67%) positive biopsy locations (UCL1) in 22 patients. Sensitivity, specificity, PPV, and NPV of mpMRI to detect whole gland residual disease (UCL1) were 43.6% (95% confidence interval [CI]: 28-59), 80.9% (95% CI: 75-86), 33.3% (95% CI: 21-47), and 86.7% (95% CI: 81-91), respectively. Based on UCL2, sensitivity, specificity, PPV, and NPV were 35.8% (95% CI: 25-48), 82.0% (95% CI: 75-88), 47.1% (95% CI: 34-61), and 74.1% (95% CI: 67-80), respectively. Limitations are the retrospective nature and short follow-up. CONCLUSIONS The diagnostic accuracy of mpMRI to detect residual clinically significant PCa following IRE was low. Follow-up template biopsies should be performed, regardless of mpMRI results. PATIENT SUMMARY We investigated the accuracy of magnetic resonance imaging (MRI) to detect residual prostate cancer after treatment with irreversible electroporation. The accuracy of MRI is insufficient, and we emphasize the importance of confirmatory prostate biopsies.
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Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Free University, Amsterdam, The Netherlands.
| | - William Gondoputro
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - James E Thompson
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Daan J Reesink
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Luigi A M J G van Riel
- Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands
| | - David Zhang
- Department of Urology, E.J. Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Jayne Matthews
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
| | - Zhixin Liu
- Department of Biostatistics, University of New South Wales, NSW, Australia
| | | | | | - Theo M de Reijke
- Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Nathan Lawrentschuk
- Department of Urology, E.J. Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
| | - Pascal E F Stijns
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - John W Yaxley
- Department of Urology, The Wesley Hospital, Brisbane, QLD, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands
| | - Phillip D Stricker
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
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8
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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9
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Azoulai D, Boustany J, Peyromaure M, Abou Chakra M, Duquesne I, Barry Delongchamps N. The proportion of potential candidates for focal therapy in localized prostate cancer in a real-life cohort and their final pathologic results. Prog Urol 2022; 32:1469-1475. [DOI: 10.1016/j.purol.2022.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
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10
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Kaneko M, Fukuda N, Nagano H, Yamada K, Yamada K, Konishi E, Sato Y, Ukimura O. Artificial intelligence trained with integration of multiparametric MR-US imaging data and fusion biopsy trajectory-proven pathology data for 3D prediction of prostate cancer: A proof-of-concept study. Prostate 2022; 82:793-803. [PMID: 35192229 DOI: 10.1002/pros.24321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND We aimed to develop an artificial intelligence (AI) algorithm that predicts the volume and location of clinically significant cancer (CSCa) using convolutional neural network (CNN) trained with integration of multiparametric MR-US image data and MRI-US fusion prostate biopsy (MRI-US PBx) trajectory-proven pathology data. METHODS Twenty consecutive patients prospectively underwent MRI-US PBx, followed by robot-assisted radical prostatectomy (RARP). The AI algorithm was trained with the integration of MR-US image data with a MRI-US PBx trajectory-proven pathology. The relationship with the 3D-cancer-mapping of RARP specimens was compared between AI system-suggested 3D-CSCa mapping and an experienced radiologist's suggested 3D-CSCa mapping on MRI alone according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2. The characteristics of detected and undetected tumors at AI were compared in 22,968 image data. The relationships between CSCa volumes and volumes predicted by AI as well as the radiologist's reading based on PI-RADS were analyzed. RESULTS The concordance of the CSCa center with that in RARP specimens was significantly higher in the AI prediction than the radiologist' reading (83% vs. 54%, p = 0.036). CSCa volumes predicted with AI were more accurate (r = 0.90, p < 0.001) than the radiologist's reading. The limitations include that the elastic fusion technology has its own registration error. CONCLUSIONS We presented a novel pilot AI algorithm for 3D prediction of PCa. AI was trained by integration of multiparametric MR-US image data and fusion biopsy trajectory-proven pathology data. This deep learning AI model may more precisely predict the 3D mapping of CSCa in its volume and center location than a radiologist's reading based on PI-RADS version 2, and has potential in the planning of focal therapy.
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Affiliation(s)
- Masatomo Kaneko
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norio Fukuda
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Hitomi Nagano
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaori Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Sato
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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11
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Jaipuria J, Ahmed HU. Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer. Curr Opin Urol 2022; 32:224-230. [PMID: 35184067 DOI: 10.1097/mou.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Focal therapy or partial gland ablation for nonmetastatic prostate cancer is gaining popularity not just as an alternative to active surveillance, but as an acceptable alternative to whole gland therapy in appropriate cases. This review summarizes recent evidence to help select patients for optimal outcomes. RECENT FINDINGS Recommendations by expert panels have become less conservative with each meeting. As experience with older modalities for focal therapy grows, newer modalities continue to be introduced. We are now in a position to offer personalized treatment pathway considering nuances of each focal therapy modality. SUMMARY The ideal case for focal therapy should be an MRI visible significant lesion (PIRADS score ≥ 3), with a positive biopsy for significant cancer (Gleason grade group 2-3) in the corresponding targeted biopsy area, and insignificant or absent disease in the nontarget random biopsy areas. Multifocal disease can also be selectively treated. Salvage focal ablation is an attractive treatment option for radio-recurrent or index focal therapy failure cases.
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Affiliation(s)
- Jiten Jaipuria
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
| | - Hashim U Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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12
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MR Imaging in Real Time Guiding of Therapies in Prostate Cancer. Life (Basel) 2022; 12:life12020302. [PMID: 35207589 PMCID: PMC8878909 DOI: 10.3390/life12020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
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13
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Shoji S, Koizumi N, Yuzuriha S, Kano T, Ogawa T, Nakano M, Kawakami M, Nitta M, Hasegawa M, Miyajima A. Development and future prospective of treatment for localized prostate cancer with high-intensity focused ultrasound. J Med Ultrason (2001) 2022:10.1007/s10396-021-01183-2. [PMID: 35032289 DOI: 10.1007/s10396-021-01183-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
High-intensity focused ultrasound (HIFU) was experimentally used for focal therapy for anti-cancer effects in prostate cancer (PC). Focal therapy is a diagnosis-based investigational treatment option for localized PC that cures clinically significant PC (csPC) while preserving the anatomical structures related to urinary and sexual function based on its spread observed using multi-parametric magnetic resonance imaging (mpMRI). The European Association of Urology indicated that the current status of focal therapy for localized PC was an investigational modality and encouraged prospective recording of outcomes and recruitment of suitable patients in 2018. During the last few years, large-population multi- and single-center prospective studies have investigated focal therapy as a treatment strategy for localized PC. In a multicenter prospective study with 5-year follow-up, failure-free survival, which was defined as avoidance of local salvage therapy (surgery or radiotherapy), systemic therapy, metastases, and prostate cancer-specific death, was 88%. In the previous studies, there was no significant influence on urinary function before and at 3 months after the treatment, although transient impairment was reported 1 month after the treatment. Pad- and leak-free continence was preserved in 80-100% of the patients after treatment. Erectile function was significantly impaired in the initial 3 months after treatment compared to the pretreatment values, but it improved 6 months after the focal therapy in the previous reports. Paired comparison studies and cohort studies with long-term follow-up will contribute to verifying this treatment's clinical outcomes for patients with localized PC.
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Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
- Department of Urology, Tokai University Hachioji Hospital, Tokyo, Japan.
| | - Norihiro Koizumi
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Soichiro Yuzuriha
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tatsuo Kano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Takahiro Ogawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Mayura Nakano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masayoshi Kawakami
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Nitta
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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14
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Yaxley WJ, Gianduzzo T, Kua B, Oxford R, Yaxley JW. Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study. Investig Clin Urol 2022; 63:285-293. [PMID: 35534217 PMCID: PMC9091832 DOI: 10.4111/icu.20210472] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Materials and Methods Results Conclusions
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Affiliation(s)
- William John Yaxley
- Department of Urology, QEII Jubilee Hospital, Brisbane, Australia
- The University of Queensland, School of Medicine, Brisbane, Australia
| | - Troy Gianduzzo
- The University of Queensland, School of Medicine, Brisbane, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - Boon Kua
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - Rachel Oxford
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - John William Yaxley
- The University of Queensland, School of Medicine, Brisbane, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
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15
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van Riel LAMJG, Swaan A, Mannaerts CK, van Kollenburg RAA, Savci Heijink CD, de Reijke TM, de Bruin DM, Freund JE. Image-guided in-Vivo Needle-Based Confocal Laser Endomicroscopy in the Prostate: Safety and Feasibility Study in 2 Patients. Technol Cancer Res Treat 2022; 21:15330338221093149. [PMID: 35790459 PMCID: PMC9272180 DOI: 10.1177/15330338221093149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To assess the safety and technical feasibility of in-vivo needle-based forward-looking confocal laser endomicroscopy in prostate tissue. Methods: For this feasibility study, 2 patients with a suspicion of prostate cancer underwent transperineal needle-based confocal laser endomicroscopy during ultrasound-guided transperineal template mapping biopsies. After intravenous administration of fluorescein, needle-based confocal laser endomicroscopy imaging was performed with a forward-looking probe (outer diameter 0.9 mm) in 2 trajectories during a manual push-forward and pullback motion. A biopsy was taken in a coregistered parallel adjacent trajectory to the confocal laser endomicroscopy trajectory for histopathologic comparison. Peri- and postprocedural adverse events, confocal laser endomicroscopy device malfunction and procedural failures were recorded. Needle-based confocal laser endomicroscopy image quality assessment, image interpretation, and histology were performed by an experienced confocal laser endomicroscopy rater and uro-pathologist, blinded to any additional information. Results: In both patients, no peri- and post-procedural adverse events were reported following needle-based confocal laser endomicroscopy. No confocal laser endomicroscopy device malfunction nor procedural failures were reported. Within 1.5 min after intravenous administration of fluorescein, needle-based confocal laser endomicroscopy image quality was sufficient for interpretation for at least 14 min, yielding more than 5000 confocal laser endomicroscopy frames per patient. The pullback confocal laser endomicroscopy recordings and most of the push-forward recordings almost only visualized erythrocytes, being classified as non-representative. During the push-forward recordings, prostate tissue was occasionally visualized in single frames, insufficient for histopathologic comparison. Prostate carcinoma was identified by biopsy in one patient (Gleason score 4 + 3 = 7, >50%), while the biopsy from the other patient showed no malignancy. Conclusion: Needle-based confocal laser endomicroscopy imaging of in-vivo prostate tissue with a forward-looking confocal laser endomicroscopy probe is safe without device malfunctions or procedural failures. Needle-based confocal laser endomicroscopy is technically feasible, but the acquired confocal laser endomicroscopy datasets are non-representative. The confocal laser endomicroscopy images’ non-representative nature is possibly caused by bleeding artifacts, movement artifacts and a lack of contact time with the tissue of interest. A different confocal laser endomicroscopy probe or procedure might yield representative images of prostatic tissue.
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Affiliation(s)
- Luigi A M J G van Riel
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Abel Swaan
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Christophe K Mannaerts
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Rob A A van Kollenburg
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - C Dilara Savci Heijink
- Department of Pathology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Theo M de Reijke
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniel M de Bruin
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Erik Freund
- Department of Pathology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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16
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Parsons MW, Hutten RJ, Tward A, Khouri A, Peterson J, Morrell G, Lloyd S, Cannon DM, Johnson SB. The Effect of Maximum Tumor Diameter by MRI on Disease Control in Intermediate and High-risk Prostate Cancer Patients Treated With Brachytherapy Boost. Clin Genitourin Cancer 2021; 20:e68-e74. [PMID: 34776367 DOI: 10.1016/j.clgc.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Larger maximum tumor diameter (MTD) has been associated with worse prostate cancer (PCa) outcomes. However, the impact of MTD in PCa treated with external beam radiotherapy and brachytherapy boost (EBRT+BB) remains unknown. MATERIALS AND METHODS Patients with PCa treated with EBRT+BB were identified from an institutional database. Clinical data including MTD, age, androgen deprivation therapy (ADT) use, prostate specific antigen (PSA), International Society of Urologic Pathology (ISUP) group, clinical T-stage, and presence of adverse pathology on imaging were retrospectively collected. Multivariable and univariable cox proportional hazards models for biochemical failure (BF) and distant metastasis (DM) were produced with MTD grouped by receiver operating characteristic (ROC) cut-point. Cumulative hazard functions for BF and DM were compared with log-rank test and stratified by ISUP group. RESULTS Of 191 patients treated with EBRT+BB, 113 had MTD measurements available. Larger MTD was associated with increased ADT use and seminal vesicle involvement. ROC optimization identified MTD of 24 mm as the optimal cut-point for both BF and DM. MTD was independently associated with both BF (HR 8.61, P = .048, 95% CI 1.02-72.97) and DM (HR 8.55, P = .05, 95% CI 1.00-73.19). In patients with ISUP group 4 to 5 disease, MTD > 24 mm was independently associated with increased risk of DM (HR 10.13, P = .04, 95% CI 1.13-91.12). CONCLUSIONS This is the first study to evaluate MTD in the setting of EBRT+BB. These results demonstrate that MTD is independently associated with BF and metastasis. This suggests a possible role for MTD in risk assessment models and clinical decision-making for men receiving EBRT+BB.
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Affiliation(s)
- Matthew W Parsons
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT
| | - Ryan J Hutten
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT
| | - Alexander Tward
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT
| | - Ashley Khouri
- University of Utah School of Medicine, Department of Radiation Oncology, Salt Lake City, UT
| | - John Peterson
- University of Utah School of Medicine, Department of Radiation Oncology, Salt Lake City, UT
| | - Glen Morrell
- University of Utah, Department of Radiology and Imaging Services, Salt Lake City, UT
| | - Shane Lloyd
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT
| | - Donald M Cannon
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT
| | - Skyler B Johnson
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT.
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17
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Ni X, Lin M, Li J, Zeng L, Li W, Huang L, Li D, Zhang L. Development of an evaluation indicator system for the rational use of proton pump inhibitors in pediatric intensive care units: An application of Delphi method. Medicine (Baltimore) 2021; 100:e26327. [PMID: 34128875 PMCID: PMC8213291 DOI: 10.1097/md.0000000000026327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
Proton pump inhibitors are frequently used to prevent gastrointestinal bleeding in critically ill patients. But there is little information in the instructions about the usages for children. It is important to monitor the appropriate use of proton pump inhibitors, especially in pediatrics. Therefore, we developed an evaluation indicator system for the rational use of proton pump inhibitors in pediatric intensive care units.First, a systematic review was conducted to developed the initial indicators. Then 2 rounds of Delphi surveys were conducted to collecting opinions from a panel of independent experts, and the indicator system was modified to form the final indicators according to the opinions. Finally, the analytic hierarchy procedure was used to determine the weight of each indicator.A total of 6 guidelines and 2 studies met the inclusion and exclusion criteria. Based on literature and discussion among experts, an initial indicator system including 4 first-rank indicators and 12 second-rank indicators was formed. After 2 rounds of Delphi surveys, 2 indicators were added, 5 indicators were deleted, and 1 indicator was revised, so the final indicator system contained a total of 13 indicators including 3 first-rank indicators (drug selection, drug usage and dosage, duration of drug therapy) and 10 second-rank indicators (the proportion of PPIs used in children, children under 1 year old, children who is using glucocorticoids, children with nonsteroidal anti-inflammatory drugs, children with gastroesophageal reflux disease, children with sepsis, children with ventilators in PICU; the strength of PPIs' use, the proportion of omeprazole in children using PPIs during the same period; the average days of PPIs used in children). By analyzing scores, all coefficients met the standard, indicating the indicators were scientific and credible.Through a two-round Delphi survey, 3 first-rank indicators and ten second-rank indicators were developed, which will help drug administrative departments to promote the rational use of PPIs for children in PICUs. What is more, our study can constitute a methodological reference for the development of other indicator systems.
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Affiliation(s)
- Xiaofeng Ni
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Medicine, Sichuan University
| | - Mao Lin
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
| | - Jialian Li
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
| | - Linan Zeng
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
| | - Wenrui Li
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
| | - Liang Huang
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
| | - Deyuan Li
- Pediatric intensive care, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
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18
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Tan WP, Rastinehad AR, Klotz L, Carroll PR, Emberton M, Feller JF, George AK, Gill IS, Gupta RT, Katz AE, Lebastchi AH, Marks LS, Marra G, Pinto PA, Song DY, Sidana A, Ward JF, Sanchez-Salas R, Rosette JDL, Polascik TJ. Utilization of focal therapy for patients discontinuing active surveillance of prostate cancer: Recommendations of an international Delphi consensus. Urol Oncol 2021; 39:781.e17-781.e24. [PMID: 33676851 DOI: 10.1016/j.urolonc.2021.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND With the advancement of imaging technology, focal therapy (FT) has been gaining acceptance for the treatment of select patients with localized prostate cancer (CaP). We aim to provide details of a formal physician consensus on the utilization of FT for patients with CaP who are discontinuing active surveillance (AS). METHODS A 3-stage Delphi consensus on CaP and FT was conducted. Consensus was defined as agreement by ≥80% of physicians. An in-person meeting was attended by 17 panelists to formulate the consensus statement. RESULTS Fifty-six respondents participated in this interdisciplinary consensus study (82% urologist, 16% radiologist, 2% radiation oncology). The participants confirmed that there is a role for FT in men discontinuing AS (48% strongly agree, 39% agree). The benefit of FT over radical therapy for men coming off AS is: less invasive (91%), has a greater likelihood to preserve erectile function (91%), has a greater likelihood to preserve urinary continence (91%), has fewer side effects (86%), and has early recovery post-treatment (80%). Patients will need to undergo mpMRI of the prostate and/or a saturation biopsy to determine if they are potential candidates for FT. Our limitations include respondent's biases and that the participants of this consensus may not represent the larger medical community. CONCLUSIONS FT can be offered to men coming off AS between the age of 60 to 80 with grade group 2 localized cancer. This consensus from a multidisciplinary, multi-institutional, international expert panel provides a contemporary insight utilizing FT for CaP in select patients who are discontinuing AS.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC
| | | | - Laurence Klotz
- Department of Urology, University of Toronto, Toronto, Ontario
| | - Peter R Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | | | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Inderbir S Gill
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Aaron E Katz
- Department of Urology, New York University, New York City, NY
| | - Amir H Lebastchi
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | | | - Peter A Pinto
- Urologic Oncology Branch of the National Cancer Institute, Bethesda, MD
| | - Daniel Y Song
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD
| | - Abhinav Sidana
- Department of Urology, University of Cincinnati, Cincinnati, OH
| | - John F Ward
- Department of Urology, MD Anderson Cancer Center, Houston, TX
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19
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MR-Guided High-Intensity Directional Ultrasound Ablation of Prostate Cancer. Curr Urol Rep 2021; 22:3. [PMID: 33403460 DOI: 10.1007/s11934-020-01020-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to review the novel treatment modality of high-intensity transurethral directional ultrasound for prostate cancer. RECENT FINDINGS Prostate cancer is a heterogeneous disease with some patients electing for active surveillance and focal therapies instead of definitive treatment with radical prostatectomy or radiation therapy. Prostate MRI has become a cornerstone of prostate cancer diagnosis, targeted biopsy, and treatment planning. Transurethral high-intensity directional ultrasound allows for MRI-guided ablation of the prostate gland with the ability to contour boundaries and spare critical structures, such as the neurovascular bundle and urinary sphincter. Although results are still emerging, this may offer patients a new option for focal therapy with a favorable side-effect profile. High-intensity transurethral directional ultrasound is an emerging treatment modality for both whole-gland and focal ablation with promising early results. Further research is needed to establish safety, tolerability, and long-term oncologic outcomes.
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20
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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von Hardenberg J, Borkowetz A, Siegel F, Kornienko K, Westhoff N, Jordan TB, Hoffmann M, Drerup M, Lieb V, Taymoorian K, Schostak M, Ganzer R, Höfner T, Cash H, Bruendl J. Potential Candidates for Focal Therapy in Prostate Cancer in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Large Multicenter Cohort Study. Eur Urol Focus 2020; 7:1002-1010. [PMID: 33877047 DOI: 10.1016/j.euf.2020.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/23/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy. OBJECTIVE To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources. DESIGN, SETTING, AND PARTICIPANTS Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions based on PI-RADS v2 were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones. RESULTS AND LIMITATIONS In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group ≤2, prostate-specific antigen [PSA] ≤15ng/mL, and life expectancy >10yr), 303 patients (12.8%; ISUP 1: n=148 [6.2%]; ISUP 2: n=155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n=288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]). CONCLUSIONS With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment. PATIENT SUMMARY We analyzed how many men who receive a magnetic resonance imaging-targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment.
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Affiliation(s)
- Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Heinrich-Lanz Center, Department of Biomedical Informatics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kira Kornienko
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Niklas Westhoff
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias B Jordan
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Manuela Hoffmann
- Department of Occupational Health and Safety, Federal Ministry of Defense, Bonn, Germany
| | - Martin Drerup
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Verena Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | | | - Martin Schostak
- Clinic of Urology, Urooncology, Robotic-assisted and Focal Therapy, Medical Faculty and University Clinics of Magdeburg, Magdeburg, Germany
| | - Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
| | - Thomas Höfner
- Department of Urology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hannes Cash
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Johannes Bruendl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
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Scheltema MJ, Chang JI, van den Bos W, Böhm M, Delprado W, Gielchinsky I, de Reijke TM, de la Rosette JJ, Siriwardana AR, Shnier R, Stricker PD. Preliminary Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Focal Therapy with Irreversible Electroporation. Eur Urol Focus 2020; 5:585-591. [PMID: 29102671 DOI: 10.1016/j.euf.2017.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/21/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in the follow-up following focal therapy of prostate cancer (PCa). OBJECTIVE To determine the diagnostic accuracy of mpMRI to detect residual PCa following focal therapy with irreversible electroporation. DESIGN, SETTING, AND PARTICIPANTS Seventy-six patients with biopsy-proven localized PCa consented for primary irreversible electroporation between February 2013 and March 2016. Final analysis was performed on 50 patients that received follow-up mpMRI at 6 mo, serial prostate-specific antigen (PSA) testing, and transperineal template-mapping biopsies at 12 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outfield regions of interest (ROI) were reported using PI-RADS version 2. A binary outcome (suspicious vs nonsuspicious) was given for the infield ablation zone. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated for different definitions of significant PCa: (1) Gleason ≥4+3 or Gleason ≥3+3 with a maximum cancer core length ≥6mm, (2) Gleason ≥3+4 or Gleason ≥3+3 with a maximum cancer core length ≥4mm, for outfield and infield ROI. Multivariate linear regression analyses evaluated the additional value of nadir PSA. RESULTS AND LIMITATIONS Sensitivity, specificity, positive predictive values, and negative predictive values of infield ROI was 43%, 86%, 33%, and 90% for definition 1 and 38%, 86%, 33%, and 88% for definition 2, respectively. For outfield ROI this was 33%, 82%, 20%, and 90% for definition 1 and 38%, 86%, 50%, and 80% for definition 2. PSA had no additional value in predicting residual significant PCa. Limitations include retrospective design, single reader, and low incidence of residual PCa. CONCLUSIONS Our preliminary data suggest that mpMRI can rule out high-volume residual PCa. However, follow-up biopsies should still be performed to determine oncological control. PATIENT SUMMARY Multiparametric magnetic resonance imaging is able to detect high-volume significant prostate cancer following focal therapy. Prostate biopsies are still required in the follow-up of focal therapy as (low-volume) significant prostate cancer is being missed by multiparametric magnetic resonance imaging.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia; Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands.
| | - John I Chang
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Willemien van den Bos
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
| | | | - Ilan Gielchinsky
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Theo M de Reijke
- Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands
| | - Jean J de la Rosette
- Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands
| | - Amila R Siriwardana
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Ron Shnier
- Southern Radiology, Randwick, Sydney, NSW, Australia
| | - Phillip D Stricker
- St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
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Norris JM, Carmona Echeverria LM, Simpson BS, Ball R, Freeman A, Kelly D, Kirkham A, Whitaker HC, Emberton M. Histopathological features of prostate cancer conspicuity on multiparametric MRI: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e039735. [PMID: 33093035 PMCID: PMC7583062 DOI: 10.1136/bmjopen-2020-039735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multiparametric MRI (mpMRI) has improved risk stratification for men with suspected prostate cancer. Indeed, mpMRI-visible tumours tend to be larger and of higher pathological grade than mpMRI-invisible tumours; however, concern remains around significant cancer that is undetected by mpMRI. There has been considerable recent interest to investigate whether tumour conspicuity on mpMRI is associated with additional histopathological features (including cellular density, microvessel density and unusual prostate cancer subtypes), which may have important clinical implications in both diagnosis and prognosis. Furthermore, analysis of these features may help reveal the radiobiology that underpins the actual mechanisms of mpMRI visibility (and invisibility) of prostate tumours. Here, we describe a protocol for a systematic review of the histopathological basis of prostate cancer conspicuity on mpMRI. METHODS AND ANALYSIS A systematic search of the MEDLINE, PubMed, Embase and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to guide screening, thematic reporting and conclusions drawn from all eligible studies. Included papers will be full-text, English-language articles, comparing the histopathological characteristics of mpMRI-visible lesions and mpMRI-invisible tumours. All studies published between January 1950 and January 2020 will be eligible for inclusion. Studies using confirmatory immunohistochemistry for the identification of immune subsets or structural components will be included. Study bias and quality will be assessed using a modified Newcastle-Ottawa scale. To ensure methodological rigour, this protocol is written in accordance with the PRISMA Protocol 2015 checklist. If appropriate, a meta-analysis will be conducted comparing histopathological feature frequency between mpMRI-visible and mpMRI-invisible disease. ETHICS AND DISSEMINATION No ethical approval will be required as this is an academic review of published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020176049.
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Affiliation(s)
- Joseph M Norris
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Benjamin S Simpson
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Rhys Ball
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- UCL Division of Surgery and Interventional Science, University College London, London, UK
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Kim CH, Kim CK, Park JJ, Park SY, Yoon YC. Yield of concurrent systemic biopsy during MRI-targeted biopsy according to Prostate Imaging Reporting and Data System version 2 in patients with suspected prostate cancer. Eur Radiol 2020; 31:1667-1675. [PMID: 32910231 DOI: 10.1007/s00330-020-07167-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/30/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the yield of concurrent systemic biopsy (SB) during MRI-targeted biopsy (MRTB) as Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) interpretations in patients with suspected prostate cancer (PCa). METHODS A total of 285 patients with suspected PCa underwent prebiopsy 3-T MRI, followed by MRI-transrectal ultrasound fusion targeted biopsy and concurrent standard SB for lesions with PI-RADS v2 scores 3-5. Detection rates and positive core rates of PCa and clinically significant cancer (CSC) were evaluated. RESULTS In concurrent MRTB and SB, PCa and CSC detection rates were 18.9% and 9.4% for PI-RADS score 3, 45.9% and 32.4% for PI-RADS score 4, and 82.1% and 72.6% for PI-RADS score 5, respectively. Overall detection rate of CSCs (40.0%) for concurrent MRTB and SB was significantly higher than that of MRTB (34.4%, p = 0.004) or SB alone (27.7%, p < 0.001): an increase of 5.6% (16 patients) compared with MRTB alone. For patients with PI-RADS score 4 or 5, the CSC detection rate of concurrent MRTB and SB was 47.0%, an increase of 6.1% when compared with MRTB (40.9%) only (p < 0.001). Of the 110 patients with both MRTB- and SB-positive findings, 22 (20.0%) had the highest Gleason score in SB compared with that in MRTB. In 9.5% (27/285) patients including 12 patients with CSCs, only SB was positive, with negative MRTB. CONCLUSION Concurrent SB with MRTB based on PI-RADS v2 can yield a higher CSC detection rate compared with MRTB alone in patients with suspected PCa. KEY POINTS • Concurrent SB with MRTB yields an increase of 5.6% CSC detection compared with MRTB alone. • Of both MRTB- and SB-positive findings, 20.0% patients have upgraded Gleason score in SB. • In 18.4% patients, only SB was positive, with negative MRTB. Adding MRTB to SB is helpful for adequate risk stratification, reducing diagnostic uncertainty of PCa.
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Affiliation(s)
- Chu Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Jung Jae Park
- Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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Early oncological control following partial gland cryo-ablation: a prospective experience specifying reflex MRI guided biopsy of the ablation zone. Prostate Cancer Prostatic Dis 2020; 24:114-119. [PMID: 32636487 DOI: 10.1038/s41391-020-0244-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/23/2020] [Accepted: 06/24/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several consensus statements recommend serial serum prostate-specific antigen (PSA), multi parametric magnetic resonance imaging (mpMRI), and prostate biopsy following partial gland ablation. We determined the rate of persistent in-field disease following primary partial gland cryo-ablation and whether PSA or mpMRI are reliable predictors of in-field disease persistence. METHODS Between March 2017 and July 2019, subjects meeting eligibility criteria for partial gland cryoablation were enrolled into an IRB approved outcomes registry. PSA, mpMRI, and prostate biopsy (four cores targeting the ablation zone + six ipsilateral systematic cores) were performed per protocol 6 months following intervention. Binary logistic regression was employed to calculate odds ratio (OR) of PSA decrease, and suspicious mpMRI effect on cancer persistence. The performance of mpMRI for predicting in-field persistence of PCa was evaluated by area under the receiver operation characteristics curve (AUC). RESULTS Of the 83 eligible men undergoing partial gland cryoablation, 70 (84.3%) underwent 6-month protocol prostate biopsy. Five (7.1%) biopsies exhibited any in-field disease persistence. Only one (1.4%) of these cancers was Gleason grade > 1. Neither PSA decrease or suspicious mpMRI reliably predicted cancer persistence, with OR of 1.6 (0.25-8.6) and 1.5 (0.02-1.3), respectively. AUC of mpMRI for predicting in-field disease persistence was 0.554. CONCLUSIONS In this cohort of patients undergoing partial gland cryo-ablation, the incidence of persistent disease was low. PSA and mpMRI were not reliable predictors of in-field disease persistence. Based on these data, consideration may be given to deferring early follow-up biopsy in appropriate patients.
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Harland N, Stenzl A, Todenhöfer T. Role of Multiparametric Magnetic Resonance Imaging in Predicting Pathologic Outcomes in Prostate Cancer. World J Mens Health 2020; 39:38-47. [PMID: 32648376 PMCID: PMC7752518 DOI: 10.5534/wjmh.200030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) and the introduction of standardized protocols for its interpretation have had a significant impact on the field of prostate cancer (PC). Multiple randomized controlled trials have shown that the sensitivity for detection of clinically significant PC is increased when mpMRI results are the basis for indication of a prostate biopsy. The added value with regards to sensitivity has been strongest for patients with persistent suspicion for PC after a prior negative biopsy. Although enhanced sensitivity of mpMRI is convincing, studies that have compared mpMRI with prostatectomy specimens prepared by whole-mount section analysis have shown a significant number of lesions that were not detected by mpMRI. In this context, the importance of an additional systematic biopsy (SB) is still being debated. While SB in combination with targeted biopsies leads to an increased detection rate, most of the tumors detected by SB only are considered clinically insignificant. Currently, multiple risk calculation tools are being developed that include not only clinical parameters but mpMRI results in addition to clinical parameters in order to improve risk stratification for PC, such as the Partin tables. In summary, mpMRI of the prostate has become a standard procedure recommended by multiple important guidelines for the diagnostic work-up of patients with suspicion of PC.
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Affiliation(s)
- Niklas Harland
- Department of Urology, University Hospital Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Germany.,Medical School, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Tilman Todenhöfer
- Medical School, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Clinical Trial Unit, Studienpraxis Urologie, Nürtingen, Germany.
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Oncological and Quality-of-life Outcomes Following Focal Irreversible Electroporation as Primary Treatment for Localised Prostate Cancer: A Biopsy-monitored Prospective Cohort. Eur Urol Oncol 2020; 3:283-290. [DOI: 10.1016/j.euo.2019.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
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Tourinho-Barbosa RR, Wood BJ, Abreu AL, Nahar B, Shin T, Guven S, Polascik TJ. Current state of image-guided focal therapy for prostate cancer. World J Urol 2020; 39:701-717. [PMID: 32444886 DOI: 10.1007/s00345-020-03254-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/11/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa). METHODS A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review. RESULTS Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3-5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare. CONCLUSION An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.
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Affiliation(s)
- Rafael R Tourinho-Barbosa
- Department of Urology, Hospital CardioPulmonar, 157, Ponciano Oliveira Street, Salvador, Bahia, 40170-530, Brazil.
- Department of Urology, Faculdade de Medicina Do ABC (ABC Medical School), São Paulo, Brazil.
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Interventional Radiology, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD, USA
| | - Andre Luis Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Toshitaka Shin
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
| | - Selcuk Guven
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Shen WW, Cui LG, Ran WQ, Sun Y, Jiang J, Pei XL, Chen W. Targeted Biopsy With Reduced Number of Cores: Optimal Sampling Scheme in Patients Undergoing Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Prostate Biopsy. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1197-1207. [PMID: 32107089 DOI: 10.1016/j.ultrasmedbio.2020.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
The 3 Tesla (3T) magnetic resonance imaging (MRI) combined ultrasound (TRUS) targeted biopsy plus 12-core systematic biopsy (TBx + 12-SBx) was considered a reliable method for prostate cancer (PCa) diagnosis. To find another optimal sampling scheme with fewer cores and the same efficiency as TBx + 12-SBx for prostate biopsy, 113 patients who underwent five different hypothetical sampling schemes were analyzed and compared with TBx + 12-SBx. The detection rates of targeted biopsy plus 6-core lateral systematic biopsy (TBx + lateral 6-SBx) for PCa and clinically significant prostate cancer (csPCa) (99.1% and 96.4%, respectively) were higher than other schemes, and the area under the receiver operating characteristic curve of TBx + lateral 6-SBx for PCa and csPCa (0.991 and 0.990, respectively) were also significantly higher than other sampling schemes except TBx plus 6-core ipsilateral systematic biopsy (TBx + ipsilateral 6-SBx). Additionally, TBx + lateral 6-SBx had the lowest missed diagnosis rate. Thus, the TBx + lateral 6-SBx may be the optimal scheme for patients undergoing MRI/TRUS fusion prostate biopsy.
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Affiliation(s)
- Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China.
| | - Wei-Qiang Ran
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Jie Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Xin-Long Pei
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
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30
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Lin M, Zeng L, Huang L, Tao Y, Zhang L. Application of Delphi method and analytic hierarchy process to establish indicator system for evaluation of rational drug use in children with primary nephrotic syndrome: Observational study. Medicine (Baltimore) 2020; 99:e19949. [PMID: 32384442 PMCID: PMC7220122 DOI: 10.1097/md.0000000000019949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/28/2020] [Accepted: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
Nephrotic syndrome (NS) can be divided into primary, secondary, and congenital NS 3 types, and primary nephrotic syndrome (PNS) accounts for about 90% of the total number of NS in children, which is a common childhood glomerular disease one. The treatment of children with PNS has been controversial and confused because of hormone tolerance, complications, multiple drug combinations, and other issues, but there are no indicators to assess the rational drug use (RDU) of children with PNS. This study aims to develop a set of indicators to assess the RDU in children with PNS.The study is an observational study and the procedure includes 3 steps:A consensus was reached after 2 rounds of the Delphi survey and each indicator was weighted. The final indicators included 2 first-rank indicators and 16 second-rank indicators. In round 1, modified 3 indicators, increase 2 indicators and delete 6 indicators. In round 2, reached consensus. The first-rank indicators comprised drug choice (46.96%) and drug usage and dosage (53.04%); The second-rank indicators aimed to the specific drug therapy, including the RDU of hormones, immunomodulators, and adjuvant drug. The score of each indicator met the requirements, therefore, childrens PNS RDU evaluation index system had been established and the index was scientific and credible.The first set indicators had been established to assess RDU of children with PNS. Monitoring these indicators will guide people towards the promotion of RDU for PNS. Whats more, the indicator provided a methodological reference for the development of other indicator sets.
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Affiliation(s)
- Mao Lin
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy
| | - Linan Zeng
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
| | - Liang Huang
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
| | - Yuhong Tao
- Department of pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy
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Cartography-based quality control of prostate cancer care: a necessary ground to targeted focal therapy. Curr Opin Urol 2020; 29:65-69. [PMID: 30320610 DOI: 10.1097/mou.0000000000000560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We summarize the evidence on accurate target definition, precise imaging, and guiding systems that are a necessary ground to targeted focal therapy. RECENT FINDINGS Accurate target detection is based on the ability of imaging to locate and characterize precisely the tumor burden and differentiation inside the prostate. There is a clear correlation with the multiparametric MRI (mpMRI) images and the morphologic attributes of the tumor. Limitations stem from the heterogeneity and the multifocality of prostate cancer. Some prostate cancers are MRI-negative tumors. Safety margins should also be elaborated based on the tumor grade and burden. PET prostate specific membrane antigen is another promising technology yielding same results as multiparametric MRI for primary detection of prostate cancer, but PET/MRI imaging is promising. Perfect guiding requires sophisticated software with good quality control to track the needle inside the prostate and to record the position allowing recall when second look biopsy, active surveillance, or targeted focal therapy are required. SUMMARY The multimodal fusion cartography model proves effective and necessary to fulfill preoperative and postoperative requirements for targeted focal therapy.
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Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities. Int J Clin Oncol 2020; 25:509-520. [PMID: 32040781 DOI: 10.1007/s10147-020-01627-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPC) because of its usefulness in combination with anatomic and functional data. MRI-targeted biopsy, such as MRI-transrectal ultrasound (TRUS) fusion image-guided prostate biopsy, has high accuracy in the detection and localization of csPC. This novel diagnostic technique contributes to the development of tailor-made medicine as focal therapy, which cures the csPC while preserving the anatomical structures related to urinary and sexual function. In the early days of focal therapy, TRUS-guided systematic biopsy was used for patient selection, and treatment was performed for patients with low-risk PC. With the introduction of mpMRI and mapping biopsy, the treatment range is now determined based on individualized cancer localization. In recent prospective studies, 87.4% of treated patients had intermediate- and high-risk PC. However, focal therapy has two main limitations. First, a randomized controlled trial would be difficult to design because of the differences in pathological features between patients undergoing focal therapy and radical treatment. Therefore, pair-matched studies and/or historical controlled studies have been performed to compare focal therapy and radical treatment. Second, no long-term (≥ 10-year) follow-up study has been performed. However, recent prospective studies have encouraged the use of focal therapy as a treatment strategy for localized PC because it contributes to high preservation of continence and erectile function.
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Tan WP, ElShafei A, Aminsharifi A, Khalifa AO, Polascik TJ. Salvage Focal Cryotherapy Offers Similar Short-term Oncologic Control and Improved Urinary Function Compared With Salvage Whole Gland Cryotherapy for Radiation-resistant or Recurrent Prostate Cancer. Clin Genitourin Cancer 2019; 18:e260-e265. [PMID: 31892490 DOI: 10.1016/j.clgc.2019.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND We compared the short-term oncologic and functional outcomes of salvage focal cryotherapy (SFC) with those of salvage total cryotherapy (STC) for radiotherapy (RT)-persistent/recurrent prostate cancer. MATERIALS AND METHODS We queried the Cryo On-Line Database registry for men who had undergone SFC and STC of the prostate for RT-persistent or recurrent disease. Propensity score weighting was used to match age at treatment, presalvage therapy prostate-specific antigen level, Gleason sum, and presalvage cryotherapy androgen deprivation therapy status. The primary outcome was progression-free survival. RESULTS A total of 385 men with biopsy-proven persistent or recurrent prostate cancer after primary RT were included in the present study. The median follow-up, age, prostate-specific antigen, and Gleason sum before salvage cryotherapy was 24.4 months (first and third quartile, 9.8 and 60.3), 70 years (first and third quartile, 66 and 74 years), 4 ng/dL (first and third quartile, 2.7 and 5.6 ng/dL), and 7 (first and third quartile, 6 and 8), respectively. After propensity score weighting, the difference in progression-free survival was not statistically significant between the patients who had undergone STC and those who had undergone SFC (79.8% vs. 76.98%; P = .11 on weighted log-rank test). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs. 22.4%; P < .001). No significant differences were found in the incidence of rectal fistula (1.4% vs. 3.8; P = .30), new-onset urinary incontinence within 12 months (9.3% vs. 15.1%; P = .19), or new-onset erectile dysfunction within 12 months (52.6% vs. 59.6%; P = .47) between the SFC and STC groups, respectively. CONCLUSIONS STC resulted in similar 2-year oncologic outcomes compared with SFC in the RT-persistent/recurrent disease population. However, the patients who had undergone SFC had a lower urinary retention rate compared with those who had undergone STC.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ahmed ElShafei
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Medical School, Cairo University, Cairo, Egypt
| | - Alireza Aminsharifi
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Department of Urology, Menoufia University, Shebin Al Kom, Egypt
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
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Fasciano D, Eich ML, Del Carmen Rodriguez Pena M, Rais-Bahrami S, Gordetsky J. Focused Submission of Tissue for Radical Prostatectomy Following Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-Targeted Biopsy. Int J Surg Pathol 2019; 28:44-50. [PMID: 31342804 DOI: 10.1177/1066896919865026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prostate cancer can be difficult to appreciate grossly and therefore partial sampling of the gland can lead to incorrect grading, staging, or margin status. However, submitting the entire prostate is more time consuming and costly. We investigated the use of magnetic resonance imaging/ultrasound-targeted biopsy for the selective submission of prostatectomy specimens. We performed a retrospective review for patients with cancer on targeted prostate biopsy who underwent subsequent radical prostatectomy. Prostatectomy specimens were submitted in their entirety and assessed for Grade Group, extraprostatic extension (EPE), margins, and number of blocks. For Targeted-Grossing (TG) assessment, apex margin, bladder neck margin, seminal vesicles, and vas deferens sections were included. For the remainder of the prostate, only sections from areas shown to be positive for cancer on targeted biopsy were included in the analysis. With total tissue submission, EPE was found in 39/81 (48.1%) cases and positive margins in 19/81 (23.5%) cases. The TG method required significantly fewer blocks: 15.8 ± 5.9 versus 44.9 ± 11.9 (P < .0001). The TG method would have diagnosed the correct stage in 73/81 (90.1%) cases, Grade Group in 74/81 (91.4%) cases, and margin status in 79/81 (97.5%) cases. EPE was missed completely by the TG method in 7 cases (P = .008), of which 5/7 (71.4%) had focal EPE. There was no significant difference in stage (P = .24), Grade Group (P = .95), or margin status (P = .16) between the 2 methods. Grossing utilizing selective tissue submission from areas found to be positive for prostate cancer on magnetic resonance imaging/ultrasound-targeted prostate biopsy remains inferior to complete submission of tissue for radical prostatectomy specimens.
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Scheltema MJ, Chang JI, Stricker PD, van Leeuwen PJ, Nguyen QA, Ho B, Delprado W, Lee J, Thompson JE, Cusick T, Spriensma AS, Siriwardana AR, Yuen C, Kooner R, Hruby G, O'Neill G, Emmett L. Diagnostic accuracy of 68Ga-prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) and multiparametric (mp)MRI to detect intermediate-grade intra-prostatic prostate cancer using whole-mount pathology: impact of the addition of 68Ga-P. BJU Int 2019; 124 Suppl 1:42-49. [DOI: 10.1111/bju.14794] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthijs J. Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Amsterdam UMC; Department of Urology; Amsterdam The Netherlands
| | - John I. Chang
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Phillip D. Stricker
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Pim J. van Leeuwen
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Antoni van Leeuwenhoek Nederlands Kanker Instituut; Amsterdam The Netherlands
| | - Quoc A. Nguyen
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Bao Ho
- St Vincent's Hospital Nuclear Medicine and PET Department; Darlinghurst NSW Australia
| | | | - Jonathan Lee
- St Vincent's Hospital Nuclear Medicine and PET Department; Darlinghurst NSW Australia
| | - James E. Thompson
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Thomas Cusick
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | | | - Amila R. Siriwardana
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Carlo Yuen
- St Vincent's Clinic; Darlinghurst NSW Australia
| | - Raji Kooner
- St Vincent's Clinic; Darlinghurst NSW Australia
| | - George Hruby
- Genesis Cancer Care; St Vincent's Hospital; Darlinghurst NSW Australia
| | | | - Louise Emmett
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Hospital Nuclear Medicine and PET Department; Darlinghurst NSW Australia
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Guenther E, Klein N, Zapf S, Weil S, Schlosser C, Rubinsky B, Stehling MK. Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments. PLoS One 2019; 14:e0215093. [PMID: 30986263 PMCID: PMC6464181 DOI: 10.1371/journal.pone.0215093] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/26/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Irreversible Electroporation (IRE) is a novel image-guided tissue ablation technology that induces cell death via very short but strong pulsed electric fields. IRE has been shown to have preserving properties towards vessels and nerves and the extracellular matrix. This makes IRE an ideal candidate to treat prostate cancer (PCa) where other treatment modalities frequently unselectively destroy surrounding structures inducing severe side effects like incontinence or impotence. We report the retrospective assessment of 471 IRE treatments in 429 patients of all grades and stages of PCa with 6-year maximum follow-up time. MATERIAL AND FINDINGS The patient cohort consisted of low (25), intermediate (88) and high-risk cancers (312). All had multi-parametric magnetic resonance imaging, and 199 men had additional 3D-mapping biopsy for diagnostic work-up prior to IRE. Patients were treated either focally (123), sub-whole-gland (154), whole-gland (134) or for recurrent disease (63) after previous radical prostatectomy, radiation therapy, etc. Adverse effects were mild (19.7%), moderate (3.7%) and severe (1.4%), never life-threatening. Urinary continence was preserved in all cases. IRE-induced erectile dysfunction persisted in 3% of the evaluated cases 12 months post treatment. Mean transient IIEF-5-Score reduction was 33% within 12-month post IRE follow-up and 15% after 12 months. Recurrences within the follow-up period occurred in 10% of the treated men, 23 in or adjacent to the treatment field and 18 outside the treatment field (residuals). Including residuals for worst case analysis, Kaplan Maier estimation on recurrence rate at 5 years resulted in 5.6% (CI95: 1.8-16.93) for Gleason 6, 14.6% (CI95: 8.8-23.7) for Gleason 7 and 39.5% (CI95: 23.5-61.4) for Gleason 8-10. CONCLUSION The results indicate comparable efficacy of IRE to standard radical prostatectomy in terms of 5-year recurrence rates and better preservation of urogenital function, proving the safety and suitability of IRE for PCa treatment. The data also shows that IRE, besides focal therapy of early PCa, can also be used for whole-gland ablations, in patients with recurrent PCa, and as a problem-solver for local tumor control in T4-cancers not amenable to surgery and radiation therapy anymore.
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Affiliation(s)
- E. Guenther
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - N. Klein
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, C/Roc Boronat, Barcelona, Spain
| | - S. Zapf
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - S. Weil
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - C. Schlosser
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
| | - B. Rubinsky
- Department of Mech. Engineering, University of California Berkeley, Berkeley, CA, United States of America
| | - M. K. Stehling
- Vitus Prostate Center, Institut für Bildgebende Diagnostik, Offenbach, Germany
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Reinišová L, Hermanová S, Pumera M. Micro/nanomachines: what is needed for them to become a real force in cancer therapy? NANOSCALE 2019; 11:6519-6532. [PMID: 30632584 DOI: 10.1039/c8nr08022d] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Conventional drug delivery systems face several issues in medical applications, such as cyto/genotoxicity and off-targeting. These issues are particularly significant for cancer therapeutics because many of the currently used systems are toxic in their free form. Self-propelled autonomous micro/nanomachines offer promising alternative drug delivery systems based on high cargo loading, fast autonomous movement, precise targeting and the on-demand release of therapeutics in vivo. With this unique set of properties, it is not surprising that they are receiving considerable research attention. However, much less is reported about the drawbacks that hinder their systemic in vivo application. In this review, a biomedical perspective is used to assess micro/nanomotor-based anticancer drug delivery systems reported to date. Advantages along with present issues are highlighted and recommendations which need to be considered to develop an effective biocompatible micro/nanomotor-based delivery system for cancer therapy are discussed.
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Affiliation(s)
- Lucie Reinišová
- Department of Polymers, Faculty of Chemical Technology, University of Chemistry and Technology Prague, Technická 5, 16628 Prague, Czech Republic
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38
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Affiliation(s)
- Connor Hoge
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Arvin George
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Abhinav Sidana
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Abstract
Focal therapy (FT) should have the same oncological efficacy as whole gland therapy with fewer side effects. Precise diagnosis with PI-RADS v2 standard multiparametric magnetic resonance imaging (MRI) and fusion or template biopsy is a basic prerequisite. Numerous ablation technologies and treatment strategies have been developed, including hemiablation. Treatment success is still inconsistently defined. The only large randomized study available compares one of the procedures to standard therapy. Therefore, even in 2019, FT must still be regarded as experimental and should only be carried out within the context of studies. Follow-up should correspond to active surveillance (AS), including MRI and fusion biopsy. Advantages and disadvantages of each ablation technique should be taken into consideration as well as the suitability of certain regions in the gland. Ideally, an individualized "à la carte" selection of various procedures should be offered. FT is well suited for patients with highly localized cancers at intermediate risk if standard therapies or AS is not possible or has been refused.
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Affiliation(s)
- M Schostak
- Urologische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
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Mannaerts CK, Kajtazovic A, Lodeizen OAP, Gayet M, Engelbrecht MRW, Jager GJ, Wijkstra H, de Reijke TM, Beerlage HP. The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy. Urol Oncol 2019; 37:298.e1-298.e9. [PMID: 30660493 DOI: 10.1016/j.urolonc.2019.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE Incorporation of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) in the diagnostic pathway for prostate cancer (CaP) is rapidly becoming common practice. In men with a prebiopsy positive mpMRI a TBx only approach, thereby omitting transrectal ultrasound-guided systematic biopsy (SBx), has been postulated. In this study we evaluated the additional clinical relevance of SBx in men with a positive prebiopsy mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3) undergoing TBx for CaP detection, Gleason grading and CaP localization. MATERIAL AND METHODS Prospective data of 255 consecutive men with a prebiopsy positive mpMRI (PI-RADS ≥ 3) undergoing 12-core SBx and subsequent MRI-transrectal ultrasound fusion TBx in 2 institutions between 2015 and 2018 was obtained. The detection rate for significant CaP (Gleason score [GS] ≥ 3 + 4) for TBx and SBx were compared. The rate of potentially missed significant CaP by a TBx only approach was determined and GS concordance and CaP localization by TBx and SBx was evaluated. RESULTS TBx yielded significant CaP in 113 men (44%) while SBx yielded significant CaP in 110 men (43%) (P = 0.856). Insignificant CaP was found in 21 men (8%) by TBx, while SBx detected 34 men (13%) with insignificant CaP (P = 0.035). A TBx only approach, omitting SBx, would have missed significant CaP in 13 of the 126 men (10%) with significant CaP on biopsy. Ten of the 118 men (8%), both positive on TBx and SBx, were upgraded in GS by SBx while 11 men (9%) had higher maximum tumor core involvement on SBx. Nineteen of the 97 men (20%) with significant CaP in both TBx and SBx were diagnosed with unilateral significant CaP on mpMRI and TBx while SBx demonstrated bilateral significant CaP. CONCLUSIONS In men with a prebiopsy positive mpMRI, TBx detects high-GS CaP while reducing insignificant CaP detection as compared to SBx. SBx and TBx as stand-alone missed significant CaP in 13% and 10% of the men with significant CaP on biopsy, respectively. A combination of SBx and TBx remains necessary for the most accurate assessment of detection, grading, tumor core involvement, and localization of CaP.
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Affiliation(s)
- Christophe K Mannaerts
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | - Amir Kajtazovic
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Olivia A P Lodeizen
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Maudy Gayet
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerrit J Jager
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Theo M de Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Harrie P Beerlage
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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41
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Scheltema MJ, Chang JI, van den Bos W, Gielchinsky I, Nguyen TV, Reijke TDM, Siriwardana AR, Böhm M, de la Rosette JJ, Stricker PD. Impact on genitourinary function and quality of life following focal irreversible electroporation of different prostate segments. ACTA ACUST UNITED AC 2019; 24:268-275. [PMID: 30211680 DOI: 10.5152/dir.2018.17374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE We aimed to evaluate the genitourinary function and quality of life (QoL) following the ablation of different prostate segments with irreversible electroporation (IRE) for localized prostate cancer (PCa). METHODS Sixty patients who received primary focal IRE for organ-confined PCa were recruited for this study. Patients were evaluated for genitourinary function and QoL per prostate segment treated (anterior vs. posterior, apex vs. base vs. apex-to-base, unilateral vs. bilateral). IRE system settings and patient characteristics were compared between patients with preserved vs. those with impaired erectile function and urinary continence. Data were prospectively collected at baseline, 3, 6, and 12 months using the expanded prostate cancer index composite, American Urological Association symptom score, SF-12 physical and mental component summary surveys. Difference over time within segments per questionnaire was evaluated using the Wilcoxon's signed rank test. Outcome differences between segments were assessed using covariance models. Baseline measurements included questionnaire scores, age, and prostate volume. RESULTS There were no statistically significant changes over time for overall urinary (P = 0.07-0.89), bowel (P = 0.06-0.79), physical (P = 0.18-0.71) and mental (P = 0.45-0.94) QoL scores within each segment. Deterioration of sexual function scores was observed at 6 months within each segment (P = 0.001-0.16). There were no statistically significant differences in QoL scores between prostate segments (P = 0.08-0.97). Older patients or those with poor baseline sexual function at time of treatment were associated with a greater risk of developing erectile dysfunction. CONCLUSION IRE is a feasible modality for all prostate segments without any significantly different effect on the QoL outcomes. Older patients and those with poor sexual function need to be counseled regarding the risk of erectile dysfunction.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands
| | - John I Chang
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst; St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Willemien van den Bos
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst., St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Ilan Gielchinsky
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia, St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Tuan V Nguyen
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia,. University of New South Wales, Sydney, NSW, Australia
| | | | - Amila R Siriwardana
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jean J de la Rosette
- Amsterdam UMC, University of Amsterdam, the Netherlands, Department of Urology, İstanbul Medipol University, İstanbul, Turkey
| | - Phillip D Stricker
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands
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Marra G, Ploussard G, Futterer J, Valerio M. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach? World J Urol 2019; 37:277-287. [PMID: 30610359 DOI: 10.1007/s00345-018-02622-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP). METHODS We performed a literature search of peer-reviewed English language articles using PubMed and the words "prostate" AND "biopsy". Web search was implemented by manual search. RESULTS Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx-TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues. CONCLUSION The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
| | - Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Choi YH, Yu JW, Kang MY, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. Combination of multiparametric magnetic resonance imaging and transrectal ultrasound-guided prostate biopsies is not enough for identifying patients eligible for hemiablative focal therapy for prostate cancer. World J Urol 2019; 37:2129-2135. [DOI: 10.1007/s00345-018-02617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
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Wysock JS, Lepor H. Optimizing patient selection for focal therapy-mapping and ablating the index lesion. Transl Androl Urol 2018; 7:S519-S525. [PMID: 30363486 PMCID: PMC6178318 DOI: 10.21037/tau.2018.03.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- James S Wysock
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, NY, USA
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45
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Demirel CH, Altok M, Davis JW. Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? Asian J Androl 2018; 21:240302. [PMID: 30178774 PMCID: PMC6337958 DOI: 10.4103/aja.aja_64_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.
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Affiliation(s)
- Cihan H Demirel
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Muammer Altok
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Swaan A, Mannaerts CK, Scheltema MJ, Nieuwenhuijzen JA, Savci-Heijink CD, de la Rosette JJ, van Moorselaar RJA, van Leeuwen TG, de Reijke TM, de Bruin DM. Confocal Laser Endomicroscopy and Optical Coherence Tomography for the Diagnosis of Prostate Cancer: A Needle-Based, In Vivo Feasibility Study Protocol (IDEAL Phase 2A). JMIR Res Protoc 2018; 7:e132. [PMID: 29784633 PMCID: PMC5987046 DOI: 10.2196/resprot.9813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Focal therapy for prostate cancer has been proposed as an alternative treatment to whole-gland therapies in selected men to diminish side effects in localized prostate cancer. As nowadays imaging cannot offer complete prostate cancer disease characterization, multicore systematic biopsies are recommended (transrectal or transperineal). Optical imaging techniques such as confocal laser endomicroscopy and optical coherence tomography allow in vivo, high-resolution imaging. Moreover, they can provide real-time visualization and analysis of tissue and have the potential to offer additive diagnostic information. OBJECTIVE This study has 2 separate primary objectives. The first is to assess the technical feasibility and safety of in vivo focal imaging with confocal laser endomicroscopy and optical coherence tomography. The second is to identify and define characteristics of prostate cancer and normal prostate tissue in confocal laser endomicroscopy and optical coherence tomography imaging by comparing these images with the corresponding histopathology. METHODS In this prospective, in vivo feasibility study, needle-based confocal laser endomicroscopy and optical coherence tomography imaging will be performed before transperineal template mapping biopsy or radical prostatectomy. First, confocal laser endomicroscopy and optical coherence tomography will be performed in 4 patients (2 for each imaging modality) undergoing transperineal template mapping biopsy to assess the feasibility and safety of confocal laser endomicroscopy and optical coherence tomography. If proven to be safe and feasible, confocal laser endomicroscopy and optical coherence tomography will be performed in 10 patients (5 for each imaging modality) undergoing radical prostatectomy. Confocal laser endomicroscopy and optical coherence tomography images will be analyzed by independent, blinded observers. Confocal laser endomicroscopy- and optical coherence tomography-based qualitative and quantitative characteristics and histopathology will be compared. The study complies with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) stage 2a recommendations. RESULTS At present, the study is enrolling patients and results and outcomes are expected in 2019. CONCLUSIONS Confocal laser endomicroscopy and optical coherence tomography are promising optical imaging techniques that can visualize and analyze tissue structure, possible tumor grade, and architecture in real time. They can potentially provide real-time, high-resolution microscopic imaging and tissue characteristics of prostate cancer in conjunction with magnetic resonance imaging or transrectal ultrasound fusion-guided biopsy procedures. This study will provide insight into the feasibility and tissue-specific characteristics of confocal laser endomicroscopy and optical coherence tomography for real-time optical analysis of prostate cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT03253458; https://clinicaltrials.gov/ct2/show/NCT03253458 (Archived by WebCite at http://www.webcitation.org/6z9owM66B). REGISTERED REPORT IDENTIFIER RR1-10.2196/9813.
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Affiliation(s)
- Abel Swaan
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Christophe K Mannaerts
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Jv Scheltema
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jakko A Nieuwenhuijzen
- Department of Urology, VU University Medical Center, VU University, Amsterdam, Netherlands
| | - C Dilara Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jean Jmch de la Rosette
- Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | | | - Ton G van Leeuwen
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Theo M de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel Martijn de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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47
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Lotte R, Lafourcade A, Mozer P, Conort P, Barret E, Comperat E, Ezziane M, de Guibert PHJ, Tavolaro S, Belin L, Boudghene F, Lucidarme O, Renard-Penna R. Multiparametric MRI for Suspected Recurrent Prostate Cancer after HIFU:Is DCE still needed? Eur Radiol 2018; 28:3760-3769. [DOI: 10.1007/s00330-018-5352-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 01/28/2023]
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48
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Scheltema MJ, Chang JI, Böhm M, van den Bos W, Blazevski A, Gielchinsky I, Kalsbeek AMF, van Leeuwen PJ, Nguyen TV, de Reijke TM, Siriwardana AR, Thompson JE, de la Rosette JJ, Stricker PD. Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy. World J Urol 2018; 36:1383-1389. [PMID: 29594551 PMCID: PMC6105143 DOI: 10.1007/s00345-018-2281-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/24/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The design, conduct and completion of randomized trials for curative prostate cancer (PCa) treatments are challenging. To evaluate the effect of robot-assisted radical prostatectomy (RARP) versus focal irreversible electroporation (IRE) on patient-reported quality of life (QoL) and early oncological control using propensity-scored matching. Methods Patients with T1c–cT2b significant PCa (high-volume ISUP 1 or any 2/3) who received unifocal IRE were pair-matched to patients who received nerve-sparing RARP. Patient-reported outcomes were prospectively assessed using the Expanded Prostate Cancer Index Composite (EPIC), AUA symptom score and Short Form of Health Survey (SF-12) physical and mental components. Oncological failure was defined as biochemical recurrence (RARP) or positive follow-up biopsies (IRE). Generalized mixed-effect models were used to compare IRE and RARP. Results 50 IRE patients were matched to 50 RARP patients by propensity score. IRE was significantly superior to RARP in preserving pad-free continence (UC) and erections sufficient for intercourse (ESI). The absolute differences were 44, 21, 13, 14% for UC and 32, 46, 27, 22% for ESI at 1.5, 3, 6, and 12 months, respectively. The EPIC summary scores showed no statistically significant differences. Urinary symptoms were reduced for IRE and RARP patients at 12 months, although IRE patient initially had more complaints. IRE patients experienced more early oncological failure than RARP patients. Conclusions These data demonstrated the superior preservation of UC and ESI with IRE compared to RARP up to 12 months after treatment. Long-term oncological data are warranted to provide ultimate proof for or against focal therapy. Electronic supplementary material The online version of this article (10.1007/s00345-018-2281-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia.
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia.
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - John I Chang
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
| | - Willemien van den Bos
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Ilan Gielchinsky
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Anton M F Kalsbeek
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
| | - Pim J van Leeuwen
- Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - Tuan V Nguyen
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- UNSW, Sydney, NSW, Australia
- School of Biomedical Engineering, University of Technology, Sydney, Australia
| | - Theo M de Reijke
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Amila R Siriwardana
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
- UNSW, Sydney, NSW, Australia
| | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
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Scheltema MJ, Postema AW, de Bruin DM, Buijs M, Engelbrecht MR, Laguna MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. Irreversible electroporation for the treatment of localized prostate cancer: a summary of imaging findings and treatment feedback. Diagn Interv Radiol 2018; 23:365-370. [PMID: 28830850 DOI: 10.5152/dir.2017.16608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Imaging plays a crucial role in ablative therapies for prostate cancer (PCa). Irreversible electroporation (IRE) is a new treatment modality used for focal treatment of PCa. We aimed to demonstrate what imaging modalities can be used by descriptively reporting contrast-enhanced ultrasonography (CEUS), multiparametric magnetic resonance imaging (mpMRI), and grey-scale transrectal ultrasound (TRUS) results. Furthermore, we aimed to correlate quantitatively the ablation zone seen on mpMRI and CEUS with treatment planning to provide therapy feedback. METHODS Imaging data was obtained from two prospective multicenter trials on IRE for localized low- to intermediate-risk PCa. The ablation zone volume (AZV) seen on mpMRI and CEUS was 3D reconstructed to correlate with the planned AZV. RESULTS Descriptive examples are provided using mpMRI, TRUS, and CEUS for treatment planning and follow-up after IRE. The mean AZV on T2-weighted imaging 4 weeks following IRE was 12.9 cm3 (standard deviation [SD]=7.0), 5.3 times larger than the planned AZV. Linear regression showed a positive correlation (r=0.76, P = 0.002). For CEUS the mean AZV was 20.7 cm3 (SD=8.7), 8.5 times larger than the planned AZV with a strong positive correlation (r=0.93, P = 0.001). Prostate volume is reduced over time (mean= -27.5%, SD=11.9%) due to ablation zone fibrosis and deformation, illustrated by 3D reconstruction. CONCLUSION The role of imaging in conjunction with IRE is of crucial importance to guide clinicians throughout the treatment protocol. CEUS and mpMRI may provide essential treatment feedback by visualizing the ablation zone dimensions and volume.
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50
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Müller S, Lilleaasen G, Sand TE, Løfsgaard L, Estop-Garanto M, Helgø D, Sund P, Mygland V. Poor reproducibility of PIRADS score in two multiparametric MRIs before biopsy in men with elevated PSA. World J Urol 2018; 36:687-691. [PMID: 29508048 PMCID: PMC5916982 DOI: 10.1007/s00345-018-2252-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/23/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Since January 2015, all men referred to urologists in Norway due to elevated PSA or other suspicion of prostate cancer underwent multiparametric MRI (mpMRI) before prostate biopsy. At our hospital, patients and the initial MRI were assessed by an urologist and if deemed necessary, patients were referred to another institution for MR/US fusion biopsies. Before MR/US biopsy, patients underwent a second mpMRI. Since we noticed disagreement of these two mpMRIs before biopsy, we retrospectively assessed the level of agreement between the two mpMRIs from the two institutions. Methods During the first 6 months of 2015, 292 patients were referred to our outpatient clinic. We referred 126 patients of these to the other institution for MR/US fusion biopsy. The 2 mpMRIs were performed within 4 weeks. We analyzed MR reports and schematics for number of lesions and highest PIRADS score per side of the prostate and histological result of the biopsies. Bland–Altman’s plot was used to compare the level of agreement between the two mpMRIs of the same patient before biopsy. Results There was a poor level of agreement between the two mpMRIs and a statistically significant difference in PIRADS scores. Regression analysis showed that there was no proportional or systematic bias. Conclusion In unselected patients with elevated PSA, there seems to be a significant variation of mpMRI results across institutions. The PIRADS scoring system needs to be validated with regards to MR equipment, mpMRI protocols and inter-reader variability of radiologists.
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Affiliation(s)
- Stig Müller
- Department of Urology, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Gunder Lilleaasen
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Tor Erik Sand
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Lars Løfsgaard
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Dan Helgø
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Peter Sund
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Vegard Mygland
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
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