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Jóźwiak R, Sobecki P, Lorenc T. Intraobserver and Interobserver Agreement between Six Radiologists Describing mpMRI Features of Prostate Cancer Using a PI-RADS 2.1 Structured Reporting Scheme. Life (Basel) 2023; 13:life13020580. [PMID: 36836937 PMCID: PMC9959628 DOI: 10.3390/life13020580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Clinical practice has revealed ambiguities in PI-RADS v2.1 scoring, but a limited number of studies are available that validate the interreader and intrareader reproducibility of the mpMRI PI-RADS lexicon. We decomposed the PI-RADS rules into a set of common data elements to evaluate the inter- and intraobserver agreement in assessing the individual features included in the PI-RADS lexicon. Six radiologists (three highly experienced, three less experienced) in two sessions independently read thirty-two lesions in the peripheral and transition zone using the structured reporting tool, blinded to clinical MRI indication. The highest agreement between radiologists was observed for the abnormality detection, the evaluation of the type of signal intensity, and the characteristic of benign prostatic hyperplasia. Moderate agreement was reported for dynamic contrast-enhanced images. This resulted in a decrease in abnormality detection (PA = 76.5%) and enhancement indication (PA = 77.3%). The lowest agreement was observed for highly subjective features: shape, signal intensity level, and type of lesion margins. The results indicate the limitations of the PI-RADS v2.1 lexicon in relation to interreader and intrareader reproducibility. We have demonstrated that it is possible to develop structured reporting systems standardized according to the PI-RADS lexicon.
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Affiliation(s)
- Rafał Jóźwiak
- Applied Artificial Intelligence Laboratory, National Information Processing Institute, 00-608 Warsaw, Poland
- Faculty of Mathematics and Information Science, Warsaw University of Technology, 00-661 Warsaw, Poland
- Correspondence:
| | - Piotr Sobecki
- Applied Artificial Intelligence Laboratory, National Information Processing Institute, 00-608 Warsaw, Poland
| | - Tomasz Lorenc
- Department of Clinical Radiology, Medical University of Warsaw, 02-091 Warszawa, Poland
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Silva Gaspar SR, Fernandes M, Castro A, Oliveira T, Santos Dias J, Palma Dos Reis J. Active surveillance protocol in prostate cancer in Portugal. Actas Urol Esp 2022; 46:329-339. [PMID: 35277378 DOI: 10.1016/j.acuroe.2022.01.002] [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: 09/27/2020] [Revised: 12/16/2020] [Accepted: 01/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To examine clinical practice patterns in locally managing patients under an active surveillance protocol among Portuguese urologists. INTRODUCTION Prostate cancer (PCa) is a heterogeneous disease with many prostate adenocarcinomas being indolent and a low probability of ever causing symptoms or death. Active surveillance (AS) is a form of conservative management aimed to reduce over-treatment for low-risk PCa patients. Over the years, experience with AS has grown considerably and is now standard in some countries, however a universal protocol still does not exist. METHODS Nationwide anonymous e-survey concerning habits and practices on AS among Portuguese urologists, that consisted of twelve questions and was sent electronically to all 368 current members of the Portuguese Urological Association. RESULTS 56 urologists were surveyed (15.21% answer rate), evenly distributed geographically and allocated according to years of experience as well as number of PCa patients managed monthly. The vast majority of respondents recommends AS to their patients, particularly ISUP grade 1 patients, whose PSA serum level is bellow 20 ng/mL. Observance of AS programs by patients was not in question but concerns exist over psychological morbidity while harboring disease. Majority believed that international guidelines surveillance protocols were adequate and sufficient, but there are some constraints concerning availability of periodic MRIs and re-biopsy needs. CONCLUSIONS AS seems to be sustained in urologist clinical practice, although patients still lag to adhere and choose for active treatment. AS may not be an easy choice for patients and clinicians due to uncertainty of disease progression, risk of loss to follow-up and repeated biopsies but is also a cause for anxiety, depression, uncertainty and a perception of danger.
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Affiliation(s)
- S R Silva Gaspar
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - M Fernandes
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - A Castro
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - T Oliveira
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - J Santos Dias
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - J Palma Dos Reis
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Tenbergen CJA, Metzger GJ, Scheenen TWJ. Ultra-high-field MR in Prostate cancer: Feasibility and Potential. MAGNETIC RESONANCE MATERIALS IN PHYSICS, BIOLOGY AND MEDICINE 2022; 35:631-644. [PMID: 35579785 PMCID: PMC9113077 DOI: 10.1007/s10334-022-01013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
Abstract
Multiparametric MRI of the prostate at clinical magnetic field strengths (1.5/3 Tesla) has emerged as a reliable noninvasive imaging modality for identifying clinically significant cancer, enabling selective sampling of high-risk regions with MRI-targeted biopsies, and enabling minimally invasive focal treatment options. With increased sensitivity and spectral resolution, ultra-high-field (UHF) MRI (≥ 7 Tesla) holds the promise of imaging and spectroscopy of the prostate with unprecedented detail. However, exploiting the advantages of ultra-high magnetic field is challenging due to inhomogeneity of the radiofrequency field and high local specific absorption rates, raising local heating in the body as a safety concern. In this work, we review various coil designs and acquisition strategies to overcome these challenges and demonstrate the potential of UHF MRI in anatomical, functional and metabolic imaging of the prostate and pelvic lymph nodes. When difficulties with power deposition of many refocusing pulses are overcome and the full potential of metabolic spectroscopic imaging is used, UHF MR(S)I may aid in a better understanding of the development and progression of local prostate cancer. Together with large field-of-view and low-flip-angle anatomical 3D imaging, 7 T MRI can be used in its full strength to characterize different tumor stages and help explain the onset and spatial distribution of metastatic spread.
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Affiliation(s)
- Carlijn J A Tenbergen
- Department of Medical Imaging, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Gregory J Metzger
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
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Protocolo de vigilancia activa para el cáncer de próstata en Portugal. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Merriel SWD, Moon D, Dundee P, Corcoran N, Carroll P, Partin A, Smith JA, Hamdy F, Moore C, Ost P, Costello T. A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance. BMC Urol 2021; 21:18. [PMID: 33541309 PMCID: PMC7863517 DOI: 10.1186/s12894-021-00789-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts. Methods A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building. Results 12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS. Conclusions The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients.
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Affiliation(s)
- Samuel W D Merriel
- College of Medicine and Health, University of Exeter, 1.18 College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Daniel Moon
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Phil Dundee
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Niall Corcoran
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Carroll
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Alan Partin
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, USA
| | - Joseph A Smith
- Department of Urologic Surgery, Vanderbilt University, Nashville, USA
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Caroline Moore
- Division of Surgery and Interventional Medicine, University College London, London, UK
| | - Piet Ost
- Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Tony Costello
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
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Johnson H, Guo J, Zhang X, Zhang H, Simoulis A, Wu AHB, Xia T, Li F, Tan W, Johnson A, Dizeyi N, Abrahamsson PA, Kenner L, Feng X, Zou C, Xiao K, Persson JL, Chen L. Development and validation of a 25-Gene Panel urine test for prostate cancer diagnosis and potential treatment follow-up. BMC Med 2020; 18:376. [PMID: 33256740 PMCID: PMC7706045 DOI: 10.1186/s12916-020-01834-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterogeneity of prostate cancer (PCa) contributes to inaccurate cancer screening and diagnosis, unnecessary biopsies, and overtreatment. We intended to develop non-invasive urine tests for accurate PCa diagnosis to avoid unnecessary biopsies. METHODS Using a machine learning program, we identified a 25-Gene Panel classifier for distinguishing PCa and benign prostate. A non-invasive test using pre-biopsy urine samples collected without digital rectal examination (DRE) was used to measure gene expression of the panel using cDNA preamplification followed by real-time qRT-PCR. The 25-Gene Panel urine test was validated in independent multi-center retrospective and prospective studies. The diagnostic performance of the test was assessed against the pathological diagnosis from biopsy by discriminant analysis. Uni- and multivariate logistic regression analysis was performed to assess its diagnostic improvement over PSA and risk factors. In addition, the 25-Gene Panel urine test was used to identify clinically significant PCa. Furthermore, the 25-Gene Panel urine test was assessed in a subset of patients to examine if cancer was detected after prostatectomy. RESULTS The 25-Gene Panel urine test accurately detected cancer and benign prostate with AUC of 0.946 (95% CI 0.963-0.929) in the retrospective cohort (n = 614), AUC of 0.901 (0.929-0.873) in the prospective cohort (n = 396), and AUC of 0.936 (0.956-0.916) in the large combination cohort (n = 1010). It greatly improved diagnostic accuracy over PSA and risk factors (p < 0.0001). When it was combined with PSA, the AUC increased to 0.961 (0.980-0.942). Importantly, the 25-Gene Panel urine test was able to accurately identify clinically significant and insignificant PCa with AUC of 0.928 (95% CI 0.947-0.909) in the combination cohort (n = 727). In addition, it was able to show the absence of cancer after prostatectomy with high accuracy. CONCLUSIONS The 25-Gene Panel urine test is the first highly accurate and non-invasive liquid biopsy method without DRE for PCa diagnosis. In clinical practice, it may be used for identifying patients in need of biopsy for cancer diagnosis and patients with clinically significant cancer for immediate treatment, and potentially assisting cancer treatment follow-up.
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Affiliation(s)
| | - Jinan Guo
- Department of Urology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Urology Minimally Invasive Engineering Centre, Shenzhen, China.,Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Clinical Medical Research Centre, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Xuhui Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, Beijing, China
| | - Heqiu Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, Beijing, China
| | - Athanasios Simoulis
- Department of Clinical Pathology and Cytology, Skåne University Hospital, Malmö, Sweden
| | - Alan H B Wu
- Clinical Laboratories, San Francisco General Hospital, San Francisco, CA, USA
| | - Taolin Xia
- Department of Urology, Foshan First People's Hospital, Foshan, China
| | - Fei Li
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | - Nishtman Dizeyi
- Department of Translational Medicine, Lund University, Clinical Research Centre, Malmö, Sweden
| | - Per-Anders Abrahamsson
- Department of Translational Medicine, Lund University, Clinical Research Centre, Malmö, Sweden
| | - Lukas Kenner
- Department of Experimental Pathology, Medical University Vienna & Unit of Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Xiaoyan Feng
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, Beijing, China
| | - Chang Zou
- Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Clinical Medical Research Centre, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Kefeng Xiao
- Department of Urology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Urology Minimally Invasive Engineering Centre, Shenzhen, China.,Shenzhen Public Service Platform on Tumor Precision Medicine and Molecular Diagnosis, Clinical Medical Research Centre, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jenny L Persson
- Department of Molecular Biology, Umeå University, 901 87, Umeå, Sweden. .,Division of Experimental Cancer Research, Department of Translational Medicine, Lund University, 205 02, Malmö, Sweden. .,Department of Biomedical Sciences, Malmö University, Malmö, Sweden.
| | - Lingwu Chen
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
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Dias JL, Bilhim T. Modern imaging and image-guided treatments of the prostate gland: MR and ablation for cancer and prostatic artery embolization for benign prostatic hyperplasia. BJR Open 2019; 1:20190019. [PMID: 33178947 PMCID: PMC7592499 DOI: 10.1259/bjro.20190019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/04/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
Multiparametric MRI (mpMRI) has proven to be an essential tool for diagnosis, post-treatment follow-up, aggressiveness assessment, and active surveillance of prostate cancer. Currently, this imaging technique is part of the daily practice in many oncological centres. This manuscript aims to review the use of mpMRI in the set of prostatic diseases, either malignant or benign: mpMRI to detect and stage prostate cancer is discussed, as well as its use for active surveillance. Image-guided ablation techniques for prostate cancer are also reviewed. The need to establish minimum acceptable technical parameters for prostate mpMRI, standardize reports, uniform terminology for describing imaging findings, and develop assessment categories that differentiate levels of suspicion for clinically significant prostate cancer led to the development of the Prostate Imaging Reporting and Data System that is reviewed. Special focus will also be given on the most up-to-date evidence of prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH). Management of patients with BPH, technical aspects of PAE, expected outcomes and level of evidence are reviewed with the most recent literature. PAE is a challenging technique that requires dedicated anatomical knowledge and comprehensive embolization skills. PAE has been shown to be an effective minimally-invasive treatment option for symptomatic BPH patients, that can be viewed between medical therapy and surgery. PAE may be a good option for symptomatic BPH patients that do not want to be operated and can obviate the need for prostatic surgery in up to 80% of treated patients.
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