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Moul JW, Shore ND, Pienta KJ, Czernin J, King MT, Freedland SJ. Application of next-generation imaging in biochemically recurrent prostate cancer. Prostate Cancer Prostatic Dis 2024; 27:202-211. [PMID: 37679601 PMCID: PMC11096127 DOI: 10.1038/s41391-023-00711-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Biochemical recurrence (BCR) following primary interventional treatment occurs in approximately one-third of patients with prostate cancer (PCa). Next-generation imaging (NGI) can identify local and metastatic recurrence with greater sensitivity than conventional imaging, potentially allowing for more effective interventions. This narrative review examines the current clinical evidence on the utility of NGI for patients with BCR. METHODS A search of PubMed was conducted to identify relevant publications on NGI applied to BCR. Given other relevant recent reviews on the topic, this review focused on papers published between January 2018 to May 2023. RESULTS NGI technologies, including positron emission tomography (PET) radiotracers and multiparametric magnetic resonance imaging, have demonstrated increased sensitivity and selectivity for diagnosing BCR at prostate-specific antigen (PSA) concentrations <2.0 ng/ml. Detection rates range between 46% and 50%, with decreasing PSA levels for choline (1-3 ng/ml), fluciclovine (0.5-1 ng/ml), and prostate-specific membrane antigen (0.2-0.49 ng/ml) PET radiotracers. Expert working groups and European and US medical societies recommend NGI for patients with BCR. CONCLUSIONS Available data support the improved detection performance and selectivity of NGI modalities versus conventional imaging techniques; however, limited clinical evidence exists demonstrating the application of NGI to treatment decision-making and its impact on patient outcomes. The emergence of NGI and displacement of conventional imaging may require a reexamination of the current definitions of BCR, altering our understanding of early recurrence. Redefining the BCR disease state by formalizing the role of NGI in patient management decisions will facilitate greater alignment across research efforts and better reflect the published literature.
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Affiliation(s)
- Judd W Moul
- Duke Cancer Institute and Division of Urology, Duke University, Durham, NC, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | | | - Johannes Czernin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Martin T King
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephen J Freedland
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Veterans Affairs Medical Center, Durham, NC, USA.
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Mourato FA, Schmitt LG, Mariussi M, Torri G, Altmayer S, Giganti F, Abreu-Gomez J, Perlis N, Berlin A, Ghai S, Haider MA, Dias AB. Prostate Magnetic Resonance Imaging Using the Prostate Imaging for Recurrence Reporting (PI-RR) Scoring System to Detect Recurrent Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2024:S2588-9311(24)00137-8. [PMID: 38824004 DOI: 10.1016/j.euo.2024.05.007] [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: 03/08/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostate Imaging for Recurrence Reporting (PI-RR) was introduced in 2021 to standardize the interpretation and reporting of multiparametric magnetic resonance imaging (MRI) for prostate cancer following whole-gland treatment. The system scores image on a scale from 1 to 5 and has shown promising results in single-center studies. The aim of our systematic review and meta-analysis was to assess the diagnostic performance of the PI-RR system in predicting the likelihood of local recurrence after whole-gland treatment. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy were followed. Relevant databases were searched up to December 2023. Primary studies met the eligibility criteria if they reported MRI diagnostic performance in prostate cancer recurrence using PI-RR. Diagnostic performance for MRI was assessed using two different cutoff points (≥3 or ≥4 for positivity according to the PI-RR system). A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity values. KEY FINDINGS AND LIMITATIONS Sixteen articles were identified for full-text reading, of which six were considered eligible, involving a total of 467 patients. Using a cutoff of PI-RR ≥3 (4 studies) for recurrent disease, the sensitivity was 77.8% (95% confidence interval [CI] 69.9-84.1%) and the specificity was 80.2% (95% CI 58.2-92.2%). Using a cutoff of PI-RR ≥4 (4 studies), the sensitivity was 61.9% (95% CI 35.6-82.7%) and the specificity was 86.6% (95% CI 75.1-93.3%). Overall, the inter-rater agreement varied from fair to excellent. CONCLUSIONS AND CLINICAL IMPLICATIONS PI-RR is accurate in detecting local recurrence after whole-gland treatment for prostate cancer and shows fair-to-good to excellent inter-reader agreement. Overall, a PI-RR cutoff of ≥3 showed high sensitivity and specificity. PATIENT SUMMARY We reviewed studies that reported on how good MRI scans using a scoring system called PI-RR were in detecting recurrence of prostate cancer. We found that this system shows good performance, with fair to excellent agreement between different radiologists.
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Affiliation(s)
- Felipe A Mourato
- Unidade de Diagnóstico por Imagem, Empresa Brasileira de Serviços Hospitalares, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil.
| | - Luiza G Schmitt
- Department of Radiation Oncology, UT Southwestern, Dallas, TX, USA
| | - Miriana Mariussi
- Department of Diagnostic Radiology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Giovanni Torri
- Department of Radiology and Diagnostic Imaging, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Stephan Altmayer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, UCL, London, UK
| | - Jorge Abreu-Gomez
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network and University of Toronto, Toronto, Canada
| | - Sangeet Ghai
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Masoom A Haider
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Adriano B Dias
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Franco PN, Frade-Santos S, García-Baizán A, Paredes-Velázquez L, Aymerich M, Sironi S, Otero-García MM. An MRI assessment of prostate cancer local recurrence using the PI-RR system: diagnostic accuracy, inter-observer reliability among readers with variable experience, and correlation with PSA values. Eur Radiol 2024; 34:1790-1803. [PMID: 37646815 DOI: 10.1007/s00330-023-09949-7] [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: 08/24/2022] [Revised: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES The Prostate Imaging for Recurrence Reporting (PI-RR) system has been recently proposed to promote standardisation in the MR assessment of prostate cancer (PCa) local recurrence after radical prostatectomy (RP) and radiation therapy (RT). This study aims to evaluate PI-RR's diagnostic accuracy, assess the inter-observer reliability among readers with variable experience, and correlate imaging results with anatomopathological and laboratory parameters. METHODS Patients who underwent a pelvic MRI for suspicion of PCa local recurrence after RP or RT were retrospectively enrolled (October 2017-February 2020). PI-RR scores were independently assessed for each patient by five readers with variable experience in prostate MRI (two senior and three junior radiologists). Biochemical data and histopathological features were collected. The reference standard was determined through biochemical, imaging, or histopathological follow-up data. Reader's diagnostic performance was assessed using contingency tables. Cohen's kappa coefficient (κ) and intraclass correlation coefficient (ICC) were calculated to measure inter-observer reliability. RESULTS The final cohort included 120 patients (median age, 72 years [IQR, 62-82]). Recurrence was confirmed in 106 (88.3%) patients. Considering a PI-RR score ≥ 3 as positive for recurrence, minimum and maximum diagnostic values among the readers were as follows: sensitivity 79-86%; specificity 64-86%; positive predictive value 95-98%; negative predictive value 33-46%; accuracy 79-87%. Regardless of reader's level of experience, the inter-observer reliability resulted good or excellent (κ ranges across all readers: 0.52-0.77), and ICC was 0.8. Prostate-specific antigen (PSA) velocity, baseline-PSA, and trigger-PSA resulted predictive of local recurrence at imaging. CONCLUSIONS The PI-RR system is an effective tool for MRI evaluation of PCa local recurrence and facilitates uniformity among radiologists. CLINICAL RELEVANCE STATEMENT This study confirmed the PI-RR system's good diagnostic accuracy for the MRI evaluation of PCa local recurrences. It showed high reproducibility among readers with variable experience levels, validating it as a promising standardisation tool for assessing patients with biochemical recurrence. KEY POINTS • In this retrospective study, the PI-RR system revealed promising diagnostic performances among five readers with different experience (sensitivity 79-86%; specificity 64-86%; accuracy 79-87%). • The inter-observer reliability among the five readers resulted good or excellent (κ ranges: 0.52-0.77) with an intraclass correlation coefficient of 0.8. • The PI-RR assessment score may facilitate standardisation and generalizability in the evaluation of prostate cancer local recurrence among radiologists.
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Affiliation(s)
- Paolo Niccolò Franco
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312, Vigo, Spain.
- School of Medicine, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy.
| | - Sofia Frade-Santos
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312, Vigo, Spain
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - Alejandra García-Baizán
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Laura Paredes-Velázquez
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - María Aymerich
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - María Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312, Vigo, Spain
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
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Dirix P, Dal Pra A, Khoo V, Carrie C, Cozzarini C, Fonteyne V, Ghadjar P, Gomez-Iturriaga A, Schmidt-Hegemann NS, Panebianco V, Zapatero A, Bossi A, Wiegel T. ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy. Clin Transl Radiat Oncol 2023; 43:100684. [PMID: 37808453 PMCID: PMC10556584 DOI: 10.1016/j.ctro.2023.100684] [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] [Received: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background The European Society for Radiotherapy & Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) panel on prostate bed delineation reflected on macroscopic local recurrences in patients referred for postoperative radiotherapy (PORT), a challenging situation without standardized approach, and decided to propose a consensus recommendation on target volume selection and definition. Methods An ESTRO ACROP contouring consensus panel consisting of 12 radiation oncologists and one radiologist, all with subspecialty expertise in prostate cancer, was established. Participants were asked to delineate the prostate bed clinical target volumes (CTVs) in two separate clinically relevant scenarios: a local recurrence at the seminal vesicle bed and one apically at the level of the anastomosis. Both recurrences were prostate-specific membrane antigen (PSMA)-avid and had an anatomical correlate on magnetic resonance imaging (MRI). Participants also answered case-specific questionnaires addressing detailed recommendations on target delineation. Discussions via electronic mails and videoconferences for final editing and consensus were performed. Results Contouring of the two cases confirmed considerable variation among the panelists. Finally, however, a consensus recommendation could be agreed upon. Firstly, it was proposed to always delineate the entire prostate bed as clinical target volume and not the local recurrence alone. The panel judged the risk of further microscopic disease outside of the visible recurrence too high to safely exclude the rest of the prostate bed from the CTV. A focused, "stereotactic" approach should be reserved for re-irradiation after previous PORT. Secondly, the option of a focal boost on the recurrence was discussed. Conclusion Radiation oncologists are increasingly confronted with macroscopic local recurrences visible on imaging in patients referred for postoperative radiotherapy. It was recommended to always delineate and irradiate the entire prostate bed, and not the local recurrence alone, whatever the exact location of that recurrence. Secondly, specific dose-escalation on the macroscopic recurrence should only be considered if an anatomic correlate is visible. Such a focal boost is probably feasible, provided that OAR constraints are prioritized. Possible dose is also dependent on the location of the recurrence. Its potential benefit should urgently be investigated in prospective clinical trials.
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Affiliation(s)
- Piet Dirix
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
- University of Bern, Bern University Hospital, Bern, Switzerland
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valérie Fonteyne
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | | | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Almudena Zapatero
- Department of Radiation Oncology, La Princesa University Hospital, Health Reasearch Institute Princesa, Madrid, Spain
| | - Alberto Bossi
- Radiation Oncology, Centre Charlebourg, La Garenne Colombe, France
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
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5
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Briody H, Sheehan M, Hanley M, O'Neill B, Dunne R, Lee MJ, Morrin MM. Biochemically recurrent prostate cancer: rationalisation of the approach to imaging. Clin Radiol 2023; 78:518-524. [PMID: 37085338 DOI: 10.1016/j.crad.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
AIM To assess the utility of magnetic resonance imaging (MRI) in addition to the additive benefit of the conventional imaging techniques, computed tomography (CT) and nuclear medicine (NM) bone scintigraphy, for investigation of biochemical recurrence (BCR) post-prostatectomy where access to prostate specific membrane antigen (PSMA) positron-emission tomography (PET)-CT is challenging. MATERIALS AND METHODS Relevant imaging over a 5-year period was reviewed. Ethical approval was granted by the internal review board. All patients with suspected BCR, defined as a PSA ≥0.2 ng/ml on two separate occasions, underwent a retrospective imaging review. This was performed on PACS archive search database in a single centre using search terms "PSA" and "prostatectomy" in the three imaging methods; MRI, CT, and NM bone scintigraphy. All PSMA PET CT performed were recorded. RESULTS One hundred and eighty-five patients were identified. Patients with an MRI pelvis that demonstrated distant metastases (i.e., pelvic bone metastases or lymph node involvement more cranial to the bifurcation of the common iliac arteries) were more likely to have a positive CT and/or NM bone scintigraphy. The Pearson correlation coefficient between the findings of M1 disease at MRI pelvis and the presence of distant metastases at CT thorax, abdomen, pelvis and NM bone scintigraphy was calculated at 0.81 (p<0.01) and 0.91 (p<0.01) respectively. CONCLUSION An imaging strategy based on risk stratification and technique-specific selection criteria leads to more appropriate use of resources, and in turn, increases the yield of conventional imaging methods. MRI prostate findings can be used to predict the additive value of CT/NM bone scintigraphy allowing a more streamlined approach to their use.
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Affiliation(s)
- H Briody
- Department of Medicine, Beaumont Hospital, Dublin, Ireland.
| | - M Sheehan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - M Hanley
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - B O'Neill
- Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland
| | - R Dunne
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - M J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M M Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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Rednam N, Kundra V. Hybrid magnetic resonance and PET imaging for prostate cancer recurrence. Curr Opin Oncol 2023; 35:231-238. [PMID: 36966496 DOI: 10.1097/cco.0000000000000932] [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: 03/27/2023]
Abstract
PURPOSE OF REVIEW Recurrence post definitive local therapy by prostatectomy or radiation therapy is often detected via rise in serum prostate-specific antigen (PSA) levels; however, PSA rise does not localize the disease. Distinguishing local versus distant recurrence guides whether to choose subsequent local versus systemic therapy. The purpose of this article is to review imaging for prostate cancer recurrence post local therapy. RECENT FINDINGS Among imaging modalities, multiparametric MRI (mpMRI) is commonly used to assess for local recurrence. New radiopharmaceuticals target prostate cancer cells and enable whole-body imaging. These tend to be more sensitive for lymph node metastases than MRI or computed tomography (CT) and for bone lesions than bone scan at lower PSA levels but can be limited for local prostate cancer recurrence. Given greater soft tissue contrast, similar criteria for lymph nodes, and greater sensitivity for prostate bone metastases, MRI is advantageous to CT. MRI of the whole body and mpMRI are now feasible within a reasonable time frame and complementary to PET imaging, enabling whole-body and pelvis-focused PET-MRI, which should be advantageous in the setting of recurrent prostate cancer. SUMMARY Hybrid PET-MRI with prostate cancer targeted radiopharmaceuticals and whole body with local multiparametric MRI can be complementary for detecting local and distant recurrence to guide treatment planning.
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Affiliation(s)
- Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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7
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Park MY, Park KJ, Kim MH, Kim JK. Focal nodular enhancement on DCE MRI of the prostatectomy bed: radiologic-pathologic correlations and prognostic value. Eur Radiol 2023; 33:2985-2994. [PMID: 36350389 DOI: 10.1007/s00330-022-09241-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the concordance of dynamic contrast-enhanced (DCE) imaging findings with clinico-pathologic characteristics and their prognostic impact for predicting biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) for prostate cancer. METHODS This retrospective study included patients who underwent MRI within 1 year after RP between November 2019 and October 2020. DCE findings and their concordance with the presence and location of positive surgical margin (PSM) were assessed using RP specimens. Kaplan-Meier and logistic regression analyses were used to evaluate the prognostic impact of DCE findings for BCR. RESULTS Among the 272 men (mean age ± standard deviation, 66.6 ± 7.4 years), focal nodular enhancement was more frequently observed in those with PSM compared to those with negative margin (85.4% versus 14.6%; p < 0.001). The sites of focal nodular enhancement were 72.9% (35/48) concordant with the PSM locations. Focal nodular enhancement was associated with a higher Gleason score, higher preoperative PSA (≥ 10 ng/mL), higher Gleason grade at the surgical margin, and non-limited margin involvement (p = 0.002, 0.006, 0.032, and 0.001, respectively). In patients without BCR at the time of MRI, focal nodular enhancement was associated with a shorter time to BCR (p < 0.001) and a significant factor predicting 1-year BCR in both univariate (odds ratio = 8.4 [95% CI: 2.5-28.3]; p = 0.001) and multivariate (odds ratio = 5.49 [1.56-19.3]; p = 0.008) analyses. CONCLUSIONS Focal nodular enhancement on post-prostatectomy MRI was associated with adverse clinico-pathologic characteristics of high risk for recurrence and can be a predictor for 1-year BCR in patients undergoing RP. KEY POINTS • Focal nodular enhancement (PI-RR DCE score ≥ 4) was 72.9% (35/48) concordant with the site of positive resection margin by radiologic-histologic correlation. • Focal nodular enhancement (PI-RR DCE score ≥ 4) was associated with higher Gleason score ( ≥ 8), preoperative PSA ( > 10 ng/mL), and Gleason grade 4 or 5 at the surgical margin and non-limited margin involvement (p ≤ 0.032). • In patients without BCR at the time of MRI, focal nodular enhancement was a significant factor predicting 1-year BCR (odds ratio = 5.49; 95% CI: 1.56-19.3; p = 0.008).
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Affiliation(s)
- Mi Yeon Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Mi-Hyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jeong Kon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea
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The Role of mpMRI in the Assessment of Prostate Cancer Recurrence Using the PI-RR System: Diagnostic Accuracy and Interobserver Agreement in Readers with Different Expertise. Diagnostics (Basel) 2023; 13:diagnostics13030387. [PMID: 36766492 PMCID: PMC9914595 DOI: 10.3390/diagnostics13030387] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND treated prostate cancer (PCa) patients develop biochemical recurrence (BCR) in 27-53% of cases; the role of MRI in this setting is still controversial. In 2021 a panel of experts proposed a "Prostate Imaging-Recurrence Reporting" (PI-RR) score, aiming to standardize the reporting. The aim of our study is to evaluate the reproducibility of the PI-RR scoring system among readers with different expertise. METHODS in this monocentric, retrospective observational study, the images of patients who underwent MRI with BCR from January 2017 to January 2022 were analyzed by two radiologists and a radiology resident. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were obtained. Interobserver agreement was calculated. The percentage of the PI-RR score of 3 was estimated to find out the proportion of uncertain exams reported among the readers. RESULTS a total of seventy-six patients were included in our study: eight previously treated with RT and sixty-eight who underwent surgery. The accuracy range was 75-80%, the sensitivity 68.4-71.1%, the specificity 81.6-89.5%, PPV 78.8-87.1%, and NPV 72.1-75.6%. The inter-reader agreement using a binary evaluation (PI-RR ≥ 3 as positive mpMRI) demonstrated a correlation coefficient (k) of 0.74 (95% CI: 0.62-0.87). The percentage for the PI-RR score of 3 was 6.6% for reader one, 14.5% for reader two, and 2.6% for reader three. CONCLUSION this study confirmed the good accuracy of mpMRI in the detection of local recurrence of PCa and the good reproducibility of PI-RR score among all readers, confirming it to be a promising tool for the standardization of the assessment of patients with BCR.
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Pecoraro M, Turkbey BI, Purysko AS, Girometti R, Giannarini G, Villeirs G, Roberto M, Catalano C, Padhani AR, Barentsz JO, Panebianco V. Diagnostic Accuracy and Observer Agreement of the MRI Prostate Imaging for Recurrence Reporting Assessment Score. Radiology 2022; 304:342-350. [PMID: 35536130 DOI: 10.1148/radiol.212252] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Prostate cancer local recurrence location and extent must be determined in an accurate and timely manner. Because of the lack of a standardized MRI approach after whole-gland treatment, a panel of international experts recently proposed the Prostate Imaging for Recurrence Reporting (PI-RR) assessment score. Purpose To determine the diagnostic accuracy of PI-RR for detecting local recurrence in patients with biochemical recurrence (BCR) after radiation therapy (RT) or radical prostatectomy (RP) and to evaluate the interreader variability of PI-RR scoring. Materials and Methods This retrospective observational study included patients who underwent multiparametric MRI between September 2016 and May 2021 for BCR after RT or RP. MRI scans were analyzed, and a PI-RR score was assigned independently by four radiologists. The reference standard was defined using histopathologic findings, follow-up imaging, or clinical response to treatment. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to assess PI-RR performance for each reader. The intraclass correlation coefficient was used to determine interreader agreement. Results A total of 100 men were included: 48 patients after RT (median age, 76 years [IQR, 70-82 years]) and 52 patients after RP (median age, 70 years [IQR, 66-74 years]). After RT, with PI-RR of 3 or greater as a cutoff (assigned when recurrence is uncertain), diagnostic performance ranges were 71%-81% sensitivity, 74%-93% specificity, 71%-89% PPV, 79%-86% NPV, and 77%-88% accuracy across the four readers. After RP, with PI-RR of 3 or greater as a cutoff, performance ranges were 59%-83% sensitivity, 87%-100% specificity, 88%-100% PPV, 66%-80% NPV, and 75%-85% accuracy. The intraclass correlation coefficient was 0.87 across the four readers for both the RT and RP groups. Conclusion MRI scoring with the Prostate Imaging for Recurrence Reporting assessment provides structured, reproducible, and accurate evaluation of local recurrence after definitive therapy for prostate cancer. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Haider in this issue.
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Affiliation(s)
- Martina Pecoraro
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Baris I Turkbey
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Andrei S Purysko
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Rossano Girometti
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Gianluca Giannarini
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Geert Villeirs
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Michela Roberto
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Carlo Catalano
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Anwar R Padhani
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Jelle O Barentsz
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Valeria Panebianco
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
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10
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Renard-Penna R, Zhang-Yin J, Montagne S, Aupin L, Bruguière E, Labidi M, Latorzeff I, Hennequin C. Targeting Local Recurrence After Surgery With MRI Imaging for Prostate Cancer in the Setting of Salvage Radiation Therapy. Front Oncol 2022; 12:775387. [PMID: 35242702 PMCID: PMC8887697 DOI: 10.3389/fonc.2022.775387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) is being increasingly used for imaging suspected recurrence in prostate cancer therapy. Functional MRI with diffusion and perfusion imaging has the potential to demonstrate local recurrence even at low PSA value. Detection of recurrence can modify the management of postprostatectomy biochemical recurrence. MRI scan acquired before salvage radiotherapy is useful for the localization of recurrent tumors and also in the delineation of the target volume. The objective of this review is to assess the role and potential impact of MRI in targeting local recurrence after surgery for prostate cancer in the setting of salvage radiation therapy.
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Affiliation(s)
- Raphaële Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Jules Zhang-Yin
- Nuclear Medicine Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Sarah Montagne
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Laurene Aupin
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Eric Bruguière
- Department of Imaging, Clinique Pasteur, Toulouse, France
| | - Mouna Labidi
- Department of Oncology, Saint-Louis Hospital, Université de Paris, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Igor Latorzeff
- Department of Radiotherapy, Clinique Pasteur, Toulouse, France
| | - Christophe Hennequin
- Department of Oncology, Saint-Louis Hospital, Université de Paris, Assistance Publique des Hôpitaux de Paris, Paris, France
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11
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Mukkamala R, Lindeman SD, Kragness KA, Shahriar I, Srinivasarao M, Low PS. Design and Characterization of Fibroblast Activation Protein Targeted Pan-Cancer Imaging Agent for Fluorescence-Guided Surgery of Solid Tumors. J Mater Chem B 2022; 10:2038-2046. [PMID: 35255116 DOI: 10.1039/d1tb02651h] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tumor-targeted fluorescent dyes have been shown to significantly improve a surgeon's ability to locate and resect occult malignant lesions, thereby enhancing a patient’s chances of long term survival. Although several...
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Affiliation(s)
- Ramesh Mukkamala
- Department of Chemistry and Institute for Drug Discovery, Purdue University, West Lafayette, Indiana 47907, USA.
| | - Spencer D Lindeman
- Department of Chemistry and Institute for Drug Discovery, Purdue University, West Lafayette, Indiana 47907, USA.
| | - Kate A Kragness
- Department of Chemistry and Institute for Drug Discovery, Purdue University, West Lafayette, Indiana 47907, USA.
| | - Imrul Shahriar
- Department of Chemistry and Institute for Drug Discovery, Purdue University, West Lafayette, Indiana 47907, USA.
| | - Madduri Srinivasarao
- Department of Chemistry and Institute for Drug Discovery, Purdue University, West Lafayette, Indiana 47907, USA.
| | - Philip S Low
- Department of Chemistry and Institute for Drug Discovery, Purdue University, West Lafayette, Indiana 47907, USA.
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12
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Lee SU, Cho KH, Kim JH, Kim YS, Nam TK, Kim JS, Cho J, Choi SH, Shim SJ, Kim JH, Chang AR. Clinical Outcome of Salvage Radiotherapy for Locoregional Clinical Recurrence After Radical Prostatectomy. Technol Cancer Res Treat 2021; 20:15330338211041212. [PMID: 34806469 PMCID: PMC8606930 DOI: 10.1177/15330338211041212] [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] [Indexed: 11/23/2022] Open
Abstract
Objectives: To assess the clinical outcomes of prostate cancer
patients treated with salvage radiotherapy (SRT) for locoregional clinical
recurrence (CR) after radical prostatectomy (RP). Methods: Records
of 60 patients with macroscopic locoregional recurrence after prostatectomy and
referrals for SRT were retrospectively investigated in the multi-institutional
database. The median radiation dose was 70.2 Gy. Biochemical failure was defined
as the prostate-specific antigen (PSA) ≥ nadir + 2 or initiation of androgen
deprivation therapy (ADT) for increased PSA. Results: Median
recurrent tumor size was 1.1 cm and pre-radiotherapy PSA level was 0.4 ng/ml. At
a median follow-up of 83.1-month after SRT, 7-year biochemical failure-free
survival (BCFFS), locoregional failure-free survival (LRFFS), distant
metastasis-free survival (DMFS), and overall survival (OS) were 67.0%, 89.7%,
83.6%, and 91.2%, respectively. Higher Gleason's scores were associated with
unfavorable BCFFS, DMFS, and OS. Pre-SRT PSA ≥0.5 ng/ml predicted worse BCFFS,
LRFFS, and DMFS. In multivariate analyses, a Gleason's score of 8 to 10 was
associated with decreased BCFFS (hazard ratio [HR] 3.12, 95% confidence interval
[CI] 1.11-8.74, P = .031) and OS (HR 17.72, 95% CI 1.75-179.64,
P = .015), and combined ADT decreased the risks of distant
metastasis (HR 0.18, 95% CI 0.04-0.92, P = .039). Two patients
(3.3%) experienced late grade 3 urinary toxicity. Conclusions: SRT
for locoregional CR after RP achieved favorable outcomes with acceptable
long-term toxicities. Higher Gleason's scores and pre-radiotherapy PSA level
were unfavorable prognostic variables. Combined ADT may decrease the risks of
metastases.
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Affiliation(s)
- Sung Uk Lee
- The Proton Therapy Center, Research Institute and Hospital70317National Cancer Center, Goyang, Korea
| | - Kwan Ho Cho
- The Proton Therapy Center, Research Institute and Hospital70317National Cancer Center, Goyang, Korea
| | - Jin Ho Kim
- 65462Department of Radiation Oncology, Seoul National University Hospital, 37990Seoul National University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, 35029University of Ulsan College of Medicine, Seoul, Korea
| | - Taek-Keun Nam
- 65722Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- 46666Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Seo Hee Choi
- 46666Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Su Jung Shim
- Dongsan Medical Center, 65673Keimyung University School of Medicine, Daegu, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ah Ram Chang
- 71544Department of Radiation Oncology, Soonchunhyang University Hospital, Seoul, Korea
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13
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Zaine H, Vandendorpe B, Bataille B, Lacornerie T, Wallet J, Mirabel X, Lartigau E, Pasquier D. Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy. Front Oncol 2021; 11:669261. [PMID: 33937082 PMCID: PMC8082188 DOI: 10.3389/fonc.2021.669261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Salvage radiotherapy is the only curative treatment for biochemical progression after radical prostatectomy. Macroscopic recurrence may be found in the prostatic bed. The purpose of our study is to evaluate the effectiveness of salvage radiotherapy of the prostate bed with a boost to the area of the macroscopic recurrence. Material and Methods From January 2005 to January 2020, 89 patients with macroscopic recurrence in the prostatectomy bed were treated with salvage radiotherapy +/- hormone therapy. The average PSA level prior to radiotherapy was 1.1 ng/mL (SD: 1.6). At the time of biochemical progression, 96% of the patients had a MRI that revealed the macroscopic recurrence, and 58% had an additional choline PET scan. 67.4% of the patients got a boost to the macroscopic nodule, while 32.5% of the patients only underwent radiotherapy of the prostate bed without a boost. The median total dose of radiotherapy was 70 Gy (Min.: 60 - Max.: 74). The most commonly-used regimen was radiotherapy of the prostatectomy bed with a concomitant boost. 48% of the patients were concomitantly treated with hormone therapy. Results After a median follow-up of 53.7 months, 77 patients were alive and 12 had died, of which 4 following metastatic progression. The 5-year and 8-year survival rates (CI95%) are, respectively, 90.2% (78.9-95.6%) and 69.8% (46.4-84.4%). The 5-year biochemical progression-free survival rate (CI95%) is 50.8% (36.7-63.3). Metastatic recurrence occurred in 11.2% of the patients. We did not find any statistically significant impact from the various known prognostic factors for biochemical progression-free survival. No toxicity with a grade of > or = to 3 was found. Conclusions Our series is one of the largest published to date. Salvage radiotherapy has its place in the management of patients with biochemical progression with local recurrence in the prostate bed, with an acceptable toxicity profile. The interest of the boost is to be evaluated in prospective trials.
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Affiliation(s)
- Hind Zaine
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Benoit Bataille
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Jennifer Wallet
- Department of Biostatistics, Centre O. Lambret, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRIStAL (Centre de Recherche en Informatique, Signal et Automatique de Lille [Research center in Computer Science, Signal and Automatic Control of Lille] UMR (Unité Mixte de Recherche [joint research center]) 9189, Lille University, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRIStAL (Centre de Recherche en Informatique, Signal et Automatique de Lille [Research center in Computer Science, Signal and Automatic Control of Lille] UMR (Unité Mixte de Recherche [joint research center]) 9189, Lille University, Lille, France
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14
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Panebianco V, Villeirs G, Weinreb JC, Turkbey BI, Margolis DJ, Richenberg J, Schoots IG, Moore CM, Futterer J, Macura KJ, Oto A, Bittencourt LK, Haider MA, Salomon G, Tempany CM, Padhani AR, Barentsz JO. Prostate Magnetic Resonance Imaging for Local Recurrence Reporting (PI-RR): International Consensus -based Guidelines on Multiparametric Magnetic Resonance Imaging for Prostate Cancer Recurrence after Radiation Therapy and Radical Prostatectomy. Eur Urol Oncol 2021; 4:868-876. [PMID: 33582104 DOI: 10.1016/j.euo.2021.01.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Imaging techniques are used to identify local recurrence of prostate cancer (PCa) for salvage therapy and to exclude metastases that should be addressed with systemic therapy. For magnetic resonance imaging (MRI), a reduction in the variability of acquisition, interpretation, and reporting is required to detect local PCa recurrence in men with biochemical relapse after local treatment with curative intent. OBJECTIVE To propose a standardised method for image acquisition and assessment of PCa local recurrence using MRI after radiation therapy (RP) and radical prostatectomy (RT). EVIDENCE ACQUISITION Prostate Imaging for Recurrence Reporting (PI-RR) was formulated using the existing literature. An international panel of experts conducted a nonsystematic review of the literature. The PI-RR system was created via consensus through a combination of face-to-face and online discussions. EVIDENCE SYNTHESIS Similar to with PI-RADS, based on the best available evidence and expert opinion, the minimum acceptable MRI parameters for detection of recurrence after radiation therapy and radical prostatectomy are set. Also, a simplified and standardised terminology and content of the reports that use five assessment categories to summarise the suspicion of local recurrence (PI-RR) are designed. PI-RR scores of 1 and 2 are assigned to lesions with a very low and low likelihood of recurrence, respectively. PI-RR 3 is assigned if the presence of recurrence is uncertain. PI-RR 4 and 5 are assigned for a high and very high likelihood of recurrence, respectively. PI-RR is intended to be used in routine clinical practice and to facilitate data collection and outcome monitoring for research. CONCLUSIONS This paper provides a structured reporting system (PI-RR) for MRI evaluation of local recurrence of PCa after RT and RP. PATIENT SUMMARY A new method called PI-RR was developed to promote standardisation and reduce variations in the acquisition, interpretation, and reporting of magnetic resonance imaging for evaluating local recurrence of prostate cancer and guiding therapy.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy.
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Baris I Turkbey
- National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA
| | | | - Jonathan Richenberg
- Department of Imaging, Brighton and Sussex University Hospitals NHS Trust and Brighton and Sussex Medical School, Brighton, UK
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katarzyna J Macura
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | | | - Masoom A Haider
- Department of Medical Imaging, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Clare M Tempany
- Department of Radiology, Brigham &Women's Hospital, Boston, MA, USA
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
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15
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Abiodun-Ojo OA, Jani AB, Akintayo AA, Akin-Akintayo OO, Odewole OA, Tade FI, Joshi SS, Master VA, Fielder B, Halkar RK, Zhang C, Goyal S, Goodman MM, Schuster DM. Salvage Radiotherapy Management Decisions in Postprostatectomy Patients with Recurrent Prostate Cancer Based on 18F-Fluciclovine PET/CT Guidance. J Nucl Med 2021; 62:1089-1096. [PMID: 33517323 DOI: 10.2967/jnumed.120.256784] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Imaging with novel PET radiotracers has significantly influenced radiotherapy decision making and radiation planning in patients with recurrent prostate cancer (PCa). The purpose of this analysis was to report the final results for management decision changes based on 18F-fluciclovine PET/CT findings and determine whether the decision change trend remained after completion of accrual. Methods: Patients with detectable prostate-specific antigen (PSA) after prostatectomy were randomized to undergo either conventional imaging (CI) only (arm A) or CI plus 18F-fluciclovine PET/CT (arm B) before radiotherapy. In arm B, positivity rates on CI and 18F-fluciclovine PET/CT for detection of recurrent PCa were determined. Final decisions on whether to offer radiotherapy and whether to include only the prostate bed or also the pelvis in the radiotherapy field were based on 18F-fluciclovine PET/CT findings. Radiotherapy decisions before and after 18F-fluciclovine PET/CT were compared. The statistical significance of decision changes was determined using the Clopper-Pearson (exact) binomial method. Prognostic factors were compared between patients with and without decision changes. Results: All 165 patients enrolled in the study had standard-of-care CI and were initially planned to receive radiotherapy. Sixty-three of 79 (79.7%) patients (median PSA, 0.33 ng/mL) who underwent 18F-fluciclovine PET/CT (arm B) had positive findings. 18F-Fluciclovine PET/CT had a significantly higher positivity rate than CI did for the whole body (79.7% vs. 13.9%; P < 0.001), prostate bed (69.6% vs. 5.1%; P < 0.001), and pelvic lymph nodes (38.0% vs. 10.1%; P < 0.001). Twenty-eight of 79 (35.4%) patients had the overall radiotherapy decision changed after 18F-fluciclovine PET/CT; in 4 of 79 (5.1%), the decision to use radiotherapy was withdrawn because of extrapelvic disease detected on 18F-fluciclovine PET/CT. In 24 of 75 (32.0%) patients with a final decision to undergo radiotherapy, the radiotherapy field was changed. Changes in overall radiotherapy decisions and radiotherapy fields were statistically significant (P < 0.001). Overall, the mean PSA at PET was significantly different between patients with and without radiotherapy decision changes (P = 0.033). Conclusion: 18F-Fluciclovine PET/CT significantly altered salvage radiotherapy decisions in patients with recurrent PCa after prostatectomy. Further analysis to determine the impact of 18F-fluciclovine PET/CT guidance on clinical outcomes after radiotherapy is in progress.
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Affiliation(s)
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Akinyemi A Akintayo
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | | | - Oluwaseun A Odewole
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Funmilayo I Tade
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | | | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia
| | - Bridget Fielder
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Raghuveer K Halkar
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia; and
| | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.,Emory University Center for Systems Imaging, Atlanta, Georgia
| | - David M Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
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16
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Udayakumar N, Porter KK. How Fast Can We Go: Abbreviated Prostate MR Protocols. Curr Urol Rep 2020; 21:59. [PMID: 33135121 DOI: 10.1007/s11934-020-01008-8] [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] [Accepted: 10/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Multiparametric MRI (mpMRI), composed of T2WI, DWI, and DCE sequences, is effective in identifying prostate cancer (PCa), but length and cost preclude its application as a PCa screening tool. Here we review abbreviated MRI protocols that shorten or omit conventional mpMRI components to reduce scan time and expense without forgoing diagnostic accuracy. RECENT FINDINGS The DCE sequence, which plays a limited diagnostic role in PI-RADS, is eliminated in variations of the biparametric MRI (bpMRI). T2WI, the lengthiest sequence, is truncated by only acquiring the axial plane or utilizing 3D acquisition with subsequent 2D reconstruction. DW-EPISMS further accelerates DWI acquisition. The fastest protocol described to date consists of just DW-EPISMS and axial-only 2D T2WI and runs less than 5 min. Abbreviated protocols can mitigate scan expense and increase scan access, allowing prostate MRI to become an efficient PCa screening tool.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, 1720 2nd Ave S, Birmingham, AL, 35249, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street S, JT N374, Birmingham, AL, 35249, USA.
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Gupta R, Sheng IY, Barata PC, Garcia JA. Non-metastatic castration-resistant prostate cancer: current status and future directions. Expert Rev Anticancer Ther 2020; 20:513-522. [PMID: 32508166 DOI: 10.1080/14737140.2020.1772759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The emergence of novel hormonal therapies and the increase availability of sensitive next-generation imaging techniques has significantly changed the management of recurrent prostate cancer. AREAS COVERED In this review, we summarize the definition, diagnosis, treatment, and ongoing clinical trials in non-metastatic castration resistant prostate cancer (M0CRPC). We have also discussed the role of newer imaging modalities in the detection of advanced prostate cancer. EXPERT OPINION M0CRPC is a disease state in prostate cancer when serologic progression (PSA only disease) occurs despite castrated levels of testosterone and imaging shows no evidence of metastasis. With the availability of next-generation imaging, more patients are migrating from M0CRPC to mCRPC space. This stage migration impacts the treatment options currently available in clinical practice and requires the integration of novel imaging in prospective studies moving forward. Until that data become available men with M0CRPC should be considered for therapy with any of these three novel oral AR inhibitors, with a positive impact in metastasis-free and overall survival. Treatment selection should be based on Quality of Life, side effects, and drug-drug interactions.
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Affiliation(s)
- Ruby Gupta
- Department of Hematology and Medical Oncology, William Beaumont Hospital , Royal Oak, MI, USA
| | - Iris Y Sheng
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute , Cleveland, OH, USA
| | - Pedro C Barata
- Deming Department of Medicine, Section of Hematology Oncology, Tulane University Medical School , New Orleans, LA, USA
| | - Jorge A Garcia
- GU Oncology Research Program, University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, OH, USA
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Sanguineti G, Bertini L, Faiella A, Ferriero MC, Marzi S, Farneti A, Landoni V. Response on DCE-MRI predicts outcome of salvage radiotherapy for local recurrence after radical prostatectomy. TUMORI JOURNAL 2020; 107:55-63. [PMID: 32180511 DOI: 10.1177/0300891620908950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the predictive role of response on dynamic contrast enhancement on magnetic resonance imaging (DCE-MRI) of visible local lesions in the setting of salvage radiotherapy (sRT) after radical prostatectomy. METHODS All patients referred for sRT for biochemical failure after radical prostatectomy from February 2014 to September 2016 were considered eligible if they had been restaged with DCE-MRI and had been found to have a visible lesion in the prostatic bed, but no distant/nodal disease on choline positron emission tomography (PET)-computed tomography (CT). Eligible patients were contacted during follow-up and offered reimaging with serial DCE-MRI until lesion resolution. Complete response (CR) was defined as the disappearance of the target lesion on DCE-MRI; prostate-specific antigen (PSA) recurrence was defined as a 0.2 ng/mL PSA rise above the nadir. Median follow-up after sRT was 41.5 months (range, 12.1-61.2 months). RESULTS Fifty-nine patients agreed to undergo repeated DCE-MRI for a total of 64 studied lesions. Overall, 57 lesions (89.1%) showed a CR after 1 (51 patients) or 2 (6 patients) scans, while 7 lesions did not show any change (no response [NR]). At 42 months, no evidence of biochemical disease (bNED) survival was 74.7±6.4% and 64.3±21.0% for patients with CR and NR lesions, respectively (hazard ratio [HR], 3.181; 95% confidence interval [CI], 0.157-64.364; p = 0.451). When only patients treated with sRT without androgen deprivation were selected (n = 41), bNED survival rates at 42 months were 72.1±8.0% and 0, respectively (HR, 52.830; 95% CI, 1.893-1474.110; p = 0.020). CONCLUSIONS Patients whose lesions disappear during follow-up have a better outcome than those with unchanged lesions after sRT alone.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Bertini
- Department of Radiology and Diagnostic Imaging, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Adriana Faiella
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Simona Marzi
- Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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Abstract
OBJECTIVE. In this article, we discuss the evolving roles of imaging modalities in patients presenting with biochemical recurrence after prostatectomy. CONCLUSION. Multiple imaging modalities are currently available to evaluate patients with prostate cancer presenting with biochemical recurrence after prostatectomy. Multiparametric MRI (mpMRI) focuses on the postsurgical bed as well as regional lymph nodes and bones. PET/CT studies using 18F-fluciclovine, 11C-choline, and prostate-specific membrane antigen (PSMA) ligands are useful in detecting locoregional and distant metastasis. Multiparametric MRI is preferred for patients with low risk of metastasis for localizing recurrence in prostate bed as well as pelvic lymph node and bone recurrence. Moreover, mpMRI aids in guiding biopsy and additional salvage treatments. For patients with high risk of metastatic disease, both mpMRI and whole-body PET/CT may be performed. PET/MRI using 68Ga-PSMA has potential to enable a one-stop shop for local recurrence and metastatic disease evaluation, and clinical trials of PET/MRI are ongoing.
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Coppola A, Platania G, Ticca C, De Mattia C, Bortolato B, Palazzi MF, Vanzulli A. Sensitivity of CE-MRI in detecting local recurrence after radical prostatectomy. Radiol Med 2020; 125:683-690. [PMID: 32078119 DOI: 10.1007/s11547-020-01149-3] [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: 09/20/2018] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
Abstract
AIM The aim of our study was to evaluate the sensitivity of contrast-enhanced magnetic resonance (CE-MR) with phased array coil in the diagnosis of local recurrence in patients with prostate cancer after radical prostatectomy and referred for salvage radiotherapy (SRT). MATERIALS AND METHODS This retrospective study included 73 patients treated with SRT after radical prostatectomy in the period between September 2006 and November 2017. All patients performed a CE-MRI with phased array coil before the start of SRT. A total of 213 patients treated at the ASST Grande Ospedale Metropolitano Niguarda in the period between September 2006 and November 2017 with SRT after radical prostatectomy were reviewed. Seventy-three patients with a CE-MRI with phased array coil of the pelvis before the start of SRT were included in the present study. RESULTS At imaging review, recurrence local recurrent disease was diagnosed in 48 of 73 patients. By considering as reference standard the decrease in prostate-specific antigen (PSA) value after radiotherapy, we defined: 41 true positive (patients with MRI evidence of local recurrence and PSA value decreasing after SRT), 7 false positive (patients with MRI evidence of local recurrence without biochemical response after SRT), 3 true negative (patients without MRI evidence of local recurrence and stable or increased PSA value after SRT) and 22 false negative (patients without MRI evidence of local recurrence and PSA value decreasing after SRT) cases. The sensitivity values were calculated in relation to the PSA value before the start of treatment, obtaining a value of 74% for PSA above 0.2 ng/mL. CONCLUSION The sensitivity of CE-MRI in local recurrence detection after radical prostatectomy increases with increasing PSA values. CE-MRI with phased array coil can detect local recurrences after radical prostatectomy with a good sensitivity in patients with pre-RT PSA value above 0.2 ng/mL.
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Affiliation(s)
| | | | - Cristiana Ticca
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Barbara Bortolato
- Unit of Radiotherapy, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro F Palazzi
- Unit of Radiotherapy, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Vanzulli
- Department of Oncology and Hemato-Oncology, Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy
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Aisa MC, Piscioli I, Di Blasi A, Scialpi M. PSA/biparametric MRI: An accurate potential diagnostic approach for detection and management of local recurrence after radical prostatectomy. Turk J Urol 2020; 46:87-88. [PMID: 31905126 PMCID: PMC6944429 DOI: 10.5152/tud.2019.19242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 09/14/2023]
Affiliation(s)
- Maria Cristina Aisa
- Section of Obstetrics and Gynaecology, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | | | - Michele Scialpi
- Section of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Ghafoor S, Burger IA, Vargas AH. Multimodality Imaging of Prostate Cancer. J Nucl Med 2019; 60:1350-1358. [PMID: 31481573 DOI: 10.2967/jnumed.119.228320] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/29/2019] [Indexed: 01/02/2023] Open
Abstract
Prostate cancer is a very heterogeneous disease, and contemporary management is focused on identification and treatment of the prognostically adverse high-risk tumors while minimizing overtreatment of indolent, low-risk tumors. In recent years, imaging has gained increasing importance in the detection, staging, posttreatment assessment, and detection of recurrence of prostate cancer. Several imaging modalities including conventional and functional methods are used in different clinical scenarios with their very own advantages and limitations. This continuing medical education article provides an overview of available imaging modalities currently in use for prostate cancer followed by a more specific section on the value of these different imaging modalities in distinct clinical scenarios, ranging from initial diagnosis to advanced, metastatic castration-resistant prostate cancer. In addition to established imaging indications, we will highlight some potential future applications of contemporary imaging modalities in prostate cancer.
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Affiliation(s)
- Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Irene A Burger
- Department of Nuclear Medicine, Baden Cantonal Hospital, Baden, Switzerland
| | - Alberto H Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
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23
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Bruni A, Ingrosso G, Trippa F, Di Staso M, Lanfranchi B, Rubino L, Parente S, Frassinelli L, Maranzano E, Santoni R, Sighinolfi MC, Lohr F, Mazzeo E. Macroscopic locoregional relapse from prostate cancer: which role for salvage radiotherapy? Clin Transl Oncol 2019; 21:1532-1537. [PMID: 30868389 DOI: 10.1007/s12094-019-02084-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/07/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Salvage radiotherapy (SRT) after radical prostatectomy for prostate cancer (PCa) is recommended as soon as PSA rises above 0.20 ng/ml, but many patients (pts) still experience local macroscopic relapse. The aim of this multicentric retrospective analysis was to evaluate the role of SRT in pts with macroscopic relapse. MATERIALS AND METHODS From 2001 to 2016, 105 consecutive pts with macroscopic PCa relapse underwent SRT ± androgen deprivation therapy (ADT). Mean age was 72 years. At time of relapse, 29 pts had a PSA value < 1.0 ng/mL, 50 from 1.1 to 5, and 25 pts > 5. Before SRT, 23 pts had undergone 18F-choline PET and 15 pts pelvic MRI. Ninety-four pts had prostatic bed relapse only, and four nodal involvement. Fifty-one pts were previously submitted to first-line ADT, while 6 pts received ≥ 2 lines. RESULTS At a median follow-up of 52 months, 89 pts were alive, while 16 were dead. Total RT dose to macroscopic lesions was > 70 Gy in 58 pts, 66-70 Gy in 43, and < 66 Gy in 4 pts. In 72 pts, target volume encompassed only the prostatic bed with sequential boost to macroscopic site; 33 pts received prophylactic pelvic RT. Ten-year overall survival was 76.1%, while distant metastasis-free survival was 73.3%. No grade 4-5 toxicities were found. CONCLUSIONS SRT ± ADT for macroscopic relapse showed a favorable oncological outcome supporting its important role in this scenario. Data from this series suggest that SRT may either postpone ADT or improve results over ADT alone in appropriately selected pts.
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Affiliation(s)
- A Bruni
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
| | - G Ingrosso
- Radiotherapy Unit, "Tor Vergata" University General Hospital, Rome, Italy
| | - F Trippa
- Radiotherapy Unit, "Santa Maria" University Hospital, Terni, Italy
| | - M Di Staso
- Radiotherapy Unit, "Nuovo San Salvatore" Hospital, L'Aquila, Italy
| | - B Lanfranchi
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - L Rubino
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - S Parente
- Radiotherapy Unit, "Nuovo San Salvatore" Hospital, L'Aquila, Italy
| | - L Frassinelli
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - E Maranzano
- Radiotherapy Unit, "Santa Maria" University Hospital, Terni, Italy
| | - R Santoni
- Radiotherapy Unit, "Tor Vergata" University General Hospital, Rome, Italy
| | - M C Sighinolfi
- Urology Unit, University Hospital of Modena, Modena, Italy
| | - F Lohr
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - E Mazzeo
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
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Abstract
Accurate tumor detection and establishment of disease extent are important for optimal management of prostate cancer. Disease stage, beginning with identification of the index prostate lesion, followed by primary tumor, lymph node, and distant metastasis evaluation, provide crucial clinical information that not only have prognostic and predictive value, but guide patient management. A wide array of radiological imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging have been used for the purpose of prostate cancer staging with variable diagnostic performance. Especially, the last years have seen remarkable technological advances in magnetic resonance imaging technology, enabling referring clinicians and radiologists to obtain even more valuable data regarding staging of prostate cancer. Marked improvements have been seen in detection of the index prostate lesion and evaluation of extraprostatic extension while further improvements are still needed in identifying metastatic lymph nodes. Novel approaches such as whole-body MRI are emerging for more accurate and reproducible assessment of bone metastasis. Post-treatment assessment of prostate cancer using radiological imaging is a topic with rapidly changing clinical context and special consideration is needed for the biochemical setting, that is, the relatively high serum prostate-specific antigen levels in studies assessing the value of radiological imaging for post-treatment assessment and emerging therapeutic approaches such as early salvage radiation therapy. The scope of this review is to provide the reader insight into the various ways radiology contribute to staging of prostate cancer in the context of both primary staging and post-treatment assessment. The strengths and limitations of each imaging modality are highlighted as well as topics that warrant future research.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Barbosa FG, Queiroz MA, Nunes RF, Viana PCC, Marin JFG, Cerri GG, Buchpiguel CA. Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread. Radiographics 2019; 39:186-212. [DOI: 10.1148/rg.2019180079] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Felipe G. Barbosa
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Marcelo A. Queiroz
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Rafael F. Nunes
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Publio C. C. Viana
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - José Flávio G. Marin
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Giovanni G. Cerri
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Carlos A. Buchpiguel
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
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Mahalingam SM, Kularatne SA, Myers CH, Gagare P, Norshi M, Liu X, Singhal S, Low PS. Evaluation of Novel Tumor-Targeted Near-Infrared Probe for Fluorescence-Guided Surgery of Cancer. J Med Chem 2018; 61:9637-9646. [PMID: 30296376 DOI: 10.1021/acs.jmedchem.8b01115] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Sumith A. Kularatne
- On Target Laboratories, 1281 Win Hentschel Blvd, West Lafayette, Indiana 47906, United States
| | - Carrie H. Myers
- On Target Laboratories, 1281 Win Hentschel Blvd, West Lafayette, Indiana 47906, United States
| | - Pravin Gagare
- On Target Laboratories, 1281 Win Hentschel Blvd, West Lafayette, Indiana 47906, United States
| | - Mohammad Norshi
- On Target Laboratories, 1281 Win Hentschel Blvd, West Lafayette, Indiana 47906, United States
| | - Xin Liu
- Purdue University Institute for Drug Discovery, 720 Clinic Drive, West Lafayette, Indiana 47907, United States
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, Pennsylvania 19104, United States
| | - Philip S. Low
- Purdue University Institute for Drug Discovery, 720 Clinic Drive, West Lafayette, Indiana 47907, United States
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Use of modern imaging methods to facilitate trials of metastasis-directed therapy for oligometastatic disease in prostate cancer: a consensus recommendation from the EORTC Imaging Group. Lancet Oncol 2018; 19:e534-e545. [DOI: 10.1016/s1470-2045(18)30571-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 02/07/2023]
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Mateo J, Fizazi K, Gillessen S, Heidenreich A, Perez-Lopez R, Oyen WJG, Shore N, Smith M, Sweeney C, Tombal B, Tomlins SA, de Bono JS. Managing Nonmetastatic Castration-resistant Prostate Cancer. Eur Urol 2018; 75:285-293. [PMID: 30119985 DOI: 10.1016/j.eururo.2018.07.035] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have rising prostate-specific antigen (PSA) and castrate testosterone levels, with no radiological findings of metastatic disease on computed tomography and bone scan. Given recent drug approvals for nmCRPC, with many other therapeutics and imaging modalities being developed, management of nmCRPC is a rapidly evolving field that merits detailed investigation. OBJECTIVE To review current nmCRPC management practices and identify opportunities for improving care of nmCRPC patients. EVIDENCE ACQUISITION A literature search up to July 2018 was conducted, including clinical trials and clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, European Association of Urology, Prostate Cancer Clinical Trials Working Group, Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence). Keywords included prostate cancer, nonmetastatic, castration resistance, rising PSA, and biochemical relapse. EVIDENCE SYNTHESIS Recommendations regarding indications for, and frequency of, imaging and PSA testing, as well as for initiating systemic therapy in nmCRPC are based on PSA rise kinetics and symptoms. Both enzalutamide and apalutamide have been shown to significantly increase metastasis-free survival in phase III placebo-controlled randomised trials in nmCRPC patients with PSA doubling time (DT) ≤10 mo. The expected impact of new imaging techniques in the assessment of nmCRPC is also reviewed. CONCLUSIONS nmCRPC is a heterogeneous disease; while observation may be an option for some patients, enzalutamide and apalutamide may be appropriate to treat nmCRPC patients with PSA-DT ≤10 mo. The emergence of more accurate imaging modalities as well as circulating tumour biomarker assays will likely redefine the assessment of nmCRPC in the near future. PATIENT SUMMARY Herein, we review key literature and clinical practice guidelines to summarise the optimal management of patients with prostate cancer and rising prostate-specific antigen despite castrate testosterone levels, but with no evidence of distant metastasis on traditional imaging. New drugs are being developed for this disease setting; novel imaging and tumour biomarker blood tests are likely to define this disease state more accurately.
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Affiliation(s)
- Joaquin Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Karim Fizazi
- Institut Gustave Roussy and University of Paris Sud, Villejuif, France
| | - Silke Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, Switzerland
| | | | | | - Wim J G Oyen
- The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Neal Shore
- Carolina Urologic Research Center and Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | - Matthew Smith
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Scott A Tomlins
- Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Johann S de Bono
- The Royal Marsden Hospital and The Institute of Cancer Research, London, UK.
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