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Reitano G, Carletti F, Zattoni F. Re: Evelien J.E. van Altena, Bernard H.E. Jansen, Marieke L. Korbee, et al. Prostate-specific Membrane Antigen Positron Emission Tomography Before Reaching the Phoenix Criteria for Biochemical Recurrence of Prostate Cancer After Radiotherapy: Earlier Detection of Recurrences. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2024.09.015. Eur Urol Oncol 2024:S2588-9311(24)00286-4. [PMID: 39675984 DOI: 10.1016/j.euo.2024.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 11/05/2024] [Indexed: 12/17/2024]
Affiliation(s)
- Giuseppe Reitano
- Department of Urology, Azienda Ospedale-Università Padova, Padova, Italy
| | - Filippo Carletti
- Department of Urology, Azienda Ospedale-Università Padova, Padova, Italy
| | - Fabio Zattoni
- Department of Urology, Azienda Ospedale-Università Padova, Padova, Italy; Department of Medicine, University of Padua, Padova, Italy.
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Yang B, Dong H, Zhang S, Ming S, Yang R, Peng Y, Gao X. PSMA PET vs. mpMRI for Lymph Node Metastasis of Prostate Cancer: A Systematic Review and Head-to-Head Comparative Meta-analysis. Acad Radiol 2024:S1076-6332(24)00874-2. [PMID: 39632217 DOI: 10.1016/j.acra.2024.11.029] [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: 10/25/2024] [Revised: 11/04/2024] [Accepted: 11/12/2024] [Indexed: 12/07/2024]
Abstract
PURPOSE To compare prostate-specific membrane antigen (PSMA) PET with multiparametric MRI (mpMRI) in the diagnosis of lymph node metastasis (LNM) in prostate cancer. METHODS A comprehensive search of PubMed, Embase, and Web of Science identified studies published up to August 24, 2024. Studies comparing PSMA PET and mpMRI accuracy in detecting LNM in prostate cancer were included. The quality of each study was assessed using the Quality Assessment of Diagnostic Performance Studies-2 tool. RESULTS This study included 23 articles with a total of 3041 patients. The pooled analysis showed PSMA PET had a sensitivity of 0.74 (95% CI:0.62-0.85) and specificity of 0.96 (95% CI:0.93-0.98) for detecting prostate cancer LNM, while mpMRI had a sensitivity of 0.45 (95% CI:0.32-0.57) and specificity at 0.92 (95% CI:0.86-0.97). PSMA PET shows notably higher sensitivity than mpMRI, (P < 0.01) with no significant difference in specificity (P = 0.18). For initial staging, PSMA PET shows significantly higher sensitivity than mpMRI (P < 0.01), with no significant specificity difference (P = 0.17). Subgroup analysis showed that both [68Ga]Ga-PSMA-11 PET and [18F]F-PSMA-1007 PET had higher sensitivity than mpMRI (P = 0.03, P < 0.01) without significant differences in specificity (P = 0.10, P = 0.73). Meanwhile, there was no significant difference in the sensitivity (P = 0.20) and specificity (P = 0.43) of [18F]F-DCFPyL PET. CONCLUSION PSMA PET is more sensitive than mpMRI in detecting LNM in prostate cancer, especially for initial staging; however, there is no significant difference in specificity between the two. Due to the high heterogeneity, more subgroup-based studies are needed to standardize imaging practices and validate these findings.
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Affiliation(s)
- Bin Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hao Dong
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Shuwei Zhang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Shaoxing Ming
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yonghan Peng
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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Madendere S, Kılıç M, Gürses B, Vural M, Armutlu A, Kulaç İ, Tarım K, Esen B, Aykanat İC, Veznikli M, Canda AE, Balbay D, Baydar DE, Kordan Y, Esen T. Can the Briganti 2019 nomogram be modified to predict lymph node metastasis risk in patients with prostate cancer detected with in-bore biopsy? Int J Urol 2024; 31:1269-1277. [PMID: 39140238 DOI: 10.1111/iju.15553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES We aimed to modify the Briganti 2019 nomogram and to test whether it is valid for patients who were diagnosed with prostate cancer through in-bore prostate biopsies. METHODS Data for 204 patients with positive multiparametric prostate MRI and prostate cancer identified either by mpMRI-cognitive/software fusion or in-bore biopsy and who underwent robot-assisted radical prostatectomy and extended pelvic lymph node dissection between 2012 and 2023 were retrospectively analyzed. The Briganti 2019 nomogram was applied to the mpMRI-cognitive/software fusion biopsy group (142 patients) in the original form, and then, two modifications were tested for the targeted component. Original and modified scores were compared. These modifications were adapted for the in-bore biopsy group (62 patients). The final histopathologic stage was regarded as the gold standard. RESULTS Nodal metastases were identified in 18/142 (12.6%) of mpMRI-cognitive/software fusion biopsy patients and 8/62 (12.9%) of the in-bore biopsy patients. In the mpMRI-cognitive/software fusion biopsy group, tumor size/core size (%) of targeted biopsy cores and positive core percentage on systematic biopsy were significant parameters for lymph node metastasis based on univariate logistic regression analyses (p < 0.05). With the modifications of these parameters for the in-bore biopsy group, V1 modification of the Briganti 2019 nomogram provided 100% sensitivity and 31.5% specificity (AUC:0.627), while V2 modification provided 75% sensitivity and 46.3% specificity (AUC:0.645). CONCLUSIONS Briganti 2019 nomogram may be modified by utilizing tumor size/core size (%) for targeted biopsy cores instead of positive core percentage on systematic biopsy or by not taking both parameters into consideration to detect node metastasis risk of patients diagnosed with in-bore biopsies.
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Affiliation(s)
| | - Mert Kılıç
- Department of Urology, VKV American Hospital, Istanbul, Turkey
| | - Bengi Gürses
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKV American Hospital, Istanbul, Turkey
| | - Ayşe Armutlu
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - İbrahim Kulaç
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Kayhan Tarım
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Barış Esen
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Mert Veznikli
- Department of Biostatistics, Koç University School of Medicine, Istanbul, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
- RMK AIMES, Rahmi M. Koç Academy of Interventional Medicine, Education and Simulation, Istanbul, Turkey
| | - Derya Balbay
- Department of Urology, VKV American Hospital, Istanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Tarık Esen
- Department of Urology, VKV American Hospital, Istanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
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Kunst N, Long JB, Westvold S, Sprenkle PC, Kim IY, Saperstein L, Rabil M, Ghaffar U, Karnes RJ, Ma X, Gross CP, Wang SY, Leapman MS. Long-Term Outcomes of Prostate-Specific Membrane Antigen-PET Imaging of Recurrent Prostate Cancer. JAMA Netw Open 2024; 7:e2440591. [PMID: 39441595 PMCID: PMC11581571 DOI: 10.1001/jamanetworkopen.2024.40591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/28/2024] [Indexed: 10/25/2024] Open
Abstract
Importance Although prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown improved sensitivity and specificity compared with conventional imaging for the detection of biochemical recurrent (BCR) prostate cancer, the long-term outcomes of a widespread shift in imaging are unknown. Objective To estimate long-term outcomes of integrating PSMA-PET into the staging pathway for recurrent prostate cancer. Design, Setting, and Participants This decision analytic modeling study simulated outcomes for patients with BCR following initial definitive local therapy. Inputs used were from the literature and a retrospective cohort study conducted at 2 institutions. The base case analysis assumed modest benefits of earlier detection and treatment, and scenario analyses considered prostate-specific antigen (PSA) level at imaging and different outcomes of earlier vs delayed treatment. The analysis was performed between April 1, 2023, and May 1, 2024. Exposures (1) Immediate PSMA-PET imaging, (2) conventional imaging (computed tomography and bone scan [CTBS]) followed by PSMA-PET if CTBS findings were negative or equivocal, and (3) CTBS alone. Main Outcomes and Measures The main outcomes were detection of metastases, deaths from prostate cancer, and life-years and quality-adjusted life-years (QALYs) gained. Results The model estimated that per 1000 simulated patients with BCR (assumed median age, 66 years), PSMA-PET is expected to diagnose 611 (95% uncertainty interval [UI], 565-656) patients with metastasis compared with 630 (95% UI, 586-675) patients diagnosed using CTBS followed by PSMA-PET and 297 (95% UI, 202-410) patients diagnosed using CTBS alone. Moreover, the estimated number of prostate cancer deaths was 512 (95% UI, 472-552 deaths) with PSMA-PET, 520 (95% UI, 480-559 deaths) with CTBS followed by PSMA-PET, and 587 (95% UI, 538-632 deaths) with CTBS alone. Imaging with PSMA-PET yielded the highest number of QALYs, which were 824 (95% UI, 698-885) higher than CTBS. These results differed by PSA level at the time of testing, with the highest incremental life-years and QALYs and lowest number of deaths from prostate cancer among patients with PSA levels of at least 5.0 ng/mL. Finally, the estimates were sensitive to the expected benefit of initiating therapy for recurrent prostate cancer earlier in the disease course. Conclusions and Relevance The results of this decision-analytic model suggest that upfront PSMA-PET imaging for the evaluation of BCR is expected to be associated with reduced cancer mortality and gains in life-years and QALYs compared with the conventional imaging strategy, assuming modest benefits of earlier detection and treatment.
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Affiliation(s)
- Natalia Kunst
- Centre for Health Economics, University of York, York, United Kingdom
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
| | - Jessica B. Long
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
| | - Sarah Westvold
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
| | | | - Isaac Y. Kim
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence Saperstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Maximilian Rabil
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Umar Ghaffar
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P. Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Michael S. Leapman
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
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Lenz L, Clegg W, Iliev D, Kasten CR, Korman H, Morgan TM, Hafron J, DeHaan A, Olsson C, Tutrone RF, Richardson T, Cline K, Yonover PM, Jasper J, Cohen T, Finch R, Slavin TP, Gutin A. Active surveillance selection and 3-year durability in intermediate-risk prostate cancer following genomic testing. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00888-y. [PMID: 39237680 DOI: 10.1038/s41391-024-00888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 08/16/2024] [Accepted: 08/23/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Genomic testing can add risk stratification information to clinicopathological features in prostate cancer, aiding in shared medical decision-making between the clinician and patient regarding whether active surveillance (AS) or definitive treatment (DT) is most appropriate. Here we examined initial AS selection and 3-year AS durability in patients diagnosed with localized intermediate-risk prostate cancer who underwent Prolaris testing before treatment decision-making. METHODS This retrospective observational cohort study included 3208 patients from 10 study sites who underwent Prolaris testing at diagnosis from September 2015 to December 2018. Prolaris utilizes a combined clinical cell cycle risk score calculated at diagnostic biopsy to stratify patients by the Prolaris AS threshold (below threshold, patient recommended to AS or above threshold, patient recommended to DT). AS selection rates and 3-year AS durability were compared in patients recommended to AS or DT by Prolaris testing. Univariable and multivariable logistic regression models and Cox proportional hazard models were used with molecular and clinical variables as predictors of initial treatment decision and AS durability, respectively. RESULTS AS selection was ~2 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Three-year AS durability was ~1.5 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Prolaris treatment recommendation remained a statistically significant predictor of initial AS selection and AS durability after accounting for CAPRA or Gleason scores. CONCLUSIONS Prolaris added significant information to clinical risk stratification to aid in treatment decision making. Intermediate-risk prostate cancer patients who were recommended to AS by Prolaris were more likely to initially pursue AS and were more likely to remain on AS at 3 years post-diagnosis than patients recommended to DT.
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Affiliation(s)
- Lauren Lenz
- Myriad Genetics, Inc., Salt Lake City, UT, USA
| | - Wyatt Clegg
- Myriad Genetics, Inc., Salt Lake City, UT, USA
| | - Diana Iliev
- Myriad Genetics, Inc., Salt Lake City, UT, USA
| | | | - Howard Korman
- Comprehensive Urology, Royal Oak, MI, USA
- Wayne State University, Detroit, MI, USA
| | | | | | | | - Carl Olsson
- Integrated Medical Professionals, Melville, NY, USA
| | | | | | | | | | - Jeff Jasper
- Myriad Genetics, Inc., Salt Lake City, UT, USA
| | - Todd Cohen
- Myriad Genetics, Inc., Salt Lake City, UT, USA
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Vera G, Rojas PA, Black JB, San Francisco IF. Usefulness of Tissue Biomarkers versus Prostate-Specific Membrane Antigen-Positron Emission Tomography for Prostate Cancer Biochemical Recurrence after Radical Prostatectomy. Cancers (Basel) 2024; 16:2879. [PMID: 39199648 PMCID: PMC11352583 DOI: 10.3390/cancers16162879] [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: 07/17/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024] Open
Abstract
Despite curative-intent local therapy, approximately 27% to 53% of prostate cancer (PCa) patients experience prostate-specific antigen (PSA) recurrence, known as biochemical recurrence (BCR). BCR significantly raises the risk of PCa-related morbidity and mortality, yet there is no consensus on optimal management. Prostate-specific membrane antigen-positron emission tomography (PSMA PET) has emerged as highly sensitive imaging, distinguishing local recurrences from distant metastases, crucially influencing treatment decisions. Genomic biomarkers such as Decipher, Prolaris, and Oncotype DX contribute to refining recurrence risk profiles, guiding decisions on intensifying adjuvant therapies, like radiotherapy and androgen deprivation therapy (ADT). This review assesses PSMA PET and biomarker utility in post-radical prostatectomy BCR scenarios, highlighting their impact on clinical decision-making. Despite their promising roles, the routine integration of biomarkers is limited by availability and cost, requiring further evidence. PSMA PET remains indispensable for restaging and treatment evaluation in these patients. Integrating biomarkers and PSMA PET promises to optimize personalized management strategies for BCR, though more comprehensive consensus-building studies are needed to define their standardized utility in clinical practice.
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Affiliation(s)
- Gabriela Vera
- Servicio de Urología, Complejo Asistencial Dr. Sotero del Rio, Santiago 8207257, Chile; (G.V.); (P.A.R.)
| | - Pablo A. Rojas
- Servicio de Urología, Complejo Asistencial Dr. Sotero del Rio, Santiago 8207257, Chile; (G.V.); (P.A.R.)
| | - Joseph B. Black
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5400, USA;
| | - Ignacio F. San Francisco
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5400, USA;
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Fang AM, Jackson J, Gregg JR, Chery L, Tang C, Surasi DS, Siddiqui BA, Rais-Bahrami S, Bathala T, Chapin BF. Surgical Management and Considerations for Patients with Localized High-Risk Prostate Cancer. Curr Treat Options Oncol 2024; 25:66-83. [PMID: 38212510 DOI: 10.1007/s11864-023-01162-4] [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] [Accepted: 12/10/2023] [Indexed: 01/13/2024]
Abstract
OPINION STATEMENT Localized high-risk (HR) prostate cancer (PCa) is a heterogenous disease state with a wide range of presentations and outcomes. Historically, non-surgical management with radiotherapy and androgen deprivation therapy was the treatment option of choice. However, surgical resection with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) is increasingly utilized as a primary treatment modality for patients with HRPCa. Recent studies have demonstrated that surgery is an equivalent treatment option in select patients with the potential to avoid the side effects from androgen deprivation therapy and radiotherapy combined. Advances in imaging techniques and biomarkers have also improved staging and patient selection for surgical resection. Advances in robotic surgical technology grant surgeons various techniques to perform RP, even in patients with HR disease, which can reduce the morbidity of the procedure without sacrificing oncologic outcomes. Clinical trials are not only being performed to assess the safety and oncologic outcomes of these surgical techniques, but to also evaluate the role of surgical resection as a part of a multimodal treatment plan. Further research is needed to determine the ideal role of surgery to potentially provide a more personalized and tailored treatment plan for patients with localized HR PCa.
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Affiliation(s)
- Andrew M Fang
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Jamaal Jackson
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Justin R Gregg
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Lisly Chery
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Chad Tang
- Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Devaki Shilpa Surasi
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bilal A Siddiqui
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Tharakeswara Bathala
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA.
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