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Marzouk K, Ehdaie B, Vertosick E, Zappala S, Vickers A. Developing an effective strategy to improve the detection of significant prostate cancer by combining the 4Kscore and multiparametric MRI. Urol Oncol 2019; 37:672-677. [PMID: 31378585 PMCID: PMC6733611 DOI: 10.1016/j.urolonc.2019.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Recent years have seen the development of biomarkers and imaging technologies designed to improve the specificity of PSA. Widespread implementation of imaging technologies, such as mp-MRI raises considerable logistical challenges. Our objective was to evaluate a biopsy strategy that utilizes selective mp-MRI as a follow-up test to biomarkers to improve the detection of significant prostate cancer. METHODS AND MATERIALS We developed a conceptual approach based on the risk calculated from the 4Kscore using results from the US prospective validation study, multiplied by the likelihood ratio of mp-MRI from the PROMIS trial. The primary outcome was Gleason grade ≥ 7 (grade group ≥ 2) cancer on biopsy. Using decision curve analysis, the net benefit was determined for our model and compared with the use of the 4Kscore and mp-MRI independently at various thresholds for biopsy. RESULTS For a cut-point of 7.5% risk of high-grade disease, patients with <5% risk from a blood marker would not have risk of significant prostate cancer sufficiently increased by a positive mp-MRI to warrant biopsy; comparably, patients with a risk >23% would not have risk sufficiently reduced by a negative imaging study to forgo biopsy. From the 4Kscore validation study, 46% of men considered for biopsy in the US have risks 5% to 23%. Net benefit was highest for the combined strategy, followed by 4Kscore alone. CONCLUSIONS Selective mp-MRI in men with intermediate scores on a secondary blood test results in a biopsy strategy that is more scalable than mp-MRI for all men with elevated PSA. Prospective validation is required to demonstrate if the predicted properties of combined blood and imaging testing are empirically confirmed.
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Affiliation(s)
- Karim Marzouk
- Urology Service, Department of Surgery, Windsor Regional Hospital, University of Western Ontario, Windsor, Ontario, Canada
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
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Geng H, Tong W, Han F, Zhu K, Cao Y, Chen X. The Role of Tumor Oxygenation Tested by Magnetic Resonance Imaging (MRI) in Prostate Cancer Grading. Med Sci Monit 2019; 25:2505-2510. [PMID: 30950457 PMCID: PMC6463617 DOI: 10.12659/msm.913110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Prostate cancer is a common malignant tumor in males. Prostate cancer grading is an important basis for evaluation of invasion. The purpose of this article was to use dynamic enhanced scan magnetic resonance imaging (MRI) to quantitatively investigate the relationship between tumor oxygenation value and prostate cancer pathological Gleason score. Material/Methods A total of 312 prostate cancer patients diagnosed by needle biopsy who received MRI dynamic enhanced scan were enrolled in this study. Multiparameter oxygen concentration image based on MRI was applied to test pO2 in tumors. Multiple spin resonance image relaxation time edit sequence and weak field diffusion model were used to estimate oxygen saturation level and pO2. hematoxylin and eosin staining and Gleason score were used to determine biological behavior and prognosis. Results According to the Gleason score system, there were 28 cases with a score of 10, 112 cases with a score of 9, 56 cases with a score of 8, and 116 cases with a score lower than 7. The enrolled patients were divided into groups: 116 cases into the middle-to-well differentiation group (Gleason score ≤7) and 196 cases into the poorly differentiation group (Gleason score at 8 to 10). Prostate cancer tumor oxygenation value was positively correlated with Gleason score (r=0.349, P<0.05) or PSA (r=0.432, P<0.05). Tumor oxygenation value in Gleason ≤7 group was obviously different from that in the group with Gleason score between 9 and 10 (P<0.05). Conclusions Tumor oxygenation value in prostate cancer was positively correlated with Gleason score. Tumor oxygenation value might be useful in clinics to evaluate prostate cancer grading and prognosis.
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Affiliation(s)
- Huaizhen Geng
- Department of Urology, Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Wen Tong
- Department of Intensive Care Unit (ICU), Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Fangzheng Han
- Department of Pathology, Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Kunming Zhu
- Department of Radiology, Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Yumei Cao
- Department of Cardiac Intervention, Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Xiude Chen
- Department of Urology, Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China (mainland)
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Zhou Y, Zhou Z, Li Q, Xu Y, Sun H, Xiao Y, Liang Z, Yan W, Ji Z, Li H. Diagnostic accuracy of magnetic resonance-guided prostate biopsy and template-guided transperineal saturation biopsy. Medicine (Baltimore) 2018; 97:e12495. [PMID: 30235754 PMCID: PMC6160219 DOI: 10.1097/md.0000000000012495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To compare the accuracy of magnetic resonance-guided prostate biopsy (MR-GPB) and template-guided transperineal prostate saturation biopsy (TTPSB).A total of 219 patients with elevated prostate-specific antigen, abnormal digital rectal examination or ultrasound findings were enrolled. All patients underwent multiparametric magnetic resonance image (mpMRI). Patients with a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 to 5 underwent MR-GPB using 2 to 5 biopsy cores and then immediately underwent an 11-region TTPSB. Patients with a PI-RADS score of 1 to 2 underwent TTPSB alone. We compared the detection rates for any cancer, clinically significant prostate cancer (csPCA), and the spatial distribution of missed csPCA lesions.Among the 219 cases, 66 (30.1%) had a PI-RADS score of 1 to 2 on mpMRI. The detection rate of TTPSB in these patients was 9.1% (6/66). In total, detection rates for any cancer and csPCA were 48.9% (107/219) and 42.9% (94/219), respectively. Detection rates for any cancer (TTPSB 87/219, 39.7%; MR-GPB76/219, 34.7%, P = .161) and csPCA (TTPSB 76/219, 34.7%; MR-GPB 72/219, 32.9%, P = .636) did not significantly differ between the 2 groups. The csPCA lesions missed by MR-GPB were most commonly located on the left (8.5%, 8/94) and right (9.6%, 9/94) sides of the urethra.MR-GPB can reduce the rate of unnecessary prostate biopsies by approximately 30% and exhibits an efficacy comparable to TTPSB for the detection of any cancer and csPCA. Nevertheless, approximately 1/4 of csPCAs were missed by MR-GPB and were most commonly located on both sides of the urethra.
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Affiliation(s)
- Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Qianyue Li
- Department of Urology, General Hospital of Xinjiang Production and Construction Corps, Urumqi
| | - Yinyan Xu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | | | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
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Guo B, Xiao J, Li L, Wang S, Wang L, Liu S. Clinical study of prenatal ultrasonography combined with T‑box transcription factor 1 as a biomarker for the diagnosis of congenital heart disease. Mol Med Rep 2018; 17:7346-7350. [PMID: 29568912 DOI: 10.3892/mmr.2018.8742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/18/2017] [Indexed: 11/05/2022] Open
Abstract
Congenital heart disease (CHD) seriously threatens fetal health. Therefore, prenatal examination to detect deformity is extremely important. The present study aimed to investigate the clinical application value of prenatal ultrasonography combined with molecular biology methods in the diagnosis of fetal CHD. A total of 1,000 pregnant women who had received fetal ultrasonography to examine fetal CHD were enrolled. Ultrasounds were performed for fetal heart examination and diagnosis, mainly on fetal heart position, size, structure and function, and heart valve morphology and function. These indexes were tested again 2 weeks after birth. Blood samples were collected from pregnant women with fetal CHD. Polymerase chain reaction (PCR) and western blotting were performed to detect the association between heart development and T‑box transcription factor 1 (TBX1) expression. The results revealed that 10 fetuses had CHD (1%), of which ultrasound detected 9 cases. The specificity and sensitivity of ultrasounds were 100 and 90%, respectively. Of the 9 cases were identified by prenatal ultrasound screening, including 2 cases had endocardial cushion defect, 1 case had pulmonary stenosis combined with right ventricular dysplasia, 1 case had tetralogy of Fallot combined with a cleft lip and palate, 2 cases had ventricular septal defect, 1 case had a single ventricle defect, 1 case had Ebstein and 1 case had a triatrial heart. One case of ventricular septal defect was missed prior to delivery. PCR and western blotting demonstrated that TBX1 expression may be associated with CHD. Therefore, ultrasonography combined with laboratory examinations represent efficient, economic and safe methods for fetal CHD detection. These methods may be significant to improve the rate of CHD diagnosis, and require further investigation.
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Affiliation(s)
- Bingcheng Guo
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Jing Xiao
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Long Li
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Shuanglong Wang
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Lijuan Wang
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Shuyong Liu
- Department of Hand and Foot Surgery, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
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Javitt MC, Kravtsov A, Keidar Z, Abadi S, Amiel GE. Multimodality Image Fusion with PSMA PET/CT and High-Intensity Focused Ultrasound Focal Therapy for Primary Diagnosis and Management of Prostate Cancer: A Planned Research Initiative. Rambam Maimonides Med J 2017; 8:RMMJ.10312. [PMID: 28777073 PMCID: PMC5652928 DOI: 10.5041/rmmj.10312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recent developments in diagnostic imaging herald a new approach to diagnosis and management of prostate cancer. Multimodality fusion that combines anatomic with functional imaging data has surpassed either of the two alone. This opens up the possibility to "find and fix" malignancy with greater accuracy than ever before. This is particularly important for prostate cancer because it is the most common male cancer in most developed countries. This article describes technical advances under investigation at our institution and others using multimodality image fusion of magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), and PSMA PET/CT (defined as the combination of prostate-specific membrane antigen [PSMA], positron emission tomography [PET], and computed tomography [CT]) for personalized medicine in the diagnosis and focal therapy of prostate cancer with high-intensity focused ultrasound (HiFUS).
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Affiliation(s)
- Marcia C Javitt
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | | | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Sobhi Abadi
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | - Gilad E Amiel
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
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Zang S, Shao G, Cui C, Li TN, Huang Y, Yao X, Fan Q, Chen Z, Du J, Jia R, Sun H, Hua Z, Tang J, Wang F. 68Ga-PSMA-11 PET/CT for prostate cancer staging and risk stratification in Chinese patients. Oncotarget 2017; 8:12247-12258. [PMID: 28103574 PMCID: PMC5355341 DOI: 10.18632/oncotarget.14691] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/27/2016] [Indexed: 11/25/2022] Open
Abstract
We evaluated the clinical utility of 68Ga-PSMA-11 PET/CT for staging and risk stratification of treatment-naïve prostate cancer (PCa) and metastatic castrate-resistant prostate cancer (mCRPC). Twenty-two consecutive patients with treatment-naïve PCa and 18 with mCRPC were enrolled. 68Ga-PSMA-11 PET/CT and magnetic resonance imaging (MRI) were performed for the evaluation of primary prostatic lesions, and bone scans were used for evaluation bone metastasis. Among the 40 patients, 37 (92.5% [22 treatment-naïve PCa, 15 mCRPC]) showed PSMA-avid lesions on 68Ga-PSMA-11 images. Only 3 patients with stable mCRPC after chemotherapy were negative for PSMA. The sensitivity, specificity and accuracy of 68Ga-PSMA-11 imaging were 97.3%, 100.0% and 97.5%, respectively. The maximum standardized uptake (SUVmax) of prostatic lesions was 17.09 ± 11.08 and 13.33 ± 12.31 in treatment-naïve PCa and mCRPC, respectively. 68Ga-PSMA-11 revealed 105 metastatic lymph nodes in 15 patients; the SUVmax was 16.85 ± 9.70 and 7.54 ± 5.20 in treatment-naïve PCa and mCRPC, respectively. 68Ga-PSMA-11 PET/CT also newly detected visceral metastasis in 9 patients (22.5%) and bone metastasis in 29 patients (72.5%). 68Ga-PSMA-11 PET/CT exhibits potential for staging and risk stratification in naïve PCa, as well as improved sensitivity for detection of lymph node and remote metastasis.
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Affiliation(s)
- Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Guoqiang Shao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Can Cui
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Tian-Nv Li
- Department of Nuclear Medicine, PET Centre, No. 1 Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
| | - Yue Huang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Xiaochen Yao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Qiu Fan
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Zejun Chen
- Department of Nuclear Medicine, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin 214400, China
| | - Jin Du
- Department of Technology Development, China Isotope Radiation Corporation, No. 1 Nansixiang, Sanlihe, West District, Beijing 100045, China
| | - Ruipeng Jia
- Department of Urology, Nanjing Medical University, Nanjing 210006, China
| | - Hongbin Sun
- Department of Urology, Nanjing Medical University, Nanjing 210006, China
| | - Zichun Hua
- The State Key Laboratory of Pharmaceutical Biotechnology, Department of Biochemistry, College of Life Sciences, Nanjing University, Nanjing 210006, China
| | - Jun Tang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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Ballas LK, de Castro Abreu AL, Quinn DI. What Medical, Urologic, and Radiation Oncologists Want from Molecular Imaging of Prostate Cancer. J Nucl Med 2017; 57:6S-12S. [PMID: 27694176 DOI: 10.2967/jnumed.115.170142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022] Open
Abstract
As molecular imaging better delineates the state of prostate cancer, clinical management will evolve. The currently licensed imaging modalities are limited by lack of specificity or sensitivity for the extent of cancer and for predicting outcome in response to therapy. Clinicians want molecular imaging that-by being more reliable in tailoring treatment and monitoring response for each patient-will become a key facet of precision medicine, surgery, and radiation therapy. Identifying patients who are candidates for specific or novel treatments is important, but equally important is the finding that a given patient may not be a good candidate for single-modality therapy. This article presents prostate cancer scenarios in which managing clinicians would welcome molecular imaging innovations to help with decision making. The potential role of newer techniques that may help fill this wish list is discussed.
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Affiliation(s)
- Leslie K Ballas
- Department of Radiation Oncology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
| | - Andre Luis de Castro Abreu
- Department of Urology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California; and
| | - David I Quinn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
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