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Dias AB, Woo S, Leni R, Rajwa P, Kasivisvanathan V, Ghai S, Haider M, Gandaglia G, Brembilla G. Is MRI ready to replace biopsy during active surveillance? Eur Radiol 2024:10.1007/s00330-024-10863-9. [PMID: 38965093 DOI: 10.1007/s00330-024-10863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/25/2024] [Indexed: 07/06/2024]
Abstract
Active surveillance (AS) is a conservative management option recommended for patients diagnosed with low-risk prostate cancer (PCa) and selected cases with intermediate-risk PCa. The adoption of prostate MRI in the primary diagnostic setting has sparked interest in its application during AS. This review aims to examine the role and performance of multiparametric MRI (mpMRI) across the entire AS pathway, from initial stratification to follow-up, also relative to the utilization of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) criteria. Given the high negative predictive value of mpMRI in detecting clinically significant PCa (csPCa), robust evidence supports its use in patient selection and risk stratification at the time of diagnosis or confirmatory biopsy. However, conflicting results have been observed when using MRI in evaluating disease progression during follow-up. Key areas requiring clarification include addressing the clinical significance of MRI-negative csPCa, optimizing MRI quality, determining the role of biparametric MRI (bpMRI) or mpMRI protocols, and integrating artificial intelligence (AI) for improved performance. CLINICAL RELEVANCE STATEMENT: MRI plays an essential role in the selection, stratification, and follow up of patients in active surveillance (AS) for prostate cancer. However, owing to existing limitations, it cannot fully replace biopsies in the context of AS. KEY POINTS: Multiparametric MRI (mpMRI) has become a crucial tool in active surveillance (AS) for prostate cancer (PCa). Conflicting results have been observed regarding multiparametric MRI efficacy in assessing disease progression. Standardizing MRI-guided protocols will be critical in addressing current limitations in active surveillance for prostate cancer.
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Affiliation(s)
- 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
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Riccardo Leni
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - 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 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
| | - Giorgio Gandaglia
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Brembilla
- Vita-Salute San Raffaele University, Milan, Italy.
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Klotz L. Should systematic prostatic biopsies be discontinued? Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00849-5. [PMID: 38937536 DOI: 10.1038/s41391-024-00849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The use of systematic biopsies in addition to targeted biopsies is based on multiple studies showing that 15-20% of "clinically significant" cancers are missed on targeted biopsies. Concern about these 'missed' cancers drives many interventions. This includes systematic biopsies in men with negative imaging and in men having targeted biopsies, and drives a preference for total gland treatment in men who may be candidates for partial gland ablation. This article summarizes recent genomic and clinical data indicating that, despite "clinically significant" histology, MRI invisible lesions are genomically and clinically favorable. These studies have demonstrated that the genetic aberrations associated with cancer visibility are the same aberrations that drive cancer invasiveness and metastasis. Thus invisible cancers, even if undiagnosed at baseline, are in most cases indolent and pose little threat to the patient. The implications are that patients should be monitored with imaging rather than systematic biopsy, and subject to repeat targeted biopsy for evidence of MR progression. Patients prefer this strategy. It has many advantages in terms of reduced burden of care, cost, psychological benefits, and less diagnosis of insignificant cancer. CONCLUSION It is now appropriate to abandon systematic biopsies in most patients.
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Affiliation(s)
- Laurence Klotz
- University of Toronto, Sunnybrook Chair of Prostate Cancer Research, Sunnybrook Health Sciences Centre, 2075 Bayview Ave MG 408, Toronto, ON, M4N3M5, Canada.
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Marras M, Ellis JL, Copelan O, Naha U, Han T, Rac G, Quek ML, Gorbonos A, Woods ME, Flanigan RC, Gupta GN, Patel HD. MRI at diagnostic versus confirmatory biopsy during MRI-based active surveillance of prostate cancer. Urol Oncol 2024:S1078-1439(24)00492-7. [PMID: 38890040 DOI: 10.1016/j.urolonc.2024.05.021] [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: 02/25/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Active surveillance (AS) is a management strategy for patients with favorable risk prostate cancer. Multi-parametric magnetic resonance imaging (mpMRI) may impact upgrading rates, but there is mixed evidence on the appropriate timing to introduce mpMRI. We evaluated timing of initial mpMRI use for patients on AS and compared upgrading and intervention rates for AS candidates who received initial mpMRI before diagnostic biopsy vs. confirmatory biopsy. SUBJECTS AND METHODS Patients enrolled in AS captured by the Prospective Loyola Urology mpMRI (PLUM) Prostate Biopsy Cohort which captures men undergoing MRI-fusion prostate biopsy. We included patients enrolled in AS between January 2014 and October 2022. We conducted a retrospective analysis of patients who underwent MRI-fusion prostate biopsy while on AS at our institution. The cohort was stratified by men who underwent first mpMRI prior to diagnostic biopsy (MRI-DBx), confirmatory biopsy (MRI-CBx), or a subsequent surveillance biopsy. Oncologic outcomes including pathologic reclassification, intervention-free survival, progression-free survival, and overall survival were evaluated. RESULTS Of 346 patients identified on AS, 94 (27.2%) received mpMRI at the time of diagnostic biopsy, 182 (52.6%) at confirmatory biopsy, and 70 (20.2%) at a later biopsy. At confirmatory biopsy (median 14 months), there was no difference in upgrading (HR 0.95, P = 0.78) or intervention rates (HR 0.97, P = 0.88) between MRI-DBx and MRI-CBx. PI-RADS score on initial mpMRI was associated with upgrading during AS follow-up relative to men with negative mpMRI (HR 4.20 (P = 0.04), 3.24 (P < 0.001), and 1.99 (P < 0.001) for PI-RADS 5, 4, and 3, respectively), and PSA density was associated with intervention (HR 1.52, P = 0.03). CONCLUSION mpMRI can serve as a prognostic tool to select and monitor AS patients, but there was no difference in upgrading or intervention rates based on initial timing of MRI.
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Affiliation(s)
- Madison Marras
- Department of Urology, Loyola University Medical Center, Maywood, IL.
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Olivia Copelan
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Ushasi Naha
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Timothy Han
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Michael E Woods
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Radiology, Loyola University Medical Center, Maywood, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Vermassen T, Lumen N, Van Praet C, Callewaert N, Delanghe J, Rottey S. The Association between Urine N-Glycome and Prognosis after Initial Therapy for Primary Prostate Cancer. Biomedicines 2024; 12:1039. [PMID: 38791001 PMCID: PMC11118943 DOI: 10.3390/biomedicines12051039] [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: 03/04/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
Next to prostate-specific antigen, no biochemical biomarkers have been implemented to guide patient follow-up after primary therapy for localized prostate cancer (PCa). We evaluated the prognostic potential of urine N-glycome in terms of event-free survival (EFS) in patients undergoing primary therapy for PCa. The prognostic features of the urine N-glycosylation profile at diagnosis, assessed in 77 PCa patients, were determined in terms of EFS next to standard clinical parameters. The majority of patients were diagnosed with International Society of Urological Pathology grade ≤ 3 (82%) T1-2 tumors (79%) and without pelvic lymph node invasion (96%). The patients underwent active surveillance (14%), robot-assisted laparoscopic prostatectomy (48%), or external beam radiotherapy (37%). Decreased ratios of biantennary core-fucosylation were noted in patients who developed an event, which was linked to a shorter EFS in both the intention-to-treat cohort and all subcohort analyses. Combining the urine N-glycan biomarker with the D'Amico Risk Classification for PCa resulted in an improved nomogram for patient classification after primary therapy. The rate of urine N-glycan biantennary core-fucosylation, typically linked to more aggressive disease status, is lower in patients who eventually developed an event following primary therapy and subsequently in patients with a worse EFS. The combination of urine N-glycan biomarkers together with clinical parameters could, therefore, improve the post-therapy follow-up of patients with PCa.
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Affiliation(s)
- Tijl Vermassen
- Department Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Biomarkers in Cancer, Department Basic and Applied Medicine, Ghent University, 9000 Ghent, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
| | - Nicolaas Lumen
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Urology (ERN eUROGEN Accredited Centre), Ghent University Hospital, 9000 Ghent, Belgium
- Uro-Oncology Research Group, Department Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Charles Van Praet
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Urology (ERN eUROGEN Accredited Centre), Ghent University Hospital, 9000 Ghent, Belgium
- Uro-Oncology Research Group, Department Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Nico Callewaert
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Molecular Biomedical Research, VIB-UGent Center for Medical Biotechnology, 9052 Ghent, Belgium
- Department Biochemistry and Microbiology, Ghent University, 9000 Ghent, Belgium
| | - Joris Delanghe
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sylvie Rottey
- Department Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Biomarkers in Cancer, Department Basic and Applied Medicine, Ghent University, 9000 Ghent, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Drug Research Unit Ghent, Ghent University Hospital, 9000 Ghent, Belgium
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5
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Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, Bomers JGR, Dudderidge T, Ehdaie B, Freeman A, Guillaumier S, Hindley R, Lakhani A, Pendse D, Punwani S, Rastinehad AR, Rouvière O, Sanchez-Salas R, Schoots IG, Sokhi HK, Tam H, Tempany CM, Valerio M, Verma S, Villeirs G, van der Meulen J, Ahmed HU, Shah TT. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations. Eur Urol 2024; 85:466-482. [PMID: 38519280 DOI: 10.1016/j.eururo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nikhil Mayor
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Cullen
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joyce G R Bomers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Amish Lakhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Olivier Rouvière
- Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France
| | | | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heminder K Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Henry Tam
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Leni R, Roscigno M, Barzaghi P, La Croce G, Catellani M, Saccà A, de Angelis M, Montorsi F, Briganti A, Da Pozzo LF. Medium-term follow up of active surveillance for early prostate cancer at a non-academic institution. BJU Int 2024; 133:614-621. [PMID: 38093673 DOI: 10.1111/bju.16259] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To report oncological outcomes of active surveillance (AS) at a single non-academic institution adopting the standardised Prostate Cancer Research International Active Surveillance (PRIAS) protocol. PATIENTS AND METHODS Competing risk analyses estimated the incidence of overall mortality, metastases, conversion to treatment, and grade reclassification. The incidence of reclassification and adverse pathological findings at radical prostatectomy were compared between patients fulfilling all PRIAS inclusion criteria vs those not fulfilling at least one. RESULTS We analysed 341 men with Grade Group 1 prostate cancer (PCa) followed on AS between 2010 and 2022. There were no PCa deaths, two patients developed distant metastases and were alive at the end of the study period. The 10-year cumulative incidence of metastases was 1.9% (95% confidence interval [CI] 0.33-6.4%). A total of 111 men were reclassified, and 127 underwent definitive treatment. Men not fulfilling at least one PRIAS inclusion criteria (n = 43) had a higher incidence of reclassification (subdistribution hazards ratio 1.73, 95% CI 1.07-2.81; P = 0.03), but similar rates of adverse pathological findings at radical prostatectomy. CONCLUSION Metastases in men on AS at a non-academic institution are as rare as those reported in established international cohorts. Men followed without stringent inclusion criteria should be counselled about the higher incidence of reclassification and reassured they can expect rates of adverse pathological findings comparable to those fulfilling all criteria. Therefore, AS should be proposed to all men with low-grade PCa regardless of whether they are followed at academic institutions or smaller community hospitals.
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Affiliation(s)
- Riccardo Leni
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Roscigno
- University of Milano-Bicocca, Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Barzaghi
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Antonino Saccà
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mario de Angelis
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Filippo Da Pozzo
- University of Milano-Bicocca, Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
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7
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Sayyid RK, Bernardino R, Al-Daqqaq Z, Tiwari R, Al-Rumayyan M, Sildva T, Cockburn JG, Klaassen Z, Fleshner NE. Association of extended core sampling with delayed intervention and pathologic outcomes for active surveillance patients A population-based analysis. Can Urol Assoc J 2024; 18:E142-E151. [PMID: 38319602 PMCID: PMC11152595 DOI: 10.5489/cuaj.8563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Combined systematic plus targeted biopsy sampling improves detection of clinically significant prostate cancer (PCa). Our objective was to evaluate whether extended core sampling at initial biopsy in active surveillance (AS) patients is associated with subsequent AS discontinuation and pathologic outcomes. METHODS National Comprehensive Cancer Network (NCCN) low- and favorable-intermediate-risk (FIR) AS patients diagnosed between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database. Prostate biopsy sampling was operationalized as: standard (10-12 cores), extended (13-20 cores), or super-extended (21+ cores). Sensitivity analyses using differing cutoffs was performed. Outcomes included delayed definitive intervention (radical prostatectomy [RP]/radiotherapy) and pathologic upgrading and/or downgrading in delayed RP patients. Multivariable logistic regression modelling adjusted for sociodemographic/oncologic variables was performed. RESULTS This cohort included 42 459 patients (low-risk: 28 411; FIR:14 048); 25-29% and 3-5% of patients underwent extended and super-extended core sampling, respectively, at diagnosis. Extended core sampling was associated with decreased odds of definitive intervention in low (odds ratio [OR] 0.89, p=0.003) and grade group 2 (GG2) FIR (OR 0.83, p=0.002) patients. Super-extended sampling was associated with decreased odds of definitive intervention in prostate-specific antigen (PSA) 10-20 FIR patients (OR 0.65, p=0.02). Super-extended sampling was associated with decreased odds of upgrading to ≥GG2 disease in low-risk (OR 0.45, p=0.032) and to ≥GG3 disease in GG2 FIR patients (OR 0.67, p=0.044). CONCLUSIONS This population-based analysis demonstrates that extended/super-extended sampling at diagnosis is associated with significantly decreased odds of AS discontinuation and pathologic upgrading in low/FIR AS patients. This highlights the significance of extended tissue sampling at initial biopsy to appropriately risk-stratify AS patients and minimize AS discontinuation rates.
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Affiliation(s)
- Rashid K. Sayyid
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rui Bernardino
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zizo Al-Daqqaq
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raj Tiwari
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Majed Al-Rumayyan
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Tiiu Sildva
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jessica G. Cockburn
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zachary Klaassen
- Department of Urology, Augusta University, Augusta, GA United States
| | - Neil E. Fleshner
- Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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8
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Caglic I, Sushentsev N, Syer T, Lee KL, Barrett T. Biparametric MRI in prostate cancer during active surveillance: is it safe? Eur Radiol 2024:10.1007/s00330-024-10770-z. [PMID: 38656709 DOI: 10.1007/s00330-024-10770-z] [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: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Active surveillance (AS) is the preferred option for patients presenting with low-intermediate-risk prostate cancer. MRI now plays a crucial role for baseline assessment and ongoing monitoring of AS. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations aid radiological assessment of progression; however, current guidelines do not advise on MRI protocols nor on frequency. Biparametric (bp) imaging without contrast administration offers advantages such as reduced costs and increased throughput, with similar outcomes to multiparametric (mp) MRI shown in the biopsy naïve setting. In AS follow-up, the paradigm shifts from MRI lesion detection to assessment of progression, and patients have the further safety net of continuing clinical surveillance. As such, bpMRI may be appropriate in clinically stable patients on routine AS follow-up pathways; however, there is currently limited published evidence for this approach. It should be noted that mpMRI may be mandated in certain patients and potentially offers additional advantages, including improving image quality, new lesion detection, and staging accuracy. Recently developed AI solutions have enabled higher quality and faster scanning protocols, which may help mitigate against disadvantages of bpMRI. In this article, we explore the current role of MRI in AS and address the need for contrast-enhanced sequences. CLINICAL RELEVANCE STATEMENT: Active surveillance is the preferred plan for patients with lower-risk prostate cancer, and MRI plays a crucial role in patient selection and monitoring; however, current guidelines do not currently recommend how or when to perform MRI in follow-up. KEY POINTS: Noncontrast biparametric MRI has reduced costs and increased throughput and may be appropriate for monitoring stable patients. Multiparametric MRI may be mandated in certain patients, and contrast potentially offers additional advantages. AI solutions enable higher quality, faster scanning protocols, and could mitigate the disadvantages of biparametric imaging.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nikita Sushentsev
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom Syer
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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Englman C, Maffei D, Allen C, Kirkham A, Albertsen P, Kasivisvanathan V, Baroni RH, Briganti A, De Visschere P, Dickinson L, Gómez Rivas J, Haider MA, Kesch C, Loeb S, Macura KJ, Margolis D, Mitra AM, Padhani AR, Panebianco V, Pinto PA, Ploussard G, Puech P, Purysko AS, Radtke JP, Rannikko A, Rastinehad A, Renard-Penna R, Sanguedolce F, Schimmöller L, Schoots IG, Shariat SF, Schieda N, Tempany CM, Turkbey B, Valerio M, Villers A, Walz J, Barrett T, Giganti F, Moore CM. PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer. Eur Urol 2024:S0302-2838(24)02232-2. [PMID: 38556436 DOI: 10.1016/j.eururo.2024.03.014] [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: 01/02/2024] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVE The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. METHODS A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1-9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. KEY FINDINGS AND LIMITATIONS Participants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of 'X' for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). CONCLUSIONS AND CLINICAL IMPLICATIONS The updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS. PATIENT SUMMARY The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations are used in clinical practice and research to guide the interpretation and reporting of magnetic resonance imaging for patients on active surveillance for prostate cancer. An international panel has updated these recommendations, clarified the areas of uncertainty, and highlighted the areas for further research.
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Affiliation(s)
- Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Davide Maffei
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Peter Albertsen
- Department of Surgery (Urology), UConn Health, Farmington, CT, USA
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein. Sao Paulo, Brazil
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Louise Dickinson
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Juan Gómez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Masoom A Haider
- Joint Department of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Canada
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Stacy Loeb
- Department of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs, New York, NY, USA
| | - Katarzyna J Macura
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Margolis
- Weill Cornell Medical College, Department of Radiology, New York, NY, USA
| | - Anita M Mitra
- Department of Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Middlesex, UK
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Philippe Puech
- Department of Radiology, University of Lille, Lille, France
| | - Andrei S Purysko
- Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jan Philipp Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, Dusseldorf, Germany
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Art Rastinehad
- Department of Urology, Lenox Hill Hospital, New York, NY, USA
| | - Raphaele Renard-Penna
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Autonoma University of Barcelona, Barcelona, Spain; Department of Medicine, Surgery and Pharmacy, Universitá degli studi di Sassari - Italy
| | - Lars Schimmöller
- Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Clare M Tempany
- Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Arnauld Villers
- Department of Urology, Hospital Claude Huriez, CHU Lille, Lille, France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Addenbrook''s Hospital, Cambridge, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Langbein BJ, Berk B, Bay C, Tuncali K, Martin N, Schostak M, Fennessy F, Tempany C, Kibel AS, Cole AP. A Phase II Prospective Blinded Trial of Magnetic Resonance Imaging and In-Bore Biopsy in Active Surveillance for Prostate Cancer. Urology 2024; 185:65-72. [PMID: 38218388 PMCID: PMC11161128 DOI: 10.1016/j.urology.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To demonstrate the added benefit of multiparametric (mp)MRI risk stratification during active surveillance. METHODS This prospective, single-arm, nonrandomized study included 82 men with low-risk prostate cancer (PCa). We compared two biopsy strategies in parallel. The first biopsy strategy was an in-bore and transrectal ultrasound (TRUS) biopsy in men with suspicious mpMRI findings. The second was a TRUS biopsy in all 82 men, blinded to the results of the previously performed mpMRI. RESULTS We identified 27/82 men with suspicious mpMRI. Of those 27 men, we detected 8/27 with csPCa on biopsy, and we identified two men with in-bore biopsy exclusively, three men with TRUS biopsy exclusively, and three men with both biopsy strategies. Of the 55/82 men with nonsuspicious mpMRI (who only received TRUS biopsies), two men had csPCa. TRUS biopsy of the entire cohort of 82 men would have led to the correct diagnosis of 80% men with csPCa, requiring all 82 men to receive biopsies (csPCa in 10% of the 82 biopsies). Conducting in-bore biopsies plus TRUS biopsies in men with suspicious mpMRI would have also led to the detection of 80% of men with csPCa, requiring only 27 men to receive biopsies (csPCa in 30% of the 27 biopsies). CONCLUSION The combination of TRUS and in-bore biopsies, limited to men with suspicious mpMRI, resulted in a similar detection rate of csPCa compared to TRUS biopsies of all men but required only one-third of men to undergo biopsy. Our results indicate that in-bore and TRUS biopsies continue to complement each other.
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Affiliation(s)
- Bjoern J Langbein
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Urooncology, Robot-Assisted and Focal Therapy, University Hospital Magdeburg, Magdeburg, Germany
| | - Brittany Berk
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Camden Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neil Martin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Martin Schostak
- Department of Urology, Urooncology, Robot-Assisted and Focal Therapy, University Hospital Magdeburg, Magdeburg, Germany
| | - Fiona Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander P Cole
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
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11
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Feng X, Chen X, Peng P, Zhou H, Hong Y, Zhu C, Lu L, Xie S, Zhang S, Long L. Values of multiparametric and biparametric MRI in diagnosing clinically significant prostate cancer: a multivariate analysis. BMC Urol 2024; 24:40. [PMID: 38365673 PMCID: PMC10870467 DOI: 10.1186/s12894-024-01411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND To investigate the value of semi-quantitative and quantitative parameters (PI-RADS score, T2WI score, ADC, Ktrans, and Kep) based on multiparametric MRI (mpMRI) or biparametric MRI (bpMRI) combined with prostate specific antigen density (PSAD) in detecting clinically significant prostate cancer (csPCa). METHODS A total of 561 patients (276 with csPCa; 285 with non-csPCa) with biopsy-confirmed prostate diseases who underwent preoperative mpMRI were included. Prostate volume was measured for calculation of PSAD. Prostate index lesions were scored on a five-point scale on T2WI images (T2WI score) and mpMRI images (PI-RADS score) according to the PI-RADS v2.1 scoring standard. DWI and DCE-MRI images were processed to measure the quantitative parameters of the index lesion, including ADC, Kep, and Ktrans values. The predictors of csPCa were screened by logistics regression analysis. Predictive models of bpMRI and mpMRI were established. ROC curves were used to evaluate the efficacy of parameters and the model in diagnosing csPCa. RESULTS The independent diagnostic accuracy of PSA density, PI-RADS score, T2WI score, ADCrec, Ktrans, and Kep for csPCa were 80.2%, 89.5%, 88.3%, 84.6%, 58.5% and 61.6%, respectively. The diagnostic accuracy of bpMRI T2WI score and ADC value combined with PSAD was higher than that of PI-RADS score. The combination of mpMRI PI‑RADS score, ADC value with PSAD had the highest diagnostic accuracy. CONCLUSIONS PI-RADS score according to the PI-RADS v2.1 scoring standard was the most accurate independent diagnostic index. The predictive value of bpMRI model for csPCa was slightly lower than that of mpMRI model, but higher than that of PI-RADS score.
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Affiliation(s)
- Xiao Feng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Xin Chen
- Department of Radiology, Jiangjin Hospital, Chongqing University, No.725, Jiangzhou Avenue, Dingshan Street, Chongqing, 402260, China
| | - Peng Peng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - He Zhou
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Yi Hong
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Chunxia Zhu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Libing Lu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Siyu Xie
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Sijun Zhang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China.
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12
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Bourgeno HA, Jabbour T, Baudewyns A, Lefebvre Y, Ferriero M, Simone G, Fourcade A, Fournier G, Oderda M, Gontero P, Bernal-Gomez A, Mastrorosa A, Roche JB, Abou Zahr R, Ploussard G, Fiard G, Halinski A, Rysankova K, Dariane C, Delavar G, Anract J, Barry Delongchamps N, Bui AP, Taha F, Windisch O, Benamran D, Assenmacher G, Vlahopoulos L, Guenzel K, Roumeguère T, Peltier A, Diamand R. The Added Value of Side-specific Systematic Biopsy in Patients Diagnosed by Magnetic Resonance Imaging-targeted Prostate Biopsy. Eur Urol Oncol 2024:S2588-9311(24)00031-2. [PMID: 38272745 DOI: 10.1016/j.euo.2024.01.007] [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: 09/27/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Systematic biopsy (SB) combined with magnetic resonance imaging (MRI)-targeted biopsy is still recommended considering the risk of missing clinically significant prostate cancer (csPCa). OBJECTIVE To evaluate the added value in csPCa detection on side-specific SB relative to MRI lesion and to externally validate the Noujeim risk stratification model that predicts the risk of csPCa on distant SB cores relative to the index MRI lesion. DESIGN, SETTING, AND PARTICIPANTS Overall, 4841 consecutive patients diagnosed by MRI-targeted biopsy and SB for Prostate Imaging Reporting and Data System score ≥3 lesions were identified from a prospectively maintained database between January 2016 and April 2023 at 15 European referral centers. A total of 2387 patients met the inclusion criteria and were included in the analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS McNemar's test was used to compare the csPCa detection rate between several biopsy strategies including MRI-targeted biopsy, side-specific SB, and a combination of both. Model performance was evaluated in terms of discrimination using area under the receiver operation characteristic curve (AUC), calibration plots, and decision curve analysis. Clinically significant prostate cancer was defined as International Society of Urological Pathology grade group ≥2. RESULTS AND LIMITATIONS Overall, the csPCa detection rate was 49%. Considering MRI-targeted biopsy as reference, the added values in terms of csPCa detection were 5.8% (relative increase of 13%), 4.2% (relative increase of 9.8%), and 2.8% (relative increase of 6.1%) for SB, ipsilateral SB, and contralateral SB, respectively. Only 35 patients (1.5%) exclusively had csPCa on contralateral SB (p < 0.001). Considering patients with csPCa on MRI-targeted biopsy and ipsilateral SB, the upgrading rate was 2% (20/961) using contralateral SB (p < 0.001). The Noujeim model exhibited modest performance (AUC of 0.63) when tested using our validation set. CONCLUSIONS The added value of contralateral SB was negligible in terms of cancer detection and upgrading rates. The Noujeim model could be included in the decision-making process regarding the appropriate prostate biopsy strategy. PATIENT SUMMARY In the present study, we collected a set of patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for the detection of prostate cancer. We found that biopsies taken at the opposite side of the MRI suspicious lesion have a negligible impact on cancer detection. We also validate a risk stratification model that predicts the risk of cancer on biopsies beyond 10 mm from the initial lesion, which could be used in daily practice to improve the personalization of the prostate biopsy.
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Affiliation(s)
- Henri-Alexandre Bourgeno
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Teddy Jabbour
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Arthur Baudewyns
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolène Lefebvre
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Marco Oderda
- Department of Urology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | | | | | - Rawad Abou Zahr
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | - Adam Halinski
- Department of Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
| | - Katerina Rysankova
- Department of Urology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Gina Delavar
- Departement of Urology, Hôpital Cochin, Paris, France
| | - Julien Anract
- Departement of Urology, Hôpital Cochin, Paris, France
| | | | | | - Fayek Taha
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | - Karsten Guenzel
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Deutschland
| | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
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13
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Valentin B, Arsov C, Ullrich T, Al-Monajjed R, Boschheidgen M, Hadaschik BA, Giganti F, Giessing M, Lopez-Cotarelo C, Esposito I, Antoch G, Albers P, Radtke JP, Schimmöller L. Magnetic Resonance Imaging-guided Active Surveillance Without Annual Rebiopsy in Patients with Grade Group 1 or 2 Prostate Cancer: The Prospective PROMM-AS Study. EUR UROL SUPPL 2024; 59:30-38. [PMID: 38298772 PMCID: PMC10829616 DOI: 10.1016/j.euros.2023.10.005] [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] [Accepted: 10/16/2023] [Indexed: 02/02/2024] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) may allow patients with prostate cancer (PC) on active surveillance (AS) to avoid repeat prostate biopsies during monitoring. Objective To assess the ability of mpMRI to reduce guideline-mandated biopsy and to predict grade group upgrading in patients with International Society of Urological Pathology grade group (GG) 1 or GG 2 PC using Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scores. The hypothesis was that the AS disqualification rate (ASDQ) rate could be reduced to 15%. Design setting and participants PROMM-AS was a prospective study assessing 2-yr outcomes for an mpMRI-guided AS protocol. A 12 mo after AS inclusion on the basis of MRI/transrectal ultrasound fusion-guided biopsy (FBx), all patients underwent mpMRI. For patients with stable mpMRI (PRECISE 1-3), repeat biopsy was deferred and follow-up mpMRI was scheduled for 12 mo later. Patients with mpMRI progression (PRECISE 4-5) underwent FBx. At the end of the study, follow-up FBx was indicated for all patients. Outcome measurements and statistical analysis We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for upgrading to GG 2 in the GG 1 group, and to GG 3 in the GG 2 group on MRI. We performed regression analyses that included clinical variables. Results and limitations The study included 101 patients with PC (60 GG 1 and 41 GG 2). Histopathological progression occurred in 31 patients, 18 in the GG 1 group and 13 in the GG 2 group. Thus, the aim of reducing the ASDQ rate to 15% was not achieved. The sensitivity, specificity, PPV, and NPV for PRECISE scoring of MRI were 94%, 64%, 81%, and 88% in the GG 1 group, and 92%, 50%, 92%, and 50%, respectively, in the GG 2 group. On regression analysis, initial prostate-specific antigen (p < 0.001) and higher PRECISE score (4-5; p = 0.005) were significant predictors of histological progression of GG 1 PC. Higher PRECISE score (p = 0.009), initial Prostate Imaging-Reporting and Data System score (p = 0.009), previous negative biopsy (p = 0.02), and percentage Gleason pattern 4 (p = 0.04) were significant predictors of histological progression of GG 2 PC. Limitations include extensive MRI reading experience, the small sample size, and limited follow-up. Conclusions MRI-guided monitoring of patients on AS using PRECISE scores avoided unnecessary follow-up biopsies in 88% of patients with GG 1 PC and predicted upgrading during 2-yr follow-up in both GG 1 and GG 2 PC. Patient summary We investigated whether MRI (magnetic resonance imaging) scores can be used to guide whether patients with lower-risk prostate cancer who are on active surveillance (AS) need to undergo repeat biopsies. Follow-up biopsy was deferred for 1 year for patients with a stable score and performed for patients whose score progressed. After 24 months on AS, all men underwent MRI and biopsy. Among patients with grade group 1 cancer and a stable MRI score, 88% avoided biopsy. For patients with MRI score progression, AS termination was correctly recommended in 81% of grade group 1 and 92% of grade group 2 cases.
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Affiliation(s)
- Birte Valentin
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | - Christian Arsov
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
- Elisabeth-Krankenhaus Rheydt, Department of Urology and Paediatric Urology, Staedtische Kliniken Moenchengladbach GmbH, Moenchengladbach, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Markus Giessing
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Irene Esposito
- Institute of Pathology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Jan Philipp Radtke
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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14
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Englman C, Barrett T, Moore CM, Giganti F. Active Surveillance for Prostate Cancer: Expanding the Role of MR Imaging and the Use of PRECISE Criteria. Radiol Clin North Am 2024; 62:69-92. [PMID: 37973246 DOI: 10.1016/j.rcl.2023.06.009] [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] [Indexed: 11/19/2023]
Abstract
Multiparametric magnetic resonance (MR) imaging has had an expanding role in active surveillance (AS) for prostate cancer. It can improve the accuracy of prostate biopsies, assist in patient selection, and help monitor cancer progression. The PRECISE recommendations standardize reporting of serial MR imaging scans during AS. We summarize the evidence on MR imaging-led AS and provide a clinical primer to help report using the PRECISE criteria. Some limitations to both serial imaging and the PRECISE recommendations must be considered as we move toward a more individualized risk-stratified approach to AS.
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Affiliation(s)
- Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Department of Urology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK.
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15
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Peyrottes A, Rouprêt M, Fiard G, Fromont G, Barret E, Brureau L, Créhange G, Gauthé M, Baboudjian M, Renard-Penna R, Roubaud G, Rozet F, Sargos P, Ruffion A, Mathieu R, Beauval JB, De La Taille A, Ploussard G, Dariane C. [Early detection of prostate cancer: Towards a new paradigm?]. Prog Urol 2023; 33:956-965. [PMID: 37805291 DOI: 10.1016/j.purol.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.
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Affiliation(s)
- A Peyrottes
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, membre junior, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France.
| | - M Rouprêt
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France
| | - G Fiard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, Grenoble Alpes university hospital, université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - G Fromont
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of pathology, CHRU, 37000 Tours, France
| | - E Barret
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - L Brureau
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Pointe-à-Pitre, university of Antilles, university of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR S 1085, 97110 Pointe-à-Pitre, Guadeloupe
| | - G Créhange
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Curie, Paris, France
| | - M Gauthé
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sintep nuclear medicine, 38100 Grenoble, France
| | - M Baboudjian
- Department of urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - R Renard-Penna
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, AP-HP, radiology, Pitie-Salpétrière hospital, 75013 Paris, France
| | - G Roubaud
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of medical oncology, institut Bergonié, 33000 Bordeaux, France
| | - F Rozet
- Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - P Sargos
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Bergonié, 33000 Bordeaux, France
| | - A Ruffion
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France
| | - R Mathieu
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Rennes, Rennes, France
| | - J-B Beauval
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - A De La Taille
- Department of urology, university hospital Henri-Mondor, AP-HP, Créteil, France
| | - G Ploussard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - C Dariane
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France
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16
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Arber T, Jaouen T, Campoy S, Rabilloud M, Souchon R, Abbas F, Moldovan PC, Colombel M, Crouzet S, Ruffion A, Neuville P, Rouvière O. Zone-specific computer-aided diagnosis system aimed at characterizing ISUP ≥ 2 prostate cancers on multiparametric magnetic resonance images: evaluation in a cohort of patients on active surveillance. World J Urol 2023; 41:3527-3533. [PMID: 37845554 DOI: 10.1007/s00345-023-04643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE To assess a region-of-interest-based computer-assisted diagnosis system (CAD) in characterizing aggressive prostate cancer on magnetic resonance imaging (MRI) from patients under active surveillance (AS). METHODS A prospective biopsy database was retrospectively searched for patients under AS who underwent MRI and subsequent biopsy at our institution. MRI lesions targeted at baseline biopsy were retrospectively delineated to calculate the CAD score that was compared to the Prostate Imaging-Reporting and Data System (PI-RADS) version 2 score assigned at baseline biopsy. RESULTS 186 patients were selected. At baseline biopsy, 51 and 15 patients had International Society of Urological Pathology (ISUP) grade ≥ 2 and ≥ 3 cancer respectively. The CAD score had significantly higher specificity for ISUP ≥ 2 cancers (60% [95% confidence interval (CI): 51-68]) than the PI-RADS score (≥ 3 dichotomization: 24% [CI: 17-33], p = 0.0003; ≥ 4 dichotomization: 32% [CI: 24-40], p = 0.0003). It had significantly lower sensitivity than the PI-RADS ≥ 3 dichotomization (85% [CI: 74-92] versus 98% [CI: 91-100], p = 0.015) but not than the PI-RADS ≥ 4 dichotomization (94% [CI:85-98], p = 0.104). Combining CAD findings and PSA density could have avoided 47/184 (26%) baseline biopsies, while missing 3/51 (6%) ISUP 2 and no ISUP ≥ 3 cancers. Patients with baseline negative CAD findings and PSAd < 0.15 ng/mL2 who stayed on AS after baseline biopsy had a 9% (4/44) risk of being diagnosed with ISUP ≥ 2 cancer during a median follow-up of 41 months, as opposed to 24% (18/74) for the others. CONCLUSION The CAD could help define AS patients with low risk of aggressive cancer at baseline assessment and during subsequent follow-up.
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Affiliation(s)
- Théo Arber
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Séphora Campoy
- Service de Biostatistique Et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, 69003, Lyon, France
- UMR 5558, Laboratoire de Biométrie Et Biologie Évolutive, CNRS, Équipe Biostatistique-Santé, 69100, Villeurbanne, France
| | - Muriel Rabilloud
- Service de Biostatistique Et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, 69003, Lyon, France
- UMR 5558, Laboratoire de Biométrie Et Biologie Évolutive, CNRS, Équipe Biostatistique-Santé, 69100, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
| | | | - Fatima Abbas
- Service de Biostatistique Et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, 69003, Lyon, France
- UMR 5558, Laboratoire de Biométrie Et Biologie Évolutive, CNRS, Équipe Biostatistique-Santé, 69100, Villeurbanne, France
| | - Paul C Moldovan
- Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Marc Colombel
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Department of Urology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
- Faculté de Médecine Lyon Est, Lyon, France
| | - Sébastien Crouzet
- LabTau, INSERM U1032, Lyon, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Department of Urology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
- Faculté de Médecine Lyon Est, Lyon, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Faculté de Médecine Lyon Sud, Pierre Bénite, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Olivier Rouvière
- LabTau, INSERM U1032, Lyon, France.
- Université de Lyon, Lyon, France.
- Université Lyon 1, Lyon, France.
- Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France.
- Faculté de Médecine Lyon Est, Lyon, France.
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17
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Sanmugalingam N, Sushentsev N, Lee KL, Caglic I, Englman C, Moore CM, Giganti F, Barrett T. The PRECISE Recommendations for Prostate MRI in Patients on Active Surveillance for Prostate Cancer: A Critical Review. AJR Am J Roentgenol 2023; 221:649-660. [PMID: 37341180 DOI: 10.2214/ajr.23.29518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations were published in 2016 to standardize the reporting of MRI examinations performed to assess for disease progression in patients on active surveillance for prostate cancer. Although a limited number of studies have reported outcomes from use of PRECISE in clinical practice, the available studies have demonstrated PRECISE to have high pooled NPV but low pooled PPV for predicting progression. Our experience in using PRECISE in clinical practice at two teaching hospitals has highlighted issues with its application and areas requiring clarification. This Clinical Perspective critically appraises PRECISE on the basis of this experience, focusing on the system's key advantages and disadvantages and exploring potential changes to improve the system's utility. These changes include consideration of image quality when applying PRECISE scoring, incorporation of quantitative thresholds for disease progression, adoption of a PRECISE 3F sub-category for progression not qualifying as substantial, and comparisons with both the baseline and most recent prior examinations. Items requiring clarification include derivation of a patient-level score in patients with multiple lesions, intended application of PRECISE score 5 (i.e., if requiring development of disease that is no longer organ-confined), and categorization of new lesions in patients with prior MRI-invisible disease.
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Affiliation(s)
- Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
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18
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Leni R, Gandaglia G, Stabile A, Mazzone E, Pellegrino F, Scuderi S, Robesti D, Barletta F, Cirulli GO, Cucchiara V, Zaffuto E, Dehò F, Montorsi F, Briganti A. Is Active Surveillance an Option for the Management of Men with Low-grade Prostate Cancer and a Positive Family History? Results from a Large, Single-institution Series. Eur Urol Oncol 2023; 6:493-500. [PMID: 37005213 DOI: 10.1016/j.euo.2023.02.014] [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: 07/27/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Family history (FH) of prostate cancer (PCa) is associated with an increased risk of PCa and adverse disease features. However, whether patients with localized PCa and FH could be considered for active surveillance (AS) remains controversial. OBJECTIVE To assess the association between FH and reclassification of AS candidates, and to define predictors of adverse outcomes in men with positive FH. DESIGN, SETTING, AND PARTICIPANTS Overall, 656 patients with grade group (GG) 1 PCa included in an AS protocol at a single institution were identified. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier analyses assessed the time to reclassification (GG ≥2 and GG ≥3 at follow-up biopsies) overall and according to FH status. Multivariable Cox regression tested the impact of FH on reclassification and identified the predictors among men with FH. Men treated with delayed radical prostatectomy (n = 197) or external-beam radiation therapy (n = 64) were identified, and the impact of FH on oncologic outcomes was assessed. RESULTS AND LIMITATIONS Overall, 119 men (18%) had FH. The median follow-up was 54 mo (interquartile range 29-84 mo), and 264 patients experienced reclassification. The 5-yr reclassification-free survival rate was 39% versus 57% for FH versus no FH (p = 0.006), and FH was associated with reclassification to GG ≥2 (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.19-2.15, p = 0.002). In men with FH, the strongest predictors of reclassification were prostate-specific antigen (PSA) density (PSAD), high-volume GG 1 (≥33% of cores involved or ≥50% of any core involved), and suspicious magnetic resonance imaging (MRI) of the prostate (HRs 2.87, 3.04, and 3.87, respectively; all p < 0.05). No association between FH, adverse pathologic features, and biochemical recurrence was observed (all p > 0.05). CONCLUSIONS Patients with FH on AS are at an increased risk of reclassification. Negative MRI, low disease volume, and low PSAD identify men with FH and a low risk of reclassification. Nonetheless, sample size and wide CIs entail caution in drawing conclusions based on these results. PATIENT SUMMARY We tested the impact of family history in men on active surveillance for localized prostate cancer. A significant risk of reclassification, but not adverse oncologic outcomes after deferred treatment, prompts the need for cautious discussion with these patients, without precluding initial expectant management.
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Affiliation(s)
- Riccardo Leni
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Armando Stabile
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Pellegrino
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Zaffuto
- Department of Urology, Circolo and Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy; University of Insubria, Varese, Italy
| | - Federico Dehò
- Department of Urology, Circolo and Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy; University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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19
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Faraj KS, Kaufman SR, Herrel LA, Oerline MK, Maganty A, Shahinian VB, Hollenbeck BK. Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer. Urol Oncol 2023; 41:430.e17-430.e23. [PMID: 37580226 PMCID: PMC10836888 DOI: 10.1016/j.urolonc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Biomarkers for prostate cancer, such as multiparametric MRI (mpMRI) and tissue-based genomics, are increasingly used for treatment decision-making. Using biomarkers indiscriminately and thus ignoring competing risks of mortality may lead to treatment in some men who derive little clinical benefit. We assessed the relationship between urology practice use of biomarkers and subsequent treatment in men with newly diagnosed prostate cancer. METHODS We used a 20% random sample of national Medicare data to perform a retrospective cohort study of men with newly diagnosed prostate cancer diagnosed from 2015 through 2019. Urology practice-level use of biomarkers was characterized based on urology practice propensity to use either biomarker after diagnosis (never, below median, above the median). Noncancer mortality risk within 10 years of diagnosis was calculated for all men. Multilevel models were used to assess the relationship between practice-level biomarker use and treatment by noncancer mortality risk. RESULTS Between 2015 and 2019, 1,764 (65%) urology practices used mpMRI and 897 (33%) used genomic testing for prostate cancer. Compared with urology practices never using each biomarker, those using mpMRI above the median (56% vs. 47%, P = 0.003) and tissue-based genomics below the median (56% vs. 50%, P = 0.03) were more likely to treat men with >75% risk of noncancer mortality. Additionally, compared with urology practices never using either biomarker, use of mpMRI (72% vs. 69%, P = 0.07) or tissue-based genomics (71% vs. 70%, P = 0.65) did not impact treatment in the healthiest group (i.e., those with <25% risk of noncancer mortality). CONCLUSIONS Compared to practices that do not use each biomarker in men with newly diagnosed prostate cancer, urology practices using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men at very high risk of dying from competing risks of mortality within 10 years of prostate cancer diagnosis.
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Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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20
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Gandaglia G, Leni R, Plagakis S, Stabile A, Montorsi F, Briganti A. Active surveillance should not be routinely considered in ISUP grade group 2 prostate cancer. BMC Urol 2023; 23:153. [PMID: 37777767 PMCID: PMC10542696 DOI: 10.1186/s12894-023-01315-5] [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: 07/19/2023] [Accepted: 09/03/2023] [Indexed: 10/02/2023] Open
Abstract
Active surveillance has been proposed as a therapeutic option in selected intermediate risk patients with biopsy grade group 2 prostate cancer. However, its oncologic safety in this setting is debated. Therefore, we conducted a non-systematic literature research of contemporary surveillance protocols including patients with grade group 2 disease to collect the most recent evidence in this setting. Although no randomized controlled trial compared curative-intent treatments, namely radical prostatectomy and radiotherapy vs. active surveillance in patients with grade group 2 disease, surgery is associated with a benefit in terms of disease control and survival when compared to expectant management in the intermediate risk setting. Patients with grade group 2 on active surveillance were at higher risk of disease progression and treatment compared to their grade group 1 counterparts. Up to 50% of those patients were eventually treated at 5 years, and the metastases-free survival rate was as low as 85% at 15-years. When considering low- and intermediate risk patients treated with radical prostatectomy, grade group 2 was one of the strongest predictors of grade upgrading and adverse features. Available data is insufficient to support the oncologic safety of active surveillance in all men with grade group 2 prostate cancer. Therefore, those patients should be counselled regarding the oncologic efficacy of upfront active treatment modalities and the lack of robust long-term data supporting the safety of active surveillance in this setting.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Riccardo Leni
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Armando Stabile
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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21
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Paulino Pereira LJ, Reesink DJ, de Bruin P, Gandaglia G, van der Hoeven EJRJ, Marra G, Prinsen A, Rajwa P, Soeterik T, Kasivisvanathan V, Wever L, Zattoni F, van Melick HHE, van den Bergh RCN. Outcomes of a Diagnostic Pathway for Prostate Cancer Based on Biparametric MRI and MRI-Targeted Biopsy Only in a Large Teaching Hospital. Cancers (Basel) 2023; 15:4800. [PMID: 37835494 PMCID: PMC10571962 DOI: 10.3390/cancers15194800] [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: 08/20/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Diagnostic pathways for prostate cancer (PCa) balance detection rates and burden. MRI impacts biopsy indication and strategy. METHODS A prospectively collected cohort database (N = 496) of men referred for elevated PSA and/or abnormal DRE was analyzed. All underwent biparametric MRI (3 Tesla scanner) and ERSPC prostate risk-calculator. Indication for biopsy was PIRADS ≥ 3 or risk-calculator ≥ 20%. Both targeted (cognitive-fusion) and systematic cores were combined. A hypothetical full-MRI-based pathway was retrospectively studied, omitting systematic biopsies in: (1) PIRADS 1-2 but risk-calculator ≥ 20%, (2) PIRADS ≥ 3, receiving targeted biopsy-cores only. RESULTS Significant PCa (GG ≥ 2) was detected in 120 (24%) men. Omission of systematic cores in cases with PIRADS 1-2 but risk-calculator ≥ 20%, would result in 34% less biopsy indication, not-detecting 7% significant tumors. Omission of systematic cores in PIRADS ≥ 3, only performing targeted biopsies, would result in a decrease of 75% cores per procedure, not detecting 9% significant tumors. Diagnosis of insignificant PCa dropped by 52%. PCa undetected by targeted cores only, were ipsilateral to MRI-index lesions in 67%. CONCLUSIONS A biparametric MRI-guided PCa diagnostic pathway would have missed one out of six cases with significant PCa, but would have considerably reduced the number of biopsy procedures, cores, and insignificant PCa. Further refinement or follow-up may identify initially undetected cases. Center-specific data on the performance of the diagnostic pathway is required.
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Affiliation(s)
- Leonor J. Paulino Pereira
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Daan J. Reesink
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Peter de Bruin
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Erik J. R. J. van der Hoeven
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Giancarlo Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy
| | - Anne Prinsen
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Timo Soeterik
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
| | - Lieke Wever
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Fabio Zattoni
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padua, Italy
| | - Harm H. E. van Melick
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
| | - Roderick C. N. van den Bergh
- Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands (P.d.B.); (H.H.E.v.M.); (R.C.N.v.d.B.)
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22
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Ninivaggi A, Guzzi F, Degennaro A, Ricapito A, Bettocchi C, Busetto GM, Sanguedolce F, Milillo P, Selvaggio O, Cormio L, Carrieri G, Falagario UG. External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy. J Clin Med 2023; 12:5748. [PMID: 37685815 PMCID: PMC10488903 DOI: 10.3390/jcm12175748] [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: 07/18/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Background: The aim of this study was to validate externally a nomogram that relies on MRI volumetric parameters and clinical data to determine the need for a standard biopsy in addition to a target biopsy for men with suspicious prostate MRI findings. Methods: We conducted a retrospective analysis of a prospectively maintained database of 469 biopsy-naïve men who underwent prostate biopsies. These biopsies were guided by pre-biopsy multiparametric Magnetic Resonance Imaging (mpMRI) and were performed at two different institutions. We included men with a PIRADSsv 2.1 score from 3 to 5. Each patient underwent both an MRI-ultrasound fusion biopsy of identified MRI-suspicious lesions and a systematic biopsy according to our protocol. The lesion volume percentage was determined as the proportion of cancer volume on MRI relative to the entire prostate volume. The study's outcomes were iPCa (Gleason Grade Group 1) and csPCa (Gleason Grade Group > 1). We evaluated the model's performance using AUC decision curve analyses and a systematic analysis of model-derived probability cut-offs in terms of the potential to avoid diagnosing iPCa and to accurately diagnose csPCa. Results: The nomogram includes age, PSA value, prostate volume, PIRADSsv 2.1 score, percentage of MRI-suspicious lesion volume, and lesion location. AUC was determined to be 0.73. By using various nomogram cut-off thresholds (ranging from 5% to 30%), it was observed that 19% to 58% of men could potentially avoid undergoing standard biopsies. In this scenario, the model might miss 0% to 10% of diagnosis of csPCa and could prevent identifying 6% to 31% of iPCa cases. These results are in line with findings from the multi-institutional external validation study based on the IMPROD trial (n = 122) and the MULTI-IMPROD trial (n = 262). According to DCA, the use of this nomogram led to an increased overall net clinical benefit when the threshold probability exceeded 10%. Conclusions: This study supports the potential value of a model relying on MRI volumetric measurements for selecting individuals with clinical suspicion of prostate cancer who would benefit from undergoing a standard biopsy in addition to a targeted biopsy.
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Affiliation(s)
- Antonella Ninivaggi
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
| | - Francesco Guzzi
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
| | - Alessio Degennaro
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
- Andrology Unit, Department of Urology, University of Foggia, 71122 Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
| | | | - Paola Milillo
- Department of Radiology, University of Foggia, 71122 Foggia, Italy
| | - Oscar Selvaggio
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
| | - Ugo Giovanni Falagario
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy (U.G.F.)
- Department of Molecular Medicine and Surgery, (Solna), Karolinska Institutet, 17177 Stockholm, Sweden
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23
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Hofmann B, Haug ES, Andersen ER, Kjelle E. Increased magnetic resonance imaging in prostate cancer management-What are the outcomes? J Eval Clin Pract 2023; 29:893-902. [PMID: 36374190 DOI: 10.1111/jep.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
RATIONALE Increased attention to cancer care has instigated altered systems for screening, diagnosis, and management of various types of cancer, such as in the prostate. While such systems very likely have improved the quality of cancer care, they also result in the altered use of specific services, such as magnetic resonance imaging (MRI). AIMS AND OBJECTIVE To study the change in the use of prostate MRI in the Norwegian health care system from 2013 to 2021 and to investigate some reasons for and potential implications of this change. METHOD Data from the Norwegian Health Economics Administration (HELFO), The Cancer Registry of Norway and Cause-of-death registry at the Norwegian Institute of public health and the health registry of Vestfold Hospital Trust were used for descriptive statistical analysis. RESULTS The number of MRIs of the prostate increased threefold from 2013 to 2021, representing an extra cost of 2 million USD in 2020. The incidence of prostate cancer was stable at about 5000 cases per year, corresponding to 178 per 100,000 men, indicating no increased overdiagnosis. However, the clinical staging has changed substantially during this period, indicating stage and grade migration. The number of negative biopsies was reduced, and there are three MRIs per reduced negative biopsy. The number of persons on active surveillance increased during the period. However, these changes are partly independent of the increase in the number of MRIs. CONCLUSION There was a substantial increase in the number of prostate MRIs and thus an increase in costs. This appears to have contributed to the reduction of negative biopsies, improved staging and increased active surveillance. However, as these effects are partly independent of the increase in MRIs, we need to document the outcomes for patients from prostate MRIs as their opportunity costs are substantial.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Sciences, Norwegian University of Science and Technology, Gjovik, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Erik Skaaheim Haug
- Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Cancer Genomics and Informatics, Oslo University Hospital, Oslo, Norway
- Norwegian Cancer Registry, Oslo, Norway
| | - Eivind Richter Andersen
- Department of Health Sciences, Norwegian University of Science and Technology, Gjovik, Norway
| | - Elin Kjelle
- Department of Health Sciences, Norwegian University of Science and Technology, Gjovik, Norway
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24
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Hu S, Chang CP, Snyder J, Deshmukh V, Newman M, Date A, Galvao C, Porucznik CA, Gren LH, Sanchez A, Lloyd S, Haaland B, O'Neil B, Hashibe M. Comparing Active Surveillance and Watchful Waiting With Radical Treatment Using Machine Learning Models Among Patients With Prostate Cancer. JCO Clin Cancer Inform 2023; 7:e2300083. [PMID: 37988640 PMCID: PMC10681553 DOI: 10.1200/cci.23.00083] [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] [Received: 05/10/2023] [Revised: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE In 2021, 59.6% of low-risk patients with prostate cancer were under active surveillance (AS) as their first course of treatment. However, few studies have investigated AS and watchful waiting (WW) separately. The objectives of this study were to develop and validate a population-level machine learning model for distinguishing AS and WW in the conservative treatment group, and to investigate initial cancer management trends from 2004 to 2017 and the risk of chronic diseases among patients with prostate cancer with different treatment modalities. METHODS In a cohort of 18,134 patients with prostate adenocarcinoma diagnosed between 2004 and 2017, 1,926 patients with available AS/WW information were analyzed using machine learning algorithms with 10-fold cross-validation. Models were evaluated using performance metrics and Brier score. Cox proportional hazard models were used to estimate hazard ratios for chronic disease risk. RESULTS Logistic regression models achieved a test area under the receiver operating curve of 0.73, F-score of 0.79, accuracy of 0.71, and Brier score of 0.29, demonstrating good calibration, precision, and recall values. We noted a sharp increase in AS use between 2004 and 2016 among patients with low-risk prostate cancer and a moderate increase among intermediate-risk patients between 2008 and 2017. Compared with the AS group, radical treatment was associated with a lower risk of prostate cancer-specific mortality but higher risks of Alzheimer disease, anemia, glaucoma, hyperlipidemia, and hypertension. CONCLUSION A machine learning approach accurately distinguished AS and WW groups in conservative treatment in this decision analytical model study. Our results provide insight into the necessity to separate AS and WW in population-based studies.
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Affiliation(s)
- Siqi Hu
- Huntsman Cancer Institute, Salt Lake City, UT
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Chun-Pin Chang
- Huntsman Cancer Institute, Salt Lake City, UT
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Christina A. Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Lisa H. Gren
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin Haaland
- Huntsman Cancer Institute, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Brock O'Neil
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, UT
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
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25
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Noujeim JP, Belahsen Y, Lefebvre Y, Lemort M, Deforche M, Sirtaine N, Martin R, Roumeguère T, Peltier A, Diamand R. Optimizing multiparametric magnetic resonance imaging-targeted biopsy and detection of clinically significant prostate cancer: the role of perilesional sampling. Prostate Cancer Prostatic Dis 2023; 26:575-580. [PMID: 36509930 DOI: 10.1038/s41391-022-00620-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The added-value of systematic biopsy (SB) in patients undergoing magnetic resonance imaging (MRI)-targeted biopsy (TB) remains unclear and the spatial distribution of positive cores relative to the MRI lesion has been poorly studied. The aim of this study was to determine the utility of perilesional biopsy in detecting clinically significant prostate cancer (csPCa). METHODS We enrolled 505 consecutive patients that underwent SB and TB for suspicious MRI lesions (PI-RADS score 3-5) at Jules Bordet Institute between June 2016 and January 2022. Patient-specific tridimensional prostate maps were reviewed to determine the distance between systematic cores containing csPCa and the MRI index lesion. Primary outcomes were the cancer detection rate (CDR) per patient and the cumulative cancer distribution rate of positive cores for each 5 mm interval from the MRI index lesion. The secondary outcome was the identification of risk groups for the presence of csPCa beyond a 10 mm margin using the chi-square automated interaction detector (CHAID) machine learning algorithm. RESULTS Overall, the CDR for csPCa of TB, SB, and combined method were 32%, 25%, and 37%, respectively. While combined method detected more csPCa compared to TB (37% vs. 32%, p < 0.001), no difference was found when TB was associated with perilesional sampling within 10 mm (37% vs. 35%, p = 0.2). The cumulative cancer distribution rate for csPCa reached 86% for the 10 mm margin. The CHAID algorithm identified three risk groups: (1) PI-RADS3 ("low-risk"), (2) PI-RADS4 or PI-RADS5 and PSA density <0.15 ng/ml ("intermediate-risk"), and (3) PI-RADS 5 and PSA density ≥0.15 ng/ml ("high-risk"). The risk of missing csPCa was 2%, 8%, and 29% for low-, intermediate- and high-risk groups, respectively. Avoiding biopsies beyond a 10 mm margin prevented the detection of 19% of non-csPCa. CONCLUSIONS Perilesional biopsy template using a 10 mm margin seems a reasonable alternative to the combined method with a comparable detection of csPCa. Our risk stratification may further enhance the selection of patients.
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Affiliation(s)
- Jean-Paul Noujeim
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yassir Belahsen
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolene Lefebvre
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Lemort
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Maxime Deforche
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Sirtaine
- Department of Pathology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Robin Martin
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
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26
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Harder FN, Heming CAM, Haider MA. mpMRI Interpretation in Active Surveillance for Prostate Cancer-An overview of the PRECISE score. Abdom Radiol (NY) 2023; 48:2449-2455. [PMID: 37160473 DOI: 10.1007/s00261-023-03912-2] [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: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023]
Abstract
Active surveillance (AS) is now included in all major guidelines for patients with low-risk PCa and selected patients with intermediate-risk PCa. Several studies have highlighted the potential benefit of multiparametric magnetic resonance imaging (mpMRI) in AS and it has been adopted in some guidelines. However, uncertainty remains about whether serial mpMRI can help to safely reduce the number of required repeat biopsies under AS. In 2017, the European School of Oncology initiated the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) panel which proposed the PRECISE scoring system to assess the likelihood of radiological tumor progression on serial mpMRI. The PRECISE scoring system remains the only major system evaluated in multiple publications. In this review article, we discuss the current body of literature investigating the application of PRECISE as it is not as yet an established standard in mpMRI reporting. We delineate the strengths of PRECISE and its potential added value. Also, we underline potential weaknesses of the PRECISE scoring system, which might be tackled in future versions to further increase its value in AS.
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Affiliation(s)
- Felix N Harder
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Carolina A M Heming
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, M5G 1X5, Canada
- Radiology Department, Instituto Nacional do Cancer (INCa), Rio de Janeiro, Brazil
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, M5G 1X5, Canada.
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27
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Stanzione A, Ponsiglione A, Alessandrino F, Brembilla G, Imbriaco M. Beyond diagnosis: is there a role for radiomics in prostate cancer management? Eur Radiol Exp 2023; 7:13. [PMID: 36907973 PMCID: PMC10008761 DOI: 10.1186/s41747-023-00321-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/05/2023] [Indexed: 03/13/2023] Open
Abstract
The role of imaging in pretreatment staging and management of prostate cancer (PCa) is constantly evolving. In the last decade, there has been an ever-growing interest in radiomics as an image analysis approach able to extract objective quantitative features that are missed by human eye. However, most of PCa radiomics studies have been focused on cancer detection and characterisation. With this narrative review we aimed to provide a synopsis of the recently proposed potential applications of radiomics for PCa with a management-based approach, focusing on primary treatments with curative intent and active surveillance as well as highlighting on recurrent disease after primary treatment. Current evidence is encouraging, with radiomics and artificial intelligence appearing as feasible tools to aid physicians in planning PCa management. However, the lack of external independent datasets for validation and prospectively designed studies casts a shadow on the reliability and generalisability of radiomics models, delaying their translation into clinical practice.Key points• Artificial intelligence solutions have been proposed to streamline prostate cancer radiotherapy planning.• Radiomics models could improve risk assessment for radical prostatectomy patient selection.• Delta-radiomics appears promising for the management of patients under active surveillance.• Radiomics might outperform current nomograms for prostate cancer recurrence risk assessment.• Reproducibility of results, methodological and ethical issues must still be faced before clinical implementation.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | | | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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28
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Chamorro Castillo L, García Morales L, Ruiz López D, Salguero Segura J, Valero Rosa J, Anglada Curado FJ, Mesa Quesada J, Blanca Pedregosa A, Carrasco Valiente J, Gómez Gómez E. The role of multiparametric magnetic resonance in active surveillance of a low-risk prostate cancer cohort from clinical practice. Prostate 2023; 83:765-772. [PMID: 36895160 DOI: 10.1002/pros.24515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Active surveillance (AS) is considered a suitable management practice for those patients with low-risk prostate cancer (PCa). At present, however, the role of multiparametric magnetic resonance imaging (mpMRI) in AS protocols has not yet been clearly established. OUTCOMES To determine the role of mpMRI and its ability to detect significant prostate cancer (SigPCa) in PCa patients enrolled in AS protocols. MATERIALS AND METHODS There were 229 patients enrolled in an AS protocol between 2011 and 2020 at Reina Sofía University Hospital. MRI interpretation was based on PIRADS v.1 or v.2/2.1 classification. Demographics, clinical, and analytical data were collected and analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for mpMRI in different scenarios. We defined SigPCa and reclassification/progression as a Gleason score (GS) ≥ 3 + 4, a clinical stage ≥T2b, or an increase in PCa volume. Kaplan-Meier and log-rank tests were used to estimate progression-free survival time. RESULTS Median age was 69.02 (±7.73) at diagnosis, with a 0.15 (±0.08) PSA density (PSAD). Eighty-six patients were reclassified after confirmatory biopsy, with a suspicious mpMRI an indication for a clear reclassification and risk-predictor factor in disease progression (p < 0.05). During follow-up, 46 patients were changed from AS to active treatment mainly due to disease progression. Ninety patients underwent ≥2mpMRI during follow-up, with a median follow-up of 29 (15-49) months. Thirty-four patients had a baseline suspicious mpMRI (at diagnostic or confirmatory biopsy): 14 patients with a PIRADS 3 and 20 patients with ≥PIRADS 4. From 14 patients with a PIRADS 3 baseline mpMRI, 29% progressed radiologically, with a 50% progression rate versus 10% (1/10 patients) for those with similar or decreased mpMRI risk. Of the 56 patients with a non-suspicious baseline mpMRI (PIRADS < 2), 14 patients (25%) had an increased degree of radiological suspicion, with a detection rate of SigPCa of 29%. The mpMRI NPV during follow-up was 0.91. CONCLUSION A suspicious mpMRI increases the reclassification and disease progression risk during follow-up and plays an important role in monitoring biopsies. In addition, a high NPV at mpMRI follow-up can help to decrease the need to monitor biopsies during AS.
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Affiliation(s)
- L Chamorro Castillo
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
| | - L García Morales
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
| | - D Ruiz López
- Radiology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), Cordoba, Spain
| | - J Salguero Segura
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Urology Department, Galdakao University Hospital, Urology, Galdakao, Spain
| | - J Valero Rosa
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
| | - F J Anglada Curado
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
| | - J Mesa Quesada
- Radiology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), Cordoba, Spain
| | - A Blanca Pedregosa
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
| | - J Carrasco Valiente
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), Cordoba, Spain
| | - Enrique Gómez Gómez
- Urology Department, Reina Sofía University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), Cordoba, Spain
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29
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Cullivan O, Roche E, Hegazy M, Taha M, Durkan G, O'Malley P, McCarthy P, Dowling CM. A critical analysis of deficiencies in the quality of information contained in prostate multiparametric MRI requests and reports. Ir J Med Sci 2023; 192:27-31. [PMID: 35094231 DOI: 10.1007/s11845-021-02875-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) has been increasingly recognised as an important tool in the diagnosis of prostate cancer. PI-RADSv2 guidelines recommend that important clinical information including prostate-specific antigen (PSA) levels, examination findings, and biopsy information should be included in mpMRI requests. PIRADS score and PSA density (PSAD) are both independent predictors for the presence of a clinically significant prostate cancer. AIMS This study aims to evaluate the quality of mpMRI requests and reports at our institution in accordance with these parameters. METHODS All prostate mpMRIs performed by radiology services in Galway University Hospital between 1st September 2019 and 1st March 2020 were reviewed. Exclusion criteria were applied. Requests and reports were analysed for the presence of the following parameters: PSA-results, examination findings, biopsy information, PI-RADS score, prostate volume, and PSAD. RESULTS A total of 586 mpMRIs were performed, and of these, 546 were included. PSA value was provided in 497 (91%) of requests, exam findings in 355 (65%), and biopsy information in 452 (82%). PIRADS score was included in 224 (41%) of reports, prostate volume in 178 (32.6%), and PSAD in 106 (19%). CONCLUSIONS Great variation in the quality of information contained in both requests and reports for prostate mpMRIs exists within our service. We aim to improve this by collaborating with our radiology colleagues to develop a proforma for requesting and reporting of mpMRIs for our radiology systems to ensure important clinical and radiological information is provided in future.
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Affiliation(s)
- Orla Cullivan
- Department of Urology, Galway University Hospital, Galway, Ireland.
| | - Emma Roche
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Mohammad Hegazy
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Mohamed Taha
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Garrett Durkan
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Paddy O'Malley
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Peter McCarthy
- Department of Radiology, Galway University Hospital, Galway, Ireland
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30
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Venderbos LD, Luiting H, Hogenhout R, Roobol MJ. Interaction of MRI and active surveillance in prostate cancer: Time to re-evaluate the active surveillance inclusion criteria. Urol Oncol 2023; 41:82-87. [PMID: 34483041 DOI: 10.1016/j.urolonc.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Abstract
Currently available data from long-running single- and multi-center active surveillance (AS) studies show that AS has excellent cancer-specific survival rates. For AS to be effective the 'right' patients should be selected for which up until 5-to-10 years ago systematic prostate biopsies were used. Because the systematic prostate strategy relies on sampling efficiency for the detection of prostate cancer (PCa), it is subject to sampling error. Due to this sampling error, many of the Gleason 3+3 PCas that were included on AS in the early days and were classified as low-risk, may in fact have had a higher Gleason score. Subsequently, AS-criteria were more strict to overcome or limit the number of men missing the potential window of curability in case their tumor would be reclassified. Five to ten years ago the prostate biopsy landscape changed drastically by the addition of magnetic resonance imaging (MRI) into the diagnostic PCa-care pathway, which has by now trickled down into the EAU guidelines. At the moment, the EAU guidelines recommend performing a (multi-parametric) MRI before prostate biopsy and combine systematic and targeted prostate biopsy when the MRI is positive (i.e. PIRADS ≥3). So because of the introduction of the MRI into the diagnostic PCa-care pathway, literature is showing that more Gleason 3+4 PCas are being diagnosed. But can it not be that the inclusion of MRI into the diagnostic PCa-care pathway causes risk inflation, resulting in men earlier eligible for AS, now being labelled ineligible for AS? Would it not be possible to include these current Gleason 3+4 PCas on AS? The authors hypothesize that the improved accuracy that comes with the introduction of MRI into the diagnostic PCa-care pathway permits to widen both the AS-inclusion and follow-up criteria. Maintaining our inclusion criteria for AS from the systematic biopsy era will unnecessarily and undesirably expose patients to the increased risk of overtreatment. The evidence behind the addition of MRI-targeted biopsies to systematic biopsies calls upon the re-evaluation of the AS inclusion criteria and research from one-size-fits-all protocols used so far, into the direction of more dynamic and individual risk-based AS-approaches.
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Affiliation(s)
- Lionne Df Venderbos
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Henk Luiting
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Renée Hogenhout
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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31
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Maffei D, Giganti F, Moore CM. Seminar: Revisiting the value of PSA-based prostate cancer screening Essay No 5: Should men undergo MRI before prostate biopsy? (Pro). Urol Oncol 2023; 41:88-91. [PMID: 35871993 DOI: 10.1016/j.urolonc.2022.04.016] [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: 08/18/2021] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
Prostate cancer is the commonest cancer in men in Europe and many countries worldwide, and the second commonest cause of cancer-related death. A screening programme to detect clinically relevant prostate cancer at a time when it can be cured, without burdensome overdiagnosis and subsequent overtreatment, is a laudable goal. We will set out the advances in MRI imaging, and the progress in MRI for men prior to biopsy, discussing whether MRI has a place before biopsy, or as a primary screening tool, in a modern approach to prostate cancer screening.
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Affiliation(s)
- Davide Maffei
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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32
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Moore CM, King LE, Withington J, Amin MB, Andrews M, Briers E, Chen RC, Chinegwundoh FI, Cooperberg MR, Crowe J, Finelli A, Fitch MI, Frydenberg M, Giganti F, Haider MA, Freeman J, Gallo J, Gibbs S, Henry A, James N, Kinsella N, Lam TBL, Lichty M, Loeb S, Mahal BA, Mastris K, Mitra AV, Merriel SWD, van der Kwast T, Van Hemelrijck M, Palmer NR, Paterson CC, Roobol MJ, Segal P, Schraidt JA, Short CE, Siddiqui MM, Tempany CMC, Villers A, Wolinsky H, MacLennan S. Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting. Eur Urol Oncol 2023; 6:160-182. [PMID: 36710133 DOI: 10.1016/j.euo.2023.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/06/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Active surveillance (AS) is recommended for low-risk and some intermediate-risk prostate cancer. Uptake and practice of AS vary significantly across different settings, as does the experience of surveillance-from which tests are offered, and to the levels of psychological support. OBJECTIVE To explore the current best practice and determine the most important research priorities in AS for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A formal consensus process was followed, with an international expert panel of purposively sampled participants across a range of health care professionals and researchers, and those with lived experience of prostate cancer. Statements regarding the practice of AS and potential research priorities spanning the patient journey from surveillance to initiating treatment were developed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel members scored each statement on a Likert scale. The group median score and measure of consensus were presented to participants prior to discussion and rescoring at panel meetings. Current best practice and future research priorities were identified, agreed upon, and finally ranked by panel members. RESULTS AND LIMITATIONS There was consensus agreement that best practice includes the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (PSA) kinetics are stable, and that changes in PSA or DRE should prompt MRI ± biopsy rather than immediate active treatment. The highest ranked research priority was a dynamic, risk-adjusted AS approach, reducing testing for those at the least risk of progression. Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients were also high priorities. Limitations include the use of a limited number of panel members for practical reasons. CONCLUSIONS The current best practice in AS includes the use of high-quality MRI to avoid DRE and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. Development of a robust, dynamic, risk-adapted approach to surveillance is the highest research priority in AS for prostate cancer. PATIENT SUMMARY A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.
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Affiliation(s)
- Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
| | | | - John Withington
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK
| | - Mahul B Amin
- Department of Pathology and Lab Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA
| | | | | | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Francis I Chinegwundoh
- Department of Urology, Barts Health NHS Trust, London, UK; City University of London, London, UK
| | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | - Jane Crowe
- Australian Prostate Centre, North Melbourne, Victoria, Australia
| | - Antonio Finelli
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Francesco Giganti
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Masoom A Haider
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | | | - Joseph Gallo
- Active Surveillance Patients International, East Stroudsburg, PA, USA
| | | | | | - Nicholas James
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Netty Kinsella
- Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Royal Marsden Hospital, London, UK
| | - Thomas B L Lam
- Academic Urology Unit, Aberdeen University, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Mark Lichty
- Active Surveillance Patients International, East Stroudsburg, PA, USA
| | - Stacy Loeb
- Department of Urology, New York University, New York, NY, USA; Department of Population Health, New York University, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Anita V Mitra
- Cancer Services, University College London Hospitals, NHS, London, UK
| | - Samuel W D Merriel
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK; Centre for Primary Care & Health Services Research, University of Manchester, Manchester, UK
| | - Theodorus van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital. University of California San Francisco School of Medicine; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco; Department of Urology, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Catherine C Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Canberra Health Services and ACT Health, Synergy Nursing and Midwifery Research Centre, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Phillip Segal
- Prostate Cancer Support Toronto, Toronto, ON, Canada
| | | | - Camille E Short
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Clare M C Tempany
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Arnaud Villers
- Department of Urology Univ. Lille, CHU Lille, Department of Urology F-59000 Lille, France
| | - Howard Wolinsky
- Answer Cancer Foundation, Tumacacori, Arizona, USA; TheActiveSurveillor.com, Flossmoor, Illinois, USA
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33
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Stavrinides V, Norris JM, Karapanagiotis S, Giganti F, Grey A, Trahearn N, Freeman A, Haider A, Carmona Echeverría LM, Bott SRJ, Brown LC, Burns-Cox N, Dudderidge TJ, El-Shater Bosaily A, Ghei M, Henderson A, Hindley RG, Kaplan RS, Oldroyd R, Parker C, Persad R, Rosario DJ, Shergill IS, Winkler M, Kirkham A, Punwani S, Whitaker HC, Ahmed HU, Emberton M. Regional Histopathology and Prostate MRI Positivity: A Secondary Analysis of the PROMIS Trial. Radiology 2022; 307:e220762. [PMID: 36511804 DOI: 10.1148/radiol.220762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The effects of regional histopathologic changes on prostate MRI scans have not been accurately quantified in men with an elevated prostate-specific antigen (PSA) level and no previous biopsy. Purpose To assess how Gleason grade, maximum cancer core length (MCCL), inflammation, prostatic intraepithelial neoplasia (PIN), or atypical small acinar proliferation within a Barzell zone affects the odds of MRI visibility. Materials and Methods In this secondary analysis of the Prostate MRI Imaging Study (PROMIS; May 2012 to November 2015), consecutive participants who underwent multiparametric MRI followed by a combined biopsy, including 5-mm transperineal mapping (TPM), were evaluated. TPM pathologic findings were reported at the whole-prostate level and for each of 20 Barzell zones per prostate. An expert panel blinded to the pathologic findings reviewed MRI scans and declared which Barzell areas spanned Likert score 3-5 lesions. The relationship of Gleason grade and MCCL to zonal MRI outcome (visible vs nonvisible) was assessed using generalized linear mixed-effects models with random intercepts for individual participants. Inflammation, PIN, and atypical small acinar proliferation were similarly assessed in men who had negative TPM results. Results Overall, 161 men (median age, 62 years [IQR, 11 years]) were evaluated and 3179 Barzell zones were assigned MRI status. Compared with benign areas, the odds of MRI visibility were higher when a zone contained cancer with a Gleason score of 3+4 (odds ratio [OR], 3.1; 95% CI: 1.9, 4.9; P < .001) or Gleason score greater than or equal to 4+3 (OR, 8.7; 95% CI: 4.5, 17.0; P < .001). MCCL also determined visibility (OR, 1.24 per millimeter increase; 95% CI: 1.15, 1.33; P < .001), but odds were lower with each prostate volume doubling (OR, 0.7; 95% CI: 0.5, 0.9). In men who were TPM-negative, the presence of PIN increased the odds of zonal visibility (OR, 3.7; 95% CI: 1.5, 9.1; P = .004). Conclusion An incremental relationship between cancer burden and prostate MRI visibility was observed. Prostatic intraepithelial neoplasia contributed to false-positive MRI findings. ClinicalTrials.gov registration no. NCT01292291 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Harmath in this issue.
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Affiliation(s)
- Vasilis Stavrinides
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Joseph M Norris
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Solon Karapanagiotis
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Francesco Giganti
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Alistair Grey
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Nick Trahearn
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Alex Freeman
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Aiman Haider
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Lina María Carmona Echeverría
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Simon R J Bott
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Louise C Brown
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Nicholas Burns-Cox
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Timothy J Dudderidge
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Ahmed El-Shater Bosaily
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Maneesh Ghei
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Alastair Henderson
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Richard G Hindley
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Richard S Kaplan
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Robert Oldroyd
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Chris Parker
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Raj Persad
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Derek J Rosario
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Iqbal S Shergill
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Mathias Winkler
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Alex Kirkham
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Shonit Punwani
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Hayley C Whitaker
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Hashim U Ahmed
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
| | - Mark Emberton
- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
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- From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.)
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Suitability of conventional systematic vs. MRI-guided targeted biopsy approaches to assess surgical treatment delay for radical prostatectomy. World J Urol 2022; 40:2955-2961. [DOI: 10.1007/s00345-022-04207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/27/2022] [Indexed: 11/12/2022] Open
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Westhoff N, Ernst R, Kowalewski KF, Derigs F, Neuberger M, Nörenberg D, Popovic ZV, Ritter M, Stephan Michel M, von Hardenberg J. Medium-term Oncological Efficacy and Patient-reported Outcomes After Focal High-intensity Focused Ultrasound: The FOXPRO Trial. Eur Urol Focus 2022; 9:283-290. [PMID: 36344395 DOI: 10.1016/j.euf.2022.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS) fusion-guided high-intensity focused ultrasound (HIFU) is a focal treatment option for MRI-visible localized prostate cancer (PCa). High-quality evidence regarding the clinical efficacy remains limited. OBJECTIVE To assess medium-term oncological efficacy along with patient-reported outcome measures (PROMs). DESIGN, SETTING, AND PARTICIPANTS This prospective single-center cohort study was performed from 2014 to 2020. Patients with primary International Society of Urological Pathologists (ISUP) grade group (GG) ≤2 by combined MRI/TRUS fusion and systematic prostate biopsy and prostate-specific antigen (PSA) <10 ng/ml were included. INTERVENTION MRI/TRUS fusion-guided focal HIFU therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the cancer-free rate of the HIFU-treated lesion by biopsy after 1 yr. Secondary endpoints included salvage treatment-free survival (STFS), metastasis-free survival (MFS), overall survival (OS), and PROMs according to International Consortium for Health Outcomes Measurement recommendations. RESULTS AND LIMITATIONS Fifty patients were included (median [range] age 68 [48-80] yr; median PSA 6.5 [1.2-9.9] ng/ml; GG 1 54% [n = 27], and GG 2 46% [n = 23]). The median (range) PSA decrease from baseline to 12 mo was 51% (35.9-72.7%). In total, 37/50 patients (74%) underwent a 1-yr biopsy. PCa was detected in 23 patients (46%; GG 1 20% [n = 10]; GG >1 26% [n = 13]; infield 40% [n = 20]). At a median follow-up of 42 (13-73) mo, PCa was detected in 30 men (60%). Among all patients, 19 (38%) underwent salvage treatments (median [95% confidence interval] STFS 53 [44.3-61.7] mo). MFS and OS were 100% and 98%, respectively. The Expanded Prostate Cancer Index Composite-26 sexual domain decreased by 20.8 points (p = 0.372). CONCLUSIONS MRI/TRUS-guided focal HIFU therapy results in complete cancer ablation in only half of the treated patients after 1 yr, with further recurrences at medium-term follow-up. A decline of potency occurs in a subset of patients. PATIENT SUMMARY Focal image-guided high-intensity focused ultrasound therapy controls cancer in one of two patients. Its impact on urinary continence and erectile function is low.
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Dinneen E, Shaw GL, Kealy R, Alexandris P, Finnegan K, Chu K, Haidar N, Santos‐Vidal S, Kudahetti S, Moore CM, Grey ADR, Berney DM, Sahdev A, Cathcart PJ, Oliver RTD, Rajan P, Cuzick J. Feasibility of aspirin and/or vitamin D3 for men with prostate cancer on active surveillance with Prolaris® testing. BJUI COMPASS 2022; 3:458-465. [PMID: 36267207 PMCID: PMC9579886 DOI: 10.1002/bco2.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To test the feasibility of a randomised controlled trial (RCT) of aspirin and/or vitamin D3 in active surveillance (AS) low/favourable intermediate risk prostate cancer (PCa) patients with Prolaris® testing. Patients and Methods Newly-diagnosed low/favourable intermediate risk PCa patients (PSA ≤ 15 ng/ml, International Society of Urological Pathology (ISUP) Grade Group ≤2, maximum biopsy core length <10 mm, clinical stage ≤cT2c) were recruited into a multi-centre randomised, double-blind, placebo-controlled study (ISRCTN91422391, NCT03103152). Participants were randomised to oral low dose (100 mg), standard dose (300 mg) aspirin or placebo and/or vitamin D3 (4000 IU) versus placebo in a 3 × 2 factorial RCT design with biopsy tissue Prolaris® testing. The primary endpoint was trial acceptance/entry rates. Secondary endpoints included feasibility of Prolaris® testing, 12-month disease re-assessment (imaging/biochemical/histological), and 12-month treatment adherence/safety. Disease progression was defined as any of the following (i) 50% increase in baseline PSA, (ii) new Prostate Imaging-Reporting and Data System (PI-RADS) 4/5 lesion(s) on multi-parametric MRI where no previous lesion, (iii) 33% volume increase in lesion size, or radiological upstaging to ≥T3, (iv) ISUP Grade Group upgrade or (v) 50% increase in maximum cancer core length. Results Of 130 eligible patients, 104 (80%) accepted recruitment from seven sites over 12 months, of which 94 patients represented the per protocol population receiving treatment. Prolaris® testing was performed on 76/94 (81%) diagnostic biopsies. Twelve-month disease progression rate was 43.3%. Assessable 12-month treatment adherence in non-progressing patients to aspirin and vitamin D across all treatment arms was 91%. Two drug-attributable serious adverse events in 1 patient allocated to aspirin were identified. The study was not designed to determine differences between treatment arms. Conclusion Recruitment of AS PCa patients into a multi-centre multi-arm placebo-controlled RCT of minimally-toxic adjunctive oral drug treatments with molecular biomarker profiling is acceptable and safe. A larger phase III study is needed to determine optimal agents, intervention efficacy, and outcome-associated biomarkers.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Gregory L. Shaw
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Roseann Kealy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Present address:
Cancer Prevention Trial Unit, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK.
| | - Panos Alexandris
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Kier Finnegan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Kimberley Chu
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Nadia Haidar
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Sara Santos‐Vidal
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Sakunthala Kudahetti
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Caroline M. Moore
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
| | - Alistair D. R. Grey
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Daniel M. Berney
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Department of Cellular Pathology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Anju Sahdev
- Department of Radiology, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Paul J. Cathcart
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - R. Timothy D. Oliver
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Prabhakar Rajan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Jack Cuzick
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
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Expanding Active Surveillance Criteria for Low- and Intermediate-risk Prostate Cancer: Can We Accurately Predict the Risk of Misclassification for Patients Diagnosed by Multiparametric Magnetic Resonance Imaging–targeted Biopsy? Eur Urol Focus 2022; 9:298-302. [PMID: 36210296 DOI: 10.1016/j.euf.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022]
Abstract
Models predicting the risk of adverse pathology (ie, International Society of Urological Pathology [ISUP] grade group ≥3, pT3, and/or pN1) among patients operated by radical prostatectomy (RP) have been proposed to expand active surveillance (AS) inclusion criteria. We aimed to test these models in a set of 1062 low-risk and favorable intermediate-risk prostate cancer (PCa) patients diagnosed by multiparametric magnetic resonance imaging (MRI) and MRI-targeted biopsy. We hypothesized that the inclusion of radiological features into a novel model would improve patient selection. Performance was assessed using discrimination, calibration, and decision curve analysis (DCA). Available models were characterized by poor discrimination (areas under the receiver operating characteristic curve [AUCs] of 59% and 60%), underestimation of predicted risk on calibration plots, and a small amount of net benefit against a probability threshold of 40-50% at the DCA. The development of a novel model slightly improved discrimination (AUC of 63% vs 59%, p = 0.001, and 63% vs 60%, p = 0.07) and net benefit against threshold probabilities of ≥30%. This first multicenter study demonstrated the poor performance of models predicting adverse pathology and that implementation of MRI and MRI-targeted biopsy in this setting was not associated with a clear improvement in patient selection. Patients harboring low-risk or favorable intermediate-risk PCa and candidates for RP cannot be referred accurately to an AS program without a non-negligible risk of misclassification. PATIENT SUMMARY: We tested prediction models that could expand the selection of prostate cancer patients for active surveillance. Models were inaccurate and associated with a high risk of misclassification despite the implementation of multiparametric magnetic resonance imaging and targeted biopsies.
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Which men with non-malignant pathology at magnetic resonance imaging-targeted prostate biopsy and persistent PI-RADS 3-5 lesions should repeat biopsy? Urol Oncol 2022; 40:452.e9-452.e16. [DOI: 10.1016/j.urolonc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
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Risk of progression following a negative biopsy in prostate cancer active surveillance. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00582-x. [PMID: 36008540 DOI: 10.1038/s41391-022-00582-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression (>33% positive cores), and serious upgrading (grade group >2) for negative compared with positive findings on initial follow-up biopsy. METHODS 13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1-2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies. RESULTS 27% of the cohort (n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45; 95% confidence interval [CI]: 0.42-0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52; 95%CI: 0.45-0.62) and serious upgrading (OR: 0.74; 95%CI: 0.59-92). Radiological progression was not assessed due to limited imaging data. CONCLUSION Despite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.
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Ayoub CH, El-Asmar JM, Abou Heidar NF, Najm N, Nasrallah AA, Tamim H, Dakik HA, El Hajj A. A novel radical prostatectomy specific index (PSI) for the prediction of major cardiovascular events following surgery. Int Urol Nephrol 2022; 54:3069-3078. [PMID: 35982275 DOI: 10.1007/s11255-022-03293-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate cancer patients tend to be older with multiple comorbidities and are thus at increased risk for postoperative cardiovascular events after radical prostatectomy (RP). Thus, proper patient selection strategies are essential to decide for or against a surgical approach. We aimed to derive a prostatectomy specific index (PSI) for patients undergoing RP and compare its performance to universally used indices. METHODS The cohort was derived from National Surgical Quality Improvement Program database between 2005 and 2012. The primary outcome was incidence of major adverse cardiovascular events at 30 days post-surgery including: death, myocardial infarction, or stroke. A multivariable logistic regression model was constructed, performance and calibration were evaluated using a ROC analysis and the Hosmer-Lemeshow test, the PSI index was derived and compared to the RCRI and AUB-HAS2 indices. RESULTS A total of 17,299 patients were included in our cohort, with a mean age of 62 ± 7.4 years. Seventy three patients had a cardiac event post RP. The final PSI index encompassed six variables: history of heart disease, age, anemia, American society of anesthesiology class, surgical approach, and hypertension. The PSI ROC analysis provided C-statistic = 0.72, calibration R2 = 0.99 and proper goodness of fit. In comparison, the C-statistics of RCRI and AUB-HAS2 were found to be 0.57 and 0.65, respectively (p value < 0.001). CONCLUSION The PSI model is a procedure tailored index for prediction of major cardiovascular events post RP. It was calibrated using a large national database aiming to optimize treatment selection strategies for prostate cancer patients.
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Affiliation(s)
- Christian H Ayoub
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Nicolas Najm
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Ali A Nasrallah
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
| | - Habib A Dakik
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
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Chang SD, Reinhold C, Kirkpatrick IDC, Clarke SE, Schieda N, Hurrell C, Cool DW, Tunis AS, Alabousi A, Diederichs BJ, Haider MA. Canadian Association of Radiologists Prostate MRI White Paper. Can Assoc Radiol J 2022; 73:626-638. [PMID: 35971326 DOI: 10.1177/08465371221105532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.
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Affiliation(s)
- Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Nicola Schieda
- Department of Diagnostic Imaging, The Ottawa Hospital- Civic Campus, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Derek W Cool
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Adam S Tunis
- Department of Medical Imaging, University of Toronto, North York General Hospital, Toronto, ON, Canada
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Masoom A Haider
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Silva Gaspar SR, Fernandes M, Castro A, Oliveira T, Santos Dias J, Palma Dos Reis J. Active surveillance protocol in prostate cancer in Portugal. Actas Urol Esp 2022; 46:329-339. [PMID: 35277378 DOI: 10.1016/j.acuroe.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/16/2020] [Accepted: 01/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To examine clinical practice patterns in locally managing patients under an active surveillance protocol among Portuguese urologists. INTRODUCTION Prostate cancer (PCa) is a heterogeneous disease with many prostate adenocarcinomas being indolent and a low probability of ever causing symptoms or death. Active surveillance (AS) is a form of conservative management aimed to reduce over-treatment for low-risk PCa patients. Over the years, experience with AS has grown considerably and is now standard in some countries, however a universal protocol still does not exist. METHODS Nationwide anonymous e-survey concerning habits and practices on AS among Portuguese urologists, that consisted of twelve questions and was sent electronically to all 368 current members of the Portuguese Urological Association. RESULTS 56 urologists were surveyed (15.21% answer rate), evenly distributed geographically and allocated according to years of experience as well as number of PCa patients managed monthly. The vast majority of respondents recommends AS to their patients, particularly ISUP grade 1 patients, whose PSA serum level is bellow 20 ng/mL. Observance of AS programs by patients was not in question but concerns exist over psychological morbidity while harboring disease. Majority believed that international guidelines surveillance protocols were adequate and sufficient, but there are some constraints concerning availability of periodic MRIs and re-biopsy needs. CONCLUSIONS AS seems to be sustained in urologist clinical practice, although patients still lag to adhere and choose for active treatment. AS may not be an easy choice for patients and clinicians due to uncertainty of disease progression, risk of loss to follow-up and repeated biopsies but is also a cause for anxiety, depression, uncertainty and a perception of danger.
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Affiliation(s)
- S R Silva Gaspar
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - M Fernandes
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - A Castro
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - T Oliveira
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - J Santos Dias
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - J Palma Dos Reis
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Epstein JI, Kibel AS. Renaming Gleason Score 6 Prostate to Noncancer: A Flawed Idea Scientifically and for Patient Care. J Clin Oncol 2022; 40:3106-3109. [PMID: 35767801 DOI: 10.1200/jco.22.00926] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jonathan I Epstein
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital and Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
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Fiard G, Giganti F. How MRI is changing prostate cancer management: a focus on early detection and active surveillance: Comment l'IRM est en train de révolutionner la prise en charge du cancer de la prostate : focus sur la détection précoce et la surveillance active. Prog Urol 2022; 32:6S19-6S25. [PMID: 36719642 DOI: 10.1016/s1166-7087(22)00171-3] [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] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The last decade has witnessed major changes in prostate cancer management. Among these, the advent of magnetic resonance imaging (MRI), by allowing the visualisation of the cancerous lesion inside the prostatic gland, opened new management horizons. MATERIAL AND METHODS We conducted a narrative review of the literature published since 2010, focusing on the place of MRI in the early detection, active surveillance and prostate cancer screening settings. RESULTS Multiparametric magnetic resonance imaging (mpMRI), interpreted using the PI-RADS scoring system, has allowed a shift from systematic to mpMRI-targeted biopsies, supported by level I evidence. Studies are ongoing to evaluate the role of MRI as a triage and screening tool. The integration of mpMRI has allowed for a better selection of active surveillance candidates, reducing the risk of misclassification. The PRECISE recommendations have been created to assess the likelihood of radiological change over time from the previous or baseline mpMRI scan, and serial mpMRI appears promising to reduce the need for repeat biopsy in active surveillance. CONCLUSION Growing evidence supports the use of MRI at all stages of the prostate cancer pathway, relying on images of optimal diagnostic quality and experience in prostate MRI reporting and biopsy targeting. © 2022 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- G Fiard
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
| | - F Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
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Jaipuria J, Ahmed HU. Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer. Curr Opin Urol 2022; 32:224-230. [PMID: 35184067 DOI: 10.1097/mou.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Focal therapy or partial gland ablation for nonmetastatic prostate cancer is gaining popularity not just as an alternative to active surveillance, but as an acceptable alternative to whole gland therapy in appropriate cases. This review summarizes recent evidence to help select patients for optimal outcomes. RECENT FINDINGS Recommendations by expert panels have become less conservative with each meeting. As experience with older modalities for focal therapy grows, newer modalities continue to be introduced. We are now in a position to offer personalized treatment pathway considering nuances of each focal therapy modality. SUMMARY The ideal case for focal therapy should be an MRI visible significant lesion (PIRADS score ≥ 3), with a positive biopsy for significant cancer (Gleason grade group 2-3) in the corresponding targeted biopsy area, and insignificant or absent disease in the nontarget random biopsy areas. Multifocal disease can also be selectively treated. Salvage focal ablation is an attractive treatment option for radio-recurrent or index focal therapy failure cases.
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Affiliation(s)
- Jiten Jaipuria
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
| | - Hashim U Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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No significant difference in intermediate key outcomes in men with low- and intermediate-risk prostate cancer managed by active surveillance. Sci Rep 2022; 12:6743. [PMID: 35468921 PMCID: PMC9039068 DOI: 10.1038/s41598-022-10741-8] [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] [Received: 12/07/2021] [Accepted: 04/04/2022] [Indexed: 11/08/2022] Open
Abstract
Active surveillance (AS) is standard of care for patients with low-risk prostate cancer (PCa), but its feasibility in intermediate-risk patients is controversial. We compared outcomes of low- and intermediate-risk patients managed with multiparametric magnetic resonance imaging (mpMRI)-supported AS in a community hospital. Of the 433 patients enrolled in AS between 2009 and 2016, 358 complied with AS inclusion criteria (Cancer of the Prostate Risk Assessment (CAPRA) score ≤ 5, Gleason grade group (GGG) ≤ 2, clinical stage ≤ cT2 and prostate-specific antigen (PSA) ≤ 20 ng/ml) and discontinuation criteria (histological-, PSA-, clinical- or radiological disease reclassification). Of the 358 patients, 177 (49%) were low-risk and 181 (51%) were intermediate-risk. Median follow-up was 4.2 years. The estimated 5-year treatment-free survival (TFS) was 56% (95% confidence interval [CI] 51-62%). Intermediate-risk patients had significantly shorter TFS compared with low-risk patients (hazard ratio 2.01, 95% CI 1.47-2.76, p < 0.001). There were no statistically significant differences in the rate of adverse pathology, biochemical recurrence-free survival and overall survival between low- and intermediate-risk patients. Two patients developed metastatic disease and three died of PCa. These results suggest that selected patients with intermediate-risk PCa may be safely managed by mpMRI-supported AS, but longer follow-up is necessary.
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The current role of MRI for guiding active surveillance in prostate cancer. Nat Rev Urol 2022; 19:357-365. [PMID: 35393568 DOI: 10.1038/s41585-022-00587-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 01/13/2023]
Abstract
Active surveillance (AS) is the recommended treatment option for low-risk and favourable intermediate-risk prostate cancer management, preserving oncological and functional outcomes. However, active monitoring using relevant parameters in addition to the usual clinical, biological and pathological considerations is necessary to compensate for initial undergrading of the tumour or to detect early progression without missing the opportunity to provide curative therapy. Indeed, several studies have raised concerns about inadequate biopsy sampling at diagnosis. However, the implementation of baseline MRI and targeted biopsy have led to improved initial stratification of low-risk disease; baseline MRI correlates well with disease characteristics and AS outcomes. The use of follow-up MRI during the surveillance phase also raises the question of the requirement for serial biopsies in the absence of radiological progression and the possibility of using completely MRI-based surveillance, with triggers for biopsies based solely on MRI findings. This concept of a tailored-risk, imaging-based monitoring strategy is aimed at reducing invasive procedures. However, the abandonment of serial biopsies in the absence of MRI progression can probably not yet be recommended in routine practice, as the data from real-life cohorts are heterogeneous and inconclusive. Thus, the evolution towards a routine, fully MRI-guided AS pathway has to be preceded by ensuring quality programme assessment for MRI reading and by demonstrating its safety in prospective trials.
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Giganti F, Stavrinides V, Moore CM. Magnetic Resonance Imaging–guided Active Surveillance of Prostate Cancer: Time to Say Goodbye to Protocol-based Biopsies. EUR UROL SUPPL 2022; 38:40-43. [PMID: 35243397 PMCID: PMC8885616 DOI: 10.1016/j.euros.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
Traditional protocols for active surveillance (AS) are commonly based on digital rectal examination, prostate-specific antigen (PSA), and standard transrectal biopsy, meaning that initial classification errors and inaccurate lesion monitoring can occur. Protocol-based biopsies are performed to assess changes in cancer grade and extent at prespecified intervals, but this approach represents a barrier to AS adherence and tolerability. There is evidence to support the use of magnetic resonance imaging (MRI) during AS, as this technique (associated with favourable PSA kinetics) offers an opportunity to follow patients on AS without the need for routine, protocol-based biopsies in the absence of signs of radiological progression provided that image quality, interpretation, and reporting of serial imaging are of the highest standards. Patient summary In this report we looked at the role of magnetic resonance imaging (MRI) scans in avoiding unnecessary prostate biopsies for patients being monitored for low- or intermediate-risk prostate cancer. We conclude that patients on active surveillance can be monitored with MRI scans over time and that biopsies could be used only when there are changes on MRI or a rising prostate-specific antigen (PSA) not explained by an increase in prostate size.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
- Corresponding author at: Division of Surgery & Interventional Science, University College London, London, UK.
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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There Is No Longer a Role for Systematic Biopsies in Prostate Cancer Diagnosis. EUR UROL SUPPL 2022; 38:12-13. [PMID: 35199041 PMCID: PMC8844398 DOI: 10.1016/j.euros.2022.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/26/2022] Open
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Kinnaird A, Yerram NK, O’Connor L, Brisbane W, Sharma V, Chuang R, Jayadevan R, Ahdoot M, Daneshvar M, Priester A, Delfin M, Tran E, Barsa DE, Sisk A, Reiter RE, Felker E, Raman S, Kwan L, Choyke PL, Merino MJ, Wood BJ, Turkbey B, Pinto PA, Marks LS. Magnetic Resonance Imaging-Guided Biopsy in Active Surveillance of Prostate Cancer. J Urol 2022; 207:823-831. [PMID: 34854746 PMCID: PMC10506469 DOI: 10.1097/ju.0000000000002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. Our study was designed to determine the prostate cancer upgrading rate when biopsy guided by magnetic resonance imaging (MRGBx) is used before entry and during AS. MATERIALS AND METHODS The cohort included 519 men with low- or intermediate-risk prostate cancer who enrolled in prospective studies (NCT00949819 and NCT00102544) between February 2008 and February 2020. Subjects were preliminarily diagnosed with Gleason Grade Group (GG) 1 cancer; AS began when subsequent MRGBx confirmed GG1 or GG2. Participants underwent confirmatory MRGBx (targeted and systematic) followed by surveillance MRGBx approximately every 12 to 24 months. The primary outcome was tumor upgrading to ≥GG3. RESULTS Upgrading to ≥GG3 was found in 92 men after a median followup of 4.8 years (IQR 3.1-6.5) after confirmatory MRGBx. Upgrade-free probability after 5 years was 0.85 (95% CI 0.81-0.88). Cancer detected in a magnetic resonance imaging lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS (HR 2.8; 95% CI 1.3-6.0), as did presence of GG2 (HR 2.9; 95% CI 1.1-8.2) In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25% and both in 47%. In 63 men undergoing prostatectomy, upgrading from MRGBx was found in only 5 (8%). CONCLUSIONS When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within a magnetic resonance imaging lesion or when pathology is GG2 than when these features are absent.
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Affiliation(s)
- Adam Kinnaird
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Edmonton, Alberta, Canada
- Cancer Research Institute of Northern Alberta (CRINA),Edmonton, Alberta, Canada
| | - Nitin K. Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Luke O’Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Wayne Brisbane
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Vidit Sharma
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ryan Chuang
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Rajiv Jayadevan
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan Priester
- Department of Bioengineering, UCLA, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Elizabeth Tran
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Danielle E. Barsa
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Anthony Sisk
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, California
| | - Robert E. Reiter
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Ely Felker
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Steve Raman
- Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J. Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Leonard S. Marks
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, California
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