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Xu S, Zhang G, Zhang J, Liu W, Wang Y, Fu X. Advances in Brain Tumor Therapy Based on the Magnetic Nanoparticles. Int J Nanomedicine 2023; 18:7803-7823. [PMID: 38144513 PMCID: PMC10749175 DOI: 10.2147/ijn.s444319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023] Open
Abstract
Brain tumors, including primary gliomas and brain metastases, are one of the deadliest tumors because effective macromolecular antitumor drugs cannot easily penetrate the blood-brain barrier (BBB) and blood-brain tumor barrier (BTB). Magnetic nanoparticles (MNPs) are considered the most suitable nanocarriers for the delivery of brain tumor drugs because of their unique properties compared to other nanoparticles. Numerous preclinical and clinical studies have demonstrated the potential of these nanoparticles in magnetic targeting, nuclear magnetic resonance, magnetic thermal therapy, and ultrasonic hyperthermia. To further develop and optimize MNPs for the diagnosis and treatment of brain tumors, we attempt to outline recent advances in the use of MNPs to deliver drugs, with a particular focus on their efficacy in the delivery of anti-brain tumor drugs based on magnetic targeting and low-intensity focused ultrasound, magnetic resonance imaging for surgical real-time guidance, and magnetothermal and ultrasonic hyperthermia therapy. Furthermore, we summarize recent findings on the clinical application of MNPs and the research limitations that need to be addressed in clinical translation.
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Affiliation(s)
- Songbai Xu
- Department of Neurosurgery, Department of Obstetrics, Obstetrics and Gynaecology Center, the First Hospital Jilin University, Changchun, People’s Republic of China
| | - Guangxin Zhang
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jiaomei Zhang
- Department of Neurosurgery, Department of Obstetrics, Obstetrics and Gynaecology Center, the First Hospital Jilin University, Changchun, People’s Republic of China
| | - Wei Liu
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yicun Wang
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xiying Fu
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
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2
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Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, Manuel GGD, Aisian I, Servian P, Abascal JM. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers (Basel) 2023; 15:4543. [PMID: 37760511 PMCID: PMC10526349 DOI: 10.3390/cancers15184543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/16/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721-0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, 08907 Hospitalet de Llobregat, Spain;
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain;
| | | | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | | | - Ignacio Aisian
- Department of Urology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain;
- Department of Medicine and Health Science, Universitat Pompeu Fabra, 08003 Barcelona, Spain
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3
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Paesano N, Catalá V, Tcholakian L, Trilla E, Morote J. A Systematic Review of the Current Status of Magnetic Resonance-Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies. Cancers (Basel) 2023; 15:3329. [PMID: 37444439 DOI: 10.3390/cancers15133329] [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: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Given this new context, our objective is to recognize the suitability of the currently available software for image fusion and the reported series using the transperineal route, as well as to generate new evidence on the complementarity of the directed and systematic biopsies, which has been established through the transrectal approach. EVIDENCE ACQUISITION This systematic review, registered in Prospero (CRD42022375619), began with a bibliographic search that was carried out in PubMed, Cochrane, and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and the studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy were followed. Warp analysis of selected studies was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. In addition, a Google search of all currently available fusion platforms was performed. Our Google search found 11 different commercially available robots to perform transperineal image fusion biopsies, of which 10 devices have published articles supporting their diagnostic effectiveness in transperineal prostate biopsies. RESULTS A total of 30 articles were selected and the characteristics and results of the biopsies of 11,313 patients were analyzed. The pooled mean age was 66.5 years (63-69). The mean pooled PSA level was 7.8 ng/mL (5.7-10.8). The mean pooled prostate volume was 45.4 cc. (34-56). The mean pooled PSA density was 0.17 (0.12-0.27). The overall cancer detection rate for all prostate cancers was 61.4%, while for csPCa it was 47.8%. PCa detection rate was more effective than that demonstrated in the systematic transrectal biopsy. However, the detection of csPCa in the systematic biopsy was only 9.5% in the reported series. To standardize our review, we grouped prostate cancer screening results according to the population studied and the software used. When the same populations were compared between elastic and rigid software, we found that rigid biopsies had a higher csPCa detection rate than biopsies with elastic fusion systems. CONCLUSION Platforms performing prostate biopsy using transperineal image fusion have better detection rates of csPCa than systematic transrectal biopsies. Rigid fusion systems have a better csPCa detection rate than elastic ones. We found no diagnostic differences between the different types of robotic systems currently available. The complementarity of systematic biopsy has also been demonstrated in transperineal imaging fusion biopsies.
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Affiliation(s)
| | | | | | - Enric Trilla
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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4
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Yu R, Jiang KW, Bao J, Hou Y, Yi Y, Wu D, Song Y, Hu CH, Yang G, Zhang YD. PI-RADS AI: introducing a new human-in-the-loop AI model for prostate cancer diagnosis based on MRI. Br J Cancer 2023; 128:1019-1029. [PMID: 36599915 PMCID: PMC10006083 DOI: 10.1038/s41416-022-02137-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aims to develop and validate an artificial intelligence (AI)-aided Prostate Imaging Reporting and Data System (PI-RADSAI) for prostate cancer (PCa) diagnosis based on MRI. METHODS The deidentified MRI data of 1540 biopsy-naïve patients were collected from four centres. PI-RADSAI is a two-stage, human-in-the-loop AI capable of emulating the diagnostic acumen of subspecialists for PCa on MRI. The first stage uses a UNet-Seg model to detect and segment biopsy-candidate prostate lesions, whereas the second stage leverages UNet-Seg segmentation is trained specifically with subspecialist' knowledge-guided 3D-Resnet to achieve an automatic AI-aided diagnosis for PCa. RESULTS In the independent test set, UNet-Seg identified 87.2% (628/720) of target lesions, with a Dice score of 44.9% (range, 22.8-60.2%) in segmenting lesion contours. In the ablation experiment, the model trained with the data from three centres was superior (kappa coefficient, 0.716 vs. 0.531) to that trained with single-centre data. In the internal and external tests, the triple-centre PI-RADSAI model achieved an overall agreement of 58.4% (188/322) and 60.1% (92/153) with a referential subspecialist in scoring target lesions; when one-point margin of error was permissible, the agreement rose to 91.3% (294/322) and 97.3% (149/153), respectively. In the paired test, PI-RADSAI outperformed 5/11 (45.5%) and matched the performance of 3/11 (27.3%) general radiologists in achieving a clinically significant PCa diagnosis (area under the curve, internal test, 0.801 vs. 0.770, p < 0.01; external test, 0.833 vs. 0.867, p = 0.309). CONCLUSIONS Our closed-loop PI-RADSAI outperforms or matches the performance of more than 70% of general readers in the MRI assessment of PCa. This system might provide an alternative to radiologists and offer diagnostic benefits to clinical practice, especially where subspecialist expertise is unavailable.
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Affiliation(s)
- Ruiqi Yu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663N. Zhongshan Rd., 20062, Shanghai, China
| | - Ke-Wen Jiang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300N, Guangzhou Rd., 210029, Nanjing, Jiangsu Province, China
| | - Jie Bao
- Department of Radiology, the First Affiliated Hospital of Soochow University, 899N, Pinghai Rd., 215006, Suzhou, China
| | - Ying Hou
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300N, Guangzhou Rd., 210029, Nanjing, Jiangsu Province, China
| | - Yinqiao Yi
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663N. Zhongshan Rd., 20062, Shanghai, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663N. Zhongshan Rd., 20062, Shanghai, China
| | - Yang Song
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663N. Zhongshan Rd., 20062, Shanghai, China
| | - Chun-Hong Hu
- Department of Radiology, the First Affiliated Hospital of Soochow University, 899N, Pinghai Rd., 215006, Suzhou, China.
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663N. Zhongshan Rd., 20062, Shanghai, China.
| | - Yu-Dong Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300N, Guangzhou Rd., 210029, Nanjing, Jiangsu Province, China.
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5
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Connor MJ, Gorin MA, Eldred-Evans D, Bass EJ, Desai A, Dudderidge T, Winkler M, Ahmed HU. Landmarks in the evolution of prostate biopsy. Nat Rev Urol 2023; 20:241-258. [PMID: 36653670 DOI: 10.1038/s41585-022-00684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/19/2023]
Abstract
Approaches and techniques used for diagnostic prostate biopsy have undergone considerable evolution over the past few decades: from the original finger-guided techniques to the latest MRI-directed strategies, from aspiration cytology to tissue core sampling, and from transrectal to transperineal approaches. In particular, increased adoption of transperineal biopsy approaches have led to reduced infectious complications and improved antibiotic stewardship. Furthermore, as image fusion has become integral, these novel techniques could be incorporated into prostate biopsy methods in the future, enabling 3D-ultrasonography fusion reconstruction, molecular targeting based on PET imaging and autonomous robotic-assisted biopsy.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Ankit Desai
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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6
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Zhang Y, Liu L, Li W, Zhang C, Song T, Wang P, Sun D, Huang X, Qin X, Ran L, Tian G, Qian J, Zhang G. PDGFB-targeted functional MRI nanoswitch for activatable T 1-T 2 dual-modal ultra-sensitive diagnosis of cancer. J Nanobiotechnology 2023; 21:9. [PMID: 36609374 PMCID: PMC9824934 DOI: 10.1186/s12951-023-01769-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
As one of the most significant imaging modalities currently available, magnetic resonance imaging (MRI) has been extensively utilized for clinically accurate cancer diagnosis. However, low signal-to-noise ratio (SNR) and low specificity for tumors continue to pose significant challenges. Inspired by the distance-dependent magnetic resonance tuning (MRET) phenomenon, the tumor microenvironment (TME)-activated off-on T1-T2 dual-mode MRI nanoswitch is presented in the current study to realize the sensitive early diagnosis of tumors. The tumor-specific nanoswitch is designed and manufactured on the basis of PDGFB-conjugating ferroferric oxide coated by Mn-doped silica (PDGFB-FMS), which can be degraded under the high-concentration GSH and low pH in TME to activate the T1-T2 dual-mode MRI signals. The tumor-specific off-on dual-mode MRI nanoswitch can significantly improve the SNR and is used successfully for the accurate diagnosis of early-stage tumors, particularly for orthotopic prostate cancer. In addition, the systemic delivery of the nanoswitch did not cause blood or tissue damage, and it can be excreted out of the body in a timely manner, demonstrating excellent biosafety. Overall, the strategy is a significant step in the direction of designing off-on dual-mode MRI nanoprobes to improve imaging accuracy, which opens up new avenues for the development of new MRI probes.
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Affiliation(s)
- Ya’nan Zhang
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.9227.e0000000119573309Hefei Cancer Hospital, Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031 People’s Republic of China
| | - Lu Liu
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Wenling Li
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Caiyun Zhang
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Tianwei Song
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Peng Wang
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Daxi Sun
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Xiaodan Huang
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Xia Qin
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Lang Ran
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Geng Tian
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China
| | - Junchao Qian
- grid.9227.e0000000119573309Hefei Cancer Hospital, Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031 People’s Republic of China ,grid.410587.fDepartment of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 Shandong China
| | - Guilong Zhang
- grid.440653.00000 0000 9588 091XSchool of Medical Imaging, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, 264003 People’s Republic of China ,grid.440653.00000 0000 9588 091XSchool of Pharmacy, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003 People’s Republic of China
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7
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Muacevic A, Adler JR, Macaluso JN, Venkataraman SS, Adams J, Nacev AN, Kumar D. Advantageous Detection of Significant Prostate Cancer Using a Low-Field, Office-Based MRI System. Cureus 2022; 14:e32105. [PMID: 36601170 PMCID: PMC9805358 DOI: 10.7759/cureus.32105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Methods to diagnose prostate cancer (PCa), a highly prevalent disease, remain inadequate in terms of accuracy, cost, and logistical constraints for both patients and providers. Early and accurate detection of PCa is crucial to patient management, most notably in increasing quality of life and lowering cost burdens when considering the associated treatment and follow-up pathways. This article aims to discuss the impact to care pathways for nine patients whose PCa was detected by a novel Food and Drug Administration-cleared low-field magnetic resonance imager (MRI) for transperineal PCa interventions but was missed by standard-of-care systematic transrectal ultrasound (TRUS). Methodology From December 2020 to March 2022, 41 men with elevated prostate-specific antigen (PSA) levels, positive digital rectal exam findings, and Prostate Imaging Reporting & Data System scores of three or higher were enrolled. Patients first underwent targeted transperineal biopsy guided by a low-field MRI (MRIgTBx) and co-registered with T2-weighted images from a pre-procedural 3-T MRI with suspicious lesions annotated by a board-certified radiologist. Following this procedure, patients underwent standard-of-care systematic transrectal ultrasound-guided biopsy (TRUSgSBx). The entire procedure was supervised by a board-certified urologist. Results Of the 41 enrolled patients, both MRIgTBx and TRUSgSBx biopsies detected PCa in 20 patients. MRIgTBx detected PCa in an additional nine patients that were missed by TRUSgSBx. Five of the nine patients elected to pursue immediate treatment. Patients with suspected PCa and a negative biopsy return to the clinic every three to six months for PSA tests, with additional biopsies performed every year for cases with increasing PSA levels. Conclusions Early detection of PCa in nine of the 41 patients using a novel MRIgTBx method has allowed for change management resulting in an improved quality of life and cost saving for those who opted for immediate treatment. Early intervention in cases where the standard-of-care TRUSgSBx treatment was falsely negative ultimately led to a decrease in additional screening procedures, biopsies, associated tests, and an improved pathway for patient management.
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8
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Jiang KW, Song Y, Hou Y, Zhi R, Zhang J, Bao ML, Li H, Yan X, Xi W, Zhang CX, Yao YF, Yang G, Zhang YD. Performance of Artificial Intelligence-Aided Diagnosis System for Clinically Significant Prostate Cancer with MRI: A Diagnostic Comparison Study. J Magn Reson Imaging 2022; 57:1352-1364. [PMID: 36222324 DOI: 10.1002/jmri.28427] [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: 05/24/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The high level of expertise required for accurate interpretation of prostate MRI. PURPOSE To develop and test an artificial intelligence (AI) system for diagnosis of clinically significant prostate cancer (CsPC) with MRI. STUDY TYPE Retrospective. SUBJECTS One thousand two hundred thirty patients from derivation cohort between Jan 2012 and Oct 2019, and 169 patients from a publicly available data (U-Net: 423 for training/validation and 49 for test and TrumpeNet: 820 for training/validation and 579 for test). FIELD STRENGTH/SEQUENCE 3.0T/scanners, T2 -weighted imaging (T2 WI), diffusion-weighted imaging, and apparent diffusion coefficient map. ASSESSMENT Close-loop AI system was trained with an Unet for prostate segmentation and a TrumpetNet for CsPC detection. Performance of AI was tested in 410 internal and 169 external sets against 24 radiologists categorizing into junior, general and subspecialist group. Gleason score >6 was identified as CsPC at pathology. STATISTICAL TESTS Area under the receiver operating characteristic curve (AUC-ROC); Delong test; Meta-regression I2 analysis. RESULTS In average, for internal test, AI had lower AUC-ROC than subspecialists (0.85 vs. 0.92, P < 0.05), and was comparable to junior (0.84, P = 0.76) and general group (0.86, P = 0.35). For external test, both AI (0.86) and subspecialist (0.86) had higher AUC than junior (0.80, P < 0.05) and general reader (0.83, P < 0.05). In individual, it revealed moderate diagnostic heterogeneity in 24 readers (Mantel-Haenszel I2 = 56.8%, P < 0.01), and AI outperformed 54.2% (13/24) of readers in summary ROC analysis. In multivariate test, Gleason score, zonal location, PI-RADS score and lesion size significantly impacted the accuracy of AI; while effect of data source, MR device and parameter settings on AI performance is insignificant (P > 0.05). DATA CONCLUSION Our AI system can match and to some case exceed clinicians for the diagnosis of CsPC with prostate MRI. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ke-Wen Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.,AI Imaging Lab, Medical Imaging College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yang Song
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, People's Republic of China
| | - Ying Hou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.,AI Imaging Lab, Medical Imaging College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Rui Zhi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.,AI Imaging Lab, Medical Imaging College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.,AI Imaging Lab, Medical Imaging College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Mei-Ling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Hai Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthcare, Shanghai, People's Republic of China
| | - Wei Xi
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, People's Republic of China
| | - Cheng-Xiu Zhang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, People's Republic of China
| | - Ye-Feng Yao
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, People's Republic of China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, People's Republic of China
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.,AI Imaging Lab, Medical Imaging College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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9
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O'Shea A, Harisinghani M. PI-RADS: multiparametric MRI in prostate cancer. MAGMA (NEW YORK, N.Y.) 2022; 35:523-532. [PMID: 35596009 DOI: 10.1007/s10334-022-01019-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Multiparametric MRI of the prostate gland has become the initial evaluation of biopsy naïve men with a clinical suspicion for prostate cancer. PI-RADS 2.1 is a joint initiative and framework for prostate MRI acquisition and reporting, which aims to standardize technique and interpretation across centers. Building upon experience accrued following the introduction of PI-RADS 2.0, version 2.1 provides key updates and important clarifications, although it is intended to be an active document, which continues to be updated. Continued advances in our understanding of prostate cancer and progress in imaging technology will undoubtedly shape future iterations of the reporting system.
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Affiliation(s)
- Aileen O'Shea
- Department of Radiology, 55 Fruit Street, Boston, MA, 02115, USA.
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10
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Stimuli-controllable iron oxide nanoparticle assemblies: Design, manipulation and bio-applications. J Control Release 2022; 345:231-274. [DOI: 10.1016/j.jconrel.2022.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/07/2023]
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11
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Kasivisvanathan V, Chan VWS, Clement KD, Levis B, Haider M, Agarwal R, Emberton M, Pond GR, Takwoingi Y, Klotz L, Moore CM. A protocol for the VISION study: An indiVidual patient data meta-analysis of randomised trials comparing MRI-targeted biopsy to standard transrectal ultraSound guided bIopsy in the detection of prOstate cancer. PLoS One 2022; 17:e0263345. [PMID: 35113918 PMCID: PMC8812968 DOI: 10.1371/journal.pone.0263345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023] Open
Abstract
Background Transrectal ultrasound (TRUS) guided biopsy for prostate cancer is prone to random and systemic error and has been shown to have a negative predictive value of 70%. PRECISION and PRECISE are among the first randomised studies to evaluate the new MRI-targeted biopsy (MRI-TB) pathway with a non-paired design to detect clinically significant prostate cancer and avoid unnecessary treatment. The trials’ results individually demonstrated non-inferiority of MRI-TB compared to TRUS biopsy. An individual patient data (IPD) meta-analysis was planned from the outset of the two trials in parallel and this IPD meta-analysis aims to further elucidate the utility of MRI-TB as the optimal diagnostic pathway for prostate cancer. Methods and materials This study is registered on PROSPERO (CRD42021249263). A search of Medline, Embase, Cochrane Central Register of Registered Trials (CENTRAL), Web of Science, and ClinicalTrials.gov was performed up until 4th February 2021. Only randomised controlled trials (PRECISE, PRECISION and other eligible trials) comparing the MRI-targeted biopsy pathway and traditional TRUS biopsy pathway will be included. The primary outcome of the review is the proportion of men diagnosed with clinically significant prostate cancer in each arm (Gleason ≥ 3+4 = 7). IPD and study-level data and characteristics will be sought from eligible studies. Analyses will be done primarily using an intention-to-treat approach, and a one-step IPD meta-analysis will be performed using generalised linear mixed models. A non-inferiority margin of 5 percentage points will be used. Heterogeneity will be quantified using the variance parameters from the mixed model. If there is sufficient data, we will investigate heterogeneity by exploring the effect of the different conducts of MRIs, learning curves of MRI reporting and MRI targeted biopsies. Trial registration This systematic review is registered on PROSPERO (CRD42021249263)
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Affiliation(s)
- Veeru Kasivisvanathan
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- Department of Urology, University College London Hospitals Trust, London, United Kingdom
- * E-mail:
| | - Vinson Wai-Shun Chan
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Keiran D. Clement
- Department of Urology, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Masoom Haider
- Toronto General Hospital, Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Ridhi Agarwal
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- Department of Urology, University College London Hospitals Trust, London, United Kingdom
- NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, United Kingdom
| | - Gregory R. Pond
- Department of Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caroline M. Moore
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- Department of Urology, University College London Hospitals Trust, London, United Kingdom
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12
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Mäkelä P, Anttinen M, Suomi V, Steiner A, Saunavaara J, Sainio T, Horte A, Taimen P, Boström P, Blanco Sequeiros R. Acute and subacute prostate MRI findings after MRI-guided transurethral ultrasound ablation of prostate cancer. Acta Radiol 2021; 62:1687-1695. [PMID: 33251811 DOI: 10.1177/0284185120976931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) is an emerging method for treatment of localized prostate cancer (PCa). TULSA-related subacute MRI findings have not been previously characterized. PURPOSE To evaluate acute and subacute MRI findings after TULSA treatment in a treat-and-resect setting. MATERIAL AND METHODS Six men with newly diagnosed MRI-visible and biopsy-concordant clinically significant PCa were enrolled and completed the study. Eight lesions classified as PI-RADS 3-5 were focally ablated using TULSA. One- and three-week follow-up MRI scans were performed between TULSA and robot-assisted laparoscopic prostatectomy. RESULTS TULSA-related hemorrhage was detected as a subtle T1 hyperintensity and more apparent T2 hypointensity in the MRI. Both prostate volume and non-perfused volume (NPV) markedly increased after TULSA at one week and three weeks after treatment, respectively. Lesion apparent diffusion coefficient values increased one week after treatment and decreased nearing the baseline values at the three-week MRI follow-up. CONCLUSION The optimal timing of MRI follow-up seems to be at the earliest at three weeks after treatment, when the post-procedural edema has decreased and the NPV has matured. Diffusion-weighted imaging has little or no added diagnostic value in the subacute setting.
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Affiliation(s)
- Pietari Mäkelä
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Visa Suomi
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Aida Steiner
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Teija Sainio
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Antero Horte
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Peter Boström
- Department of Urology, Turku University Hospital, Turku, Finland
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Clinically Significant Prostate Cancer Detection After A Negative Prebiopsy MRI Examination: Comparison of Biparametric Versus Multiparametric MRI. AJR Am J Roentgenol 2021; 218:859-866. [PMID: 34817189 DOI: 10.2214/ajr.21.26569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The frequency of clinically significant prostate cancer (csPCa) following negative biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) has not been well investigated in direct comparative studies. Objective: To compare the frequency of csPCa after negative prebiopsy bpMRI and mpMRI, and to evaluate factors that predict csPca in the two cohorts. Methods: This retrospective study included 232 men (mean age, 64.5 years) with negative bpMRI from August 2017 to March 2020 and193 men (mean age, 69.0 years) with negative mpMRI from January 2018 to December 2018, defining PI-RADS category of 1 or 2 as negative. Our institution offers bpMRI as a low-cost self-pay option for patients without insurer coverage of prebiospy mpMRI. Patient characteristics and subsequent biopsy results were recorded. csPCa was defined as Gleason score ≥3+4. Multivariable regression analyses were performed to identify independent predictors of csPCa. AUC of prostate specific antigen density (PSAD) for csPCA was computed, and diagnostic performance of PSAD was assessed at a clinically established threshold of 0.15 ng/mL2. Results: Systematic biopsy was performed after negative bpMRI in 41.4% (96/232), versus after negative mpMRI in 30.5% (59/193) (p=.02). Among those undergoing biopsy, csPCa was present in 15.6% (15/96) in the mpMRI cohort versus 13.6% (8/59) in the bpMRI cohort (p=.69). NPV for csPCa was 84% (81/96) for bpMRI and 86% (51/59) for mpMRI. In multivariable analyses, independent predictors of csPCa included smaller prostate volume (OR=0.27, p<.001) and greater PSAD (OR=3.09, p<.001). In multivariable models, bpMRI (compared with mpMRI) did not independently predict csPCa (p>.05). PSAD had AUC for csPCa of 0.77 (95% CI: 0.64, 0.89) in the bpMRI cohort versus 0.68 (95% CI: 0.42, 0.93) in the mpMRI cohort. For detecting csPCa, PSAD threshold of 0.15 ng/mL2 had NPV of 90% and PPV of 28%, in the bpMRI cohort, versus NPV of 92% and PPV of 44%in the mpMRI cohort. Conclusion: The frequency of csPCa was not significantly different on systematic biopsy performed after negative bpMRI and mpMRI examinations. PSAD had similar diagnostic utility for csPca in both cohorts. Clinical Impact: Either bpMRI or mpMRI, in combination with PSAD, can help avoid negative prostate biopsies.
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14
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Devetzis K, Kum F, Popert R. Recent Advances in Systematic and Targeted Prostate Biopsies. Res Rep Urol 2021; 13:799-809. [PMID: 34805013 PMCID: PMC8598205 DOI: 10.2147/rru.s291963] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
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Affiliation(s)
| | - Francesca Kum
- King's College School of Medicine, London, UK.,Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Richard Popert
- Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
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15
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LI ZH, QIAN K, Ozioma-Udochukwu A, PAN CS, MA XH, HAN YY, ZHENG JJ, CUI P, WEI G, SHEN ZY, WU AG. A Smart Glutathione and H2O2 Dual-Responsive Signal Inversion Magnetic Resonance Imaging Contrast Agent for Tumor Diagnosis. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2021. [DOI: 10.1016/s1872-2040(21)60111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Wee CW, Jang BS, Kim JH, Jeong CW, Kwak C, Kim HH, Ku JH, Kim SH, Cho JY, Kim SY. Prediction of Pathologic Findings with MRI-Based Clinical Staging Using the Bayesian Network Modeling in Prostate Cancer: A Radiation Oncologist Perspective. Cancer Res Treat 2021; 54:234-244. [PMID: 34015891 PMCID: PMC8756129 DOI: 10.4143/crt.2020.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/16/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to develop a model for predicting pathologic extracapsular extension (ECE) and seminal vesicle invasion (SVI) while integrating magnetic resonance imaging-based T-staging (cTMRI, cT1c-cT3b). Materials and Methods A total of 1,915 who underwent radical prostatectomy between 2006-2016 met the inclusion/exclusion criteria. We performed a multivariate logistic regression analysis as well as Bayesian network (BN) modeling based on possible confounding factors. The BN model was internally validated using 5-fold validation. Results According to the multivariate logistic regression analysis, initial prostate-specific antigen (iPSA) (β=0.050, p<0.001), percentage of positive biopsy cores (PPC) (β=0.033, p<0.001), both lobe involvement on biopsy (β=0.359, p=0.009), Gleason score (β=0.358, p<0.001), and cTMRI (β=0.259, p<0.001) were significant factors for ECE. For SVI, iPSA (β=0.037, p<0.001), PPC (β=0.024, p<0.001), GS (β=0.753, p<0.001), and cTMRI (β=0.507, p<0.001) showed statistical significance. BN models to predict ECE and SVI were also successfully established. The overall AUC/accuracy of the BN models were 0.76/73.0% and 0.88/89.6% for ECE and SVI, respectively. According to internal comparison between the BN model and Roach formula, BN model had improved AUC values for predicting ECE (0.76 vs. 0.74; p=0.060) and SVI (0.88 vs. 0.84, p<0.001). Conclusion wo models to predict pathologic ECE and SVI integrating cTMRI were established and installed on a separate website for public access to guide radiation oncologists.
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Affiliation(s)
- Chan Woo Wee
- Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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17
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Initial phantom studies for an office-based low-field MR system for prostate biopsy. Int J Comput Assist Radiol Surg 2021; 16:741-748. [PMID: 33891253 PMCID: PMC8134310 DOI: 10.1007/s11548-021-02364-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Purpose Prostate cancer is the second most prevalent cancer in US men, with about 192,000 new cases and 33,000 deaths predicted for 2020. With only a 31% 5-year survival rate for patients with an initial diagnosis of stage-four prostate cancer, the necessity for early screening and diagnosis is clear. In this paper, we present navigation accuracy results for Promaxo’s MR system intended to be used in a physician’s office for image-guided transperineal prostate biopsy. Methods The office-based low-field MR system was used to acquire images of prostate phantoms with needles inserted through a transperineal template. Coordinates of the estimated sample core locations in the office-based MR system were compared to ground truth needle coordinates identified in a 1.5T external reference scan. The error was measured as the distance between the planned target and the ground truth core center and as the shortest perpendicular distance between the planned target and the ground truth trajectory of the whole core. Results The average error between the planned target and the ground truth core center was 2.57 ± 1.02 mm, [1.93–3.21] 95% CI. The average error between the planned target to the actual core segment was 2.05 ± 1.24 mm, [1.53–2.56] 95% CI. Conclusion The average navigation errors were below the clinically significant threshold of 5 mm. The initial phantom results demonstrate the feasibility of the office-based system for prostate biopsy.
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18
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Laakso H, Ylä-Herttuala E, Sierra A, Jambor I, Poutanen M, Liljenbäck H, Virtanen H, Merisaari H, Aronen H, Minn H, Roivainen A, Liimatainen T. Docetaxel chemotherapy response in PC3 prostate cancer mouse model detected by rotating frame relaxations and water diffusion. NMR IN BIOMEDICINE 2021; 34:e4483. [PMID: 33543563 DOI: 10.1002/nbm.4483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
MRI is a common method of prostate cancer diagnosis. Several MRI-derived markers, including the apparent diffusion coefficient (ADC) based on diffusion-weighted imaging, have been shown to provide values for prostate cancer detection and characterization. The hypothesis of the study was that docetaxel chemotherapy response could be picked up earlier with rotating frame relaxation times TRAFF2 and TRAFF4 than with the continuous wave T1ρ , adiabatic T1ρ , adiabatic T2ρ , T1 , T2 or water ADC. Human PC3 prostate cancer cells expressing a red fluorescent protein were implanted in 21 male mice. Docetaxel chemotherapy was given once a week starting 1 week after cell implantation for 10 randomly selected mice, while the rest served as a control group (n = 11). The MRI consisted of relaxation along a fictitious field (RAFF) in the second (RAFF2) and fourth (RAFF4) rotating frames, T1 and T2 , continuous wave T1ρ , adiabatic T1ρ and adiabatic T2ρ relaxation time measurements and water ADC. MRI was conducted at 7 T, once a week up to 4 weeks from cell implantation. The tumor volume was monitored using T2 -weighted MRI and optical imaging. The histology was evaluated after the last imaging time point. Significantly reduced RAFFn, T1ρ, T2ρ and conventional relaxation times 4 weeks after tumor implantation were observed in the treated tumors compared with the controls. The clearest short- and long-term responses were obtained with T1 , while no clear improvement in response to treatment was detected with novel methods compared with conventional methods or with RAFFn compared with all others. The tumor volume decreased after a two-week time point for the treated group and increased significantly in the control group, which was supported by increasing red fluorescent light emission in the control tumors. Decreased relaxation times were associated with successful chemotherapy outcomes. The results indicate altered relaxation mechanisms compared with higher dose chemotherapies previously published.
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Affiliation(s)
- Hanne Laakso
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Elias Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Alejandra Sierra
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matti Poutanen
- Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Heidi Liljenbäck
- Turku Center for Disease Modeling, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Helena Virtanen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Merisaari
- Department of Radiology, University of Turku, Turku, Finland
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Hannu Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Anne Roivainen
- Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Timo Liimatainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Clinical Radiology, Oulu University Hospital, Oulu, Finland
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19
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Ecke TH, Schwaiger D, Nesterov G, Koswig S, Selinski S, Barrett T, Gnanapragasam V, Koch S, Hallmann S. Comparison of initial and second opinion reads of multiparametric magnetic resonance imaging of the prostate for transperineal template-guided biopsies with MRI-Ultrasound fusion. Urol Oncol 2021; 39:781.e1-781.e7. [PMID: 33563540 DOI: 10.1016/j.urolonc.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists for the detection of significant cancer in transperineal fusion prostate biopsy. METHODS The evaluated data included age, PSA (ng/ml), PSA density, Gleason score, digital rectal examination (DRE), prostate volume of 149 patients. Twenty-seven patients (18%) had no previous prostate biopsy, 114 patients (77%) had a previous negative biopsy, and 8 patients (5%) were on active surveillance. Using PI-RADS v2 scores for mpMRI a second report was performed by a specialist uroradiologist. In all cases a subsequent transperineal biopsy was performed with at least 2 cores per target and additional background systemic cores. Initial and second-opinion radiology reports were evaluated for detection of any cancer and Gleason score (GS) 7-10 cancer, including positive predictive value and negative (NPV) and compared by Fisher's exact test. RESULTS At transperineal biopsy, 51 % (76/149) of patients had a GS 6-10 prostate cancer (PCa), 27 % (40/149) of patients had a GS 3 + 3 PCa and 12 % (18/149) a GS 3 + 4 and 12 % (18/149) had a GS ≥4 + 3 PCa. Agreement between initial and second-opinion reads was observed in 57.7% (86/149; kappa value = 0.32). The detection of clinically significant cancers with second-opinion reads was significantly higher (0.61; 17/28) compared to initial reads (0.35; 17/49); P = 0.034. CONCLUSIONS Second reading of prostate mpMRIs by subspecialised uroradiologists significantly improved the positive predictive value for detection of clinically significant prostate cancer and showed a trend towards improved NPV for MRI-negative cases where biopsy could be safely avoided. Urologists should be aware that the experience of the reporter will affect the report when making decisions if and how to obtain biopsies. Reporter experience may help to reduce overcalling and avoid over-targeting of lesions.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany; Brandenburg Medical School, BB, Germany.
| | - Dagmar Schwaiger
- Department of Radiology, Vivantes Klinikum Friedrichshain, Berlin, Germany
| | | | - Stephan Koswig
- Department of Radio-Oncology, HELIOS Hospital Bad Saarow, Germany
| | - Silvia Selinski
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | | | - Stefan Koch
- Brandenburg Medical School, BB, Germany; Institute of Pathology, HELIOS Hospital Bad Saarow, Germany
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20
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Bao J, Zhi R, Hou Y, Zhang J, Wu C, Wang X, Zhang Y. Optimized
MRI
Assessment for Clinically Significant Prostate Cancer: A
STARD
‐Compliant Two‐Center Study. J Magn Reson Imaging 2020; 53:1210-1219. [PMID: 33075177 DOI: 10.1002/jmri.27394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jie Bao
- Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China
| | - Rui Zhi
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Ying Hou
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Jing Zhang
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Chen‐Jiang Wu
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xi‐Ming Wang
- Department of Radiology The First Affiliated Hospital of Soochow University Suzhou China
| | - Yu‐Dong Zhang
- Department of Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Hu X, Yang ZQ, Shao YX, Dou WC, Xiong SC, Yang WX, Li X. MRI-targeted biopsy versus standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis of randomized controlled trials. Abdom Radiol (NY) 2020; 45:3283-3292. [PMID: 31897680 DOI: 10.1007/s00261-019-02370-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE For men with a suspicion of prostate cancer (PCa), the transrectal ultrasound-guided biopsy (TRUS-Bx) was recommended. Multi-parametric magnetic resonance imaging (mp-MRI) could be more useful to more accurately selected patients who are with a clinical suspicion of PCa and eligible for biopsy, and avoid a biopsy if the result was negative. In the present study, we compared the MRI-targeted biopsy (MRI-TBx) with TRUS-Bx. METHODS We searched the following online database: PubMed, Embase, and Cochrane Library, and the search was updated to March 2019. RESULTS Finally, a total of 8 randomized controlled trials (RCTs) comprising 2593 patients were enrolled in the final analysis. MRI-TBx and TRUS-Bx did not significantly differ in overall PCa (RR = 1.30; 95% CI 0.98-1.72; P = 0.067), clinically significant PCa (RR = 1.35; 95% CI 0.98-1.86; P = 0.065), and clinically insignificant PCa (RR = 0.76; 95% CI 0.40-1.46; P = 0.416). While in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa (RR = 1.40; 95% CI 1.01-1.94; P = 0.045). CONCLUSION In the present study, we found that MRI-TBx potentially benefits the detection of overall and clinically significant PCa compared with TRUS-Bx in patients with a suspicion of PCa. Furthermore, in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa and a potentially higher detection rate of clinically significant PCa. While for patients with prior negative biopsy, we did not detect significant differences in overall and clinically significant PCa between two groups. More large and multicenter RCTs are further required.
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Affiliation(s)
- Xu Hu
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhi-Qiang Yang
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan-Xiang Shao
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wei-Chao Dou
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - San-Chao Xiong
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wei-Xiao Yang
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiang Li
- Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
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Bosaily AES, Frangou E, Ahmed HU, Emberton M, Punwani S, Kaplan R, Brown LC, Freeman A, Jameson C, Hindley R, Peppercorn D, Thrower A, Winkler M, Barwick T, Stewart V, Burns-Cox N, Burn P, Ghei M, Kumaradevan J, Prasad R, Ash-Miles J, Shergill I, Agarwal S, Rosario D, Salim F, Bott S, Evans H, Henderson A, Ghosh S, Dudderidge T, Smart J, Tung K, Kirkham A. Additional Value of Dynamic Contrast-enhanced Sequences in Multiparametric Prostate Magnetic Resonance Imaging: Data from the PROMIS Study. Eur Urol 2020; 78:503-511. [PMID: 32312543 DOI: 10.1016/j.eururo.2020.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MP-MRI) is established in the diagnosis of prostate cancer, but the need for enhanced sequences has recently been questioned. OBJECTIVE To assess whether dynamic contrast-enhanced imaging (DCE) improves accuracy over T2 and diffusion sequences. DESIGN, SETTING, AND PARTICIPANTS PROMIS was a multicentre, multireader trial, with, in this part, 497 biopsy-naïve men undergoing standardised 1.5T MP-MRI using T2, diffusion, and DCE, followed by a detailed transperineal prostate mapping (TPM) biopsy at 5 mm intervals. Likert scores of 1-5 for the presence of a significant tumour were assigned in strict sequence, for (1) T2 + diffusion and then (2) T2 + diffusion + dynamic contrast-enhanced images. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the primary analysis, the primary PROMIS outcome measure (Gleason score ≥4 + 3 or ≥6 mm maximum cancer length) on TPM was used, and an MRI score of ≥3 was considered positive. RESULTS AND LIMITATIONS Sensitivity without and with DCE was 94% and 95%, specificity 37% and 38%, positive predictive value 51% and 51%, and negative predictive value 90% and 91%, respectively (p > 0.05 in each case). The number of patients avoiding biopsy (scoring 1-2) was similar (123/497 vs 121/497, p = 0.8). The number of equivocal scores (3/5) was slightly higher without DCE (32% vs 28% p = 0.031). The proportion of MRI equivocal (3/5) and positive (4-5) cases showing significant tumours were similar (23% and 71% vs 20% and 69%). No cases of dominant Gleason 4 or higher were missed with DCE, compared with a single case with T2 + diffusion-weighted imaging. No attempt was made to correlate lesion location on MRI and histology, which may be considered a limitation. Radiologists were aware of the patient's prostate-specific antigen. CONCLUSIONS Contrast adds little when MP-MRI is used to exclude significant prostate cancer. PATIENT SUMMARY An intravenous injection of contrast may not be necessary when magnetic resonance imaging is used as a test to rule out significant tumours in the prostate.
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Affiliation(s)
- Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, Royal Free NHS foundation Trust, London, UK.
| | | | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital NHS Foundation Trust, London, UK
| | | | | | - Alex Freeman
- University College Hospital NHS Foundation Trust, London, UK
| | - Charles Jameson
- University College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Mathias Winkler
- Imperial Urology, Imperial College London Healthcare NHS Trust, London, UK
| | - Tara Barwick
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Victoria Stewart
- Department of Radiology, Imperial College London Healthcare NHS Trust, London, UK
| | - Nick Burns-Cox
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Paul Burn
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | | | | | | | | | | | | | | | - Simon Bott
- Frimley Health NHS Foundation Trust, Camberley, UK
| | - Hywel Evans
- Frimley Health NHS Foundation Trust, Camberley, UK
| | | | - Sukanya Ghosh
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Smart
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ken Tung
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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23
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Remmers S, Roobol MJ. Personalized strategies in population screening for prostate cancer. Int J Cancer 2020; 147:2977-2987. [PMID: 32394421 PMCID: PMC7586980 DOI: 10.1002/ijc.33045] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
This review discusses evidence for population-based screening with contemporary screening tools. In Europe, prostate-specific antigen (PSA)-based screening led to a relative reduction of prostate cancer (PCa) mortality, but also to a substantial amount of overdiagnosis and unnecessarily biopsies. Risk stratification based on a single variable (a clinical variable or based on the presence of a lesion on prostate imaging) or based on multivariable approaches can aid in reducing unnecessary prostate biopsies and overdiagnosis by selecting men who can benefit from further clinical assessment. Multivariable approaches include clinical variables, and biomarkers, often combined in risk calculators or nomograms. These risk calculators can also incorporate the result of MRI imaging. In general, as compared to a purely PSA based approach, the combination of relevant prebiopsy information results in superior selection of men at higher risk of harboring clinically significant prostate cancer. Currently, it is not possible to draw any conclusions on the superiority of these multivariable risk-based approaches since head-to-head comparisons are virtually lacking. Recently initiated large population-based screening studies in Finland, Germany and Sweden, incorporating various multivariable risk stratification approaches will hopefully give more insight in whether the harm-benefit ratio can be improved, that is, maintain (or improving) the ability to reduce metastatic disease and prostate cancer mortality while reducing harm caused by unnecessary testing and overdiagnosis including related overtreatment.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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24
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Grey ADR, Connor MJ, Tam J, Loch T. Can transrectal prostate ultrasound compete with multiparametric MRI in the detection of clinically significant prostate cancer? Transl Androl Urol 2020; 9:1492-1500. [PMID: 32676436 PMCID: PMC7354342 DOI: 10.21037/tau.2020.02.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We consider the current and future role of transrectal ultrasound imaging in the diagnosis of prostate cancer, with a particular focus on the pre-biopsy localization and targeting role that multiparametric MRI (mpMRI) has come to occupy for some men in recent years. We draw a distinction between transrectal ultrasound (TRUS) used only as a means of distributing zonal biopsies with its employment as a means for identifying and targeting sonographically abnormal lesions. The role of AI in lesion identification and targeting will be reviewed. Comparisons of cost and availability, frequency of contraindications and diagnostic accuracy between these two imaging modalities will be drawn.
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Affiliation(s)
- Alistair D R Grey
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Division of Surgical and Interventional Sciences, Faculty of Medicine, University College London, London, UK.,Department of Urology, Barts and The Royal London Hospitals, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Martin J Connor
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joseph Tam
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tillmann Loch
- Department of Urology Diakonissenkrankenhaus, Flensburg, University Teaching Hospital of Christian-Albrechts-Universität Kiel, Flensburg, Germany
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25
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Farzin A, Etesami SA, Quint J, Memic A, Tamayol A. Magnetic Nanoparticles in Cancer Therapy and Diagnosis. Adv Healthc Mater 2020; 9:e1901058. [PMID: 32196144 PMCID: PMC7482193 DOI: 10.1002/adhm.201901058] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/15/2020] [Indexed: 12/16/2022]
Abstract
There is urgency for the development of nanomaterials that can meet emerging biomedical needs. Magnetic nanoparticles (MNPs) offer high magnetic moments and surface-area-to-volume ratios that make them attractive for hyperthermia therapy of cancer and targeted drug delivery. Additionally, they can function as contrast agents for magnetic resonance imaging (MRI) and can improve the sensitivity of biosensors and diagnostic tools. Recent advancements in nanotechnology have resulted in the realization of the next generation of MNPs suitable for these and other biomedical applications. This review discusses methods utilized for the fabrication and engineering of MNPs. Recent progress in the use of MNPs for hyperthermia therapy, controlling drug release, MRI, and biosensing is also critically reviewed. Finally, challenges in the field and potential opportunities for the use of MNPs toward improving their properties are discussed.
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Affiliation(s)
- A. Farzin
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - S. Alireza Etesami
- Department of Mechanical Engineering, The University of Memphis. Memphis, TN 38152, USA
| | - Jacob Quint
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
| | - Adnan Memic
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
| | - Ali Tamayol
- Division of Engineering in Medicine Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02139, USA
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, Lincoln, NE, 68588, USA
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
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26
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Gholizadeh N, Pundavela J, Nagarajan R, Dona A, Quadrelli S, Biswas T, Greer PB, Ramadan S. Nuclear magnetic resonance spectroscopy of human body fluids and in vivo magnetic resonance spectroscopy: Potential role in the diagnosis and management of prostate cancer. Urol Oncol 2020; 38:150-173. [PMID: 31937423 DOI: 10.1016/j.urolonc.2019.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/22/2019] [Accepted: 10/31/2019] [Indexed: 01/17/2023]
Abstract
Prostate cancer is the most common solid organ cancer in men, and the second most common cause of male cancer-related mortality. It has few effective therapies, and is difficult to diagnose accurately. Prostate-specific antigen (PSA), which is currently the most effective diagnostic tool available, cannot reliably discriminate between different pathologies, and in fact only around 30% of patients found to have elevated levels of PSA are subsequently confirmed to actually have prostate cancer. As such, there is a desperate need for more reliable diagnostic tools that will allow the early detection of prostate cancer so that the appropriate interventions can be applied. Nuclear magnetic resonance (NMR) spectroscopy and magnetic resonance spectroscopy (MRS) are 2 high throughput, noninvasive analytical procedures that have the potential to enable differentiation of prostate cancer from other pathologies using metabolomics, by focusing specifically on certain metabolites which are associated with the development of prostate cancer cells and its progression. The value that this type of approach has for the early detection, diagnosis, prognosis, and personalized treatment of prostate cancer is becoming increasingly apparent. Recent years have seen many promising developments in the fields of NMR spectroscopy and MRS, with improvements having been made to hardware as well as to techniques associated with the acquisition, processing, and analysis of related data. This review focuses firstly on proton NMR spectroscopy of blood serum, urine, and expressed prostatic secretions in vitro, and then on 1- and 2-dimensional proton MRS of the prostate in vivo. Major advances in these fields and methodological principles of data collection, acquisition, processing, and analysis are described along with some discussion of related challenges, before prospects that proton MRS has for future improvements to the clinical management of prostate cancer are considered.
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Affiliation(s)
- Neda Gholizadeh
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Jay Pundavela
- Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rajakumar Nagarajan
- Human Magnetic Resonance Center, Institute for Applied Life Sciences, University of Massachusetts Amherst, MA, USA
| | - Anthony Dona
- Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - Scott Quadrelli
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Radiology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tapan Biswas
- Department of Instrumentation and Electronics Engineering, Jadavpur University, Kolkata, India
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia; Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia; Imaging Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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27
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Woodrum DA, Kawashima A, Gorny KR, Mynderse LA. Magnetic Resonance-Guided Prostate Ablation. Semin Intervent Radiol 2019; 36:351-366. [PMID: 31798208 PMCID: PMC6887527 DOI: 10.1055/s-0039-1697001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade "localized" prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.
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28
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Tomašković I, Nikles S, Tomić M, Pezelj I, Ružić B. PROSTATE CANCER DIAGNOSIS IN 2019 - CHANGES IN EUROPEAN GUIDELINES AND IMPACT ON DAILY PRACTICE. Acta Clin Croat 2019; 58:7-11. [PMID: 34975191 PMCID: PMC8693554 DOI: 10.20471/acc.2019.58.s2.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Changes in the diagnostic pathway for prostate cancer advised in the most recent Guidelines of the European Association of Urology bring many endeavors for everyday practice. Availability, costs and radiological expertise are still representing a challenge for the adoption of these guidelines in everyday clinical practice. In this article we discuss the current situation regarding these issues and future options.
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Abstract
Prostate cancer can be low- or high-risk to the patient’s health. Current screening on the basis of prostate-specific antigen (PSA) levels has a tendency towards both false positives and false negatives, both of which have negative consequences. We obtained a dataset of 35,875 patients from the screening arm of the National Cancer Institute’s Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. We segmented the data into instances without prostate cancer, instances with low-risk prostate cancer, and instances with high-risk prostate cancer. We developed a pipeline to deal with imbalanced data and proposed algorithms to perform preprocessing on such datasets. We evaluated the accuracy of various machine learning algorithms in predicting high-risk prostate cancer. An accuracy of 91.5% can be achieved by the proposed pipeline, using standard scaling, SVMSMOTE sampling method, and AdaBoost for machine learning. We then evaluated the contribution of rate of change of PSA, age, BMI, and filtration by race to this model’s accuracy. We identified that including the rate of change of PSA and age in our model increased the area under the curve (AUC) of the model by 6.8%, whereas BMI and race had a minimal effect.
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30
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Dias JL, Bilhim T. Modern imaging and image-guided treatments of the prostate gland: MR and ablation for cancer and prostatic artery embolization for benign prostatic hyperplasia. BJR Open 2019; 1:20190019. [PMID: 33178947 PMCID: PMC7592499 DOI: 10.1259/bjro.20190019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/04/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
Multiparametric MRI (mpMRI) has proven to be an essential tool for diagnosis, post-treatment follow-up, aggressiveness assessment, and active surveillance of prostate cancer. Currently, this imaging technique is part of the daily practice in many oncological centres. This manuscript aims to review the use of mpMRI in the set of prostatic diseases, either malignant or benign: mpMRI to detect and stage prostate cancer is discussed, as well as its use for active surveillance. Image-guided ablation techniques for prostate cancer are also reviewed. The need to establish minimum acceptable technical parameters for prostate mpMRI, standardize reports, uniform terminology for describing imaging findings, and develop assessment categories that differentiate levels of suspicion for clinically significant prostate cancer led to the development of the Prostate Imaging Reporting and Data System that is reviewed. Special focus will also be given on the most up-to-date evidence of prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH). Management of patients with BPH, technical aspects of PAE, expected outcomes and level of evidence are reviewed with the most recent literature. PAE is a challenging technique that requires dedicated anatomical knowledge and comprehensive embolization skills. PAE has been shown to be an effective minimally-invasive treatment option for symptomatic BPH patients, that can be viewed between medical therapy and surgery. PAE may be a good option for symptomatic BPH patients that do not want to be operated and can obviate the need for prostatic surgery in up to 80% of treated patients.
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31
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Emberton M. Dropping the GAD - just a fad? The case for a simpler, quicker, safer and cheaper prostate magnetic resonance imaging. BJU Int 2019; 124:183-184. [PMID: 31321868 DOI: 10.1111/bju.14801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Mark Emberton
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
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32
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Pickersgill NA, Vetter JM, Raval NS, Andriole GL, Shetty AS, Ippolito JE, Kim EH. The Accuracy of Prostate Magnetic Resonance Imaging Interpretation: Impact of the Individual Radiologist and Clinical Factors. Urology 2019; 127:68-73. [DOI: 10.1016/j.urology.2019.01.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/31/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
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Brown LC, Ahmed HU, Faria R, El-Shater Bosaily A, Gabe R, Kaplan RS, Parmar M, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham A, Oldroyd R, Parker C, Bott S, Burns-Cox N, Dudderidge T, Ghei M, Henderson A, Persad R, Rosario DJ, Shergill I, Winkler M, Soares M, Spackman E, Sculpher M, Emberton M. Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: the PROMIS study. Health Technol Assess 2019; 22:1-176. [PMID: 30040065 DOI: 10.3310/hta22390] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Men with suspected prostate cancer usually undergo transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided biopsy can cause side effects and has relatively poor diagnostic accuracy. Multiparametric magnetic resonance imaging (mpMRI) used as a triage test might allow men to avoid unnecessary TRUS-guided biopsy and improve diagnostic accuracy. OBJECTIVES To (1) assess the ability of mpMRI to identify men who can safely avoid unnecessary biopsy, (2) assess the ability of the mpMRI-based pathway to improve the rate of detection of clinically significant (CS) cancer compared with TRUS-guided biopsy and (3) estimate the cost-effectiveness of a mpMRI-based diagnostic pathway. DESIGN A validating paired-cohort study and an economic evaluation using a decision-analytic model. SETTING Eleven NHS hospitals in England. PARTICIPANTS Men at risk of prostate cancer undergoing a first prostate biopsy. INTERVENTIONS Participants underwent three tests: (1) mpMRI (the index test), (2) TRUS-guided biopsy (the current standard) and (3) template prostate mapping (TPM) biopsy (the reference test). MAIN OUTCOME MEASURES Diagnostic accuracy of mpMRI, TRUS-guided biopsy and TPM-biopsy measured by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using primary and secondary definitions of CS cancer. The percentage of negative magnetic resonance imaging (MRI) scans was used to identify men who might be able to avoid biopsy. RESULTS Diagnostic study - a total of 740 men were registered and 576 underwent all three tests. According to TPM-biopsy, the prevalence of any cancer was 71% [95% confidence interval (CI) 67% to 75%]. The prevalence of CS cancer according to the primary definition (a Gleason score of ≥ 4 + 3 and/or cancer core length of ≥ 6 mm) was 40% (95% CI 36% to 44%). For CS cancer, TRUS-guided biopsy showed a sensitivity of 48% (95% CI 42% to 55%), specificity of 96% (95% CI 94% to 98%), PPV of 90% (95% CI 83% to 94%) and NPV of 74% (95% CI 69% to 78%). The sensitivity of mpMRI was 93% (95% CI 88% to 96%), specificity was 41% (95% CI 36% to 46%), PPV was 51% (95% CI 46% to 56%) and NPV was 89% (95% CI 83% to 94%). A negative mpMRI scan was recorded for 158 men (27%). Of these, 17 were found to have CS cancer on TPM-biopsy. Economic evaluation - the most cost-effective strategy involved testing all men with mpMRI, followed by MRI-guided TRUS-guided biopsy in those patients with suspected CS cancer, followed by rebiopsy if CS cancer was not detected. This strategy is cost-effective at the TRUS-guided biopsy definition 2 (any Gleason pattern of ≥ 4 and/or cancer core length of ≥ 4 mm), mpMRI definition 2 (lesion volume of ≥ 0.2 ml and/or Gleason score of ≥ 3 + 4) and cut-off point 2 (likely to be benign) and detects 95% (95% CI 92% to 98%) of CS cancers. The main drivers of cost-effectiveness were the unit costs of tests, the improvement in sensitivity of MRI-guided TRUS-guided biopsy compared with blind TRUS-guided biopsy and the longer-term costs and outcomes of men with cancer. LIMITATIONS The PROstate Magnetic resonance Imaging Study (PROMIS) was carried out in a selected group and excluded men with a prostate volume of > 100 ml, who are less likely to have cancer. The limitations in the economic modelling arise from the limited evidence on the long-term outcomes of men with prostate cancer and on the sensitivity of MRI-targeted repeat biopsy. CONCLUSIONS Incorporating mpMRI into the diagnostic pathway as an initial test prior to prostate biopsy may (1) reduce the proportion of men having unnecessary biopsies, (2) improve the detection of CS prostate cancer and (3) increase the cost-effectiveness of the prostate cancer diagnostic and therapeutic pathway. The PROMIS data set will be used for future research; this is likely to include modelling prognostic factors for CS cancer, optimising MRI scan sequencing and biomarker or translational research analyses using the blood and urine samples collected. Better-quality evidence on long-term outcomes in prostate cancer under the various management strategies is required to better assess cost-effectiveness. The value-of-information analysis should be developed further to assess new research to commission. TRIAL REGISTRATION Current Controlled Trials ISRCTN16082556 and NCT01292291. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 39. See the NIHR Journals Library website for further project information. This project was also supported and partially funded by the NIHR Biomedical Research Centre at University College London (UCL) Hospitals NHS Foundation Trust and UCL and by The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research Biomedical Research Centre and was co-ordinated by the Medical Research Council's Clinical Trials Unit at UCL (grant code MC_UU_12023/28). It was sponsored by UCL. Funding for the additional collection of blood and urine samples for translational research was provided by Prostate Cancer UK.
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Affiliation(s)
- Louise Clare Brown
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rhian Gabe
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Katie Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Chris Parker
- Department of Academic Urology, Royal Marsden Hospital, Sutton, UK
| | | | | | | | - Maneesh Ghei
- Department of Urology, Whittington Hospital, London, UK
| | | | - Rajendra Persad
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | | | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Raeside M, Low A, Cohen P, Sutherland P, Gormly K. Prostate MRI evolution in clinical practice: Audit of tumour detection and staging versus prostatectomy with staged introduction of multiparametric MRI and Prostate Imaging Reporting and Data System v2 reporting. J Med Imaging Radiat Oncol 2019; 63:487-494. [DOI: 10.1111/1754-9485.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/02/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Mitchell Raeside
- Dr Jones & Partners Medical Imaging Eastwood South Australia Australia
| | - Andrew Low
- Royal Adelaide Hospital Adelaide South Australia Australia
| | | | | | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging Eastwood South Australia Australia
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Abstract
The initial diagnosis of prostate cancer has been traditionally performed using systematic core biopsies with the use of magnetic resonance imaging (MRI) reserved to problem-solving scenarios. There is currently an ongoing paradigm shift towards the use of MRI prior to targeted biopsy as the standard approach. Prostate cancer therefore does not remain the last solid tumor entity diagnosed by non-targeted techniques but joins other solid tumor entities for which targeted diagnostic approaches have existed for a while. However, the complexity of the background tissue signal in the prostate makes lesion detection challenging. This article will provide an overview of the components of multiparametric prostate MRI and their interpretation using structured interpretation according to the current PI-RADSv2 (Prostate Imaging Reporting and Data System version 2) guidelines and of novel ultrasound techniques for primary diagnosis.
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36
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Parry MA, Srivastava S, Ali A, Cannistraci A, Antonello J, Barros-Silva JD, Ubertini V, Ramani V, Lau M, Shanks J, Nonaka D, Oliveira P, Hambrock T, Leong HS, Dhomen N, Miller C, Brady G, Dive C, Clarke NW, Marais R, Baena E. Genomic Evaluation of Multiparametric Magnetic Resonance Imaging-visible and -nonvisible Lesions in Clinically Localised Prostate Cancer. Eur Urol Oncol 2019; 2:1-11. [PMID: 30929837 PMCID: PMC6472613 DOI: 10.1016/j.euo.2018.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The prostate cancer (PCa) diagnostic pathway is undergoing a radical change with the introduction of multiparametric magnetic resonance imaging (mpMRI), genomic testing, and different prostate biopsy techniques. It has been proposed that these tests should be used in a sequential manner to optimise risk stratification. OBJECTIVE To characterise the genomic, epigenomic, and transcriptomic features of mpMRI-visible and -nonvisible PCa in clinically localised disease. DESIGN, SETTING, AND PARTICIPANTS Multicore analysis of fresh prostate tissue sampled immediately after radical prostatectomy was performed for intermediate- to high-risk PCa. INTERVENTION Low-pass whole-genome, exome, methylation, and transcriptome profiling of patient tissue cores taken from microscopically benign and cancerous areas in the same prostate. Circulating free and germline DNA was assessed from the blood of five patients. OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS Correlations between preoperative mpMRI and genomic characteristics of tumour and benign prostate samples were assessed. Gene profiles for individual tumour cores were correlated with existing genomic classifiers currently used for prognostication. RESULTS AND LIMITATIONS A total of 43 prostate cores (22 tumour and 21 benign) were profiled from six whole prostate glands. Of the 22 tumour cores, 16 were tumours visible and six were tumours nonvisible on mpMRI. Intratumour genomic, epigenomic, and transcriptomic heterogeneity was found within mpMRI-visible lesions. This could potentially lead to misclassification of patients using signatures based on copy number or RNA expression. Moreover, three of the six cores obtained from mpMRI-nonvisible tumours harboured one or more genetic alterations commonly observed in metastatic castration-resistant PCa. No circulating free DNA alterations were found. Limitations include the small cohort size and lack of follow-up. CONCLUSIONS Our study supports the continued use of systematic prostate sampling in addition to mpMRI, as avoidance of systematic biopsies in patients with negative mpMRI may mean that clinically significant tumours harbouring genetic alterations commonly seen in metastatic PCa are missed. Furthermore, there is inconsistency in individual genomics when genomic classifiers are applied. PATIENT SUMMARY Our study shows that tumour heterogeneity within prostate tumours visible on multiparametric magnetic resonance imaging (mpMRI) can lead to misclassification of patients if only one core is used for genomic analysis. In addition, some cancers that were missed by mpMRI had genomic aberrations that are commonly seen in advanced metastatic prostate cancer. Avoiding biopsies in mpMRI-negative cases may mean that such potentially lethal cancers are missed.
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Affiliation(s)
- Marina A Parry
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Shambhavi Srivastava
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Computational Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Adnan Ali
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Genitourinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Cancer Research Centre, Manchester, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Alessio Cannistraci
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Jenny Antonello
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - João Diogo Barros-Silva
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Valentina Ubertini
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Vijay Ramani
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Maurice Lau
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Jonathan Shanks
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Daisuke Nonaka
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Pedro Oliveira
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Thomas Hambrock
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Hui Sun Leong
- Computational Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Nathalie Dhomen
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Crispin Miller
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Computational Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; RNA Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Ged Brady
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Caroline Dive
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Noel W Clarke
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Genitourinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Cancer Research Centre, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, Salford NHS Foundation Trust, Salford, UK.
| | - Richard Marais
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK.
| | - Esther Baena
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK.
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37
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Gaur S, Harmon S, Gupta RT, Margolis DJ, Lay N, Mehralivand S, Merino MJ, Wood BJ, Pinto PA, Shih JH, Choyke PL, Turkbey B. A Multireader Exploratory Evaluation of Individual Pulse Sequence Cancer Detection on Prostate Multiparametric Magnetic Resonance Imaging (MRI). Acad Radiol 2019; 26:5-14. [PMID: 29705281 PMCID: PMC6202287 DOI: 10.1016/j.acra.2018.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine independent contribution of each prostate multiparametric magnetic resonance imaging (mpMRI) sequence to cancer detection when read in isolation. MATERIALS AND METHODS Prostate mpMRI at 3-Tesla with endorectal coil from 45 patients (n = 30 prostatectomy cases, n = 15 controls with negative magnetic resonance imaging [MRI] or biopsy) were retrospectively interpreted. Sequences (T2-weighted [T2W] MRI, diffusion-weighted imaging [DWI], and dynamic contrast-enhanced [DCE] MRI; N = 135) were separately distributed to three radiologists at different institutions. Readers evaluated each sequence blinded to other mpMRI sequences. Findings were correlated to whole-mount pathology. Cancer detection sensitivity, positive predictive value for whole prostate (WP), transition zone, and peripheral zone were evaluated per sequence by reader, with reader concordance measured by index of specific agreement. Cancer detection rates (CDRs) were calculated for combinations of independently read sequences. RESULTS 44 patients were evaluable (cases median prostate-specific antigen 6.83 [ range 1.95-51.13] ng/mL, age 62 [45-71] years; controls prostate-specific antigen 6.85 [2.4-10.87] ng/mL, age 65.5 [47-71] years). Readers had highest sensitivity on DWI (59%) vs T2W MRI (48%) and DCE (23%) in WP. DWI-only positivity (DWI+/T2W-/DCE-) achieved highest CDR in WP (38%), compared to T2W-only (CDR 24%) and DCE-only (CDR 8%). DWI+/T2W+/DCE- achieved CDR 80%, an added benefit of 56.4% from T2W-only and of 42% from DWI-only (P < .0001). All three sequences interpreted independently positive gave highest CDR of 90%. Reader agreement was moderate (index of specific agreement: T2W = 54%, DWI = 58%, DCE = 33%). CONCLUSIONS When prostate mpMRI sequences are interpreted independently by multiple observers, DWI achieves highest sensitivity and CDR in transition zone and peripheral zone. T2W and DCE MRI both add value to detection; mpMRI achieves highest detection sensitivity when all three mpMRI sequences are positive.
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Affiliation(s)
- Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, NIH, 10 Center Drive, Room B3B85, Bethesda, MD 20814, USA. ; ;
| | - Stephanie Harmon
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, 8560 Progress Drive, Frederick, MD 21707, USA.
| | - Rajan T. Gupta
- Duke University Medical Center, Duke Cancer Institute, Durham, NC 27710, USA.
| | - Daniel J. Margolis
- Weill Cornell Imaging, New York-Presbytarian Hospital, New York, NY 10021, USA.
| | - Nathan Lay
- Computer-Aided Diagnosis Laboratory, Clinical Center, NIH, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, NIH, 10 Center Drive, Bethesda, MD 20814, USA. ;
| | - Maria J. Merino
- Department of Pathology, National Cancer Institute, NIH, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Bradford J. Wood
- Center for Interventional Oncology, Clinical Center, NIH, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, 10 Center Drive, Bethesda, MD 20814, USA. ;
| | - Joanna H. Shih
- Biometric Research Branch, National Cancer Institute, NIH, 6130 Executive Plaza, Room 8132, Rockville, MD 20852, USA.
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, 10 Center Drive, Room B3B85, Bethesda, MD 20814, USA. ; ;
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, 10 Center Drive, Room B3B85, Bethesda, MD 20814, USA. ; ;
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Ma J, Chen K. Impact of metallic trace elements on relaxivities of iron-oxide contrast agents. RSC Adv 2019; 9:30932-30936. [PMID: 35529357 PMCID: PMC9072193 DOI: 10.1039/c9ra07227f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 12/04/2022] Open
Abstract
In this work, well-defined 3 nm-sized Ca2+, Fe3+, Na+, Mg2+, Zn2+, Ni2+, Co2+, and Cd2+ cation-adsorbed Fe3O4/γ-Fe2O3 nanoparticles were used as prototype systems to investigate the influence of metallic trace elements in body fluids on the relaxivities of iron-oxide contrast agents. It was found that surface-adsorbed cations formed a deterioration layer to induce pronounced relaxivity loss. Theoretical study showed that such relaxivity loss can be well described by a modified GCAS function, taking into account the harmonic cation oscillations around Fe3O4/γ-Fe2O3 nanoparticles. Quantum mechanics analyses revealed that even-parity and odd-parity states of harmonic oscillations are dominant in r1 and r2 relaxivities, respectively. Moreover, the harmonic oscillations of Na+ and Mg2+ cations around Fe3O4/γ-Fe2O3 nanoparticles are found to be classical forbidden, which are quite different from their counterparts located in the classical permissive area. Distribution of relaxivity loss can be well described by a modified GCAS function.![]()
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Affiliation(s)
- Ji Ma
- Lab of Functional and Biomedical Nanomaterials
- College of Materials Science and Engineering
- Qingdao University of Science and Technology
- Qingdao 266042
- China
| | - Kezheng Chen
- Lab of Functional and Biomedical Nanomaterials
- College of Materials Science and Engineering
- Qingdao University of Science and Technology
- Qingdao 266042
- China
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39
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Otti VC, Miller C, Powell RJ, Thomas RM, McGrath JS. The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer. BJU Int 2018; 123:82-90. [PMID: 29804315 DOI: 10.1111/bju.14420] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the extent to which clinically significant prostate cancer (csPCa) can be detected in a routine National Health Service setting in men with no previous biopsy, when multiparametric magnetic resonance imaging (mpMRI) is introduced into the diagnostic pathway. PATIENTS AND METHODS In all, 1 090 mpMRIs were performed between July 2013 and April 2016 in biopsy-naïve men with an abnormal prostate-specific antigen level and/or digital rectal examination. Data were collected from patient records at the Royal Devon and Exeter NHS Foundation Trust. mpMRI Prostate Imaging Reporting and Data System (PI-RADS) scores were compared to transperineal or transrectal ultrasonography (TRUS)-guided biopsy findings as the reference standard. csPCa was defined as Gleason score of ≥3+4. The diagnostic accuracy of mpMRI was also assessed. RESULTS The mpMRI was interpretable in 1 023 men and 792 underwent biopsy, of which 106 were transperineal. The median number of cores taken in transperineal and TRUS-guided biopsy were 10 and 6, respectively. The detection rate of csPCa was 37%; csPCa rose from 15% of PI-RADS 1 and 2 to 86% of PI-RADS 5. The sensitivity, negative predictive value, specificity, and positive predictive value were 82%, 85%, 59% and 54%, respectively. The study is limited by its retrospective nature and lack of reporting of follow-up for 'missed cancers'. Men with low mpMRI PI-RADS were also less likely to undergo biopsy. Whilst this selection bias may overestimate the detection rate of csPCa, this reflects the shared decisions patients and clinicians make in day-to-day practice outside of research centres. CONCLUSION In a routine clinical setting, the higher the mpMRI PI-RADS, the greater the detection rate of csPCa in biopsy-naïve men. A normal mpMRI does not exclude csPCa; however, mpMRI may have utility in informing shared-decision making on whether to proceed to biopsy and subsequent treatment.
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Affiliation(s)
- Vanessa C Otti
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,University of Exeter Medical School, Exeter, UK
| | | | - Roy J Powell
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,University of Exeter Medical School, Exeter, UK
| | | | - John S McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,University of Exeter Medical School, Exeter, UK
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40
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Wang Y, Zhu J, Qin Z, Wang Y, Chen C, Wang Y, Zhou X, Zhang Q, Meng X, Song N. Optimal biopsy strategy for prostate cancer detection by performing a Bayesian network meta-analysis of randomized controlled trials. J Cancer 2018; 9:2237-2248. [PMID: 30026819 PMCID: PMC6036722 DOI: 10.7150/jca.24690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/16/2018] [Indexed: 12/23/2022] Open
Abstract
Objective: With the increasing recognition of the over-diagnosis and over-treatment of prostate cancer (PCa), the choice of a better prostate biopsy strategy had confused both the patients and clinical surgeons. Hence, this network meta-analysis was conducted to clarify this question. Methods: In the current network meta-analysis, twenty eligible randomized controlled trials (RCTs) with 4,571 participants were comprehensively identified through Pubmed, Embase and Web of Science databases up to July 2017. The pooled odds ratio (OR) with 95% credible interval (CrI) was calculated by Markov chain Monte Carlo methods. A Bayesian network meta-analysis was conducted by using R-3.4.0 software with the help of package "gemtc" version 0.8.2. Results: Six different PCa biopsy strategies and four clinical outcomes were ultimately analyzed in this study. Although, the efficacy of different PCa biopsy strategies by ORs with corresponding 95% CrIs had not yet reached statistical differences, the cumulative rank probability indicated that overall PCa detection rate from best to worst was FUS-GB plus TRUS-GB, FUS-GB, CEUS, MRI-GB, TRUS-GB and TPUS-GB. In terms of clinically significant PCa detection, CEUS, FUS-GB or FUS-GB plus TRUS-GB had a higher, whereas TRUS-GB or TPUS-GB had a relatively lower significant detection rate. Meanwhile, TPUS-GB or TRUS-GB had a higher insignificant PCa detection rate. As for TRUS-guided biopsy, the general trend was that the more biopsy cores, the higher overall PCa detection rate. As for targeted biopsy, it could yield a comparable or even a better effect with fewer cores, compared with traditional random biopsy. Conclusion: Taken together, in a comprehensive consideration of four clinical outcomes, our outcomes shed light on that FUS-GB or FUS-GB plus TRUS-GB showed their superiority, compared with other puncture methods in the detection of PCa. Moreover, TPUS or TRUS-GB was more easily associated with the over-diagnosis and over-treatment of PCa. In addition, targeted biopsy was obviously more effective than traditional random biopsy. The subsequent RCTs with larger sample sizes were required to validate our findings.
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Affiliation(s)
- Yi Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jundong Zhu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.,Current affiliation: Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Zhiqiang Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yamin Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chen Chen
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yichun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiang Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qijie Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xianghu Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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41
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Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland, including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume and low-grade prostate cancer. However, many patients are wanting a less morbid focal treatment alternative. With recent advances in software and hardware of magnetic resonance imaging (MRI), multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion transrectal ultrasound (TRUS) biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software based transperineal grid template. In addition, advances in MR-compatible thermal ablation technology allow accurate focal or regional delivery of thermal ablative energy to the biopsy-proved, MRI-detected tumor. MR-guided ablative treatment options include cryoablation, laser ablation, and high-intensity focused ultrasound with real-time or near simultaneous monitoring of the ablation zone. We present a contemporary review of MR-guided techniques for prostatic interventions.
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Elkjær MC, Andersen MH, Høyer S, Pedersen BG, Borre M. Prostate cancer: in-bore magnetic resonance guided biopsies at active surveillance inclusion improve selection of patients for active treatment. Acta Radiol 2018; 59:619-626. [PMID: 28747132 DOI: 10.1177/0284185117723372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Active surveillance (AS) of low-risk prostate cancer (PCa) is an accepted alternative to active treatment. However, the conventional diagnostic trans-rectal ultrasound guided biopsies (TRUS-bx) underestimate PCa aggressiveness in almost half of the cases, when compared with the surgical specimen. Purpose To investigate if additional multi-parametric magnetic resonance imaging (mpMRI) of the prostate and MRI-guided in-bore biopsies (MRGB) at AS inclusion would improve selection of patients for active treatment. Material and Methods All patients enrolled in AS programs at two Danish centers, from October 2014 to January 2016, were offered an mpMRI 8-12 weeks after the initial diagnostic TRUS-bx. Candidates had low-risk disease (PSA < 10 ng/mL, <cT2b, Gleason score [GS] < 7). Prostate lesions were scored on the five-point PIRADS scale (version 1 and 2). MRGB were performed on PIRADS 4 or 5 lesions. Significant cancer was defined as GS > 6 or GS 6 (3 + 3) lesions with ≥ 6 mm maximal cancer core length (MCCL). Results A total of 78 patients were included and in 21 patients a total of 22 PIRADS-score 4 or 5 lesions were detected. MRGB pathology revealed that 17 (81%) of these and 22% of the entire AS population harbored significant cancers at AS inclusion. In eight (38%) cases, the GS was upgraded. Also, nine patients (43%) had GS 6 (3 + 3) foci with MCCL ≥ 6 mm. Conclusion In an AS cohort based on TRUS and TRUS-bx diagnostic strategies, supplemental mpMRI and in-bore MRGB were able to efficiently reclassify a substantial number of patients as candidates for immediate active treatment.
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Affiliation(s)
| | | | - Søren Høyer
- Department of Pathology, Aarhus University Hospital, NBG, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Skejby, Denmark
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43
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New approach of ultra-focal brachytherapy for low- and intermediate-risk prostate cancer with custom-linked I-125 seeds: A feasibility study of optimal dose coverage. Brachytherapy 2018. [PMID: 29525514 DOI: 10.1016/j.brachy.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To present the feasibility study of optimal dose coverage in ultra-focal brachytherapy (UFB) with multiparametric MRI for low- and intermediate-risk prostate cancer. METHODS AND MATERIALS UFB provisional dose plans for small target volumes (<7 cc) were calculated on a prostate training phantom to optimize the seeds number and strength. Clinical UFB consisted in a contour-based nonrigid registration (MRI/Ultrasound) to implant a fiducial marker at the location of the tumor focus. Dosimetry was performed with iodine-125 seeds and a prescribed dose of 160 Gy. On CT scans acquired at 1 month, dose coverage of 152 Gy to the ultra-focal gross tumor volume was evaluated. Registrations between magnetic resonance and CT scans were assessed on the first 8 patients with three software solutions: VariSeed, 3D Slicer, and Mirada, and quantitative evaluations of the registrations were performed. Impact of these registrations on the initial dose matrix was performed. RESULTS Mean differences between simulated dose plans and extrapolated Bard nomogram for UFB volumes were 36.3% (26-56) for the total activity, 18.3% (10-30) for seed strength, and 22.5% (16-38) for number of seeds. Registration method implemented in Mirada performed significantly better than VariSeed and 3D Slicer (p = 0.0117 and p = 0.0357, respectively). For dose plan evaluation between Mirada and VariSeed, D100% (Gy) for ultra-focal gross tumor volume had a mean difference of 28.06 Gy, mean values being still above the objective of 152 Gy. D90% for the prostate had a mean difference of 1.17 Gy. For urethra and rectum, dose limits were far below the recommendations. CONCLUSIONS This UFB study confirmed the possibility to treat with optimal dose coverage target volumes smaller than 7 cc.
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Improving the Diagnosis of Clinically Significant Prostate Cancer with Magnetic Resonance Imaging. J Belg Soc Radiol 2018. [PMCID: PMC6095051 DOI: 10.5334/jbsr.1438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Desroches J, Jermyn M, Pinto M, Picot F, Tremblay MA, Obaid S, Marple E, Urmey K, Trudel D, Soulez G, Guiot MC, Wilson BC, Petrecca K, Leblond F. A new method using Raman spectroscopy for in vivo targeted brain cancer tissue biopsy. Sci Rep 2018; 8:1792. [PMID: 29379121 PMCID: PMC5788981 DOI: 10.1038/s41598-018-20233-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023] Open
Abstract
Modern cancer diagnosis requires histological, molecular, and genomic tumor analyses. Tumor sampling is often achieved using a targeted needle biopsy approach. Targeting errors and cancer heterogeneity causing inaccurate sampling are important limitations of this blind technique leading to non-diagnostic or poor quality samples, and the need for repeated biopsies pose elevated patient risk. An optical technology that can analyze the molecular nature of the tissue prior to harvesting could improve cancer targeting and mitigate patient risk. Here we report on the design, development, and validation of an in situ intraoperative, label-free, cancer detection system based on high wavenumber Raman spectroscopy. This optical detection device was engineered into a commercially available biopsy system allowing tumor analysis prior to tissue harvesting without disrupting workflow. Using a dual validation approach we show that high wavenumber Raman spectroscopy can detect human dense cancer with >60% cancer cells in situ during surgery with a sensitivity and specificity of 80% and 90%, respectively. We also demonstrate for the first time the use of this system in a swine brain biopsy model. These studies set the stage for the clinical translation of this optical molecular imaging method for high yield and safe targeted biopsy.
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Affiliation(s)
- Joannie Desroches
- Dept. of Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 rue, Saint-Denis, H2X 0A9, QC, Canada
| | - Michael Jermyn
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr, Hanover, NH, 03755, USA
- Brain Tumour Research Centre, Montreal Neurological Institute and Hospital, Dept. of Neurology and Neurosurgery, McGill University, 3801 University St., Montreal, QC, H3A 2B4, Canada
| | - Michael Pinto
- Dept. of Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7, Canada
| | - Fabien Picot
- Dept. of Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7, Canada
| | - Marie-Andrée Tremblay
- Dept. of Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7, Canada
| | - Sami Obaid
- Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, 1560 Sherbrooke E, Montreal, QC H2L 4M1, Canada
| | - Eric Marple
- EMVision LLC, 1471 F Road, Loxahatchee, Florida, 33470, United States
| | - Kirk Urmey
- EMVision LLC, 1471 F Road, Loxahatchee, Florida, 33470, United States
| | - Dominique Trudel
- Department of Pathology, Centre Hospitalier Universitaire de Montréal, 1058 Rue Saint-Denis, Montreal, Québec, H2X 3J4, Canada
| | - Gilles Soulez
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 rue, Saint-Denis, H2X 0A9, QC, Canada
- Centre hospitalier de L'Université de Montréal, Hôpital Notre-Dame-Pavillon Lachapelle, Montréal, QC, H2L 4M1, Canada
| | - Marie-Christine Guiot
- Division of Neuropathology, Department of Pathology, Montreal Neurological Institute and Hospital, McGill University, 3801 University St, Montreal, QC, H3A 2B4, Canada
| | - Brian C Wilson
- University Health Network/University of Toronto, TMDT 15-314, 101 College St., Toronto, ON, M5G 1L7, Canada
| | - Kevin Petrecca
- Brain Tumour Research Centre, Montreal Neurological Institute and Hospital, Dept. of Neurology and Neurosurgery, McGill University, 3801 University St., Montreal, QC, H3A 2B4, Canada.
| | - Frédéric Leblond
- Dept. of Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7, Canada.
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 rue, Saint-Denis, H2X 0A9, QC, Canada.
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Wu X, Yu C, Li T, Lin L, Xu Q, Zhu Q, Ye L, Gao X. Obesity was an independent risk factor for febrile infection after prostate biopsy: A 10-year single center study in South China. Medicine (Baltimore) 2018; 97:e9549. [PMID: 29505534 PMCID: PMC5943121 DOI: 10.1097/md.0000000000009549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
To detect the best antibiotic protocol for prostate biopsy and to assess the potential risk factors postbiopsy in Chinese patients.A total of 1526 patients underwent biopsy were assessed retrospectively. The effect of 3 antibiotic protocols was compared, including fluoroquinolone (FQ) monotherapy, third-generation cephalosporin combined with FQ and targeted antibiotics according to the prebiopsy rectal swab culture result. Postbiopsy infection (PBI) was defined as fever and/or active urinary tract symptoms such as dysuria or frequency with pyuria and/or leucocytosis, sepsis is defined as the presence of clinically or microbiologically documented infection in conjunction with systemic inflammatory response syndrome. The relationship between infections and clinical characteristics of patients was assessed. Data were first picked out in univariate analysis and then enter multivariate logistic regression.Thirty-three (2.2%) patients developed febrile infection. The combination antibiotic prophylaxis could significantly decrease the rate of PBI than FQ monotherapy (1.0% vs 4.0%, P = .000). The infection rate of the targeted antibiotic group was 1.1%, but there was no significant statistic difference compared with FQ alone (P = .349). Escherichia coli was the most predominant pathogen causing infection. Rectal swab revealed as high as 47.1% and 36.0% patients harbored FQ resistant and ESBL-producing organisms, respectively. In univariate analysis, overweight (BMI between 25 and 28 kg/m), obesity (BMI > 28 kg/m), diabetes were picked out as potential risk factors. Obesity remained as risk factor (OR = 12.827, 95% CI: 0.983-8.925, P = .001) while overweight and diabetes were close to significance (P = .052, .053, respectively).The combined cephalosporin with FQ prophylaxis could significantly decrease the risk of infectious complications. Obesity was an independent risk factor for PBI.
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Godley KC, Syer TJ, Toms AP, Smith TO, Johnson G, Cameron D, Malcolm PN. Accuracy of high b-value diffusion-weighted MRI for prostate cancer detection: a meta-analysis. Acta Radiol 2018; 59:105-113. [PMID: 28376634 DOI: 10.1177/0284185117702181] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The diagnostic accuracy of diffusion-weighted imaging (DWI) to detect prostate cancer is well-established. DWI provides visual as well as quantitative means of detecting tumor, the apparent diffusion coefficient (ADC). Recently higher b-values have been used to improve DWI's diagnostic performance. Purpose To determine the diagnostic performance of high b-value DWI at detecting prostate cancer and whether quantifying ADC improves accuracy. Material and Methods A comprehensive literature search of published and unpublished databases was performed. Eligible studies had histopathologically proven prostate cancer, DWI sequences using b-values ≥ 1000 s/mm2, less than ten patients, and data for creating a 2 × 2 table. Study quality was assessed with QUADAS-2 (Quality Assessment of diagnostic Accuracy Studies). Sensitivity and specificity were calculated and tests for statistical heterogeneity and threshold effect performed. Results were plotted on a summary receiver operating characteristic curve (sROC) and the area under the curve (AUC) determined the diagnostic performance of high b-value DWI. Results Ten studies met eligibility criteria with 13 subsets of data available for analysis, including 522 patients. Pooled sensitivity and specificity were 0.59 (95% confidence interval [CI], 0.57-0.61) and 0.92 (95% CI, 0.91-0.92), respectively, and the sROC AUC was 0.92. Subgroup analysis showed a statistically significant ( P = 0.03) improvement in accuracy when using tumor visual assessment rather than ADC. Conclusion High b-value DWI gives good diagnostic performance for prostate cancer detection and visual assessment of tumor diffusion is significantly more accurate than ROI measurements of ADC.
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Affiliation(s)
- Keith Craig Godley
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Andoni Paul Toms
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Hansen NL, Koo BC, Warren AY, Kastner C, Barrett T. Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection. Eur J Radiol 2017; 95:307-313. [PMID: 28987685 DOI: 10.1016/j.ejrad.2017.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/13/2017] [Accepted: 08/16/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate sub-differentiation of PI-RADS-3 prostate lesions using pre-defined T2- and diffusion-weighted (DWI) MRI criteria, to aid the biopsy decision process. METHODS 143 patients with PIRADS-3 index lesions on MRI underwent targeted transperineal-MR/US fusion biopsy. Radiologists with 2 and 7-years experience performed blinded retrospective second-reads using set criteria and assigned biopsy recommendations. Inter-reader agreement, Gleason score (GS), positive (PPV) predictive values (±95% confidence intervals) were calculated and compared by Fisher's exact test with Bonferroni-Hom correction. RESULTS 43% (61/143) patients had GS 6-10 and 21% (30/143) GS≥3+4 cancer. For peripheral zone lesions, significant differences in any cancer detection were found for shape (0.26±0.13 geographical vs. 0.69±0.23 rounded; p=0.0055) and ADC (mild 0.21±0.12 vs marked 0.81±0.19; p=0.0001). For transition zone, significantly increased cancer detection was shown for location (anterior 0.63±0.15 vs. mid/posterior 0.31±0.14; p=0.0048), border (pseudo-capsule 0.32±0.14 vs. ill-defined 0.61±0.15; p=0.0092), and ADC (mild 0.35±0.12 vs marked restriction 0.68±0.17; p=0.0057). Biopsy recommendations had 62% inter-reader agreement (89/143). Experienced reader PPVs were significantly higher for any cancer with "biopsy-recommended" 0.61±0.11 vs. "no biopsy" 0.21±0.10 (p=0.0001), and for GS 7-10 cancers: 0.32±0.10 vs. 0.08±0.07, respectively (p=0.0003). CONCLUSION Identification of certain objective imaging criteria as well as a subjective biopsy recommendation from an experienced radiologist can help to increase the predictive value of equivocal prostate lesions and inform the decision making process of whether or not to biopsy.
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Affiliation(s)
- N L Hansen
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, DE, Germany
| | - B C Koo
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - A Y Warren
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - C Kastner
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - T Barrett
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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Bladou F, Fogaing C, Levental M, Aronson S, Alameldin M, Anidjar M. Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted. Can Urol Assoc J 2017; 11:E330-E337. [PMID: 29382454 DOI: 10.5489/cuaj.4308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is being more widely used in the detection of prostate cancer (PCa), particularly after an initial negative biopsy. In this study, we compared 12-core systematic biopsy (SYS), MRI-targeted biopsy (TAR), and the association of systematic and MRI-targeted (SYS+TAR) prostate biopsy in patients with previous biopsy and those who were biopsy-naive to evaluate the differences in terms of cancer detection and clinically significant cancer detection between the three modalities. METHODS Overall, 203 consecutive patients with suspicion of PCa were analyzed; 48.2% were biopsy-naive and 51.7% had at least one previous negative prostate biopsy. The median age was 66 years, median prostate-specific antigen (PSA) level was 7.9 ng/mL and median prostate volume was 46 mL. 38.9% had SYS, 19.2% TAR only, and 41.8% had SYS+TAR biopsy. RESULTS Overall, the PCa detection (PCaDR) was 63%. The SYS+TAR biopsy detected significantly more cancer than SYS and TAR only biopsies (72.9% vs. 56.9% and 53.8% respectively; p=0.03). Detection rate of clinically significant cancer (csPCaDR) was 50.7% overall; 65.8% in the SYS+TAR biopsy vs. 39.2% in the SYS and 48.7% in the TAR groups (p=0.002). In the biopsy-naive group, PCaDR and csPCaDR were significantly higher in the SYS+TAR group than in the SYS and TAR groups (p=0.01). In the repeat biopsy group, PCaDR and csPCaDR were equivalent in the TAR and SYS+TAR groups and higher than in the SYS group (p=0.001). CONCLUSIONS TAR biopsy, when added to SYS biopsy, was associated with a higher detection rate of csPCa in biopsy-naive patients when compared to TAR and SYS only biopsies. In patients after previous negative biopsy, detection rates of csPCa were equivalent for SYS+TAR and TAR only biopsies, but higher than SYS.
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Affiliation(s)
- Franck Bladou
- Department of Urology; Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Cora Fogaing
- Department of Urology; Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mark Levental
- Department of Radiology; Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Samuel Aronson
- Department of Urology; Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mona Alameldin
- Department of Pathology; Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maurice Anidjar
- Department of Urology; Jewish General Hospital, McGill University, Montreal, QC, Canada
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Aleckovic-Halilovic M, Zelhof B, Solomon L, Ahmed A, Woywodt A. Screening for prostate cancer in renal transplant candidates: Single-centre experience over 10 years. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817693994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The purpose of this article is to report 10 years of single-centre experience with prostate cancer screening in renal transplant candidates. Patients and methods: This is a single-centre retrospective analysis of results of prostate cancer screening as a part of renal pre-transplant workup. We included all male patients suitable for transplant workup over 10 years. Patients with persistently elevated prostate specific antigen were considered for prostate biopsy. Biopsy results, treatment data and short-term outcomes for patients diagnosed with prostate cancer were collected. Results: We identified 542 patients with a mean age of 52 years. Thirty-one (5.7%) patients were referred to a urologist. Twenty-three (74%) of those referred were biopsied. Histological findings for 10 biopsies (44%) were normal, three (13%) had prostatic intraepithelial neoplasm and nine patients (39%) had invasive adenocarcinoma. One case (4%) was inconclusive. All patients with a normal biopsy proceeded with pre-transplant workup. Out of nine patients diagnosed with prostate cancer, five were transplant listed, two were receiving treatment and two were subsequently deceased. Conclusion: Prostate specific antigen screening with repeat testing and the use of age-adjusted normal values led to the diagnosis of prostate cancer that had major implications for transplant listing. For the majority of cancers the diagnosis did not deny transplant surgery to patients but only delayed listing for transplant.
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Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
- Department of Nephrology, Dialysis and Transplantation, University Clinical Hospital Tuzla, Bosnia and Herzegovina
| | - Bachar Zelhof
- Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Laurie Solomon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Aimun Ahmed
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
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