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Jäderling F, Bergman M, Engel JC, Mortezavi A, Picker W, Haug ES, Eklund M, Nordström T. Tailoring biopsy strategy in the MRI-fusion prostate biopsy era: systematic, targeted or neither? BMC Urol 2024; 24:168. [PMID: 39112967 PMCID: PMC11304837 DOI: 10.1186/s12894-024-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/25/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) followed by targeted biopsy (TBx) is utilized for prostate cancer (PCa) detection. However, the value of adding systematic biopsies (SBx) to targeted biopsy procedures (combined biopsy; CBx) in men with suspicious MRI findings has not been determined. METHODS We analysed biopsy outcomes in 429 men with MRI lesions in the prospective multicenter STHLM3MRI pilot study, planned for prostate biopsy. Participants underwent 1.5T biparametric MRI without contrast enhancement, reported according to the PI-RADS v2, and with TBx plus SBx if the MRI lesion score was ≥ 3. The endpoints were clinically nonsignificant (nsPCa) and clinically significant PCa (csPCa), defined as ISUP grade groups 1 and ≥ 2, respectively. RESULTS The median age was 65 years (59-70), and the median PSA 6.0 ng/ml (4.1-9.0). The detection rates of csPCa when using TBx or SBx combined were 18%, 46%, and 85% in men with PIRADS scores of 3 (n = 195), 4 (n = 121), and 5 (n = 113), respectively. This combined strategy detected csPCa in more men than TBx alone (43.6% vs 39.2%, p < 0.02), with similar detection of nsPCa (19.3% vs 17.7%, p = 0.2). In men with equivocal lesions (PI-RADS 3), the detection rates for csPCa were similar for the combined strategy and for TBx alone (17.9% and 15.4%, p = 0.06). However, there was an increase in the detection of nsPCa when using the combined strategy (21.0% vs 15.4%, p < 0.02). Men with equivocal lesions and a PSA density < 0.1 ng/ml2 or a Stockholm 3 test < 0.11 had a low risk of harboring csPCa. CONCLUSIONS Supplementing targeted with systematic biopsies enhances clinically significant cancer detection. However, in men with equivocal lesions, this combination has potential for detecting nonsignificant disease. A subgroup of men with equivocal MRI findings may be identified as having a low risk for significant cancer and spared unnecessary biopsies.
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Affiliation(s)
- Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Radiology, Capio S:T Görans Hospital, Stockholm, Sweden.
| | - Martin Bergman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, S-171 77, Sweden
- Department of Surgery, Capio S:T Görans Hospital, Stockholm, Sweden
| | - Jan Chandra Engel
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ashkan Mortezavi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, S-171 77, Sweden
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden
| | | | | | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, S-171 77, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, S-171 77, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Tammisetti VS, Jacobs MA. Evidence-based Diagnostic Performance Benchmarks in Prostate MRI: An Unmet Clinical Need. Radiology 2024; 312:e241792. [PMID: 39136559 DOI: 10.1148/radiol.241792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Affiliation(s)
- Varaha S Tammisetti
- From the Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center, 6431 Fannin St, Room R172, Houston, TX 77030 (V.S.T., M.A.J.); The Russell H. Morgan Department of Radiology and Radiological Science and Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Md (M.A.J.); Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Tex (M.A.J.); and Department of Computer Science, Rice University, Houston, Tex (M.A.J.)
| | - Michael A Jacobs
- From the Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center, 6431 Fannin St, Room R172, Houston, TX 77030 (V.S.T., M.A.J.); The Russell H. Morgan Department of Radiology and Radiological Science and Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Md (M.A.J.); Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Tex (M.A.J.); and Department of Computer Science, Rice University, Houston, Tex (M.A.J.)
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Klotz L. Should systematic prostatic biopsies be discontinued? Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00849-5. [PMID: 38937536 DOI: 10.1038/s41391-024-00849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The use of systematic biopsies in addition to targeted biopsies is based on multiple studies showing that 15-20% of "clinically significant" cancers are missed on targeted biopsies. Concern about these 'missed' cancers drives many interventions. This includes systematic biopsies in men with negative imaging and in men having targeted biopsies, and drives a preference for total gland treatment in men who may be candidates for partial gland ablation. This article summarizes recent genomic and clinical data indicating that, despite "clinically significant" histology, MRI invisible lesions are genomically and clinically favorable. These studies have demonstrated that the genetic aberrations associated with cancer visibility are the same aberrations that drive cancer invasiveness and metastasis. Thus invisible cancers, even if undiagnosed at baseline, are in most cases indolent and pose little threat to the patient. The implications are that patients should be monitored with imaging rather than systematic biopsy, and subject to repeat targeted biopsy for evidence of MR progression. Patients prefer this strategy. It has many advantages in terms of reduced burden of care, cost, psychological benefits, and less diagnosis of insignificant cancer. CONCLUSION It is now appropriate to abandon systematic biopsies in most patients.
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Affiliation(s)
- Laurence Klotz
- University of Toronto, Sunnybrook Chair of Prostate Cancer Research, Sunnybrook Health Sciences Centre, 2075 Bayview Ave MG 408, Toronto, ON, M4N3M5, Canada.
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García Rojo E, García Gómez B, Sopeña Sutil R, Vallejo Arzayus D, Justo Quintas J, García Barreras S, Brime Menéndez R, Peña Vallejo E, Calzas Montalvo C, López Curtis D, Bozzini G, Romero Otero J. Comparison in Detection Rate of Clinically Significant Prostate Cancer Between Microultrasound-guided Prostate Biopsy (ExactVu) and Multiparametric Resonance Imaging-guided Prostate Biopsy (Koelis System). Urology 2024; 183:163-169. [PMID: 38167595 DOI: 10.1016/j.urology.2023.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/05/2023] [Accepted: 09/12/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare the detection rate of clinically significant prostate cancer (csPC) and prostate cancer (PC) and to find out the diagnostic concordance between microultrasound (mUS), a high-resolution imaging system that can identify suspicious prostate lesions and biopsy them in real time, and multiparametric magnetic resonance imaging (mpMRI)-guided prostate fusion biopsies. METHODS A prospective, multicenter, single-blind, single cohort study was conducted involving 80 patients with clinically suspected PC who underwent concomitant mpMRI-guided fusion prostate biopsy (Koelis System) and mUS-guided biopsy (ExactVu System) RESULTS: The detection rate of csPC was slightly higher for image-guided fusion biopsy (21.25% vs 18.75%), but this difference was not statistically significant (P = .453). There was also no significant difference in overall PC diagnosis (50% vs 51.25%, P = .897). The degree of agreement between the 2 diagnostic techniques for the detection of csPC as assessed by Cohen's Kappa concordance index was satisfactory κ ̂ = 0.676. The degree of International Society of Urological Pathology of targeted biopsies obtained from concordant lesions was also represented by satisfactory concordance with a Kappa index of κ ̂ = 0. 696. CONCLUSION mUS-guided biopsy is presented as an effective diagnostic method for the diagnosis of csPC compared to image-guided fusion biopsy. No differences are found in the detection rates of csPC and PC between the 2 strategies and satisfactory concordance is found in terms of histopathological findings.
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Affiliation(s)
- Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain.
| | - Borja García Gómez
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Raquel Sopeña Sutil
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | | | - Juan Justo Quintas
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Silvia García Barreras
- Department of Urology, Hospital Universitario HM Puerta del Sur, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Ricardo Brime Menéndez
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Elena Peña Vallejo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Cristina Calzas Montalvo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - David López Curtis
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Giorgio Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Javier Romero Otero
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain; Department of Urology, Hospital Universitario HM Puerta del Sur, HM Hospitales and ROC Clinic, Madrid, Spain
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Gómez Gómez E, Cano Castiñeira R, Burgos J, Rodríguez Antolín A, Miles BJ, Martínez Salamanca JI, Bianco F, Fernández L, Calmarza I, Pastor J, Butler RG, de Pedro N. ProsTAV, a novel blood-based test for biopsy decision management in significant prostate cancer. Prostate 2023; 83:1323-1331. [PMID: 37409738 DOI: 10.1002/pros.24594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Current pathways in early diagnosis of prostate cancer (PCa) can lead to unnecessary biopsy procedures. Here, we used telomere analysis to develop and evaluate ProsTAV®, a risk model for significant PCa (Gleason score >6), with the objective of improving the PCa diagnosis pathway. METHODS This retrospective, multicentric study analyzed telomeres from patients with serum PSA 3-10 ng/mL. High-throughput quantitative fluorescence in-situ hybridization was used to evaluate telomere-associated variables (TAVs) in peripheral blood mononucleated cells. ProsTAV® was developed by multivariate logistics regression based on three clinical variables and six TAVs. The predictive capacity and accuracy of ProsTAV® were summarized by receiver operating characteristic (ROC) curves and its clinical benefit with decision curves analysis. RESULTS Telomeres from 1043 patients were analyzed. The median age of the patients was 63 years, with a median PSA of 5.2 ng/mL and a percentage of significant PCa of 23.9%. A total of 874 patients were selected for model training and 169 patients for model validation. The area under the ROC curve of ProsTAV® was 0.71 (95% confidence interval [CI], 0.62-0.79), with a sensitivity of 0.90 (95% CI, 0.88-1.0) and specificity of 0.33 (95% CI, 0.24-0.40). The positive predictive value was 0.29 (95% CI, 0.21-0.37) and the negative predictive value was 0.91 (95% CI, 0.83-0.99). ProsTAV® would make it possible to avoid 33% of biopsies. CONCLUSIONS ProsTAV®, a predictive model based on telomere analysis through TAV, could be used to increase the prediction capacity of significant PCa in patients with PSA between 3 and 10 ng/mL.
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Affiliation(s)
- Enrique Gómez Gómez
- Department of Urology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | - Javier Burgos
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Brian J Miles
- Urologic Oncology, Houston Methodist Hospital, Houston, Texas, USA
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Niu S, Liu Y, Ding X, Xu Y, Yu H, Feng X, Chang X, Wang H, Li J, Gong H, Ao L, Liu J, Lin M, Wang B, Ma X, Xu B, Zhang X. 18 F-DCFPyL positron emission tomography/magnetic resonance imaging-guided ultrasound fusion biopsy is an identical pathway in prostate cancer diagnosis. Prostate 2023; 83:142-150. [PMID: 36281654 DOI: 10.1002/pros.24446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate biopsy is still unavoidable in patients with a rising prostate-specific antigen even though multiparametric magnetic resonance imaging (MRI) is widely used. 18 F-DCFPyL positron emission tomography (PET)/MRI was proved to be promising both in sensitivity and specificity. But its guiding fusion biopsy and the advantages in the diagnosis of prostate disease is seldom reported. This study aimed to verify the feasibility and advantage of 18 F-DCFPyL PET/MRI-guided fusion targeted biopsy (TB) over whole-mount histopathology (WMH) for prostate cancer diagnosis. METHODS A prospective study of 94 biopsy-naïve patients were conducted using 18 F-DCFPyL PET/MRI scans and scored on a scale of 1-4. Systematic biopsy was performed for all patients. Patients with suspicious lesions also underwent PET/MRI/transrectal ultrasound-guided fusion biopsy. Patients with pathologically confirmed cancer underwent surgery and WMH sections. Systematic biopsy was compared with TB for the detection of index tumors (ITs). Significant cancer was defined as Grade group (GG) 2 or higher no matter the length of the cancer core. RESULTS 18 F-DCFPyL PET/MRI detected 30/94 (32%) patients with a score of 4, all of whom were verified to have prostate cancer. While it detected 10 patients with a score of 1 (10.6%), they were shown to have no cancer. The sensitivity and specificity of 18 F-DCFPyL PET/MRI were 94.4% and 75%, respectively, if images with a score of 3 are defined as positive. Systematic biopsy detected 18% (203/1128) samples as prostate cancer; conversely, TB detected 113 samples out of 259 scores (43.6%). A statistically significant difference was seen between the PCa detection rates by TB and SB (p < 0.001). All targeted lesions were pathologically proven to be the IT on WMH. CONCLUSIONS In biopsy-naïve patients, the ultrasound fusion biopsy targeted by 18 F-DCFPyL PET/MRI is an identical pathway for the detection of prostate cancer.
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Affiliation(s)
- Shaoxi Niu
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Yachao Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Ding
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yong Xu
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Hongkai Yu
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Xiaodong Feng
- Student Brigade of Basic Medicine School, Air Force Medical University, Xi'an, China
| | - Xiao Chang
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Haiyi Wang
- Department of Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jinhang Li
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huijie Gong
- Department of Urology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Liyan Ao
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mu Lin
- MR Collaborations, Diagnostic Imaging, Siemens Healthcare, Shanghai, China
| | - Baojun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
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7
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Schmid FA, Lieger L, Saba K, Sigg S, Lehner F, Waisbrod S, Müller A, Sulser T, Eberli D, Mortezavi A. Therapy decisions after diagnosis of prostate cancer in men with negative prostate MRI. Prostate 2023; 83:56-63. [PMID: 36073730 PMCID: PMC10087805 DOI: 10.1002/pros.24435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND To investigate the clinical implications of magnetic resonance imaging (MRI) negative prostate cancer (PCa) in a cohort of men undergoing transperineal prostate biopsy. METHODS We included all men without prior diagnosis of PCa undergoing transperineal template saturation ± fusion-guided targeted biopsy of the prostate between November 2014 and March 2018. Before biopsy, all patients underwent MRI and biopsies were performed irrespective of imaging results. Baseline characteristics, imaging, biopsy results, and follow-up information were retrieved from the patient charts. Patients were classified as either MRI negative (Prostate Imaging Reporting and Data System [PIRADS] ≤ 2) or positive (PIRADS ≥ 3). ISUP grade group 1 was defined as clinically nonsignificant (nsPCa) and ≥2 as clinically significant PCa (csPCa). Primary outcome was the individual therapeutic decision after diagnosis of PCa stratified according to MRI visibility. Secondary outcomes were the sensitivity and specificity of MRI, and the urooncological outcomes after radical prostatectomy (RP). RESULTS From 515 patients undergoing prostate biopsy, 171 (33.2%) patients had a negative and 344 (66.8%) a positive MRI. Pathology review stratified for MRI negative and positive cases revealed nsPCa in 27 (15.8%) and 32 (9.3%) and csPCa in 26 (15.2%) and 194 (56.4%) of the patients, respectively. The rate of active treatment in the MRI negative was lower compared with the MRI positive cohort (12.3% vs. 53.2%; odd ratio [OR] = 0.12; p < 0.001). While men with negative MRI were more likely to undergo active surveillance (AS) than MRI positive patients (18.1% vs. 10.8%; OR = 1.84; p = 0.027), they rarely underwent RP (6.4% vs. 40.7%, OR = 0.10; p < 0.001). Logistic regression revealed that a negative MRI was independently protective for active treatment (OR = 0.32, p = 0.014). The specificity, sensitivity, negative, and positive predictive value of MRI for detection of csPCa were 49.2%, 88.2%, 56.4%, and 84.8%, respectively. The rate of adverse clinicopathological outcome features (pT3/4, ISUP ≥4, or prostate-specific antigen [PSA]-persistence) following RP was 4.7% for men with MRI negative compared to 17.4% for men with MRI positive PCa (OR = 3.1, p = 0.19). CONCLUSION Only few men with MRI negative PCa need active cancer treatment at the time of diagnosis, while the majority opts for AS. Omitting prostate biopsies and performing a follow-up MRI may be a safe alternative to reduce the number of unnecessary interventions.
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Affiliation(s)
- Florian A Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Lieger
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karim Saba
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvan Sigg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabienne Lehner
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sharon Waisbrod
- Department of Urology, Spital-Limmattal, Schlieren, Switzerland
| | | | - Tullio Sulser
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Basel, Basel, Switzerland
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Woo HH, Khanani H, Thompson NJ, Sorensen BJ, Baskaranathan S, Bergersen P, Chalasani V, Dean T, Dias M, Symons J, Wines M, Jain A, Nassour AJ, Tarlinton LC. Multiparametric Magnetic Resonance Imaging of the Prostate and Prostate-specific Membrane Positron Emission Tomography Prior to Prostate Biopsy (MP4 Study). EUR UROL SUPPL 2022; 47:119-125. [PMID: 36601041 PMCID: PMC9806699 DOI: 10.1016/j.euros.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background Prostate-specific membrane antigen (PSMA) positron emission tomography/computerised tomography (PET/CT) is increasingly being utilised in the diagnostic pathway for prostate cancer (PCa). Recent publications have suggested that this might help identify those who can avoid biopsy. Objective The primary objective of this study was to determine whether PET magnetic resonance imaging (MRI) fusion could negate the need to biopsy prior to prostatectomy in a selected population of men. Design setting and participant Multiparametric MRI (mpMRI) for PCa is our standard of care prior to prostate biopsy. Biopsy-naïve men with one or more Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions ≥10 mm on mpMRI were invited to undergo PSMA PET/CT prior to biopsy. Following ethics approval, 60 men were recruited between September 2020 and March 2021. The key exclusion criteria included a previous history of PCa and previous prostate surgery or biopsy. Outcome measurements and statistical analysis A positive PET MRI fusion scan was defined as "consistent with" as per the Memorial Sloan Kettering Cancer Center lexicon of certainty, and concordance with biopsy results was analysed. Clinically significant PCa (csPCa) was defined as grade group (GG) ≥2 on pathology. A chi-square analysis was performed with statistical significance defined at p < 0.05. Results and limitations A total of 71 mpMRI lesions were positive on 61 (86%) PET MRI fusion scans. Fifty-nine of 61 lesions biopsied confirmed csPCa in 54 (92%). Of five of 59 lesions for which either biopsy was negative or low-grade cancer was found, three had rebiopsy of which two were confirmed to have csPCa corroborating with PET MRI fusion and one was reconfirmed to have GG1 only. For the remaining two, both had another lesion elsewhere in the gland confirming csPCa, and hence rebiopsy was not performed. Ultimately, 56 of 59 (95%) lesions with a positive PET MRI fusion scan were confirmed to have csPCa. All GG ≥3 cancers had a positive PET MRI fusion scan. Conclusions This prospective study of PET MRI fusion assessment of men with PI-RADS 4 or 5 lesion ≥10 mm on mpMRI confirms that the majority of men (95%) with a positive PET MRI fusion scan will have csPCa. This supports recently published retrospective data suggesting that selected men might avoid prostate biopsy prior to radical prostatectomy. Patient summary In this research, we have confirmed that prostate-specific membrane antigen positron emission tomography/computerised tomography in combination with magnetic resonance imaging could have an important role in enabling a diagnosis of prostate cancer. Using the combination of these scans, we could confidently predict the presence of aggressive prostate cancer in some men for which treatment is warranted. This means that there are some men who could possibility proceed directly to having prostate cancer surgery without the need for a confirmatory prostate biopsy.
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Affiliation(s)
- Henry H. Woo
- College of Health and Medicine, Australian National University, Canberra, Australia,SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Hadia Khanani
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Nadine J. Thompson
- SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Brian J. Sorensen
- SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Sris Baskaranathan
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Philip Bergersen
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Venu Chalasani
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Thomas Dean
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Max Dias
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - James Symons
- College of Health and Medicine, Australian National University, Canberra, Australia,SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Michael Wines
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Anika Jain
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Anthony-Joe Nassour
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Lisa C. Tarlinton
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, NSW, Australia,Corresponding author. SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, NSW 2076, Australia. Tel. +61 2 9480 9850; Fax: +61 2 9480 9845.
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9
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Ghai S, Perlis N, Atallah C, Jokhu S, Corr K, Lajkosz K, Incze PF, Zlotta AR, Jain U, Fleming H, Finelli A, van der Kwast TH, Haider MA. Comparison of Micro-US and Multiparametric MRI for Prostate Cancer Detection in Biopsy-Naive Men. Radiology 2022; 305:390-398. [PMID: 35852425 DOI: 10.1148/radiol.212163] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Multiparametric MRI has led to increased detection of clinically significant prostate cancer (csPCa). Micro-US is being investigated for csPCa detection. Purpose To compare multiparametric MRI and micro-US in detecting csPCa (grade group ≥2) and to determine the proportion of MRI nodules visible at micro-US for real-time targeted biopsy. Materials and methods This prospective, single-center trial enrolled biopsy-naive men with suspected prostate cancer (PCa) between May 2019 and September 2020. All patients underwent multiparametric MRI followed by micro-US; findings at both were interpreted in a blinded fashion, followed by targeted biopsy and nontargeted systematic biopsy using micro-US. Proportions were compared using the exact McNemar test. The differences in proportions were calculated. Results Ninety-four men (median age, 61 years; IQR, 57-68 years) were included. MRI- and micro-US-targeted biopsy depicted csPCa in 37 (39%) and 33 (35%) of the 94 men, respectively (P = .22); clinically insignificant PCa in 14 (15%) and 15 (16%) (P > .99); and cribriform and/or intraductal PCa in 14 (15%) and 13 (14%) (P > .99). The MRI- plus micro-US-targeted biopsy pathway depicted csPCa in 38 of the 94 (40%) men. The addition of nontargeted systematic biopsy to MRI- plus micro-US-targeted biopsy did not enable identification of any additional men with csPCa but did help identify nine additional men with clinically insignificant PCa (P = .04). Biopsy was avoided in 32 of the 94 men (34%) with MRI and nine of the 94 men (10%) with micro-US (P < .001). Among 93 MRI targets, 62 (67%) were prospectively visible at micro-US. Conclusion MRI and micro-US showed similar rates of prostate cancer detection, but more biopsies were avoided with the MRI pathway than with micro-US, with no benefit of adding nontargeted systematic biopsy to the MRI- plus micro-US-targeted biopsy pathway. Most MRI lesions were prospectively visible at micro-US, allowing real-time targeted biopsy. ClinicalTrials.gov registration no.: NCT03938376 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Sangeet Ghai
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Nathan Perlis
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Chantal Atallah
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Sarah Jokhu
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Kateri Corr
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Katherine Lajkosz
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Peter F Incze
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Alexandre R Zlotta
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Umesh Jain
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Hannah Fleming
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Theodorus H van der Kwast
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
| | - Masoom A Haider
- From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.)
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10
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Deniffel D, Perlis N, Ghai S, Girgis S, Healy GM, Fleshner N, Hamilton R, Kulkarni G, Toi A, van der Kwast T, Zlotta A, Finelli A, Haider MA. Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy. Eur Radiol 2022; 32:7544-7554. [PMID: 35507051 DOI: 10.1007/s00330-022-08822-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 04/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to develop and compare strategies that help optimize current prostate biopsy practice by identifying patients who may forgo concurrent systematic biopsy (SBx) in favor of MRI-targeted (TBx) alone. METHODS Retrospective study on 745 patients who underwent combined MRI-TBx plus SBx. Primary outcome was the upgrade to clinically significant prostate cancer (csPCa; grade group ≥ 2) on SBx versus MRI-TBx. Variables (age, previous biopsy status, Prostate Imaging Reporting and Data System (PI-RADS) score, index lesion size/location, number of lesions, PSA, PSA density, prostate volume) associated with the primary outcome were identified by logistic regression and used for biopsy strategies. Clinical utility was assessed by decision curve analysis (DCA). RESULTS SBx detected 47 (6%) additional men with csPCa. The risk of detecting csPCa uniquely on SBx was significantly lower in men with PI-RADS 5 (versus PI-RADS 3: OR 0.30, p = 0.03; versus PI-RADS 4: OR 0.33, p = 0.01), and previous negative biopsy (versus previous positive biopsy: OR 0.40, p = 0.007), and increased with age (per 10 years: OR 1.64, p = 0.016). No significant association was observed for other variables. DCA identified the following strategies as most useful: (a) avoid SBx in men with PI-RADS 5 and (b) additionally in those with previous negative biopsy, resulting in avoiding SBx in 201 (27%) and 429 (58%), while missing csPCa in 5 (1%) and 15 (2%) patients, respectively. CONCLUSION Not all men benefit equally from the combination of SBx and MRI-TBx. SBx avoidance in men with PI-RADS 5 and/or previous negative biopsy may reduce the risk of excess biopsies with a low risk of missing csPCa. KEY POINTS • In men undergoing MRI-targeted biopsy, the risk of detecting clinically significant prostate cancer (csPCa) only on additional systematic biopsy (SBx) decreased in men with PI-RADS 5, previous negative biopsy, and younger age. • Using these variables may help select men who could avoid the risk of excess SBx. • If missing csPCa in 5% was acceptable, forgoing SBx in men with PI-RADS 5 and/or previous negative biopsy enabled the highest net reduction in SBx.
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Affiliation(s)
- Dominik Deniffel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | | | - Gerard M Healy
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Girish Kulkarni
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ants Toi
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Alexandre Zlotta
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada. .,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada.
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11
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Artificial Intelligence Algorithm-Based MRI for Differentiation Diagnosis of Prostate Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8123643. [PMID: 35799629 PMCID: PMC9256308 DOI: 10.1155/2022/8123643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 12/16/2022]
Abstract
The rapid increase in prostate cancer (PCa) patients is similar to that of benign prostatic hyperplasia (BPH) patients, but the treatments are quite different. In this research, magnetic resonance imaging (MRI) images under the weighted low-rank matrix restoration algorithm (RLRE) were utilized to differentiate PCa from BPH. The diagnostic effects of different sequences of MRI images were evaluated to provide a more effective examination method for the clinical differential diagnosis of PCa and BPH. 150 patients with suspected PCa were taken as the research objects. Pathological examination revealed that 137 patients had PCa and 13 patients had BPH. The pathological results were the gold standard and were compared with the MRI results of different sequences. Therefore, the accuracy of the MRI results was evaluated. The results showed that with the rise of Gaussian noise, the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) of all three algorithms gradually decreased, but the PSNR and SSIM of the RLRE algorithm were always higher than those of the RL and BM3D algorithms (P < 0.05). The sensitivity (97.08%), specificity (92.31%), accuracy (96.67%), and consistency (0.678) of the dynamic contrast enhancement (DCE) sequence were higher than those of the plain scan (86.13%, 69.23%, 84.67%, and 0.469, respectively). In conclusion, the RLRE algorithm could promote the resolution of MRI images and improve the display effect. DCE could better differentiate PCa from BPH, had great clinical application value, and was worthy of clinical promotion.
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12
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Campistol M, Morote J, Regis L, Celma A, Planas J, Trilla E. Proclarix, A New Biomarker for the Diagnosis of Clinically Significant Prostate Cancer: A Systematic Review. Mol Diagn Ther 2022; 26:273-281. [PMID: 35471698 DOI: 10.1007/s40291-022-00584-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI) has improved the early detection of clinically significant prostate cancer (csPCa). However, an appropriate selection of men for mpMRI or prostate biopsy is still challenging, which is why new biomarkers or predictive models are recommended to determine those patients who will benefit from prostate biopsy. Proclarix is a new test that provides the risk of csPCa based on thrombospondin-1 (THBS1), cathepsin D (CTSD), prostate-specific antigen (PSA), and percentage of free PSA (%fPSA), as well as age. This systematic review analyzes the current clinical status of Proclarix and future development. EVIDENCE ACQUISITION A systematic review of the literature was carried out by two independent reviewers. The Medical Subject Heading (MeSH) terms 'prostate', 'thrombospondin-1', 'cathepsin-D' and 'Proclarix' were used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison and Outcomes (PICO) selection criteria were followed. Finally, four articles analyzed the clinical usefulness of Proclarix. EVIDENCE SYNTHESIS Proclarix has been developed in men with PSA levels between 2 and 10 ng/mL, normal digital rectal examination (DRE), and prostate volume (PV) ≥ 35 cm3. Proclarix is associated with the PCa grade group and is more effective than %fPSA in detecting csPCa. Two studies analyzed the efficacy of Proclarix in men undergoing guided and systematic biopsies, obtaining similar results to PSA density. CONCLUSION Initial studies have shown the potential benefit of Proclarix in patients with specific characteristics. Future studies are needed to verify the clinical usefulness of Proclarix in men with suspected PCa before and after mpMRI.
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Affiliation(s)
- Míriam Campistol
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain. .,Department of Surgery, Universitat Autònoma de Barcelona/Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
| | - Juan Morote
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona/Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona/Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Ana Celma
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona/Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona/Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona/Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
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Khlebtsov B, Burov A, Pylaev T, Savkina A, Prikhozhdenko E, Bratashov D, Khlebtsov N. Improving SERS bioimaging of subcutaneous phantom in vivo with optical clearing. JOURNAL OF BIOPHOTONICS 2022; 15:e202100281. [PMID: 34856066 DOI: 10.1002/jbio.202100281] [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: 09/07/2021] [Revised: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 06/13/2023]
Abstract
Surface-enhanced Raman scattering (SERS) has proven to be a promising technique for different types of imaging including preoperative and intraoperative in vivo tumor visualization. However, the strong scattering of the turbid tissue limits its use in subcutaneous areas. In this article, we used an optical clearing technique to improve the SERS signal from a subcutaneous tumor phantom. The phantom is a 2 mm sphere of calcium alginate with incorporated petal-like gap-enhanced Raman tags. The use of optical clearing increases the SERS signal target-to-background ratio for 5 times and allow to decrease the total imaging time for at least 10 times. In addition, SERS imaging assisted with optical clearing made it possible to more precisely determine the shape and boundaries of the implanted phantom. The combination of optical clearing and SERS is a promising strategy for the clinical imaging of subcutaneous objects that are usually shielded by dermal tissue.
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Affiliation(s)
- Boris Khlebtsov
- Institute of Biochemistry and Physiology of Plants and Microorganisms RAS, Saratov, Russia
| | - Andrey Burov
- Institute of Biochemistry and Physiology of Plants and Microorganisms RAS, Saratov, Russia
| | - Timofey Pylaev
- Institute of Biochemistry and Physiology of Plants and Microorganisms RAS, Saratov, Russia
- Saratov State Medical University, Saratov, Russia
| | | | | | | | - Nikolai Khlebtsov
- Institute of Biochemistry and Physiology of Plants and Microorganisms RAS, Saratov, Russia
- Saratov State University, Saratov, Russia
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Optimizing prostate-targeted biopsy schemes in men with multiple mpMRI visible lesions: should we target all suspicious areas? Results of a two institution series. Prostate Cancer Prostatic Dis 2021; 24:1137-1142. [PMID: 33941867 DOI: 10.1038/s41391-021-00371-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND To assess the diagnostic added value of sampling secondary lesions at prostate mpMRI (SL) in addition to index lesion (IL) in detecting significant prostate cancer (csPCa) when also systematic biopsy (SBx) is performed. METHODS We relied on a cohort of 312 men with two suspicious lesions at prostate mpMRI who underwent subsequent targeted biopsy of each lesion (TBx) and concomitant SBx at two tertiary-referral centers between 2013 and 2019. The study outcome was the added value of targeting SL (i.e., the one with a lower PI-RADS score and/or the smaller size compared to IL) in the detection of csPCa. To this aim, we compared different biopsy strategies (SBx + overall TBx vs SBx + IL-targeted biopsy vs SBx + SL-targeted biopsy) and assessed whether SL features could be correlated with detection of csPCa at overall TBx in a multivariable logistic regression model (MVA). RESULTS Overall, 44% of men had csPCa at TBx of all lesions while 39% and 23% of men had csPCa found in IL and SL, respectively. The rate of csPCa found at SBx, IL-TBx, and SL-TBx only was 5%, 6%, and 2%, respectively. The detection rate of csPCa for SBx + IL-TBx was 47%. The addition of SL-TBx increased csPCa detection by only 2% (p = 0.12). At MVA, neither PI-RADS of SL nor the number of cores targeting SL was associated with an increased detection of csPCa (all p > 0.3). Conversely, age (OR: 1.07), PSA (OR: 1.07), prostate volume (OR: 0.98), and PI-RADS of the IL (OR: 2.36) were independently associated with csPCa detection at TBx (all p < 0.01). CONCLUSIONS There is no significant benefit in terms of csPCa detection when an adequate SBx is performed in combination with IL-TBx in patients with multiple mpMRI lesions. In these men target biopsy of secondary lesions can be safely omitted.
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15
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Samtani S, Burotto M, Roman JC, Cortes-Herrera D, Walton-Diaz A. MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer. Diagnostics (Basel) 2021; 11:diagnostics11091551. [PMID: 34573893 PMCID: PMC8466276 DOI: 10.3390/diagnostics11091551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).
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Affiliation(s)
- Suraj Samtani
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Fundacion Chilena de Inmuno Oncologia, Santiago 8420383, Chile
| | - Mauricio Burotto
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Oncología Médica, Clinica Universidad de los Andes, Santiago 7620157, Chile
| | - Juan Carlos Roman
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
| | | | - Annerleim Walton-Diaz
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
- Departamento de Oncologia Básico-Clinico Universidad de Chile, Santiago 8380455, Chile
- Correspondence:
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Comparison of Accuracies between Real-Time Nonrigid and Rigid Registration in the MRI-US Fusion Biopsy of the Prostate. Diagnostics (Basel) 2021; 11:diagnostics11081481. [PMID: 34441415 PMCID: PMC8392836 DOI: 10.3390/diagnostics11081481] [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: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI and US is essential. The purpose of our study was to show any decrease in errors using a real-time nonrigid registration technique for prostate biopsy. Nineteen patients with suspected prostate cancer were prospectively enrolled in this study. Registration accuracy was calculated by the measuring distance of corresponding points by rigid and nonrigid registration between MRI and US, and compared for rigid and nonrigid registration methods. Overall cancer detection rates were also evaluated by patient and by core. Prostate volume was measured automatically from MRI and manually from US, and compared to each other. Mean distances between the corresponding points in MRI and US were 5.32 ± 2.61 mm for rigid registration and 2.11 ± 1.37 mm for nonrigid registration (p < 0.05). Cancer was diagnosed in 11 of 19 patients (57.9%), and in 67 of 266 biopsy cores (25.2%). There was no significant difference in prostate-volume measurement between the automatic and manual methods (p = 0.89). In conclusion, nonrigid registration reduces targeting errors.
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Dai Z, Liu Y, Huangfu Z, Wang L, Liu Z. Magnetic Resonance Imaging (MRI)-Targeted Biopsy in Patients with Prostate-Specific Antigen (PSA) Levels <20 ng/mL: A Single-Center Study in Northeastern China. Med Sci Monit 2021; 27:e930234. [PMID: 34365459 PMCID: PMC8359686 DOI: 10.12659/msm.930234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background We investigated the feasibility of applying magnetic resonance imaging (MRI)-targeted biopsy (TB) in patients with prostate-specific antigen (PSA) levels <20 ng/mL. Material/Methods We retrospectively analyzed 218 patients with PSA levels <20 ng/mL and suspicious lesions according to the Prostate Imaging Recording and Data System version 2.0 (PI-RADS v2). All 218 men underwent transperineal MRI-TB, followed by template-guided 12-core systematic biopsy (SB). Of the 218 patients undergoing TB, 100 received MRI-ultrasound-assisted software fusion biopsy (FB) and 118 received cognitive biopsy (CB). Clinically significant prostate cancer (csPCa) was defined as a Gleason score ≥3+4. Results The overall TB positive rate was similar to that of SB (P=0.156), but with a higher diagnostic rate for csPCa (P=0.034). SB misdiagnosed csPCa in 11.47% of cases; TB misdiagnosed csPCa in 5.50% of cases. SB+TB detected more tumors with a Gleason score of 7 than did SB alone (43 vs 22). Detection rates of csPCa were similar for CB and FB (P=0.217). In total, 47 men had 2 MRI-determined suspicious areas. Of 265 suspicious areas, 143 (53.96%) had a PI-RADS v2 score of 3; 92 (34.71%) had a score of 4; and 30 (11.32%) had a score of 5. The positive detection rates for csPCa in patients with PI-RADS v2 scores of 3, 4, and 5, were 11.19%, 48.91%, and 80.00%, respectively. Conclusions TB increased the positive biopsy detection rate but missed some cases of csPCa. TB combined with SB may be the most suitable biopsy for patients with PSA <20 ng/mL.
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Affiliation(s)
- Zhihong Dai
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Yangyang Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Zhao Huangfu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Liang Wang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Zhiyu Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
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Yin H, Shao J, Song H, Ding W, Xu B, Cao H, Wang J. MRI Screening and MRI/US Fusion-Guided Transperineal Biopsy in Detecting Prostate Cancer. Technol Cancer Res Treat 2021; 20:15330338211019418. [PMID: 34013808 PMCID: PMC8142015 DOI: 10.1177/15330338211019418] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Systematic biopsy plays a vital role in diagnosing prostate cancer, but it can lead to misdiagnoses or undertreatment. Advances in magnetic resonance imaging (MRI) and its guided targeting technology provide the possibility of improving the use of biopsies. This study aimed to evaluate the performance of MRI screening and MRI/ultrasound (MRI/US) fusion-guided transperineal biopsy in the detection of prostate cancer. METHODS We performed a retrospective study on patients with suspected prostate cancer in the Kunshan Hospital Affiliated with Jiangsu University from January 2017 to December 2019. All of the patients underwent MRI examinations, followed by a systematic biopsy (either alone or in combination with MRI/US fusion-guided targeted biopsy, based on MRI-visible lesions). We evaluated the diagnostic accuracy of MRI screening and compared biopsy methods by considering sensitivity, specificity, and area under the curve (AUC) values. RESULTS A total of 157 patients were enrolled, including 112 patients with MRI-visible lesions and 45 patients without MRI-visible lesions. The cancer detection rate (CDR) was higher in patients with MRI-visible lesions (P < 0.001); however, the serum prostate-specific antigen (PSA) indicators were similar (P > 0.05). The AUC of MRI was 0.63, which was superior to the AUC values of ultrasound (AUC = 0.55, P = 0.031) and digital rectal examination (AUC = 0.52, P = 0.041) for screening prostate cancer. Both overall CDR and clinically significant prostate cancer detection rates were improved if we combined systematic biopsy and MRI/US fusion-guided targeted biopsy procedures. CONCLUSION Overall, prior MRI screening may serve as a classifier for avoiding the overuse of biopsies. A combination of systematic and MRI/US fusion-guided targeted biopsy procedures offers an optimal regimen for detecting prostate cancer.
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Affiliation(s)
- Hongqing Yin
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Jun Shao
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wei Ding
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Bin Xu
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Hui Cao
- Department of Ultrasound, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Getaneh AM, Heijnsdijk EA, de Koning HJ. Cost-effectiveness of multiparametric magnetic resonance imaging and MRI-guided biopsy in a population-based prostate cancer screening setting using a micro-simulation model. Cancer Med 2021; 10:4046-4053. [PMID: 33991077 PMCID: PMC8209626 DOI: 10.1002/cam4.3932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The introduction of multiparametric magnetic resonance imaging (mpMRI) and MRI-guided biopsy has improved the diagnosis of prostate cancer. However, it remains uncertain whether it is cost-effective, especially in a population-based screening strategy. METHODS We used a micro-simulation model to assess the cost-effectiveness of an MRI-based prostate cancer screening in comparison to the classical prostate-specific antigen (PSA) screening, at a population level. The test sensitivity parameters for the mpMRI and MRI-guided biopsy, grade misclassification rates, utility estimates, and the unit costs of different interventions were obtained from literature. We assumed the same screening attendance rate and biopsy compliance rate for both strategies. A probabilistic sensitivity analysis, consisting of 1000 model runs, was performed to estimate a mean incremental cost-effectiveness ratio (ICER) and assess uncertainty. A €20,000 willingness-to-pay (WTP) threshold per quality-adjusted life year (QALY) gained, and a discounting rate of 3.5% was considered in the analysis. RESULTS The MRI-based screening improved the life-years (LY) and QALYs gained by 3.5 and 3, respectively, in comparison to the classical screening pathway. Based on the probabilistic sensitivity analyses, the MRI screening pathway leads to total discounted mean incremental costs of €15,413 (95% confidence interval (CI) of €14,556-€16,272) compared to the classical screening pathway. The corresponding discounted mean incremental QALYs gained was 1.36 (95% CI of 1.31-1.40), resulting in a mean ICER of €11,355 per QALY gained. At a WTP threshold of €20,000, the MRI screening pathway has about 84% chance to be more cost-effective than the classical screening pathway. CONCLUSIONS For triennial screening from age 55-64, incorporation of mpMRI as a reflex test after a positive PSA test result with a subsequent MRI-guided biopsy has a high probability to be more cost-effective as compared with the classical prostate cancer screening pathway.
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Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline Am Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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20
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Yadav K, Sureka B, Elhence P, Choudhary GR, Pandey H. Pitfalls in Prostate Cancer Magnetic Resonance Imaging. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1730757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractImage-guided prostate biopsies are changing the outlook of prostate cancer (PCa) diagnosis, with the degree of suspicion on multiparametric magnetic resonance imaging (mp-MRI) being a strong predictor of targeted biopsy outcome. It is important not only to detect these suspicious lesions but also to be aware of the potential pitfalls in mp-MRI prostate imaging. The aim of this pictorial essay is to show a wide spectrum of representative cases, which are frequently misdiagnosed as PIRADS ⅘ while reporting mp-MRI of the prostate. We provide some valuable recommendations to avoid these fallacies and improve mp-MRI of prostate evaluation.
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Affiliation(s)
- Kuldeep Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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21
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Getaneh AM, Heijnsdijk EAM, de Koning HJ. The comparative effectiveness of mpMRI and MRI-guided biopsy vs regular biopsy in a population-based PSA testing: a modeling study. Sci Rep 2021; 11:1801. [PMID: 33469144 PMCID: PMC7815791 DOI: 10.1038/s41598-021-81459-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
The benefit of prostate cancer screening is counterbalanced by the risk of overdiagnosis and overtreatment. The use of a multi-parametric magnetic resonance imaging (mpMRI) test after a positive prostate-specific antigen (PSA) test followed by magnetic resonance imaging-guided biopsy (MRIGB) may reduce these harms. The aim of this study was to determine the effects of mpMRI and MRIGB vs the regular screening pathway in a population-based prostate cancer screening setting. A micro-simulation model was used to predict the effects of regular PSA screening (men with elevated PSA followed by TRUSGB) and MRI based screening (men with elevated PSA followed by mpMRI and MRIGB). We predicted reduction of overdiagnosis, harm-benefit ratio (overdiagnosis per cancer death averted), reduction in number of biopsies, detection of clinically significant cancer, prostate cancer death averted, life-years gained (LYG), and quality adjusted life years (QALYs) gained for both strategies. A univariate sensitivity analysis and threshold analysis were performed to assess uncertainty around the test sensitivity parameters used in the MRI strategy.In the MRI pathway, we predicted a 43% reduction in the risk of overdiagnosis, compared to the regular pathway. Similarly a lower harm-benefit ratio (overdiagnosis per cancer death averted) was predicted for this strategy compared to the regular screening pathway (1.0 vs 1.8 respectively). Prostate cancer mortality reduction, LY and QALYs gained were also slightly increased in the MRI pathway than the regular screening pathway. Furthermore, 30% of men with a positive PSA test could avoid a biopsy as compared to the regular screening pathway. Compared to regular PSA screening, the use of mpMRI as a triage test followed by MRIGB can substantially reduce the risk of overdiagnosis and improve the harm-benefit balance, while maximizing prostate cancer mortality reduction and QALYs gained.
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Affiliation(s)
- Abraham M Getaneh
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Muglia VF, Vargas HA. Doctor, a patient is on the phone asking about the endorectal coil! Abdom Radiol (NY) 2020; 45:4003-4011. [PMID: 32300836 DOI: 10.1007/s00261-020-02528-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The question referred to in the title of this article is a relatively common situation when performing prostate MRI in some healthcare settings. Moreover, the answer is not always straightforward. The decisions on type of receiver coil for prostate MRI and whether or not an endorectal coil (ERC) should be used is based on several factors. These relate to the patient (e.g., body habitus, presence of metallic devices in the pelvis), the focus of the exam (diagnosis, staging, recurrence), and characteristics of the MRI system (e.g., magnetic field strength and hardware components including coil design and number of elements/channels available in the surface coil). Historically, the combined use of an ERC and a surface coil was the optimal combination for maximizing the signal-to-noise ratio (SNR), particularly for low-strength magnetic fields (1.5T). However, there are several disadvantages associated with the use of an ERC, and several studies have advocated equivalent clinical performance of modern MRI systems for diagnosis and staging of prostate cancer (PCa), either with ERC or surface alone. Accordingly, there is a wide variation in the precise imaging technique across institutions. This article focuses on the most relevant aspects of the decision of whether to use an ERC for PCa MR imaging.
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Affiliation(s)
- Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Av. Bandeirantes 3900, Campus Monte Alegre, Ribeirão Prêto, 14049-900, Brazil.
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23
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Bazargani S, Bandyk M, Balaji KC. Variability of the Positive Predictive Value of PI-RADS for Prostate MRI across 26 Centers: What about the Negatives? Radiology 2020; 298:E57. [PMID: 33141006 DOI: 10.1148/radiol.2020202870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Soroush Bazargani
- Departments of Urology and Radiology, University of Florida, Jacksonville College of Medicine, 653 W 8th St, LRC Bldg Fl 2, Jacksonville, FL 32209-6511
| | - Mark Bandyk
- Departments of Urology and Radiology, University of Florida, Jacksonville College of Medicine, 653 W 8th St, LRC Bldg Fl 2, Jacksonville, FL 32209-6511
| | - K C Balaji
- Departments of Urology and Radiology, University of Florida, Jacksonville College of Medicine, 653 W 8th St, LRC Bldg Fl 2, Jacksonville, FL 32209-6511
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Lughezzani G, Maffei D, Saita A, Paciotti M, Diana P, Buffi NM, Colombo P, Elefante GM, Hurle R, Lazzeri M, Guazzoni G, Casale P. Diagnostic Accuracy of Microultrasound in Patients with a Suspicion of Prostate Cancer at Magnetic Resonance Imaging: A Single-institutional Prospective Study. Eur Urol Focus 2020; 7:1019-1026. [PMID: 33069624 DOI: 10.1016/j.euf.2020.09.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI) represents the gold standard for the diagnosis of clinically significant prostate cancer (csPCa). The search for alternative diagnostic techniques is still ongoing. OBJECTIVE To determine the accuracy of microultrasound (microUS) for the diagnosis of csPCa within prospectively collected cohort of patients with a suspicion of prostate cancer (PCa) according to MRI. DESIGN, SETTING, AND PARTICIPANTS A total of 320 consecutive patients with at least one Prostate Imaging Reporting and Data System (PIRADS) ≥3 lesion according to MRI were prospectively enrolled. INTERVENTION All patients received microUS before prostate biopsy using the ExactVu system; the Prostate Risk Identification using microUS (PRI-MUS) protocol was used to identify targets. The urologists were blinded to MRI results until after the microUS targeting was completed. All patients received both targeted (based on either microUS or MRI findings) and randomized biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The sensitivity and specificity of microUS to determine the presence of csPCa (defined as at least one core with a Gleason score ≥7 PCa) were determined. Multivariable logistic regression analysis was fitted to determine the predictors of csPCa. RESULTS AND LIMITATIONS Clinically significant PCa was diagnosed in 116 (36.3%) patients. The sensitivity and negative predictive value of microUS for csPCa diagnosis were 89.7% and 81.5%, while specificity and positive predictive value were 26.0% and 40.8%, respectively. A combination of microUS-targeted and randomized biopsies would allow diagnosing the same proportion of csPCa as that diagnosed by an approach combining MRI-targeted and randomized biopsies (n = 113; 97.4%), with only three (2.6%) csPCa cases diagnosed by a microUS-targeted and three (2.6%) by an MRI-targeted approach. In a logistic regression model, an increasing PRI-MUS score was an independent predictor of csPCa (p ≤ 0.005). The main limitation of the current study is represented by the fact that all patients had suspicious MRI. CONCLUSIONS Microultrasound is a promising imaging modality for targeted prostate biopsies. Our results suggest that a microUS-based biopsy strategy may be capable of diagnosing the great majority of cancers, while missing only few patients with csPCa. PATIENT SUMMARY According to our results, microultrasound (microUS) may represent an effective diagnostic alternative to magnetic resonance imaging for the diagnosis of clinically significant prostate cancer, providing high sensitivity and a high negative predictive value. Further randomized studies are needed to confirm the potential role of microUS in the diagnostic pathway of patients with a suspicion of prostate cancer.
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Affiliation(s)
- Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy.
| | - Davide Maffei
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Marco Paciotti
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Pietro Diana
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | | | | | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy
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Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution. Prostate Cancer Prostatic Dis 2020; 24:169-176. [PMID: 32759972 DOI: 10.1038/s41391-020-0263-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transrectal (TR) and transperineal (TP) approaches for prostate biopsy have different morbidity profiles. Our institution transitioned to a preference for multiparametric MRI-based triage and TP biopsy since 2014. The aim of this study was to compare clinical, microbiological and health economic outcomes between TR and TP prostate biopsy. METHODS A consecutive cohort study considered prostate biopsies over an 11 year period. Hospital presentations across the region within 30 days of biopsy were analysed for details and subsequent outcomes according to biopsy approach. Cost for each encounter (routine and unplanned) were analysed and generalised linear models applied, as well as cost implications for inclusion of mpMRI-based triage and TP biopsy preference. RESULTS In total, 2048 prostate biopsies were performed. Similar re-presentation rates per occurred for each biopsy approach (90 patients, TR 4.8%, TP 3.8%, p = 0.29), with 23 patients presenting more than once (119 total presentations). Presentations after TR biopsy were more likely to be of infectious aetiology (TR 2.92%, TP 0.26% de novo, p < 0.001) and result in hospital admission (TR 43/49, 93.4%; TP 14/24, 58.3%; p = 0.007) for similar rates of urinary retention (TR 2.76% vs TP 3.63%, p = 1). The mean overall cost (biopsy and re-presentations) was higher for the TP group (p < 0.001), adjusted for year and age, but reduced over time and was similar for patients who re-presented (p = 0.98). Incorporation of mpMRI (with subsequently avoided biopsies), TP biopsy and re-presentations resulted in AU$783.27 saving per biopsy. CONCLUSIONS TR biopsy resulted in more infectious complications and hospital admissions than TP biopsy for similar rates of re-presentation and urinary retention. TP biopsy costs reduced over time and use in conjunction with mpMRI provides an overall cost saving. Routine TP biopsy is safe and feasible, with further cost savings expected with other approaches (local anaesthetic) under investigation.
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26
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Klotz L, Lughezzani G, Maffei D, Sánchez A, Pereira JG, Staerman F, Cash H, Luger F, Lopez L, Sanchez-Salas R, Abouassaly R, Shore ND, Eure G, Paciotti M, Astobieta A, Wiemer L, Hofbauer S, Heckmann R, Gusenleitner A, Kaar J, Mayr C, Loidl W, Rouffilange J, Gaston R, Cathelineau X, Klein E. Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: A multicenter, prospective analysis. Can Urol Assoc J 2020; 15:E11-E16. [PMID: 32701437 DOI: 10.5489/cuaj.6712] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer. METHODS We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (Prostate Imaging-Reporting and Data System [PI-RADS] >3 and micro-ultrasound targets (Prostate Risk Identification using Micro-ultrasound [PRIMUS] >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2. RESULTS Overall, 39.5% were positive for clinically significant prostate cancer. Micro-ultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites. CONCLUSIONS In this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings.
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Affiliation(s)
| | | | | | | | | | | | - Hannes Cash
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Rob Abouassaly
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, United States
| | - Gregg Eure
- Urology of Virginia, Virginia Beach, VA, United States
| | | | | | - Laura Wiemer
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Jasmin Kaar
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | - Clemens Mayr
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | - Wolfgang Loidl
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | | | | | | | - Eric Klein
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States
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Abstract
The role of prostate MRI in clinical practice has continued to broaden over time. Multiple iterations of PI-RADS reporting have aided in improving detection and reporting of prostate cancer. In addition, recent recommendations from the PI-RADS Steering Committee promote an MRI-first approach with an MRI-directed prostate cancer diagnostic pathway. It is imperative for radiologists to be knowledgeable and familiar with prostate MRI and PI-RADS recommendations, as there is an increasing demand for prostate imaging by clinicians and patients alike.
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Affiliation(s)
- Grace C Lo
- Division of Body Imaging, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
| | - Daniel J A Margolis
- Division of Body Imaging, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY, 10065, USA
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Mehdi A, Cheishvili D, Arakelian A, Bismar TA, Szyf M, Rabbani SA. DNA methylation signatures of Prostate Cancer in peripheral T-cells. BMC Cancer 2020; 20:588. [PMID: 32576165 PMCID: PMC7310561 DOI: 10.1186/s12885-020-07078-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/15/2020] [Indexed: 01/03/2023] Open
Abstract
Background Prostate Cancer (PCa) is the second most common cancer in men where advancements have been made for early detection using imaging techniques, however these are limited by lesion size. Immune surveillance has emerged as an effective approach for early detection and to monitor disease progression. In recent studies, we have shown that host peripheral blood immune cells undergo changes in DNA methylation in liver and breast cancer. Methods In the current study, we examined the DNA methylation status of peripheral blood T cells of men with positive biopsy for PCa versus men with negative biopsy having benign prostate tissue, defined as controls. T cells DNA was isolated and subjected to Illumina Infinium methylation EPIC array and validated using Illumina amplicon sequencing and pyrosequencing platforms. Results Differential methylation of 449 CG sites between control and PCa T cell DNA showed a correlation with Gleason score (p < 0.05). Two hundred twenty-three differentially methylated CGs between control and PCa (∆ß +/− 10%, p < 0.05), were enriched in pathways involved in immune surveillance system. Three CGs which were found differentially methylated following DMP (Differentially methylated probes) analysis of ChAMP remained significant after BH (Benjamini-Hochberg) correction, of which, 2 CGs were validated. Predictive ability of combination of these 3 CGs (polygenic methylation score, PMS) to detect PCa had high sensitivity, specificity and overall accuracy. PMS also showed strong positive correlation with Gleason score and tumor volume of PCa patients. Conclusions Results from the current study provide for the first-time a potential role of DNA methylation changes in peripheral T cells in PCa. This non-invasive methodology may allow for early intervention and stratification of patients into different prognostic groups to reduce PCa associated morbidity from repeat invasive prostate biopsies and design therapeutic strategy to reduce PCa associated mortality.
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Affiliation(s)
- Ali Mehdi
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - David Cheishvili
- HKG Epitherapeutics, Hong Kong, China.,Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Ani Arakelian
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Tarek A Bismar
- Departments of Pathology & Laboratory Medicine, Oncology, Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Moshe Szyf
- Department of Pharmacology, McGill University, Montreal, Quebec, Canada
| | - Shafaat A Rabbani
- Department of Medicine, McGill University, Montreal, Quebec, Canada. .,Department of Human Genetics, McGill University, Montreal, Quebec, Canada. .,McGill University Health Centre, 1001 Décarie Blvd. (Glen site), Room EM1.3232, Montréal, QC, H4A3J1, Canada.
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Abstract
Multiparametric MRI has a changing role in prostate cancer diagnosis. Internationally recognized consensus documents such as prostate imaging reporting and data system version have been developed and adapted to standardize the acquisition and reporting of prostate MRI. The improvement in scanning techniques and development of highly sensitive functional sequences have improved the detection of clinically significant prostate cancer as well as treatment planning and follow up. This has led to a recent NICE recommendation to use prostate MRI as the initial investigation in men with clinically suspected localized disease. The results of several recent international MRI prostate trials are influencing the way imaging is used to stratify which patients require a prostate biopsy as well as how MRI guidance is used to target biopsies.
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Padhani AR, Schoots I, Villeirs G. Contrast Medium or No Contrast Medium for Prostate Cancer Diagnosis. That Is the Question. J Magn Reson Imaging 2020; 53:13-22. [PMID: 32363651 DOI: 10.1002/jmri.27180] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/20/2022] Open
Abstract
The benefits and drawbacks of the dynamic contrast-enhanced MRI sequence for prostate cancer diagnosis are increasingly being recognized, with many centers adopting the biparametric (bp) MRI approach as the default initial approach. The abandonment of the routine use of contrast medium requires an assessment of the loss of diagnostic power against the gains in operational logistics, costs, time, capacity, and side effects. It is the balance of these factors weighted against the clinical priorities of patients that determines which patient groups can safely avoid dynamic contrast enhancement. Although systematic reviews and individual studies are broadly supportive of the bpMRI approach, the pathway impacts for men with suspected cancer using the bpMRI approach are still not well documented for clinical practice. Robust prospectively acquired data for bpMRI regarding biopsy avoidance, detection of clinically significant and insignificant cancers, and for increasing the precision of tumor grade and volume are needed. There is a requirement for prospective, randomized, or blinded head-to-head, multicenter studies, addressing the noninferiority of biopsy yields prompted by bpMRI and multiparametric MRI approaches. These studies should more precisely define patient groups where the benefits and harms of contrast enhancement are aligned to their clinical priorities. Only then can we be confident in recommending bpMRI as an initial diagnostic approach for prostate cancer diagnosis. Level of Evidence 1 Technical Efficacy Stage 5.
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Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Ivo Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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Israël B, Leest MVD, Sedelaar M, Padhani AR, Zámecnik P, Barentsz JO. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 2: Interpretation. Eur Urol 2020; 77:469-480. [DOI: 10.1016/j.eururo.2019.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023]
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Álvarez-Maestro M, Gómez Rivas J, Quesada Olarte J, Carrión D, Trelles Guzman C, Ballesteros C, Quintana L, Aguilera Bazán A, Martínez-Piñeiro L, Liatsikos E, Barret E. Magnetic resonance as imaging diagnostic tool in prostate cancer: New evidences-The EAU Section of Uro-Technology position. Actas Urol Esp 2020; 44:148-155. [PMID: 31866160 DOI: 10.1016/j.acuro.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
Abstract
Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging as the most sensitive and specific imaging tool for detection, lesion characterization and staging of PCa. Therefore, we carried out an updated review of magnetic resonance imaging in the diagnostic PCa reviewing the latest papers published in PubMed.
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Klocker H, Golding B, Weber S, Steiner E, Tennstedt P, Keller T, Schiess R, Gillessen S, Horninger W, Steuber T. Development and validation of a novel multivariate risk score to guide biopsy decision for the diagnosis of clinically significant prostate cancer. BJUI COMPASS 2020; 1:15-20. [PMID: 35474911 PMCID: PMC8988838 DOI: 10.1002/bco2.8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives Selecting patients suspected of having prostate cancer (PCa) for a prostate biopsy remains a challenge. Prostate-specific antigen (PSA)-based testing is hampered by its low specificity that often leads to negative biopsy results or detection of clinically insignificant cancers, especially in the 2-10 ng/mL range. The objective was to evaluate a novel diagnostic test called Proclarix incorporating thrombospondin-1 and cathepsin D alongside total and free PSA as well as age for predicting clinically significant PCa. Patients and methods The test was developed following a retrospective study design using biobanked samples of 955 men from two reference centres. A multivariate approach was used for model development followed by validation to discriminate significant (grade group ≥2) from insignificant or no cancer at biopsy. The test specificity, positive predictive value (PPV) and negative predictive value (NPV) at a fixed sensitivity of 90% were compared to percent free PSA (%fPSA) alone. The number of avoidable prostate biopsies deemed to be representative of clinical utility was also assessed. Results In the targeted patient population, the test displayed increased diagnostic accuracy compared to %fPSA alone. Application of the established model on 955 patients at a fixed sensitivity of 90% for significant disease resulted in a specificity of 43%, NPV of 95% and a PPV of 25%. This is in comparison to a specificity of 17%, NPV of 89% and PPV of 19% for %fPSA alone and had the potential to reduce the total number of biopsies needed to identify clinically significant cancer. Further, the test score correlated with significance of cancer assessed on prostate biopsy. Conclusions The Proclarix test can be used as an aid in the decision-making process if to biopsy men in this challenging patient population. The use of the test could reduce the number of biopsies performed avoiding invasive procedures, anxiety, discomfort, pain and complications.
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Affiliation(s)
- Helmut Klocker
- Department of UrologyMedical University InnsbruckInnsbruckAustria
| | | | | | - Eberhard Steiner
- Department of UrologyMedical University InnsbruckInnsbruckAustria
| | - Pierre Tennstedt
- Martini Clinic Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | | | | | - Silke Gillessen
- Medical Oncology DepartmentOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
| | | | - Thomas Steuber
- Martini Clinic Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
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Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol 2020; 17:41-61. [PMID: 31316185 DOI: 10.1038/s41585-019-0212-4] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and consequent overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mpMRI) of the prostate has been identified as a test that could mitigate these diagnostic errors. The performance of mpMRI can vary depending on the population being studied, the execution of the MRI itself, the experience of the radiologist, whether additional biomarkers are considered and whether mpMRI-targeted biopsy is carried out alone or in addition to systematic biopsy. A number of challenges to implementation remain, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. Nevertheless, emerging clinical trial data support the adoption of this technology as part of the standard of care for the diagnosis of prostate cancer.
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Affiliation(s)
- Armando Stabile
- Division of Surgery and Interventional Science, University College London, London, UK.
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Samir S Taneja
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Baboudjian M, Bandelier Q, Gondran-Tellier B, Abdallah R, Michel F, Sichez PC, Di-Crocco E, Akiki A, Gaillet S, Delaporte V, Andre M, Daniel L, Karsenty G, Lechevallier E, Boissier R. MRI-targeted biopsy for detecting prostate cancer: have the guidelines changed our practices and our prostate cancer detection rate? Int Urol Nephrol 2019; 52:611-618. [DOI: 10.1007/s11255-019-02353-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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36
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Stabile A, Muttin F, Zamboni S, Moschini M, Gandaglia G, Fossati N, Dell’Oglio P, Capitanio U, Cucchiara V, Mazzone E, Bravi CA, Mirone V, Montorsi F, Briganti A. Therapeutic approaches for lymph node involvement in prostate, bladder and kidney cancer. Expert Rev Anticancer Ther 2019; 19:739-755. [DOI: 10.1080/14737140.2019.1659135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Armando Stabile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Muttin
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Dell’Oglio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo A. Bravi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Federico II of Naples, Naples, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Abstract
PURPOSE OF REVIEW The use of MRI in the early detection of prostate cancer (PCa) is increasing rapidly. In the last couple of years, there have been a number of key publications that have led to its adoption in the UK and European guidelines. RECENT FINDINGS PROMIS showed that standard biopsy missed up to half of clinically significant disease, compared with 5 mm template mapping biopsy. Three studies then compared the standard transrectal ultrasound (TRUS) pathway with an MRI with or without targeted biopsy pathway. These showed that MRI-targeted biopsies detect more clinically significant disease and reduce overdetection of indolent disease whilst allowing between one-third to one half of men to avoid an immediate biopsy. Cost-effectiveness data show that using MRI to determine who gets a biopsy and how that biopsy is done is a cost-neutral approach when men at lowest risk do not undergo biopsy. SUMMARY Prostate MRI is a useful and cost-effective tool for early detection of PCa that minimizes the impact of overdetection and overtreatment whilst maximizing the detection of PCa, which could benefit from treatment. The next challenge is to ensure that centres offering MRI are able to offer high-quality MRI acquisition and reporting.
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Woo S, Suh CH, Eastham JA, Zelefsky MJ, Morris MJ, Abida W, Scher HI, Sidlow R, Becker AS, Wibmer AG, Hricak H, Vargas HA. Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Oncol 2019; 2:605-616. [PMID: 31204311 DOI: 10.1016/j.euo.2019.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/14/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
CONTEXT Recent studies suggested that magnetic resonance imaging (MRI) followed by targeted biopsy ("MRI-stratified pathway") detects more clinically significant prostate cancers (csPCa) than the systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx) pathway, but controversy persists. Several randomized clinical trials (RCTs) were recently published, enabling generation of higher-level evidence to evaluate this hypothesis. OBJECTIVE To perform a systematic review and meta-analysis of RCTs comparing the detection rates of csPCa in the MRI-stratified pathway and the systematic TRUS-Bx pathway in patients with a suspicion of prostate cancer (PCa). EVIDENCE ACQUISITION PubMed, EMBASE, and Cochrane databases were searched up to March 18, 2019. RCTs reporting csPCa detection rates of both pathways in patients with a clinical suspicion of prostate cancer were included. Relative csPCa detection rates of the MRI-stratified pathway were pooled using random-effect model. Study quality was assessed using the Cochrane risk of bias tool for randomized trials. A comparison of detection rates of clinically insignificant PCa (cisPCa) and any PCa was also performed. EVIDENCE SYNTHESIS Nine RCTs (2908 patients) were included. The MRI-stratified pathway detected more csPCa than the TRUS-Bx pathway (relative detection rate 1.45 [95% confidence interval {CI} 1.09-1.92] for all patients, and 1.42 [95% CI 1.02-1.97] and 1.60 [95% CI 1.01-2.54] for biopsy-naïve and prior negative biopsy patients, respectively). Detection rates were not significantly different between pathways for cisPCa (0.89 [95% CI 0.49-1.62]), but higher in the MRI-stratified pathway for the detection of any PCa (1.39 [95% CI 1.05-1.84]). CONCLUSIONS The MRI-stratified pathway detected more csPCa than the systematic TRUS-guided biopsy pathway in men with a clinical suspicion of PCa, for both biopsy-naïve patients and those with prior negative biopsy. The detection rate of any PCa was higher in the MRI-stratified pathway, but not significantly different from that of cisPCa. PATIENT SUMMARY Our meta-analysis of clinical trials shows that the magnetic resonance imaging-stratified pathway detects more clinically significant prostate cancers than the transrectal ultrasound-guided prostate biopsy pathway in men with a suspicion of prostate cancer.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wassim Abida
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Sidlow
- Integrative Medicine Service, Division of Survivorship and Supportive Care, Bendheim Center for Integrative Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas G Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Assessing the Clinical Value of Positive Multiparametric Magnetic Resonance Imaging in Young Men with a Suspicion of Prostate Cancer. Eur Urol Oncol 2019; 4:594-600. [PMID: 31204312 DOI: 10.1016/j.euo.2019.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a lack of evidence on the ability of magnetic resonance imaging (MRI) of the prostate to detect clinically significant prostate cancer (csPCa) in young patients. OBJECTIVE We hypothesised that the diagnostic performance of MRI for csPCa varies according to patient's age. To address this, we assessed the variation in the csPCa detection rate of MRI targeted biopsy (MRI-TBx) versus systematic random biopsy (SBx) across different patient ages. DESIGN, SETTING, AND PARTICIPANTS We retrospectively identified 930 patients who underwent prostate MRI and subsequent biopsy at two referral centres between 2013 and 2018. The Prostate Imaging Reporting and Data System (PI-RADS) was used for MRI reporting. INTERVENTION A lesion with a PI-RADS score of ≥3 detected at MRI received an MRI-TBx in addition to an SBx during the same session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcome of our study was the relationship between age and csPCa detection rate at MRI-TBx and SBx, respectively. Clinically significant prostate cancer (PCa) was defined as the presence of PCa with Gleason score ≥3+4. Multivariable logistic regression analyses (MVAs) predicting csPCa detection were assessed for both MRI-TBx and SBx. Covariates were age, prostate-specific antigen density, PI-RADS score, previous biopsy status, digital rectal examination, and the number of targeted and systematic cores. The hypothesis that MRI accuracy in detecting csPCa differed by age was finally tested with a nonparametric loess analysis. RESULTS AND LIMITATIONS The overall rate of csPCa was 54% (n=506). Overall, 325 (35%) and 461 (50%) patients had csPCa at SBx and MRI-TBx, respectively. The median numbers of SBx and MRI-TBx cores were 12 (interquartile range [IQR]: 10-13) and 5 (IQR: 4-7), respectively. At MVA, age at biopsy was an independent predictor of csPCa at MRI-TBx only (odds ratio: 1.05), after accounting for confounders. In men aged less than roughly 50yr, SBx had a higher probability of detecting csPCa relative to MRI-TBx (25% vs 16% at 40yr). Conversely, in patients aged >50yr, the probability of csPCa was higher in MRI-TBx than in SBx, reaching the highest difference for very elderly patients (48% vs 68% at 80yr). The main limitations were the retrospective design and the small number of young patients. CONCLUSIONS In this study, we reported the performance of MRI and MRI-TBx in detecting csPCa changes according to patients' age. PATIENT SUMMARY In young patients, the performance of a systematic random biopsy in detecting clinically significant prostate cancer (csPCa) is higher relative to magnetic resonance imaging targeted biopsy (MRI-TBx), reflecting the lower accuracy of MRI in younger men. Conversely, in older patients, MRI-TBx showed a clinical benefit with a higher csPCa detection rate compared with SBx, suggesting an increase of MRI accuracy with the increase of age.
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Padhani AR, Barentsz J, Villeirs G, Rosenkrantz AB, Margolis DJ, Turkbey B, Thoeny HC, Cornud F, Haider MA, Macura KJ, Tempany CM, Verma S, Weinreb JC. PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway. Radiology 2019; 292:464-474. [PMID: 31184561 DOI: 10.1148/radiol.2019182946] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High-quality evidence shows that MRI in biopsy-naive men can reduce the number of men who need prostate biopsy and can reduce the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm. In men with prior negative biopsy results who remain under persistent suspicion, MRI improves the detection and localization of life-threatening prostate cancer with greater clinical utility than the current standard of care, systematic transrectal US-guided biopsy. Systematic analyses show that MRI-directed biopsy increases the effectiveness of the prostate cancer diagnosis pathway. The incorporation of MRI-directed pathways into clinical care guidelines in prostate cancer detection has begun. The widespread adoption of the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric MRI data acquisition, interpretation, and reporting has promoted these changes in practice. The PI-RADS MRI-directed biopsy pathway enables the delivery of key diagnostic benefits to men suspected of having cancer based on clinical suspicion. Herein, the PI-RADS Steering Committee discusses how the MRI pathway should be incorporated into routine clinical practice and the challenges in delivering the positive health impacts needed by men suspected of having clinically significant prostate cancer.
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Affiliation(s)
- Anwar R Padhani
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Jelle Barentsz
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Geert Villeirs
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Andrew B Rosenkrantz
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Daniel J Margolis
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Baris Turkbey
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Harriet C Thoeny
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - François Cornud
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Masoom A Haider
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Katarzyna J Macura
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Clare M Tempany
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Sadhna Verma
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Jeffrey C Weinreb
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
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van der Leest M, Cornel E, Israël B, Hendriks R, Padhani AR, Hoogenboom M, Zamecnik P, Bakker D, Setiasti AY, Veltman J, van den Hout H, van der Lelij H, van Oort I, Klaver S, Debruyne F, Sedelaar M, Hannink G, Rovers M, Hulsbergen-van de Kaa C, Barentsz JO. Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naïve Men with Elevated Prostate-specific Antigen: A Large Prospective Multicenter Clinical Study. Eur Urol 2019; 75:570-578. [DOI: 10.1016/j.eururo.2018.11.023] [Citation(s) in RCA: 379] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/12/2018] [Indexed: 01/21/2023]
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Cantiello F, Russo GI, Kaufmann S, Cacciamani G, Crocerossa F, Ferro M, De Cobelli O, Artibani W, Cimino S, Morgia G, Damiano R, Nikolaou K, Kröger N, Stenzl A, Bedke J, Kruck S. Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis 2018; 22:206-220. [PMID: 30487646 DOI: 10.1038/s41391-018-0113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS. METHODS A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification. RESULTS In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83. CONCLUSIONS Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | - Sascha Kaufmann
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Fabio Crocerossa
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Walter Artibani
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Rocco Damiano
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Konstantin Nikolaou
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Nils Kröger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Arnulf Stenzl
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Bedke
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Stephan Kruck
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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