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Iorga M, Useva A, Regan B, Pinkhasov A, Byler T, Wiener S. Prostate volume on computed tomography correlates well with magnetic resonance imaging measurements and is reproducible across rater training levels. Int Urol Nephrol 2024; 56:3241-3247. [PMID: 38776056 DOI: 10.1007/s11255-024-04036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/08/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Data are lacking for the accuracy of computed tomography (CT) in measuring prostate size, which can streamline care and prevent invasive procedures. We evaluate agreement and intra/inter-observer variability in prostate sizing between CT and magnetic resonance imaging (MRI) planimetry for a wide range of gland sizes. METHODS We retrospectively reviewed 700 patients who underwent MRI fusion biopsy at a single institution and identified 89 patients that had a CT within 2 years of the MRI. Six reviewers from different training levels were categorized as student, resident, or attending and each measured prostate size on CT by the prolate ellipse method. Bland-Altman analysis determined the degree of agreement between CT and MRI. Inter- and intra-observer reliability was calculated for CT. RESULTS Mean CT volume was higher than MRI volume in the < 60 g group (51.5 g vs. 44.5 g, p = 0.004), but not in the ≥ 60 g group (101 g vs. 100 g, p = 0.458). The bias for overestimation of prostate volume by CT was 4.1 g across prostate volumes, but the proportional agreement between modalities improved with size. The Pearson correlation coefficient between CT/MRI and inter/intra-rater reliability for CT increased in the ≥ 60 g vs. the < 60 g group for all training levels. CONCLUSIONS Our data show that there is greater clinical utility for prostate size estimation by CT than previously established, particularly for larger glands where accurate size estimation may influence therapeutic decisions. In larger glands, prostate size estimation by CT is also reproducible across various training levels.
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Affiliation(s)
- Michael Iorga
- Department of Urology, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Anastasija Useva
- Department of Urology, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Bethany Regan
- School of Medicine, Upstate Medical University, Syracuse, NY, USA
| | - Alexandr Pinkhasov
- Department of Urology, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Timothy Byler
- Department of Urology, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Scott Wiener
- Department of Urology, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
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Palmisano F, Lorusso V, Legnani R, Martorello V, Nedbal C, Tramanzoli P, Marchesotti F, Ferraro S, Talso M, Granata AM, Sighinolfi MC, Rocco B, Gregori A. Analysis of the Performance and Accuracy of a PSA and PSA Ratio-Based Nomogram to Predict the Probability of Prostate Cancer in a Cohort of Patients with PIRADS 3 Findings at Multiparametric Magnetic Resonance Imaging. Cancers (Basel) 2024; 16:3084. [PMID: 39272942 PMCID: PMC11394649 DOI: 10.3390/cancers16173084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND PIRADS score 3 represents a challenge in prostate cancer (PCa) detection with MRI. Our study aimed to evaluate the application of a nomogram on a cohort of patients with PIRADS 3. METHODS We analyzed 286 patients undergoing fusion prostate biopsy from January 2020 to February 2024. Only PIRADS 3 patients were included. Two nomograms, previously developed and based on clinical variables such as age, total PSA (specifically 2-10 ng/mL) and PSA ratio were applied to estimate the probability (Nomograms A and B) for PCa Grade Group (GG) > 3 and GG < 3. RESULTS Out of the 70 patients available for analysis, 14/70 patients (20%) had PCa, 4/14 were GG 1 (28.6%), 1/14 were GG 2 (7.1%), 5/14 were GG 3 (35.8%), 2/14 were GG 4 (14.3%) and 2/14 were GG 5 (14.3%). The median probability of PCa GG > 3 and GG < 3 was 5% and 33%, respectively. A significant difference (p = 0.033) was found between patients with negative versus positive biopsy for Nomogram B. There was a significant difference (p = 0.029) for Nomogram B comparing patients with GG < 3 and GG > 3. Using a cut-off of 40% for Nomogram B, sensitivity and specificity were 70% and 80%, respectively. CONCLUSIONS This cohort has a low probability of harboring PCa especially ISUP > 3. Nomogram B has good accuracy for discriminating patients with PCa from those with negative biopsy.
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Affiliation(s)
- Franco Palmisano
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | - Vito Lorusso
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | - Rebecca Legnani
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | - Vincenzo Martorello
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | - Carlotta Nedbal
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | - Pietro Tramanzoli
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | | | - Simona Ferraro
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | | | | | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy
- University of Milan, 20122 Milan, Italy
| | - Andrea Gregori
- Department of Urology, ASST Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
- University of Milan, 20122 Milan, Italy
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Ma MW, Wang K, Gao XS, Zhu TZ, Li HZ, Shen Q, Yang KW, Qiu JX. Integration of Multiparameter MRI into Conventional Pretreatment Risk Factors to Predict Positive Surgical Margins After Radical Prostatectomy. Clin Genitourin Cancer 2024; 22:281-290.e1. [PMID: 38065717 DOI: 10.1016/j.clgc.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION/BACKGROUND Positive surgical margins (PSMs) after radical prostatectomy (RP) can increase the risk of biochemical recurrence in prostate cancer (PCa) patients. However, the prediction of the likelihood of PSMs in patients undergoing similar surgical procedures remains a challenge. We aim to develop a predictive model for PSMs in patients undergoing non-nerve-sparing RP. PATIENTS AND METHODS In this retrospective study, we analyzed data from PCa patients who underwent minimally invasive non-nerve-sparing RP at our hospital between June 2017 and June 2021. We identified independent risk factors associated with PSMs using clinical and MRI-based parameters in univariate and multivariate logistic regression analyzes. These factors were then used to develop a nomogram for predicting the probability of PSMs. The predictive performance was validated using calibration and receiver operating characteristic curve, area under the curve ,and decision curve analysis. RESULTS Multivariate analyzes revealed prostate-specific antigen density, tumor size, tumor location at the apex, tumor contact length, extracapsular extension (ECE) level, and apparent diffusion coefficient value as independent risk factors. A nomogram was developed and validated with high accuracy (C-index = 0.78). Furthermore, we found that 44.2% of patients diagnosed with organ-confined disease had ECE after surgery, and 29.1% of patients with Gleason scores ≤7 had higher pathological scores. Interestingly, the tumor burden calculated from PCa biopsy cores was overestimated when compared to postoperative PCa specimens. CONCLUSION We developed a reliable nomogram for predicting the risk of PSMs in PCa patients undergoing non-nerve-sparing RP. The study highlights the importance of incorporating these parameters in personalized surgical management.
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Affiliation(s)
- Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, Beijing China
| | - Ke Wang
- Department of Radiology, Peking University First Hospital, Beijing China
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing China.
| | - Tian-Zhao Zhu
- Department of Radiology, Peking University First Hospital, Beijing China
| | - Hong-Zhen Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing China
| | - Qi Shen
- Department of Urological Pathology, Peking University First Hospital, Beijing China
| | - Kai-Wei Yang
- Department of Urology, Peking University First Hospital, Beijing China
| | - Jian-Xing Qiu
- Department of Radiology, Peking University First Hospital, Beijing China.
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Leung JSL, Ma WK, Ho BSH, Chun STT, Na R, Zhan Y, Ng CY, Ip CH, Ng ATL, Lam YC. Prostate health index can stratify patients with Prostate Imaging Reporting and Data System score 3 lesions on magnetic resonance imaging to reduce prostate biopsies. Asian J Androl 2024; 26:20-24. [PMID: 37695241 PMCID: PMC10846822 DOI: 10.4103/aja202332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023] Open
Abstract
We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging. Men with biochemical or clinical suspicion of having prostate cancer who underwent multiparametric magnetic resonance imaging in two tertiary centers (Queen Mary Hospital and Princess Margaret Hospital, Hong Kong, China) between January 2017 and June 2022 were included. Ultrasound-magnetic resonance imaging fusion biopsies were performed after prostate health index testing. Those who only had Prostate Imaging Reporting and Data System score 3 lesions were further stratified into four prostate health index risk groups and the cancer detection rates were analyzed. Out of the 747 patients, 47.3% had Prostate Imaging Reporting and Data System score 3 lesions only. The detection rate of clinically significant prostate cancer in this group was 15.0%. The cancer detection rates of clinically significant prostate cancer had statistically significant differences 5.3% in prostate health index <25.0, 7.4% in prostate health index 25.0-34.9, 17.9% in prostate health index 35.0-54.9, and 52.6% in prostate health index ≥55.0 (P < 0.01). Among the patients, 26.9% could have avoided a biopsy with a prostate health index <25.0, at the expense of a 5.3% risk of missing clinically significant prostate cancer. Prostate health index could be used as an additional risk stratification tool for patients with Prostate Imaging Reporting and Data System score 3 lesions. Biopsies could be avoided in patients with low prostate health index, with a small risk of missing clinically significant prostate cancer.
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Affiliation(s)
- John Shung-Lai Leung
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
- Division of Urology, Department of Surgery, Princess Margaret Hospital, Hong Kong, China
| | - Wai-Kit Ma
- Division of Urology, Department of Surgery, Princess Margaret Hospital, Hong Kong, China
| | - Brian Sze-Ho Ho
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Stacia Tsun-Tsun Chun
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Rong Na
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Yongle Zhan
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Chi-Yuen Ng
- Division of Urology, Department of Surgery, Princess Margaret Hospital, Hong Kong, China
| | - Chi-Ho Ip
- Division of Urology, Department of Surgery, Princess Margaret Hospital, Hong Kong, China
| | - Ada Tsui-Lin Ng
- Division of Urology, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Yiu-Chung Lam
- Division of Urology, Department of Surgery, Princess Margaret Hospital, Hong Kong, China
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Sushentsev N, Abrego L, Colarieti A, Sanmugalingam N, Stanzione A, Zawaideh JP, Caglic I, Zaikin A, Blyuss O, Barrett T. Using a Recurrent Neural Network To Inform the Use of Prostate-specific Antigen (PSA) and PSA Density for Dynamic Monitoring of the Risk of Prostate Cancer Progression on Active Surveillance. EUR UROL SUPPL 2023; 52:36-39. [PMID: 37182116 PMCID: PMC10172696 DOI: 10.1016/j.euros.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
The global uptake of prostate cancer (PCa) active surveillance (AS) is steadily increasing. While prostate-specific antigen density (PSAD) is an important baseline predictor of PCa progression on AS, there is a scarcity of recommendations on its use in follow-up. In particular, the best way of measuring PSAD is unclear. One approach would be to use the baseline gland volume (BGV) as a denominator in all calculations throughout AS (nonadaptive PSAD, PSADNA), while another would be to remeasure gland volume at each new magnetic resonance imaging scan (adaptive PSAD, PSADA). In addition, little is known about the predictive value of serial PSAD in comparison to PSA. We applied a long short-term memory recurrent neural network to an AS cohort of 332 patients and found that serial PSADNA significantly outperformed both PSADA and PSA for follow-up prediction of PCa progression because of its high sensitivity. Importantly, while PSADNA was superior in patients with smaller glands (BGV ≤55 ml), serial PSA was better in men with larger prostates of >55 ml. Patient summary Repeat measurements of prostate-specific antigen (PSA) and PSA density (PSAD) are the mainstay of active surveillance in prostate cancer. Our study suggests that in patients with a prostate gland of 55 ml or smaller, PSAD measurements are a better predictor of tumour progression, whereas men with a larger gland may benefit more from PSA monitoring.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Corresponding author. Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK. Tel. +44 1223 336895.
| | - Luis Abrego
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
| | - Anna Colarieti
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | - Arnaldo Stanzione
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jeries Paolo Zawaideh
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Iztok Caglic
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | - Alexey Zaikin
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- Department of Mathematics, University College London, London, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
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Lin YT, Hung SW, Chiu KY, Chai JW, Lin JC. Assessment of Prostate Volume and Prostate-specific Antigen Density With the Segmentation Method on Magnetic Resonance Imaging. In Vivo 2023; 37:786-793. [PMID: 36881046 PMCID: PMC10026687 DOI: 10.21873/invivo.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM This study aimed to compare the prostate volume (PV) and prostate-specific antigen density (PSAD) obtained using the ellipsoid volume formula or segmentation methods on magnetic resonance imaging (MRI) and further predict prostate cancer (PCa). PATIENTS AND METHODS Retrospectively, the enrolled patients underwent prostate MRI and had PSA levels between 4 and 10 ng/ml. The PV was measured with both the ellipsoid volume formula (PVe) and the segmentation method (PVs). The transitional zone volume (TZV) was measured with the segmentation method. The PSADe, PSADs, and PSAD_TZV were calculated. Bland-Altman plots were used to compare the agreements. ROC curve analysis was used to compare the diagnostic accuracies to predict PCa. The results were also compared between the PCa and the no-PCa groups, and among tumors with different locations and different Gleason scores (GS). RESULTS Seventy-six of the 117 enrolled patients were classified into the PCa group. There were high agreements between PVs and PVe as well as between PSADs and PSADe, while several outliers were mainly due to post-transurethral resection of the prostate changes and irregular hyperplastic nodules. The diagnostic accuracy of PSADe (AUC: 0.732) was slightly higher than that of PSADs (AUC: 0.729) and PSAD_TZV (AUC: 0.715). The PSADe and PSADs were not different among different tumor locations but were higher in GS ≥7 lesions (both p=0.006). CONCLUSION The segmentation method can be an alternative method to measure PV and calculate PSAD before prostate biopsy, particularly in post-transurethral resection of the prostate patients or those with irregular hyperplastic nodules.
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Affiliation(s)
- Yen-Ting Lin
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Siu-Wan Hung
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Jin-Ching Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C.;
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
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Youn SY, Choi MH, Lee YJ, Grimm R, von Busch H, Han D, Son Y, Lou B, Kamen A. Prostate gland volume estimation: anteroposterior diameters measured on axial versus sagittal ultrasonography and magnetic resonance images. Ultrasonography 2023; 42:154-164. [PMID: 36475357 PMCID: PMC9816709 DOI: 10.14366/usg.22104] [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: 06/22/2022] [Accepted: 10/24/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the accuracy of prostate volume estimates calculated from the ellipsoid formula using the anteroposterior (AP) diameter measured on axial and sagittal images obtained through ultrasonography (US) and magnetic resonance imaging (MRI). METHODS This retrospective study included 456 patients with transrectal US and MRI from two university hospitals. Two radiologists independently measured the prostate gland diameters on US and MRI: AP diameters on axial and sagittal images, transverse, and longitudinal diameters on midsagittal images. The volume estimates, volumeax and volumesag, were calculated from the ellipsoid formula by using the AP diameter on axial and sagittal images, respectively. The prostate volume extracted from MRI-based whole-gland segmentation was considered the gold standard. The intraclass correlation coefficient (ICC) was used to evaluate the inter-method agreement between volumeax and volumesag, and agreement with the gold standard. The Wilcoxon signedrank test was used to analyze the differences between the volume estimates and the gold standard. RESULTS The prostate gland volume estimates showed excellent inter-method agreement, and excellent agreement with the gold standard (ICCs >0.9). Compared with the gold standard, the volume estimates were significantly larger on MRI and significantly smaller on US (P<0.001). The volume difference (segmented volume-volume estimate) was greater in patients with larger prostate glands, especially on US. CONCLUSION Volumeax and volumesag showed excellent inter-method agreement and excellent agreement with the gold standard on both US and MRI. However, prostate volume was overestimated on MRI and underestimated on US.
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Affiliation(s)
- Seo Yeon Youn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Correspondence to: Moon Hyung Choi, MD, PhD, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea Tel. +82-2-2030-3013 Fax. +82-2-2030-3026 E-mail:
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Robert Grimm
- Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany
| | | | | | - Yohan Son
- Siemens Healthineers Ltd., Seoul, Korea
| | - Bin Lou
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Ali Kamen
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
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Kobayashi Y, Arai H, Honda M. Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up. PLoS One 2022; 17:e0272652. [PMID: 35951591 PMCID: PMC9371260 DOI: 10.1371/journal.pone.0272652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. Objective To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. Material and methods We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5–7), b: moderate (8–11), c: mild to moderate (12–16), d: mild (17–21), and e: no erectile dysfunction (22–25). Data are displayed as median or median (interquartile range). Results The study comprised 51 patients with a median age of 75 (70.5–79.5) years. Median prostate and transition zone volumes were 69.5 (46.5–78.8) mL and 30.5 (19–43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). Conclusion TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.
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Affiliation(s)
- Yasuyuki Kobayashi
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
- * E-mail:
| | - Hiroki Arai
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| | - Masahito Honda
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
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9
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Greenberg SA, Cowan JE, Lonergan PE, Washington SL, Nguyen HG, Zagoria RJ, Carroll PR. The effect of preoperative membranous urethral length on likelihood of postoperative urinary incontinence after robot-assisted radical prostatectomy. Prostate Cancer Prostatic Dis 2022; 25:344-350. [DOI: 10.1038/s41391-022-00527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/01/2022] [Accepted: 03/03/2022] [Indexed: 11/09/2022]
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10
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Prostate volume prediction on MRI: tools, accuracy and variability. Eur Radiol 2022; 32:4931-4941. [PMID: 35169895 DOI: 10.1007/s00330-022-08554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE A reliable estimation of prostate volume (PV) is essential to prostate cancer management. The objective of our multi-rater study was to compare intra- and inter-rater variability of PV from manual planimetry and ellipsoid formulas. METHODS Forty treatment-naive patients who underwent prostate MRI were selected from a local database. PV and corresponding PSA density (PSAd) were estimated on 3D T2-weighted MRI (3 T) by 7 independent radiologists using the traditional ellipsoid formula (TEF), the newer biproximate ellipsoid formula (BPEF), and the manual planimetry method (MPM) used as ground truth. Intra- and inter-rater variability was calculated using the mixed model-based intraclass correlation coefficient (ICC). RESULTS Mean volumes were 67.00 (± 36.61), 66.07 (± 35.03), and 64.77 (± 38.27) cm3 with the TEF, BPEF, and MPM methods, respectively. Both TEF and BPEF overestimated PV relative to MPM, with the former presenting significant differences (+ 1.91 cm3, IQ = [- 0.33 cm3, 5.07 cm3], p val = 0.03). Both intra- (ICC > 0.90) and inter-rater (ICC > 0.90) reproducibility were excellent. MPM had the highest inter-rater reproducibility (ICC = 0.999). Inter-rater PV variation led to discrepancies in classification according to the clinical criterion of PSAd > 0.15 ng/mL for 2 patients (5%), 7 patients (17.5%), and 9 patients (22.5%) when using MPM, TEF, and BPEF, respectively. CONCLUSION PV measurements using ellipsoid formulas and MPM are highly reproducible. MPM is a robust method for PV assessment and PSAd calculation, with the lowest variability. TEF showed a high degree of concordance with MPM but a slight overestimation of PV. Precise anatomic landmarks as defined with the BPEF led to a more accurate PV estimation, but also to a higher variability. KEY POINTS • Manual planimetry used for prostate volume estimation is robust and reproducible, with the lowest variability between readers. • Ellipsoid formulas are accurate and reproducible but with higher variability between readers. • The traditional ellipsoid formula tends to overestimate prostate volume.
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11
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Estimation of the Prostate Volume from Abdominal Ultrasound Images by Image-Patch Voting. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Estimation of the prostate volume with ultrasound offers many advantages such as portability, low cost, harmlessness, and suitability for real-time operation. Abdominal Ultrasound (AUS) is a practical procedure that deserves more attention in automated prostate-volume-estimation studies. As the experts usually consider automatic end-to-end volume-estimation procedures as non-transparent and uninterpretable systems, we proposed an expert-in-the-loop automatic system that follows the classical prostate-volume-estimation procedures. Our system directly estimates the diameter parameters of the standard ellipsoid formula to produce the prostate volume. To obtain the diameters, our system detects four diameter endpoints from the transverse and two diameter endpoints from the sagittal AUS images as defined by the classical procedure. These endpoints are estimated using a new image-patch voting method to address characteristic problems of AUS images. We formed a novel prostate AUS data set from 305 patients with both transverse and sagittal planes. The data set includes MRI images for 75 of these patients. At least one expert manually marked all the data. Extensive experiments performed on this data set showed that the proposed system results ranged among experts’ volume estimations, and our system can be used in clinical practice.
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Ghafoor S, Becker AS, Woo S, Causa Andrieu PI, Stocker D, Gangai N, Hricak H, Vargas HA. Comparison of PI-RADS Versions 2.0 and 2.1 for MRI-based Calculation of the Prostate Volume. Acad Radiol 2021; 28:1548-1556. [PMID: 32814644 DOI: 10.1016/j.acra.2020.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES Prostate gland volume (PGV) should be routinely included in MRI reports of the prostate. The recently updated Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 includes a change in the recommended measurement method for PGV compared to version 2.0. The purpose of this study was to evaluate the agreement of MRI-based PGV calculations with the volumetric manual slice-by-slice prostate segmentation as a reference standard using the linear measurements per PI-RADS versions 2.0 and 2.1. Furthermore, to assess inter-reader agreement for the different measurement approaches, determine the influence of an enlarged transition zone on measurement accuracy and to assess the value of the bullet formula for PGV calculation. MATERIALS AND METHODS Ninety-five consecutive treatment-naive patients undergoing prostate MRI were retrospectively analyzed. Prostates were manually contoured and segmented on axial T2-weighted images. Four different radiologists independently measured the prostate in three dimensions according to PI-RADS v2.0 and v2.1, respectively. MRI-based PGV was calculated using the ellipsoid and bullet formulas. Calculated volumes were compared to the reference manual segmentations using Wilcoxon signed-rank test. Inter-reader agreement was calculated using intraclass correlation coefficient (ICC). RESULTS Inter-reader agreement was excellent for the ellipsoid and bullet formulas using PI-RADS v2.0 (ICC 0.985 and 0.987) and v2.1 (ICC 0.990 and 0.994), respectively. The median difference from the reference standard using the ellipsoid formula derived PGV was 0.4 mL (interquartile range, -3.9 to 5.1 mL) for PI-RADS v2.0 (p = 0.393) and 2.6 mL (interquartile range, -1.6 to 7.3 mL) for v2.1 (p < 0.001) with a median difference of 2.2 mL. The bullet formula overestimated PGV by a median of 13.3 mL using PI-RADS v2.0 (p < 0.001) and 16.0 mL using v2.1 (p < 0.001). In the presence of an enlarged transition zone the PGV tended to be higher than the reference standard for PI-RADS v2.0 (median difference of 4.7 mL; p = 0.018) and for v2.1 (median difference of 5.7 mL, p < 0.001) using the ellipsoid formula. CONCLUSION Inter-reader agreement was excellent for the calculated PGV for both methods. PI-RADS v2.0 measurements with the ellipsoid formula yielded the most accurate volume estimates. The differences between PI-RADS v2.0 and v2.1 were statistically significant although small in absolute numbers but may be of relevance in specific clinical scenarios like prostate-specific antigen density calculation. These findings validate the use of the ellipsoid formula and highlight that the bullet formula should not be used for prostate volume estimation due to systematic overestimation.
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Affiliation(s)
- Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Colvin R, Walker D, Hafron J, Seifman B, Nandalur S, Gangwish D, Nandalur KR. Which measurement method should be used for prostate volume for PI-RADS? A comparison of ellipsoid and segmentation methods. Clin Imaging 2021; 80:454-458. [PMID: 34562834 DOI: 10.1016/j.clinimag.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/08/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Prostate volume and PSA density (PSAd) are important in the risk stratification of suspected prostate cancer (Pca). PI-RADS v2.1 allows for determining volume via segmentation or ellipsoid calculation. The purpose of our study was to compare ellipsoid and segmentation volume calculation methods and evaluate if PSAd diagnostic performance is altered. METHODS We retrospectively assessed 397 patients (mean age/standard deviation: 63.7/7.4 years) who underwent MRI and prostate biopsy or prostatectomy, with Pca classified by Gleason ≥3 + 4 and ≥4 + 4 disease. Prostate total volumes were determined with ellipsoid calculations (TVe) and with semi-automated segmentation (TVs), along with inter-rater reliability with intraclass correlation coefficient (ICC). PSAd was calculated for TVe and TVs and ROC curves were created to compare performance for Gleason ≥3 + 4 and ≥4 + 4 disease. RESULTS TVe was significantly higher than TVs (p < 0.0001), with mean TVe = 55.4 mL and TVs = 51.0 mL. ROC area under the curve for PSAd derived with TVe (0.63, 95%CI:0.59-0.68) and TVs (0.64, 95%CI:0.59-0.68) showed no significant difference for Gleason ≥3 + 4 disease (p = 0.45), but PSAd derived with TVs (0.63, 95%CI: 0.58-0.68) significantly outperformed TVe (0.61, 95%CI: 0.57-0.67) for Gleason ≥4 + 4 disease (p = 0.02). Both methods demonstrated excellent inter-rater reliability with TVe with ICC of 0.93(95%CI: 0.92-0.94) and TVs with ICC of 0.98(95%CI: 0.98-0.99). CONCLUSION Traditional ellipsoid measurements tend to overestimate total prostate volume compared to segmentation, but both methods demonstrate similar diagnostic performance of derived PSA density for PI-RADS clinically significant disease. For higher grade disease, PSAd derived from segmentation volumes demonstrates statistically significant superior performance. Both methods are viable, but segmentation volume is potentially better.
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Affiliation(s)
- Robert Colvin
- Department of Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - David Walker
- Department of Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - Jason Hafron
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - Brian Seifman
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - Sirisha Nandalur
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - David Gangwish
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - Kiran R Nandalur
- Department of Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America.
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Ferraris F, Yaber F, Smith AB, Barreiro D. The end of "very low risk" in localized prostate cancer? Prostate 2021; 81:615-617. [PMID: 34010453 DOI: 10.1002/pros.24168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 05/07/2021] [Indexed: 02/02/2023]
Affiliation(s)
| | - Fabian Yaber
- National University of Rosario and Sanatorio de la Mujer, Santa Fe, Argentina
| | - Angela B Smith
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Diego Barreiro
- Instituto de Investigaciones Médicas Dr. Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
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Initial phantom studies for an office-based low-field MR system for prostate biopsy. Int J Comput Assist Radiol Surg 2021; 16:741-748. [PMID: 33891253 PMCID: PMC8134310 DOI: 10.1007/s11548-021-02364-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Purpose Prostate cancer is the second most prevalent cancer in US men, with about 192,000 new cases and 33,000 deaths predicted for 2020. With only a 31% 5-year survival rate for patients with an initial diagnosis of stage-four prostate cancer, the necessity for early screening and diagnosis is clear. In this paper, we present navigation accuracy results for Promaxo’s MR system intended to be used in a physician’s office for image-guided transperineal prostate biopsy. Methods The office-based low-field MR system was used to acquire images of prostate phantoms with needles inserted through a transperineal template. Coordinates of the estimated sample core locations in the office-based MR system were compared to ground truth needle coordinates identified in a 1.5T external reference scan. The error was measured as the distance between the planned target and the ground truth core center and as the shortest perpendicular distance between the planned target and the ground truth trajectory of the whole core. Results The average error between the planned target and the ground truth core center was 2.57 ± 1.02 mm, [1.93–3.21] 95% CI. The average error between the planned target to the actual core segment was 2.05 ± 1.24 mm, [1.53–2.56] 95% CI. Conclusion The average navigation errors were below the clinically significant threshold of 5 mm. The initial phantom results demonstrate the feasibility of the office-based system for prostate biopsy.
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Prostatic peripheral zone thickness: what is normal on magnetic resonance imaging? Abdom Radiol (NY) 2020; 45:4185-4193. [PMID: 32719960 DOI: 10.1007/s00261-020-02650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the precision of a technique of measuring the PZ thickness on T2-weighted MRI and report normal parameters in patients with normal-sized prostates. We also wanted to establish the mean and second standard deviations (2SD) above and below the mean as criteria for abnormally narrow or expanded PZ thickness. METHODS Of the initial 1566 consecutive cohort referred for evaluation for carcinoma based on elevated PSA (prostate specific antibody) or DRE (digital rectal examination), 132 separate subjects with normal-sized prostates were selected for this study. Mean age was 58.2 years (15-82). Median serum PSA was 6.2 ng/mL (range 0.3-145). Most were asymptomatic for lower urinary tract symptoms (LUTS). Inclusion criteria in this study required technically adequate T2-weighted MRI and total prostatic volume (TPV) ≤ 25 cc. Exclusion criteria included post-prostatic surgical and radiation patients, patients having had medical management or minimally invasive therapy for BPH, those being treated for prostatitis. Patients with suspected tumor expanding or obscuring measurement boundaries were also not considered. Transition zone (TZ) and peripheral zone (PZ) volumes were determined using the prolate ellipsoid model. Posterolateral measurement of the PZ was obtained at the axial level of maximal transverse diameter of the prostate on a line drawn from the outer boundary of the TZ to the inner boundary of the external prostatic capsule (EPC). The data were normally distributed. Therefore, it was analyzed using the 2-sided student t-test and Pearson product correlation statistic. RESULTS Mean pooled (composite) measurement for the posterolateral PZ (PLPZ) was 10 mm (CI 9.5-10.5 mm) with SD of 2.87 mm. Means were statistically the same for the 2 observers (p = 0.75). Pearson correlation between the two observers was 0.63. CONCLUSIONS In a prostate ≤ 25 cc volume , the posterolateral PZ should be no thicker than 15.8 mm and averages 10.0 mm when measured in the maximal axial plane on MRI. These norms were independent of age or use of endorectal coil. The technique measurement demonstrated clinically useful precision.
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Giganti F, Stavrinides V, Stabile A, Osinibi E, Orczyk C, Radtke JP, Freeman A, Haider A, Punwani S, Allen C, Emberton M, Kirkham A, Moore CM. Prostate cancer measurements on serial MRI during active surveillance: it's time to be PRECISE. Br J Radiol 2020; 93:20200819. [PMID: 32955923 DOI: 10.1259/bjr.20200819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The PRECISE criteria for reporting multiparametric MRI in patients on active surveillance (AS) for prostate cancer (PCa) score the likelihood of clinically significant change over time using a 1-5 scale, where 4 or 5 indicates radiological progression. According to the PRECISE recommendations, the index lesion size can be reported using different definitions of volume (planimetry or ellipsoid formula) or by measuring one or two diameters. We compared different measurements using planimetry as the reference standard and stratified changes according to the PRECISE scores. METHODS We retrospectively analysed 196 patients on AS with PCa confirmed by targeted biopsy who had two MR scans (baseline and follow-up). Lesions were measured on T2 weighted imaging (T2WI) according to all definitions. A PRECISE score was assessed for each patient. RESULTS The ellipsoid formula exhibited the highest correlation with planimetry at baseline (ρ = 0.97) and follow-up (ρ = 0.98) imaging, compared to the biaxial measurement and single maximum diameter. There was a significant difference (p < 0.001) in the yearly percentage volume change between radiological regression/stability (PRECISE 2-3) and progression (PRECISE 4-5) for planimetry (39.64%) and for the ellipsoid formula (46.78%). CONCLUSION The ellipsoid formula could be used to monitor tumour growth during AS. Evidence of a significant yearly percentage volume change between radiological regression/stability (PRECISE 2-3) and progression (PRECISE 4-5) has been also observed. ADVANCES IN KNOWLEDGE The ellipsoid formula is a reasonable surrogate for planimetry in capturing tumour volume changes on T2WI in patients on imaging-led AS. This is also associated with radiological changes using the PRECISE recommendations.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Elizabeth Osinibi
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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