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Eineluoto JT, Sandeman K, Pohjonen J, Sopyllo K, Nordling S, Stürenberg C, Malén A, Kilpeläinen TP, Santti H, Petas A, Matikainen M, Pellinen T, Järvinen P, Kenttämies A, Rannikko A, Mirtti T. Associations of PTEN and ERG with Magnetic Resonance Imaging Visibility and Assessment of Non-organ-confined Pathology and Biochemical Recurrence After Radical Prostatectomy. Eur Urol Focus 2020; 7:1316-1323. [PMID: 32620540 DOI: 10.1016/j.euf.2020.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/18/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diagnosing clinically significant prostate cancer (PCa) is challenging, but may be facilitated by biomarkers and multiparametric magnetic resonance imaging (MRI). OBJECTIVE To determine the association between biomarkers phosphatase and tensin homolog (PTEN) and ETS-related gene (ERG) with visible and invisible PCa lesions in MRI, and to predict biochemical recurrence (BCR) and non-organ-confined (non-OC) PCa by integrating clinical, MRI, and biomarker-related data. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of a population-based cohort of men with PCa, who underwent preoperative MRI followed by radical prostatectomy (RP) during 2014-2015 in Helsinki University Hospital (n = 346), was conducted. A tissue microarray corresponding to the MRI-visible and MRI-invisible lesions in RP specimens was constructed and stained for PTEN and ERG. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations of PTEN and ERG with MRI-visible and MRI-invisible lesions were examined (Pearson's χ2 test), and predictions of non-OC disease together with clinical and MRI parameters were determined (area under the receiver operating characteristic curve and logistic regression analyses). BCR prediction was analyzed by Kaplan-Meier and Cox proportional hazard analyses. RESULTS AND LIMITATIONS Patients with MRI-invisible lesions (n = 35) had less PTEN loss and ERG-positive expression compared with patients (n = 90) with MRI-visible lesions (17.2% vs 43.3% [p = 0.006]; 8.6% vs 20.0% [p = 0.125]). Patients with invisible lesions had better, but not statistically significantly improved, BCR-free survival probability in Kaplan-Meier analyses (p = 0.055). Rates of BCR (5.7% vs 21.1%; p = 0.039), extraprostatic extension (11.4% vs 44.6%; p < 0.001), seminal vesicle invasion (0% vs 21.1%; p = 0.003), and lymph node metastasis (0% vs 12.2%; p = 0.033) differed between the groups in favor of patients with MRI-invisible lesions. Biomarkers had no independent role in predicting non-OC disease or BCR. The short follow-up period was a limitation. CONCLUSIONS PTEN loss, BCR, and non-OC RP findings were more often encountered with MRI-visible lesions. PATIENT SUMMARY Magnetic resonance imaging (MRI) of the prostate misses some cancer lesions. MRI-invisible lesions seem to be less aggressive than MRI-visible lesions.
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Affiliation(s)
- Juho T Eineluoto
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Kevin Sandeman
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joona Pohjonen
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Konrad Sopyllo
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Stig Nordling
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Carolin Stürenberg
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Adrian Malén
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrikki Santti
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anssi Petas
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Matikainen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teijo Pellinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kenttämies
- HUS Medical Imaging Center Department of Diagnostic Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Coşkun M, Sarp AF, Karasu Ş, Gelal MF, Türkbey B. Assessment of the compliance with minimum acceptable technical parameters proposed by PI-RADS v2 guidelines in multiparametric prostate MRI acquisition in tertiary referral hospitals in the Republic of Turkey. ACTA ACUST UNITED AC 2020; 25:421-427. [PMID: 31650967 DOI: 10.5152/dir.2019.18537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Although the clinical use of multiparametric prostate magnetic resonance imaging (mpMRI) is increasing, the adherence to parameters for mpMRI, which had been described in the Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) for an optimum image acquisition is unknown. In this paper, we aimed to determine the compliance with the minimum acceptable technical parameters for prostate mpMRI defined by PI-RADS v2 in tertiary care centers in Turkey. METHODS We sent a survey to all radiology departments of tertiary referral hospitals in Turkey (n=120) to evaluate their adherence to PI-RADS v2 technical specifications. Statistical analysis was performed using chi-square, Fisher exact, ANOVA, and the Student t tests. The cutoff values for image acquisition times were also determined with receiver operating characteristics (ROC) analysis. P values <0.05 were considered statistically significant. RESULTS One hundred and eleven clinics responded to our survey (response rate, 92.5%). Prostate MRI was reported to be performed in 61 centers, of which 26 (42.6%) used 3 T (Tesla) scanner while 35 (57.4%) used 1.5 T. The adherence to slice thickness, in-plane phase and frequency resolutions on T2-weighted imaging were 68.9%, 41%, and 9.8%, respectively. The adherence to the same parameters on diffusion-weighted imaging (DWI) were higher compared with T2-weighted imaging (85.2%, 62.3%, and 78.7%, respectively). In comparative analysis, the adherence to slice thickness, field of view (FOV) and in-plane phase resolution on T2-weighted imaging were higher for 3 T compared with 1.5 T scanners (P = 0.004, P = 0.041, and P = 0.001, respectively). T2-weighted imaging acquisition time was significantly longer for the centers that adhered to FOV (P = 0.034) and in-plane T2-weighted imaging phase resolution (P = 0.028). The DWI scan time was significantly longer when they adhered to DWI-FOV (P = 0.014) and b value ≥1400 s/mm2 (P = 0.008). The calculated cutoff of scan times were 220 s in T2-weighted imaging and 312 s in DWI to ensure the compliance with voxel sizes and b value criteria. CONCLUSION The tertiary referral centers in Turkey did not meet majority of the technical specifications of PI-RADS v2 during prostate MRI acquisition. Awareness to the minimum acceptable technical parameters of mpMRI should be increased to potentially improve the quality of prostate cancer imaging.
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Affiliation(s)
- Mehmet Coşkun
- Department of Radiology, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Ali Fırat Sarp
- Department of Radiology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Şebnem Karasu
- Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mustafa Fazıl Gelal
- Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Barış Türkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Hennigan ST, Trostel SY, Terrigino NT, Voznesensky OS, Schaefer RJ, Whitlock NC, Wilkinson S, Carrabba NV, Atway R, Shema S, Lake R, Sweet AR, Einstein DJ, Karzai F, Gulley JL, Chang P, Bubley GJ, Balk SP, Ye H, Sowalsky AG. Low Abundance of Circulating Tumor DNA in Localized Prostate Cancer. JCO Precis Oncol 2019; 3:PO.19.00176. [PMID: 31528835 PMCID: PMC6746181 DOI: 10.1200/po.19.00176] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Despite decreased screening-based detection of clinically insignificant tumors, most diagnosed prostate cancers are still indolent, indicating a need for better strategies for detection of clinically significant disease before treatment. We hypothesized that patients with detectable circulating tumor DNA (ctDNA) were more likely to harbor aggressive disease. METHODS We applied ultra-low-pass whole-genome sequencing to profile cell-free DNA from 112 patients diagnosed with localized prostate cancer and performed targeted resequencing of plasma DNA for somatic mutations previously identified in matched solid tumor in nine cases. We also performed similar analyses of data from patients with metastatic prostate cancer. RESULTS In all cases of localized prostate cancer, even in clinically high-risk patients who subsequently had recurrent disease, ultra-low-pass whole-genome sequencing and targeted resequencing did not detect ctDNA in plasma acquired before surgery or before recurrence. In contrast, using both approaches, ctDNA was detected in patients with metastatic prostate cancer. CONCLUSION Our findings demonstrate clear differences between localized and advanced prostate cancer with respect to the dissemination and detectability of ctDNA. Because allele-specific alterations in ctDNA are below the threshold for detection in localized prostate cancer, other approaches to identify cell-free nucleic acids of tumor origin may demonstrate better specificity for aggressive disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ross Lake
- National Institutes of Health, Bethesda, MD
| | | | | | | | | | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Huihui Ye
- Beth Israel Deaconess Medical Center, Boston, MA
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Ye H, Sowalsky AG. Molecular correlates of intermediate- and high-risk localized prostate cancer. Urol Oncol 2018; 36:368-374. [PMID: 30103901 DOI: 10.1016/j.urolonc.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/13/2017] [Accepted: 12/24/2017] [Indexed: 12/22/2022]
Abstract
Clinicopathologic parameters, including Gleason score, remain the most validated prognostic factors for patients diagnosed with localized prostate cancer (PCa). However, patients of the same risk groups have exhibited heterogeneity of disease outcomes. To improve risk classification, multiple molecular risk classifiers have been developed, which were designed to inform beyond existing clinicopathologic classifiers. Alterations affecting tumor suppressors and oncogenes, such as PTEN, MYC, BRCA2, and TP53, which have been long associated with aggressive PCa, demonstrated grade-dependent frequency of alterations in localized PCas. In addition to these genetic hallmarks, several RNA-based commercial tests have been recently developed to help identify men who would benefit from earlier interventions. Large genomic studies also correlate germline genetic alterations and epigenetic features with adverse outcomes, further strengthening the link between the risk of metastasis and a stepwise accumulation of driver molecular lesions.
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Affiliation(s)
- Huihui Ye
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam G Sowalsky
- Prostate Cancer Genetics Section, Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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