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Lim B, Choi SY, Kyung YS, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Value of clinical parameters and MRI with PI-RADS V2 in predicting seminal vesicle invasion of prostate cancer. Scand J Urol 2020; 55:17-21. [PMID: 33349092 DOI: 10.1080/21681805.2020.1833981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the usefulness of magnetic resonance imaging (MRI) with Prostate Imaging Reporting and Data System version 2 (PI-RADSV2) and clinical parameters in predicting seminal vesicle invasion (SVI). MATERIAL AND METHODS In this retrospective study, we identified 569 prostate cancer patients who underwent radical prostatectomy with MRI before surgery. SVI was interpreted with PI-RADSV2. Clinical parameters such as the prostate-specific antigen (PSA) and Gleason score (GS) were analyzed for the prediction of SVI. Logistic regression models and receiver operating characteristic (ROC) curves were used to evaluate SVI based on clinical parameters and MRI with PI-RADSV2. RESULTS The median age at presentation was 67 years (43-85 years). The median PSA level was 6.1 ng/mL (2.2-72.8 ng/mL). There were 113 patients with a biopsy GS of ≥ 8. A total of 34 patients (6.0%) were interpreted to have SVI by MRI of which 20 were true positive, and 52 patients (9.1%) had true SVI in the final pathologic analysis. In multivariable analysis, PSA (HR: 1.03, 95% CI: 1.00-1.07), biopsy GS ≥ 8 (HR: 4.14, 95% CI: 2.12-8.09), and MRI with PI-RADSV2 (HR: 14.67, 95% CI: 6.34-33.93) were significantly associated with pathologic SVI. The area under the curve of the model based on the clinical parameters PSA and GS plus MRI (0.862) was significantly larger than that of the model based on clinical parameters alone (0.777, p < 0.001). CONCLUSIONS MRI with PI-RADSV2 using the clinical parameters PSA and GS was effective in predicting SVI.
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Affiliation(s)
- Bumjin Lim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Young Choi
- Department of Urology Chung, ANG University Hospital, Seoul, Korea
| | - Yoon Soo Kyung
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lebastchi AH, Gupta N, DiBianco JM, Piert M, Davenport MS, Ahdoot MA, Gurram S, Bloom JB, Gomella PT, Mehralivand S, Turkbey B, Pinto PA, George AK. Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review. Transl Androl Urol 2020; 9:1415-1427. [PMID: 32676426 PMCID: PMC7354341 DOI: 10.21037/tau.2020.03.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Conventional staging for prostate cancer (PCa) is performed for men diagnosed with unfavorable-intermediate or higher risk disease. Computed tomography (CT) of the abdomen and pelvis and whole body bone scan remains the standard of care for the detection of visceral, nodal, and bone metastasis. The implementation of the 2012 United States Preventive Services Task Force recommendation against routine prostate specific antigen (PSA) screening resulted in a rise of metastatic PCa at the time of diagnosis, emphasizing the importance of effective imaging modalities for evaluating metastatic disease. CT plays a major role in clinical staging at the time of PCa diagnosis, but multi-parametric magnetic resonance imaging (MRI) is now integrated into many prostate biopsy protocols for the detection of primary PCa, and may be a surrogate for CT for nodal staging. Current guidelines incorporate both CT and MRI as appropriate cross-sectional imaging modalities for the identification of nodal metastasis in indicated patients. There is an ongoing debate about the utility of traditional cross-sectional imaging modalities as well as advanced imaging modalities in detection of both organ-confined PCa detection and nodal involvement.
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Affiliation(s)
- Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nikhil Gupta
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - John M DiBianco
- Department of Urology, George Washington University Medical School, Washington D.C., USA
| | - Morand Piert
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael A Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patrick T Gomella
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Can Extraprostatic Extension Be Predicted by Tumor-Capsule Contact Length in Prostate Cancer? Relationship With International Society of Urological Pathology Grade Groups. AJR Am J Roentgenol 2019; 214:588-596. [PMID: 31670596 DOI: 10.2214/ajr.19.21828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE. The objective of our study was to evaluate the relationship between the tumor-capsule contact length, defined as tumor contact length (TCL), and extraprostatic extension (EPE) using the MRI-based TCL measurements and the real TCL measurements from pathology and to determine whether the International Society of Urological Pathology (ISUP) grade group of the tumors influenced this relationship. MATERIALS AND METHODS. In this retrospective study, we reviewed prostate multiparametric MRI (mpMRI) studies performed between 2012 and 2018 of 1576 patients and found that 134 patients also underwent radical prostatectomy (RP) after mpMRI. Finally, 86 patients with index lesions in contact with the prostate capsule in RP specimens were enrolled in the study. ROC analysis was used to evaluate the cutoff values of TCLs measured at pathology and TCLs measured on MRI in terms of EPE according to ISUP grade groups. RESULTS. There was no statistically significant cutoff value for pathology-based TCL measurements in individual ISUP grade groups and subgroups. Although not statistically significant, pathology-based TCL cutoff values decreased (from 21.0 to 11.0 mm) as ISUP grade group increased in terms of EPE positivity. When the relationship between MRI-based TCL measurements and EPE was considered, statistically significant cutoff values (range, 14.5-16.6 mm) could be determined in many groups and subgroups with low ISUP grades (sensitivity, 66.7-100%; specificity, 52.8-93.0%; p = 0.006-0.042). However, no statistically significant cutoff value was found for high ISUP grades. CONCLUSION. ISUP grade groups may have an effect on the TCL-EPE relationship. When the MRI-based TCL and EPE relationship is evaluated independent of ISUP grade group, a cutoff value around 15-16 mm may be usable to predict EPE.
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5
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Turkbey B, Choyke PL. Prostate Magnetic Resonance Imaging: Lesion Detection and Local Staging. Annu Rev Med 2019; 70:451-459. [DOI: 10.1146/annurev-med-053117-123215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dramatic changes in the use of prostate magnetic resonance imaging (MRI) have occurred in the last decade. The recognition that MRI detects and localizes cancers with reasonable accuracy led to the development of directed biopsies. These image-guided biopsies have a higher sensitivity for clinically significant cancers and a lower sensitivity for indolent disease. Prospective trials provide level 1 evidence supporting the use of prostate MRI. For local staging, while the specificity of prostate MRI is high, its sensitivity is lacking for microscopic extraprostatic extension. Computer-aided diagnosis of prostate MRI promises to bring the diagnostic power of MRI to nonexpert readers and thus further integrate MRI into the diagnostic workup.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Baumgartner EM, Porter KK, Nix JW, Rais-Bahrami S, Gordetsky JB. Detection of extraprostatic disease and seminal vesicle invasion in patients undergoing magnetic resonance imaging-targeted prostate biopsies. Transl Androl Urol 2018; 7:S392-S396. [PMID: 30363466 PMCID: PMC6178323 DOI: 10.21037/tau.2018.03.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Finding incidental extraprostatic extension (EPE) or seminal vesicle invasion (SVI) by prostate cancer (PCa) is rare on standard prostate biopsy. We evaluated the clinical-pathologic features associated with EPE and SVI on multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided targeted biopsy (TB). Methods A retrospective review was performed from 2014-2017, selecting patients who had undergone TB. Clinical, pathologic, and radiologic features were evaluated. Results Five out of 333 (1.5%) patients who had PCa detected on TB had EPE and/or SVI. The average age and prostate-specific antigen (PSA) was 71 years and 17 ng/mL, respectively. The average number of cores taken on TB was 4.2. Two patients had a prior negative SB and two patients had a prior positive SB, one of which underwent radiation therapy. All patients had a PIRADSv2 suspicion score of 4 or 5. Four out of five (80%) patients underwent both SB and concurrent TB, of which 3/4 (75%) had EPE identified only on TB. One out of four (25%) patients also had both EPE and SVI, identified only on TB. One patient underwent only TB for MRI suspicion of SVI, which was pathologically confirmed on TB. On TB, one patient had Grade Group 3, two patients had Grade Group 4, and two patients had Grade Group 5 PCa. Perineural invasion (PNI) was present in 4/5 (80%) patients on TB. Conclusions Based on our small series, we hypothesize that MRI/US fusion TB outperforms SB in the identification of EPE and SVI. However, given the small sample size and the overall rarity of these pathologic findings on prostate biopsy, further validation is needed.
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Affiliation(s)
- Erin M Baumgartner
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Stone NN, Stock RG. Stage T3b prostate cancer diagnosed by seminal vesicle biopsy and treated with neoadjuvant hormone therapy, permanent brachytherapy and external beam radiotherapy. BJU Int 2018; 123:277-283. [PMID: 29956864 DOI: 10.1111/bju.14464] [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] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To report the long-term results of prostate brachytherapy followed by external beam radiotherapy (EBRT) in men with a positive seminal vesicle biopsy (+SVB). PATIENTS AND METHODS In all, 1081 men with localised prostate cancer were treated with permanent brachytherapy, of which 615 had staging SVB and 53 (9.4%) were positive. Higher stage, Gleason score and PSA level were associated with a +SVB (P < 0.001). Patients with +SVB and negative laparoscopic pelvic lymph node dissection, bone and CT scans had 3 months of androgen-deprivation therapy (ADT) followed by 103 Pd implant to the prostate (dose 100 Gy) and proximal SVs, and 2 months later 45 Gy EBRT. ADT was continued for a median of 6 months (total ADT 9 months). The mean (range) follow-up was 9 (5-22) years. RESULTS Biochemical freedom from failure (computed by the Phoenix definition), freedom from metastasis, and cause-specific survival (CSS) for patients with a negative SVB (-SVB) vs +SVB at 15 years, was 76.3% vs 60.6% (P = 0.001), 95.4% vs 78.2% (P < 0.001), and 95% vs 70.4% (P < 0.001), respectively. Prostate cancer death occurred in 45 of 590 (7.6%) men with a -SVB vs eight of 25 (32%) with a +SVB (odds ratio 5.7, 95% confidence interval 2.35-13.9, P < 0.001). Cox proportion hazard rates (HRs) demonstrated Gleason score (P < 0.001, HR 1.9), stage (P = 0.010, HR 1.42), RT dose (P = 0.013, HR 0.991), and +SVB (P = 0.001, HR 4.48), as significantly associated with CSS. CONCLUSIONS Men with a +SVB have inferior CSS compared to those with a -SVB. However, a strategy that included a SVB in high-risk patients and implantation of the SVs in men undergoing combined therapy still yields favourable long-term results.
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Affiliation(s)
- Nelson N Stone
- Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard G Stock
- Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Spatial Tracking of Targeted Prostate Biopsy Locations: Moving Towards Effective Focal Partial Prostate Gland Ablation with Improved Treatment Planning. Curr Urol Rep 2017; 18:93. [DOI: 10.1007/s11934-017-0741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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9
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Preventing clinical progression and need for treatment in patients on active surveillance for prostate cancer. Curr Opin Urol 2017; 28:46-54. [PMID: 29028765 DOI: 10.1097/mou.0000000000000455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. RECENT FINDINGS Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5α-reductase inhibitors and others might inhibit disease progression in patients on active surveillance. SUMMARY Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.
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Abstract
Prostate cancer is the most common male malignant tumor in Germany, which thus places growing demands on differentiated imaging and risk-adapted therapeutic approaches. Multiparametric MRI (mpMRI) of the prostate enables reliable detection of clinically significant cancers and is currently the leading imaging modality for the detection, characterization, and local staging of prostate cancer. According to the German S3 guideline, mpMRI of the prostate is currently primarily recommended in patients with previous negative TRUS biopsies and persisting tumor suspicion. The serial use of mpMRI in the pretherapeutic setting can support individual therapy planning of patients with locally advanced prostate cancer in the near future.
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11
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Lebastchi AH, Watson MJ, Russell CM, George AK, Weizer AZ, Turkbey B. Using Imaging to Predict Treatment Response in Genitourinary Malignancies. Eur Urol Focus 2017; 4:804-817. [PMID: 28918178 DOI: 10.1016/j.euf.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/09/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023]
Abstract
CONTEXT Over the previous2 decades, there have been numerous advancements in the diagnostic evaluation, therapeutic management, and postoperative assessment of genitourinary malignancies. OBJECTIVE To present a review of current and novel imaging modalities and their utility in the assessment of therapeutic response in the systemic management of renal, testicular, and prostate cancers. EVIDENCE ACQUISITION A PubMed/Medline search of the current published literature inclusive of prospective and retrospective original research, systematic reviews, and meta-analyses was conducted evaluating imaging modalities for renal cell carcinoma, prostate cancer, and testicular cancer. All relevant literature was individually reviewed and summarized to provide a concise description of the currently available imaging modalities and their efficacy in assessing treatment response of the genitourinary malignancies targeted in this review. EVIDENCE SYNTHESIS Conventional imaging techniques play a pivotal role in predicting the treatment response of genitourinary malignancies and have, therefore, been incorporated into clinical guidelines. Advancements in imaging technology have led to increased utilization for prognostication of a genitourinary cancer's response to therapy. CONCLUSIONS A good understanding of current recommended imaging techniques to evaluate treatment response in genitourinary malignancies is of paramount importance for today's clinician, who faces increasing treatment modalities. PATIENT SUMMARY In this review, we summarize available imaging modalities in the evaluation of treatment response in kidney, prostate, or testicular tumors. We believe that a good understanding of current imaging modalities is of paramount importance for healthcare providers treating these cancers.
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Affiliation(s)
- Amir H Lebastchi
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Watson
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Arvin K George
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Gordetsky J, Rais-Bahrami S, Epstein JI. Pathological Findings in Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-guided Biopsy: Relation to Prostate Cancer Focal Therapy. Urology 2017; 105:18-23. [DOI: 10.1016/j.urology.2017.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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Meng X, Rosenkrantz AB, Taneja SS. Role of prostate magnetic resonance imaging in active surveillance. Transl Androl Urol 2017; 6:444-452. [PMID: 28725586 PMCID: PMC5503957 DOI: 10.21037/tau.2017.05.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Active surveillance (AS) has emerged as a beneficial strategy for management of low risk prostate cancer (PCa) and prevention of overtreatment of indolent disease. However, selection of patients for AS using traditional 12-core transrectal prostate biopsy is prone to sampling error and presents a challenge for accurate risk stratification. In fact, around a third of men are upgraded on repeat biopsy which disqualifies them as appropriate AS candidates. This uncertainty affects adoption of AS among patients and physicians, leading to current AS protocols involving repetitive prostate biopsies and unclear triggers for progression to definitive treatment. Prostate magnetic resonance imaging (MRI) has the potential to overcome some of these limitations through localization of significant tumors in the prostate. In conjunction with MRI-targeted prostate biopsy, improved sampling and detection of clinically significant PCa can help streamline the process of selecting suitable men for AS and early exclusion of men who require definitive treatment. MRI can also help minimize the invasive nature of monitoring for disease progression while on AS. Men with stable MRI findings have high negative predictive value for Gleason upgrade on subsequently biopsy, suggesting that men may potentially be monitored by serial MRI examinations with biopsy reserved for significant changes on imaging. Targeted biopsy on AS also allows for specific sampling of concerning lesions, although further data is necessary to evaluate the relative contribution of systematic and targeted biopsy in detecting the 25-30% of men who progress on AS. Further research is also warranted to better understand the nature of clinically significant cancers that are missed on MRI and why certain men have progression of disease that is not visible on prostate MRI. Consensus is also needed over what constitutes progression on MRI, when prostate biopsy can be safely avoided, and how to best utilize this additional information in current AS protocols. Despite these challenges, prostate MRI, either alone or in conjunction with MRI-targeted prostate biopsy, has the potential to significantly improve our current AS paradigm and rates of AS adoption among patients moving forward.
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Affiliation(s)
- Xiaosong Meng
- Department of Urology, NYU Langone Medical Center, New York, NY 10016, USA
| | | | - Samir S Taneja
- Department of Urology, NYU Langone Medical Center, New York, NY 10016, USA.,Department of Radiology, NYU Langone Medical Center, New York, NY 10016, USA
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Abstract
MR/US fusion biopsy has emerged as a significant refinement of traditional prostate cancer diagnostic techniques. Utilizing not only quantitative imaging suspicion information from mpMRI but also the spatial accuracy and three-dimensional localization allows such strategies to specifically sample areas of concern with the gland. As such, diagnostic certainty is markedly improved. In this manuscript, we aim to highlight the multidisciplinary approach (amongst urologists, radiologists, pathologists, imaging technologists, nursing staff, and patients) which is required to launch and maintain a successful prostate imaging program.
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DCE-MRI, DW-MRI, and MRS in Cancer: Challenges and Advantages of Implementing Qualitative and Quantitative Multi-parametric Imaging in the Clinic. Top Magn Reson Imaging 2017; 25:245-254. [PMID: 27748710 PMCID: PMC5081190 DOI: 10.1097/rmr.0000000000000103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Multi-parametric magnetic resonance imaging (mpMRI) offers a unique insight into tumor biology by combining functional MRI techniques that inform on cellularity (diffusion-weighted MRI), vascular properties (dynamic contrast-enhanced MRI), and metabolites (magnetic resonance spectroscopy) and has scope to provide valuable information for prognostication and response assessment. Challenges in the application of mpMRI in the clinic include the technical considerations in acquiring good quality functional MRI data, development of robust techniques for analysis, and clinical interpretation of the results. This article summarizes the technical challenges in acquisition and analysis of multi-parametric MRI data before reviewing the key applications of multi-parametric MRI in clinical research and practice.
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Lindenberg L, Ahlman M, Turkbey B, Mena E, Choyke P. Evaluation of Prostate Cancer with PET/MRI. J Nucl Med 2017; 57:111S-116S. [PMID: 27694163 DOI: 10.2967/jnumed.115.169763] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Abstract
In the ongoing effort to understand and cure prostate cancer, imaging modalities are constantly evolving to assist in clinical decisions. Multiparametric MRI can be used to direct prostate biopsies, improve diagnostic yield, and help clinicians make more accurate decisions. PET is superior in providing biologic information about the cancer and is sensitive and highly specific. Integrated PET/MRI is a welcome technical advance with great potential to influence the diagnosis and management of prostate cancer in clinical practice.
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Affiliation(s)
- Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark Ahlman
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland; and
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Lai WS, Gordetsky JB, Thomas JV, Nix JW, Rais-Bahrami S. Factors predicting prostate cancer upgrading on magnetic resonance imaging-targeted biopsy in an active surveillance population. Cancer 2017; 123:1941-1948. [PMID: 28140460 DOI: 10.1002/cncr.30548] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The objective of this study was to create a nomogram model integrating clinical and multiparametric magnetic resonance imaging (MP-MRI)-based variables to predict prostate cancer upgrading in a population of active surveillance (AS) patients. METHODS Prostate cancer patients on AS who underwent MP-MRI with magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy were identified. Clinical and imaging variables, including the prostate-specific antigen density (PSAD), number of lesions, total lesion volume, total lesion density, Prostate Imaging Reporting and Data System magnetic resonance imaging suspicion score (MRI-SS), and duration between prereferral systematic and MRI/US fusion-guided biopsy sessions, were assessed. Logistic regression modeling was used to assess upgrading on MRI/US fusion-guided biopsy. A predictive model for upgrading was calculated with the significant factors identified. RESULTS Seventy-six patients were analyzed with a mean age of 62.5 years and a median prostate-specific antigen (PSA) level of 5.1 ng/mL. The average duration between prereferral and MRI/US biopsies was 21 months. Twenty patients (26.32%) were upgraded. The PSAD, duration between prereferral and MRI/US biopsies, MRI-SS, and MRI total lesion density were significantly associated with upgrading. A logistic regression model using these factors to predict upgrading on confirmatory MRI/US fusion biopsy had an area under the curve (AUC) of 0.84, whereas the AUC was 0.69 with PSA alone. On the basis of this model, a nomogram was generated, and using a probability cutoff of 22% as an indication of upgrading, it produced sensitivity, specificity, positive predictive, and negative predictive values of 80%, 81.25%, 57.1%, and 92.86%, respectively. CONCLUSIONS The integration of MRI findings with clinical parameters can add value to a model predicting upgrading from a Gleason score of 3 + 3 = 6 in men on AS. This can potentially be used as a noninvasive approach to confirm AS patients with low-risk disease for whom biopsy may be deferred. Cancer 2017;123:1941-1948. © 2017 American Cancer Society.
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Affiliation(s)
- Win Shun Lai
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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18
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Higher Prostate Cancer Grade Groups Are Detected in Patients Undergoing Multiparametric MRI-targeted Biopsy Compared With Standard Biopsy. Am J Surg Pathol 2017; 41:101-105. [DOI: 10.1097/pas.0000000000000723] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - D Böhmer
- Klinik für Radioonkologie und Strahlentherapie, Charité Campus Benjamin Franklin, Berlin, Deutschland
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20
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Reed A, Valle LF, Shankavaram U, Krauze A, Kaushal A, Schott E, Cooley-Zgela T, Wood B, Pinto P, Choyke P, Turkbey B, Citrin DE. Effect of Prostate Magnetic Resonance Imaging/Ultrasound Fusion-guided Biopsy on Radiation Treatment Recommendations. Int J Radiat Oncol Biol Phys 2016; 97:947-951. [PMID: 28333017 DOI: 10.1016/j.ijrobp.2016.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Targeted magnetic resonance imaging (MRI)/ultrasound fusion prostate biopsy (MRI-Bx) has recently been compared with the standard of care extended sextant ultrasound-guided prostate biopsy (SOC-Bx), with the former associated with an increased rate of detection of clinically significant prostate cancer. The present study sought to determine the influence of MRI-Bx on radiation therapy and androgen deprivation therapy (ADT) recommendations. METHODS AND MATERIALS All patients who had received radiation treatment and had undergone SOC-Bx and MRI-Bx at our institution were included. Using the clinical T stage, pretreatment prostate-specific antigen, and Gleason score, patients were categorized into National Comprehensive Cancer Network risk groups and radiation treatment or ADT recommendations assigned. Intensification of the recommended treatment after multiparametric MRI, SOC-Bx, and MRI-Bx was evaluated. RESULTS From January 2008 to January 2016, 73 patients received radiation therapy at our institution after undergoing a simultaneous SOC-Bx and MRI-Bx (n=47 with previous SOC-Bx). Repeat SOC-Bx and MRI-Bx resulted in frequent upgrading compared with previous SOC-Bx (Gleason score 7, 6.7% vs 44.6%; P<.001; Gleason score 8-10, 2.1% vs 38%; P<.001). MRI-Bx increased the proportion of patients classified as very high risk from 24.7% to 41.1% (P=.027). Compared with SOC-Bx alone, including the MRI-Bx findings resulted in a greater percentage of pathologically positive cores (mean 37% vs 44%). Incorporation of multiparametric MRI and MRI-Bx results increased the recommended use and duration of ADT (duration increased in 28 of 73 patients and ADT was added for 8 of 73 patients). CONCLUSIONS In patients referred for radiation treatment, MRI-Bx resulted in an increase in the percentage of positive cores, Gleason score, and risk grouping. The benefit of treatment intensification in accordance with the MRI-Bx findings is unknown.
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Affiliation(s)
- Aaron Reed
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Luca F Valle
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Uma Shankavaram
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andra Krauze
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aradhana Kaushal
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Erica Schott
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Peter Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol 2016; 12:2513-2529. [DOI: 10.2217/fon-2016-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.
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Affiliation(s)
- Jamie N Holtz
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
| | - Kae Jack Tay
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| | - Rajan T Gupta
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
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Muthigi A, Sidana A, George AK, Kongnyuy M, Maruf M, Valayil S, Wood BJ, Pinto PA. Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance-targeted biopsy. Urol Oncol 2016; 35:32.e1-32.e7. [PMID: 27743850 DOI: 10.1016/j.urolonc.2016.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/04/2016] [Accepted: 08/19/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVE Multiparametric magnetic resonance imaging (MRI) and magnetic resonance (MR) -targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique. METHODS An anonymous online questionnaire was designed to collect information on urologists' beliefs and use of prostate multiparametric MRI and MR-targeted biopsy. The survey was sent to members of the Society of Urologic Oncology, the Endourological Society, and European Association of Urology. Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR-targeted biopsy. RESULTS A total of 302 responses were received (Endourological Society: 175, European Association of Urology: 23, and Society of Urologic Oncology: 104). Most respondents (83.6%) believe MR-targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. Overall, 85.7% of responders use prostate MRI in their practice, and 63.0% use MR-targeted biopsy. The 2 most common settings for use of MR-targeted biopsy include patients with history of prior negative biopsy result (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not use MR-targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02-3.40], P = 0.043) and performing greater than 25 radical prostatectomies per year (2.32 [1.18-4.56], P = 0.015) remained independent predictors for using MR-targeted biopsy. CONCLUSIONS Most respondents of our survey look favorably on use of prostate MRI and MR-targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.
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Affiliation(s)
- Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael Kongnyuy
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Subin Valayil
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Kongnyuy M, George AK, Rastinehad AR, Pinto PA. Magnetic Resonance Imaging-Ultrasound Fusion-Guided Prostate Biopsy: Review of Technology, Techniques, and Outcomes. Curr Urol Rep 2016; 17:32. [PMID: 26902626 DOI: 10.1007/s11934-016-0589-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transrectal ultrasound (TRUS)-guided (12-14 core) systematic biopsy of the prostate is the recommended standard for patients with suspicion of prostate cancer (PCa). Advances in imaging have led to the application of magnetic resonance imaging (MRI) for the detection of PCa with subsequent development of software-based co-registration allowing for the integration of MRI with real-time TRUS during prostate biopsy. A number of fusion-guided methods and platforms are now commercially available with common elements in image and analysis and planning. Implementation of fusion-guided prostate biopsy has now been proven to improve the detection of clinically significant PCa in appropriately selected patients.
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Affiliation(s)
- Michael Kongnyuy
- Urologic Oncology Branch, National Institutes of Health, National Cancer Institute, 10 Center Drive, Bethesda, MD, 20814, USA.
| | - Arvin K George
- Urologic Oncology Branch, National Institutes of Health, National Cancer Institute, 10 Center Drive, Bethesda, MD, 20814, USA.
| | | | - Peter A Pinto
- Urologic Oncology Branch, National Institutes of Health, National Cancer Institute, 10 Center Drive, Bethesda, MD, 20814, USA.
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Lindenberg L, Ahlman M, Turkbey B, Mena E, Choyke P. Advancement of MR and PET/MR in Prostate Cancer. Semin Nucl Med 2016; 46:536-543. [PMID: 27825433 DOI: 10.1053/j.semnuclmed.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiparametric magnetic resonance (mpMRI) imaging has assumed a larger role in the diagnosis and management of prostate cancer. The current method of detecting prostate cancer relies on blind systematic biopsy, guided only by transrectal ultrasound that generally directs the needle biopsy to sextants of the prostate rather than specific lesions. MpMRI is playing an increasing role in the detection of primary cancer as it can visualize cancers and direct biopsies. However, even mpMRI is inherently nonspecific and numerous biopsies performed under MR guidance prove to be negative. Positron emission tomography (PET) has the potential to improve the sensitivity and specificity for prostate cancer in combination with mpMRI. Prostate-specific membrane antigen is a widely expressed tumor antigen in prostate cancer for which multiple PET ligands, labeled with 68Ga and 18F, are being developed. However, the low spatial resolution of PET mandates that it be combined with a higher resolution imaging modality, which typically has been computed tomography (CT). However, MRI is not only better at localizing lesions in the prostate and prostatic bed, but it is also more sensitive than CT for early bone marrow changes in bone metastases caused by prostate cancer. Prostate-specific membrane antigen-based PET agents show promise in the early detection of recurrent and metastatic disease. Recent developments in hybrid imaging now allow PET/MRI to be performed simultaneously on a single scanner allowing one-to-one correspondence between the PET activity and MRI findings. This offers the opportunity for both high sensitivity and specificity with excellent anatomic location and could allow for more targeted biopsies and treatments. Here, we review the current status of PET/MRI for prostate cancer.
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Affiliation(s)
- Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Ahlman
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Esther Mena
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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25
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Kongnyuy M, Sidana A, George AK, Muthigi A, Iyer A, Ho R, Chelluri R, Mertan F, Frye TP, Su D, Merino MJ, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Tumor contact with prostate capsule on magnetic resonance imaging: A potential biomarker for staging and prognosis. Urol Oncol 2016; 35:30.e1-30.e8. [PMID: 27567248 DOI: 10.1016/j.urolonc.2016.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The high-spatial resolution of multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer. mpMRI characteristics (extraprostatic extension [EPE], number of lesions, etc.) may predict final pathological findings (positive lymph node [pLN] and pathological ECE [pECE]) and biochemical recurrence (BCR). Tumor contact length (TCL) on MRI, defined as the length of a lesion in contact with the prostatic capsule, is a novel marker with promising early results. We aimed to evaluate TCL as a predictor of +pathological EPE (+pEPE),+pathological LN (+pLN), and BCR in patients undergoing robotic-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS A review was performed of a prospectively maintained single-institution database of men with prostate cancer who underwent prostate mpMRI followed by robotic-assisted laparoscopic radical prostatectomy without prior therapy from 2007 to 2015. TCL was measured using T2-weighted magnetic resonance images. Logistic and Cox regression analysis were used to assess associations of clinical, imaging, and histopathological variables with pEPE, pLN, and BCR. Receiver operating characteristic curves were used to characterize and compare TCL performance with Partin tables. RESULTS There were 87/379 (23.0%)+pEPE, 18/384 (4.7%)+pLN, and 33/371 (8.9%) BCR patients. Patients with adverse pathology/oncologic outcomes had longer TCL compared to those without adverse outcomes (+pEPE: 19.8 vs. 10.1mm, P<0.0001,+pLN: 38.0 vs. 11.7mm, P<0.0001, and BCR: 19.2 vs. 11.2mm, P = 0.001). On multivariate analysis, TCL remained a predictor of+pEPE (odds ratio: 1.04, P = 0.001),+pLN (odds ratio: 1.07, P<0.0001), and BCR (hazard ratio: 1.03, P = 0.02). TCL thresholds for predicting+pEPE and+pLN were 12.5 and 19.7mm, respectively. TCL alone was found to have good predictive ability for+pEPE and+PLN (pEPE:TCLAUC: 0.71 vs. PartinAUC: 0.66, P = 0.21; pLN:TCLAUC: 0.77 vs. PartinAUC: 0.88, P = 0.04). CONCLUSION We demonstrate that TCL is an independent predictor of+pEPE, +pLN, and BCR. If validated, this imaging biomarker may facilitate and inform patient counseling and decision-making.
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Affiliation(s)
- Michael Kongnyuy
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amogh Iyer
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Richard Ho
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Raju Chelluri
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Francesca Mertan
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Thomas P Frye
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Daniel Su
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Watson MJ, George AK, Maruf M, Frye TP, Muthigi A, Kongnyuy M, Valayil SG, Pinto PA. Risk stratification of prostate cancer: integrating multiparametric MRI, nomograms and biomarkers. Future Oncol 2016; 12:2417-2430. [PMID: 27400645 DOI: 10.2217/fon-2016-0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Accurate risk stratification of prostate cancer is achieved with a number of existing tools to ensure the identification of at-risk patients, characterization of disease aggressiveness, prediction of cancer burden and extrapolation of treatment outcomes for appropriate management of the disease. Statistical tables and nomograms using classic clinicopathological variables have long been the standard of care. However, the introduction of multiparametric MRI, along with fusion-guided targeted prostate biopsy and novel biomarkers, are being assimilated into clinical practice. The majority of studies to date present the outcomes of each in isolation. The current review offers a critical and objective assessment regarding the integration of multiparametric MRI and fusion-guided prostate biopsy with novel biomarkers and predictive nomograms in contemporary clinical practice.
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Affiliation(s)
- Matthew J Watson
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Arvin K George
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mahir Maruf
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Thomas P Frye
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Akhil Muthigi
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Michael Kongnyuy
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Subin G Valayil
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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27
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Midline lesions of the prostate: role of MRI/TRUS fusion biopsy and implications in Gleason risk stratification. Int Urol Nephrol 2016; 48:1445-52. [PMID: 27305918 DOI: 10.1007/s11255-016-1336-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/24/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE MRI-TRUS fusion biopsy (FBx) has proven efficacy in targeting suspicious areas that are traditionally missed by systematic 12-core biopsy (SBx). Midline prostate lesions are undersampled during SBx, as traditional approaches aim laterally during TRUS biopsy. The aim of our study was to determine the utility of FBx for targeting midline lesions identified on multiparametric MRI (mpMRI). METHODS A review was performed of a prospectively maintained database of patients undergoing mpMRI followed by FBx and SBx from 2007 to 2015. Midline location was defined as any lesion crossing the midline on axial imaging and involving both prostatic lobes. Index lesion was defined as lesion with highest Gleason score on biopsy. Patient demographic, imaging, and histopathologic data were collected. Multivariate logistic regression was conducted to determine independent predictors of having clinically significant (CS) cancer (Gleason ≥ 7) in midline lesions. RESULTS Out of 1266 patients, we identified 202 suspicious midline lesions in 190 patients [median (IQR) age 63 (10) years; PSA 7.6 (6.6)]. Eighty-eight (46.3 %) patients had cancer detection on FBx of midline lesion. A midline target represented the index lesion of the prostate in 63/190 (33.2 %) patients. Risk category upgrading based on FBx of a midline lesion compared to SBx occurred in 45/190 patients (23.7 %). On multivariate analysis, higher PSA (p = .001), lower MRI-derived prostate volume (p < .001), and moderate-high or high suspicion on mpMRI (p = .014) predicted CS cancer in midline lesions. CONCLUSIONS MRI-TRUS FBx facilitates sampling of midline lesions. Integration of mpMRI and FBx for targeting of midline lesions improves detection of CS prostate cancer.
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Abstract
Prostate cancer is unique in that unlike other solid organ malignancies, only recently has imaging been employed to routinely detect and localize disease. The introduction of transrectal ultrasound was a significant development, transitioning digitally guided prostate biopsies to ultrasound guidance. The arrival of multiparametric MRI has become the next major step, transforming the way Urologist's diagnose, stage, and treat prostate cancer. Recent recommendations against PSA screening have changed the landscape of urologic oncology with the changing needs being reflected in the initiation of additional robust imaging techniques at different time points in prostate cancer care. The current review aims to provide a clinical perspective in the history, current standard of care, and novel imaging modalities in the evaluation of prostate cancer.
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29
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Fascelli M, George AK, Frye T, Turkbey B, Choyke PL, Pinto PA. The role of MRI in active surveillance for prostate cancer. Curr Urol Rep 2016; 16:42. [PMID: 26017850 DOI: 10.1007/s11934-015-0507-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Approximately one in seven American men will be diagnosed with prostate cancer during his lifetime, and at least 50% of newly diagnosed patients will present with low-risk disease. In the last decade, the decision-making paradigm for management has shifted due to high rates of disease detection and overtreatment, attributed to prostate-specific antigen screening, with more men deferring definitive treatment for active surveillance. The advent of multiparametric magnetic resonance imaging (MP-MRI) and MRI/ transrectal ultrasound-guided fusion-guided prostate biopsy has refined the process of diagnosis, identifying patients with clinically-significant cancer and larger disease burden who would most likely benefit from intervention. In parallel, the utilization of MP-MRI in the surveillance of low-grade, low-volume disease is on the rise, reflecting support in a growing body of literature. The aim of this review is to appraise and summarize the data evaluating the role of magnetic resonance imaging in active surveillance for prostate cancer.
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Affiliation(s)
- Michele Fascelli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, MSC 1210, 10 Center Drive, Bethesda, MD, 20892-1210, USA
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30
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Abstract
The diagnosis and treatment of prostate cancer continue to evolve with advances in science and technology. The utilization of multiparametric MRI (mp-MRI) to identify lesions in the prostate has given clinicians the ability to visualize malignancy in the prostate with greater confidence. With this new ability came the advancement of fusion biopsy platforms, which allow for direct targeting of these lesions. As with any new technology in medicine, the proper use of these modalities and how they fit into current clinical practice need to be addressed. This review summarizes the current knowledge on how to best optimize which men undergo mp-MRI and fusion biopsies both in the screening and treatment settings.
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Albisinni S, De Groote A, Deneft F, Thoma P, Catteau X, Roumeguère T, Wildschutz T. [Can preoperative prostate MRI before radical prostatectomy predict extracapsular extension and the side of the index lesion?]. Prog Urol 2016; 26:281-6. [PMID: 26996453 DOI: 10.1016/j.purol.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/28/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the role of preoperative multi-parametric magnetic resonance imaging (MP-MRI) in patients undergoing radical prostatectomy. Specifically, the accuracy of MP-MRI in detecting extracapsular extension (ECE) and individuating the side of the index lesion have been explored. METHODS Thirty-five consecutive patients undergoing radical prostatectomy have been retrospectively analyzed. The MRI exam incorporated T2-weighted imaging, diffusion-weighted imaging and dynamic contrast enhancement in all patients. χ(2) test was performed to assess an association between an MP-MRI suggestive of ECE and pathologic ECE; similar tests were performed to study the association between the MRI-detected side of the index lesion and its true localization on final pathology. Univariate logistic regression models were constructed to evaluate possible predictors of ECE, including MP-MRI suspected ECE. RESULTS Seventeen percent (6/35) of men presented ECE on final pathology. MP-MRI was predictive of pathologic ECE with a negative predictive value and specificity of 93% and 90%, respectively. Global accuracy of MP-MRI in predicting ECE was 86%. MRI-detected ECE was significantly predictive of pathologic ECE on logistic regression (OR: 17.3, 95% CI: 2.2-138.2, P=0.007). Moreover, MRI significantly predicted the side of the index lesion (P=0.012). CONCLUSIONS In this single center cohort, preoperative MP-MRI was significantly predictive of ECE and side of the index lesion. Further studies are necessary to individuate patients who can benefit from preoperative MP-MRI. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- S Albisinni
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique; Département d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme, université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique.
| | - A De Groote
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - F Deneft
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - P Thoma
- Département de radiologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - X Catteau
- Département d'anatomopathologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - T Roumeguère
- Département d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme, université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - T Wildschutz
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
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Radtke JP, Teber D, Hohenfellner M, Hadaschik BA. The current and future role of magnetic resonance imaging in prostate cancer detection and management. Transl Androl Urol 2016; 4:326-41. [PMID: 26816833 PMCID: PMC4708229 DOI: 10.3978/j.issn.2223-4683.2015.06.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Accurate detection of clinically significant prostate cancer (PC) and correct risk attribution are essential to individually counsel men with PC. Multiparametric MRI (mpMRI) facilitates correct localization of index lesions within the prostate and MRI-targeted prostate biopsy (TPB) helps to avoid the shortcomings of conventional biopsy such as false-negative results or underdiagnosis of aggressive PC. In this review we summarize the different sequences of mpMRI, characterize the possibilities of incorporating MRI in the biopsy workflow and outline the performance of targeted and systematic cores in significant cancer detection. Furthermore, we outline the potential of MRI in patients undergoing active surveillance (AS) and in the pre-operative setting. Materials and methods An electronic MEDLINE/PubMed search up to February 2015 was performed. English language articles were reviewed for inclusion ability and data were extracted, analyzed and summarized. Results Targeted biopsies significantly outperform conventional systematic biopsies in the detection of significant PC and are not inferior when compared to transperineal saturation biopsies. MpMRI can detect index lesions in app. 90% of cases as compared to prostatectomy specimen. The diagnostic performance of biparametric MRI (T2w + DWI) is not inferior to mpMRI, offering options to diminish cost- and time-consumption. Since app 10% of significant lesions are still MRI-invisible, systematic cores seem to be necessary. In-bore biopsy and MRI/TRUS-fusion-guided biopsy tend to be superior techniques compared to cognitive fusion. In AS, mpMRI avoids underdetection of significant PC and confirms low-risk disease accurately. In higher-risk disease, pre-surgical MRI can change the clinically-based surgical plan in up to a third of cases. Conclusions mpMRI and targeted biopsies are able to detect significant PC accurately and mitigate insignificant PC detection. As long as the negative predictive value (NPV) is still imperfect, systematic cores should not be omitted for optimal staging of disease. The potential to correctly classify aggressiveness of disease in AS patients and to guide and plan prostatectomy is evolving.
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Affiliation(s)
- Jan Philipp Radtke
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Dogu Teber
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Markus Hohenfellner
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Boris A Hadaschik
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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Rastinehad AR, Abboud SF, George AK, Frye TP, Ho R, Chelluri R, Fascelli M, Shih J, Villani R, Ben-Levi E, Yaskiv O, Turkbey B, Choyke PL, Merino MJ, Wood BJ, Pinto PA. Reproducibility of Multiparametric Magnetic Resonance Imaging and Fusion Guided Prostate Biopsy: Multi-Institutional External Validation by a Propensity Score Matched Cohort. J Urol 2016; 195:1737-43. [PMID: 26812301 DOI: 10.1016/j.juro.2015.12.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE As the adoption of magnetic resonance imaging/ultrasound fusion guided biopsy expands, the reproducibility of outcomes at expert centers becomes essential. We sought to validate the comprehensive NCI (National Cancer Institute) experience with multiparametric magnetic resonance imaging and fusion guided biopsy in an external, independent, matched cohort of patients. MATERIALS AND METHODS We compared 620 patients enrolled in a prospective trial comparing systematic biopsy to fusion guided biopsy at NCI to 310 who underwent a similar procedure at Long Island Jewish Medical Center. The propensity score, defined as the probability of being treated outside NCI, was calculated using the estimated logistic regression model. Patients from the hospital were matched 1:1 for age, prostate specific antigen, magnetic resonance imaging suspicion score and prior negative biopsies. Clinically significant disease was defined as Gleason 3 + 4 or greater. RESULTS Before matching we found differences between the cohorts in age, magnetic resonance imaging suspicion score (each p <0.001), the number of patients with prior negative biopsies (p = 0.01), and the overall cancer detection rate and the cancer detection rate by fusion guided biopsy (each p <0.001). No difference was found in the rates of upgrading by fusion guided biopsy (p = 0.28) or upgrading to clinically significant disease (p = 0.95). A statistically significant difference remained in the overall cancer detection rate and the rate by fusion guided biopsy after matching. On subgroup analysis we found a difference in the overall cancer detection rate and the rate by fusion guided biopsy (p <0.001 and 0.003) in patients with prior negative systematic biopsy but no difference in the 2 rates (p = 0.39 and 0.51, respectively) in biopsy naïve patients. CONCLUSIONS Improved detection of clinically significant cancer by magnetic resonance imaging and fusion guided biopsy is reproducible by an experienced multidisciplinary team consisting of dedicated radiologists and urologists.
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Affiliation(s)
- Ardeshir R Rastinehad
- Department of Urology and Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven F Abboud
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland
| | - Arvin K George
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland
| | - Thomas P Frye
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland
| | - Richard Ho
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland
| | - Raju Chelluri
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland
| | - Michele Fascelli
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland
| | - Joanna Shih
- Biometric Research Branch, National Institutes of Health, Bethesda, Maryland
| | - Robert Villani
- Department of Radiology, North Shore-Long Island Jewish Hofstra School of Medicine, New Hyde Park, New York
| | - Eran Ben-Levi
- Department of Radiology, North Shore-Long Island Jewish Hofstra School of Medicine, New Hyde Park, New York
| | - Oksana Yaskiv
- Department of Pathology, North Shore-Long Island Jewish Hofstra School of Medicine, New Hyde Park, New York
| | - Baris Turkbey
- Molecular Imaging Program, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
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Sankineni S, Choyke PL, Pinto P, Turkbey B. Imaging in Localized Prostate Cancer. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fascelli M, Rais-Bahrami S, Sankineni S, Brown AM, George AK, Ho R, Frye T, Kilchevsky A, Chelluri R, Abboud S, Siddiqui MM, Merino MJ, Wood BJ, Choyke PL, Pinto PA, Turkbey B. Combined Biparametric Prostate Magnetic Resonance Imaging and Prostate-specific Antigen in the Detection of Prostate Cancer: A Validation Study in a Biopsy-naive Patient Population. Urology 2015; 88:125-34. [PMID: 26680244 DOI: 10.1016/j.urology.2015.09.035] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To validate the use of biparametric (T2- and diffusion-weighted) magnetic resonance imaging (B-MRI) and prostate-specific antigen (PSA) or PSA density (PSAD) in a biopsy-naive cohort at risk for prostate cancer (PCa). METHODS All patients (n = 59) underwent PSA screening and digital rectal exam prior to a B-MRI followed by MRI or transrectal ultrasound fusion-guided targeted biopsy. Previously reported composite formulas incorporating screen positive lesions (SPL) on B-MRI and PSA or PSAD were developed to maximize PCa detection. For PSA, a patient was considered screen positive if PSA level + 6 × (the number of SPL) >14. For PSAD, screening was positive if PSAD × 14 + (the number of SPL) >4.25. These schemes were employed in this new test set to validate the initial formulas. Performance assessment of these formulas was determined for all cancer detection and for tumors with Gleason ≥3 + 4. RESULTS Screen positive lesions on B-MRI had the highest sensitivity (95.5%) and negative predictive value of 71.4% compared with PSA and PSAD. B-MRI significantly improved sensitivity (43.2-72.7%, P = .0002) when combined with PSAD. The negative predictive value of PSA increased with B-MRI, achieving 91.7% for B-MRI and PSA for Gleason ≥3 + 4. Overall accuracies of the composite equations were 81.4% (B-MRI and PSA) and 78.0% (B-MRI and PSAD). CONCLUSION Validation with a biopsy-naive cohort demonstrates the parameter SPL performed better than PSA or PSAD alone in accurately detecting PCa. The combined use of B-MRI, PSA, and PSAD resulted in improved accuracy for detecting clinically significant PCa.
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Affiliation(s)
- Michele Fascelli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Departments of Urology and Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Sandeep Sankineni
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anna M Brown
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Richard Ho
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Thomas Frye
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amichai Kilchevsky
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Raju Chelluri
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Steven Abboud
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - M Minhaj Siddiqui
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Surgery, Division of Urology, University of Maryland, Baltimore, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, Department of Radiology and Imaging Services, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Center for Interventional Oncology, Department of Radiology and Imaging Services, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Okoro C, George AK, Siddiqui MM, Rais-Bahrami S, Walton-Diaz A, Shakir NA, Rothwax JT, Raskolnikov D, Stamatakis L, Su D, Turkbey B, Choyke PL, Merino MJ, Parnes HL, Wood BJ, Pinto PA. Magnetic Resonance Imaging/Transrectal Ultrasonography Fusion Prostate Biopsy Significantly Outperforms Systematic 12-Core Biopsy for Prediction of Total Magnetic Resonance Imaging Tumor Volume in Active Surveillance Patients. J Endourol 2015; 29:1115-21. [PMID: 25897467 DOI: 10.1089/end.2015.0027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To correlate the highest percentage core involvement (HPCI) and corresponding tumor length (CTL) on systematic 12-core biopsy (SBx) and targeted magnetic resonance imaging/transrectal ultrasonography (MRI/TRUS) fusion biopsy (TBx), with total MRI prostate cancer (PCa) tumor volume (TV). PATIENTS AND METHODS Fifty patients meeting criteria for active surveillance (AS) based on outside SBx, who underwent 3.0T multiparametric prostate MRI (MP-MRI), followed by SBx and TBx during the same session at our institution were examined. PCa TVs were calculated using MP-MRI and then correlated using bivariate analysis with the HPCI and CTL for SBx and TBx. RESULTS For TBx, HPCI and CTL showed a positive correlation (R(2)=0.31, P<0.0001 and R(2)=0.37, P<0.0001, respectively) with total MRI PCa TV, whereas for SBx, these parameters showed a poor correlation (R(2)=0.00006, P=0.96 and R(2)=0.0004, P=0.89, respectively). For detection of patients with clinically significant MRI derived tumor burden greater than 500 mm(3), SBx was 25% sensitive, 90.9% specific (falsely elevated because of missed tumors and extremely low sensitivity), and 54% accurate in comparison with TBx, which was 53.6% sensitive, 86.4% specific, and 68% accurate. CONCLUSIONS HPCI and CTL on TBx positively correlates with total MRI PCa TV, whereas there was no correlation seen with SBx. TBx is superior to SBx for detecting tumor burden greater than 500 mm(3). When using biopsy positive MRI derived TVs, TBx better reflects overall disease burden, improving risk stratification among candidates for active surveillance.
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Affiliation(s)
- Chinonyerem Okoro
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Arvin K George
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - M Minhaj Siddiqui
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Soroush Rais-Bahrami
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Annerleim Walton-Diaz
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Nabeel A Shakir
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Jason T Rothwax
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Dima Raskolnikov
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Lambros Stamatakis
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Daniel Su
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Baris Turkbey
- 2 Molecular Imaging Program, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Peter L Choyke
- 2 Molecular Imaging Program, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Maria J Merino
- 3 Laboratory of Pathology, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Howard L Parnes
- 4 Division of Cancer Prevention, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Bradford J Wood
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.,5 Center for Interventional Oncology, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Peter A Pinto
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.,5 Center for Interventional Oncology, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
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When to biopsy seminal vesicles. Actas Urol Esp 2015; 39:203-9. [PMID: 25466644 DOI: 10.1016/j.acuro.2014.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. MATERIAL AND METHODS observational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10 ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. RESULTS Forty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P < .01) and PSA density (P < .01), as well as a lower mean prostate volume (P < .01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P < .01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P < .01), 4.65 times higher for PSA levels >19.60 ng/dL (P < .01) and 2.95 times higher if there is a suspicious rectal examination (P = .014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P < .01). The ROC curves showed maximum sensitivity and specificity at 19.6 ng/mL for PSA and 0.39 for PSA density. CONCLUSIONS In this series, greater involvement of seminal vesicles was associated with a PSA level ≥20 ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.
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Raskolnikov D, George AK, Rais-Bahrami S, Turkbey B, Siddiqui MM, Shakir NA, Okoro C, Rothwax JT, Walton-Diaz A, Sankineni S, Su D, Stamatakis L, Merino MJ, Choyke PL, Wood BJ, Pinto PA. The Role of Magnetic Resonance Image Guided Prostate Biopsy in Stratifying Men for Risk of Extracapsular Extension at Radical Prostatectomy. J Urol 2015; 194:105-111. [PMID: 25623751 DOI: 10.1016/j.juro.2015.01.072] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Magnetic resonance imaging detects extracapsular extension by prostate cancer with excellent specificity but low sensitivity. This limits surgical planning, which could be modified to account for focal extracapsular extension with image directed guidance for wider excision. In this study we evaluate the performance of multiparametric magnetic resonance imaging in extracapsular extension detection and determine which preoperative variables predict extracapsular extension on final pathology when multiparametric magnetic resonance imaging predicts organ confined disease. MATERIALS AND METHODS From May 2007 to March 2014, 169 patients underwent pre-biopsy multiparametric magnetic resonance imaging, magnetic resonance imaging/transrectal ultrasound fusion guided biopsy, extended sextant 12-core biopsy and radical prostatectomy at our institution. A subset of 116 men had multiparametric magnetic resonance imaging negative for extracapsular extension and were included in the final analysis. RESULTS The 116 men with multiparametric magnetic resonance imaging negative for extracapsular extension had a median age of 61 years (IQR 57-66) and a median prostate specific antigen of 5.51 ng/ml (IQR 3.91-9.07). The prevalence of extracapsular extension was 23.1% in the overall population. Sensitivity, specificity, and positive and negative predictive values of multiparametric magnetic resonance imaging for extracapsular extension were 48.7%, 73.9%, 35.9% and 82.8%, respectively. On multivariate regression analysis only patient age (p=0.002) and magnetic resonance imaging/transrectal ultrasound fusion guided biopsy Gleason score (p=0.032) were independent predictors of extracapsular extension on final radical prostatectomy pathology. CONCLUSIONS Because of the low sensitivity of multiparametric magnetic resonance imaging for extracapsular extension, further tools are necessary to stratify men at risk for occult extracapsular extension that would otherwise only become apparent on final pathology. Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy Gleason score can help identify which men with prostate cancer have extracapsular extension that may not be detectable by imaging.
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Affiliation(s)
- Dima Raskolnikov
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - M Minhaj Siddiqui
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nabeel A Shakir
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chinonyerem Okoro
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason T Rothwax
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Annerleim Walton-Diaz
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sandeep Sankineni
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel Su
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lambros Stamatakis
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland.
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Reply by Authors. J Urol 2014. [DOI: 10.1016/j.juro.2014.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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George AK, Pinto PA, Rais-Bahrami S. Multiparametric MRI in the PSA screening era. BIOMED RESEARCH INTERNATIONAL 2014; 2014:465816. [PMID: 25250323 PMCID: PMC4163437 DOI: 10.1155/2014/465816] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/18/2014] [Indexed: 01/03/2023]
Abstract
Prostate cancer remains significant public health concern amid growing controversies regarding prostate specific antigen (PSA) based screening. The utility of PSA has been brought into question, and alternative measures are investigated to remedy the overdetection of indolent disease and safeguard patients from the potential harms resulting from an elevated PSA. Multiparametric MRI of the prostate has shown promise in identifying patients at risk for clinically significant disease but its role within the current diagnostic and treatment paradigm remains in question. The current review focuses on recent applications of MRI in this pathway.
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Affiliation(s)
- Arvin K. George
- National Cancer Institute, Urologic Oncology Branch, National Institutes of Health, 10 Center Drive, 2950-W, Building 10, CRC Room 2W-5940, Bethesda, MD 20892-1210, USA
| | - Peter A. Pinto
- National Cancer Institute, Urologic Oncology Branch, National Institutes of Health, 10 Center Drive, 2950-W, Building 10, CRC Room 2W-5940, Bethesda, MD 20892-1210, USA
| | - Soroush Rais-Bahrami
- National Cancer Institute, Urologic Oncology Branch, National Institutes of Health, 10 Center Drive, 2950-W, Building 10, CRC Room 2W-5940, Bethesda, MD 20892-1210, USA
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