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Lophatananon A, Byrne MHV, Barrett T, Warren A, Muir K, Dokubo I, Georgiades F, Sheba M, Bibby L, Gnanapragasam VJ. Assessing the impact of MRI based diagnostics on pre-treatment disease classification and prognostic model performance in men diagnosed with new prostate cancer from an unscreened population. BMC Cancer 2022; 22:878. [PMID: 35953766 PMCID: PMC9367076 DOI: 10.1186/s12885-022-09955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Pre-treatment risk and prognostic groups are the cornerstone for deciding management in non-metastatic prostate cancer. All however, were developed in the pre-MRI era. Here we compared categorisation of cancers using either only clinical parameters or with MRI enhanced information in men referred for suspected prostate cancer from an unscreened population. Patient and methods Data from men referred from primary care to our diagnostic service and with both clinical (digital rectal examination [DRE] and systematic biopsies) and MRI enhanced attributes (MRI stage and combined systematic/targeted biopsies) were used for this study. Clinical vs MRI data were contrasted for clinico-pathological and risk group re-distribution using the European Association of Urology (EAU), American Urological Association (AUA) and UK National Institute for Health Care Excellence (NICE) Cambridge Prognostic Group (CPG) models. Differences were retrofitted to a population cohort with long-term prostate cancer mortality (PCM) outcomes to simulate impact on model performance. We further contrasted individualised overall survival (OS) predictions using the Predict Prostate algorithm. Results Data from 370 men were included (median age 66y). Pre-biopsy MRI stage reassignments occurred in 7.8% (versus DRE). Image-guided biopsies increased Grade Group 2 and ≥ Grade Group 3 assignments in 2.7% and 2.9% respectively. The main change in risk groups was more high-risk cancers (6.2% increase in the EAU and AUA system, 4.3% increase in CPG4 and 1.9% CPG5). When extrapolated to a historical population-based cohort (n = 10,139) the redistribution resulted in generally lower concordance indices for PCM. The 5-tier NICE-CPG system outperformed the 4-tier AUA and 3-tier EAU models (C Index 0.70 versus 0.65 and 0.64). Using an individualised prognostic model, changes in predicted OS were small (median difference 1% and 2% at 10- and 15-years’ respectively). Similarly, estimated treatment survival benefit changes were minimal (1% at both 10- and 15-years’ time frame). Conclusion MRI guided diagnostics does change pre-treatment risk groups assignments but the overall prognostic impact appears modest in men referred from unscreened populations. Particularly, when using more granular tiers or individualised prognostic models. Existing risk and prognostic models can continue to be used to counsel men about treatment option until long term survival outcomes are available.
Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09955-w.
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Affiliation(s)
- Artitaya Lophatananon
- Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, Manchester, UK
| | - Matthew H V Byrne
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Anne Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kenneth Muir
- Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, Manchester, UK
| | - Ibifuro Dokubo
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fanos Georgiades
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mostafa Sheba
- Kasr Al Any School of Medicine, Cairo University, Giza, Egypt
| | - Lisa Bibby
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK. .,Cambridge Urology Translational Research and Clinical Trials Office, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
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Abstract
PURPOSE OF REVIEW Although most studies focus on the tumour component of prostate cancer (PCa), increasing attention is being paid to the prostatic tumour microenvironment (TME) and its role in diagnosis, prognosis, and therapy development. Herein, we review the prognostic capability of tumour and nontumour derived biomarkers, the immunomodulatory effects of focal therapy (FT) on TME, and its potential as part of a multidisciplinary approach to PCa treatment. RECENT FINDINGS Tumour cells have always been the natural candidates to explore new biomarkers, but recent evidence highlights the prognostic contribution of TME cell markers. TME plays a critical role in PCa progression and tumours may escape from the immune system by establishing a microenvironment that suppresses effective antitumour immunity. It has been demonstrated that FT has an immunomodulatory effect and may elicit an immune response that can either favour or inhibit tumorigenesis. TME shows to be an additional target to enhance oncological control. SUMMARY A better understanding of TME has the potential to reliably elucidate PCa heterogeneity and assign a prognostic profile in accordance with prostate tumour foci. The joint contribution of biomarkers derived from both tumour and TME compartments may improve patient selection for FT by accurately stratifying disease aggressivity according to the characteristics of tumour foci. Preclinical studies have suggested that FT may act as a TME modulator, highlighting its promising role in multimodal therapeutic management.
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Miszczyk M, Rembak-Szynkiewicz J, Magrowski Ł, Stawiski K, Namysł-Kaletka A, Napieralska A, Kraszkiewicz M, Woźniak G, Stąpór-Fudzińska M, Głowacki G, Pradere B, Laukhtina E, Rajwa P, Majewski W. The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer. Cancers (Basel) 2022; 14:cancers14071613. [PMID: 35406385 PMCID: PMC8997034 DOI: 10.3390/cancers14071613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
Prostate Imaging-Reporting and Data System (PI-RADS) has been widely implemented as a diagnostic tool for significant prostate cancer (PCa); less is known about its prognostic value, especially in the setting of primary radiotherapy. We aimed to analyze the association between PI-RADS v. 2.1 classification and risk of metastases, based on a group of 152 patients treated with ultra-hypofractionated stereotactic CyberKnife radiotherapy for localized low or intermediate risk-group prostate cancer. We found that all distant failures (n = 5) occurred in patients diagnosed with a PI-RADS score of 5, and axial measurements of the target lesion were associated with the risk of developing metastases (p < 0.001). The best risk stratification model (based on a combination of greatest dimension, the product of multiplication of PI-RADS target lesion axial measurements, and age) achieved a c-index of 0.903 (bootstrap-validated bias-corrected 95% CI: 0.848−0.901). This creates a hypothesis that PI-RADS 5 and the size of the target lesion are important prognostic factors in early-stage PCa patients and should be considered as an adverse prognostic measure for patients undergoing early treatment such as radiation or focal therapy.
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Affiliation(s)
- Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
- Correspondence: ; Tel.: +48-663-040-809
| | - Justyna Rembak-Szynkiewicz
- Radiology Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
| | - Łukasz Magrowski
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
| | - Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, 90-419 Łódź, Poland;
| | - Agnieszka Namysł-Kaletka
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Aleksandra Napieralska
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Małgorzata Kraszkiewicz
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Grzegorz Woźniak
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Małgorzata Stąpór-Fudzińska
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Grzegorz Głowacki
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Benjamin Pradere
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (E.L.); (P.R.)
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
| | - Paweł Rajwa
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (E.L.); (P.R.)
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Wojciech Majewski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (A.N.-K.); (A.N.); (M.K.); (G.W.); (M.S.-F.); (G.G.); (B.P.); (W.M.)
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Satish P, Freeman A, Kelly D, Kirkham A, Orczyk C, Simpson BS, Giganti F, Whitaker HC, Emberton M, Norris JM. Relationship of prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e050376. [PMID: 34987040 PMCID: PMC8734010 DOI: 10.1136/bmjopen-2021-050376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI) has improved the triage of men with suspected prostate cancer, through precision prebiopsy identification of clinically significant disease. While multiple important characteristics, including tumour grade and size have been shown to affect conspicuity on mpMRI, tumour location and association with mpMRI visibility is an underexplored facet of this field. Therefore, the objective of this systematic review and meta-analysis is to collate the extant evidence comparing MRI performance between different locations within the prostate in men with existing or suspected prostate cancer. This review will help clarify mechanisms that underpin whether a tumour is visible, and the prognostic implications of our findings. METHODS AND ANALYSIS The databases MEDLINE, PubMed, Embase and Cochrane will be systematically searched for relevant studies. Eligible studies will be full-text English-language articles that examine the effect of zonal location on mpMRI conspicuity. Two reviewers will perform study selection, data extraction and quality assessment. A third reviewer will be involved if consensus is not achieved. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will inform the methodology and reporting of the review. Study bias will be assessed using a modified Newcastle-Ottawa scale. A thematic approach will be used to synthesise key location-based factors associated with mpMRI conspicuity. A meta-analysis will be conducted to form a pooled value of the sensitivity and specificity of mpMRI at different tumour locations. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021228087.
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Affiliation(s)
- Pranav Satish
- UCL Division of Surgery & Interventional Science, UCL Medical School, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Joseph M Norris
- Division of Surgery and Interventional Science, University College London, London, UK
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Gnanapragasam VJ, Barrett T, Pacey S, Warren A. Does modern active surveillance offer an opportunity for new therapeutic strategies in early prostate cancer? BJU Int 2021; 127:628-629. [PMID: 33774889 DOI: 10.1111/bju.15409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Vincent J Gnanapragasam
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK.,Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK.,Department of Radiology, University of Cambridge, Cambridge, UK
| | - Simon Pacey
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK.,Department of Oncology, University of Cambridge, Cambridge, UK
| | - Anne Warren
- Translational Prostate Cancer Group, CRUK Cambridge Cancer Centre, Cambridge, UK.,Department of Pathology, Addenbrookes Hospital, Cambridge, UK
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