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Himmelsbach R, Hackländer A, Weishaar M, Morlock J, Schoeb D, Jilg C, Gratzke C, Grabbert M, Sigle A. Retrospective analysis of the learning curve in perineal robot-assisted prostate biopsy. Prostate 2024; 84:1165-1172. [PMID: 38824436 DOI: 10.1002/pros.24753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-fusion biopsy (FBx) of the prostate allows targeted sampling of suspicious lesions within the prostate, identified by multiparametric MRI. Due to its reliable results and feasibility, perineal MRI/TRUS FBx is now the gold standard for prostate cancer (PC) diagnosis. There are various systems for performing FBx on the market, for example, software-based, semirobotic, or robot-assisted platform solutions. Their semiautomated workflow promises high process quality independent of the surgeon's experience. The aim of this study was to analyze how the surgeon's experience influences the cancer detection rate (CDR) via targeted biopsy (TB) and the procedure's duration in robot-assisted FBx. PATIENTS AND METHODS A total of 1716 men who underwent robot-assisted FBx involving a combination of targeted and systematic sampling between October 2015 and April 2022 were analyzed. We extracted data from the patients' electronic medical records retrospectively. Primary endpoints were the CDR by TB and the procedure's duration. For our analysis, surgeons were divided into three levels of experience: ≤20 procedures (little), 21-100 procedures (intermediate), and >100 procedures (high). Statistical analysis was performed via regression analyses and group comparisons. RESULTS Median age, prostate-specific antigen level, and prostate volume of the cohort were 67 (±7.7) years, 8.13 (±9.4) ng/mL, and 53 (±34.2) mL, respectively. Median duration of the procedure was 26 (±10.9) min. The duration decreased significantly with the surgeon's increasing experience from 35.1 (little experience) to 28.4 (intermediate experience) to 24.0 min (high experience) (p < 0.001). Using TB only, significant PC (sPC) was diagnosed in 872/1758 (49.6%) of the men. The CDR revealed no significant correlation with the surgeon's experience in either group comparison (p = 0.907) or in regression analysis (p = 0.65). CONCLUSION While the duration of this procedure decreases with increasing experience, the detection rate of sPC in TB is not significantly associated with the experience of the surgeon performing robot-assisted FBx. This robot-assisted biopsy system's diagnostic accuracy therefore appears to be independent of experience.
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Affiliation(s)
- Ruth Himmelsbach
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Alexander Hackländer
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Moritz Weishaar
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Jonathan Morlock
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Dominik Schoeb
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Cordula Jilg
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Markus Grabbert
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
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Zattoni F, Fasulo V, Kasivisvanathan V, Kesch C, Marra G, Martini A, Falagario U, Soeterik T, van den Bergh R, Rajwa P, Gandaglia G. Enhancing Prostate Cancer Detection Accuracy in Magnetic Resonance Imaging-targeted Prostate Biopsy: Optimizing the Number of Cores Taken. EUR UROL SUPPL 2024; 66:16-25. [PMID: 39027654 PMCID: PMC11254588 DOI: 10.1016/j.euros.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Background and objective The shift toward targeted biopsy (TBx) aims at enhancing prostate cancer (PCa) detection while reducing overdiagnosis of clinically insignificant disease. Despite the improved ability of TBx in identifying clinically significant PCa (csPCa), the optimal number and location of targeted cores remain unclear. This review aims to assess the optimal number of prostate biopsy magnetic resonance imaging (MRI)-targeted cores to detect csPCa. Methods A narrative literature search was conducted using PubMed, focusing on studies published between January 2014 and January 2024, addressing factors influencing targeted core numbers during prostate biopsy. The search included both retrospective and prospective studies, prioritizing those with substantial sample sizes and employing terms such as "prostate biopsy", "mpMRI", "core number", and "cancer detection". Key findings and limitations Two biopsy cores identified csPCa in 55-65% of cases. This detection rate improved to approximately 90% when the number of cores was ≥5. The inclusion of perilesional and systematic biopsies could maximize the detection of csPCa (from 10% to 45%), especially in patients under active surveillance or with prior negative biopsy results, although there is an increase in the overdiagnosis of indolent tumors (from 4% to 20%). Transperineal software-assisted target prostate biopsy may enhance cancer detection, particularly for tumors located at the apex/anterior part of the prostate. Increasing the number of TBx cores may incrementally raise the risk of complications (by 2-14% with each added core) and result in severe pain and significant discomfort for up to 17% and 25% of TBx patients, respectively. However, the overall rate and severity of these complications remain within acceptable limits. Conclusions and clinical implications The optimal number of cores for targeted prostate biopsies should balance minimizing sampling errors with effective cancer detection and should be tailored to each patient's unique prostate characteristics. Up to five cores per MRI target may be considered to enhance the detection of csPCa, with adjustments based on factors such as prostate and lesion volume, Prostate Imaging Reporting and Data System, biopsy techniques, complications, patient discomfort, and anxiety. Patient summary In this report, we found that increasing the number of biopsy cores up to ≥5 improves the detection rates of significant prostate cancer significantly to around 90%. Although inclusion of nearby and systematic biopsies enhances detection, increasing the biopsy count may lead to higher risks of complications and indolent tumors. A customized biopsy approach based on multiple variables could be helpful in determining the appropriate number of targeted biopsies on a case-by-case basis.
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Affiliation(s)
- Fabio Zattoni
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Department of Medicine - DIMED, University of Padua, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Giancarlo Marra
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Alberto Martini
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ugo Falagario
- Department of Urology, University of Foggia, Foggia, Italy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Timo Soeterik
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - EAU-YAU Prostate Cancer Working Party (PCa-WP)
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Department of Medicine - DIMED, University of Padua, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University Hospital Essen, Essen, Germany
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
- Department of Urology, University of Foggia, Foggia, Italy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
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Sawhney V, Huang R, Huang WC, Lepor H, Taneja SS, Wysock J. Predictors of Contralateral Disease in Men with Unilateral Lesions on Multiparametric MRI. Urology 2024:S0090-4295(24)00564-8. [PMID: 39004105 DOI: 10.1016/j.urology.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/27/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To evaluate predictors of contralateral clinically significant prostate cancer (csPCa) in men with biopsy proven unilateral lesions on magnetic resonance imaging (MRI). METHODS We retrospectively identified men with no prior diagnosis of PCa with unilateral biopsy confirmed csPCa PI-RADS 2-5 lesions within our institutional biopsy database. Multivariate logistic regression was used to identify clinical predictors of contralateral disease. RESULTS Four hundred ninety men met study inclusion criteria, of which 385 men (78.6%) had no contralateral csPCa and 105 men (21.4%) had contralateral csPCa. (Figure 1). Prior negative biopsy (OR 0.34 [0.14, 0.75], p = 0.012), PSA density (OR 18.8 [2.77, 249], p = 0.017), and tumor location in the transverse plane ("Posterior": OR 1.93 [1.02, 3.87], p =0.048; "Throughout Transverse Plane": OR 6.56 [2.26, 19.6], p <0.001) were significantly associated with contralateral csPCa in multivariate logistic regression models. However, there appear to be no attributes within the MRI-targeted tumor that reliably predict contralateral csPCa (Table 2). CONCLUSIONS Approximately 20% of men with unilateral MRI findings and csPCa on targeted-biopsy were found to have contralateral csPCa. Prior negative biopsy was associated with a decreased odds of contralateral csPCa. PSA density and tumor in the posterior aspect of or throughout the transverse plane were associated with increased odds of contralateral csPCA. Consideration of these clinical factors may afford an opportunity to only use SB in cases in which the odds of contralateral csPCa are high.
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Affiliation(s)
- Vyom Sawhney
- Department of Urology, NYU Langone Health, New York, NY.
| | - Richard Huang
- Department of Urology, NYU Langone Health, New York, NY
| | | | - Herbert Lepor
- Department of Urology, NYU Langone Health, New York, NY
| | | | - James Wysock
- Department of Urology, NYU Langone Health, New York, NY
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Soleimani S. Editorial for "Deep Learning-Based T2-Weighted MR Image Quality Assessment and Its Impact on Prostate Cancer Detection Rates". J Magn Reson Imaging 2024; 59:2224-2225. [PMID: 37787598 DOI: 10.1002/jmri.29033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Sahar Soleimani
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lin Y, Belue MJ, Yilmaz EC, Harmon SA, An J, Law YM, Hazen L, Garcia C, Merriman KM, Phelps TE, Lay NS, Toubaji A, Merino MJ, Wood BJ, Gurram S, Choyke PL, Pinto PA, Turkbey B. Deep Learning-Based T2-Weighted MR Image Quality Assessment and Its Impact on Prostate Cancer Detection Rates. J Magn Reson Imaging 2024; 59:2215-2223. [PMID: 37811666 PMCID: PMC11001787 DOI: 10.1002/jmri.29031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Image quality evaluation of prostate MRI is important for successful implementation of MRI into localized prostate cancer diagnosis. PURPOSE To examine the impact of image quality on prostate cancer detection using an in-house previously developed artificial intelligence (AI) algorithm. STUDY TYPE Retrospective. SUBJECTS 615 consecutive patients (median age 67 [interquartile range [IQR]: 61-71] years) with elevated serum PSA (median PSA 6.6 [IQR: 4.6-9.8] ng/mL) prior to prostate biopsy. FIELD STRENGTH/SEQUENCE 3.0T/T2-weighted turbo-spin-echo MRI, high b-value echo-planar diffusion-weighted imaging, and gradient recalled echo dynamic contrast-enhanced. ASSESSMENTS Scans were prospectively evaluated during clinical readout using PI-RADSv2.1 by one genitourinary radiologist with 17 years of experience. For each patient, T2-weighted images (T2WIs) were classified as high-quality or low-quality based on evaluation of both general distortions (eg, motion, distortion, noise, and aliasing) and perceptual distortions (eg, obscured delineation of prostatic capsule, prostatic zones, and excess rectal gas) by a previously developed in-house AI algorithm. Patients with PI-RADS category 1 underwent 12-core ultrasound-guided systematic biopsy while those with PI-RADS category 2-5 underwent combined systematic and targeted biopsies. Patient-level cancer detection rates (CDRs) were calculated for clinically significant prostate cancer (csPCa, International Society of Urological Pathology Grade Group ≥2) by each biopsy method and compared between high- and low-quality images in each PI-RADS category. STATISTICAL TESTS Fisher's exact test. Bootstrap 95% confidence intervals (CI). A P value <0.05 was considered statistically significant. RESULTS 385 (63%) T2WIs were classified as high-quality and 230 (37%) as low-quality by AI. Targeted biopsy with high-quality T2WIs resulted in significantly higher clinically significant CDR than low-quality images for PI-RADS category 4 lesions (52% [95% CI: 43-61] vs. 32% [95% CI: 22-42]). For combined biopsy, there was no significant difference in patient-level CDRs for PI-RADS 4 between high- and low-quality T2WIs (56% [95% CI: 47-64] vs. 44% [95% CI: 34-55]; P = 0.09). DATA CONCLUSION Higher quality T2WIs were associated with better targeted biopsy clinically significant cancer detection performance for PI-RADS 4 lesions. Combined biopsy might be needed when T2WI is lower quality. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Julie An
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | - Lindsey Hazen
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charisse Garcia
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford J Wood
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Wu Q, Tu X, Zhang C, Ye J, Lin T, Liu Z, Yang L, Qiu S, Bao Y, Wei Q. Transperineal magnetic resonance imaging targeted biopsy versus transrectal route in the detection of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024; 27:212-221. [PMID: 37783837 DOI: 10.1038/s41391-023-00729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has deeply altered the prostate biopsy strategy to detect prostate cancer. However, it is still debatable whether the detection rate differs between transrectal (TR) and transperineal (TP) MRI-targeted biopsy (MRI-TB). To compare the effectiveness of these two methods for detecting both overall prostate cancer (PCa) and clinically significant PCa (csPCa), We performed a review and meta-analysis. METHODS Until January 2023, we conducted a thorough search of Cochrane, Embase, Ovid, and PubMed. In total, 1482 references were identified, and 15 records were finally included. For PCa and csPCa discovered by TP and TR MRI-TB, we combined the relative sensitivity (RR) with 95% confidence intervals (CI). The RR between the TP and TR routes was established. RESULTS Our study included 8826 patients in total and revealed that TP MRI-TB detected more PCa (RR 1.25 [95% CI 1.12, 1.39], p < 0.0001). In patients who underwent TP MRI-TB and TR MRI-TB at the same time or separately, TP MRI-TB had a greater detection rate of csPCa in per-patient analysis (one cohort (RR 1.33 [95% CI 1.09, 1.63], p = 0.005); two cohorts (RR 1.37 [95% CI 1.16, 1.61], p = 0.0002)). However, the detection rate of csPCa between the TP route and the TR route was comparable in per-lesion analysis (RR 0.91 [95% CI 0.76, 1.08], p = 0.28). Additionally, in the prostate's anterior region, we found that TP MRI-TB detected more csPCa (per-lesion (RR 1.52 [95% CI 1.04, 2.23], p = 0.03); per-patient (RR 2.55 [95% CI 1.56, 4.16], p = 0.0002)). CONCLUSION According to this comprehensive study, TP MRI-TB is more effective than TR MRI-TB at detecting PCa and csPCa. Significant results persisted for detecting csPCa located in the anterior zone. The results need to be taken carefully notwithstanding the heterogeneity among the included studies.
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Affiliation(s)
- Qiyou Wu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Tu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chichen Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianjun Ye
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhai Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
- Department of Molecular Oncology, Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500, Switzerland
| | - Yige Bao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
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Duwe G, Schmitteckert M, Haack M, Sparwasser P, Dotzauer R, Thomas A, Tsaur I, Brandt MP, Kurosch M, Mager R, Haferkamp A, Boehm K, Höfner T. Value of perilesional biopsies in multiparametric magnetic resonance imaging-targeted biopsy and systematic biopsy in detection of prostate cancer: results of a prospective, non-randomized, surgeon-blinded study. World J Urol 2024; 42:297. [PMID: 38709326 DOI: 10.1007/s00345-024-05000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE The goal of this study is to address if detection rates of clinically significant prostate cancer (csPCa) can be increased by additional perilesional biopsies (PB) in magnetic resonance (MR)/ultrasound fusion prostate biopsy in biopsy-naïve men. METHODS This prospective, non-randomized, surgeon-blinded study was conducted between February 2020 and July 2022. Patients were included with PSA levels < 20 ng/ml and ≥ one PI-RADS lesion (grades 3-5) per prostate lobe. Prostate biopsy was performed by two urologists. The first performed the MR-fusion biopsy with 3-5 targeted biopsies (TB) and 6 PB in a standardized pattern. The second performed the systematic (12-fold) biopsy (SB) without knowledge of the MR images. Primary outcome of this study is absence or presence of csPCa (≥ ISUP grade 2) comparing TB, PB and SB, using McNemar test. RESULTS Analyses were performed for each PI-RADS lesion (n = 218). There was a statistically significant difference in csPC detection rate of TB + SB between PI-RADS 3, 4 and 5 lesions (18.0% vs. 42.5% vs. 82.6%, p < 0.001) and TB + PB (19.7% vs. 29.1% vs. 78.3%). Comparing only maximum ISUP grade per lesion, even SB plus TB plus PB did not detect more csPCa compared to SB plus TB (41.3% vs. 39.9%, p > 0.05). CONCLUSION We present prospective study data investigating the role of perilesional biopsy in detection of prostate cancer. We detected no statistically significant difference in the detection of csPCa by the addition of PB. Therefore, we recommend continuing 12-fold bilateral SB in addition to TB.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Melanie Schmitteckert
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls University, Tübingen, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls University, Tübingen, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Martin Kurosch
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadinger Strasse 1, 4020, Linz, Austria
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Lang J, McClure TD, Margolis DJA. MRI-Ultrasound Fused Approach for Prostate Biopsy-How It Is Performed. Cancers (Basel) 2024; 16:1424. [PMID: 38611102 PMCID: PMC11010881 DOI: 10.3390/cancers16071424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
The use of MRI-ultrasound image fusion targeted biopsy of the prostate in the face of an elevated serum PSA is now recommended by multiple societies, and results in improved detection of clinically significant cancer and, potentially, decreased detection of indolent disease. This combines the excellent sensitivity of MRI for clinically significant prostate cancer and the real-time biopsy guidance and confirmation of ultrasound. Both transperineal and transrectal approaches can be implemented using cognitive fusion, mechanical fusion with an articulated arm and electromagnetic registration, or pure software registration. The performance has been shown comparable to in-bore MRI biopsy performance. However, a number of factors influence the performance of this technique, including the quality and interpretation of the MRI, the approach used for biopsy, and experience of the practitioner, with most studies showing comparable performance of MRI-ultrasound fusion to in-bore targeted biopsy. Future improvements including artificial intelligence promise to refine the performance of all approaches.
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Affiliation(s)
- Jacob Lang
- Department of Urology, Weill Cornell Medicine, New York, NY 10068, USA
| | - Timothy Dale McClure
- Department of Urology, Weill Cornell Medicine, New York, NY 10068, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY 10068, USA
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Zheng Y, Zhang J, Huang D, Hao X, Qin W, Liu Y. Detecting MRI-Invisible Prostate Cancers Using a Weakly Supervised Deep Learning Model. Int J Biomed Imaging 2024; 2024:2741986. [PMID: 38532840 PMCID: PMC10965281 DOI: 10.1155/2024/2741986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background MRI is an important tool for accurate detection and targeted biopsy of prostate lesions. However, the imaging appearances of some prostate cancers are similar to those of the surrounding normal tissue on MRI, which are referred to as MRI-invisible prostate cancers (MIPCas). The detection of MIPCas remains challenging and requires extensive systematic biopsy for identification. In this study, we developed a weakly supervised UNet (WSUNet) to detect MIPCas. Methods The study included 777 patients (training set: 600; testing set: 177), all of them underwent comprehensive prostate biopsies using an MRI-ultrasound fusion system. MIPCas were identified in MRI based on the Gleason grade (≥7) from known systematic biopsy results. Results The WSUNet model underwent validation through systematic biopsy in the testing set with an AUC of 0.764 (95% CI: 0.728-0.798). Furthermore, WSUNet exhibited a statistically significant precision improvement of 91.3% (p < 0.01) over conventional systematic biopsy methods in the testing set. This improvement resulted in a substantial 47.6% (p < 0.01) decrease in unnecessary biopsy needles, while maintaining the same number of positively identified cores as in the original systematic biopsy. Conclusions In conclusion, the proposed WSUNet could effectively detect MIPCas, thereby reducing unnecessary biopsies.
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Affiliation(s)
- Yao Zheng
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, China
| | - Jingliang Zhang
- Department of Urology, Xijing Hospital, Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi Province, China
| | - Dong Huang
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, China
| | - Xiaoshuo Hao
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi Province, China
| | - Yang Liu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, China
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10
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Jiang H, Imran M, Muralidharan P, Patel A, Pensa J, Liang M, Benidir T, Grajo JR, Joseph JP, Terry R, DiBianco JM, Su LM, Zhou Y, Brisbane WG, Shao W. MicroSegNet: A deep learning approach for prostate segmentation on micro-ultrasound images. Comput Med Imaging Graph 2024; 112:102326. [PMID: 38211358 DOI: 10.1016/j.compmedimag.2024.102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Abstract
Micro-ultrasound (micro-US) is a novel 29-MHz ultrasound technique that provides 3-4 times higher resolution than traditional ultrasound, potentially enabling low-cost, accurate diagnosis of prostate cancer. Accurate prostate segmentation is crucial for prostate volume measurement, cancer diagnosis, prostate biopsy, and treatment planning. However, prostate segmentation on micro-US is challenging due to artifacts and indistinct borders between the prostate, bladder, and urethra in the midline. This paper presents MicroSegNet, a multi-scale annotation-guided transformer UNet model designed specifically to tackle these challenges. During the training process, MicroSegNet focuses more on regions that are hard to segment (hard regions), characterized by discrepancies between expert and non-expert annotations. We achieve this by proposing an annotation-guided binary cross entropy (AG-BCE) loss that assigns a larger weight to prediction errors in hard regions and a lower weight to prediction errors in easy regions. The AG-BCE loss was seamlessly integrated into the training process through the utilization of multi-scale deep supervision, enabling MicroSegNet to capture global contextual dependencies and local information at various scales. We trained our model using micro-US images from 55 patients, followed by evaluation on 20 patients. Our MicroSegNet model achieved a Dice coefficient of 0.939 and a Hausdorff distance of 2.02 mm, outperforming several state-of-the-art segmentation methods, as well as three human annotators with different experience levels. Our code is publicly available at https://github.com/mirthAI/MicroSegNet and our dataset is publicly available at https://zenodo.org/records/10475293.
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Affiliation(s)
- Hongxu Jiang
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, 32608, United States
| | - Muhammad Imran
- Department of Medicine, University of Florida, Gainesville, FL, 32608, United States
| | - Preethika Muralidharan
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, 32608, United States
| | - Anjali Patel
- College of Medicine , University of Florida, Gainesville, FL, 32608, United States
| | - Jake Pensa
- Department of Bioengineering, University of California, Los Angeles, CA, 90095, United States
| | - Muxuan Liang
- Department of Biostatistics, University of Florida, Gainesville, FL, 32608, United States
| | - Tarik Benidir
- Department of Urology, University of Florida, Gainesville, FL, 32608, United States
| | - Joseph R Grajo
- Department of Radiology, University of Florida, Gainesville, FL, 32608, United States
| | - Jason P Joseph
- Department of Urology, University of Florida, Gainesville, FL, 32608, United States
| | - Russell Terry
- Department of Urology, University of Florida, Gainesville, FL, 32608, United States
| | | | - Li-Ming Su
- Department of Urology, University of Florida, Gainesville, FL, 32608, United States
| | - Yuyin Zhou
- Department of Computer Science and Engineering, University of California, Santa Cruz, CA, 95064, United States
| | - Wayne G Brisbane
- Department of Urology, University of California, Los Angeles, CA, 90095, United States
| | - Wei Shao
- Department of Medicine, University of Florida, Gainesville, FL, 32608, United States.
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11
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Yilmaz EC, Lin Y, Belue MJ, Harmon SA, Phelps TE, Merriman KM, Hazen LA, Garcia C, Johnson L, Lay NS, Toubaji A, Merino MJ, Patel KR, Parnes HL, Law YM, Wood BJ, Gurram S, Choyke PL, Pinto PA, Turkbey B. PI-RADS Version 2.0 Versus Version 2.1: Comparison of Prostate Cancer Gleason Grade Upgrade and Downgrade Rates From MRI-Targeted Biopsy to Radical Prostatectomy. AJR Am J Roentgenol 2024; 222:e2329964. [PMID: 37729551 DOI: 10.2214/ajr.23.29964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND. Precise risk stratification through MRI/ultrasound (US) fusion-guided targeted biopsy (TBx) can guide optimal prostate cancer (PCa) management. OBJECTIVE. The purpose of this study was to compare PI-RADS version 2.0 (v2.0) and PI-RADS version 2.1 (v2.1) in terms of the rates of International Society of Urological Pathology (ISUP) grade group (GG) upgrade and downgrade from TBx to radical prostatectomy (RP). METHODS. This study entailed a retrospective post hoc analysis of patients who underwent 3-T prostate MRI at a single institution from May 2015 to March 2023 as part of three prospective clinical trials. Trial participants who underwent MRI followed by MRI/US fusion-guided TBx and RP within a 1-year interval were identified. A single genitourinary radiologist performed clinical interpretations of the MRI examinations using PI-RADS v2.0 from May 2015 to March 2019 and PI-RADS v2.1 from April 2019 to March 2023. Upgrade and downgrade rates from TBx to RP were compared using chi-square tests. Clinically significant cancer was defined as ISUP GG2 or greater. RESULTS. The final analysis included 308 patients (median age, 65 years; median PSA density, 0.16 ng/mL2). The v2.0 group (n = 177) and v2.1 group (n = 131) showed no significant difference in terms of upgrade rate (29% vs 22%, respectively; p = .15), downgrade rate (19% vs 21%, p = .76), clinically significant upgrade rate (14% vs 10%, p = .27), or clinically significant downgrade rate (1% vs 1%, p > .99). The upgrade rate and downgrade rate were also not significantly different between the v2.0 and v2.1 groups when stratifying by index lesion PI-RADS category or index lesion zone, as well as when assessed only in patients without a prior PCa diagnosis (all p > .01). Among patients with GG2 or GG3 at RP (n = 121 for v2.0; n = 103 for v2.1), the concordance rate between TBx and RP was not significantly different between the v2.0 and v2.1 groups (53% vs 57%, p = .51). CONCLUSION. Upgrade and downgrade rates from TBx to RP were not significantly different between patients whose MRI examinations were clinically interpreted using v2.0 or v2.1. CLINICAL IMPACT. Implementation of the most recent PI-RADS update did not improve the incongruence in PCa grade assessment between TBx and surgery.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Lindsey A Hazen
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Charisse Garcia
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Latrice Johnson
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institute, NIH, Bethesda, MD
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD
- Department of Radiology, Clinical Center, NIH, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, 10 Center Dr, MSC 1182, Bldg 10, Rm B3B85, Bethesda, MD 20892
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12
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Avolio PP, Lughezzani G, Anidjar M, Hassan T, Rompré-Brodeur A, Buffi NM, Lazzeri M, Sanchez-Salas R. The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review. World J Urol 2023; 41:3267-3276. [PMID: 37555985 DOI: 10.1007/s00345-023-04521-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx. METHODS A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound. RESULTS MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program. CONCLUSION MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.
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Affiliation(s)
- Pier Paolo Avolio
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Toufic Hassan
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Alexis Rompré-Brodeur
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Nicolò Maria Buffi
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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13
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Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, Manuel GGD, Aisian I, Servian P, Abascal JM. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers (Basel) 2023; 15:4543. [PMID: 37760511 PMCID: PMC10526349 DOI: 10.3390/cancers15184543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/16/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721-0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, 08907 Hospitalet de Llobregat, Spain;
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain;
| | | | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | | | - Ignacio Aisian
- Department of Urology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain;
- Department of Medicine and Health Science, Universitat Pompeu Fabra, 08003 Barcelona, Spain
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14
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Avolio PP, Fasulo V, Sanchez-Salas R, Maffei D, Frego N, Lazzeri M, Paciotti M, Saita A, Hurle R, Guazzoni G, Casale P, Buffi NM, Lughezzani G. Diagnostic accuracy of multiparametric MRI- and microultrasound-targeted biopsy in biopsy-naïve patients with a PI-RADS 5 lesion: a single-institutional study. World J Urol 2023; 41:2335-2342. [PMID: 37418017 DOI: 10.1007/s00345-023-04480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI)- and microultrasound (microUS)-guided targeted biopsy (TBx) in detecting prostate cancer (PCa) and clinically significant (cs) PCa among men with Prostate Imaging Reporting and Data System (PI-RADS 5) lesions and to compare this combined TBx (CTBx) strategy with CTBx plus systemic biopsy (SBx). METHODS One hundred and thirty-six biopsy-naïve patients with PI-RADS 5 lesion at multiparametric MRI undergoing CTBx plus SBx were retrospectively evaluated. Analysis of diagnostic performance of microUS-TBx, MRI-TBx, CTBx, SBx and combined CTBx plus SBx was performed. Cost (downgrade, upgrade and biopsy core) to effectiveness (detection rate) was compared. RESULTS CTBx achieved a comparable detection rate to CTBx plus SBx in diagnosis of PCa and csPCa (PCa: 78.7% [107/136] vs 79.4% [108/136]; csPCa: 67.6% [92/136] vs 67.6% [92/136]; p > 0.05) and outperformed SBx (PCa: 58.8% [80/136]; csPCa: 47.8% [65/136]; p < 0.001). Using CTB would have avoided 41.1% (56/136) unnecessary SBx, without missing any csPCa. The rate of any upgrading or csPCa upgrading was significantly higher by SBx than by CTBx [33/65 (50.8%) vs 17/65 (26.1%) and 20/65 (30.8%) vs 4/65 (6.15%), respectively, p < 0.05]. Considering csPCa detection rate, microUS showed high sensitivity and positive predictive value (94.6%, 87.9%, respectively), with lower specificity and negative predictive value (25.0% and 44.4%, respectively). At multivariable logistic regression models, positive microUS was identified as an independent predictor of csPCa (p = 0.024). CONCLUSIONS A combined microUS/MRI-TBx approach could be the ideal imaging tool for characterizing primary disease in PI-RADS five patients, allowing SBx to be avoided.
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Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- , Via Rita Levi Montalcini, 4, 20090, Rozzano, MI, Italy.
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15
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Noujeim JP, Belahsen Y, Lefebvre Y, Lemort M, Deforche M, Sirtaine N, Martin R, Roumeguère T, Peltier A, Diamand R. Optimizing multiparametric magnetic resonance imaging-targeted biopsy and detection of clinically significant prostate cancer: the role of perilesional sampling. Prostate Cancer Prostatic Dis 2023; 26:575-580. [PMID: 36509930 DOI: 10.1038/s41391-022-00620-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The added-value of systematic biopsy (SB) in patients undergoing magnetic resonance imaging (MRI)-targeted biopsy (TB) remains unclear and the spatial distribution of positive cores relative to the MRI lesion has been poorly studied. The aim of this study was to determine the utility of perilesional biopsy in detecting clinically significant prostate cancer (csPCa). METHODS We enrolled 505 consecutive patients that underwent SB and TB for suspicious MRI lesions (PI-RADS score 3-5) at Jules Bordet Institute between June 2016 and January 2022. Patient-specific tridimensional prostate maps were reviewed to determine the distance between systematic cores containing csPCa and the MRI index lesion. Primary outcomes were the cancer detection rate (CDR) per patient and the cumulative cancer distribution rate of positive cores for each 5 mm interval from the MRI index lesion. The secondary outcome was the identification of risk groups for the presence of csPCa beyond a 10 mm margin using the chi-square automated interaction detector (CHAID) machine learning algorithm. RESULTS Overall, the CDR for csPCa of TB, SB, and combined method were 32%, 25%, and 37%, respectively. While combined method detected more csPCa compared to TB (37% vs. 32%, p < 0.001), no difference was found when TB was associated with perilesional sampling within 10 mm (37% vs. 35%, p = 0.2). The cumulative cancer distribution rate for csPCa reached 86% for the 10 mm margin. The CHAID algorithm identified three risk groups: (1) PI-RADS3 ("low-risk"), (2) PI-RADS4 or PI-RADS5 and PSA density <0.15 ng/ml ("intermediate-risk"), and (3) PI-RADS 5 and PSA density ≥0.15 ng/ml ("high-risk"). The risk of missing csPCa was 2%, 8%, and 29% for low-, intermediate- and high-risk groups, respectively. Avoiding biopsies beyond a 10 mm margin prevented the detection of 19% of non-csPCa. CONCLUSIONS Perilesional biopsy template using a 10 mm margin seems a reasonable alternative to the combined method with a comparable detection of csPCa. Our risk stratification may further enhance the selection of patients.
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Affiliation(s)
- Jean-Paul Noujeim
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yassir Belahsen
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolene Lefebvre
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Lemort
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Maxime Deforche
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Sirtaine
- Department of Pathology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Robin Martin
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
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Yilmaz EC, Belue MJ, Turkbey B, Reinhold C, Choyke PL. A Brief Review of Artificial Intelligence in Genitourinary Oncological Imaging. Can Assoc Radiol J 2023; 74:534-547. [PMID: 36515576 DOI: 10.1177/08465371221135782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Genitourinary (GU) system is among the most commonly involved malignancy sites in the human body. Imaging plays a crucial role not only in diagnosis of cancer but also in disease management and its prognosis. However, interpretation of conventional imaging methods such as CT or MR imaging (MRI) usually demonstrates variability across different readers and institutions. Artificial intelligence (AI) has emerged as a promising technology that could improve the patient care by providing helpful input to human readers through lesion detection algorithms and lesion classification systems. Moreover, the robustness of these models may be valuable in automating time-consuming tasks such as organ and lesion segmentations. Herein, we review the current state of imaging and existing challenges in GU malignancies, particularly for cancers of prostate, kidney and bladder; and briefly summarize the recent AI-based solutions to these challenges.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Caroline Reinhold
- McGill University Health Center, McGill University, Montreal, Canada
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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Agrotis G, Tsougos I, Oikonomou A, Vassiou K, Karatzas A, Tamposis I, Fanariotis M, Vamvakas A, Tzortzis V, Vlychou M. Combination of fusion guided multiparametric MRI-transrectal US with systematic biopsy of the prostate for the detection of clinically significant prostate cancer: A prospective single-center study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 37267147 DOI: 10.1002/jcu.23497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE To investigate the diagnostic efficacy of fusion guided multiparametric MRI (mpMRI)-transrectal ultrasound (TRUS) biopsy versus systematic biopsy of the prostate in patients with suspicion of prostate cancer. METHODS A total of 185 patients with PI-RADS 3 lesions or higher underwent fusion guided targeted and systematic prostate biopsy. Histology of samples was correlated with PI-RADS score and biopsy method for each patient. RESULTS A total of 81/185 (43.8%) cases positive for cancer were detected; 23/81 (28.4%) cases with clinically insignificant prostate cancer-insPCa and 58/81 (71.6%) cases with clinically significant prostate cancer-csPCa. There was a statistically significant difference in the overall detection of adenocarcinomas between methods (p = .035, McNemar test). Moreover, there was a statistically significant difference in the detection of insPCa between the two methods (p = .004, McNemar test). Systematic biopsy detected 13 patients with insPCa more (14.4%) than the targeted biopsy method. However, there is no statistical difference in the detection rate of csPCa between the two methods (p = 1, McNemar test). When both techniques were combined more cases of csPCa were detected. CONCLUSION The combined implementation of fusion-guided targeted mpMRI-TRUS and systematic biopsy of the prostate provides higher detection number of csPCa, compared to each method alone. The potential of fusion-guided mpMRI-TRUS biopsy of the prostate needs to be further assessed since each method has its limitations; therefore, systematic prostate biopsy still plays an important role in clinical practice.
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Affiliation(s)
- Georgios Agrotis
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | - Ioannis Tsougos
- Department of Medical Physics, University Hospital of Larissa, Larissa, Greece
| | | | - Katerina Vassiou
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | | | - Ioannis Tamposis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | | | - Alexandros Vamvakas
- Department of Medical Physics, University Hospital of Larissa, Larissa, Greece
| | - Vasilis Tzortzis
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marianna Vlychou
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
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18
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Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
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19
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Yilmaz EC, Shih JH, Belue MJ, Harmon SA, Phelps TE, Garcia C, Hazen LA, Toubaji A, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Prospective Evaluation of PI-RADS Version 2.1 for Prostate Cancer Detection and Investigation of Multiparametric MRI-derived Markers. Radiology 2023; 307:e221309. [PMID: 37129493 PMCID: PMC10323290 DOI: 10.1148/radiol.221309] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/21/2023] [Accepted: 02/10/2023] [Indexed: 05/03/2023]
Abstract
Background Data regarding the prospective performance of Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 alone and in combination with quantitative MRI features for prostate cancer detection is limited. Purpose To assess lesion-based clinically significant prostate cancer (csPCa) rates in different PI-RADS version 2.1 categories and to identify MRI features that could improve csPCa detection. Materials and Methods This single-center prospective study included men with suspected or known prostate cancer who underwent multiparametric MRI and MRI/US-guided biopsy from April 2019 to December 2021. MRI scans were prospectively evaluated using PI-RADS version 2.1. Atypical transition zone (TZ) nodules were upgraded to category 3 if marked diffusion restriction was present. Lesions with an International Society of Urological Pathology (ISUP) grade of 2 or higher (range, 1-5) were considered csPCa. MRI features, including three-dimensional diameter, relative lesion volume (lesion volume divided by prostate volume), sphericity, and surface to volume ratio (SVR), were obtained from lesion contours delineated by the radiologist. Univariable and multivariable analyses were conducted at the lesion and participant levels to determine features associated with csPCa. Results In total, 454 men (median age, 67 years [IQR, 62-73 years]) with 838 lesions were included. The csPCa rates for lesions categorized as PI-RADS 1 (n = 3), 2 (n = 170), 3 (n = 197), 4 (n = 319), and 5 (n = 149) were 0%, 9%, 14%, 37%, and 77%, respectively. csPCa rates of PI-RADS 4 lesions were lower than PI-RADS 5 lesions (P < .001) but higher than PI-RADS 3 lesions (P < .001). Upgraded PI-RADS 3 TZ lesions were less likely to harbor csPCa compared with their nonupgraded counterparts (4% [one of 26] vs 20% [20 of 99], P = .02). Predictors of csPCa included relative lesion volume (odds ratio [OR], 1.6; P < .001), SVR (OR, 6.2; P = .02), and extraprostatic extension (EPE) scores of 2 (OR, 9.3; P < .001) and 3 (OR, 4.1; P = .02). Conclusion The rates of csPCa differed between consecutive PI-RADS categories of 3 and higher. MRI features, including lesion volume, shape, and EPE scores of 2 and 3, predicted csPCa. Upgrading of PI-RADS category 3 TZ lesions may result in unnecessary biopsies. ClinicalTrials.gov registration no. NCT03354416 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Goh in this issue.
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Affiliation(s)
- Enis C. Yilmaz
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Joanna H. Shih
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Mason J. Belue
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Stephanie A. Harmon
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Tim E. Phelps
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Charisse Garcia
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Lindsey A. Hazen
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Antoun Toubaji
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Maria J. Merino
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Sandeep Gurram
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Peter L. Choyke
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Bradford J. Wood
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Peter A. Pinto
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
| | - Baris Turkbey
- From the Molecular Imaging Branch (E.C.Y., M.J.B., S.A.H., T.E.P.,
P.L.C., B.T.), Biometric Research Program, Division of Cancer Treatment and
Diagnosis (J.H.S.), Center for Interventional Oncology (C.G., L.A.H., B.J.W.),
Department of Radiology, Clinical Center (C.G., L.A.H., B.J.W.), Laboratory of
Pathology (A.T., M.J.M.), and Urologic Oncology Branch (S.G., P.A.P.), National
Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182,
Building 10, Room B3B85, Bethesda, MD 20892
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20
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Connor MJ, Gorin MA, Eldred-Evans D, Bass EJ, Desai A, Dudderidge T, Winkler M, Ahmed HU. Landmarks in the evolution of prostate biopsy. Nat Rev Urol 2023; 20:241-258. [PMID: 36653670 DOI: 10.1038/s41585-022-00684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/19/2023]
Abstract
Approaches and techniques used for diagnostic prostate biopsy have undergone considerable evolution over the past few decades: from the original finger-guided techniques to the latest MRI-directed strategies, from aspiration cytology to tissue core sampling, and from transrectal to transperineal approaches. In particular, increased adoption of transperineal biopsy approaches have led to reduced infectious complications and improved antibiotic stewardship. Furthermore, as image fusion has become integral, these novel techniques could be incorporated into prostate biopsy methods in the future, enabling 3D-ultrasonography fusion reconstruction, molecular targeting based on PET imaging and autonomous robotic-assisted biopsy.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Ankit Desai
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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Krausewitz P, Fostitsch D, Weiten R, Kluemper N, Stein J, Luetkens J, Kristiansen G, Ellinger J, Ritter M. Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study. World J Urol 2023; 41:19-25. [PMID: 36477403 PMCID: PMC9849165 DOI: 10.1007/s00345-022-04230-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution. METHODS Two hundred and fifty-nine men with PI-RADS 3-5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2. RESULTS CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4-5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors. CONCLUSION SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Dorothea Fostitsch
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Richard Weiten
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Niklas Kluemper
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Johannes Stein
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Julian Luetkens
- Department of Diagnostic and Interventional Radiology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Jörg Ellinger
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany
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22
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Assessing the Role of High-resolution Microultrasound Among Naïve Patients with Negative Multiparametric Magnetic Resonance Imaging and a Persistently High Suspicion of Prostate Cancer. EUR UROL SUPPL 2022; 47:73-79. [PMID: 36601049 PMCID: PMC9806704 DOI: 10.1016/j.euros.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) is an invaluable diagnostic tool in the decision-making for prostate biopsies (PBx). However, a non-negligible proportion of patients with negative MRI (nMRI) may still harbour prostate cancer (PCa). Objective To assess whether microultrasound (micro-US) can help in substratifying the presence of PCa and clinically significant PCa (csPCa; ie, any Gleason score ≥7 PCa) in patients with nMRI despite a persistently high clinical suspicion of PCa. Design setting and participants A total of 125 biopsy-naïve patients who underwent micro-US-guided PBx with the ExactVu system for a persistently high suspicion of PCa despite nMRI were prospectively enrolled. Intervention The Prostate Risk Identification using micro-US (PRI-MUS) protocol was used to identify suspicious areas; PBx included targeted sampling of PRI-MUS ≥3 areas and systematic sampling. Outcome measurements and statistical analysis The primary endpoint was the assessment of micro-US diagnostic accuracy in detecting csPCa. Secondary endpoints included determining the proportion of patients with nMRI who may avoid PBx after micro-US or transrectal US, presence of cribriform and intraductal patterns on biopsy core examination, predictors of csPCa in patients presenting with nMRI, and comparing micro-US-targeted and systematic PBx in identifying csPCa. Results and limitations Considering csPCa detection rate, micro-US showed optimal sensitivity and negative predictive value (respectively, 97.1% and 96.4%), while specificity and positive predictive value were 29.7% and 34.0%, respectively. Twenty-eight (22.4%) patients with a negative micro-US examination could have avoided PBx with one (2.9%) missed csPCa. Cribriform and intraductal patterns were found in 14 (41.2%) and four (11.8%) of csPCa patients, respectively. In multivariable logistic regression models, positive micro-US, age, digital rectal examination, and prostate-specific antigen density ≥0.15 emerged as independent predictors of PCa. Targeted and systematic sampling identified 33 (97.1%) and 26 (76.5%) csPCa cases, respectively. The main limitation of the current study is represented by its retrospective single-centre nature on an operator-dependent technology. Conclusions Micro-US represents a valuable tool to rule out the presence of csPCa among patients with a persistent clinical suspicion despite nMRI. Patient summary According to our results, microultrasound (micro-US) may represent an effective tool for the diagnosis of clinically significant prostate cancer in patients with negative magnetic resonance imaging (nMRI), providing high sensitivity and negative predictive value. Further randomised studies are needed to confirm the potential role of micro-US in the diagnostic pathway of patients with a persistent suspicion of prostate cancer despite nMRI.
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Vesal S, Gayo I, Bhattacharya I, Natarajan S, Marks LS, Barratt DC, Fan RE, Hu Y, Sonn GA, Rusu M. Domain generalization for prostate segmentation in transrectal ultrasound images: A multi-center study. Med Image Anal 2022; 82:102620. [PMID: 36148705 PMCID: PMC10161676 DOI: 10.1016/j.media.2022.102620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
Prostate biopsy and image-guided treatment procedures are often performed under the guidance of ultrasound fused with magnetic resonance images (MRI). Accurate image fusion relies on accurate segmentation of the prostate on ultrasound images. Yet, the reduced signal-to-noise ratio and artifacts (e.g., speckle and shadowing) in ultrasound images limit the performance of automated prostate segmentation techniques and generalizing these methods to new image domains is inherently difficult. In this study, we address these challenges by introducing a novel 2.5D deep neural network for prostate segmentation on ultrasound images. Our approach addresses the limitations of transfer learning and finetuning methods (i.e., drop in performance on the original training data when the model weights are updated) by combining a supervised domain adaptation technique and a knowledge distillation loss. The knowledge distillation loss allows the preservation of previously learned knowledge and reduces the performance drop after model finetuning on new datasets. Furthermore, our approach relies on an attention module that considers model feature positioning information to improve the segmentation accuracy. We trained our model on 764 subjects from one institution and finetuned our model using only ten subjects from subsequent institutions. We analyzed the performance of our method on three large datasets encompassing 2067 subjects from three different institutions. Our method achieved an average Dice Similarity Coefficient (Dice) of 94.0±0.03 and Hausdorff Distance (HD95) of 2.28 mm in an independent set of subjects from the first institution. Moreover, our model generalized well in the studies from the other two institutions (Dice: 91.0±0.03; HD95: 3.7 mm and Dice: 82.0±0.03; HD95: 7.1 mm). We introduced an approach that successfully segmented the prostate on ultrasound images in a multi-center study, suggesting its clinical potential to facilitate the accurate fusion of ultrasound and MRI images to drive biopsy and image-guided treatments.
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Affiliation(s)
- Sulaiman Vesal
- Department of Urology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Iani Gayo
- Centre for Medical Image Computing, Wellcome/EPSRC Centre for Interventional & Surgical Sciences, and Department of Medical Physics & Biomedical Engineering, University College London, 66-72 Gower St, London WC1E 6EA, UK
| | - Indrani Bhattacharya
- Department of Urology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA; Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Shyam Natarajan
- Department of Urology, University of California Los Angeles, 200 Medical Plaza Driveway, Los Angeles, CA 90024, USA
| | - Leonard S Marks
- Department of Urology, University of California Los Angeles, 200 Medical Plaza Driveway, Los Angeles, CA 90024, USA
| | - Dean C Barratt
- Centre for Medical Image Computing, Wellcome/EPSRC Centre for Interventional & Surgical Sciences, and Department of Medical Physics & Biomedical Engineering, University College London, 66-72 Gower St, London WC1E 6EA, UK
| | - Richard E Fan
- Department of Urology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Yipeng Hu
- Centre for Medical Image Computing, Wellcome/EPSRC Centre for Interventional & Surgical Sciences, and Department of Medical Physics & Biomedical Engineering, University College London, 66-72 Gower St, London WC1E 6EA, UK
| | - Geoffrey A Sonn
- Department of Urology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Mirabela Rusu
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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24
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Deniffel D, Perlis N, Ghai S, Girgis S, Healy GM, Fleshner N, Hamilton R, Kulkarni G, Toi A, van der Kwast T, Zlotta A, Finelli A, Haider MA. Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy. Eur Radiol 2022; 32:7544-7554. [PMID: 35507051 DOI: 10.1007/s00330-022-08822-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 04/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to develop and compare strategies that help optimize current prostate biopsy practice by identifying patients who may forgo concurrent systematic biopsy (SBx) in favor of MRI-targeted (TBx) alone. METHODS Retrospective study on 745 patients who underwent combined MRI-TBx plus SBx. Primary outcome was the upgrade to clinically significant prostate cancer (csPCa; grade group ≥ 2) on SBx versus MRI-TBx. Variables (age, previous biopsy status, Prostate Imaging Reporting and Data System (PI-RADS) score, index lesion size/location, number of lesions, PSA, PSA density, prostate volume) associated with the primary outcome were identified by logistic regression and used for biopsy strategies. Clinical utility was assessed by decision curve analysis (DCA). RESULTS SBx detected 47 (6%) additional men with csPCa. The risk of detecting csPCa uniquely on SBx was significantly lower in men with PI-RADS 5 (versus PI-RADS 3: OR 0.30, p = 0.03; versus PI-RADS 4: OR 0.33, p = 0.01), and previous negative biopsy (versus previous positive biopsy: OR 0.40, p = 0.007), and increased with age (per 10 years: OR 1.64, p = 0.016). No significant association was observed for other variables. DCA identified the following strategies as most useful: (a) avoid SBx in men with PI-RADS 5 and (b) additionally in those with previous negative biopsy, resulting in avoiding SBx in 201 (27%) and 429 (58%), while missing csPCa in 5 (1%) and 15 (2%) patients, respectively. CONCLUSION Not all men benefit equally from the combination of SBx and MRI-TBx. SBx avoidance in men with PI-RADS 5 and/or previous negative biopsy may reduce the risk of excess biopsies with a low risk of missing csPCa. KEY POINTS • In men undergoing MRI-targeted biopsy, the risk of detecting clinically significant prostate cancer (csPCa) only on additional systematic biopsy (SBx) decreased in men with PI-RADS 5, previous negative biopsy, and younger age. • Using these variables may help select men who could avoid the risk of excess SBx. • If missing csPCa in 5% was acceptable, forgoing SBx in men with PI-RADS 5 and/or previous negative biopsy enabled the highest net reduction in SBx.
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Affiliation(s)
- Dominik Deniffel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | | | - Gerard M Healy
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Girish Kulkarni
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ants Toi
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Alexandre Zlotta
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, M5G 1X5, Toronto, ON, Canada. .,Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada.
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25
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Padhani AR, Raman SS, Schoots IG. Towards a judicious use of perilesional biopsy in the era of MRI-targeting, parting of the ways from systematic prostate biopsy. Eur Radiol 2022; 32:7491-7493. [PMID: 36074267 DOI: 10.1007/s00330-022-09097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK.
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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26
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The Potential and Emerging Role of Quantitative Imaging Biomarkers for Cancer Characterization. Cancers (Basel) 2022; 14:cancers14143349. [PMID: 35884409 PMCID: PMC9321521 DOI: 10.3390/cancers14143349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Modern, personalized therapy approaches are increasingly changing advanced cancer into a chronic disease. Compared to imaging, novel omics methodologies in molecular biology have already achieved an individual characterization of cancerous lesions. With quantitative imaging biomarkers, analyzed by radiomics or deep learning, an imaging-based assessment of tumoral biology can be brought into clinical practice. Combining these with other non-invasive methods, e.g., liquid profiling, could allow for more individual decision making regarding therapies and applications. Abstract Similar to the transformation towards personalized oncology treatment, emerging techniques for evaluating oncologic imaging are fostering a transition from traditional response assessment towards more comprehensive cancer characterization via imaging. This development can be seen as key to the achievement of truly personalized and optimized cancer diagnosis and treatment. This review gives a methodological introduction for clinicians interested in the potential of quantitative imaging biomarkers, treating of radiomics models, texture visualization, convolutional neural networks and automated segmentation, in particular. Based on an introduction to these methods, clinical evidence for the corresponding imaging biomarkers—(i) dignity and etiology assessment; (ii) tumoral heterogeneity; (iii) aggressiveness and response; and (iv) targeting for biopsy and therapy—is summarized. Further requirements for the clinical implementation of these imaging biomarkers and the synergistic potential of personalized molecular cancer diagnostics and liquid profiling are discussed.
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Diamand R, Mjaess G, Ploussard G, Fiard G, Oderda M, Lefebvre Y, Sirtaine N, Roumeguère T, Peltier A, Albisinni S. Magnetic Resonance Imaging-Targeted Biopsy and Pretherapeutic Prostate Cancer Risk Assessment: a Systematic Review: Biopsie ciblée par Imagerie par résonance magnétique et évaluation pré-thérapeutique du risque de cancer de la prostate : revue systématique. Prog Urol 2022; 32:6S3-6S18. [PMID: 36719644 DOI: 10.1016/s1166-7087(22)00170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (MRI) has been included in prostate cancer (PCa) diagnostic pathway and may improve disease characterization. The aim of this systematic review is to assess the added value of MRI-targeted biopsy (TB) in pre-therapeutic risk assessment models over existing tools based on systematic biopsy (SB) for localized PCa. EVIDENCE ACQUISITION A systematic search was conducted using Pubmed (Medline), Scopus and ScienceDirect databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We included studies through October 2021 reporting on TB in pretherapeutic risk assessment models. EVIDENCE SYNTHESIS We identified 24 eligible studies including 24'237 patients for the systematic review. All included studies were retrospective and conducted in patients undergoing radical prostatectomy. Nine studies reported on the risk of extraprostatic extension, seven on the risk of lymph node invasion, three on the risk of biochemical recurrence and nine on the improvement of PCa risk stratification. Overall, the combination of TB with imaging, clinical and biochemical parameters outperformed current pretherapeutic risk assessment models. External validation studies are lacking for certain endpoints and the absence of standardization among TB protocols, including number of TB cores and fusion systems, may limit the generalizability of the results. CONCLUSION TB should be incorporated in pretherapeutic risk assessment models to improve clinical decision making. Further high-quality studies are required to determine models' generalizability while there is an urgent need to reach consensus on a standardized TB protocol. Long-term outcomes after treatment are also awaited to confirm the superiority of such models over classical risk classifications only based on SB. © 2022 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- R Diamand
- Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - G Mjaess
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - G Ploussard
- Department of Urology, La Croix du Sud Hospital, IUCT-O, Quint Fonsegrives, France
| | - G Fiard
- Department of Urology, Grenoble Alpes University Hospital, Grenoble INP, CNRS, University Grenoble Alpes, Grenoble, France
| | - M Oderda
- Department of Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Y Lefebvre
- Department of Radiology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - N Sirtaine
- Department of Pathology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - T Roumeguère
- Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - A Peltier
- Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - S Albisinni
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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28
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Hagens MJ, Fernandez Salamanca M, Padhani AR, van Leeuwen PJ, van der Poel HG, Schoots IG. Diagnostic Performance of a Magnetic Resonance Imaging-directed Targeted plus Regional Biopsy Approach in Prostate Cancer Diagnosis: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 40:95-103. [PMID: 35540708 PMCID: PMC9079161 DOI: 10.1016/j.euros.2022.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/26/2022] Open
Abstract
Context Systematic biopsies are additionally recommended to maximize the diagnostic performance of the magnetic resonance imaging (MRI) diagnostic pathway for men with suspected prostate cancer (PCa) and positive scans. To reduce unnecessary systematic biopsies (SBx), MRI-directed approaches comprising targeted plus regional biopsy (TBx + RBx) are being investigated. Objective To systematically evaluate the diagnostic performance of MRI-directed TBx + RBx approaches in comparison to MRI-directed TBx alone and TBx + SBx approaches. Evidence acquisition The MEDLINE and Embase databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process. Identified reports were critically appraised according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Detection of grade group (GG) ≥2 PCa was the endpoint of interest. Fixed-effect meta-analyses were conducted to characterize summary effect sizes and quantify heterogeneity. Only MRI-positive men were included. Evidence synthesis A total of eight studies were included for analysis. Among a cumulative total of 2603 men with suspected PCa, the GG ≥2 PCa detection rate did not significantly differ between MRI-directed TBx + RBx and TBx + SBx approaches (risk ratio [RR] 0.95, 95% confidence interval [CI] 0.90–1.01; p = 0.09). The TBx + RBx results were obtained using significantly fewer biopsy cores and avoiding contralateral SBx altogether. By contrast, there was significant difference in GG ≥2 PCa detection between MRI-directed TBx + RBx and TBx approaches (RR 1.18, 95% CI 1.10–1.25; p < 0.001). Conclusions MRI-directed TBx + RBx approaches showed a nonsignificant difference in detection of GG ≥2 PCa compared to the recommended practice of MRI-directed TBx + SBx. However, owing to the extensive heterogeneity among the studies included, future prospective clinical studies are needed to further investigate, optimize, and standardize this promising biopsy approach. Patient summary We reviewed the scientific literature on prostate biopsy approaches using magnetic resonance imaging (MRI)-directed targeted biopsy plus regional biopsy of the prostate. The studies we identified found arguments to potentially embrace such a combined biopsy approach for future diagnostics in prostate cancer.
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Affiliation(s)
- Marinus J. Hagens
- Department of Urology, Amsterdam University Medical Centers VUmc, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
- Corresponding author. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Tel. +31 205 128 272.
| | - Mar Fernandez Salamanca
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anwar R. Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Department of Urology, Amsterdam University Medical Centers VUmc, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
| | - Ivo G. Schoots
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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29
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Padhani AR, Schoots IG, Giannarini G. Re: Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling. Eur Urol 2022; 82:143-144. [PMID: 35367083 DOI: 10.1016/j.eururo.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK.
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
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30
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Koparal MY, Sözen TS, Karşıyakalı N, Aslan G, Akdoğan B, Şahin B, Türkeri L. Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association. Prostate 2022; 82:425-432. [PMID: 34927740 DOI: 10.1002/pros.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. PATIENTS AND METHODS This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. RESULTS The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). CONCLUSION Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.
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Affiliation(s)
| | - Tevfik Sinan Sözen
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - Nejdet Karşıyakalı
- Department of Urology, School of Medicine, Acıbadem University, İstanbul, Turkey
| | - Güven Aslan
- Department of Urology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bülent Akdoğan
- Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bahadır Şahin
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Levent Türkeri
- Department of Urology, School of Medicine, Acıbadem University, İstanbul, Turkey
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31
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Bernardino RMM, Leão R, Henrique R, Pinheiro LC, Kumar P, Suravajhala P, Beck HC, Carvalho AS, Matthiesen R. Extracellular Vesicle Proteome in Prostate Cancer: A Comparative Analysis of Mass Spectrometry Studies. Int J Mol Sci 2021; 22:ijms222413605. [PMID: 34948404 PMCID: PMC8707426 DOI: 10.3390/ijms222413605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
Molecular diagnostics based on discovery research holds the promise of improving screening methods for prostate cancer (PCa). Furthermore, the congregated information prompts the question whether the urinary extracellular vesicles (uEV) proteome has been thoroughly explored, especially at the proteome level. In fact, most extracellular vesicles (EV) based biomarker studies have mainly targeted plasma or serum. Therefore, in this study, we aim to inquire about possible strategies for urinary biomarker discovery particularly focused on the proteome of urine EVs. Proteomics data deposited in the PRIDE archive were reanalyzed to target identifications of potential PCa markers. Network analysis of the markers proposed by different prostate cancer studies revealed moderate overlap. The recent throughput improvements in mass spectrometry together with the network analysis performed in this study, suggest that a larger standardized cohort may provide potential biomarkers that are able to fully characterize the heterogeneity of PCa. According to our analysis PCa studies based on urinary EV proteome presents higher protein coverage compared to plasma, plasma EV, and voided urine proteome. This together with a direct interaction of the prostate gland and urethra makes uEVs an attractive option for protein biomarker studies. In addition, urinary proteome based PCa studies must also evaluate samples from bladder and renal cancers to assess specificity for PCa.
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Affiliation(s)
- Rui Miguel Marques Bernardino
- Computational and Experimental Biology Group, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal;
- Urology Department, Centro Hospitalar e Universitário de Lisboa Central, 1169-050 Lisbon, Portugal;
- Correspondence: (R.M.M.B.); (R.M.); Tel.: +351-939218696 (R.M.M.B. & R.M.)
| | - Ricardo Leão
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal;
| | - Rui Henrique
- Pathology Department, Instituto Português de Oncologia, 4200-072 Porto, Portugal;
| | - Luis Campos Pinheiro
- Urology Department, Centro Hospitalar e Universitário de Lisboa Central, 1169-050 Lisbon, Portugal;
| | - Prashant Kumar
- Institute of Bioinformatics, International Technology Park, Bangalore 560066, India;
- Somaiya Institute of Research and Consultancy (SIRAC), Somaiya Vidyavihar University (SVU), Vidyavihar, Mumbai 400077, India
| | - Prashanth Suravajhala
- Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri Campus, Clappana P.O., Kollam 690525, India;
| | - Hans Christian Beck
- Centre for Clinical Proteomics, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, 5000 Odense, Denmark;
| | - Ana Sofia Carvalho
- Computational and Experimental Biology Group, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal;
| | - Rune Matthiesen
- Computational and Experimental Biology Group, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal;
- Correspondence: (R.M.M.B.); (R.M.); Tel.: +351-939218696 (R.M.M.B. & R.M.)
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