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Kageyama K, Jogo A, Yamamoto A, Yamasaki T, Murai K, Uchida J. CT-guided transperineal biopsy for prostate cancer in the absence of rectal access. Radiol Case Rep 2024; 19:5900-5903. [PMID: 39319170 PMCID: PMC11421230 DOI: 10.1016/j.radcr.2024.09.015] [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] [Received: 06/14/2024] [Revised: 08/31/2024] [Accepted: 09/03/2024] [Indexed: 09/26/2024] Open
Abstract
This case report presents CT-guided transperineal biopsy as an alternative method for diagnosis of prostate cancer in a patient with anorectal stenosis. A 69-year-old male had a history of anorectal surgeries. Conventional transrectal biopsy was unfeasible due to anorectal stenosis. The CT-guided transperineal biopsy was successfully performed using a cranio-caudal puncture technique, revealing adenocarcinoma. After the biopsy, the patient received appropriate hormone therapy and radiation therapy. This case report highlights the feasibility and safety of CT-guided transperineal biopsy for the patients with anorectal complications.
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Affiliation(s)
- Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abenoku, Osaka 5458585, Japan
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abenoku, Osaka 5458585, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abenoku, Osaka 5458585, Japan
| | - Takeshi Yamasaki
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abenoku, Osaka 5458585, Japan
| | - Kazuki Murai
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abenoku, Osaka 5458585, Japan
| | - Junji Uchida
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abenoku, Osaka 5458585, Japan
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2
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Murad V, Perlis N, Ghai S. MR-guided Focused Ultrasound Focal Therapy for Prostate Cancer. Magn Reson Imaging Clin N Am 2024; 32:629-640. [PMID: 39322352 DOI: 10.1016/j.mric.2024.04.001] [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: 09/27/2024]
Abstract
Prostate cancer (PCa) is a prevalent malignancy in men, and the management of localized disease has evolved significantly in recent years. Focal therapy, wherein the biopsy confirmed site of tumor with margins is treated leaving the remaining gland intact, has emerged as a promising strategy for treating localized clinically significant PCa, minimizing side effects associated with radical therapies. We present the technical aspects, a summary of the most relevant evidence to date on the performance and safety of this technique, and the characteristic MR imaging findings during treatment, in the early posttreatment period and in the long term.
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Affiliation(s)
- Vanessa Murad
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's, College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's, College Hospital, University of Toronto, Toronto, Ontario, Canada.
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3
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Cimadamore A, Giannarini G, Crestani A, Lopez-Beltran A, Montironi R, Cheng L. How To Report the Minor Component of a High-grade Pattern in Radical Prostatectomy Specimens: Time To Abandon the "Tertiary" Terminology? Eur Urol 2024; 86:291-294. [PMID: 38548491 DOI: 10.1016/j.eururo.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 09/25/2024]
Abstract
The International Society of Urological Pathology and Genitourinary Pathology Society differ in their recommendations for reporting of minor components of high-grade pattern in prostatectomy specimens. This can affect the grade group assigned, particularly when there are only two Gleason patterns in a cancer nodule. We therefore argue that the term "tertiary" should be changed to "minor" component.
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Affiliation(s)
- Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, via Chiusaforte, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Alessandro Crestani
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Polytechnic University of the Marche Region, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Department of Surgery/Urology, Brown University Warren Alpert Medical School, Lifespan Academic Medical Center; Legorreta Cancer Center at Brown University, 222 Richmond St, Providence, RI, 02903, USA.
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4
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Rouvière O, van Leenders GJLH, Eberli D. Systematic Prostate Biopsy Versus Perilesional Sampling: If It Isn't Broke, Why Fix It? Eur Urol 2024; 86:295-296. [PMID: 39043548 DOI: 10.1016/j.eururo.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
The 2024 EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines for prostate cancer recommend a targeted and perilesional biopsy (TPLBx) strategy for primary diagnosis. In comparison to the classical approach of combined targeted and systematic biopsy, TPLBx may reduce overdiagnosis of insignificant cancers and mitigate the grade shift associated with targeted biopsy.
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Affiliation(s)
- Olivier Rouvière
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon-Est, Université Lyon 1, Lyon, France.
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Daniel Eberli
- Department of Urology, Universitätsspital Zurich, Zurich, Switzerland
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5
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Ploussard G, Barret E, Fiard G, Lenfant L, Malavaud B, Giannarini G, Almeras C, Aziza R, Renard-Penna R, Descotes JL, Rozet F, Beauval JB, Salin A, Rouprêt M. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsies for Prostate Cancer Diagnosis: Final Results of the Randomized PERFECT trial (CCAFU-PR1). Eur Urol Oncol 2024; 7:1080-1087. [PMID: 38403523 DOI: 10.1016/j.euo.2024.01.019] [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: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Recent guidelines favor transperineal (TP) prostate biopsies over the transrectal (TR) approach due to a reduced sepsis risk. Yet, evidence from controlled trial comparing both approaches within the MRI-targeted pathway for significant prostate cancer (PCa) detection is lacking. OBJECTIVE To compare the significant PCa detection rate between magnetic resonance imaging (MRI)-targeted TR and TP approaches in biopsy-naïve patients. DESIGN, SETTING, AND PARTICIPANTS In this noninferiority controlled trial, we randomized (ratio 1:1) 270 MRI-positive biopsy-naïve patients. INTERVENTION MRI-targeted TP versus TR biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES The primary outcome was the detection rate of significant PCa (International Society of Urological Pathology [ISUP] ≥2) in MRI-targeted biopsies. Secondary outcomes were any-grade PCa detection, detection on concomitant systematic biopsy, complications, and functional outcomes. RESULTS AND LIMITATIONS Targeted biopsies identified significant PCa in 47.2% of TP and 54.2% of TR participants (-7%, p = 0.6235). On a per-lesion analysis, posterior lesions yielded higher detection rates via TR (59.0% vs 44.3%, p = 0.0443), while anterior lesions were more frequently detected via TP (40.6% vs 26.5%, p = 0.2228). The overall (any grade) cancer detection rate in targeted biopsies was comparable between groups: 71.3% (TP) versus 64.1% (TR; p = 0.2209) with significantly more ISUP 1 cases detected in the TP arm. Adverse events of grade ≥2 were not different between TP (35.7%) and TR (40.5%, p = 0.4256). One TR patient (0.8%) experienced grade 3 sepsis. Quality of life, and urinary and sexual function, as well as pain scores, were comparable between groups. CONCLUSIONS Despite a comparable overall detection rate for any-grade PCa, noninferiority of TP over TR for MRI-targeted biopsies for significant PCa detection was not demonstrated. However, MRI lesion location influenced biopsy route performance, suggesting that a pragmatic approach based on lesion location might enhance significant PCa assessment. PATIENT SUMMARY This trial compared the efficacy and safety of two biopsy approaches for prostate cancer diagnosis. Both approaches seem complementary according to the lesion location.
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Affiliation(s)
| | - Eric Barret
- Institut Mutualiste Montsouris, Paris, France
| | - Gaëlle Fiard
- Grenoble Alpes University Hospital, University Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Louis Lenfant
- AP-HP - Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | | | | | - Christophe Almeras
- Clinique Capio La Croix du Sud Cabinet d'Urologie, Quint-Fonsegrives, France
| | - Richard Aziza
- Comprehensive Cancer Cancer IUCT-Oncopole, Toulouse, France
| | | | | | | | | | | | - Morgan Rouprêt
- AP-HP - Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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6
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Nguyen JK, Harik LR, Klein EA, Li J, Corrigan D, Liu S, Chan E, Hawley S, Auman H, Newcomb LF, Carroll PR, Cooperberg MR, Filson CP, Simko JP, Nelson PS, Tretiakova MS, Troyer D, True LD, Vakar-Lopez F, Weight CJ, Lin DW, Brooks JD, McKenney JK. Proposal for an optimised definition of adverse pathology (unfavourable histology) that predicts metastatic risk in prostatic adenocarcinoma independent of grade group and pathological stage. Histopathology 2024; 85:598-613. [PMID: 38828674 PMCID: PMC11365761 DOI: 10.1111/his.15231] [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: 09/22/2023] [Revised: 04/22/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
AIMS Histological grading of prostate cancer is a powerful prognostic tool, but current criteria for grade assignment are not fully optimised. Our goal was to develop and test a simplified histological grading model, based heavily on large cribriform/intraductal carcinoma, with optimised sensitivity for predicting metastatic potential. METHODS AND RESULTS Two separate non-overlapping cohorts were identified: a 419-patient post-radical prostatectomy cohort with long term clinical follow-up and a 209-patient post-radical prostatectomy cohort in which all patients had pathologically confirmed metastatic disease. All prostatectomies were re-reviewed for high-risk histological patterns of carcinoma termed 'unfavourable histology'. Unfavourable histology is defined by any classic Gleason pattern 5 component, any large cribriform morphology (> 0.25 mm) or intraductal carcinoma, complex intraluminal papillary architecture, grade 3 stromogenic carcinoma and complex anastomosing cord-like growth. For the outcome cohort, Kaplan-Meier analysis compared biochemical recurrence, metastasis and death between subjects with favourable and unfavourable histology, stratified by pathological stage and grade group. Multivariable Cox proportional hazards models evaluated adding unfavourable histology to the Memorial Sloan Kettering Cancer Center (MSKCC) post-prostatectomy nomogram and stratification by percentage of unfavourable histology. At 15 years unfavourable histology predicted biochemical recurrence, with sensitivity of 93% and specificity of 88%, metastatic disease at 100 and 48% and death at 100 and 46%. Grade group 2 prostate cancers with unfavourable histology were associated with metastasis independent of pathological stage, while those without had no risk. Histological models for prediction of metastasis based on only large cribriform/intraductal carcinoma or increasing diameter of cribriform size improved specificity, but with lower sensitivity. Multivariable Cox proportional hazards models demonstrated that unfavourable histology significantly improved discriminatory power of the MSKCC post-prostatectomy nomogram for biochemical failure (likelihood ratio test P < 0.001). In the retrospective review of a separate RP cohort in which all patients had confirmed metastatic disease, none had unequivocal favourable histology. CONCLUSIONS Unfavourable histology at radical prostatectomy is associated with metastatic risk, predicted adverse outcomes better than current grading and staging systems and improved the MSKCC post-prostatectomy nomogram. Most importantly, unfavourable histology stratified grade group 2 prostate cancers into those with and without metastatic potential, independent of stage. While unfavourable histology is driven predominantly by large cribriform/intraductal carcinoma, the recognition and inclusion of other specific architectural patterns add to the sensitivity for predicting metastatic disease. Moreover, a simplified dichotomous model improves communication and could increase implementation.
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Affiliation(s)
- Jane K. Nguyen
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Lara R. Harik
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Eric A. Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jianbo Li
- Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Dillon Corrigan
- Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Shiguang Liu
- Department of Pathology, University of Florida Health, Jacksonville, FL
| | - Emily Chan
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | - Sarah Hawley
- Canary Foundation, Palo Alto, CA
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Lisa F. Newcomb
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Peter R. Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA
| | | | | | - Jeff P. Simko
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | - Peter S. Nelson
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Maria S. Tretiakova
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA
| | - Dean Troyer
- Department of Pathology, Eastern Virginia Medical School, Norfolk, VA
| | - Lawrence D. True
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA
| | - Funda Vakar-Lopez
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA
| | | | - Daniel W Lin
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - James D. Brooks
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Jesse K. McKenney
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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7
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Varma M, Berney DM, Kristiansen G, van der Kwast TH. Intraductal carcinoma of the prostate: conflicting recommendations confuse clinicians. J Clin Pathol 2024:jcp-2024-209690. [PMID: 39299759 DOI: 10.1136/jcp-2024-209690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Murali Varma
- Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Daniel M Berney
- Centre of Cancer Biomarkers and Biotherapeutics, Queen Mary University of London, London, UK
| | - Glen Kristiansen
- Institute of Pathology, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
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8
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Agosti V, Munari E. Histopathological evaluation and grading for prostate cancer: current issues and crucial aspects. Asian J Androl 2024:00129336-990000000-00244. [PMID: 39254403 DOI: 10.4103/aja202440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/05/2024] [Indexed: 09/11/2024] Open
Abstract
A crucial aspect of prostate cancer grading, especially in low- and intermediate-risk cancer, is the accurate identification of Gleason pattern 4 glands, which includes ill-formed or fused glands. However, there is notable inconsistency among pathologists in recognizing these glands, especially when mixed with pattern 3 glands. This inconsistency has significant implications for patient management and treatment decisions. Conversely, the recognition of glomeruloid and cribriform architecture has shown higher reproducibility. Cribriform architecture, in particular, has been linked to the worst prognosis among pattern 4 subtypes. Intraductal carcinoma of the prostate (IDC-P) is also associated with high-grade cancer and poor prognosis. Accurate identification, classification, and tumor size evaluation by pathologists are vital for determining patient treatment. This review emphasizes the importance of prostate cancer grading, highlighting challenges like distinguishing between pattern 3 and pattern 4 and the prognostic implications of cribriform architecture and intraductal proliferations. It also addresses the inherent grading limitations due to interobserver variability and explores the potential of computational pathology to enhance pathologist accuracy and consistency.
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Affiliation(s)
- Vittorio Agosti
- Section of Pathology, Department of Molecular and Translational Medicine, University of Brescia, Brescia 25121, Italy
| | - Enrico Munari
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona 37126, Italy
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9
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Bogaard M, Strømme JM, Kidd SG, Johannessen B, Bakken AC, Lothe RA, Axcrona K, Skotheim RI, Axcrona U. GRIN3A: A biomarker associated with a cribriform pattern and poor prognosis in prostate cancer. Neoplasia 2024; 55:101023. [PMID: 38944914 PMCID: PMC11267071 DOI: 10.1016/j.neo.2024.101023] [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: 01/19/2024] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
Prostate cancer with a cribriform pattern, including invasive cribriform carcinoma (ICC) and/or intraductal carcinoma (IDC) is associated with a poor prognosis, and the underlying mechanisms are unclear. Therefore, we aimed to identify biomarkers for this feature. Using a radical prostatectomy cohort, we performed within-patient differential expression analyses with RNA sequencing data to compare samples with a cribriform pattern to those with non-cribriform Gleason pattern 4 (NcGP4; n=13). ACSM1, GRIN3A, PCDHB2, and REG4 were identified as differentially expressed, and validation was performed using real-time reverse transcription polymerase chain reaction (n=99; 321 RNA samples) and RNA in situ hybridization on tissue microarrays (n=479; 2047 tissue cores). GRIN3A was significantly higher expressed in cribriform pattern vs. NcGP4, when assessed within the same patient (n=27; p=0.005) and between different patients (n=83; p=0.001). Tissue cores with IDC more often expressed GRIN3A compared to ICC, NcGP4, and benign tissue (52 % vs. ≤ 32 %). When IDC and NcGP4 was compared within the same patient (173 pairs of tissue cores; 54 patients), 38 (22 %) of the tissue microarray core pairs had GRIN3A expression in only IDC, 33 (19 %) had expression in both IDC and NcGP4, 14 (8 %) in only NcGP4 and 88 (51 %) were negative in both entities (p=0.001). GRIN3A was as well associated with biochemical recurrence (log-rank, p=0.002). In conclusion, ectopic GRIN3A expression is an RNA-based biomarker for the presence of cribriform prostate cancer, particularly for IDC.
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Affiliation(s)
- Mari Bogaard
- Department of Pathology, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jonas M Strømme
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Susanne G Kidd
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjarne Johannessen
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway
| | - Anne C Bakken
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway
| | - Ragnhild A Lothe
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karol Axcrona
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Rolf I Skotheim
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Ulrika Axcrona
- Department of Pathology, Oslo University Hospital-Radiumhospitalet, Oslo, Norway; Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway.
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10
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Falkenbach F, Ahmad-Sterkau F, Kachanov M, Beyersdorff D, Koehler D, Ambrosini F, Ortner G, Maurer T, Graefen M, Budäus L. Bimodal imaging: Detection rate of clinically significant prostate cancer is higher in MRI lesions visible to transrectal ultrasound. Prostate 2024. [PMID: 39219063 DOI: 10.1002/pros.24785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/26/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND To explore the detection rates of clinically significant prostate cancer (csPCa; ISUP ≥2) in patients with a single MRI lesion that is visible or invisible on transrectal ultrasound (TRUS) during biopsy. METHODS Retrospective analyses of patients who underwent targeted and systematic biopsy of the prostate for one MRI-visible lesion (PI-RADS score ≥ 3) between 2017 and 2022. TRUS-visibility, PI-RADS score, and clinical parameters were recorded prospectively. Univariable and multivariable logistic regression models were used to identify predictors of csPCa. RESULTS 277 consecutive patients with one MRI-visible lesion were identified. A correlating lesion on TRUS was present in 147/277 (53%). The median age, PSA level, and prostate volume were 68.0 years (IQR: 62.0-73.0), 7.3 ng/ml (IQR: 5.4-10.8) and 45.0 cc (IQR: 32.0-68.0), respectively. Baseline parameters were not significantly different between the two groups. CsPCa was detected in 59/130 (45%) without and in 102/147 (69%) patients with a corresponding TRUS lesion. In multivariable logistic regression analysis predicting csPCa, TRUS-visibility (OR: 2.13, CI: 1.14-4.03, p = 0.02) and PI-RADS score (PI-RADS 4: OR: 7.28, CI: 3.33-17.19; PI-RADS 5: OR: 13.39, CI: 5.27-36.83, p < 0.001) achieved independent predictor status. CONCLUSIONS Bimodal-visible lesions more often harbored csPCa and were easier to target. TRUS-visibility of MRI lesions is an independent predictor of csPCa. Therefore, education in both modalities is essential. Despite MRI, the ultrasound should still be diligently examined.
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Affiliation(s)
- Fabian Falkenbach
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fatima Ahmad-Sterkau
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mykyta Kachanov
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Beyersdorff
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesca Ambrosini
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gernot Ortner
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Fernandez-Mateos J, Cresswell GD, Trahearn N, Webb K, Sakr C, Lampis A, Stuttle C, Corbishley CM, Stavrinides V, Zapata L, Spiteri I, Heide T, Gallagher L, James C, Ramazzotti D, Gao A, Kote-Jarai Z, Acar A, Truelove L, Proszek P, Murray J, Reid A, Wilkins A, Hubank M, Eeles R, Dearnaley D, Sottoriva A. Tumor evolution metrics predict recurrence beyond 10 years in locally advanced prostate cancer. NATURE CANCER 2024; 5:1334-1351. [PMID: 38997466 PMCID: PMC11424488 DOI: 10.1038/s43018-024-00787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/23/2024] [Indexed: 07/14/2024]
Abstract
Cancer evolution lays the groundwork for predictive oncology. Testing evolutionary metrics requires quantitative measurements in controlled clinical trials. We mapped genomic intratumor heterogeneity in locally advanced prostate cancer using 642 samples from 114 individuals enrolled in clinical trials with a 12-year median follow-up. We concomitantly assessed morphological heterogeneity using deep learning in 1,923 histological sections from 250 individuals. Genetic and morphological (Gleason) diversity were independent predictors of recurrence (hazard ratio (HR) = 3.12 and 95% confidence interval (95% CI) = 1.34-7.3; HR = 2.24 and 95% CI = 1.28-3.92). Combined, they identified a group with half the median time to recurrence. Spatial segregation of clones was also an independent marker of recurrence (HR = 2.3 and 95% CI = 1.11-4.8). We identified copy number changes associated with Gleason grade and found that chromosome 6p loss correlated with reduced immune infiltration. Matched profiling of relapse, decades after diagnosis, confirmed that genomic instability is a driving force in prostate cancer progression. This study shows that combining genomics with artificial intelligence-aided histopathology leads to the identification of clinical biomarkers of evolution.
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Affiliation(s)
- Javier Fernandez-Mateos
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - George D Cresswell
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Nicholas Trahearn
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Katharine Webb
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Chirine Sakr
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Andrea Lampis
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Christine Stuttle
- The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Catherine M Corbishley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- St. George's Hospital Healthcare NHS Trust, London, UK
| | | | - Luis Zapata
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Inmaculada Spiteri
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Timon Heide
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Computational Biology Research Centre, Human Technopole, Milan, Italy
| | - Lewis Gallagher
- Molecular Pathology Section, The Institute of Cancer Research, London, UK
- Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Chela James
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Computational Biology Research Centre, Human Technopole, Milan, Italy
| | | | - Annie Gao
- Bob Champion Cancer Unit, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - Ahmet Acar
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
| | - Lesley Truelove
- Bob Champion Cancer Unit, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Paula Proszek
- Molecular Pathology Section, The Institute of Cancer Research, London, UK
- Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Julia Murray
- The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Alison Reid
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Anna Wilkins
- The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Michael Hubank
- Molecular Pathology Section, The Institute of Cancer Research, London, UK
- Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Ros Eeles
- The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Andrea Sottoriva
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
- Computational Biology Research Centre, Human Technopole, Milan, Italy.
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12
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Ozkaya M, Simsekoglu MF, Kalender G, Sahin KC, Gurses I. Clinical and histopathological parameters in transrectal ultrasound-guided biopsies associated with tumor upgrading after radical prostatectomy: A comparative analysis of risk groups. Prostate 2024; 84:1146-1156. [PMID: 38798171 DOI: 10.1002/pros.24751] [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: 09/28/2023] [Revised: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Thanks to technological advances, prostate cancer (PCa) can be diagnosed at a younger age. It is known that most of these patients are in the low-intermediate risk group, and the histological grade of the tumor increases in half of those undergoing radical prostatectomy (Rp) compared to their diagnostic biopsies. This is especially important in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options in patients diagnosed at an early age. Our aim was to investigate clinical and histopathological parameters that may be associated with an increase in the histological grade of the tumor in patients with acinar adenocarcinoma who were diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and underwent Rp. METHODS A total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS-Bx without metastasis and who underwent Rp were grouped according to the D'Amico risk classification. Age at diagnosis, serum prostate-specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI-RADS) score, clinical stage, Gleason Grade Group (GGG), high-grade intraepithelial neoplasia in tumor-free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI on TRUS-Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately. RESULTS Of the patients, 72 (35.1%) were in the low-risk group, 95 (46.3%) in the intermediate-risk group, and 38 (18.5%) in the high-risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low-risk group (p < 0.05) and had an advanced median age. HGPIN in single and ≥2 tumor-free cores and PNI were more common in these patients (p < 0.01, p < 0.001, and p < 0.05, respectively). According to the multivariable analysis, advanced age (odds ratio [OR]: 1.087, 95% confidence interval [CI]: 1.029-1.148, p < 0.05), high serum PSA (OR: 1.047, 95% CI: 1.006-1.090, p < 0.05), HGPIN in ≥2 tumor-free cores (OR: 6.346, 95% CI: 3.136-12.912, p < 0.001), and PNI (OR: 3.138, 95% CI: 1.179-8.356, p < 0.05) were independent risk factors for a tumor upgrade. Furthermore, being in the low-risk group was an independent risk factor when compared to the intermediate- and high-risk groups (OR: 0.187, 95% CI: 0.080-0.437, p < 0.001 and OR: 0.054, 95% CI: 0.013-0.230, p < 0.001, respectively). The HGPIN diagnosis was more common in the low- and intermediate-risk groups. Advanced age at diagnosis, high serum PSA and PSA density values were associated with PNI on TRUS-Bx. High serum PSA and PSA density values were associated with LVI on TRUS-Bx. Surgical margin positivity was higher in cases with PNI and LVI detected by TRUS-Bx. HGPIN in ≥2 tumor-free cores, PNI, and LVI on TRUS-Bx were associated with a higher rate of lymph node metastases. CONCLUSIONS In patients diagnosed with acinar adenocarcinoma, the presence of HGPIN even in a single tumor-free core on TRUS-Bx was found to be significant in terms of showing an increase in the histological tumor grade in Rp. The diagnosis of HGPIN in ≥2 tumor-free cores on TRUS-Bx was determined as an independent risk factor for an increased Gleason score after Rp. Furthermore, an advanced age, a high serum PSA value, being in the low-risk group, and the presence of PNI were associated with a tumor upgrade. HGPIN in ≥2 tumor-free cores, PNI, and LVI were also associated with lymph node metastasis. Therefore, the diagnosis of HGPIN should be signed out on pathological reports.
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Affiliation(s)
- Mustafa Ozkaya
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Muhammed Fatih Simsekoglu
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Goktug Kalender
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kadir Can Sahin
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Iclal Gurses
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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13
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Zhu M, Sali R, Baba F, Khasawneh H, Ryndin M, Leveillee RJ, Hurwitz MD, Lui K, Dixon C, Zhang DY. Artificial intelligence in pathologic diagnosis, prognosis and prediction of prostate cancer. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:200-215. [PMID: 39308594 PMCID: PMC11411179 DOI: 10.62347/jsae9732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024]
Abstract
Histopathology, which is the gold-standard for prostate cancer diagnosis, faces significant challenges. With prostate cancer ranking among the most common cancers in the United States and worldwide, pathologists experience an increased number for prostate biopsies. At the same time, precise pathological assessment and classification are necessary for risk stratification and treatment decisions in prostate cancer care, adding to the challenge to pathologists. Recent advancement in digital pathology makes artificial intelligence and learning tools adopted in histopathology feasible. In this review, we introduce the concept of AI and its various techniques in the field of histopathology. We summarize the clinical applications of AI pathology for prostate cancer, including pathological diagnosis, grading, prognosis evaluation, and treatment options. We also discuss how AI applications can be integrated into the routine pathology workflow. With these rapid advancements, it is evident that AI applications in prostate cancer go beyond the initial goal of being tools for diagnosis and grading. Instead, pathologists can provide additional information to improve long-term patient outcomes by assessing detailed histopathologic features at pixel level using digital pathology and AI. Our review not only provides a comprehensive summary of the existing research but also offers insights for future advancements.
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Affiliation(s)
- Min Zhu
- Department of Computational Pathology, NovinoAI1443 NE 4th Ave, Fort Lauderdale, FL 33304, USA
| | - Rasoul Sali
- Department of Computational Pathology, NovinoAI1443 NE 4th Ave, Fort Lauderdale, FL 33304, USA
- Department of Radiation Oncology, Stanford University School of MedicineStanford, CA 94305, USA
| | - Firas Baba
- Department of Computational Pathology, NovinoAI1443 NE 4th Ave, Fort Lauderdale, FL 33304, USA
| | - Hamdi Khasawneh
- King Hussein School of Computing Sciences, Princess Sumaya University for TechnologyAmman 11855, Jordan
| | - Michelle Ryndin
- College of Agriculture and Life Sciences, Cornell University616 Thurston Ave, Ithaca, NY 14853, USA
| | - Raymond J Leveillee
- Department of Surgery, Florida Atlantic University, Division of Urology, Bethesda Hospital East, Baptist Health South Florida2800 S. Seacrest Drive, Boynton Beach, FL 33435, USA
| | - Mark D Hurwitz
- Department of Radiation Medicine, New York Medical College and Westchester Medical CenterValhalla, NY 10595, USA
| | - Kin Lui
- Department of Urology, Mount Sinai HospitalNew York, NY 10029, USA
| | - Christopher Dixon
- Department of Urology, Good Samaritan Hospital, Westchester Medical Center Health NetworkSuffern, NY 10901, USA
| | - David Y Zhang
- Department of Computational Pathology, NovinoAI1443 NE 4th Ave, Fort Lauderdale, FL 33304, USA
- Pathology and Laboratory Services, Department of Veterans Affairs New York Harbor Healthcare SystemNew York, NY 10010, USA
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14
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Cimadamore A, Cheng L, Lopez-Beltran A, Franzese C, Giannarini G, Crestani A, Rogers ET, Montironi R. Patients ask and pathologists answer: ten questions around prostate cancer grading. Virchows Arch 2024:10.1007/s00428-024-03891-9. [PMID: 39153109 DOI: 10.1007/s00428-024-03891-9] [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: 06/10/2024] [Revised: 07/27/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024]
Abstract
Pathologists have closely collaborated with clinicians, mainly urologists, to update the Gleason grading system to reflect the current practice and approach in prostate cancer diagnosis, prognosis, and treatment. This has led to the development of what is called patient advocacy and patient information. Ten common questions asked by patients to pathologists concerning PCa grading and the answers given by the latter are reported.
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Affiliation(s)
- Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, Udine, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University Warren Alpert Medical School, Lifespan Health, and the Legorreta Cancer Center at Brown University, Providence, RI, USA
| | | | - Carmine Franzese
- Urology Unit, University Hospital, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Gianluca Giannarini
- Urology Unit, University Hospital, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Alessandro Crestani
- Urology Unit, University Hospital, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Eamonn T Rogers
- Department of Urology, National University of Ireland Galway, Galway, Ireland
| | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, c/o Polytechnic University of the Marche Region, Via Tronto 10, 60126, Ancona, Italy.
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15
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Tekin E, Şeker NS, Özen A, Açıkalın MF, Can C, Çolak E. Prognostic significance of invasive cribriform gland size and percentage in Gleason score 7 prostate adenocarcinoma. Am J Clin Pathol 2024:aqae082. [PMID: 39121022 DOI: 10.1093/ajcp/aqae082] [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: 02/06/2024] [Accepted: 06/08/2024] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVES Cribriform glands are linked to poorer outcomes in prostate adenocarcinoma. We aimed to assess the prognostic role of the percentage of cribriform glands and the size of the largest invasive cribriform gland in Gleason score 7 prostate adenocarcinomas. METHODS The presence, percentage, and size of the invasive cribriform glands were investigated and their association with prognostic factors were assessed in 177 Grade Groups 2 and 3 prostate adenocarcinomas. RESULTS Biochemical recurrence-free survival was statistically significantly lower in cases with a cribriform gland percentage greater than 10% (P < .001) and in cases where the largest invasive cribriform gland size was greater than 0.5 mm (P < .001). Mean largest cribriform gland size and percentage were statistically significant associated with more advanced pT status, lymph node metastasis, biochemical recurrence, and higher preoperative prostate-specific antigen values. CONCLUSIONS Our findings suggest that the presence of a cribriform pattern, increases in the percentage of such patterns, and increases in the size of the largest cribriform gland within a given tumor are associated with poor prognosis. We suggest that a more aggressive clinical approach may be needed in Grade Group 2 and 3 cases with invasive cribriform glands larger than 0.5 mm and a cribriform gland percentage greater than 10%, especially in prostate needle biopsy specimens.
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Affiliation(s)
- Emel Tekin
- Department of Pathology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Nazlı Sena Şeker
- Department of Pathology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Ata Özen
- Department of Urology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Mustafa Fuat Açıkalın
- Department of Pathology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Cavit Can
- Department of Urology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Ertuğrul Çolak
- Department of Bioistatistics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
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16
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Logan JM, Martini C, Sorvina A, Johnson IRD, Brooks RD, Caruso MC, Huzzell C, Moore CR, Karageorgos L, Butler LM, Tewari P, Prabhakaran S, Hickey SM, Klebe S, Samaratunga H, Delahunt B, Moretti K, O'Leary JJ, Brooks DA, Ung BSY. Reinterpretation of prostate cancer pathology by Appl1, Sortilin and Syndecan-1 biomarkers. Sci Data 2024; 11:852. [PMID: 39117701 PMCID: PMC11310308 DOI: 10.1038/s41597-024-03696-0] [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: 01/31/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
The diagnosis of prostate cancer using histopathology is reliant on the accurate interpretation of prostate tissue sections. Current standards rely on the assessment of Haematoxylin and Eosin (H&E) staining, which can be difficult to interpret and introduce inter-observer variability. Here, we present a digital pathology atlas and online resource of prostate cancer tissue micrographs for both H&E and the reinterpretation of samples using a novel set of three biomarkers as an interactive tool, where clinicians and scientists can explore high resolution histopathology from various case studies. The digital pathology prostate cancer atlas when used in conjunction with the biomarkers, will assist pathologists to accurately grade prostate cancer tissue samples.
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Affiliation(s)
- Jessica M Logan
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia.
| | - Carmela Martini
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Alexandra Sorvina
- Centre for Cancer Biology, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Ian R D Johnson
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Robert D Brooks
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Maria C Caruso
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Chelsea Huzzell
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Courtney R Moore
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Litsa Karageorgos
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Lisa M Butler
- South Australian ImmunoGENomics Cancer Institute and Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, 5005, Australia
- Solid Tumour Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia
| | - Prerna Tewari
- Department of Histopathology, Trinity College Dublin, D02 PN40, Dublin, Ireland
| | - Sarita Prabhakaran
- Department of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Shane M Hickey
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Hemamali Samaratunga
- Aquesta Uropathology, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Brett Delahunt
- Malaghan Institute of Medical Research, Wellington, 6012, New Zealand
| | - Kim Moretti
- Discipline of Surgery, University of Adelaide, Adelaide, SA, 5371, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5005, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3800, Australia
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin, D02 PN40, Dublin, Ireland
| | - Douglas A Brooks
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
| | - Ben S-Y Ung
- Clinical and Health Sciences, University of South Australia, Bradley Building, City West Campus, North Terrace, Adelaide, SA, 5000, Australia
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia City East Campus, Frome Rd, Adelaide, SA, 5000, Australia
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17
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Demichel N, Coffinet J, Taha F, Tambwe R, Belkessa N, Zayani C, Durlach A, Larre S, Gomis P, Leon P. Factors improving the diagnostic performance of targeted biopsies in the diagnosis of significant prostate cancer. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102712. [PMID: 39117280 DOI: 10.1016/j.fjurol.2024.102712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/10/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION MRI-targeted biopsy improves detection of significant prostate cancer (csPCa) and grade prediction. The aim of this study was to identify factors improving the diagnostic performance of targeted biopsies (TB) in detecting csPCa. METHODS Retrospective monocenter study of patients who underwent a radical prostatectomy (RP) for prostate cancer (PCa) and diagnosed by transrectal combined biopsies (CB) with elastic MRI/ultrasound fusion. We evaluate the diagnostic performance of standardized (SB), targeted (TB) and CB for csPCa, including sensitivity, specificity, and ROC curve. Univariables and logistic regression analysis were performed to analyze factors improving the diagnostic performance of TB in detecting csPCa on final histopathology. RESULTS Two hundred and four men underwent RP after CB with suspicious lesions (PI-RADS≥3) on MRI were included. csPCa was significantly associated with prostate volume, PSA density, a lesion index in the peripheral zone, with a diameter≥7mm. TB were positives for 174 patients (85.3%). Prostate volume, PSA density, radiological coherence, previous biopsies, and a number of biopsies≥3 were significantly associated with a cancer detection. csPCa on TB, a prostate volume<60mL, an index lesion≥7mm and a peripheral zone location were significant predictive factors for diagnostic of csPCa on final histopathology. Area under the ROC curve values, sensitivities and specificities of CB and TB (adjusted model) were 0.78 [0.72-0.84], 77.3 [70.3-83.4], 78.1 [60-90.7], and 0.85 [0.79-0.90], 83.7 [77.3-88.9] and 75 [56.6-88.5] respectively. CONCLUSION This study confirms the benefit of CB and suggests that TB for a selected population could be as effective as CB.
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Affiliation(s)
- Natacha Demichel
- Department of Urologic Surgery, Reims University Hospital, 45, rue Cognacq Jay, 51100 Reims, France.
| | - Julien Coffinet
- Department of Anesthesiology and Critical Care, polyclinique Courlancy-Bezannes, 51430 Reims, France
| | - Fayek Taha
- Department of Urologic Surgery, Reims University Hospital, 45, rue Cognacq Jay, 51100 Reims, France
| | - Ricky Tambwe
- Department of Urologic Surgery, Saint-Gregoire Private Hospital Center, 35760 Saint-Gregoire, France
| | | | - Chokri Zayani
- Department of Radiology, Epernay Hospital, 51200 Epernay, France
| | - Anne Durlach
- Department of Anatomopathology, Reims University Hospital, 51100 Reims, France
| | - Stephane Larre
- Department of Urologic Surgery, Reims University Hospital, 45, rue Cognacq Jay, 51100 Reims, France
| | - Philippe Gomis
- Department of Anesthesiology and Critical Care, Reims University Hospital, Reims, France
| | - Priscilla Leon
- Department of Urologic Surgery, Pasteur Royan Clinic, 17200 Royan, France
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18
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Heetman JG, Paulino Pereira LJ, Kelder JC, Soeterik TFW, Wever L, Lavalaye J, van der Hoeven EJRJ, Lam MGEH, van Melick HHE, van den Bergh RCN. The additional value of 68Ga-PSMA PET/CT SUVmax in predicting ISUP GG ≥ 2 and ISUP GG ≥ 3 prostate cancer in biopsy. Prostate 2024; 84:1025-1032. [PMID: 38704755 DOI: 10.1002/pros.24716] [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: 11/24/2023] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Prebiopsy magnetic resonance imaging (MRI) increases the detection rate of clinically significant prostate cancer (csPCa). Prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA PET/CT) maximum standardized uptake value (SUVmax) of the prostate may offer additional value in predicting the likelihood of csPCa in biopsy. METHODS A single-center cohort study involving patients with biopsy-proven PCa who underwent both MRI and PSMA PET/CT between 2020 and 2021. Logistic regression models were developed for International Society of Urological Pathology (ISUP) Grade Group (GG) ≥ 2 and GG ≥ 3 using noninvasive prebiopsy parameters: age, (log-)prostate-specific antigen (PSA) density, PI-RADS 5 lesion presence, extraprostatic extension (EPE) on MRI, and SUVmax of the prostate. Models with and without SUVmax were compared using Likelihood ratio tests and area under the curve (AUC). DeLong's test was used to compare the AUCs. RESULTS The study included 386 patients, with 262 (68%) having ISUP GG ≥ 2 and 180 (47%) having ISUP GG ≥ 3. Including SUVmax significantly improved both models' goodness of fit (p < 0.001). The GG ≥ 2 model had a higher AUC with SUVmax 89.16% (95% confidence interval [CI]: 86.06%-92.26%) than without 87.34% (95% CI: 83.93%-90.76%) (p = 0.026). Similarly, the GG ≥ 3 model had a higher AUC with SUVmax 82.51% (95% CI: 78.41%-86.6%) than without 79.33% (95% CI: 74.84%-83.83%) (p = 0.003). The SUVmax inclusion improved the GG ≥ 3 model's calibration at higher probabilities. CONCLUSION SUVmax of the prostate on PSMA PET/CT potentially improves diagnostic accuracy in predicting the likelihood of csPCa in prostate biopsy.
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Affiliation(s)
- Joris G Heetman
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | | | - Johannes C Kelder
- Department of Cardiology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Timo F W Soeterik
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Lieke Wever
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | | | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harm H E van Melick
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
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19
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van den Kroonenberg DL, Jager A, Garrido-Utrilla A, Reitsma JB, Postema AW, Beerlage HP, Oddens JR. Clinical Validation of Multiparametric Ultrasound for Detecting Clinically Significant Prostate Cancer Using Computer-Aided Diagnosis: A Direct Comparison with the Magnetic Resonance Imaging Pathway. EUR UROL SUPPL 2024; 66:60-66. [PMID: 39050912 PMCID: PMC11267110 DOI: 10.1016/j.euros.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
We present the protocol for a study testing the hypothesis that a computer-aided diagnosis (CAD) system for three-dimensional multiparametric ultrasound (3D mpUS) is noninferior to magnetic resonance imaging (MRI) in guiding prostate biopsies for detection of clinically significant prostate cancer (csPCa). The prospective study has a fully paired design for assessment of diagnostic accuracy and is registered on ClinicalTrials.gov as NCT06281769. A total of 438 biopsy-naïve men scheduled for prostate MRI evaluation because of an abnormal digital rectal examination and/or elevated serum prostate-specific antigen will be included. All patients will undergo both MRI (multiparametric or biparametric) and 3D mpUS with CAD (PCaVision). Suspicious lesions will be independently identified using each imaging technique. MRI targeted biopsy (TBx) and/or PCaVision TBx will be performed if suspicious lesions are identified on imaging. When both PCaVision and MRI identify lesions in an individual patient, the TBx order for this patient will be randomized. Three TBx samples per lesion will be taken for a maximum of two lesions per modality. The primary objective is the detection rate for csPCa (International Society of Urological Pathology grade group [GG] ≥2) with the PCaVision versus the MRI TBx pathway. The noninferiority margin for the absolute difference in detection rates is set at a difference of 5%. Secondary outcomes are the proportion of men in whom TBx could have been safely omitted in each pathway. Additional diagnostic accuracy analyses will be performed for different definitions of PCa (GG ≥3; GG ≥2 with cribriform growth and/or intraductal carcinoma; and GG 1). The frequency of insufficient image quality for the two pathways will also be assessed. Lastly, we will determine the diagnostic performance for csPCa detection at various 3D mpUS image quality thresholds for PCaVision.
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Affiliation(s)
| | - Auke Jager
- Department of Urology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Johannes B. Reitsma
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Arnoud W. Postema
- Department of Urology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | | | - Jorg R. Oddens
- Department of Urology, Amsterdam UMC, Amsterdam, The Netherlands
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20
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Zhang Y, Li Z, Gao C, Zhang L, Huang Y, Qu H, Shu C, Wei Y, Xu M, Cui F. Radiomic nomogram based on bi-parametric magnetic resonance imaging to predict the International Society of Urological Pathology grading ≥ 3 prostate cancer: a multicenter study. Clin Radiol 2024; 79:e985-e993. [PMID: 38763807 DOI: 10.1016/j.crad.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/29/2024] [Accepted: 04/18/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE To create a reliable radiomic nomogram for the prediction of the International Society of Urological Pathology (ISUP) grading ≥ 3 prostate cancer (PCa) patients. METHODS patients with verified PCa were obtained from three different hospitals. The patients were divided into training, internal validation, and two external validation groups. A radiomic signature (rad-score) extracted from T2WI, diffusion-weighted imaging, and apparent diffusion coefficient (ADC) maps were constructed in the training cohort. Eight clinical features were performed to develop a clinical model using univariate and multivariate logistic regression. The combined model incorporated the radiomic signature and clinical model. The model's performance was assessed by the receiver operating characteristic (ROC) curve. RESULTS Rad-score, magnetic resonance imaging T-stage, and ADC value were significant predictors of ISUP ≥ 3 PCa. A nomogram of these three factors was shown to have greater diagnostic accuracy than using only the radiomic signature or clinical model alone. The area under the ROC curve was 0.85, 0.88, 0.81, 0.81 for the training, internal, and two external validation cohorts, respectively. In the stratified analysis based on the MR scanner model, the area under the ROC curve of predicting ISUP ≥ 3 PCa for GE, Siemens, and combined groups were 0.84, 0.83, and 0.84, respectively, in the combined training group and an internal validation group. CONCLUSIONS The proposed nomogram has the potential to predict the differentiation degree of ISUP PCa patients.
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Affiliation(s)
- Y Zhang
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
| | - Z Li
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - C Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - L Zhang
- Department of Radiology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Y Huang
- Department of Urology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - H Qu
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - C Shu
- Department of Pathology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Y Wei
- Advanced Analytics, Global Medical Service, GE Healthcare, Hangzhou, 310007, China
| | - M Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
| | - F Cui
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
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21
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Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, Eberli D, De Meerleer G, De Santis M, Farolfi A, Gandaglia G, Gillessen S, Grivas N, Henry AM, Lardas M, van Leenders GJLH, Liew M, Linares Espinos E, Oldenburg J, van Oort IM, Oprea-Lager DE, Ploussard G, Roberts MJ, Rouvière O, Schoots IG, Schouten N, Smith EJ, Stranne J, Wiegel T, Willemse PPM, Tilki D. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2024; 86:148-163. [PMID: 38614820 DOI: 10.1016/j.eururo.2024.03.027] [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: 03/02/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines provide recommendations for the management of clinically localised prostate cancer (PCa). This paper aims to present a summary of the 2024 version of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on the screening, diagnosis, and treatment of clinically localised PCa. METHODS The panel performed a literature review of all new data published in English, covering the time frame between May 2020 and 2023. The guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence. KEY FINDINGS AND LIMITATIONS A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for selected favourable intermediate-risk patients with International Society of Urological Pathology grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term intensified hormonal treatment. CONCLUSIONS AND CLINICAL IMPLICATIONS The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa guidelines reflect the multidisciplinary nature of PCa management. PATIENT SUMMARY This article is the summary of the guidelines for "curable" prostate cancer. Prostate cancer is "found" through a multistep risk-based screening process. The objective is to find as many men as possible with a curable cancer. Prostate cancer is curable if it resides in the prostate; it is then classified into low-, intermediary-, and high-risk localised and locally advanced prostate cancer. These risk classes are the basis of the treatments. Low-risk prostate cancer is treated with "active surveillance", a treatment with excellent prognosis. For low-intermediary-risk active surveillance should also be discussed as an option. In other cases, active treatments, surgery, or radiation treatment should be discussed along with the potential side effects to allow shared decision-making.
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Affiliation(s)
- Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK.
| | | | | | | | | | - Julie Darraugh
- European Association of Urology, Arnhem, The Netherlands
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Maria De Santis
- Department of Urology, Universitätsmedizin Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | | | - Matthew Liew
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | | | - Jan Oldenburg
- Akershus University Hospital (Ahus), Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands
| | | | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Olivier Rouvière
- Department of Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, UFR Lyon-Est, Lyon, France
| | - 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
| | | | - Emma J Smith
- European Association of Urology, Arnhem, The Netherlands
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital-Västra Götaland, Gothenburg, Sweden
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
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22
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van Velthoven R, Diamand R, Mozer P, Barry de Longchamp N. Letter to the Editor on "Comparison in Detection Rate of Clinically Significant Prostate Cancer Between Microultrasound-guided Prostate Biopsy (ExactVu) and Multiparametric Resonance Imaging-guided Prostate Biopsy (Koelis System)". Urology 2024; 190:173-174. [PMID: 38729267 DOI: 10.1016/j.urology.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/17/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Roland van Velthoven
- Urology Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Mozer
- Service d'Urologie, Groupe Hospitalier Pitié-Salpétrière, Paris, France
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23
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Ning J, Spielvogel CP, Haberl D, Trachtova K, Stoiber S, Rasul S, Bystry V, Wasinger G, Baltzer P, Gurnhofer E, Timelthaler G, Schlederer M, Papp L, Schachner H, Helbich T, Hartenbach M, Grubmüller B, Shariat SF, Hacker M, Haug A, Kenner L. A novel assessment of whole-mount Gleason grading in prostate cancer to identify candidates for radical prostatectomy: a machine learning-based multiomics study. Theranostics 2024; 14:4570-4581. [PMID: 39239512 PMCID: PMC11373617 DOI: 10.7150/thno.96921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/10/2024] [Indexed: 09/07/2024] Open
Abstract
Purpose: This study aims to assess whole-mount Gleason grading (GG) in prostate cancer (PCa) accurately using a multiomics machine learning (ML) model and to compare its performance with biopsy-proven GG (bxGG) assessment. Materials and Methods: A total of 146 patients with PCa recruited in a pilot study of a prospective clinical trial (NCT02659527) were retrospectively included in the side study, all of whom underwent 68Ga-PSMA-11 integrated positron emission tomography (PET) / magnetic resonance (MR) before radical prostatectomy (RP) between May 2014 and April 2020. To establish a multiomics ML model, we quantified PET radiomics features, pathway-level genomics features from whole exome sequencing, and pathomics features derived from immunohistochemical staining of 11 biomarkers. Based on the multiomics dataset, five ML models were established and validated using 100-fold Monte Carlo cross-validation. Results: Among five ML models, the random forest (RF) model performed best in terms of the area under the curve (AUC). Compared to bxGG assessment alone, the RF model was superior in terms of AUC (0.87 vs 0.75), specificity (0.72 vs 0.61), positive predictive value (0.79 vs 0.75), and accuracy (0.78 vs 0.77) and showed slightly decreased sensitivity (0.83 vs 0.89) and negative predictive value (0.80 vs 0.81). Among the feature categories, bxGG was identified as the most important feature, followed by pathomics, clinical, radiomics and genomics features. The three important individual features were bxGG, PSA staining and one intensity-related radiomics feature. Conclusion: The findings demonstrate a superior assessment of the developed multiomics-based ML model in whole-mount GG compared to the current clinical baseline of bxGG. This enables personalized patient management by identifying high-risk PCa patients for RP.
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Affiliation(s)
- Jing Ning
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Clemens P Spielvogel
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - David Haberl
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Karolina Trachtova
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Central European Institute of Technology, Masaryk University, Brno 62500, Czech Republic
| | - Stefan Stoiber
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Vojtech Bystry
- Central European Institute of Technology, Masaryk University, Brno 62500, Czech Republic
| | - Gabriel Wasinger
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Gurnhofer
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
| | - Gerald Timelthaler
- Center for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Michaela Schlederer
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
| | - Laszlo Papp
- Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Helga Schachner
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Bernhard Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Working Group of Diagnostic Imaging in Urology, Austrian Society of Urology, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, University of Texas Southwestern, Dallas, Texas
- Division of Medical Oncology, Department of Urology, Weill Medical College of Cornell University, New York, New York
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Alexander Haug
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Lukas Kenner
- Christian Doppler Laboratory for Applied Metabolomics, 1090 Vienna, Austria
- Clinical Institute of Pathology, Department for Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Styria, Austria
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24
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Riddle N, Parkash V, Guo CC, Shen SS, Perincheri S, Ramirez AS, Auerbach A, Belchis D, Humphrey PA. Recent Advances in Genitourinary Tumors: Updates From the 5th Edition of the World Health Organization Blue Book Series. Arch Pathol Lab Med 2024; 148:952-964. [PMID: 38031818 DOI: 10.5858/arpa.2022-0509-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 12/01/2023]
Abstract
CONTEXT.— Urinary and Male Genital Tumours is the 8th volume of the World Health Organization Classification of Tumours series, 5th edition. Released in hard copy in September 2022, it presents an update to the classification of male genital and urinary tumors in the molecular age. Building upon previous volumes in this series, significant effort has been made to harmonize terminology across organ systems for biologically similar tumors (eg, neuroendocrine tumors). Genomic terminology has been standardized and genetic syndromes covered more comprehensively. This review presents a concise summary of this volume, highlighting new entities, notable modifications relative to the 4th edition, and elements of relevance to routine clinical practice. OBJECTIVE.— To provide a comprehensive update on the World Health Organization classification of urinary and male genital tumors, highlighting updated diagnostic criteria and terminology. DATA SOURCES.— The 4th and 5th editions of the World Health Organization Classification of Tumours: Urinary and Male Genital Tumours. CONCLUSIONS.— The World Health Organization has made several changes in the 5th edition of the update on urinary and male genital tumors that pathologists need to be aware of for up-to-date clinical practice.
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Affiliation(s)
- Nicole Riddle
- From the Department of Pathology, Tampa General Hospital, Tampa, Florida (Riddle)
- Pathology and Laboratory Medicine, Ruffolo, Hooper, and Associates, University of South Florida Health, Tampa (Riddle)
| | - Vinita Parkash
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Parkash, Perincheri, Humphrey)
| | - Charles C Guo
- the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Guo)
| | - Steven S Shen
- the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Shen)
| | - Sudhir Perincheri
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Parkash, Perincheri, Humphrey)
| | | | - Aaron Auerbach
- the Department of Hematopathology, The Joint Pathology Center, Silver Spring, Maryland (Auerbach)
| | - Deborah Belchis
- the Department of Pathology, Luminis Health, Baltimore, Maryland (Belchis)
| | - Peter A Humphrey
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Parkash, Perincheri, Humphrey)
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25
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Smani S, Sundaresan V, Lokeshwar SD, Choksi AU, Carbonella J, Brito J, Renzulli J, Sprenkle P, Leapman MS. Risk factors for Gleason score upgrade from prostate biopsy to radical prostatectomy. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:981-996. [PMID: 39280242 PMCID: PMC11390291 DOI: 10.37349/etat.2024.00259] [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: 04/07/2024] [Accepted: 05/20/2024] [Indexed: 09/18/2024] Open
Abstract
Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.
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Affiliation(s)
- Shayan Smani
- Yale School of Medicine, New Haven, CT 06520, USA
| | | | - Soum D Lokeshwar
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Ankur U Choksi
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jeffrey Carbonella
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Joseph Brito
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Joseph Renzulli
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Preston Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
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26
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Roest C, Yakar D, Rener Sitar DI, Bosma JS, Rouw DB, Fransen SJ, Huisman H, Kwee TC. Multimodal AI Combining Clinical and Imaging Inputs Improves Prostate Cancer Detection. Invest Radiol 2024:00004424-990000000-00236. [PMID: 39074400 DOI: 10.1097/rli.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
OBJECTIVES Deep learning (DL) studies for the detection of clinically significant prostate cancer (csPCa) on magnetic resonance imaging (MRI) often overlook potentially relevant clinical parameters such as prostate-specific antigen, prostate volume, and age. This study explored the integration of clinical parameters and MRI-based DL to enhance diagnostic accuracy for csPCa on MRI. MATERIALS AND METHODS We retrospectively analyzed 932 biparametric prostate MRI examinations performed for suspected csPCa (ISUP ≥2) at 2 institutions. Each MRI scan was automatically analyzed by a previously developed DL model to detect and segment csPCa lesions. Three sets of features were extracted: DL lesion suspicion levels, clinical parameters (prostate-specific antigen, prostate volume, age), and MRI-based lesion volumes for all DL-detected lesions. Six multimodal artificial intelligence (AI) classifiers were trained for each combination of feature sets, employing both early (feature-level) and late (decision-level) information fusion methods. The diagnostic performance of each model was tested internally on 20% of center 1 data and externally on center 2 data (n = 529). Receiver operating characteristic comparisons determined the optimal feature combination and information fusion method and assessed the benefit of multimodal versus unimodal analysis. The optimal model performance was compared with a radiologist using PI-RADS. RESULTS Internally, the multimodal AI integrating DL suspicion levels with clinical features via early fusion achieved the highest performance. Externally, it surpassed baselines using clinical parameters (0.77 vs 0.67 area under the curve [AUC], P < 0.001) and DL suspicion levels alone (AUC: 0.77 vs 0.70, P = 0.006). Early fusion outperformed late fusion in external data (0.77 vs 0.73 AUC, P = 0.005). No significant performance gaps were observed between multimodal AI and radiologist assessments (internal: 0.87 vs 0.88 AUC; external: 0.77 vs 0.75 AUC, both P > 0.05). CONCLUSIONS Multimodal AI (combining DL suspicion levels and clinical parameters) outperforms clinical and MRI-only AI for csPCa detection. Early information fusion enhanced AI robustness in our multicenter setting. Incorporating lesion volumes did not enhance diagnostic efficacy.
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Affiliation(s)
- Christian Roest
- From the Department of Radiology, Medical Imaging Center, University Medical Center Groningen, Groningen, the Netherlands (C.R., D.Y., D.I.R.S., S.J.F., T.C.K.); Department of Radiology, Netherlands Cancer Center Antoni van Leeuwenhoek, Amsterdam, the Netherlands (D.Y.); Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands (J.S.B., H.H.); and Department of Radiology, Martini Ziekenhuis Groningen, Groningen, the Netherlands (D.B.R.)
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Sushentsev N, Hamm G, Flint L, Birtles D, Zakirov A, Richings J, Ling S, Tan JY, McLean MA, Ayyappan V, Horvat Menih I, Brodie C, Miller JL, Mills IG, Gnanapragasam VJ, Warren AY, Barry ST, Goodwin RJA, Barrett T, Gallagher FA. Metabolic imaging across scales reveals distinct prostate cancer phenotypes. Nat Commun 2024; 15:5980. [PMID: 39013948 PMCID: PMC11252279 DOI: 10.1038/s41467-024-50362-5] [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: 10/03/2023] [Accepted: 07/07/2024] [Indexed: 07/18/2024] Open
Abstract
Hyperpolarised magnetic resonance imaging (HP-13C-MRI) has shown promise as a clinical tool for detecting and characterising prostate cancer. Here we use a range of spatially resolved histological techniques to identify the biological mechanisms underpinning differential [1-13C]lactate labelling between benign and malignant prostate, as well as in tumours containing cribriform and non-cribriform Gleason pattern 4 disease. Here we show that elevated hyperpolarised [1-13C]lactate signal in prostate cancer compared to the benign prostate is primarily driven by increased tumour epithelial cell density and vascularity, rather than differences in epithelial lactate concentration between tumour and normal. We also demonstrate that some tumours of the cribriform subtype may lack [1-13C]lactate labelling, which is explained by lower epithelial lactate dehydrogenase expression, higher mitochondrial pyruvate carrier density, and increased lipid abundance compared to lactate-rich non-cribriform lesions. These findings highlight the potential of combining spatial metabolic imaging tools across scales to identify clinically significant metabolic phenotypes in prostate cancer.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Gregory Hamm
- Integrated BioAnalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Lucy Flint
- Integrated BioAnalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Daniel Birtles
- Integrated BioAnalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Aleksandr Zakirov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jack Richings
- Predictive AI & Data, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Stephanie Ling
- Integrated BioAnalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Jennifer Y Tan
- Predictive AI & Data, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Vinay Ayyappan
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ines Horvat Menih
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cara Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Jodi L Miller
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Ian G Mills
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon T Barry
- Bioscience, Early Oncology, AstraZeneca, Cambridge, UK
| | - Richard J A Goodwin
- Integrated BioAnalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ferdia A Gallagher
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Liu J, Cundy TP, Woon DTS, Desai N, Palaniswami M, Lawrentschuk N. A systematic review on artificial intelligence evaluating PSMA PET scan for intraprostatic cancer. BJU Int 2024. [PMID: 39003625 DOI: 10.1111/bju.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
OBJECTIVES To assess artificial intelligence (AI) ability to evaluate intraprostatic prostate cancer (PCa) on prostate-specific membrane antigen positron emission tomography (PSMA PET) scans prior to active treatment (radiotherapy or prostatectomy). MATERIALS AND METHODS This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42023438706). A search was performed on Medline, Embase, Web of Science, and Engineering Village with the following terms: 'artificial intelligence', 'prostate cancer', and 'PSMA PET'. All articles published up to February 2024 were considered. Studies were included if patients underwent PSMA PET scan to evaluate intraprostatic lesions prior to active treatment. The two authors independently evaluated titles, abstracts, and full text. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used. RESULTS Our search yield 948 articles, of which 14 were eligible for inclusion. Eight studies met the primary endpoint of differentiating high-grade PCa. Differentiating between International Society of Urological Pathology (ISUP) Grade Group (GG) ≥3 PCa had an accuracy between 0.671 to 0.992, sensitivity of 0.91, specificity of 0.35. Differentiating ISUP GG ≥4 PCa had an accuracy between 0.83 and 0.88, sensitivity was 0.89, specificity was 0.87. AI could identify non-PSMA-avid lesions with an accuracy of 0.87, specificity of 0.85, and specificity of 0.89. Three studies demonstrated ability of AI to detect extraprostatic extensions with an area under curve between 0.70 and 0.77. Lastly, AI can automate segmentation of intraprostatic lesion and measurement of gross tumour volume. CONCLUSION Although the current state of AI differentiating high-grade PCa is promising, it remains experimental and not ready for routine clinical application. Benefits of using AI to assess intraprostatic lesions on PSMA PET scans include: local staging, identifying otherwise radiologically occult lesions, standardisation and expedite reporting of PSMA PET scans. Larger, prospective, multicentre studies are needed.
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Affiliation(s)
- Jianliang Liu
- EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas P Cundy
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Dixon T S Woon
- EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Nanadakishor Desai
- Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Gómez-Gómez E, Martínez-Salamanca JI, Bianco F, Miles BJ, Burgos J, Quintas JJ, Cano-Castiñeira R, Gómez-Ferrer Á, Rodríguez-Antolín A, Chéchile G, Fernández L, Martín A, Hidalgo P, Parramón M. ProsTAV, a clinically useful test in prostate cancer: an extension study. World J Urol 2024; 42:395. [PMID: 38985190 PMCID: PMC11236897 DOI: 10.1007/s00345-024-05098-8] [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: 04/19/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE To assess the clinical performance of ProsTAV®, a blood-based test based on telomere associate variables (TAV) measurement, to support biopsy decision-making when diagnosing suspicious prostate cancer (PCa). METHODS Preliminary data of a prospective observational pragmatic study of patients with prostate-specific antigen (PSA) levels 3-10 ng/ml and suspicious PCa. Results were combined with other clinical data, and all patients underwent prostate biopsies according to each center's routine clinical practice, while magnetic resonance imaging (MRI) before the prostate biopsy was optional. Sensitivity, specificity, positive and negative predicted values, and subjects where biopsies could have been avoided using ProsTAV were determined. RESULTS The mean age of the participants (n = 251) was 67.4 years, with a mean PSA of 5.90 ng/ml, a mean free PSA of 18.9%, and a PSA density of 0.14 ng/ml. Digital rectal examination was abnormal in 21.1% of the subjects, and according to biopsy, the prevalence of significant PCa was 47.8%. The area under the ROC curve of ProsTAV was 0.7, with a sensitivity of 0.90 (95% CI, 0.85-0.95) and specificity of 0.27 (95% CI, 0.19-0.34). The positive and negative predictive values were 0.53 (95% CI, 0.46-0.60) and 0.74 (95% CI, 0.62-0.87), respectively. ProsTAV could have reduced the biopsies performed by 27% and showed some initial evidence of a putative benefit in the diagnosis pathway combined with MRI. CONCLUSIONS ProsTAV increases the prediction capacity of significant PCa in patients with PSA between 3 and 10 ng/ml and could be considered a complementary tool to improve the patient diagnosis pathway.
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Affiliation(s)
- Enrique Gómez-Gómez
- Department of Urology, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain
| | | | | | - Brian J Miles
- Urologic Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Javier Burgos
- Department of Urology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Roque Cano-Castiñeira
- Department of Urology, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain
- Department of Urology, Hospital Infanta Margarita, Córdoba, Spain
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Ghai S, Klotz L, Pond GR, Kebabdjian M, Downes MR, Belanger EC, Moussa M, van der Kwast TH. Comparison of Multiparametric MRI-targeted and Systematic Biopsies for Detection of Cribriform and Intraductal Carcinoma Prostate Cancer. Radiology 2024; 312:e231948. [PMID: 39012252 DOI: 10.1148/radiol.231948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Background Intraductal carcinoma (IDC) and invasive cribriform (Cr) subtypes of prostate cancer (PCa) are an indication of aggressiveness, but the evidence regarding whether MRI can be used to detect Cr/IDC-pattern PCa is contradictory. Purpose To compare the detection of Cr/IDC-pattern PCa at multiparametric MRI (mpMRI)-targeted biopsy versus systematic biopsy in biopsy-naive men at risk for PCa. Materials and Methods This study was a secondary analysis of a prospective randomized controlled trial that recruited participants with a clinical suspicion of PCa between April 2017 and November 2019 at five centers. Participants were randomized 1:1 to either the MRI arm or the systematic biopsy arm. Targeted biopsy was performed in participants with a Prostate Imaging Reporting and Data System score of at least 3. MRI features were recorded, and biopsy slides and prostatectomy specimens were reviewed for the presence or absence of Cr/IDC histologic patterns. Comparison of Cr/IDC patterns was performed using generalized linear mixed modeling. Results A total of 453 participants were enrolled, with 226 in the systematic biopsy arm (median age, 65 years [IQR, 59-70 years]; 196 biopsies available for assessment) and 227 in the mpMRI-targeted biopsy arm (median age, 67 years [IQR, 60-72 years]; 132 biopsies available for assessment). Identification of Cr/IDC PCa was lower in the systematic biopsy arm compared with the mpMRI arm (31 of 196 biopsies [16%] vs 33 of 132 biopsies [25%]; P = .01). No evidence of a difference in mean cancer core length (CCL) (11.3 mm ± 4.4 vs 9.7 mm ± 4.5; P = .09), apparent diffusion coefficient (685 µm2/sec ± 178 vs 746 µm2/sec ± 245; P = .52), or dynamic contrast-enhanced positivity (27 [82%] vs 37 [90%]; P = .33) for clinically significant PCa (csPCa) was observed between participants with or without Cr/IDC disease in the MRI arm. Cr/IDC-positive histologic patterns overall had a higher mean CCL compared with Cr/IDC-negative csPCa (11.1 mm ± 4.4 vs 9.2 mm ± 4.1; P = .009). Conclusion MRI-targeted biopsy showed increased detection of Cr/IDC histologic patterns compared with systematic biopsy. Clinical trial registration no. NCT02936258 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Scialpi and Martorana in this issue.
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Affiliation(s)
- Sangeet Ghai
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Laurence Klotz
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Gregory R Pond
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Marlene Kebabdjian
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Michelle R Downes
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Eric C Belanger
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Madeleine Moussa
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
| | - Theodorus H van der Kwast
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.)
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Gross M, Eisenhuber E, Assinger P, Schima R, Susani M, Doblhammer S, Schima W. MRI-guided in-bore biopsy of the prostate - defining the optimal number of cores needed. Cancer Imaging 2024; 24:81. [PMID: 38956721 PMCID: PMC11218164 DOI: 10.1186/s40644-024-00734-3] [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: 03/24/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Numerous studies have shown that magnetic resonance imaging (MRI)-targeted biopsy approaches are superior to traditional systematic transrectal ultrasound guided biopsy (TRUS-Bx). The optimal number of biopsy cores to be obtained per lesion identified on multiparametric MRI (mpMRI) images, however, remains a matter of debate. The aim of this study was to evaluate the incremental value of additional biopsy cores in an MRI-targeted "in-bore"-biopsy (MRI-Bx) setting. PATIENTS AND METHODS Two hundred and forty-five patients, who underwent MRI-Bx between June 2014 and September 2021, were included in this retrospective single-center analysis. All lesions were biopsied with at least five biopsy cores and cumulative detection rates for any cancer (PCa) as well as detection rates of clinically significant cancers (csPCa) were calculated for each sequentially labeled biopsy core. The cumulative per-core detection rates are presented as whole numbers and as proportion of the maximum detection rate reached, when all biopsy cores were considered. CsPCa was defined as Gleason Score (GS) ≥ 7 (3 + 4). RESULTS One hundred and thirty-two of 245 Patients (53.9%) were diagnosed with prostate cancer and csPCa was found in 64 (26.1%) patients. The first biopsy core revealed csPCa/ PCa in 76.6% (49/64)/ 81.8% (108/132) of cases. The second, third and fourth core found csPCa/ PCa not detected by previous cores in 10.9% (7/64)/ 8.3% (11/132), 7.8% (5/64)/ 5.3% (7/132) and 3.1% (2/64)/ 3% (4/132) of cases, respectively. Obtaining one or more cores beyond the fourth biopsy core resulted in an increase in detection rate of 1.6% (1/64)/ 1.5% (2/132). CONCLUSION We found that obtaining five cores per lesion maximized detection rates. If, however, future research should establish a clear link between the incidence of serious complications and the number of biopsy cores obtained, a three-core biopsy might suffice as our results suggest that about 95% of all csPCa are detected by the first three cores.
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Affiliation(s)
- Moritz Gross
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Dornbacher Strasse 20-30, Vienna, 1170, Austria
| | - Edith Eisenhuber
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Dornbacher Strasse 20-30, Vienna, 1170, Austria
| | - Petra Assinger
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Dornbacher Strasse 20-30, Vienna, 1170, Austria
| | | | - Martin Susani
- Varga, Braun, Pathology Laboratory, Vienna, 1210, Austria
| | | | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Dornbacher Strasse 20-30, Vienna, 1170, Austria.
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Paralkar D, Akbari A, Aron M. Prostatic adenocarcinoma: molecular underpinnings and treatment-related options. Urol Oncol 2024; 42:203-210. [PMID: 38508940 DOI: 10.1016/j.urolonc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/28/2024] [Accepted: 03/03/2024] [Indexed: 03/22/2024]
Abstract
Prostate cancer is heterogeneous with varied pathologic features and presents with a wide spectrum of clinical manifestations from indolent to advanced cancer. Interrogation of the molecular landscape of prostate cancer has unveiled the complex genomic alterations in these tumors, which significantly impacts tumor biology. The documented array of chromosomal alterations, gene fusions, and epigenetic changes not only play a crucial role in oncogenesis and disease progression, but also impacts response and resistance to various therapeutic modalities. Various gene expression assays have been developed and are currently recommended in aiding clinical decision making in these clinically and molecularly heterogeneous cancer. In this review, we provide an overview of the molecular underpinnings of prostate cancer, and briefly review the current status of molecular testing and therapeutic options in the management of these tumors.
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Affiliation(s)
- Divyangi Paralkar
- Department of Urology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Room 2409, HC4, Los Angeles, California
| | - Amir Akbari
- Department of Pathology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Room 2409, HC4, Los Angeles, California
| | - Manju Aron
- Department of Urology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Room 2409, HC4, Los Angeles, California; Department of Pathology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Room 2409, HC4, Los Angeles, California.
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33
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Chang CH, Yu PH, Hsieh PF, Hong JH, Chiang CH, Cheng HM, Wu HC, Huang CY, Lin TP. Prostate health index density aids the diagnosis of prostate cancer detected using magnetic resonance imaging targeted prostate biopsy in Taiwanese multicenter study. J Chin Med Assoc 2024; 87:678-685. [PMID: 38829960 DOI: 10.1097/jcma.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) followed by MRI-targeted prostate biopsy is the current standard for diagnosing prostate cancer (PCa). However, studies evaluating the value of biomarkers, including prostate health index (PHI) and its derivatives using this method are limited. We aimed to investigate the efficacy of PHI density (PHID) in guiding MRI-targeted prostate biopsies to identify clinically significant PCas (csPCa). METHODS The multicenter prospectively registered prostate biopsy database from three medical centers in Taiwan included patients with PHI and MRI-targeted and/or systematic prostate biopsies. We assessed the required values of prostate-specific antigen (PSA), prostate volume, PHI, PHID, and Prostate Imaging Reporting & Data System (PI-RADS) score using multivariable analyses, receiver operating characteristic curve analysis, and decision curve analyses (DCA). csPCa was defined as the International Society of Urological Pathology Gleason group ≥2 PCa, with an emphasis on reducing unwarranted biopsies. RESULTS The study cohort comprised 420 individuals. Diagnoses of PCa and csPCa were confirmed in 62.4% and 47.9% of the participants, respectively. The csPCa diagnosis rates were increased with increasing PI-RADS scores (20.5%, 44.2%, and 73.1% for scores 3, 4, and 5, respectively). Independent predictors for csPCa detection included PHI, prostate volume, and PI-RADS scores of 4 and 5 in multivariable analyses. The area under the curve (AUC) for csPCa of PHID (0.815) or PHI (0.788) was superior to that of PSA density (0.746) and PSA (0.635) in the entire cohort, and the superiority of PHID (0.758) was observed in PI-RADS 3 lesions. DCA revealed that PHID achieved the best net clinical benefit in PI-RADS 3-5 and 4/5 cases. Among PI-RADS 3 lesions, cutoff values of PHID 0.70 and 0.43 could eliminate 51.8% and 30.4% of omitted biopsies, respectively. CONCLUSION PHI-derived biomarkers, including PHID, performed better than other PSA-derived biomarkers in diagnosing PCa in MRI-detected lesions.
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Affiliation(s)
- Ching-Hsin Chang
- Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan, ROC
- Taiwan Prostate Cancer Collaboration Group
| | - Ping-Hsuan Yu
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Po-Fan Hsieh
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, China Medical University Hospital, Taichung, Taiwan, ROC
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Jian-Hua Hong
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Chih-Hung Chiang
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Division of Urology, Department of Surgery, and Department of Research and Development, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
| | - Hao-Min Cheng
- Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Hsi-Chin Wu
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, China Medical University Hospital, Taichung, Taiwan, ROC
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Department of Urology, China Medical University Beigang Hospital, Beigang, Taiwan, ROC
| | - Chao-Yuan Huang
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Taiwan Prostate Cancer Collaboration Group
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Jager A, Oddens JR, Postema AW, Miclea RL, Schoots IG, Nooijen PGTA, van der Linden H, Barentsz JO, Heijmink SWTPJ, Wijkstra H, Mischi M, Turco S. Is There an Added Value of Quantitative DCE-MRI by Magnetic Resonance Dispersion Imaging for Prostate Cancer Diagnosis? Cancers (Basel) 2024; 16:2431. [PMID: 39001493 PMCID: PMC11240399 DOI: 10.3390/cancers16132431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
In this multicenter, retrospective study, we evaluated the added value of magnetic resonance dispersion imaging (MRDI) to standard multiparametric MRI (mpMRI) for PCa detection. The study included 76 patients, including 51 with clinically significant prostate cancer (csPCa), who underwent radical prostatectomy and had an mpMRI including dynamic contrast-enhanced MRI. Two radiologists performed three separate randomized scorings based on mpMRI, MRDI and mpMRI+MRDI. Radical prostatectomy histopathology was used as the reference standard. Imaging and histopathology were both scored according to the Prostate Imaging-Reporting and Data System V2.0 sector map. Sensitivity and specificity for PCa detection were evaluated for mpMRI, MRDI and mpMRI+MRDI. Inter- and intra-observer variability for both radiologists was evaluated using Cohen's Kappa. On a per-patient level, sensitivity for csPCa for radiologist 1 (R1) for mpMRI, MRDI and mpMRI+MRDI was 0.94, 0.82 and 0.94, respectively. For the second radiologist (R2), these were 0.78, 0.94 and 0.96. R1 detected 4% additional csPCa cases using MRDI compared to mpMRI, and R2 detected 20% extra csPCa cases using MRDI. Inter-observer agreement was significant only for MRDI (Cohen's Kappa = 0.4250, p = 0.004). The results of this study show the potential of MRDI to improve inter-observer variability and the detection of csPCa.
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Affiliation(s)
- Auke Jager
- Department of Urology, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Arnoud W Postema
- Leiden University Medical Center, Department of Urology, 2333 ZA Leiden, The Netherlands
| | - Razvan L Miclea
- Department of Radiology and Nuclear Imaging, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Radiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Peet G T A Nooijen
- Department of Pathology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Hans van der Linden
- Department of Pathology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology, Radboud University Nijmegen Medical Center, 6525 GA Nijmegenfi, The Netherlands
| | - Stijn W T P J Heijmink
- Department of Radiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Hessel Wijkstra
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Simona Turco
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
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Tercan E, Erbatu OU, Üçer O, Metin S, Ne E N. Evaluating the effect of histopathological parameters of prostate adenocarcinoma on prognosis in radical prostatectomy specimens. Ann Saudi Med 2024; 44:234-248. [PMID: 39127900 DOI: 10.5144/0256-4947.2024.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Over the past decade, significant updates have been made regarding the classification and grading of prostate adenocarcinoma in radical prostatectomy specimens, following decisions reached in international conferences and through impactful publications. These alterations are closely linked to patient prognosis. OBJECTIVES Observe the incidence of these changes and their impact on patient prognosis. Additionally, investigate the relationship between histopathological and clinical parameters to assist in multidisciplinary treatment planning. DESIGN Retrospective cohort study. SETTING Tertiary university hospital. METHODS Hematoxylin and eosin, along with immunohistochemistry stained sections, were reevaluated, and clinical information, including patient demographics, preoperative PSA levels, and patient follow-up were collected from patients who underwent radical prostatectomy at our center. SAMPLE SIZE 182 patients. MAIN OUTCOME MEASURES Biochemical recurrence. RESULTS The study highlighted the negative prognostic effects of factors such as Gleason grade group, lymphovascular invasion, intraductal carcinoma, positive surgical margins, extraprostatic extension, pathological T stage, and seminal vesicle invasion. These factors are important determinants of recurrence-free survival in prostate adenocarcinoma patients. CONCLUSION This study identified comedonecrosis and intraductal carcinoma as independent negative prognostic factors. A 3-mm cutoff for positive surgical margins was supported, while the current cutoff for extraprostatic extension may require reevaluation. The impact of cribriform pattern and ductal carcinoma appears to be influenced by the grade group. No independent relationship was found between the Gleason score/pattern on positive surgical margins or extraprostatic extension and prognosis. Further, large-scale studies with long-term follow-up are needed. LIMITATIONS The study is limited by the relatively small number of patients for certain parameters.
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Affiliation(s)
- Ergün Tercan
- From the Department of Pathology, Manisa Celal Bayar University, Manisa, Turkey
| | - O Uzcan Erbatu
- From the Department of Urology, Manisa Celal Bayar University, Manisa, Turkey
| | - Oktay Üçer
- From the Department of Urology, Manisa Celal Bayar University, Manisa, Turkey
| | - Sefa Metin
- From the Department of Pharmacology, Pharmaceuticals and Medical Devices Agency of Türkiye, Ankara, Turkey
| | - Nalan Ne E
- From the Department of Pathology, Manisa Celal Bayar University, Manisa, Turkey
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Davik P, Elschot M, Frost Bathen T, Bertilsson H. Repeat Prostate-specific Antigen Testing Improves Risk-based Selection of Men for Prostate Biopsy After Magnetic Resonance Imaging. EUR UROL SUPPL 2024; 65:21-28. [PMID: 38974460 PMCID: PMC11225807 DOI: 10.1016/j.euros.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 07/09/2024] Open
Abstract
Background and objective The aim of our study was to investigate whether repeat prostate-specific antigen (PSA) testing as currently recommended improves risk stratification for men undergoing magnetic resonance imaging (MRI) and targeted biopsy for suspected prostate cancer (PCa). Methods Consecutive men undergoing MRI and prostate biopsy who had at least two PSA tests before prostate biopsy were retrospectively registered and assigned to a development cohort (n = 427) or a validation (n = 174) cohort. Change in PSA level was assessed as a predictor of clinically significant PCa (csPCa; Gleason score ≥3 + 4, grade group ≥2) by multivariable logistic regression analysis. We developed a multivariable prediction model (MRI-RC) and a dichotomous biopsy decision strategy incorporating the PSA change. The performance of the MRI-RC model and dichotomous decision strategy was assessed in the validation cohort and compared to prediction models and decision strategies not including PSA change in terms of discriminative ability and decision curve analysis. Results Men who had a decrease on repeat PSA testing had significantly lower risk of csPCa than men without a decrease (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.16-0.54; p < 0.001). Men with an increased repeat PSA had a significantly higher risk of csPCa than men without an increase (OR 2.97, 95% CI 1.62-5.45; p < 0.001). Risk stratification using both the MRI-RC model and the dichotomous decision strategy was improved by incorporating change in PSA as a parameter. Conclusions and clinical implications Repeat PSA testing gives predictive information regarding men undergoing MRI and targeted prostate biopsy. Inclusion of PSA change as a parameter in an MRI-RC model and a dichotomous biopsy decision strategy improves their predictive performance and clinical utility without requiring additional investigations. Patient summary For men with a suspicion of prostate cancer, repeat PSA (prostate-specific antigen) testing after an MRI (magnetic resonance imaging) scan can help in identifying patients who can safely avoid prostate biopsy.
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Affiliation(s)
- Petter Davik
- Department of Urology, St. Olav’s Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olav’s Hospital, Trondheim, Norway
| | - Tone Frost Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olav’s Hospital, Trondheim, Norway
| | - Helena Bertilsson
- Department of Urology, St. Olav’s Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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García-Zoghby L, Amo-Salas M, Soriano Castrejón ÁM, García Vicente AM. Whole-body tumour burden on [18F]DCFPyL PET/CT in biochemical recurrence of prostate cancer: association with tumour biology and PSA kinetics. Eur J Nucl Med Mol Imaging 2024; 51:2467-2483. [PMID: 38520513 DOI: 10.1007/s00259-024-06685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE The objective was to assess the association between molecular imaging (mi) variables on [18F]DCFPyL-PET/CT with clinical and disease characteristics and prostate specific antigen (PSA) related variables in patients with biochemical recurrence of prostate cancer (BRPC). MATERIAL AND METHODS We analysed patients with BRPC after radical treatment. We obtained clinical and PSA variables: International Society of Urology Pathology (ISUP) grade group, European Association of Urology (EAU) risk classification, PSA (PSA≤1ng/ml, 1 2), PSA doubling time (PSAdt) and PSA velocity (PSAvel). All PET/CT scans were reviewed with the assistance of automated Prostate Molecular Imaging Standardized Evaluation (aPROMISE) software and lesions' segmentation in positive scans was performed using this platform. Standardized uptake value (SUV) derived variables; tumour burden variables [whole-body tumour volume (wbTV), whole-body tumour lesion activity (wbTLA) and whole-body mi PSMA (wbPSMA)] and miTNM staging were obtained. Cut-off of PSA and kinetics able to predict PET/CT results were obtained. Associations between disease and mi variables were analysed using ANOVA, Kruskal-Wallis and Spearman's correlation tests. Multivariate analysis was also performed. RESULTS Two hundred and seventy-five patients were studied. [18F]DCFPyL-PET/CT were positive in 165/275 patients. In multivariate analysis, moment of biochemical recurrence, ISUP group, PSA level and PSAvel showed significant association with the detection rate. miTNM showed significant association with PSA level (p<0.001) and kinetics (p<0.001), being higher in patients with metastatic disease. Both PSA and PSAvel showed moderate correlation with wbTV, wbTLA and wbPSMA (p<0.001). A weak correlation with SUVs was found. Mean wbTV, wbTLA and wbPSMA values were significantly higher in PSA > 2ng/ml, PSAdt ≤ 6 months and PSAvel ≥ 0.2ng/ml/month groups. Also, wbTV (p=0.039) and wbPSMA (p=0.020) were significantly higher in patients with ISUP grade group 5. PSA and PSAvel cut-offs (1.15 ng/ml and 0.065 ng/ml/month) were significantly associated with a positive PET/CT. CONCLUSION Higher PSA values, unfavourable PSA kinetics and ISUP grade group 5 were robust predictive variables of larger tumour burden variables on [18F]DCFPyL PET/CT assessed by aPROMISE platform.
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Affiliation(s)
- Laura García-Zoghby
- Nuclear Medicine Department, University Hospital of Toledo, Av. del Río Guadiana, s/n, 45007, Toledo, Spain.
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Cam. Moledores, s/n, 13071, Ciudad Real, Spain
| | | | - Ana María García Vicente
- Nuclear Medicine Department, University Hospital of Toledo, Av. del Río Guadiana, s/n, 45007, Toledo, Spain
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Zhou L, Xu LL, Zheng LL, Chen C, Xu L, Zeng JL, Li SY. Predictors of Gleason Grading Group Upgrading in Low-Risk Prostate Cancer Patients From Transperineal Biopsy After Radical Prostatectomy. Acad Radiol 2024; 31:2838-2847. [PMID: 38233258 DOI: 10.1016/j.acra.2024.01.012] [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: 11/17/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the predictors of Gleason Grading Group (GGG) upgrading in low-risk prostate cancer (Gleason score=3 + 3) from transperineal biopsy after radical prostatectomy (RP). MATERIALS AND METHODS The clinical data of 160 patients who underwent transperineal biopsy and RP from January 2017 to December 2022 were retrospectively analyzed. First, univariate and multivariate logistic regression analysis were used to obtain independent predictors of postoperative GGG upgrading. Then receiver operating characteristic curve was used to evaluate the diagnostic efficacy of predictors. Finally, Linear-by-Linear Association test was used to analyze the risk trends of patients in different predictor groups in the postoperative GGG. RESULTS In this study, there were 81 cases (50.6%) in the GGG concordance group and 79 cases (49.4%) in the GGG upgrading group. Univariate analysis showed age, free/total prostate-specific antigen (f/tPSA), proportion of positive biopsies, positive target of magnetic-resonance imaging (MRI) and positive target of contrast-enhanced ultrasound had significant effects on GGG upgrading (all P < .05). In multivariate logistic regression analysis, age (odds ratio [OR]=1.066, 95%CI=1.007-1.127, P = .027), f/tPSA (OR=0.001, 95%CI=0-0.146, P = .001) and positive target of MRI (OR=3.005, 95%CI=1.353-76.674, P = .007) were independent predictors. The prediction model (area under curve=0.751 P < .001) had higher predictive efficacy than all independent predictors. The proportion of patients in exposed group of different GGG increased with the level of GGG, but decreased in nonexposed group, and the linear trend was significantly different (all P < .001). CONCLUSION Age, f/tPSA, and positive target of MRI were independent predictors of postoperative GGG upgrading. The predictive model constructed had the best diagnostic efficacy.
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Affiliation(s)
- Ling Zhou
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Li-Long Xu
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Lin-Lin Zheng
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (C.C.)
| | - Li Xu
- Department of Urology Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (L.X.)
| | - Ji-Ling Zeng
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (J.Z.)
| | - Shi-Yan Li
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.).
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Latcu SC, Cumpanas AA, Barbos V, Buciu VB, Raica M, Baderca F, Gaje PN, Ceausu RA, Dumitru CS, Novacescu D, Cut TG, Petrica L. Clinical Tools for Optimizing Therapeutic Decision-Making in Prostate Cancer: A Five-Year Retrospective Analysis. Life (Basel) 2024; 14:838. [PMID: 39063592 PMCID: PMC11278064 DOI: 10.3390/life14070838] [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: 05/08/2024] [Revised: 06/03/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
The effective staging of prostate cancer is essential for optimizing treatment and predicting outcomes. This study assessed the correlation between detailed preoperative diagnostic scores and postoperative outcomes to evaluate the accuracy of cancer restaging and its impact on treatment decisions and prognosis after prostatectomy. This retrospective study analyzed 133 prostate cancer patients who underwent prostatectomies at "Pius Brinzeu" Clinical Emergency Hospital in Timisoara over five years. Preoperative Gleason scores increased significantly across risk categories, from an average of 6.21 in low-risk patients to 7.57 in high-risk patients. This trend continued postoperatively, with scores rising from 7.04 to 8.33, respectively. The average increase in Gleason scores from preoperative to postoperative assessments was most pronounced in high-risk patients, at 0.76. Significant changes in clinical staging included increases in NCCN risk, where high-risk patients showed a 30% increase, and ISUP grade, with a 26.7% increase in the high-risk category. Notably, nodal status changes were also significant in high-risk patients, showing a 23.3% increase. The incidence of MRI-detected adenopathy was notably higher in the high-risk group (50%). Furthermore, there were significant correlations between the preoperative CAPRA score and postoperative ISUP grade (r = 0.261) and the preoperative PIRADS score and postoperative ISUP grade (r = 0.306). Similar observations were made between the preoperative and postoperative Gleason scores (r = 0.286) and the number of positive fragments (r = 0.227) with the postoperative ISUP grading. Furthermore, the preoperative CAPRA score was significantly correlated (r = 0.261) with the postoperative ISUP grading. Preoperative MRI findings, which included assessments of adenopathy and seminal vesicle invasion, were also significantly correlated (r = 0.218) with the postoperative pathological findings. Additionally, a significant correlation was found between the preoperative PIRADS score and postoperative ISUP grade (r = 0.306). In forecasting the aggressiveness and staging of prostate cancer following surgery, preoperative PSA levels showed an AUC of 0.631; the preoperative Gleason score had an AUC adjusted to 0.582, and the number of positive biopsy fragments indicated an AUC of 0.566. These results highlight the necessity of accurate and comprehensive preoperative assessments to better predict disease progression and refine treatment strategies.
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Affiliation(s)
- Silviu Constantin Latcu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (S.C.L.); (V.B.); (V.-B.B.)
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Alin Adrian Cumpanas
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Vlad Barbos
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (S.C.L.); (V.B.); (V.-B.B.)
| | - Victor-Bogdan Buciu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (S.C.L.); (V.B.); (V.-B.B.)
| | - Marius Raica
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (M.R.); (F.B.); (P.N.G.); (R.A.C.); (C.-S.D.); (D.N.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Flavia Baderca
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (M.R.); (F.B.); (P.N.G.); (R.A.C.); (C.-S.D.); (D.N.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Pusa Nela Gaje
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (M.R.); (F.B.); (P.N.G.); (R.A.C.); (C.-S.D.); (D.N.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Raluca Amalia Ceausu
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (M.R.); (F.B.); (P.N.G.); (R.A.C.); (C.-S.D.); (D.N.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Cristina-Stefania Dumitru
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (M.R.); (F.B.); (P.N.G.); (R.A.C.); (C.-S.D.); (D.N.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Dorin Novacescu
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (M.R.); (F.B.); (P.N.G.); (R.A.C.); (C.-S.D.); (D.N.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Ligia Petrica
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania;
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania
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McDonald JAL, O'Brien J, Kelly B, Murphy D, Lawrentschuk N, Eapen R, Mitchell C. The highs and lows of grading intraductal carcinoma of the prostate. J Clin Pathol 2024:jcp-2024-209421. [PMID: 38876777 DOI: 10.1136/jcp-2024-209421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Jodie Ai Ling McDonald
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Jonathan O'Brien
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Brian Kelly
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Urology, Eastern Health, Box Hill, Victoria, Australia
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Surgery, University of Melbourne and Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia
| | - Renu Eapen
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Woernle A, Englman C, Dickinson L, Kirkham A, Punwani S, Haider A, Freeman A, Kasivisivanathan V, Emberton M, Hines J, Moore CM, Allen C, Giganti F. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging 2024; 59:1930-1952. [PMID: 37804007 DOI: 10.1002/jmri.29025] [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: 07/01/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisivanathan
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
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Schieda N, Nisha Y, Hadziomerovic AR, Prabhakar S, Flood TA, Breau RH, McGrath TA, Ramsay T, Morash C. Comparison of Positive Predictive Values of Biparametric MRI and Multiparametric MRI-directed Transrectal US-guided Targeted Prostate Biopsy. Radiology 2024; 311:e231383. [PMID: 38860899 DOI: 10.1148/radiol.231383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background Biparametric MRI (bpMRI) of the prostate is an alternative to multiparametric MRI (mpMRI), with lower cost and increased accessibility. Studies investigating the positive predictive value (PPV) of bpMRI-directed compared with mpMRI-directed targeted biopsy are lacking in the literature. Purpose To compare the PPVs of bpMRI-directed and mpMRI-directed targeted prostate biopsies. Materials and Methods This retrospective cross-sectional study evaluated men who underwent bpMRI-directed or mpMRI-directed transrectal US (TRUS)-guided targeted prostate biopsy at a single institution from January 2015 to December 2022. The PPVs for any prostate cancer (PCa) and clinically significant PCa (International Society of Urological Pathology grade ≥2) were calculated for bpMRI and mpMRI using mixed-effects logistic regression modeling. Results A total of 1538 patients (mean age, 67 years ± 8 [SD]) with 1860 lesions underwent bpMRI-directed (55%, 849 of 1538) or mpMRI-directed (45%, 689 of 1538) prostate biopsy. When adjusted for the number of lesions and Prostate Imaging Reporting and Data System (PI-RADS) score, there was no difference in PPVs for any PCa or clinically significant PCa (P = .61 and .97, respectively) with bpMRI-directed (55% [95% CI: 51, 59] and 34% [95% CI: 30, 38], respectively) or mpMRI-directed (56% [95% CI: 52, 61] and 34% [95% CI: 30, 39], respectively) TRUS-guided targeted biopsy. PPVs for any PCa and clinically significant PCa stratified according to clinical indication were as follows: biopsy-naive men, 64% (95% CI: 59, 69) and 43% (95% CI: 39, 48) for bpMRI, 67% (95% CI: 59, 75) and 51% (95% CI: 43, 59) for mpMRI (P = .65 and .26, respectively); and active surveillance, 59% (95% CI: 49, 69) and 30% (95% CI: 22, 39) for bpMRI, 73% (95% CI: 65, 89) and 38% (95% CI: 31, 47) for mpMRI (P = .04 and .23, respectively). Conclusion There was no evidence of a difference in PPV for clinically significant PCa between bpMRI- and mpMRI-directed TRUS-guided targeted biopsy. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Nicola Schieda
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Yashmin Nisha
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Alexa R Hadziomerovic
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Suman Prabhakar
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Trevor A Flood
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Rodney H Breau
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Trevor A McGrath
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Tim Ramsay
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Christopher Morash
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
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Kato M, Shiota M, Kimura T, Hanazawa R, Hirakawa A, Takamatsu D, Tashiro K, Matsui Y, Hashine K, Saito R, Yokomizo A, Yamamoto Y, Narita S, Hashimoto K, Matsumoto H, Akamatsu S, Nishiyama N, Eto M, Kitamura H, Tsuzuki T. Validation study on the 2 mm diameter cutoff in lymph node-positive cases following radical prostatectomy in accordance with the AJCC/UICC TNM 8th edition: Real-world data analysis from a Japanese cohort. Int J Urol 2024; 31:662-669. [PMID: 38424729 DOI: 10.1111/iju.15434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) 8th edition has proposed micrometastasis as a lymph node metastasis (LN+) of diameter ≤2 mm in prostate cancer. However, supporting evidence has not described. We evaluated LN+ patients' survival after radical prostatectomy (RP) based on the LN maximum tumor diameter (MTD). METHODS Data from 561 LN+ patients after RP and pelvic LN dissection (PLND) treated between 2006 and 2019 at 33 institutions were retrospectively investigated. Patients were stratified by a LN+ MTD cutoff of 2 mm. Outcomes included castration resistance-free survival (CRFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS In total, 282 patients were divided into two groups (LN+ MTD >2 mm [n = 206] and ≤2 mm [n = 76]). Patients of LN+ status >2 mm exhibited significantly decreased CRFS and MFS, and poorer CSS and OS. No patients developed CRPC in the LN+ status ≤2 mm group when the PLND number was ≥14. Multivariate analysis showed the number of LN removed, RP Gleason pattern 5, and MTD in LN+ significantly predicted CRFS. CONCLUSIONS Patients of LN+ status ≤2 mm showed better prognoses after RP. In all the patients in the ≤2-mm group, the progression to CRPC could be prevented with appropriate interventions, particularly when PLND is performed accurately. Our findings support the utility of the pN substaging proposed by the AJCC/UICC 8th edition; this will facilitate precision medicine for patients with advanced prostate cancer.
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Affiliation(s)
- Masashi Kato
- Department of Urology, Nagoya University, Nagoya, Japan
| | - Masaki Shiota
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dai Takamatsu
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Katsuyoshi Hashine
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Ryoichi Saito
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Yoshiyuki Yamamoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | | | | | | | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | | | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan
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44
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Leung D, Castellani D, Nicoletti R, Dilme RV, Sierra JM, Serni S, Franzese C, Chiacchio G, Galosi AB, Mazzucchelli R, Palagonia E, Dell'Oglio P, Galfano A, Bocciardi AM, Zhao X, Ng CF, Lee HY, Sakamoto S, Vasdev N, Rivas JG, Campi R, Teoh JYC. The Oncological and Functional Prognostic Value of Unconventional Histology of Prostate Cancer in Localized Disease Treated with Robotic Radical Prostatectomy: An International Multicenter 5-Year Cohort Study. Eur Urol Oncol 2024; 7:581-588. [PMID: 38185614 DOI: 10.1016/j.euo.2023.12.006] [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: 10/02/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE The impact of prostate cancer of unconventional histology (UH) on oncological and functional outcomes after robot-assisted radical prostatectomy (RARP) and adjuvant radiotherapy (aRT) receipt is unclear. We compared the impact of cribriform pattern (CP), ductal adenocarcinoma (DAC), and intraductal carcinoma (IDC) in comparison to pure adenocarcinoma (AC) on short- to mid-term oncological and functional results and receipt of aRT after RARP. METHODS We retrospectively collected data for a large international cohort of men with localized prostate cancer treated with RARP between 2016 and 2020. The primary outcomes were biochemical recurrence (BCR)-free survival, erectile and continence function. aRT receipt was a secondary outcome. Kaplan-Meier survival and Cox regression analyses were performed. KEY FINDINGS AND LIMITATIONS A total of 3935 patients were included. At median follow-up of 2.8 yr, the rates for BCR incidence (AC 10.7% vs IDC 17%; p < 0.001) and aRT receipt (AC 4.5% vs DAC 6.3% [p = 0.003] vs IDC 11.2% [p < 0.001]) were higher with UH. The 5-yr BCR-free survival rate was significantly poorer for UH groups, with hazard ratios of 1.67 (95% confidence interval [CI] 1.16-2.40; p = 0.005) for DAC, 5.22 (95% CI 3.41-8.01; p < 0.001) for IDC, and 3.45 (95% CI 2.29-5.20; p < 0.001) for CP in comparison to AC. Logistic regression analysis revealed that the presence of UH doubled the risk of new-onset erectile dysfunction at 1 yr, in comparison to AC (grade group 1-3), with hazard ratios of 2.13 (p < 0.001) for DAC, 2.14 (p < 0.001) for IDC, and 2.01 (p = 0.011) for CP. Moreover, CP, but not IDC or DAC, was associated with a significantly higher risk of incontinence (odds ratio 1.97; p < 0.001). The study is limited by the lack of central histopathological review and relatively short follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS In a large cohort, UH presence was associated with worse short- to mid-term oncological outcomes after RARP. IDC independently predicted a higher rate of aRT receipt. At 1-yr follow-up after RP, patients with UH had three times higher risk of erectile dysfunction post RARP; CP was associated with a twofold higher incontinence rate. PATIENT SUMMARY Among patients with prostate cancer who undergo robot-assisted surgery to remove the prostate, those with less common types of prostate cancer have worse results for cancer control, erection, and urinary continence and a higher probability of receiving additional radiotherapy after surgery.
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Affiliation(s)
- David Leung
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Division of Urology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Rossella Nicoletti
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carmine Franzese
- Division of Urology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giuseppe Chiacchio
- Division of Urology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Division of Urology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Erika Palagonia
- Urology Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Dell'Oglio
- Urology Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Galfano
- Urology Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Xue Zhao
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nikhil Vasdev
- Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jeremy Yuen-Chun Teoh
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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45
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Hagens MJ, Ribbert LLA, Jager A, Veerman H, Barwari K, Boodt B, de Bruijn RE, Claessen A, Leter MR, van der Noort V, Smeenge M, Roeleveld TA, Rynja SP, Schaaf M, Weltings S, Vis AN, Bekers E, van Leeuwen PJ, van der Poel HG. Histopathological concordance between prostate biopsies and radical prostatectomy specimens-implications of transrectal and transperineal biopsy approaches. Prostate Cancer Prostatic Dis 2024; 27:312-317. [PMID: 37660218 DOI: 10.1038/s41391-023-00714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal). METHODS We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy. RESULTS In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01-1.75], p = 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52-0.93], p = 0.01). CONCLUSIONS The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.
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Affiliation(s)
- M J Hagens
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands.
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands.
| | - L L A Ribbert
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - A Jager
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - H Veerman
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - K Barwari
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Andros Clinics, Amsterdam, the Netherlands
| | - B Boodt
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Flevoziekenhuis, Almere, the Netherlands
| | - R E de Bruijn
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Ziekenhuis Amstelland, Amstelveen, the Netherlands
| | - A Claessen
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | - M R Leter
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - V van der Noort
- Department of Statistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Smeenge
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, St Jansdal Ziekenhuis, Harderwijk, the Netherlands
| | - T A Roeleveld
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - S P Rynja
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - M Schaaf
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, BovenIJ Ziekenhuis, Amsterdam, the Netherlands
| | - S Weltings
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Zaans Medisch Centrum, Zaandam, the Netherlands
| | - A N Vis
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - E Bekers
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - P J van Leeuwen
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
| | - H G van der Poel
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
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Shao Y, Bazargani R, Karimi D, Wang J, Fazli L, Goldenberg SL, Gleave ME, Black PC, Bashashati A, Salcudean S. Prostate Cancer Risk Stratification by Digital Histopathology and Deep Learning. JCO Clin Cancer Inform 2024; 8:e2300184. [PMID: 38900978 PMCID: PMC11371114 DOI: 10.1200/cci.23.00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 04/16/2024] [Indexed: 06/22/2024] Open
Abstract
PURPOSE Prostate cancer (PCa) represents a highly heterogeneous disease that requires tools to assess oncologic risk and guide patient management and treatment planning. Current models are based on various clinical and pathologic parameters including Gleason grading, which suffers from a high interobserver variability. In this study, we determine whether objective machine learning (ML)-driven histopathology image analysis would aid us in better risk stratification of PCa. MATERIALS AND METHODS We propose a deep learning, histopathology image-based risk stratification model that combines clinicopathologic data along with hematoxylin and eosin- and Ki-67-stained histopathology images. We train and test our model, using a five-fold cross-validation strategy, on a data set from 502 treatment-naïve PCa patients who underwent radical prostatectomy (RP) between 2000 and 2012. RESULTS We used the concordance index as a measure to evaluate the performance of various risk stratification models. Our risk stratification model on the basis of convolutional neural networks demonstrated superior performance compared with Gleason grading and the Cancer of the Prostate Risk Assessment Post-Surgical risk stratification models. Using our model, 3.9% of the low-risk patients were correctly reclassified to be high-risk and 21.3% of the high-risk patients were correctly reclassified as low-risk. CONCLUSION These findings highlight the importance of ML as an objective tool for histopathology image assessment and patient risk stratification. With further validation on large cohorts, the digital pathology risk classification we propose may be helpful in guiding administration of adjuvant therapy including radiotherapy after RP.
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Affiliation(s)
- Yanan Shao
- Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Roozbeh Bazargani
- Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Davood Karimi
- Radiology, Harvard and Boston Children's Hospital, Boston, MA
| | - Jane Wang
- Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Ladan Fazli
- The Vancouver Prostate Centre, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - S. Larry Goldenberg
- The Vancouver Prostate Centre, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin E. Gleave
- The Vancouver Prostate Centre, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter C. Black
- The Vancouver Prostate Centre, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ali Bashashati
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Septimiu Salcudean
- Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
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Compérat E, Kläger J, Rioux-Leclercq N, Oszwald A, Wasinger G. Cribriform versus Intraductal: How to Determine the Difference. Cancers (Basel) 2024; 16:2002. [PMID: 38893122 PMCID: PMC11171388 DOI: 10.3390/cancers16112002] [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: 05/07/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Over the years, our understanding of cribriform and intraductal prostate cancer (PCa) has evolved significantly, leading to substantial changes in their classification and clinical management. This review discusses the histopathological disparities between intraductal and cribriform PCa from a diagnostic perspective, aiming to aid pathologists in achieving accurate diagnoses. Furthermore, it discusses the ongoing debate surrounding the different recommendations between ISUP and GUPS, which pose challenges for practicing pathologists and complicates consensus among them. Recent studies have shown promising results in integrating these pathological features into clinical decision-making tools, improving predictions of PCa recurrence, cancer spread, and mortality. Future research efforts should focus on further unraveling the biological backgrounds of these entities and their implications for clinical management to ultimately improve PCa patient outcomes.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Kläger
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - André Oszwald
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Gabriel Wasinger
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
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Huynh LM, Swanson S, Cima S, Haddadin E, Baine M. Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography-Derived Radiomic Models in Prostate Cancer Prognostication. Cancers (Basel) 2024; 16:1897. [PMID: 38791977 PMCID: PMC11120365 DOI: 10.3390/cancers16101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/24/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
The clinical integration of prostate membrane specific antigen (PSMA) positron emission tomography and computed tomography (PET/CT) scans represents potential for advanced data analysis techniques in prostate cancer (PC) prognostication. Among these tools is the use of radiomics, a computer-based method of extracting and quantitatively analyzing subvisual features in medical imaging. Within this context, the present review seeks to summarize the current literature on the use of PSMA PET/CT-derived radiomics in PC risk stratification. A stepwise literature search of publications from 2017 to 2023 was performed. Of 23 articles on PSMA PET/CT-derived prostate radiomics, PC diagnosis, prediction of biopsy Gleason score (GS), prediction of adverse pathology, and treatment outcomes were the primary endpoints of 4 (17.4%), 5 (21.7%), 7 (30.4%), and 7 (30.4%) studies, respectively. In predicting PC diagnosis, PSMA PET/CT-derived models performed well, with receiver operator characteristic curve area under the curve (ROC-AUC) values of 0.85-0.925. Similarly, in the prediction of biopsy and surgical pathology results, ROC-AUC values had ranges of 0.719-0.84 and 0.84-0.95, respectively. Finally, prediction of recurrence, progression, or survival following treatment was explored in nine studies, with ROC-AUC ranging 0.698-0.90. Of the 23 studies included in this review, 2 (8.7%) included external validation. While explorations of PSMA PET/CT-derived radiomic models are immature in follow-up and experience, these results represent great potential for future investigation and exploration. Prior to consideration for clinical use, however, rigorous validation in feature reproducibility and biologic validation of radiomic signatures must be prioritized.
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Affiliation(s)
- Linda My Huynh
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68105, USA; (L.M.H.); (S.C.)
- Department of Urology, University of California, Irvine, CA 92868, USA;
| | - Shea Swanson
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68105, USA; (L.M.H.); (S.C.)
| | - Sophia Cima
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68105, USA; (L.M.H.); (S.C.)
| | - Eliana Haddadin
- Department of Urology, University of California, Irvine, CA 92868, USA;
| | - Michael Baine
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68105, USA; (L.M.H.); (S.C.)
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Zabihollahy F, Miao Q, Naim S, Sonni I, Vangala S, Kim H, Hsu W, Sisk A, Reiter R, Raman SS, Sung K. Investigating MRI-Associated Biological Aspects of Racial Disparities in Prostate Cancer for African American and White Men. J Magn Reson Imaging 2024. [PMID: 38751322 DOI: 10.1002/jmri.29397] [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: 05/08/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Understanding the characteristics of multiparametric MRI (mpMRI) in patients from different racial/ethnic backgrounds is important for reducing the observed gaps in clinical outcomes. PURPOSE To investigate the diagnostic performance of mpMRI and quantitative MRI parameters of prostate cancer (PCa) in African American (AA) and matched White (W) men. STUDY TYPE Retrospective. SUBJECTS One hundred twenty-nine patients (43 AA, 86 W) with histologically proven PCa who underwent mpMRI before radical prostatectomy. FIELD STRENGTH/SEQUENCE 3.0 T, T2-weighted turbo spin echo imaging, a single-shot spin-echo EPI sequence diffusion-weighted imaging, and a gradient echo sequence dynamic contrast-enhanced MRI with an ultrafast 3D spoiled gradient-echo sequence. ASSESSMENT The diagnostic performance of mpMRI in AA and W men was assessed using detection rates (DRs) and positive predictive values (PPVs) in zones defined by the PI-RADS v2.1 prostate sector map. Quantitative MRI parameters, including Ktrans and ve of clinically significant (cs) PCa (Gleason score ≥ 7) tumors were compared between AA and W sub-cohorts after matching age, prostate-specific antigen (PSA), and prostate volume. STATISTICAL TESTS Weighted Pearson's chi-square and Mann-Whitney U tests with a statistically significant level of 0.05 were used to examine differences in DR and PPV and to compare parameters between AA and matched W men, respectively. RESULTS A total number of 264 PCa lesions were identified in the study cohort. The PPVs in the peripheral zone (PZ) and posterior prostate of mpMRI for csPCa lesions were significantly higher in AA men than in matched W men (87.8% vs. 68.1% in PZ, and 89.3% vs. 69.6% in posterior prostate). The Ktrans of index csPCa lesions in AA men was significantly higher than in W men (0.25 ± 0.12 vs. 0.20 ± 0.08 min-1; P < 0.01). DATA CONCLUSION This study demonstrated race-related differences in the diagnostic performances and quantitative MRI measures of csPCa that were not reflected in age, PSA, and prostate volume. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Fatemeh Zabihollahy
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Qi Miao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Sohaib Naim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ida Sonni
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William Hsu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Robert Reiter
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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50
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Li P, Ni P, Kombak FE, Wolters E, Haines GK, Si Q. Targeted biopsy added to systematic biopsy improves cancer detection in prostate cancer screening. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2024; 17:173-181. [PMID: 38859919 PMCID: PMC11162608 DOI: 10.62347/jhyy2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)/ultrasound targeted biopsy has frequently been used together with a 12-core systematic biopsy for prostate cancer screening in the past few years. However, the efficacy of targeted biopsy compared to systematic biopsy, as well as its clinical-histologic correlation, has been assessed by a limited number of studies and is further investigated in this study. DESIGN We collected 960 cases with both targeted and systematic prostate biopsies from 04/2019 to 04/2022 (Table 1). We compared cancer detection rates between targeted and systematic prostate biopsies in different grade groups. Correlations with the size of prostate lesions, prostate-specific antigen (PSA) level, and Prostate Imaging-Reporting and Data System (PI-RADS) scale were also analyzed for each of these biopsy methods. RESULTS Among the 960 men who underwent targeted biopsy with systematic biopsy, prostatic adenocarcinoma was diagnosed in 652 (67.9%) cases. 489 (50.9%) cases were diagnosed by targeted biopsy and 576 (60.0%) cases were diagnosed by systematic biopsy. In the 384 cases diagnosed negative by systematic biopsy, targeted biopsy identified cancer in 76 (8%) cases. Systematic biopsy was able to detect 163 cancer cases that were missed by targeted biopsy. Systematic biopsy detected more grade group 1 cancers compared to targeted biopsy. However, for higher grade cancers, the differences between the cancer detection rates of targeted biopsy and systematic biopsy became negligible. Targeted biopsy upgraded the grade group categorized by systematic biopsy in several cases (3.8%, 7.0%, 2.6%, 1.1% and 0.9% in Grade Groups 1, 2, 3, 4, and 5 respectively). Targeted biopsy was more likely to detect cancer in larger lesions (13.17 mm VS 11.41 mm, P=0.0056) and for higher PI-RADS scales (4.19 VS 3.68, P<0.0001). The cancers detected by targeted biopsy also had higher PSA levels (10.38 ng/ml VS 6.39 ng/ml, P=0.0026). CONCLUSION Targeted biopsy with systematic biopsy improved cancer detection rate compared to systematic biopsy alone. Targeted biopsy is not more sensitive for grade groups 1, 4, or 5 cancers but is as sensitive as systematic biopsy for detecting grade group 2 and 3 cancers. Targeted biopsy is more effective at detecting cancers when patients have larger lesions, higher PI-RADS scales, and higher PSA levels.
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Affiliation(s)
- Peizi Li
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Pu Ni
- Department of Pathology, Mount Sinai West HospitalNew York, NY, USA
| | - Faruk Erdem Kombak
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Emily Wolters
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - George Kenneth Haines
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Qiusheng Si
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount SinaiNew York, NY, USA
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